The World Bank Kiribati COVID-19 Emergency Response Project (P174219) REPORT NO.: RES54723 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF THE KIRIBATI COVID-19 EMERGENCY RESPONSE PROJECT APPROVED ON JUNE 25, 2020 TO REPUBLIC OF KIRIBATI HEALTH, NUTRITION & POPULATION EAST ASIA AND PACIFIC Regional Vice President: Manuela V. Ferro Country Director: Stephen N. Ndegwa Regional Director: Daniel Dulitzky Practice Manager/Manager: Aparnaa Somanathan Task Team Leader(s): Wayne Jeremy Irava, Susan Lynette Ivatts The World Bank Kiribati COVID-19 Emergency Response Project (P174219) ABBREVIATIONS AND ACRONYMS AUD Australian Dollar COVID-19 Coronavirus disease E&S Environmental and Social ICT Information and Communication Technology KFSU Kiribati Fiduciary Services Unit KPW Kiribati Pharmaceutical Warehouse M&E Monitoring and Evaluation MFED Ministry of Finance and Economic Development MHMS Ministry of Health and Medical Services MISE Ministry for Infrastructure and Sustainable Energy MPA Multiphase Programmatic Approach PDO Project Development Objective PMU Project Management Unit SPRP Strategic Preparedness and Response Program US$ United States of America Dollar The World Bank Kiribati COVID-19 Emergency Response Project (P174219) BASIC DATA Product Information Project ID Financing Instrument P174219 Investment Project Financing Environmental and Social Risk Classification (ESRC) Moderate Approval Date Current Closing Date 25-Jun-2020 30-Jun-2023 Organizations Borrower Responsible Agency Republic of Kiribati 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) 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$3.76 billion or 87% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. Loans and Credits denominated in SDRs and Euros are being affected because of fluctuations between the SDRs and Euros against the US dollar. At this late stage of implementation, several operations are processing refunds to their special accounts and therefore, total disbursements are affected. Four country operations closed by the end of FY22. Eight operations are closing by the end of the CY. The World Bank Kiribati COVID-19 Emergency Response Project (P174219) Sixty-nine (69) operations or 79 percent of projects approved have reached 70-100 percent disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). 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 represents 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. 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 the Recipient’s territory. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-D6900 25-Jun-2020 07-Jul-2020 23-Jul-2020 30-Jun-2023 2.50 .95 1.52 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No The World Bank Kiribati COVID-19 Emergency Response Project (P174219) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Request for Restructuring 1. This restructuring paper seeks the approval of the World Bank’s Country Director for Papua New Guinea and Pacific Islands to extend the closing date of the Kiribati COVID-19 Emergency Response Project (P174219, Grant No. IDA- D6900) by 12 months from June 30, 2023 to June 30, 2024. The proposed extension period will provide additional time needed to construct the new Kiribati Pharmaceutical Warehouse (KPW) under Component 1. A formal extension request letter from the Ministry of Finance and Economic Development (MFED) was received on December 1, 2022. The project was approved on June 25, 2020, comprising a US$ 2.5 million grant provided under the World Bank’s COVID-19 Strategic Preparedness and Response Program (SPRP) using the Multiphase Programmatic Approach (MPA). The project was made effective on July 23, 2022 and has disbursed US$0.95 million or 38.36 percent of the total financing as of January 2023. The bulk of the remaining funds are allocated for the construction of the KPW. B. Project Status 2. Progress towards achievement of the project development objective (PDO)1 and implementation progress are rated moderately satisfactory. The PDO indicators relating to the emergency response aspect of the project have been achieved.2 The third PDO indicator which relates more broadly to health system strengthing is on track to be achieved and will be bolstered by completion of the KPW activity.3 The project comprises two components: Component 1 - Strengthening Essential Health Service Delivery Capacity (US$ 2.10 million); and Component 2 - Implementation Management and Monitoring and Evaluation (US$0.40 million) which includes financing for a Project Management Unit (PMU) housed within the Ministry of Health and Medical Services (MHMS, implementing agency). Component 1 - Strengthening Essential Health Service Delivery Capacity4 3. Most project activities under Component 1 have been completed or are