The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) Rwanda COVID-19 Emergency Response Project (P173855) EASTERN AND SOUTHERN AFRICA | Rwanda | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 8 | ARCHIVED on 26-Mar-2024 | ISR59639 | Implementing Agencies: Ministry of Finance and Economic Planning (MINECOFIN), Ministry of Health (MoH) / Rwanda Biomedical Center (RBC) Key Dates Key Project Dates Bank Approval Date: 07-Apr-2020 Effectiveness Date: 20-Apr-2020 Planned Mid Term Review Date: 30-Sep-2022 Actual Mid-Term Review Date: 31-May-2022 Original Closing Date: 30-Jun-2022 Revised Closing Date: 30-Jun-2025 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The objective of the Project is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in the Republic of Rwanda. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1. Case Detection, Confirmation and Contact Tracing:(Cost $6840000.00 M) Component 2: Public Health Measures and Clinical Care Capacity:(Cost $69250000.00 M) Component 3. Implementation Management and Monitoring and Evaluation:(Cost $1100000.00 M) Component 4. Contingency Emergency Response Component (CERC) Component 5. Protecting Essential Health Services:(Cost $15000000.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions The Rwanda COVID 19 Emergency Response Project has been under implementation with steady progress towards achieving the Project Development Objective. After 44 months of implementation, (i) the project has disbursed US$78.69 million out of the total net commitment of US$ 92.18 million, which represents 86.00 percent, (ii) four of the six PDO indicators have already been achieved, and (iii) excellent progress has been made across all the intermediate indicators with ten of the indicators fully achieved. The project is being implemented in line with the projected disbursement and planned activities in the approved workplan, and continues to be effectively implemented through an experienced implementation unit which has a solid track record working with the World Bank.  3/26/2024 Page 1 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) 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 Good progress is being made in the implementation of AF-V operations. As of February 16, 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. Partial cancellations have been/are being processed under several operations -- Afghanistan, Bangladesh, Belarus, Benin, Cabo Verde, Cameroon, Ethiopia, Gabon, Georgia, Lao, Madagascar, Mali, Nepal, Nigeria, Pakistan, Philippines, PNG, Sierra Leone, South Africa, Sudan, ROC AF2, and Togo. 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 February 16, 2024, amount to US$6.51 billion or 76 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. Five (5) operations are fully disbursed (Argentina, El Salvador AF1, Indonesia, Sri Lanka AF-V 1, and Ukraine AF-V 3). Sixty (60) AF-V/MPA- V operations or 51% of operations approved have disbursed over 70% of their commitments. Out of 60, twenty-five (25) operations or 42% have disbursed 90+. Ninety-eight (98) operations or 84 percent of total operations approved are disbursing. EAP has the highest percentage of disbursements at 96 percent, followed by ECA at 88 percent, LAC at 84 percent, SAR at 81 percent, MNA at 78 percent, AFE and AFW at 62 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. 3/26/2024 Page 2 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) 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 Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Low Low Low Macroeconomic Substantial Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Fiduciary Substantial Moderate Moderate Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Moderate Moderate Results PDO Indicators by Objectives / Outcomes Prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems IN01392274 ►Proportion of suspected cases of COVID-19 reported and investigated based on national guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 100.00 100.00 100.00 Date 07-Apr-2020 31-Mar-2023 15-Feb-2024 30-Jun-2025 IN01392276 ►Number of designated laboratories with COVID-19 diagnostic capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 156.00 156.00 151.00 3/26/2024 Page 3 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) Date 07-Apr-2020 31-Mar-2023 31-Mar-2023 30-Jun-2025 The end target for this indicator was revised in accordance with the current testing strategy. At the start, COVID-19 test was done at NRL using PCR. Overtime, the number of PCR testing centers increased to 11. Later, with the availability of Rapid tests, 100 private health facilities countrywide and all public Comments: hospitals (8 referral hospitals, 8 provincial hospitals and 39 district hospitals were engaged to provide Rapid tests. IN01392278 ►Proportion of designated healthcare facilities with isolation capacity (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 100.00 100.00 100.00 Date 07-Apr-2020 31-Mar-2023 15-Feb-2024 