The World Bank
Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803)
REPORT NO.: RES55080
RESTRUCTURING PAPER
ON A
PROPOSED PROJECT RESTRUCTURING
OF
SIERRA LEONE COVID-19 EMERGENCY PREPAREDNESS AND RESPONSE PROJECT
APPROVED ON APRIL 2, 2020
TO
REPUBLIC OF SIERRA LEONE
HEALTH, NUTRITION & POPULATION
WESTERN AND CENTRAL AFRICA
Regional Vice President: Ousmane Diagana
Country Director: Pierre Frank Laporte
Regional Director: Dena Ringold
Practice Manager: Magnus Lindelow
Task Team Leaders: Yohana Dukhan, Nicolas Rosemberg
The World Bank
Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803)
ABBREVIATIONS AND ACRONYMS
AF Additional Financing
AVAT Africa Vaccine Acquisition Trust
AWPB Annual Work Plan and Budget
GoSL Government of Sierra Leone
J&J Johnson and Johnson
M&E Monitoring and Evaluation
MoHS Ministry of Health and Sanitation
PDO Project Development Objective
The World Bank
Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803)
BASIC DATA
Product Information
Project ID Financing Instrument
P173803 Investment Project Financing
Environmental and Social Risk Classification (ESRC)
Substantial
Approval Date Current Closing Date
02-Apr-2020 30-Jun-2023
Organizations
Borrower Responsible Agency
Ministry of Finance
Multiphase Programmatic Approach (MPA) Program Development Objective
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
Multiphase Programmatic Approach (MPA) Status (Public Disclosure)
Status and Key Decisions (Public Disclosure)
Considerable efforts continue to be made to advance the implementation of the 87 MPA operations. As of
March 15, 2023, 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 March 15, 2023, amount
to US$3.88 billion or 91% of overall commitments. This amount does not include disbursements under
MPA-V operations which are reported together with AF-V operations. Loans and Credits denominated in
SDRs and Euros are being affected because of fluctuations between the SDRs and Euros against the US
dollar. Four country operations closed by the end of FY22 and other seven operations closed by the end of
the CY. Individual COVID-19 MPA operations will not have to complete an ICR. Instead, one ICR will be
prepared for the entire COVID-19 MPA Program based on final ISRs prepared by country operations’
teams.
The World Bank
Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803)
Seventy (70) country projects or 80 percent of projects approved have reached 70-100+ percent
disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR
against the US$). Out of the 70 operations, 57 operations or 81 percent have disbursed over 90+% of
commitments. Out of the 70 operations, 38 operations are fully disbursed, and 16 operations have
disbursed 95-99 percent of commitments. There are six operations with disbursements of 50 percent or
less. Out of these six operations, one has not disbursed (AFW), and one operation has disbursed 30 percent
(AFW). The projects are benefitting around 3.7 billion people or 50% of the global population. When
countries with 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-V 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. ECA has the highest percentage of
disbursements (97%), followed by MNA (96%), SAR (94%), LAC (92%), EAP (89%), AFE and AFW (77%). AFE
lower disbursements compared to other regions are a result of low disbursements under two operations. In
the case of AFW low disbursements are a result of no disbursements under one operation and only 30
percent under another. Retroactive Financing (RF) represents 20 percent of commitments. SAR has the
highest percentage of RF at 37 percent, followed by ECA at 18 percent. IDA represents 39 percent and IBRD
41 percent of disbursements.
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 (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 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 COVID-19 MPA and a key contribution to
the WBG’s overall COVID-19 response. As of early March 2023, 634 million doses have been purchased and
503 million have been delivered with Bank financing to 56 countries.
