The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) Project Information Document (PID) Appraisal Stage | Date Prepared/Updated: 19-Jun-2023 | Report No: PIDA36098 Apr 07, 2023 Page 1 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) BASIC INFORMATION OPS_TABLE_BASIC_DATA A. Basic Project Data Country Project ID Project Name Parent Project ID (if any) Senegal P181056 Second Additional P173838 Financing for the Senegal COVID-19 Response Project Parent Project Name Region Estimated Appraisal Date Estimated Board Date Senegal COVID-19 Response WESTERN AND CENTRAL 24-Apr-2023 30-Jun-2023 Project AFRICA Practice Area (Lead) Financing Instrument Borrower(s) Implementing Agency Health, Nutrition & Population Investment Project Ministry of Finances and Ministry of Health and Financing Budget Social Action Proposed Development Objective(s) Parent To prevent, detect and respond to the COVID-19 disease outbreak in Senegal. Proposed Development Objective(s) Additional Financing 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 in Senegal Components Component 1. Emergency COVID-19 Response Component 2. Community Engagement and Risk Communication Component 3. Project Management and Monitoring PROJECT FINANCING DATA (US$, Millions) SUMMARY -NewFin1 Total Project Cost 15.00 Total Financing 15.00 of which IBRD/IDA 0.00 Financing Gap 0.00 DETAILS -NewFinEnh1 Apr 07, 2023 Page 2 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) Non-World Bank Group Financing Trust Funds 15.00 Global Financing Facility 15.00 Environmental and Social Risk Classification Substantial Other Decision (as needed) B. Introduction and Context 1. This Project Paper seeks the approval of the World Bank’s Regional Vice President to provide a Global Financing Facility for Women, Children and Adolescents (GFF) grant in the amount of US$15.0 million equivalent for a Second Additional Financing (AF2). The AF2 will support the costs of expanding the activities of the Senegal COVID-19 Response Project (P173838) under the COVID-19 Strategic Preparedness and Response Program (SPRP) using the Multiphase Programmatic Approach (MPA), approved by the Board on April 2, 2020, and the vaccines AF to the SPRP approved on October 13, 2020.1 The primary objectives of the second AF is to further expand preparedness and response activities to continue to address the Coronavirus Disease 2019 [COVID-19] impacts in Senegal. The Senegal COVID-19 Response Project (P173838) with an amount of US$20 million equivalent was approved on April 2, 2020, and the First Additional Financing for the Senegal COVID-19 Response Project (AF1 – P175992) with an aim to enable affordable and equitable access to COVID-19 vaccines was approved on June 2, 2021, with an amount of US$134 million. As of June 5, 2023, commitments under the parent project have been fully disbursed. As of the same date, disbursements under the AF1 operation have reached $50.62 million or 38% with the remaining funds fully committed. 2. The proposed AF2 will enable a scale up of project activities to support the Government of Senegal’s (GoS’s) response to the impacts of the COVID-19 pandemic. This will include further strengthening of preparedness and response activities including overall systems strengthening to ensure resilience in the face of future waves of COVID-19 as well as other health emergencies. Unlike many other countries in the region, COVID-19 vaccinations became an integral part of essential health services (EHS) under the national immunization program in Senegal in 2021. COVID-19 treatment and the rapid scale-up and delivery of COVID-19 vaccinations when vaccines became available overburdened the health system, 1 The World Bank approved a US$12 billion WBG Fast Track COVID-19 Facility (FTCF or “the Facilityâ€?) to assist IBRD and IDA countries in addressing the global pandemic and its impacts. Of this amount, US$6 billion came from IBRD/IDA (“the Bankâ€?) and US$6 bil lion from the International Finance Corporation (IFC). The IFC subsequently increased its contribution to US$8 billion, bringing the FTCF total to US$14 billion. The AF of US$12 billion (IBRD/IDA) was approved on October 13, 2020 to support the purchase and deployment of vaccines as well as strengthening the related immunization and healthcare delivery system. Apr 07, 2023 Page 3 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) which created disruptions to other EHS during the pandemic with a decline in several key health indicators. Furthermore, vaccine hesitancy throughout the country kept COVID-19 vaccine coverage low with some improvements