nearing completion including: (a) the refurbishment of the existing Tungaru Central Hospital national medical store under Subcomponent 1.1 (completed), (b) the installation of new information and communication technology (ICT) equipment to upgrade the health information network, including (i) the installation of new servers and system backups, (ii) upgrading internet service providers, (iii) the installation of a new phone system for MHMS and between hospitals in Tarawa (completed); and (c) the procurement and distribution of tablets to outer island health facilities and training of some health care workers (including from the outer islands) to support the digitization and centralization of the health information system under Subcomponent 1.2 1The PDO comprises two parts (i) supporting the emergency response “to detect and respond to the threat posed by COVID-19” and (ii) supporting health system improvements more broadly by strengthening “national systems for public health preparedness.” 2 PDO1: Emergency response protocols and plans revised and adopted (Target: Yes, Actual: Yes); PDO2: Percentage of suspected cases of COVID-19 reported and investigated per approved protocol (Target: 100 Percent, Actual 100 percent). 3 PDO3: Availability of essential medicines and supplies at all health facilities (Target: 90 percent, Actual 75.6 percent). 4 Component 1 is broken into two subcomponents: Subcomponent 1.1 - Upgrading and constructing warehouses for pharmaceuticals and medical supplies, and Subcomponent 1.2 - Connecting health facilities to a centralized health information management database to support health monitoring and reporting and strengthening the communication system to support telehealth services. The World Bank Kiribati COVID-19 Emergency Response Project (P174219) (training carried out in November 2022, sim-card arrangements being finalized with Vodaphone, follow up training and distribution scheduled for February 2023). 4. The construction of the new KPW is delayed due to significant challenges in securing a location for the warehouse as suitable land is scarce in Tarawa. The site has been confirmed at the Old Tungaru Hospital. A detailed work plan for the KPW was prepared by the MHMS in consultation with the Ministry of Infrastructure and Sustainable Energy (MISE), the Kiribati Fiduciary Services Unit (KFSU), and the MHMS-contracted engineering and design firm. The work plan, which was submitted to the World Bank, indicates that a 12-month project extension is needed to complete construction. As such, a formal request letter for a project restructuring was received on December 1, 2022, to extend the project closing date. Cost estimates for the KPW were updated by MISE on November 22, 2022, for AUD$1.84 million. The undisbursed amount of approximately AUD$2.53 million equivalent (61.64 percent of the total financing) remains sufficient to fund the KPW. Component 2 - Implementation Management and Monitoring and Evaluation 5. A PMU comprising one Project Manager was established to lead project implementation and has been greatly expanded5 under the new Kiribati Health System Strengthening Project (P176306, approved on April 4, 2022). This increase in capacity is expected to bolster implementation of KPW activity through the proposed extension period. With support from the new Monitoring and Evaluation (M&E) Officer, the PMU will also field a follow up beneficiary survey to learn how the ICT investments have improved operations and worker satisfaction as well as a survey on the upgrades and refurbishments of the existing Tungaru Central Hospital national medical store that were completed under the project. 6. Environmental and social (E&S) risk management performance is rated satisfactory. E&S instruments (Environmental and Social Management Framework, Labor Management Procedures, Stakeholder Engagement Plan and Code of Environmental and Social Practice) were developed and cleared during project preparation and their implementation and Environmental and Social Commitment Plan compliance was verified during the recent mission. The restructuring will not finance any new activities or trigger any new or additional E&S risks. Therefore, the project’s existing E&S instruments can be applied for the restructured project without requiring any updates. 7. Financial management (FM) performance is rated moderately satisfactory and there are no overdue audits. The Interim unaudited Financial Report (IFR) for the period January-June 2022, due on August 14, 2022, has been submitted but is yet to be finalized. The FM team is working closely with the KFSU to obtain supporting documentation including the updated contract register and bank statement needed to finalize the review. Procurement performance is rated moderately satisfactory. 