30-Jun-2025 All 56 public hospitals have isolation capacity for at least 2 cases. Health centers and private health facilities does not have isolation capacity, however they may avail a holding room where they may keep Comments: an identified COVID-19 case before the referral. COVID-19 Vaccine Coverage IN01392275 ►Percentage of population 18 years and above receiving a booster, which is included in the population targets defined in the national plan, disaggregated by sex (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 46.00 79.70 56.00 Date 28-Feb-2022 31-Mar-2023 15-Feb-2024 30-Jun-2025 As of 15th February 2024, 79.7% of the population aged 18 years and above have been reached with a Comments: booster dose. IN01392277 ►Percentage of the population fully vaccinated which is included in the priority population targets as defined in the national plan disaggregated by sex, age group and location. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 77.00 79.90 86.00 Date 05-Feb-2021 31-Mar-2023 15-Feb-2024 30-Jun-2025 The vaccination coverage rate is calculated against the total population of the country (estimated at over 13 million in 2021. As of February 2024, 79.9% of the population (equivalent to 10.8 million people) have Comments: received at least two doses IN01392279 ►Number of doses of COVID-19 vaccine procured with Project funding (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,601,440.00 3,601,440.00 6,000,000.00 Date 29-Jan-2021 31-Mar-2023 31-Mar-2023 30-Jun-2025 3/26/2024 Page 4 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) So far, 3.6 million doses were procured through the second AF (fully delivered and deployed). The target will need to be adjusted to 36 million doses given that the country has got sufficient donations from other Comments: sources and could no longer use WB funding to purchase vaccines. Intermediate Results Indicators by Components Component 1: Case Detection, Confirmation and Contact Tracing IN01392280 ►Number of laboratory staff trained to conduct COVID-19 diagnosis (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 192.00 192.00 50.00 Date 07-Apr-2020 31-Mar-2023 31-Mar-2023 30-Jun-2023 FY2020/21: Q1&Q2 (76); Q3&Q4 (34) Comments: FY2021/22: Q1&Q2 (19); Q3&Q4 (63) IN01392285 ►Percentage of grievances documented, processed and resolved within 30 days (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 100.00 100.00 Date 20-Oct-2020 31-Mar-2023 15-Feb-2024 30-Jun-2025 The Grievance Redress Mechanism (GRM) was established and the committees were set up to resolve the beneficiary issues across the country. There are 2,151 GRCs in 30 districts established at Cell, Sector, District and Central levels. Through Training of Trainers, 1,180 GRC members received training on GRM and e-GRM, and through cascade training, all 2,151 GRCs were trained. The GRCs have resolved 10 grievances which 7 were solely about awareness raising to explain and remove confusion on the vaccines given to children to prevent the widespread of COVID-19 and the Comments: remaining 3 were concerns about not having enough food to eat since COVID-19 put down a lot of their livelihood businesses. The GRCs will continue resolving issues that may arise under the CERC component and these will be documented and reported every quarter as part of the safeguards progress report. IN01392289 ►Total tests performed by the Government facilities, disaggregated by sex (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,634,311.00 3,634,311.00 0.00 Date 20-Oct-2020 31-Mar-2023 31-Mar-2023 30-Jun-2025 1,877,632 males and 1,756,679 females performed by the public health facilities out of the 5,430,216 tests Comments: performed as of September 2022 3/26/2024 Page 5 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) Time response to COVID-19 IN01392281 ►Proportion of targeted healthcare facilities with clinical capacity for COVID-19 patients (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 100.00 100.00 100.00 Date 07-Apr-2020 31-Mar-2023 15-Feb-2024 30-Jun-2023 All 55 public hospitals (8 referral hospitals, 8 provincial hospitals and 39 district hospitals) have established at least 2 rooms each for the management of COVID-19 cases Comments: IN01392286 ►Number of health staff trained in infection prevention and control (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 3,554.00 3,554.00 2,000.00 Date 07-Apr-2020 31-Mar-2023 31-Mar-2023 30-Jun-2023 COVID-19 Vaccine Knowledge, Acceptance, and Safety IN01392282 ►Number of mass media campaigns on COVID-19 prevention and vaccination (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 96.00 96.00 90.00 Date 05-Feb-2021 31-Mar-2023 31-Mar-2023 30-Jun-2023 IN01392291 ►Proportion of serious Adverse events following immunization (AEFI) reported and investigated, by sex (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 78.00 78.00 95.00 Date 05-Feb-2021 31-Mar-2023 31-Mar-2023 30-Jun-2025 According to table 6 of the AM, there were 641 AEFI cases reported, including 