As of March 15, 2023, the Bank had approved 116 operations (including MPA-V operations) to support
vaccine procurement and rollout in 80 countries amounting to $10.1 billion. However, the Costa Rica
operation was cancelled in early March 2023 at the Government’s request. There are now 115 operations
The World Bank
Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803)
with a commitment of $9.92 billion. The 115 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) 12
in Latin America and the Caribbean; (v) 9 in Middle East and North Africa; and (vi) 9 in South Asia. Thirty-two
operations are being implemented in Fragile and Conflict-affected situations. IDA continues to represent 42
percent and IBRD 58 percent of disbursements. Total disbursements under these projects as of March 15,
2023, amount to US$5.65 billion or 57 percent of overall commitments. Disbursements under MPA-V
operations are included in this total while disbursements under the six restructured projects are counted
under parent projects. Disbursements under AF-V operations have slowed down in the past months because
of excess donor funding for vaccines’ procurement and lower needs than anticipated for IBRD/IDA funds for
the procurement of vaccines. Thirty-five (35) or 30 percent of AF-V and MPA-V operations have disbursed
70 percent or more of their commitments. Out of the 35, twelve operations have disbursed 90+
percent. Out of the twelve, three operations are fully disbursed, and six operations have disbursed 98-99
percent of commitments. Eighty-five (85) operations or 73 percent of total operations approved are
disbursing. Retroactive Financing (RF) represents 37 percent of overall commitments. High levels of RF
have been authorized under different operations - Ukraine (100%), Panama and Turkey (90%), Argentina and
Guyana (80%), and Belize, and Sri Lanka (70%). One hundred and twelve (112) loan/financing agreements or
97 percent of projects approved have been signed. One hundred and ten (110) loan/financing agreements or
95 percent of projects approved have become effective. As with the MPA operations, streamlined
procedures, delegated approval, wide use of Bank Facilitated Procurement, coupled with flexible project
design, and intensified efforts across the Bank have contributed to the rapid design, processing, and
implementation of the operations.
OPS_TABLE_PDO_CURRENTPDO
Project Development Objective (PDO)
Original PDO
To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health
preparedness in Sierra Leone.
OPS_TABLE_PDO_CURRENTPDO
Summary Status of Financing (US$, Millions)
Net
Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed
IDA-D9600 13-Dec-2021 20-Dec-2021 23-Feb-2022 30-Jun-2023 18.10 2.50 13.80
IDA-D8530 28-May-2021 03-Jun-2021 28-Jun-2021 30-Jun-2023 5.00 4.81 .11
IDA-D6030 02-Apr-2020 03-Apr-2020 03-Apr-2020 30-Jun-2023 7.50 7.64 0
The World Bank
Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803)
TF-B5745 28-May-2021 03-Jun-2021 28-Jun-2021 30-Jun-2023 3.50 3.50 0
Policy Waiver(s)
Does this restructuring trigger the need for any policy waiver(s)?
No
I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING
1. The Government of Sierra Leone (GoSL) responded to the COVID-19 pandemic promptly and the number of
COVID-19 cases has been relatively low. Even prior to the detection of the first COVID-19 case in the country, the
GoSL took preparedness and response measures to contain the virus, such as the deployment of detection and
response teams and instituting quarantine and social distance measures. As of March 29, 2023, Sierra Leone had
reported 7,762 cumulative COVID-19 cases and 125 deaths, bringing the case fatality rate to 1.6 percent (excluding
community deaths). Since the beginning of 2022, the number of confirmed cases and the transmission rate have
remained low, although it should be noted that testing has also been low.
2. The GoSL launched its COVID-19 vaccination program on March 15, 2021. As of February 16, 2023, a total of
4,685,605 people were vaccinated with their first dose, and 3,837,624 people have received their second dose.
This represents 94.1 percent of the target population vaccinated with their first dose and 77.1 percent of the
target population fully vaccinated; this exceeds the national target of 66 percent of all people aged 12 and above.
Among those vaccinated, 47.9 percent are males, and 52.1 percent are females. The COVID-19 vaccine intake has
increased significantly following surge vaccination efforts led by the Ministry of Health and Sanitation (MoHS).
The MoHS plans to reach 90 percent full vaccination coverage by the end of 2023. To achieve this target, the MoHS
has integrated COVID-19 vaccination into routine immunization services and the upcoming surge efforts will focus
on high-risk population groups. In addition, the MoHS plans to increase the uptake of booster doses, currently at
10.1 percent of the target population.
3. Progress towards the achievement of the project development objective (PDO) is rated satisfactory. The PDO
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 Sierra Leone.