8. A revision of end targets in the results framework is envisioned. Given the extension of the project closing date, the end target dates for all indicators will be revised to June 30, 2024. The values will remain the same. 5The expanded PMU comprises a Project Manager, Senior Project Officer, M&E Officer, and E&S Risk Officer. A World Bank Short Term Health Consultant is also providing in-country implementation support. The World Bank Kiribati COVID-19 Emergency Response Project (P174219) C. Rationale for Restructuring 9. The construction of the KPW remains a high priority in support of health system strengthening by addressing significant problems of space and storage for medical supplies as well as improving and strengthening supply chain management in the country. A 12-month extension of the closing date will allow the needed time for the construction of the warehouse and full disbursement of funds. Further, the new Kiribati Health System Strengthening Project includes complementary financing for the KPW activity including the fit-out and upgrading of the asset management system where needed. Given the PMU is resourced through two World Bank-financed projects, there is sufficient budget to cover both project management and M&E costs through the extension period. II. DESCRIPTION OF PROPOSED CHANGES 10. The proposed changes are as follows: a. Extension of the closing date of the Grant No. IDA-D6900 by 12-months from June 30, 2023 to June 30, 2024. b. Revised results framework in line with the new closing date. Target values remain the same, end-target dates, however, have been revised. III. SUMMARY OF CHANGES Changed Not Changed Results Framework ✔ Loan Closing Date(s) ✔ Disbursement Estimates ✔ Implementation Schedule ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ MPA Program Development Objective ✔ MPA Expected Results and Indicators ✔ PBCs ✔ Components and Cost ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ The World Bank Kiribati COVID-19 Emergency Response Project (P174219) Disbursements Arrangements ✔ Overall Risk Rating ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ 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 The World Bank Kiribati COVID-19 Emergency Response Project (P174219) 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 • 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_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-D6900 Effective 30-Jun-2023 30-Jun-2024 30-Oct-2024 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Year Current Proposed 2020 0.00 0.00 2021 400,000.00 364,900.00 2022 1,500,000.00 390,861.00 2023 600,000.00 744,239.00 2024 0.00 1,000,000.00 2025 0.00 0.00 . The World Bank Kiribati COVID-19 Emergency Response Project (P174219) . Results framework COUNTRY: Kiribati Kiribati COVID-19 Emergency Response Project Project Development Objectives(s) To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in the Recipient’s territory. Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline End Target Strengthen national systems for public health preparedness in Kiribati Emergency response protocols and plans revised and adopted No Yes (Yes/No) Action: This indicator has been Revised Percentage of suspected cases of COVID-19 reported and 0.00 100.00 investigated per approved protocol (Percentage) Action: This indicator has been Revised Availability of essential medicines and supplies at all health 74.00 90.00 facilities (Percentage) Action: This indicator has been Revised PDO Table SPACE Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Strengthening essential health service delivery capacity The World Bank Kiribati COVID-19 Emergency Response Project (P174219) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Percentage of health facilities connected to a centralized health information management database and communication system 0.00 70.00 to support telehealth services (Percentage) Action: This indicator has been Revised Increased storage capacity for COVID-19 buffer stocks and No Yes essential medicines (Yes/No) Action: This indicator has been Revised Percentage of health facilities submitting completed surveillance 10.00 80.00 reports within two weeks of the end of each month (Percentage) Action: This indicator has been Revised Implementation Management and Monitoring and Evaluation MHMS reporting at least every six months against its Strategic No Yes Health Plan core indicator set (Yes/No) Action: This indicator has been Revised Beneficiaries who expressed satisfaction with the project interventions, including on delivery and communication 0.00 75.00 modalities (Percentage) Action: This indicator has been Revised IO Table SPACE The World Bank Kiribati COVID-19 Emergency Response Project (P174219)