noted in the last few months due to the Ministry of Health and Social Action’s (MoHSA’s) revised strategy to strengthen EHS, which includes COVID-19 treatments and vaccinations. However, to ensure continued access to these essential services by all, the MoHSA needs additional resources to maintain and reinforce the progress made in preparedness and response and explore new approaches and innovations to deliver health services to the population. The need for additional resources to expand the COVID-19 response was formally conveyed by the GoS in an Expression of Interest to the GFF Secretariat dated August 17, 2021, and a request to process AF2 was formally submitted on February 27, 2023. The proposed AF2 will form part of an expanded health response to the pandemic, which is being supported by development partners under the coordination of the GoS. 3. The project will also undergo Level II Restructuring. Beyond the addition new activities to scale up the COVID-19 preparedness and response, the Project will undergo Level II Restructuring align the PDO to the MPA PDO and to modify the results framework. The closing date of both the parent project and the AF1 operation is December 31, 2025, which will give ample time to complete activities under both the AF1 and the proposed AF2. Country Context 4. The COVID-19 pandemic has exacerbated Senegal’s pre-existing structural vulnerabilities amid steady economic growth trends. Senegal’s pre-COVID19 growth trend was among the strongest in sub- Saharan Africa recording for the period of 2014-2019 GDP growth higher than 5 percent, with a peak of 7.2 percent in 2017. These are especially strong when compared with Senegal’s regional and structural peers. However, high growth did not result in higher living standards or a substantial reduction in poverty and inequality in the country (national poverty rate declined from 43 to 37.8 percent between 2011 and 2019). The shock induced by the COVID-19 pandemic resulted in an increased poverty incidence (38.2 in 2020), and the ongoing conflict in Ukraine since 2022, exacerbates existing inequalities and exposes deeply rooted structural weaknesses, due to higher food and energy prices and trade disruptions. Sectoral and Institutional Context 5. Senegal was the second country in Sub-Saharan Africa to report its first imported case of COVID- 19, on March 2, 2020, which led to the Government’s activation of emergency management mechanisms and request for World Bank financing After several waves of the disease in the country, COVID-19 cases and deaths have declined. As of June 4, 2023, the cumulative number of confirmed cases is 88,999 (an increase of 675 cases since September 22, 2022) with 87,027 recovered, 0 patients under treatment (a reduction of 108 patients since September 22, 2022), and 1,971 deaths (no additional deaths since June 15, 2022). As of May 31st, 2023, Senegal is ranked third in the highest number of cumulative cases and second in the highest number of cumulative death due to COVID-19 in West Africa. 6. Senegal was among the first countries to begin its COVID-19 vaccination deployment on February 23, 2021, with an ambitious strategy for COVID-19 vaccinations expecting to reach 80-90 percent of its eligible population; 55 percent of which would be reached through AF1. However, as observed in many countries in sub-Saharan Africa and around the world, vaccine hesitancy continues to remain high. This is mainly due to the lack of information of the safety and efficacy of the COVID-19 vaccines, the Apr 07, 2023 Page 4 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) downward trend of COVID-19 cases and deaths in the country due to a younger population, and the Government’s initial lack of commitment to change their vaccination strategy to accommodate for the low vaccine coverage. As of June 4, 2023, 2,164,429 people have received at least one dose of the COVID- 19 vaccines and 1,457,586 people have been fully vaccinated for COVID-19, which represents 23.71 percent (6.57 percent increase since September 22, 2022) and 15.97 percent (3.78 percent increase since September 22, 2022) of the eligible target population (18 years of age and over) respectively. As of May 21, 2023, Senegal is trailing behind compared to other countries in West Africa ranking 12 th out of 14 in the number of people who have completed the initial COVID-19 vaccination protocol. Only 135 cases of Adverse Events Following Immunization (AEFIs) have been reported. After a yearlong suspension of shipment of COVID-19 vaccines in the country (January 2022-2023), the MoHSA lifted the suspension and is accepting bilateral donations. As of February 10, 2023, the Government has received 7,232,098 vaccine doses (Sinopharm, AstraZeneca (AZ), Johnson and Johnson [J&J], Pfizer). Approximately 23.8 percent of vaccines received have expired and were disposed according to GoS regulations. 