The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) REPORT NO.: RES56988 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF REGIONAL DISEASE SURVEILLANCE SYSTEMS ENHANCEMENT (REDISSE) - PHASE I APPROVED ON JUNE 28, 2016 TO ECOWAS, REPUBLIC OF GUINEA, REPUBLIC OF SENEGAL, REPUBLIC OF SIERRA LEONE HEALTH, NUTRITION & POPULATION WESTERN AND CENTRAL AFRICA Regional Vice President: Ousmane Diagana Director of Regional Integration: Boutheina Guermazi Regional Director: Dena Ringold Practice Manager: Magnus Lindelow Task Team Leaders: Moussa Dieng, Andre L. Carletto, Djibrilla Karamoko, Yohana Dukhan, Zenab Konkobo Kouanda The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) ABBREVIATIONS AND ACRONYMS AF Additional Financing AF2 Second Additional Financing DHSE Directorate of Health Security and Emergencies ECOWAS Economic Community of West African States GRM Grievance Redress Mechanism ICU Intensive Care Unit IDA International Development Association ISR Implementation Status and Results Report JEE Joint External Evaluation MDTF Multi-Donor Trust Fund MoHS Ministry of Health and Sanitation PDO Project Development Objective REDISSE Regional Disease Surveillance Systems Enhancement WB World Bank The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) BASIC DATA Product Information Project ID Financing Instrument P154807 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 28-Jun-2016 31-Aug-2023 Organizations Borrower Responsible Agency ECOWAS,Republic of Guinea,Republic of Senegal,Republic of Sierra Leone Project Development Objective (PDO) Original PDO The objectives of the Project are: (i) to strengthen national and regional cross-sectoral capacity for collaborative disease surveillance and epidemic preparedness in West Africa, thereby addressing systemic weaknesses within the animal and human health systems that hinder effective disease surveillance and response; and (ii) in the event of an Eligible Emergency, to provide immediate and effective response to said Eligible Emergency. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-72270 06-Dec-2022 30-Dec-2022 28-Feb-2023 31-Aug-2023 7.00 0 7.88 IDA-E1330 06-Dec-2022 03-Jan-2023 22-Feb-2023 31-Aug-2023 5.00 0 5.40 IDA-58820 28-Jun-2016 04-Aug-2016 02-Dec-2016 30-Jun-2023 20.00 18.99 .67 IDA-58830 28-Jun-2016 23-Aug-2016 23-Jan-2017 31-Aug-2023 20.00 19.30 .41 IDA-58840 28-Jun-2016 31-Aug-2016 16-Dec-2016 31-Aug-2023 30.00 28.04 1.55 IDA-D1290 28-Jun-2016 04-Aug-2016 02-Dec-2016 30-Jun-2023 10.00 8.68 1.16 The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) IDA-D1300 28-Jun-2016 23-Aug-2016 23-Jan-2017 31-Aug-2023 10.00 9.40 .44 IDA-D1310 28-Jun-2016 28-Oct-2016 27-Jan-2017 31-Aug-2023 20.00 19.34 .48 TF-B1239 01-Oct-2019 21-Jan-2020 17-Mar-2020 31-Aug-2023 8.96 4.79 4.17 TF-A2534 28-Jun-2016 28-Oct-2016 27-Jan-2017 31-Aug-2023 4.06 3.84 .23 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. BACKGROUND 1. The Regional Disease Surveillance Systems Enhancement (REDISSE) - Phase I Project was approved by the World Bank (WB) Board of Executive Directors on June 28, 2016 for US$114.06 million. This amount includes International Development Association (IDA) Credits, IDA Grants, and a Grant from the Multi-Donor Trust Fund (MDTF) from the Department of Foreign Affairs, Trade, and Development in Canada to three countries and the Economic Community of West African States (ECOWAS) through its specialized institution, the West African Health Organization (WAHO): Republic of Guinea (US$20 million IDA Credit and US$10 million IDA Grant); Republic of Senegal (US$30 million IDA Credit); Republic of Sierra Leone (US$20 million IDA Credit and US$10 million IDA Grant); and WAHO (US$20 million IDA Grant and US$4.06 million MDTF). In November 2019, an MDTF first Additional Financing (AF) in the amount of US$8.96 million to WAHO was approved and a second Additional Financing (AF2) in the total amount of US$12.0 million (US$5.0 to WAHO and US$7.0 to Senegal) was also approved in December 2022 with an extension of the Project closing date to August 31, 2023 for Senegal, Guinea, and WAHO and June 30, 2023 for Sierra Leone. In Sierra Leone, the Project became effective on December 16, 2016. This Restructuring Paper seeks approval to carry out a Level 2 restructuring to cancel funds from the IDA Credit and Grant in Sierra Leone and formalize the reallocation of funds between disbursement categories. 