4. Project implementation has progressed well and is rated moderately satisfactory. The parent Sierra Leone
COVID-19 Emergency Preparedness and Response Project (P173803), in an amount of US$7.50 million, was
approved on April 2, 2020, and became effective on April 3, 2020. The first Additional Financing (AF) (AF1,
P176441) of US$8.50 million was approved on May 28, 2021, and became effective on June 28, 2021. The second
AF (AF2, P177850) in the amount of US$18.10 million was approved on December 13, 2021 and became effective
on February 23, 2022. Furthermore, AF1 and AF2 provided the financial resources for the country to purchase and
deploy COVID-19 vaccines. The parent project and AF1 have been fully disbursed and most critical activities have
been brought to completion. Highlights of achievements include: (i) improved turnaround time of COVID-19
diagnostic from 72 hours to between 24 and 48 hours with the increased number of designated laboratories from
two to five; (ii) the activation of 12 laboratories across the districts with diagnostic test kits and assorted
equipment; (iii) scaling up of the 117 Toll-Free Emergency Call Center, which informs strategic decisions of the
The World Bank
Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803)
Emergency Operations Center, the National COVID-19 Emergency Response Center, and the District COVID-19
Emergency Response Center; (iv) intensified risk communication and community engagement for COVID-19
prevention and control and vaccination; (v) a rumor-control mechanism put in place; (vi) procurement of 463,200
Johnson and Johnson (J&J) vaccine doses under AF1; and (vii) support for COVID-19 vaccine deployment, including
through multiple surge campaigns.
5. Fiduciary (financial management and procurement) performance is progressing in a satisfactory manner, while
project management and monitoring and evaluation (M&E) are rated Moderately Unsatisfactory and require
intensified and prioritized action as part of the 2023 Annual Work Plan and Budget (AWPB). A dedicated mission
focused on M&E took place in late March 2023 and follow-up capacity building sessions have been scheduled to
improve the project’s performance in this area.
6. The environmental and social performance of the parent project are Moderately Satisfactory. All the safeguards
instruments for the parent project, AF1 and AF2 have been prepared and disclosed. This includes the
Environmental and Social Management Framework that was updated for AF2 and a Healthcare Waste
Management Plan (HCWMP) for the AF2.
7. The project continues to provide support to the MoHS, particularly the Extended Program of Immunization
(EPI). The MoHS has completed the AWPB process for 2023 to ensure the effective use of funds (under the parent
project and AF1). Activities planned for 2023 include training of staff, risk communication activities, M&E of the
COVID-19 vaccination campaign, procurement of personal protective equipment (for which contracts were signed
in 2022) and support to the next three surge campaigns, as well as project management-related costs, including
those linked to the supervision of the implementation of safeguards activities.
8. The MoHS confirmed that the World Bank financing requested to procure COVID-19 vaccines under AF2 is no
longer needed. During the preparation of AF2, it was agreed that AF2 funds would be used to procure 1.42 million
doses of J&J vaccines from the Africa Vaccine Acquisition Trust (AVAT), in addition to the 463,200 vaccine doses
procured under AF1. Following a donation from the MasterCard Foundation for the acquisition of 1.51 million
doses of J&J through AVAT and given the availability of sufficient stocks to continue vaccination efforts, the GoSL
requested that the project no longer procure these doses and that these funds be cancelled. It should be noted
that Sierra Leone did not accrue additional contractual obligations with AVAT for the procurement of the 1.42
million vaccine doses using IDA resources.
II. DESCRIPTION OF PROPOSED CHANGES
9. The purpose of the restructuring is to cancel and reallocate funds under AF2. There are no changes to the PDO,
component descriptions, implementation arrangements, closing date, the project’s results framework or risk
ratings. As indicated above, AF1 financed the acquisition of 463,200 vaccine doses from AVAT through UNICEF.
These vaccines have already been delivered by UNICEF and received. The GoSL subsequently requested the
procurement of an additional 1.42 million doses using AF2 funds. Following the donation of 1.51 million doses
from MasterCard Foundation, the doses to be procured under AF2 are no longer needed. The GoSL did not accrue
additional contractual obligations with AVAT or UNICEF for the 1.42 million doses that were going to be financed
using AF2 resources. Since there is no need to purchase additional vaccine doses, the GoSL requested on March
30, 2023, to cancel all undisbursed funds (SDR 9,729,943.31) under AF2, which were meant to cover the
procurement of 1.42 million COVID-19 vaccines doses, as well as part of the costs related to their deployment.
The World Bank
Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803)
Therefore, the partial cancellation does not have any negative implications on the achievement of the PDO or the
GoSL’s goal to vaccinate the eligible population as planned. The reallocation among the categories is needed as a
result of the cancellation of funds.