7. The AF2 is being proposed at a critical juncture in the GoS’s response to COVID-19. It will finance a scale up of activities and new activities to achieve the PDO and address the impact of the COVID-19 pandemic on key health indicators. The proposed AF2 will reinforce GoS’s efforts to: (i) strengthen the capacity of the public health system for preparedness and response to COVID-19 and to future epidemics/pandemics and other threats to health security and (ii) ensure operationalization of COVID-19 treatment and vaccines as an essential component of integrated EHS service delivery in eight regions of the country not supported by the ISMEA operation2 (P162042). The GoS was among the first in the Africa region to begin its national COVID-19 vaccination program in February 2021. However, unlike other countries in the region, the MoHSA opted to integrate COVID-19 vaccinations in the essential immunization program instead of conducting, in parallel, mass COVID-19 vaccination campaigns to avoid fragmentation and verticalization of the program as well as to avoid sustainability issues due to insufficient financing and human resources to cover COVID-19 vaccinations. At this stage of the pandemic, an integrated approach to COVID-19 response is particularly important to increase uptake of COVID-19 vaccines, particularly among the most vulnerable population groups. 8. Moreover, the COVID-19 pandemic led to a decline or stagnation in several key health indicators such as the rate of adequate coverage of antenatal care (ANCs),3 rate of women attending at least four ANCs,4 the percentage of newborns having benefitedÌ? from immediate care packages at birth,5 percentage of women with access to modern contraception,6 the consultation of ill mothers, newborns, children, adolescents including the malnourished, and deworming services. It also caused, as in many countries, a decline in routine immunization such as an 11.0 percent drop in poliovirus type 3 (89 percent coverage in 2 The ISMEA operation (P162042) is being implemented in 6 priority regions out of 14: Kédougou, Kolda, Kaffrine, Tambacounda, Sédhiou, and Ziguinchor. 3 The rate of adequate ANC coverage fell from 40 percent in 2020 to 32 percent in 2022 (Senegal DHIS2) with an expected target of 77.2 percent by the end of 2022. 4 The rate of women attending at least four ANCs stagnated with a rate of 65.4 percent in 2020 to 63.6 percent in 2021 and 65 percent in 2022. The expected target was 84.0 percent by the end of 2022. 5 The percentage of newborns to receive an immediate care package at birth has had minimal increases with 83 percent in 2020, 89 percent in 2021 and 90 percent in 2022 with an expected target of 100 percent to have been reached by the end of 2022. 6 The modern contraception rate among 15-49 is at 25.5 percent with an expected target of 45.0 percent to have been reached by the end of 2022. Apr 07, 2023 Page 5 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) 2019 to 78 percent coverage in 2021).7 Disruptions in EHS are a precursor to a reduction in the use of health services by the population, which are associated with an increase in maternal and child mortality. In addition, hospital services and ambulatory consultations across the country were particularly affected by the pandemic. The West Africa Ebola epidemic in 2014 had similar effects on maternal and child health with impacts on EHS beyond the initial outbreak.8 Some of the main constraints observed that led to these consequences include: (i) inadequate training of providers and community actors on co-delivery of COVID- 19 vaccinations with other EHS at the service level; (ii) the shortage of essential medicines, products and routine vaccines in health facilities; (ii) the lack of preparation of health staff to manage patients who had COVID-19 using appropriate protective measures; (iii) insufficient information on the measures health facilities took to reduce COVID-19 cases, which led to the delay in patients seeking care due to fear of contracting COVID-19; and (iv) spreading of false rumors about COVID-19 and the vaccines, which increased vaccine hesitancy and may have led to less patients seeking out health services. Therefore, continued World Bank engagement is essential to enable a sustained and