2. The REDISSE Program is an interdependent Series of Projects to strengthen national, regional, and multisectoral capacity for integrated disease surveillance and response in West and Central Africa. The REDISSE Program was developed jointly by the Health, Nutrition, and Population and the Agriculture Global Practices under the One Health approach to ensure that the human-animal-environment interface is addressed in strengthening regional and country-specific disease surveillance systems. Overall, the REDISSE Program supports regional institutions such as the WAHO and the Economic Community of Central African States, and 16 countries in West and Central Africa including Guinea, Senegal, Sierra Leone (REDISSE Phase I); Guinea-Bissau, Liberia, Togo, Nigeria (REDISSE Phase II); Benin, Niger, Mali, Mauritania (REDISSE Phase III); and Angola, Chad, Central African Republic, the Democratic The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) Republic of Congo, and the Republic of Congo (REDISSE Phase IV). The REDISSE Program has five components: (i) surveillance and information systems; (ii) strengthened laboratory capacity; (iii) health emergencies preparedness and rapid response; (iv) workforce training, deployment and retention, and (v) institutional capacity building for project management, coordination and advocacy. B. PROJECT STATUS 3. After six years of implementation, REDISSE Phase I has strengthened health preparedness, response capacities, and disease surveillance across sectors in the Participating Countries and strengthened regional level collaboration and facilitated knowledge and resource sharing between Participating Countries and regional institutions. To date, 83.2 percent of the total financing of the Project has been disbursed (85.01 percent of IDA resources and 66.27 percent of the MDTF funds): 95.67 percent in Guinea, 75.78 percent in Senegal, 89.6 percent in Sierra Leone, and 73.57 percent in WAHO. 4. The overall progress towards the achievement of the Project Development Objective (PDO) and the implementation progress have been rated Satisfactory in the last Implementation Status and Results Report (ISR), dated January 2023. During the last reporting period, progress measured by PDO indicators varied among the Participating Countries — in Guinea, only one of five PDO indicators has been achieved; in Senegal, three out the five PDO indicators have been met; and in Sierra Leone, two out the five PDO indicators have been met. Three out of the six regional aggregate indicators have been met. It is noteworthy to mention that countries are in the process of finalizing their self-assessment of Joint External Evaluation (JEE) indicators, and an update to the indicators and an increase in some of their performances are expected soon. Despite the program’s inherent focus on disease surveillance and health emergency preparedness and response in the region, in most Participating Countries of all REDISSE phases, the program experienced implementation delays due to the impact of the COVID-19 pandemic including the burden on health service delivery and public health systems across Participating Countries, and the competing and multilayered priorities that resulted from the crisis. 5. Nonetheless, project activities have laid the groundwork for more robust disease surveillance and response systems in the Participating Countries prior to the pandemic, which enabled them to quickly respond to several outbreaks that emerged during the project’s lifetime, including COVID-19. The impact of the Project in strengthening disease surveillance and response systems had positive roll-over externalities on the Participating Countries, resulting in an early and robust response against COVID-19. In addition, the Project was at the forefront of Participating Countries’ responses and allowed a rapid mobilization of funds to address the countries’ initial prevention and response activities. REDISSE Phase I reallocated US$25.28 million of its funds to support the countries’ response against COVID-19, in line with its objective of responding to eligible health emergencies. 