The World Bank Implementation Status & Results Report Turkey Emergency COVID-19 Health Project (P173988) Turkey Emergency COVID-19 Health Project (P173988) EUROPE AND CENTRAL ASIA | Turkiye | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 5 | ARCHIVED on 03-Jan-2023 | ISR54253 | Implementing Agencies: Ministry of Health, Ministry of Treasury and Finance Key Dates Key Project Dates Bank Approval Date: 24-Apr-2020 Effectiveness Date: 27-May-2020 Planned Mid Term Review Date: 19-Sep-2022 Actual Mid-Term Review Date: 08-Jun-2022 Original Closing Date: 31-Dec-2022 Revised Closing Date: 31-Dec-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The Project development objective is to prevent, detect, and respond to the threat posed by COVID-19 in Turkey. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Emergency COVID-19 Response:(Cost $598.00 M) Component 2: Project Management, Monitoring and Evaluation:(Cost $2.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The original EUR 91.4 million loan (IBRD-91030, US$ 100 million) was approved on April 24, 2020. The EUR 450.7 million Additional Financing (AF) Loan (IBRD-93930, US$ 500 million) was approved on May 26, 2022. An additional EUR 225.3 million (US$ 250 million equivalent) is provided as co-financing from the Asian Infrastructure and Investment Bank (AIIB). Progress towards achievement of the PDO has been rated Moderately Satisfactory (MS) since August 2020; overall implementation progress has been rated MS since June 2022. Activities under both components are progressing well and are on schedule. One of the PDO indicators surpassed its end target and two are lagging, given the ongoing surge of non-COVID-19 respiratory illnesses, including influenza and respiratory syncytial virus and given that the Government invested significantly in treatment equipment using its own resources. All seven intermediate results indicators have been achieved. As of December 19, 2022, total disbursements stand at 98%. 1/3/2023 Page 1 of 8 The World Bank Implementation Status & Results Report Turkey Emergency COVID-19 Health Project (P173988) MPA Program Development Objective MPA PDO Table The Program Development Objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness MPA Table Multiphase Programmatic Approach (MPA) Status MPA Table Body Sustained efforts continue to be made to advance the implementation of the 87 MPA operations. As of December 19, 2022, 88 MPA-projects had been approved with a total commitment of US$4.3 billion. One operation (Guatemala) was cancelled in mid-September 2021, at the request of the Government. Six parent projects were restructured to include vaccine-related procurement. Twenty-three (23) operations are being implemented in Fragile and Conflict-affected situations. Total disbursements as of December 19, 2022, amount to US$3.76 billion or 87% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. Loans and Credits denominated in SDRs and Euros are being affected because of fluctuations between the SDRs and Euros against the US dollar. At this late stage of implementation, several operations are processing refunds to the special accounts and therefore, total disbursements are affected. Four country operations closed by the end of FY22. Eight operations are closing by the end of the CY. Sixty-nine (69) country projects or 79 percent of projects approved have reached 70-100 percent disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). Out of the 69 operations, 53 operations or 77 percent have disbursed over 90+% of commitments. Out of the 69 operations, 34 operations or 49 percent are fully disbursed and four operations have disbursed 99 percent of commitment. There are nine operations with disbursements of 50 percent or less. Out of these nine operations, one has not disbursed (AFW), and two have disbursed 30 percent or less. The projects are benefitting around 3.7 billion people or 50% of the global population. If countries that have AF-V operations are counted, the projects are benefitting 4.1 billion of 51 percent of the global population. This is because some countries that don’t have a parent project have AF operations. Of the 87 active projects: (i) 33 are in Africa – 12 in AFE and 21 in AFW; (ii) 12 in East Asia; (iii) 14 in Europe and Central Asia; (iv) 11 in Latin America and the Caribbean; (v) 8 in Middle East and North Africa; and (vi) 9 in South Asia. Eighty-six (86) or 99% of projects approved are disbursing. MNA has the highest percentage of disbursements, followed by ECA, SRA, EAP LAC, AFE, and AFW. Retroactive Financing represent 19 percent of commitments. SRA has the highest percentage of RF at 35 percent. Streamlined procedures, delegated approvals, coupled with flexible project design and intensified efforts across the Bank have contributed to the progress. Implementation is being guided by Bank teams working in parallel with other health related projects, including Additional Financing operations supporting vaccine procurement and deployment