The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) Rwanda COVID-19 Emergency Response Project (P173855) EASTERN AND SOUTHERN AFRICA | Rwanda | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 6 | ARCHIVED on 29-Jun-2023 | ISR56339 | Implementing Agencies: Ministry of Finance and Economic Planning (MINECOFIN), Ministry of Health (MoH) / Rwanda Biomedical Center (RBC) Key Dates Key Project Dates Bank Approval Date: 07-Apr-2020 Effectiveness Date: 20-Apr-2020 Planned Mid Term Review Date: 30-Sep-2022 Actual Mid-Term Review Date: 31-May-2022 Original Closing Date: 30-Jun-2022 Revised Closing Date: 30-Jun-2025 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The objective of the Project is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in the Republic of Rwanda. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1. Case Detection, Confirmation and Contact Tracing:(Cost $6840000.00 M) Component 2: Public Health Measures and Clinical Care Capacity:(Cost $69250000.00 M) Component 3. Implementation Management and Monitoring and Evaluation:(Cost $1100000.00 M) Component 4. Contingency Emergency Response Component (CERC) Component 5. Protecting Essential Health Services:(Cost $15000000.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions The Rwanda COVID 19 Emergency Response Project has been under implementation for 35 months with steady progress towards achieving the Project Development Objective. The project continues to be effectively implemented through an experienced implementation unit which has a solid track record working with the World Bank.  6/29/2023 Page 1 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) MPA Program Development Objective MPA PDO Table The Program Development Objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness MPA Table Multiphase Programmatic Approach (MPA) Status MPA Table Body Sustained efforts continue to be made to advance the implementation of the 87 MPA operations. As of June 15, 2023, 88 MPA-projects have 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. Total disbursements as of June 15, 2023, amount to US$3.89 billion or 91% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. A large refund from the UN to the project account of the Myanmar operation was processed in late March due to the inability to implement the project. This transaction affected total disbursements. Also, (i) Loans and Credits denominated in SDRs and Euros are being affected because of fluctuations between the SDRs and Euros against the US dollar, and (ii) at this late stage of project implementation, several operations are processing refunds to the special/project accounts, which have an impact on total disbursements. Thirteen operations closed by the end of CY22. Thirty five operations have closing dates by the end of CY23. However, there are several projects that are/will be processing extensions so this number is likely to change. As with the Mid Term Review issued on March 25, 2023, no individual COVID-19 MPA operation will have to complete an ICR. Instead, one ICR will be prepared for the entire COVID-19 MPA Program after the closing date of the Program -- December 31, 2025. This Global ICR will be based on final ISRs packages prepared by country operations’ teams. A template for the final ISR was issued by OPCS on March 25, 2022. Several operations have/are preparing final ISR packages. The overall conclusion of the MTR was that the COVID-19 MPA Program embodied a rapid, innovative approach to new lending for human health response. The MTR concluded that the COVID-19 MPA has been successful, notwithstanding considerable uncertainty and multiple constraints in the early stages of the pandemic. The Bank’s emergency response was remarkably swift in the most vulnerable countries facing human capital losses and development setbacks. Further, the MTR concluded that notwithstanding the challenges, the MPA is on track to achieve its PrDO, “prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness.“ Seventy one (71) country projects or 83 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 71 operations, 59 operations or 83% have disbursed 90+% of commitments. Out of the 71 operations, 38 operations are fully disbursed and sixteen (16) operations have disbursed 95-99% of commitments. As reported in mid-April, 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 do not have a parent project have AF-V operations. Eighty-six (86) or 99% of projects approved are disbursing. ECA has the highest percentage of disbursements at 99%, followed by MNA with 96%, SAR with 94%, LAC with 92%, EAP with 85%, AFE and AFW with 78%. Disbursements for EAP operations are being affected by relatively low disbursements in Fiji, Kiribati, Samoa, and Solomon Islands. AFE lower disbursements compared to other regions are a result of low disbursements under two operations. In the case of AFW low overall disbursements are a result of no disbursements under one operation and only 30 percent under another. Retroactive Financing (RF) continues to represent 20 percent of commitments. SAR has the highest percentage of RF at 37 percent, followed by ECA at 18 percent. IDA continues to represent 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. 