6. At regional level, ECOWAS/WAHO has been implementing region-wide activities to support Member States technical and operational capacities, while also coordinating cross-border and knowledge sharing activities. Among the activities that have been more heavily supported from a regional standpoint are: (i) health information systems strengthening across the West African region; (ii) training of human, animal, and environmental health professionals The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) from different countries at a Master’s degree level; (iii) the provision of technical assistance to Member States in the development of their National Action Plans for Health Security; (iv) training of country health professionals on the implementation of the new version of the Integrated Diseases Surveillance Systems modules, with the support of the World Health Organization; and (v) support and supervision of the implementation of the One Health approach through country-specific and regional One Health platforms. 7. Financial Management (FM) and Procurement have consistently been rated as Satisfactory. Despite minor FM shortcomings, there are no major issues that would prevent the timely and reliable provision of information and fiduciary systems required to manage and monitor the implementation of the project. Similarly, procurement related activities are being implemented optimally in all Participating Countries and agreed procurement arrangements remain in place. However, there is a need for continued support to ensure that procurement processes are expedited as the Project’s closing date approaches, particularly, when it relates to updating and presenting the procurement activities’ documentation, that will ensure all post-review processes are performed by the WB. 8. The overall Environmental and Social Safeguards (E&S) performance is rated Moderately Satisfactory. All Participating Countries are implementing E&S requirements in compliance with E&S instruments developed. All three participating countries have Grievance Redress Mechanisms (GRM) in place, albeit with varying degrees of functionality. Since the inception of the Project, no occupational health and safety incidents have been reported. 9. In November 2019, the Project underwent a Level 2 Restructuring concurrently with the MDTF first Additional Financing to (i) address weaknesses in the results framework by adjusting baseline and target values to reflect baseline JEE results; (ii) remove indicators not needed for an effective Project monitoring; and (iii) add indicators to monitor gender disparities in access to training opportunities. This process also included an AF in the amount of US$8.96 million (TF0B1239) for the benefit of ECOWAS/WAHO. This AF became effective on March 17, 2020, and contracts were signed with the Centre for International Cooperation in Health and Development and Fondation Mérieux (Merieux Foundation), on March 4, 2020, and March 6, 2020, respectively, to implement the next phase of WAHO’s implementation. 10. An AF2 in the amount of US$12.00 million (IDA grant US$5.00 million for WAHO, and IDA Credit US$7.00 million for Senegal) was approved by the WB’s Board of Executive Directors on December 6, 2022and included the extension of the closing date for REDISSE I as follows: (i) Senegal (No. 5884-SN), Guinea (No. 5883-GN and No. D1300) and ECOWAS (No. D1310) from January 31, 2023, to August 31, 2023; and (ii) Sierra Leone (No. 5882-SL and No. D1290-SL) to June 30, 2023. Given the delays in Project implementation and activity completion due to the COVID-19 pandemic, this extension of closing date has allowed for the completion of the overall pending activities and the full utilization of the remaining undisbursed amount of the parent Project as well as the AF. C. PROJECT PERFORMANCE AND RATIONALE FOR RESTRUCTURING — SIERRA LEONE Project Performance in Sierra Leone The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) 11. In Sierra Leone, the Project has made good implementation progress under the