efforts. Notwithstanding challenges of implementation, the MPA is on track to achieve its PrDO, which is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. The Additional Financing (MPA AF-V) to the COVID-19 Strategic Preparedness and Response Program utilizing the Multiphase Programmatic Approach (Global COVID-19 MPA) was approved by the Board on October 13, 2021. The AF-V was approved with an envelope of US$12 billion ($6 billion from IDA and $6 billion from IBRD) in financing. On June 30, 2021, President Malpass announced the expansion of financing available for COVID-19 vaccine financing to $20 billion over the next 18 months, adding $8 billion to the previously announced $12 billion. The AF-V is expected to enable vaccination for up to 750 million people, with potential surge capacity for an additional 250 million people in the poorest 1/3/2023 Page 2 of 8 The World Bank Implementation Status & Results Report Turkey Emergency COVID-19 Health Project (P173988) countries while scaling support to strengthen immunization delivery, with design flexibility at the country level. The AF-V is a scale-up of planned vaccination activities anticipated and supported under the Global COVID-19 MPA and a key contribution to the WBG’s overall COVID-19 response. As of November 2022, 632 million doses had been procured with Bank financing out of which 484 million doses have been delivered. As of December 19, 2022, the Bank has approved 116 operations (including MPA-V operations) to support vaccine procurement and rollout in 80 countries amounting to $10.1 billion. The 116 operations approved, include 6 operations that involved restructuring of parent projects (Bhutan, Cameroon, North Macedonia, Philippines, and Pakistan) and in the case of Lebanon, restructuring of the Health Resilience Project. Of the 116 approved operations: (i) 64 are in Africa – 29 in AFE and 35 in AFW; (ii) 10 in East Asia and the Pacific; (iii) 11 in Europe and Central Asia; (iv) 13 in Latin America and the Caribbean; (v) 9 in Middle East and North Africa; and (vi) 9 in South Asia. Seventy-two (72) projects or 62 percent of total operations approved are disbursing. Twenty-three operations are in Fragile and Conflict-affected countries. IDA represents 41 percent and IBRD 59 percent of disbursements. Total disbursements under these projects as of December 19, 2022, amount to US$5.45 billion or 54 percent of overall commitments. Disbursements under MPA-V operations are included in this total while disbursements under the six restructured projects are counted under parent projects. Thirty (30) or 26 percent of AF-V and MPA-V operations have disbursed 70 percent or more of their commitments. Out of the 30, twelve operations or 40 percent have disbursed 90 percent. Out of the twelve, three operations are fully disbursed. Retroactive Financing (RF) represents 38 percent of overall commitments. High RF has been authorized under different operations - Ukraine (100%), Panama and Turkey (90%), Argentina and Guyana (80%), and Belize, Iraq and Sri Lanka (70%). One hundred and nine (109) loan/financing agreements or 94 percent of projects approved have been signed. One hundred (100) loan/financing agreements or 86 percent of projects approved have become effective. As with the MPA operations, streamlined procedures, delegated approval, coupled with flexible project design, and intensified efforts across the Bank have contributed to the rapid design, processing, and implementation of the operations. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Moderate Moderate Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary Substantial Moderate Moderate Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Substantial Substantial Results 1/3/2023 Page 3 of 8 The World Bank Implementation Status & Results Report Turkey Emergency COVID-19 Health Project (P173988) PDO Indicators by Objectives / Outcomes Prevent, detect and respond to the threat posed by COVID-19 IN01227893 ►Number of people tested for COVID-19 identification per approved protocol under the Project (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 9,357,600.00 9,357,600.00 300,000.00 Date 02-Apr-2020 14-Oct-2021 15-Dec-2022 31-Dec-2023 The actual value of this indicator surpassed its end target value. Comments: IN01227894 ►Diagnosed cases treated per approved protocol under the Project (cumulative) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8.28 14.93 25.00 Date 02-Apr-2020 14-Oct-2021 19-Dec-2022 31-Dec-2023 This indicator is lagging. In addition to the project’s contribution, Ministry of Health has significantly invested in treatment equipment by using its own resources, thus reducing the share (and the treatment coverage) of Bank-financed treatment equipment within total number of equipment in the country. This Comments: figure will not increase and meet the current end target by the closing date. To reflect this change in the country context, targets for this indicator need revision. IN01227895 ►Percentage of population