comprehensive response to health emergencies in Senegal in two main areas: (i) better integration of COVID-19 vaccines within the broader adult immunization programs as well as part of the EHS package of services, which would allow quicker roll-out and uptake of pandemic treatments/vaccines in the future since the infrastructure will be present and (ii) measures to address the COVID-19 impacts on other EHS by accelerating the achievement of targets set for key indicators impacted by the COVID-19 pandemic and ensure better resilience for future waves of COVID-19 or health emergencies. The total World Bank support to the Senegal COVID-19 health sector response to date is US$162.5 million equivalent: (i) US$154.0 million of the COVID-19 response project approved under the MPA COVID-19 SPRP Phases I and II; (ii) US$7.0 million from the REDISSE I project (P154807) and US$ 1.5 million from Pandemic Emergency Facility (PEF). AF2 will complement the activities under the parent project and AF1 with the support of the GFF with a US$15.0 million grant to integrate EHS delivery to ensure preparedness and resilience for emergencies. C. Proposed Development Objective(s) Original PDO To prevent, detect and respond to the COVID-19 disease outbreak in Senegal. Current PDO To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Senegal. Key Results 9. Project indicators are being revised to better measure progress towards the PDO and to address some of the changes at the MoHSA-level as it relates to indicators that are no longer being tracked. Two PDO sub-indicators are being dropped, one intermediate-level indicator is being revised to increase the final target and one intermediate-level indicator’s date of achievement is being revised. Additional project 7 WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), 2023 8WBG. (2023). Collapse and Recovery: How the COVID-19 pandemic eroded human capital and what to do about it. Retrieved at: https://openknowledge.worldbank.org/server/api/core/bitstreams/6fb17cf5-1fad-4147-b7bb-691f63c29541/content Apr 07, 2023 Page 6 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) indicators are also being added to measure the overall progress towards the PDO with the new investments. Seven new intermediate indicators are being proposed (see Table 1 for more information). Table 1: Summary of changes to the PDO and Intermediate Results Indicators under AF2 Indicator Level Status Rationale/ Comments The GoS did not track the percentage of females that are receiving the initial series of COVID-19 vaccines. However, Population vaccinated; females 1 PDO sub-indicator Dropped the GoS continues to track the (Percentage) percentage of females vaccinated in the priority group, which is also being monitored by this project. The GoS is no longer tracking the percentage of females with co- Percentage of population morbidities that are part of the priority vaccinated, which is included in group. However, the GoS continues to the priority population targets track the percentage of females 2 PDO sub-indicator Dropped defined in national plan; Females vaccinated within this population group with co-morbidities vaccinated as well as the percentage of females that (Percentage) are healthcare workers vaccinated in the priority group, which are both also being monitored by this project. The date of the end target was revised as Number of meetings held by the Intermediate/ 3 Revised CNGE meetings are continuing on a platform Component 3 monthly basis. This indicator is being introduced to measure progress in access to EHS. ANCs Percentage of women attending at Intermediate/ 4 New stayed stagnant during the COVID-19 least 4 ANCs Subcomponent 1.2 pandemic, which has repercussions on maternal and newborn health. This is a corporate indicator, which will Number of people who have allow the quantification of direct Intermediate/ 5 received essential health, nutrition, New beneficiaries including number of Subcomponent 1.2 and population (HNP) services patients accessing essential health, nutrition, and population services. Intermediate sub- This is a sub-indicator to the corporate indicator/ indicator introduced to track the direct 6a Number of children immunized Subcomponent 1.2 New beneficiaries of routine immunizations. It will specifically track 0-11 months who are fully vaccinated. Number of women and children Intermediate sub- This is a sub-indicator to the corporate 6b who have received basic nutrition indicator/ New indicator introduced to track the direct services Subcomponent 1.2 beneficiaries of nutrition services. Intermediate