leadership of the Ministry of Health and Sanitation (MoHS) and implemented by the Directorate of Health Security and Emergencies (DHSE). Of the five PDO indicators, two have been met, two have not met their target but have presented positive trends, and one has not been measured (“Multi-hazard national public health emergency preparedness and response is developed and implemented”). Out of the nineteen intermediate results indicators, eleven have been met, seven have not reached their targets, and one has not been measured (“Efficient reporting to WHO, OIE/FAO”). Due to the evolution of the JEE tool and methodology, the two indicators could not be measured, but after technical discussions and assessing the changes to the tool, the new way to measure the indicators in line with the Project’s design was identified. Therefore, given the upcoming closing date of the Project a new version of the Results Framework will be included as part of the country-specific inputs to the next and final regional ISR. Recent achievements in Sierra Leone across each component are provided below: a. Component 1: Surveillance and Information Systems. The Project has supported animal surveillance through the training of Community Animal Health Workers, the implementation of the antimicrobial resistance strategic plan, support to the central call lines for community surveillance and early warning systems, established and strengthen Points of Entry (PoE) for cross-border surveillance in the seven border districts, and supported the operational activities of district-level surveillance teams (both for human and animal health). b. Component 2: Strengthening of Laboratory Capacity. Recently, the Project has supported the upgrade of the software for the national laboratory logistics and inventory management software system, the procurement and installation of water pumping machines for the national animal health laboratory, the training of laboratory managers in quality assurance and management, the development of nineteen standard operation procedures for sample referral and specimen processing, procured laboratory reagents, equipment, and consumables, and supported veterinary laboratory facilities. More recently, the Project supported the solarization of laboratories and the rehabilitation of cold rooms at the National Reference Public Health Laboratory and regional laboratories. c. Component 3: Preparedness and Emergency Response. Major activities completed under this component include the development of multisectoral simulation exercises, established the national and district Emergency Operation Centers (EOCs), upgraded the national software for the coordination of the EOCs, provided training to rapid response teams and EOC personnel, and provided support for the development of specific public health hazard management plans. By the end of the Project, it is expected that the Project will also support the procurement of rabies vaccines and the deployment of Ministry of Agriculture staff for a livestock b-anthrax vaccination campaign. d. Component 4: Human Resource Management for Effective Disease Surveillance and Epidemic Preparedness. The Project has supported the training of One Health risk communication personnel and popularized the One Health risk communication strategy, provided funds for the mapping and assessment of health workforce needs, especially on field epidemiology, and supported the training of veterinarians at a doctorate level. As part of the final activities, the Project supported DHSE in the popularization and training at district level on the new Public Health Act and the establishment of the National Public Health Agency. e. Component 5: Institutional Capacity Building, Project Management, Coordination, and Advocacy. Sierra Leone has a functional One Health platform supported under the Project. Additionally, this component has supported The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) the operationalization of the One Health committees and other technical working groups. More recently, the Project has supported the initial steps of the establishment of the National Public Health Agency. Rationale For Restructuring — Sierra Leone 