vaccinated, which is included in the priority population targets defined in national plan (by gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.90 62.90 63.30 66.00 Date 14-Mar-2022 16-Mar-2022 15-Dec-2022 31-Dec-2023 This indicator is lagging. There is a recent significant surge in the Influenza and RSV (respiratory syncytial virus) cases therefore the vaccination efforts shifted from COVID-19 vaccination and focused on Comments: vaccination for influenza as a priority. IN01227911 Percentage of population vaccinated, which is included in the priority population targets defined in national plan (males) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 61.30 61.30 61.90 65.30 Date 14-Mar-2022 16-Mar-2022 15-Dec-2022 31-Dec-2023 IN01227912 Percentage of population vaccinated, which is included in the priority population targets defined in national plan (females) (Percentage, Custom Breakdown) 1/3/2023 Page 4 of 8 The World Bank Implementation Status & Results Report Turkey Emergency COVID-19 Health Project (P173988) Baseline Actual (Previous) Actual (Current) End Target Value 62.70 62.70 63.30 66.70 Date 14-Mar-2022 16-Mar-2022 15-Dec-2022 31-Dec-2023 Intermediate Results Indicators by Components Emergency COVID-19 Response IN01227913 ►Number of laboratories with COVID-19 diagnostic equipment, test kits, and reagents under the Project (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 300.00 300.00 35.00 Date 02-Apr-2020 14-Oct-2021 15-Dec-2022 31-Dec-2023 The actual value of this indicator surpassed its end target. Comments: IN01227914 ►Number of ICU beds equipped with mechanical ventilators procured under the Project (cumulative) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,500.00 4,000.00 3,500.00 Date 02-Apr-2020 14-Oct-2021 15-Dec-2022 31-Dec-2023 The actual value of this indicator surpassed its end target. Comments: IN01227915 ►Number of health staff equipped with Personal Protective Equipment (PPEs) procured under the Project (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 791,215.00 831,215.00 90,000.00 Date 02-Apr-2020 14-Oct-2021 15-Dec-2022 31-Dec-2023 The actual value of this indicator surpassed its end target. Comments: IN01227916 ►Country has reported to have contextualized their risk communication and community engagement strategies (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 02-Apr-2020 14-Oct-2021 15-Dec-2022 31-Dec-2023 This indicator monitors the process of creating risk communication and community engagement strategies Comments: for the COVID-19 response and putting in place an implementation plan focusing on: (i) tailoring information to different audiences, needs, priorities; and (ii) establishing a feedback mechanism to enable 1/3/2023 Page 5 of 8 The World Bank Implementation Status & Results Report Turkey Emergency COVID-19 Health Project (P173988) community members and community-based organizations to articulate local needs systematically and regularly. The MoH has detailed its information disclosure strategies in the Stakeholder Engagement Plan (SEP) report dated December 2020. The disclosure plan includes details on the information to be disclosed, methods of disclosure, levels of communication (national, regional, district and community level communication), timeline and platforms to be used for communication, targeted stakeholders, share of target population to be reached and responsible unit for each communication action. Information is tailored to different audiences, needs and priorities. In the SEP, the MoH identified stakeholder groups, their key characteristics, expectations, their specific communication needs (such as accessibility of target groups, need to have large prints for certain target groups, need to make daytime meetings for certain target groups etc.), their language needs, and means to engage with each group (through email, phone, radio, letter etc.). The MoH Communication Center (SABIM), the Meeting Point in Health (SBN), the Presidency Contact Center (CIMER), Patient Rights’ Boards in public hospitals and the PMSU’s webpage are the main channels through which MoH collects community feedback on grievances, complaints and suggestions related with the COVID-19 Emergency Health project. Once received, the feedback is categorized according to the content and shared with the relevant MoH department or health care service provider (such as hospitals, family medicine centers etc.). The SEP and forms for Request, Suggestions and Grievances were published on the MoH-PMSU website on September 16, 2020 and opened for consultation. Internally, MoH Provincial Health Directorates in 81 provinces and relevant hospitals in these provinces were consulted. To engage with civil society more broadly, the MoH reached out to two Health NGOs: i) MEYAD: Association of Mobbing Training Assistance and Research; and ii) Nurses and Midwives' Association. Additionally, TEYİT.org, an NGO working to ensure access to accurate information on the web and on the social media by fact-checking, has reached