10. Reallocations between disbursement categories are presented in Section IV below. The proposed IDA Grant
amount to be cancelled under AF2 (IDA-D9600) is SDR 9,729,943.31 (from Categories 1 and 2).
III. SUMMARY OF CHANGES
Changed Not Changed
Cancellations Proposed ✔
Reallocation between Disbursement Categories ✔
Implementing Agency ✔
DDO Status ✔
Project's Development Objectives ✔
MPA Program Development Objective ✔
MPA Expected Results and Indicators ✔
Results Framework ✔
Components and Cost ✔
Loan Closing Date(s) ✔
Disbursements Arrangements ✔
Disbursement Estimates ✔
Overall Risk Rating ✔
Legal Covenants ✔
Institutional Arrangements ✔
Financial Management ✔
Procurement ✔
Implementation Schedule ✔
Other Change(s) ✔
Economic and Financial Analysis ✔
The World Bank
Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803)
Technical Analysis ✔
Social Analysis ✔
Environmental Analysis ✔
IV. DETAILED CHANGE(S)
MPA PROGRAM DEVELOPMENT OBJECTIVE
Current MPA Program Development Objective
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
EXPECTED MPA PROGRAM RESULTS
Current Expected MPA Results and their Indicators for the MPA Program
Progress towards the achievement of the PDO would be measured by outcome indicators. Individual country-specific
projects (or phases) under the MPA Program will identify relevant indicators, including among others:
• Country has activated their public health Emergency Operations Centre or a coordination mechanism for
COVID-19;
• Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents;
• Number of acute healthcare facilities with isolation capacity;
• Number of suspected cases of COVID-19 reported and investigated per approved protocol;
• Number of diagnosed cases treated per approved protocol;
• Personal and community non-pharmaceutical interventions adopted by the country (e.g., installation of
handwashing facilities, provision of supplies and behavior change campaigns, continuity of water and sanitation service
provision in public facilities and households, schools closures, telework and remote meetings, reduce/cancel mass
gatherings);
• Policies, regulations, guidelines, or other relevant government strategic documents incorporating a multi-
sectoral health approach developed/or revised and adopted;
• Multi-sectoral operational mechanism for coordinated response to outbreaks by human, animal and wildlife
sectors in place;
• Coordinated surveillance systems in place in the animal health and public health sectors for zoonotic
diseases/pathogens identified as joint priorities; and
The World Bank
Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803)
• Mechanisms for responding to infectious and potential zoonotic diseases established and functional; and
• Outbreak/pandemic emergency risk communication plan and activities developed and tested
OPS_DETAILEDCHANGES_CANCELLATIONS_TABLE
CANCELLATIONS
Value Reason
Current Cancellation New
Ln/Cr/Tf Status Currency Date of for
Amount Amount Amount
Cancellation Cancellation
IDA-D6030- Disburs
XDR 5,500,000.00 0.00 5,500,000.00
001 ing
IDA-D8530- Disburs
XDR 3,500,000.00 0.00 3,500,000.00
001 ing
BORROWER'
S REQUEST
IDA-D9600- Disburs
XDR 12,800,000.00 9,729,943.31 30-Mar-2023 3,070,056.69 FOR
001 ing
COUNTRY
REASONS
TF-B5745- Disburs
USD 3,500,000.00 0.00 3,500,000.00
001 ing
OPS_DETAILEDCHANGES_REALLOCATION _TABLE
REALLOCATION BETWEEN DISBURSEMENT CATEGORIES
Financing %
Current Allocation Actuals + Committed Proposed Allocation
(Type Total)
Current Proposed
IDA-D9600-001 | Currency: XDR
iLap Category Sequence No: 1 Current Expenditure Category: GD,WK,NCS,CS,TR&OC prtA.2g
141,400.00 0.00 0.00 100.00 100.00
iLap Category Sequence No: 2 Current Expenditure Category: Proj COVID-19 vaccin acquis prt C.5
9,701,000.00 0.00 0.00 100.00 100.00
iLap Category Sequence No: 3 Current Expenditure Category: GD,WK,NCS,CS,TR&OC prtC3
2,828,700.00 0.00 2,620,056.69 100.00 100.00
The World Bank
Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803)
iLap Category Sequence No: 4 Current Expenditure Category: GD,WK,NCS,TR&OC prtA.1(f)
128,900.00 0.00 450,000.00 100.00 100.00
Total 12,800,000.00 0.00 3,070,056.69
.
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