sub- This is a sub-indicator to the corporate indicator/ indicator introduced to track the number Number of deliveries attended by 6c Subcomponent 1.2 New of pregnant women who seek care for skilled health personnel labor and delivery by a qualified healthcare personnel. Apr 07, 2023 Page 7 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) Intermediate/ This indicator is being introduced to Subcomponent 1.2 determine access to modern contraception to women and adolescent 7 Contraceptive prevalence rate New girls. Increases in this indicator would showcase improvements in the delivery to the last mile. Percentage of health facilities Intermediate/ This indicator will help to track stock-out reporting no stock-out of tracer Subcomponent 1.2 of essential medicines and vaccines in essential medicines and medical selected health facilities. 8 New products, including COVID-19 vaccinations, at the time of the health facility supervision visit Intermediate/ New This indicator will measure the number Subcomponent 1.2 of health personnel trained in integrated Number of health personnel EHS service delivery. This will include 9 trained sub-indicators that disaggregate between continuous professional development and long-term professional development. Intermediate/ New This indicator will measure the number Number of community actors Subcomponent 2.1 of community actors in the health sector 10 trained that have been trained in integrated EHS for community-level service delivery. Intermediate/ Revised This indicator is being revised to increase Number of TV, radio and social Subcomponent 2.2 the final target to accommodate AF2 11 media spots produced on COVID- financing for TV, radio and social media 19 spots that will be produced. Implementation of the third and Intermediate/ New This indicator will ensure improvements 12 fourth phases of the rapid Subcomponent 3.2 in the HMIS by ensuring data collection surveillance system and analysis of key EHS. D. Project Description A. Proposed Changes 10. The changes proposed for AF2 entail expanding the scope of activities in the parent project and AF1. The PDO for the proposed AF2 will be modified to align with the MPA PDO as follows: to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Senegal. New activities being proposed will be integrated in all three components and the Results Framework will be adjusted to reflect the expanded scope and new activities proposed under AF2 as well as some revisions due to MoHSA no longer collecting data for certain indicators. The implementation arrangements will also be revised to include other key agencies to support activities. The closing date will remain the same (December 31, 2025). (i) Proposed New Activities: Apr 07, 2023 Page 8 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) 11. Component 1 of the Global COVID-19 MPA (SPRP). Emergency COVID-19 Response (Original: US$16.5 million; AF1: US$129 million; AF2: US$9.2 million, GFF TF). This component will continue to provide immediate support to the country to strengthen pandemic preparedness and response. It will also support investments to bring EHS capacity to the level required to deliver COVID-19 vaccines efficiently and effectively at scale among other key EHS services to overcome some of the bottlenecks identified in ensuring integrated service delivery. Under this component, scale up of and inclusion of new interventions will be integrated under Sub-component 1.2 (Health System Strengthening). 12. Subcomponent 1.2: Health System Strengthening (Original: US$8 million; AF1: US$5 Million; AF2: US$9.2 million, GFF TF). This subcomponent will continue to support efforts to strengthen the public health system’s capacity to provide optimal medical care to patients at risk, measures for contingency planning, as well as to continue to maintain EHS and minimize risks for patients and health personnel by prioritizing eight regions9 that are not currently supported by a Bank-financed operation. This will include continued financing for: (i) medical supplies, products, and equipment for healthcare facilities; (ii) personal protective equipment (PPE) for health personnel engaged in patient case management; (iii) training of health personnel; and (iv) supervision activities at the health facility level. New activities that will be financed in this subcomponent are divided into three main thematic areas as follows: (i) strengthening the capacities of health personnel on co-delivery of COVID-19 treatment and vaccines, routine vaccines, and other EHS; (ii) strengthening integrated EHS services and supply chain management for delivery to the last mile; and (iii) support for digitalization. 