out to the MoH to provide feedback. Feedback from these NGOs were in the form of queries and suggestions and were on the following subjects: COVID-19 project procurement processes, the status of the project, COVID-19 testing methods used, emerging risks concerning health and safety of healthcare workers, faster COVID-19 diagnosis methods, public awareness, positive discrimination for healthcare workers for public services, improvement on the rights and employment conditions of healthcare workers and safe techniques for the diagnosis of COVID-19. Under the pandemic restrictions, all feedback has been collected digitally. The MoH responded to these queries and shared their suggestions with the MoH Scientific Committee. IN01227917 ►Established and functioning M&E system supporting epidemic preparedness and response (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Yes No Yes Yes Date 15-Dec-2022 14-Oct-2021 15-Dec-2022 31-Dec-2023 This indicator met its end target. The General Directorate of Public Health has a pandemic plan, and the systems for monitoring and evaluation, pandemic surveillance, event and indicator-based surveillance are in place and functional. The prioritization guide for the biological, chemical, radio-nuclear and environmental health threats and their risk assessment algorithms have been developed. Biological and chemical threats risk mapping Comments: procedures have also been prepared. Cooperation protocols have been signed with General Directorate of Meteorology and the General Directorate of Environmental Impact Assessment. MoH made efforts to build capacity for the early warning response system. Training materials for the Early Warning and Response System have been developed and trainings conducted for two centers in two provinces, Trainings are planned to be rolled out to other provinces. IN01227918 ►Vaccine stock management tools and operating procedures updated to reflect the characteristics of COVID-19 vaccines. (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes 1/3/2023 Page 6 of 8 The World Bank Implementation Status & Results Report Turkey Emergency COVID-19 Health Project (P173988) Date 01-Feb-2022 11-Feb-2022 15-Dec-2022 31-Dec-2023 This indicator met its end target. General Directorate of Public Health has a comprehensive vaccine stock and cold chain system operating within the scope of the immunization program. This system is also used for the storage, distribution and administration of COVID-19 vaccines. with updates on the COVID-19 vaccines have been introduced. Comments: The MoH has published a regulation to provide updates on the procedures to administer, store and distribute COVID-19 vaccines. The procedures were communicated to 81 provinces through an official letter and the storage, distribution and administration are carried out in accordance with this regulation. IN01227919 ►Standard operating procedures (SOPs) or guidelines established for collection and disposal of medical waste to the relevant stakeholders (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 01-Feb-2022 11-Feb-2022 15-Dec-2022 31-Dec-2023 This indicator met its end target. SOPs and guidelines are ln place for collection and disposal of medical waste: It is a legal obligation for the health facilities to prepare and implement a Medical Waste Management Plan in accordance with the Article 9 of the Medical Waste Control Regulation (Official Gazette, 25.01.2017, no 29959). All health facilities need to prepare and implement the Medical Waste Management Plan in line with the standard format developed by the MoH. https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=23273&MevzuatTur=7&MevzuatTertip=5 https://ohsad.org/wp-content/uploads/2017/05/9852tibbi-atik-yonetim-plduyurupdf.pdf Comments: Additionally, the Scientific Advisory Board of the Ministry of Health has published the Guidelines and Infection Control Measures to be followed in Health Facilities during the COVID-19 Pandemic in March 2021. The Guidelines include specific procedures to be followed for COVID-19 related waste collection and disposal practices. covid19-saglikkurumlarindacalismarehberiveenfeksiyonkontrolonlemleripdf.pdf Concerning warehouses, no medical waste is produced in the vaccine warehouses. Expired vaccines or vaccines in defective condition are returned to the manufacturer. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173988 IBRD-91030 Effective USD 100.00 100.00 0.00 97.89 10.89 90% P173988 IBRD-93930 Effective USD 500.00 500.00 0.00 475.50 0.55 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173988 IBRD-91030 Effective 24-Apr-2020 04-May-2020 27-May-2020 31-Dec-2022 31-Dec-2023 P173988 IBRD-93930 Effective 26-May-2022 27-May-2022 27-May-2022 31-Dec-2023 31-Dec-2023 1/3/2023 Page 7 of 8 The World Bank Implementation Status & Results Report Turkey Emergency COVID-19 Health Project (P173988) Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) P178462-Turkey Emergency COVID-19 Health Project Additional Financing 1/3/2023 Page 8 of 8