74 cases reported as severe, 23 moderate cases, and 409 minor cases. RBC has reported that 58 out of the 74 severe cases Comments: have been investigated Health System Strengthening IN01392283 ►Number of people screened for underlying chronic conditions, disaggregated sex and age group (Number, Custom) 3/26/2024 Page 6 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,978,569.00 2,164,274.00 300,000.00 Date 08-Mar-2021 31-Mar-2023 15-Feb-2024 30-Jun-2025 The figure comprises the people screened for NCDs from July 2023 up to 15th February 2024 as detailed below: Male 976,110 Female 1,188,164 Comments: Under 35 years old 64,928 35 years old and above 2,099,346 IN01392287 ►Percentage of targeted hospitals with functioning oxygen therapy system (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 66.00 100.00 100.00 Date 08-Mar-2021 31-Mar-2022 15-Feb-2024 30-Jun-2023 All 56 public hospitals have functioning oxygen therapy systems in place. Comments: Maintaining Essential Health Services during and beyond COVID-19 IN01392284 ►Number of outpatient consultations, disaggregated by age and sex (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 18,860,619.00 20,669,719.00 11,185,624.00 19,622,500.00 Date 24-Mar-2021 31-Mar-2023 31-Dec-2023 30-Jun-2025 The current reporting system disaggregate data by only two age groups: under five years old and above five years old. Data reported is for the FY22/23. A total of 8,769,514 males and 12,653,390 females of which 3,839,257 were under five years of age and 17,583,647 were over five years of age. In addition to that during the first semester of FY23/24 (July to December 2023), 11,185,624 consultations were recorded as per below details; FY23/24 (July to December FY23/24 2023) Comments: Female 12,653,390 6,532,699 Male 8,769,514 4,652,925 Under 5 years Consultations 3,839,257 1,891,349 Over 5 years consultations 17,583,647 9,294,275 IN01392288 3/26/2024 Page 7 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) ►Number of new acceptors of modern contraception (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 238,392.00 307,657.00 170,646.00 248,023.00 Date 24-Mar-2021 31-Mar-2023 31-Dec-2023 30-Jun-2023 Reported quarterly (Q1-Q4) FY20/21 283,635 FY21/22 307657 Comments: FY22/23 331,938 FY23/24 (July to December 2023) 170,646 IN01392290 ►Number of deliveries conducted within the facility (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 315,814.00 347,844.00 192,086.00 328,573.00 Date 24-Mar-2021 31-Mar-2023 31-Dec-2023 30-Jun-2023 Reporting annually - Q1-Q4 FY20/21 321,898 FY21/22 347,844 Comments: FY22/23 348,549 FY23/24 (July to December 2023) 192,086 IN01392292 ►Number of pregnant women receiving four antenatal care visits (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 175,057.00 104,071.00 190,280.00 Date 24-Mar-2021 31-Mar-2023 31-Dec-2023 30-Jun-2023 reporting annually: FY20/21 157,120 FY21/22 175,057 Comments: FY22/23 182,310 FY23/24 (July to December 2023) 104,071 IN01392293 3/26/2024 Page 8 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) ►Number of infants receiving Pentavalent 3 vaccine (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 345,423.00 344,703.00 197,237.00 352,330.00 Date 24-Mar-2021 31-Mar-2023 31-Dec-2023 30-Jun-2023 Reporting Annually: (Q1-Q4) FY20/21 330,341 FY21/22 344,703 Comments: FY22/23 350,545 FY23/24 (July to December 2023) 197,237 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173855 IDA-66150 Closed USD 14.25 14.25 0.00 15.04 0.00 100% P173855 IDA-68710 Effective USD 15.00 15.00 0.00 14.84 0.05 100% P173855 IDA-70920 Effective USD 16.00 16.00 0.00 10.48 4.81 69% P173855 IDA-D8050 Effective USD 15.00 15.00 0.00 14.92 0.03 100% P173855 IDA-E0220 Effective USD 16.00 16.00 0.00 12.68 2.55 83% P173855 TF-B4324 Closed USD 0.94 0.93 0.01 0.93 0.00 100% P173855 TF-B6226 Effective USD 15.00 15.00 0.00 9.80 5.20 65% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173855 IDA-66150 Closed 07-Apr-2020 09-Apr-2020 20-Apr-2020 30-Jun-2022 30-Jun-2022 P173855 IDA-68710 Effective 16-Apr-2021 22-Apr-2021 21-Jun-2021 30-Jun-2023 30-Jun-2025 P173855 IDA-70920 Effective 31-Mar-2022 07-Apr-2022 06-Jun-2022 30-Jun-2025 30-Jun-2025 P173855 IDA-D8050 Effective 16-Apr-2021 22-Apr-2021 21-Jun-2021 30-Jun-2023 30-Jun-2025 P173855 IDA-E0220 Effective 31-Mar-2022 07-Apr-2022 06-Jun-2022 30-Jun-2025 30-Jun-2025 3/26/2024 Page 9 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) P173855 TF-B4324 Closed 30-Nov-2020 06-Dec-2020 06-Dec-2020 31-Jan-2021 28-Feb-2021 P173855 TF-B6226 Effective 02-Sep-2021 02-Sep-2021 02-Sep-2021 30-Jun-2023 30-Jun-2025 Cumulative Disbursements Restructuring History Level 2 Approved on 29-Jan-2021 ,Level 2 Approved on 14-Jun-2021 Related Project(s) P175252-Additional Financing for Rwanda COVID-19 Emergency Response Project ,P176304-Additional Financing to the COVID-19 Emergency Response Project ,P178282-Third Additional Financing Rwanda COVID-19 Emergency Response Project 3/26/2024 Page 10 of 10