12. By early 2023, in light of the impossibility to complete civil works before the Project closing, the MoHS conducted a prioritization exercise to identify new activities to be financed with the remaining funds. Among such activities, US$1.17 million was allocated to purchasing of equipment for the Intensive Care Unit (ICU) of Connaught Hospital in Freetown. Despite multiple efforts from the MoHS and the Integrated Health Projects Administration Unit, the project implementation unit, to identify different pathways to expedite the purchase and delivery, the procurement process could not be finalized before Project closing. Therefore, given the limitations and challenges and the high risk of becoming an ineligible expenditure, the activity was eventually cancelled in May 2023. 13. Given the uncommitted balance of US$1.17 million that was released after the procurement of ICU equipment for Connaught Hospital was dropped, and the impossibility of using these funds before the Project’s closing date on June 30, the Ministry of Finance (MoF) requested, in a letter received by the WB on June 12, 2023 (reference MF-MPD 301/147/04), the cancellation of the unused funds and their recommitment to the country’s national portfolio budget allocation. The request includes (i) a cancellation of a total of SDR 922,218.69 (equivalent to US$1,232,144.24) – divided as follows: 67 percent from the IDA Credit 58820-SL and 33 percent from the IDA Grant D1290-SL; and (ii) a recommitment of the proceeds to the country portfolio to address the constraint of financing the operations in the pipeline of the IDA-20 cycle. II. DESCRIPTION OF PROPOSED CHANGES 14. This Level 2 restructuring proposes to formalize the cancellation and reallocation of funds for the Sierra Leone Credit and Gran consistent with the Investment Project Financing Procedures. a. Reallocation between disbursement categories: Cancellation of a total of SDR 922,218.69 as follows: (i) SDR 617,886.52 from Category 2 of IDA Credit 58820-SL; and (ii) SDR 304,332.17 from Category 2 of IDA Grant D1290- SL. Subsequently, the allocations under Category 2 will be reduced, while the allocations under Categories 1 and 3 will remain unchanged (See Table 1 for additional details): TABLE 1: CANCELLATION AND REALLOCATION OF FUNDS PER DISBURSEMENT CATEGORY Category Amount of the Credit Amount of the Grant IDA- IDA-58820 Allocated D1290 allocated (expressed in SDR) (Expressed in SDR) 1 Goods, non-consulting services, consultants’ services, training, and Operational Costs under Parts 1, 2.2, 2.3 12,900,000.00 6,500,000.00 (i), 3.1 (i), 3.2 (i) and (iii), 4 and 5.1 of the Project The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) 2 Goods and Works under Part 2.1 of the Project 682,113.48 295,667.83 3 Emergency Expenditures under Part 3.3 of the Project - - Amount cancelled on June 12, 2023 617,886.52 304,332.17 Original total amount 14,200,000.00 7,100,000.00 b. Changes in Costs of Components: Given the above mentioned cancellation, changes in the components will be processed through this Restructuring. Namely, the cancellation to the Credit and Grant will reduce the total envelope of Sub-Component 2.1. See Table 2 for additional details. Revised Amount Original Amount (post-cancellation) (US$ million) (US$ million) Component 1: Surveillance and Information Systems 5.33 5.33 Sub-Component 1.1 Support coordinated community-level surveillance 1.07 1.07 systems and processes across the animal and human health sector Sub-Component 1.2 Develop capacity for interoperable surveillance and 1.19 1.19 reporting systems Sub-Component 1.3 Establish an early warning system for infectious 3.07 3.07 disease trends prediction Component 2: Strengthening of Laboratory Capacity 2.48 1.25 Sub-Component 2.1 Review, upgrade and network laboratory facilities 2.0 0.77 Sub-Component 2.2 Improve data management and specimen 0.36 0.36 management Sub-Component 2.3 Enhance regional reference laboratory networking 0.12 0.12 functions Component 3: Preparedness and Emergency Response 13.93 13.93 Sub-Component 3.1 Enhance cross-sectoral coordination and 1.77 1.77 collaboration for preparedness and response Sub-Component 3.2 Strengthen