The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Central African Republic COVID-19 Preparedness and Response Project (P173832) WESTERN AND CENTRAL AFRICA | Central African Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 9 | ARCHIVED on 05-Feb-2024 | ISR59673 | Implementing Agencies: Central African Republic, Ministry of Health and Population Key Dates Key Project Dates Bank Approval Date: 20-Apr-2020 Effectiveness Date: 27-Apr-2020 Planned Mid Term Review Date: 03-Mar-2022 Actual Mid-Term Review Date: 02-Mar-2022 Original Closing Date: 30-Jun-2022 Revised Closing Date: 30-Jun-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To prepare for and respond to the threat posed by COVID-19 in the Central African Republic. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Preparedness and Response:(Cost $31.60 M) Project Coordination and management:(Cost $1.40 M) Contingent Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions COVID-19 project restructuring process was completed in May 2023 followed by revision of the Annual Work Budget Plan in close coordination with GAVI, WHO and UNICEF to include new proposed activities to strengthen the overall national immunization capacity. A memorandum of understanding between UNICEF and the government to purchase 1,468,800 doses of J&J vaccines was signed in April 2023, and all doses were delivered by October 2023, with more than 50 percent used during integrated vaccine mass campaigns which accelerated the implementation of the National Vaccine Deployment Plan with the vaccination coverage of 80 percent as of today. MPA Program Development Objective MPA PDO Table 2/5/2024 Page 1 of 11 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) 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 Good progress is being made in the implementation of AF-V operations. As of January 15, 2024, the Bank has approved 117 operations (including MPA-V operations) to support vaccine procurement and rollout in 78 countries amounting to $8.70 billion. Four operations have been approved in the past months including: (i) Senegal AF2 operation for $15 million financed by a Grant from The Global Finance Facility (GFF) approved on June 30, 2023; (ii) a Second AF (IDA Grant of $1.50 million) approved on August 31, 2023 for Sao Tome and Principe, (iii) a Grant of $3.94 approved for Chad on July 23, 2023; and (iv) Zimbabwe AF2 operation for $15 million financed by a Grant from the GFF approved on December 7, 2023. 121 operations had been approved amounting to $10 billion, but partial cancellations have been processed in the past months under several operations. In addition, four operations were cancelled: (i) Costa Rica loan ($120 million), (ii) Peru loan ($500 million), (iii) Gabon loan ($12 million), which loan agreement lapsed, and (iv) Philippines AF2 loan of $300 million. The Afghanistan operation commitment of $113 million was reduced to $60 million. Of the 117 approved operations: (i) 67 are in Africa – 32 in AFE and 35 in AFW; (ii) 10 in East Asia and the Pacific; (iii) 11 in Europe and Central Asia; (iv) 11 in Latin America and the Caribbean; (v) 9 in Middle East and North Africa; and (vi) 9 in South Asia. The 117 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. Thirty-two (32) operations are being implemented in Fragile and Conflict-affected situations. IDA represents 45 percent and IBRD 55 percent of disbursements. Total disbursements under these projects as of January 15, 2024, amount to US$6.46 billion or 74 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. With less than planned demand for IDA/IBRD funds for vaccine procurement because, inter alia, over supply of vaccines from donations from various sources, several projects have been/are being restructured and more will need to be restructured to reallocate funds or partially cancel funds allocated to procurement of COVID-19 vaccines and deployment. Guidance was issued under an Email from Juan Pablo Uribe of July 7, 2023, which provided direction for the use of undisbursed funds under COVID-19 operations. Four (4) operations are fully disbursed (Argentina, Indonesia, Sri Lanka AF-V 1, and Ukraine AF-V 3). Fifty-three (53) operations or 45 percent of operations approved have disbursed over 70 percent of their commitments. Out of the 53, twenty-two (22) operations have disbursed 90+ percent. Ninety-eight (98) operations or 84 percent of total operations approved are disbursing. EAP has the highest percentage of disbursements at 94 percent, followed by ECA at 87 percent, LAC at 84 percent, SAR at 80 percent, MNA at 79 percent, AFE at 61 percent, and AFW at 59 percent. Retroactive Financing (RF) represents 37 percent of overall commitments. ECA has the highest level of RF at 74 percent, followed by SAR at 68 percent, LAC at 59 percent, MNA and AFE at 29 percent