Managing social and environmental risks in Sri Lanka's fight against COVID-19

When COVID-19 struck Sri Lanka in January 2020, the government responded quickly with early lockdowns, proactive contact tracing, and testing. The severity and scale of the pandemic made it clear for Sri Lanka, as for the rest of the world, that a more urgent and enhanced approach was needed to deal with the complex medical and social calamity.

The government and the World Bank fast-tracked the Sri Lanka COVID-19 Emergency Response and Health System Preparedness Project. The machinery deployed aimed to upgrade emergency operation centers, boost the capacity of healthcare facilities, strengthen COVID surveillance and response systems, optimize risk communication, and administer life-saving vaccines.

The potential environmental and social risks were identified in advance, and risk management strategies were implemented. The World Bank's Environmental Social Framework (ESF) provided tools to address health and safety risks for frontline workers, risks of excluding vulnerable groups from accessing services, pollution and hazardous waste risks due to increased healthcare waste, and risks due to misinformation affecting vaccine uptake. 

Community engagement and risk communication were pivotal. Specialized services to high-risk groups such as victims of gender-based violence (GBV) were provided. Mobility support to strengthen outreach, provision of protective equipment to healthcare personnel, measures to manage healthcare waste were integrated along with screening and compliance information.

Guided by the environmental and social framework, the project:

• Ensured the inclusion of remote and vulnerable groups via mobile health services: Vaccinations were prioritized for the elderly, sick, and persons with disabilities. Some 3,567,856 people among high-risk groups received social and financial support. Cash transfers and in-kind support were made to elders, people with special needs, people with chronic kidney disease, people who lost their livelihoods during the pandemic, and people who needed to quarantine in their homes. The project also trained 310 staff and equipped them to work on prevention and care measures at elderly care homes. 
• Engaged communities and received their feedback: Consultations with affected and vulnerable groups and interested parties helped the project team fine-tune its responses to specific needs via various communities like ‘Friends of the Facility Committee.’  Mobility support in form of 2-wheelers and 3-wheelers was provided for healthcare staff.  Specialized services were arranged catering to vulnerable groups during lockdowns, such as pregnant mothers and the elderly. Vaccinations and other health services were made accessible in remote locations, and urgent grants were financed for low-income households that lost their livelihoods during lockdown. 
• Strengthened GBV prevention and response services through TV commercials and social media awareness campaigns: Increased incidents of GBV were reported during lockdowns. GBV counseling and awareness were stepped-up.   Building up health capacity also helped operationalize hotlines and expand GBV services through Mithuru Piyasas or hospital-based GBV care centers. More than 9,400 women have used these services so far.
• Sought to change critical behaviors: Risk Communication campaigns helped address the concerns of vulnerable groups and mitigate COVID misperceptions and vaccine hesitancy.
• Improved healthcare waste management in health facilities: Health Care Waste Management Plans (HCWMPs) were implemented to ensure community health and safety related to the handling, transportation, and disposal of medical waste. 
• Created a national health sector grievance redress mechanism : As all World Bank-financed projects under the ESF are required to have a grievance redress mechanism (GRM), the national health sector GRM policy guideline was operationalized by establishing a national call center at the national level, assigning focal points at hospitals, and raising awareness of the mechanism. Hence the project-level GRM has supported to establish the National GRM for the health sector. Grievances received through the post, e-mail, and the national hotline are processed by GRM units and committees established in hospitals. Since its establishment, the national health sector GRM has resolved about 1,800 grievances.

Today, the project can be credited with helping in Sri Lanka's ongoing fight against COVID-19. Sri Lanka has fared better than many other countries with its 94 percent recovery rate and 2.5 percent active case rate as of November 2021. Still, the pandemic is far from over, and the Omicron surge means that the situation remains fluid. This ESF-supported project is preparing the country for future challenges by building up the social and health development sectors to withstand not only COVID-19 with its waves and variants, but also future pandemics.