capacity for emergency response 12.16 12.16 Sub-Component 3.3 Contingency emergency response 0.00 0.00 Component 4: Human Resources Management for Effective Disease 5.16 5.16 Surveillance and Epidemic Preparedness Sub-Component 4.1 Healthcare Workforce mapping, planning and 0.90 0.90 recruitment. Sub-Component 4.2 Enhance health workforce Training, Motivation and 4.26 4.26 Retention Component 5: Institutional Capacity Building, Project Management, 3.1 3.1 Coordination and Advocacy Sub-component 5.1 Project coordination, fiduciary management, monitoring and evaluation, data generation, and knowledge 1.54 1.54 management Sub-component 5.2 Institutional support, capacity building, advocacy, and 1.56 1.56 communication TOTAL 30.00 28.77 The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) III. SUMMARY OF CHANGES Changed Not Changed Components and Cost ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ Results Framework ✔ Loan Closing Date(s) ✔ Disbursements Arrangements ✔ Disbursement Estimates ✔ Overall Risk Rating ✔ The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_COMPONENTS_TABLE COMPONENTS Current Current Proposed Proposed Cost Action Component Name Component Name Cost (US$M) (US$M) Component 1: Surveillance and Component 1: Surveillance and 36.98 No Change 36.98 Information Systems Information Systems Component 2: Strengthening of Component 2: Strengthening 17.03 Revised 15.80 Laboratory Capacity of Laboratory Capacity Component 3: Preparedness and Component 3: Preparedness 25.96 No Change 25.96 Emergency Response and Emergency Response Component 4: Human Resource Component 4: Human Management for Effective Resource Management for 14.10 No Change 14.10 Disease Surveillance and Effective Disease Surveillance Epidemic Preparedness. and Epidemic Preparedness. Component 5: Institutional Component 5: Institutional Capacity Building, Project Capacity Building, Project 29.06 No Change 29.06 Management, Coordination, and Management, Coordination, Advocacy and Advocacy TOTAL 123.13 121.90 The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) OPS_DETAILEDCHANGES_CANCELLATIONS_TABLE CANCELLATIONS Value Reason Current Cancellation New Ln/Cr/Tf Status Currency Date of for Amount Amount Amount Cancellation Cancellation BORROWER' Disburs S REQUEST IDA-58820- ing&Re XDR 14,200,000.00 617,886.52 12-Jun-2023 13,582,113.48 FOR 001 paying COUNTRY REASONS Disburs IDA-58830- ing&Re XDR 14,200,000.00 0.00 14,200,000.00 001 paying Disburs IDA-58840- ing&Re EUR 26,400,000.00 0.00 26,400,000.00 001 paying IDA-72270- Effectiv EUR 7,200,000.00 0.00 7,200,000.00 001 e BORROWER' S REQUEST IDA-D1290- Disburs XDR 7,100,000.00 304,332.17 12-Jun-2023 6,795,667.83 FOR 001 ing COUNTRY REASONS IDA-D1300- Disburs XDR 7,100,000.00 0.00 7,100,000.00 001 ing IDA-D1310- Disburs XDR 14,200,000.00 0.00 14,200,000.00 001 ing IDA-E1330- Effectiv XDR 4,000,000.00 0.00 4,000,000.00 001 e TF-A2534- Disburs USD 4,064,168.00 0.00 4,064,168.00 001 ing TF-B1239- Disburs USD 8,960,731.00 0.00 8,960,731.00 001 ing OPS_DETAILEDCHANGES_REALLOCATION _TABLE REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Financing % Current Allocation Actuals + Committed Proposed Allocation (Type Total) Current Proposed IDA-58820-001 | Currency: XDR iLap Category Sequence No: 1 Current Expenditure Category: GD,NCS,NC,TR,OC 1,2.2,2.3,3.2,4,5.1 The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) 12,900,000.00 12,792,366.87 12,900,000.00 67.00 67.00 iLap Category Sequence No: 2 Current Expenditure Category: GDS and WKS part 2.1 1,300,000.00 0.00 682,113.48 67.00 67.00 iLap Category Sequence No: 3 Current Expenditure Category: Emergency expenditures part 3.3 0.00 0.00 0.00 0.00 0.00 Total 14,200,000.00 12,792,366.87 13,582,113.48 IDA-D1290-001 | Currency: XDR iLap Category Sequence No: 1 Current Expenditure Category: GD,NCS,NC,TR,OC 1,2.2,2.3,3.2,4,5.1 6,500,000.00 5,819,302.19 6,500,000.00 33.00 33.00 iLap Category Sequence No: 2 Current Expenditure Category: GDS and WKS part 2.1 600,000.00 0.00 295,667.83 33.00 33.00 iLap Category Sequence No: 3 Current Expenditure Category: Emergency expenditures part 3.3 0.00 0.00 0.00 100.00 100.00 Total 7,100,000.00 5,819,302.19 6,795,667.83 .