and AFW at 13 percent. Disbursements to UN agencies represent 22 percent of overall disbursements, while Direct Payment represents 16 percent of disbursements. As with the COVID-19 MPA operations, streamlined procedures, delegated approval, wide use of Bank Facilitated Procurement (BFP), coupled with flexible project design, and intensified efforts from counterparts and Bank staff have contributed to the rapid design, processing, and implementation of the AF-V operations. Risks Systematic Operations Risk-rating Tool 2/5/2024 Page 2 of 11 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic High Substantial Substantial Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program High Substantial Substantial Institutional Capacity for Implementation and High Substantial Substantial Sustainability Fiduciary High High Substantial Environment and Social Substantial Substantial Substantial Stakeholders Substantial Substantial Substantial Other -- -- -- Overall High Substantial Substantial Results PDO Indicators by Objectives / Outcomes To prepare for and respond to the threat posed by COVID-19 in the Central African Republic. IN01393465 ►Health staff trained in infection prevention per MOH-approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 516.00 516.00 500.00 Date 27-Apr-2020 16-Jun-2023 16-Jun-2023 30-Jun-2024 Exceeded end target for original financing phase. This indicator is no longer tracked during AF phase. Comments: IN01393835 Health staff trained in infection prevention per MOH-approved protocols (Number, Custom) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 516.00 500.00 Date 27-Apr-2020 -- 14-Dec-2023 30-Jun-2024 IN01393581 ►Personal protective equipment (PPE) kit (masks, face shield, gloves, gown) delivered to targeted health facilities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 17,250.00 17,250.00 9,000.00 Date 27-Apr-2020 16-Jun-2023 16-Jun-2023 30-Jun-2024 Exceeded end target under the original financing phase by almost two-fold. This indicator is no longer Comments: tracked under the AF. 2/5/2024 Page 3 of 11 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) IN01393836 Personal protective equipment (PPE) kit (masks, face shield, gloves, gown) delivered to targeted health facilities (Number, Custom) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 17,250.00 9,000.00 Date 27-Apr-2020 -- 14-Dec-2023 30-Jun-2024 IN01393582 ►COVID-19 risk communication messages broadcasted to communities (number of days) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 474.00 474.00 90.00 Date 27-Apr-2020 16-Jun-2023 16-Jun-2023 30-Jun-2024 Mobile COVID-19 voice messages began being transmitted on April 27, 2020, and has been active since Comments: then. The support is no longer continued under the AF phase. IN01393650 COVID-19 risk communication messages broadcasted to communities (number of days) (Number, Custom) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 474.00 90.00 Date 27-Apr-2020 -- 14-Dec-2023 30-Jun-2024 IN01393583 ►Population vaccinated (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 13.00 50.00 80.00 70.00 Date 08-Feb-2022 16-Jun-2023 14-Dec-2023 30-Jun-2024 Reflects percentage of population receiving first dose of the overall target population. The end target has been revised to reflect the third National Vaccine Deployment Plan updated in November 2022 which sets Comments: the population coverage target at 70 percent from the initial 52 percent under PNVD I. The end target has surpassed. IN01393838 Population vaccinated (Percentage, Custom) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 13.00 -- 80.00 70.00 Date 08-Feb-2022 -- 14-Dec-2023 30-Jun-2024 IN01393843 ►Proportion of women among those vaccinated (Percentage, Custom Supplement) (Percentage, Custom) 2/5/2024 Page 4 of 11 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 -- 43.00 50.00 Date 08-Feb-2022 -- 14-Dec-2023 30-Jun-2024 Intermediate Results Indicators by Components Component 1: Preparedness and response IN01393586 ►Additional patient "beds" made available in designated care centers and hospitals (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 73.00 73.00 70.00 Date 27-Apr-2020 16-Jun-2023 16-Jun-2023 30-Jun-2024 Exceeded end target under the original financing phase. This activity is no longer supported under AF Comments: phase and indicator no longer tracked. IN01393839 Additional patient "beds" made available in designated care centers and hospitals (Number, Custom) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 73.00 70.00 Date 27-Apr-2020 -- 14-Dec-2023 30-Jun-2024 IN01393588 ►Laboratories with trained staff and consumables for collecting COVID-19 samples and transporting to Pasteur Institute laboratory (IBP) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 91.00 91.00 15.00 Date 27-Apr-2020 16-Jun-2023 16-Jun-2023 