6/29/2023 Page 2 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) 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, 2020. The AF-V was approved with an envelope of US$12 billion ($6 billion from IDA and $6 billion from IBRD) in financing. 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. No additional AF-V operation has been approved since late October 2022. As of June 15, 2023, the Bank has approved 113 operations to support vaccine procurement and rollout in 78 countries. A new operation is being processed in Senegal. One hundred and sixteen (116) operations had been approved amounting to $10 billion, but: (i) the Costa Rica operation ($120 million), (ii) the Peru operation ($500 million), and the (iii) Gabon ($12 million) were cancelled at the request of the governments. Also, the Afghanistan operation commitment of $113 million was reduced to $60 million. Total commitment for the 113 operations is $9.19 billion. The 113 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 113 approved operations: (i) 63 are in Africa – 29 in AFE and 34 in AFW; (ii) 10 in East Asia and the Pacific; (iii) 11 in Europe and Central Asia; (iv) 11 in Latin America and the Caribbean; (v) 9 in Middle East and North Africa; and (vi) 9 in South Asia. Thirty-two operations are being implemented in Fragile and Conflict-affected situations. IDA continues to represent 43 percent and IBRD 57 percent of disbursements. Total disbursements under these projects as of June 15, 2023, amount to US$5.84 billion or 64 percent of overall commitments. Disbursements under MPA-V operations are included in this total while disbursements under the six restructured projects are counted under parent projects. With less than planned demand for IDA/IBRD funds for vaccine procurement because, inter alia, over supply of vaccines from donations from various sources, several projects are being and more will need to be restructured to reallocate funds allocated for procurement of COVID-19 vaccines and deployment. A Guidance Note has been prepared by HNP together with OPCS and other departments to seek approval by management for utilization of undisbursed funds. The Note will provide guidance to teams regarding the utilization of committed but unused funds under AF-V operations for the procurement of commodities, including routine vaccines. Thirty-six (36) AF-V/MPA-V operations or 32% of operations approved have disbursed over 70% of their commitments. Out of the 36, twelve operations or 33% have disbursed 90+. Out of the 12, three operations are fully disbursed (Argentina, Sri Lanka AF-V 1, and Ukraine AF-V 3). Five operations have disbursed 98-99% of commitments (Ecuador AF-V 1, Indonesia, Iraq, Sierra Leone AF-V 1, and Yemen). Seven operations have disbursed 95-99%. Ninety-one (91) operations or 81 percent of total operations approved are disbursing. ECA has the highest percentage of disbursements at 85%, followed by SAR at 77%, EAP at 72%, LAC at 69%, MNA at 65%, AFE at 52% and AFW at 48%. 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 thirteen (113) loan/financing agreements or 100 percent of projects approved have been signed. One hundred and twelve (112) loan/financing agreements or 99 percent of projects approved have become effective. As with the COVID-19 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 AF-V operations. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Low Low Low 6/29/2023 Page 3 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) Macroeconomic Substantial Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Fiduciary Substantial Moderate Moderate Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Moderate Moderate Results PDO Indicators by Objectives / Outcomes Prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems IN01296292 ►Proportion of suspected cases of COVID-19 reported and investigated based on national guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 100.00 100.00 100.00 Date 07-Apr-2020 24-Oct-2022 31-Mar-2023 30-Jun-2025 IN01296294 ►Number of designated laboratories with COVID-19 diagnostic capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 156.00 156.00 151.00 Date 07-Apr-2020 24-Oct-2022 31-Mar-2023 30-Jun-2025 The end target for this indicator was revised in accordance with the current testing strategy. At the start, COVID-19 test was done at NRL using PCR. Overtime, the number of PCR testing centers increased to 11. Later, with the availability of Rapid tests, 100 private health facilities countrywide and all public Comments: hospitals (8 referral hospitals, 8 provincial hospitals and 39 district hospitals were engaged to provide Rapid tests. IN01296296 ►Proportion of designated healthcare facilities with isolation capacity (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 100.00 100.00 100.00 Date 07-Apr-2020 24-Oct-2022 31-Mar-2023 30-Jun-2025 6/29/2023 Page 4 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) All 51 public hospitals have isolation capacity for at