13. Component 2: Community Engagement and Risk Communication (Original: US$2 million; AF1: US$3 million; AF2: US$4.1 million, GFF TF). Original activities will be maintained to ensure effective risk communication and community/citizen engagement to raise public awareness and knowledge on prevention and control of COVID-19 among the general population, including greater awareness about climate change risks and adaptation measures. 14. Subcomponent 2.1: Community Engagement for Prevention (Original: US$0.75 million; AF1: US$0.0 million; AF2: US$2.7 million, GFF TF). This sub-component will scale-up community-based disease surveillance and strengthen early warning networks for a robust emergency reporting and feedback system against notifiable diseases as well as strengthen resilience for integrated EHS delivery. New activities that will be financed include: (i) support for the coordination of activities and to build the capacity of community actors on integrated EHS; (ii) support to community actors with supplies, equipment and PPE; (iii) support for the implementation of integrated EHS and other community interventions; (iv) support for key activities that will enhance the motivation of community actors to deliver integrated EHS; and (v) support management and supervision activities at the community-level. 15. Subcomponent 2.2: Comprehensive Behavioral Change and Risk Communication ( Original: US$1.25 million; AF1: US$3 million; AF2: US$1.4 million). Communication activities will be scaled up to address the continued vaccine hesitancy as well as the decline in utilization of other EHS services. This will include continued financing of: (i) television and radio spots at the national and community levels to 9 The eight regions that will be prioritized are: Dakar, Diourbel, Fatick, Kaolack, Louga, Matam, Saint-Louis, and Thiès Apr 07, 2023 Page 9 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) increase awareness of COVID-19 treatment and vaccinations and (ii) capacity building for healthcare professionals to address gender-based violence (GBV) and sexual exploitation and abuse/ sexual harassment (SEA/ SH) concerns through psychosocial support. New activities that will be financed include: (i) update of an inclusive communication plan that also specifically targets vulnerable people such as women and adolescent girls and is adapted to sociocultural realities; (ii) strengthening social communication activities for integrated EHS including digital communication and risk communication; and (iii) television and radio spots at the national and community levels on integrated, high-quality EHS services. 16. Component 3: Project Management and Monitoring and Evaluation (M&E) (Original: US$1.5 million; AF1: US$2 million; AF2: US$1.7 million, GFF TF). This component will continue to support project management and M&E activities for prevention, preparedness, and response for health emergencies. The existing PCU will continue to be responsible for the overall administration, procurement, environmental and social aspects, FM, and M&E of project activities. New activities will be financed under Subcomponent 3.2: M&E (Original: US$0.5 million; AF1: US$0.5 million; AF2: US$1.7 million) to ensure proper monitoring of integrated EHS. (ii) Financing Arrangements 17. The increase in scope as outlined above will be reflected in an increase in indicative component allocations from US$154 million (equivalent) for the parent project and AF1 to US$169 million (equivalent) with AF2, with 61.3% allocated to Component 1, 27.3% to Component 2 and 11.3% to Component 3 (see Table 2 below). Table 2: Project Cost and Financing Parent AF1 Cost AF2 Cost Parent IDA Project (US$, (US$, Project + Financing Project Components Cost millions) millions) AF1 + AF2 (US$, (US$, GFF TF Cost (US$, millions) millions) millions) Component 1: Emergency COVID-19 Response 16.50 129.00 9.20 154.7 145.5 Subcomponent 1.1: Case Detection, Confirmation, 5.00 3.00 - 8.00 8.00 Contact Tracing, Recording, Reporting Subcomponent 1.2: Health System Strengthening 8.00 5.00 9.20 22.2 13.00 Subcomponent 1.3: Social and Financial Support to 3.50 0 - 3.50 3.50 Households [US$3.5 million]. Subcomponent 1.4: COVID-19 Vaccine Acquisition, - 119.00 - 119.00 119.00 Planning and Distribution Subcomponent 1.5: Pharmacovigilance and Patient - 2.00 - 2.00 2.00 Safety Component 2: Community Engagement and Risk 2.00 3.00 4.1 9.10 5.00 Communications Subcomponent 2.1: Community Engagement for 0.75 0 2.7 3.45 0.75 Prevention