30-Jun-2024 Initial target was set at 15 assuming only district hospital laboratories. However, a large number of primary level health facilities staff in CAR where they have small laboratories were also trained and are now also Comments: collecting COVID-19 samples. The actuals include these facilities. The indicator is no longer tracked under the AF. IN01393840 Laboratories with trained staff and consumables for collecting COVID-19 samples and transporting to Pasteur Institute laboratory (IBP) (Number, Custom) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 -- 91.00 15.00 Date 27-Apr-2020 -- 14-Dec-2023 30-Jun-2024 IN01393589 2/5/2024 Page 5 of 11 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) ►Risk comminication strategy developed and disseminated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 27-Apr-2020 16-Jun-2023 16-Jun-2023 30-Jun-2024 Strategy has been elaborated and the govt is starting to use it in parts. Comments: IN01393846 Risk comminication strategy developed and disseminated (Yes/No, Custom) (Yes/No, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value No -- Yes Yes Date 27-Apr-2020 -- 14-Dec-2023 30-Jun-2024 IN01393590 ►Targeted facilities that have received selected drugs required to respond to the surge in patients due to COVID-19 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 90.00 Date 27-Apr-2020 30-Dec-2022 30-Dec-2022 30-Jun-2022 All treatment centers (4 in Bangui and 32 in the rest of the country) have received medication by August 2021. The number of treatment centers increased, where in all centers, selected medication to care for the Comments: COVID19 patients were supplied: July 2020: 9 out of 9 health facilities; January 2021: 15 out of 15 health facilities; August 2021: 36 out of 36 health facilities. IN01393847 Targeted facilities that have received selected drugs required to respond to the surge in patients due to COVID-19 (Percentage, Custom) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 100.00 90.00 Date 27-Apr-2020 -- 14-Dec-2023 30-Jun-2024 IN01393591 ►Targeted communities informed on hygiene behavior (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 90.00 Date 27-Apr-2020 16-Jun-2023 16-Jun-2023 30-Jun-2024 Hygiene promotion activities were organized at the health facility and community levels in the country. Over 250,000 soaps were distributed, in addition to hygiene kits, masks and food stamps, along with hygiene sanitation campaigns with strong community sensitization of COVID19 risk and Comments: prevention.Provision and treatment of potable water was also realized in 10 districts in the country. As this activity will continue under the AF, the end target date will be extended. IN01393844 Targeted communities informed on hygiene behavior (Percentage, Custom) (Percentage, Custom Breakdown) 2/5/2024 Page 6 of 11 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 100.00 90.00 Date 27-Apr-2020 -- 14-Dec-2023 30-Jun-2024 IN01393592 ►Doses of COVID-19 vaccines administered as a percentage of doses received (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 35.00 91.00 91.00 60.00 Date 25-Feb-2022 16-Jun-2023 16-Jun-2023 30-Jun-2024 IN01393845 Doses of COVID-19 vaccines administered as a percentage of doses received (Percentage, Custom) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 35.00 -- 91.00 60.00 Date 25-Feb-2022 -- 14-Dec-2023 30-Jun-2024 IN01393593 ►Share of vaccinators who are female (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 38.00 38.00 30.00 Date 31-Jan-2022 16-Jun-2023 16-Jun-2023 30-Jun-2024 IN01393848 Share of vaccinators who are female (Percentage, Custom) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 -- 38.00 30.00 Date 31-Jan-2022 -- 14-Dec-2023 30-Jun-2024 IN01393594 ►Districts in which the vaccination deployment strategy targets areas where women congregate (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 35.00 35.00 25.00 Date 25-Feb-2022 16-Jun-2023 16-Jun-2023 30-Jun-2024 IN01393851 Districts in which the vaccination deployment strategy targets areas where women congregate (Number, Custom) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 35.00 25.00 2/5/2024 Page 7 of 11 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Date 25-Feb-2022 -- 14-Dec-2023 30-Jun-2024 IN01393595 ►Targeted sites where solar-powered cold chain equipment has been installed and functional (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 76.00 76.00 90.00 Date 25-Feb-2022 16-Jun-2023 16-Jun-2023 30-Jun-2024 To align with the NVDP III targets, this indicator target will be revised to reach 90 percent coverage in Comments: target sites. IN01393682 Targeted sites where solar-powered cold chain equipment has been installed and functional (Percentage, Custom (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 76.00 70.00 Date 25-Feb-2022 -- 