least 2 cases. Health centers and private health facilities does not have isolation capacity, however they may avail a holding room where they may keep an identified COVID-19 case before the referral. FY2020/2021: 400 (Q1 to Q4 and each Quarter: 100) Comments: FY2021/2022: 400 (Q1 to Q4 and each Quarter: 100) FY2022/2023: 100 (Q1) COVID-19 Vaccine Coverage IN01296293 ►Percentage of population 18 years and above receiving a booster, which is included in the population targets defined in the national plan, disaggregated by sex (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 42.00 46.00 56.00 Date 28-Feb-2022 24-Oct-2022 31-Mar-2023 30-Jun-2025 The vaccination objectives included administering a booster dose (third dose) to every person aged 18 years and above, and a second booster dose (fourth dose) to every person aged 50 and above and to every adult person (18 years and above) with known underlying health conditions. As of March 2023, 46% Comments: of the population (over 6 million people aged 18 years and above) have been reached with a booster dose, while over 600,000 individual (5% of the population) have received a second booster dose. IN01296295 ►Percentage of the population fully vaccinated which is included in the priority population targets as defined in the national plan disaggregated by sex, age group and location. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 67.00 77.00 86.00 Date 05-Feb-2021 24-Oct-2022 31-Mar-2023 30-Jun-2025 The vaccination coverage rate is calculated against the total population of the country (estimated at over 13 million in 2021). The government set a target to fully vaccinate (with two doses) over 11 million people (or 86% of the population) from 5 years and above by the end of December 2022. As of May 31, 2022, over 8.54 million people aged 12 years and above have been fully vaccinated. With respect to the Comments: targeted population of 11.25  million, the vaccination progress (implementation) rate is 76%. Although, it was possible to estimate 10% female and 11%. As of March 2023, 80% of the population (equivalent to 10.5 million people) have received at least one dose; including over 10 million people or 77% of the population who are fully vaccinated.  Male and female are equally reached with the vaccination. IN01296297 ►Number of doses of COVID-19 vaccine procured with Project funding (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,601,440.00 3,601,440.00 6,000,000.00 Date 29-Jan-2021 24-Oct-2022 31-Mar-2023 30-Jun-2025 So far, 3.6 million doses were procured through the second AF (fully delivered and deployed). The target will need to be adjusted to 36 million doses given that the country has got sufficient donations from other Comments: sources and could no longer use WB funding to purchase vaccines. Intermediate Results Indicators by Components 6/29/2023 Page 5 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) Component 1: Case Detection, Confirmation and Contact Tracing IN01296298 ►Number of laboratory staff trained to conduct COVID-19 diagnosis (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 192.00 192.00 50.00 Date 07-Apr-2020 24-Oct-2022 31-Mar-2023 30-Jun-2023 FY2020/21: Q1&Q2 (76); Q3&Q4 (34) Comments: FY2021/22: Q1&Q2 (19); Q3&Q4 (63) IN01296303 ►Percentage of grievances documented, processed and resolved within 30 days (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 20-Oct-2020 24-Oct-2022 31-Mar-2023 30-Jun-2025 RBC initiated the establishment of Grievance Redress Mechanism committees at decentralized levels. Currently, consultation meetings were done, presented to the project steering committee members and will be approved by end October 2022. In October 2022, the recruitment of Community Health Worker (CHW) Coordinators are in progress of establishment and is planned to be completed by December 2022. Comments: The CHW Coordinator is the core team of the Grievance Redress Committee (GRC). The proposed GRCs consists of Cell - CHW's based - Sector Health Committee - District Health Management - RBC -SPIU team. IN01296307 ►Total tests performed by the Government facilities, disaggregated by sex (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,634,311.00 3,634,311.00 0.00 Date 20-Oct-2020 24-Oct-2022 31-Mar-2023 30-Jun-2025 1,877,632 males and 1,756,679 females performed by the public health facilities out of the 5,430,216 tests Comments: performed as of September 2022 Time response to COVID-19 IN01296299 ►Proportion of targeted healthcare facilities with clinical capacity for COVID-19 patients (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 100.00 100.00 100.00 6/29/2023 Page 6 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) Date 07-Apr-2020 24-Oct-2022 31-Mar-2023 30-Jun-2023 All 55 public hospitals (8 referral hospitals, 8 provincial hospitals and 39 district hospitals) have established at least 2 rooms each for the management of COVID-19 cases Comments: FY2020/21: Q1-Q4 (400 or 100 per quarter) FY2021/22: Q1-Q4 (400 or 100 per quarter) IN01296304 ►Number of health staff trained in infection prevention and control (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 3,554.00 3,554.00 2,000.00 Date 07-Apr-2020 24-Oct-2022 31-Mar-2023 30-Jun-2023 COVID-19 Vaccine Knowledge, Acceptance, and Safety IN01296300 ►Number of mass media campaigns on COVID-19 prevention and vaccination (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 96.00 96.00 90.00 Date 05-Feb-2021 24-Oct-2022 31-Mar-2023 30-Jun-2023 IN01296309 ►Proportion of serious Adverse events following immunization (AEFI) reported and investigated, by sex (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 78.00 78.00 95.00 Date 05-Feb-2021 24-Oct-2022 31-Mar-2023 30-Jun-2025 According to table 6 of the AM, there were 641 AEFI cases reported, including 74 cases reported as severe, 23 moderate cases, and 409 minor cases. RBC has reported that 58 out of the 74 severe cases Comments: have been investigated Health System Strengthening IN01296301 ►Number of people screened for underlying chronic conditions, disaggregated sex and age group (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 617,283.00 1,978,569.00 300,000.00 Date 08-Mar-2021 24-Oct-2022 31-Mar-2023 30-Jun-2025 Female: 1,128,763 or 57 percent, Male: 849,806 or 43 percent; Diabetes: 11,267 for (1.8 percent), Comments: Hypertension: 76,314 6/29/2023 Page 7 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) IN01296305 ►Percentage of targeted hospitals with functioning oxygen therapy system (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 66.00 100.00 100.00 Date 08-Mar-2021 24-Oct-2022 31-Mar-2022 30-Jun-2023 The 1st batch of 22 hospitals completed. Comments: The 2nd batch of 10 hospital completed. 16 hospitals will complete by December 2022. Maintaining Essential Health Services during and beyond COVID-19 IN01296302 ►Number of outpatient consultations, disaggregated by age and sex (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 18,860,619.00 20,669,719.00 20,669,719.00 19,622,500.00 Date 24-Mar-2021 24-Oct-2022 31-Mar-2023 30-Jun-2025 The current reporting system disaggregate data by only two age groups: under five years old and above five years old. Data reported is for the FY21/22. A total of 8,616,514 males and 12,249,206 females of Comments: which 3,328,142 were under five years of age and 17,537,578 were over five years of age. IN01296306 ►Number of new acceptors of modern contraception (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 238,392.00 307,657.00 307,657.00 248,023.00 Date 24-Mar-2021 24-Oct-2022 31-Mar-2023 30-Jun-2023 Reported quarterly (Q1-Q4) FY2020/21: 283,635 Comments: FY2021/22:307657 IN01296308 ►Number of deliveries conducted within the facility (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 315,814.00 347,844.00 347,844.00 328,573.00 Date 24-Mar-2021 24-Oct-2022 31-Mar-2023 30-Jun-2023 Reporting annually - Q1-Q4 FY2020/21: 321,898 Comments: FY2021/22:347,844 IN01296310 ►Number of pregnant women receiving four antenatal care visits (Number, Custom) 6/29/2023 Page 8 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 175,057.00 175,057.00 190,280.00 Date 24-Mar-2021 24-Oct-2022 31-Mar-2023 30-Jun-2023 reporting annually: FY 2020/2021: 157,120 Comments: FY 2021/2022: 175,057 IN01296311 ►Number of infants receiving Pentavalent 3 vaccine (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 345,423.00 344,703.00 344,703.00 352,330.00 Date 24-Mar-2021 24-Oct-2022 31-Mar-2023 30-Jun-2023 Reporting Annually: (Q1-Q4) FY2020/21: 330,341 Comments: FY2021/22:344,703 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173855 IDA-66150 Closed USD 14.25 14.25 0.00 15.04 0.00 100% P173855 IDA-68710 Effective USD 15.00 15.00 0.00 14.84 0.05 100% P173855 IDA-70920 Effective USD 16.00 16.00 0.00 8.41 6.95 55% P173855 IDA-D8050 Effective USD 15.00 15.00 0.00 14.92 0.03 100% P173855 IDA-E0220 Effective USD 16.00 16.00 0.00 9.62 5.64 63% P173855 TF-B4324 Closed USD 0.94 0.93 0.01 0.93 0.00 100% P173855 TF-B6226 Effective USD 15.00 15.00 0.00 7.38 7.62 49% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173855 IDA-66150 Closed 07-Apr-2020 09-Apr-2020 20-Apr-2020 30-Jun-2022 30-Jun-2022 6/29/2023 Page 9 of 10 The World Bank Implementation Status & Results Report Rwanda COVID-19 Emergency Response Project (P173855) P173855 IDA-68710 Effective 16-Apr-2021 22-Apr-2021 21-Jun-2021 30-Jun-2023 30-Jun-2025 P173855 IDA-70920 Effective 31-Mar-2022 07-Apr-2022 06-Jun-2022 30-Jun-2025 30-Jun-2025 P173855 IDA-D8050 Effective 16-Apr-2021 22-Apr-2021 21-Jun-2021 30-Jun-2023 30-Jun-2025 P173855 IDA-E0220 Effective 31-Mar-2022 07-Apr-2022 06-Jun-2022 30-Jun-2025 30-Jun-2025 P173855 TF-B4324 Closed 30-Nov-2020 06-Dec-2020 06-Dec-2020 31-Jan-2021 28-Feb-2021 P173855 TF-B6226 Effective 02-Sep-2021 02-Sep-2021 02-Sep-2021 30-Jun-2023 30-Jun-2025 Cumulative Disbursements Restructuring History Level 2 Approved on 29-Jan-2021 ,Level 2 Approved on 14-Jun-2021 Related Project(s) P175252-Additional Financing for Rwanda COVID-19 Emergency Response Project ,P176304-Additional Financing to the COVID-19 Emergency Response Project ,P178282-Third Additional Financing Rwanda COVID-19 Emergency Response Project 6/29/2023 Page 10 of 10