Subcomponent 2.2: Comprehensive Behavioral Change 1.25 3.00 1.4 5.65 4.25 and Risk Communication Component 3: Project Management and M&E 1.50 2.00 1.7 5.2 3.50 Subcomponent 3.1: Project Management 1.00 1.50 - 2.50 2.50 Apr 07, 2023 Page 10 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) Subcomponent 3.2: Monitoring and Evaluation (M&E) 0.50 0.50 1.7 2.7 1.00 Total Costs 20.00 134.00 15.00 169.00 154.00 . Legal Operational Policies Triggered? No Projects on International Waterways OP 7.50 No Projects in Disputed Areas OP 7.60 Summary of Assessment of Environmental and Social Risks and Impacts . The Environmental and Social risks are substantial mainly because of the risks linked to the management of biomedical waste (especially handling highly infectious medical wastes), occupational and community health and safety risks, and the lack of access to EHS for marginalized and vulnerable groups, which can lead to social tensions. Misinformation and rumors regarding COVID-19 and the COVID-19 vaccines as well as other routine vaccines continues and has brought up sentiments of institutional mistrust and the quality of health services. The AF2 will put measures in place to ensure these risks are reduced through a scale-up of community-based activities, including risk communication and social mobilization and community engagement to raise public awareness and knowledge among the general population and vulnerable groups. E. Implementation Institutional and Implementation Arrangements 18. The MoHSA will remain the implementing ministry of the proposed AF2. The SG of the MoHSA will continue to be responsible for the overall coordination and oversight of the implementation of the project and the MoHSA’s DAGE will continue to be the unit responsible for the FM and procurement functions of the project. The DGSP will continue to be responsible for the technical coordination of the project. The DP under the DGSP will continue to take the operational lead for the preparation, deployment, and monitoring of COVID-19 vaccines. The National Interagency Coordinating Committee for the EPI (Comité National de Coordination Inter Agence du Programme Elargi de Vaccination, CCIA) ensures the political validation of strategies and plans related to immunization. For activities proposed under AF2, a technical committee was established under the DGSP to closely monitor the activities and the Directorate of Maternal and Child Health (Direction de la Santé de la Mere et de l’ Enfant – DSME), in coordination with the medical regions, will provide the operational lead in the implementation of the activities. The PCU will continue to be responsible for the day-to-day management of the project by: (a) coordinating the project activities; (b) ensuring the proper fiduciary management of project activities in all components under oversight of the MoHSA’s DAGE; (c) preparing consolidated annual work plans, updating the Project Implementation Manual (PIM), Environmental and Social Framework (ESF) quarterly reports, budgets, and M&E; and (d) preparing the implementation report of the project to be submitted Apr 07, 2023 Page 11 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) to the Steering Committee and the World Bank Group (WBG). A Senior Procurement Specialist and Internal Auditor will be recruited to ensure adequate support for the implementation of AF2 activities as well as the remaining AF1 activities. 19. A Multisectoral Steering Committee will continue to assure the overall governance of the project, including the validation of plans and monitoring of project implementation. The Steering Committee is chaired by the MoHSA and include representatives from other ministries such as the Ministry of Livestock and Animal Protection, the Ministry of Agriculture and Rural Equipment, the Ministry of Environment and Sustainable Development, and the Ministry of Water and Sanitation. . CONTACT POINT World Bank Djibrilla Karamoko Senior Health Specialist Fatoumata Binta Maama Barry Health Specialist Moussa Dieng Senior Economist Borrower/Client/Recipient Ministry of Finances and Budget Implementing Agencies Ministry of Health and Social Action Marie Khemesse Ngom Ndiaye Minister of Health ndiayekhemesse@yahoo.fr Apr 07, 2023 Page 12 of 13 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) FOR MORE INFORMATION CONTACT The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects APPROVAL Djibrilla Karamoko Task Team Leader(s): Fatoumata Binta Maama Barry Moussa Dieng Approved By Practice Manager/Manager: Country Director: Luc Lecuit 23-Jun-2023 Apr 07, 2023 Page 13 of 13