14-Dec-2023 30-Jun-2024 IN01393596 ►Districts reached by gender-sensitive messages/materials disseminated of public communications and advocacy on COVID-19 vaccination (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 35.00 35.00 25.00 Date 25-Feb-2022 16-Jun-2023 16-Jun-2023 30-Jun-2024 IN01393849 Districts reached by gender-sensitive messages/materials disseminated of public communications and advocacy on COVID-19 vaccination (Number, Custom) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 35.00 25.00 Date 25-Feb-2022 -- 14-Dec-2023 30-Jun-2024 IN01393597 ►Districts with community engagement plan implemented for increasing demand for COVID-19 vaccines by the population (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 35.00 35.00 25.00 Date 25-Feb-2022 16-Jun-2023 16-Jun-2023 30-Jun-2024 IN01393683 Districts with community engagement plan implemented for increasing demand for COVID-19 vaccines by the population (Number, Custom) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 35.00 25.00 2/5/2024 Page 8 of 11 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Date 25-Feb-2022 -- 14-Dec-2023 30-Jun-2024 IN01393598 ►Districts with a mobile or out-reach facility to administer vaccines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 35.00 35.00 25.00 Date 25-Feb-2022 16-Jun-2023 16-Jun-2023 30-Jun-2024 IN01393852 Districts with a mobile or out-reach facility to administer vaccines (Number, Custom) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 35.00 25.00 Date 25-Feb-2022 -- 14-Dec-2023 30-Jun-2024 IN01393599 ►Consultation workshops with citizen groups and the media to overcome vaccine hesitancy and enable equitable access to vaccination services (per year) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2.00 Date 25-Feb-2022 16-Jun-2023 16-Jun-2023 30-Jun-2024 Feedback received during these consultations will be used to inform and adjust activities aiming at overcoming vaccine hesitancy and enabling equitable access to vaccination services. As the Ministry Comments: obtains feedback from these consultation processes, adjustments of the content of the activities, communication materials or any other adjustments will be made to incorporate the feedback. IN01393853 Consultation workshops with citizen groups and the media to overcome vaccine hesitancy and enable equitable access to vaccination services (per year) (Number, Custom) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 1.00 2.00 Date 25-Feb-2022 -- 14-Dec-2023 30-Jun-2024 Component 2: Project Implementation, Monitoring and Supervision IN01393585 ►M&E system established to monitor COVID-19 preparedness and response (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 27-Apr-2020 16-Jun-2023 16-Jun-2023 30-Jun-2024 Surveillance data on COVID19 cases are collected and reports are disseminated through the Emergency Comments: response committee (COUSP) of the Ministry of Health and WHO. So a surveillance system is operating (which started before Project effectiveness), but this is the surveillance of COVID-19 itself, and not a more 2/5/2024 Page 9 of 11 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) comprehensive Monitoring & Evaluation of overall preparedness and response. There are two initiatives underway to put in place systems for disease surveillance overall, which are not yet completed. IN01393850 M&E system established to monitor COVID-19 preparedness and response (Yes/No, Custom) (Yes/No, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value No -- Yes Yes Date 27-Apr-2020 -- 14-Dec-2023 30-Jun-2024 IN01393587 ►Standard operational procedures (SOP) for collection and disposal of medical waste developed and shared with relevant stakeholders (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Jan-2022 16-Jun-2023 16-Jun-2023 30-Jun-2024 IN01393856 Standard operational procedures (SOP) for collection and disposal of medical waste developed and shared with relevant stakeholders (Yes/No, Custom) (Yes/No, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value No -- Yes Yes Date 31-Jan-2022 -- 14-Dec-2023 30-Jun-2024 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173832 IDA-D6170 Effective USD 7.50 7.50 0.00 7.66 0.00 100% P173832 IDA-D9790 Effective USD 25.50 25.50 0.00 19.09 5.20 79% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173832 IDA-D6170 Effective 20-Apr-2020 22-Apr-2020 27-Apr-2020 30-Jun-2022 30-Jun-2024 P173832 IDA-D9790 Effective 25-Feb-2022 09-Mar-2022 05-May-2022 30-Jun-2024 30-Jun-2024 Cumulative Disbursements 2/5/2024 Page 10 of 11 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Restructuring History Level 2 Approved on 16-May-2023 Related Project(s) P177554-Central African Republic COVID19 AF Vaccine Deployment ,P177618-Central African Republic COVID-19 Preparedness & Response Additional Financing 2/5/2024 Page 11 of 11