The World Bank Republic of Congo COVID-19 Emergency Response Project (P173851) REPORT NO.: RES57150 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF REPUBLIC OF CONGO COVID-19 EMERGENCY RESPONSE PROJECT APPROVED ON APRIL 20, 2020 TO REPUBLIC OF CONGO HEALTH, NUTRITION & POPULATION WESTERN AND CENTRAL AFRICA Regional Vice President: Ousmane Diagana Country Director: Cheick Fantamady Kante Regional Director: Dena Ringold Practice Manager/Manager: Magnus Lindelow Task Team Leader: Lombe Kasonde The World Bank Republic of Congo COVID-19 Emergency Response Project (P173851) ABBREVIATIONS AND ACRONYMS AF Additional Financing AVAT Africa Vaccine Acquisition Trust AWPB Annual Work Plan and Budget MPA Multiphase programmatic approach PDO Project Development Objective PIU Project Implementation Unit RoC Republic of Congo SPRP Strategic Preparedness and Response Program The World Bank Republic of Congo COVID-19 Emergency Response Project (P173851) BASIC DATA Product Information Project ID Financing Instrument P173851 Investment Project Financing Environmental and Social Risk Classification (ESRC) Substantial Approval Date Current Closing Date 20-Apr-2020 30-Apr-2024 Organizations Borrower Responsible Agency Republic of Congo 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 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 The World Bank Republic of Congo COVID-19 Emergency Response Project (P173851) 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. OPS_TABLE_PDO_CURRENTPDO The World Bank Republic of Congo COVID-19 Emergency Response Project (P173851) Project Development Objective (PDO) Original PDO To prevent, detect, and respond to the threat posed by COVID-19 and strengthen the national system for public health preparedness in the Republic of Congo. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-71940 29-Jun-2022 20-Sep-2022 24-Jan-2023 30-Apr-2024 29.67 0 30.45 IDA-69530 02-Jun-2021 30-Jun-2021 27-Aug-2021 30-Apr-2024 12.00 4.44 7.01 IDA-66340 20-Apr-2020 24-Apr-2020 26-May-2020 30-Apr-2024 11.31 11.42 .44 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING 1. This Project Paper seeks approval to partially cancel funds from the third Additional Financing (AF3) to the Republic of Congo (RoC) COVID-19 Emergency Response Project (P173851) (IDA Credit 71940) in the amount of EUR 27.8 million (US$29.67 million equivalent). The Project was prepared 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 objective of the Project is to improve COVID-19 vaccine deployment and strengthen the health system to support pandemic preparedness and the COVID-19 response. The need for cancellation was formally conveyed by the Government of RoC in a letter dated June 29, 2023. 2. The Parent project, in the amount of US$11.31 million equivalent prepared under the SPRP, was approved on April 20, 2020, and became effective on May 26, 2020. The Parent project enabled the country to mount a rapid initial response and put in place public health control measures by implementing RoC’S Integrated National COVID-19 Preparedness and Response Plan. This was followed by a first AF (AF1) (P175805)2 in the 1The World Bank approved a US$12 billion Fast Track COVID-19 Facility (“the Facility”) 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 Bank”) and US$6 billion from the International Finance Corporation (IFC). The IFC subsequently increased its contribution to US$8 billion, bringing the Facility 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 health care delivery system. 2 The project paper can be found at: https://documents1.worldbank.org/curated/en/637721623329801754/pdf/Congo-Republic-of-COVID- The World Bank Republic of Congo COVID-19 Emergency Response Project (P173851) amount of US$12 million equivalent which was approved on June 2, 2021 and became effective on August 27, 2021. AF1 supported vaccine acquisition and deployment efforts and enabled the implementation of RoC’s National Deployment and Vaccination Plan (NDVP). A second AF (AF2), in the amount of US$3 million from the Health Emergency Preparedness and Response Trust Fund (P177008), was approved on March 23, 2022 and became effective June 28, 2022, with activities focusing on supporting the country’s preparedness for future health emergencies. A third AF (AF3) (P178126) in the amount of US$29.67 million was approved on June 29, 2022, and became effective on January 27, 2023. The objective of AF3 was to accelerate the deployment of available COVID-19 vaccines as despite high-level Government efforts, the vaccination rate has stagnated at around 11.3 percent of the population since June 2022. AF3 was also intended to expand infection prevention and control activities and implement the medical waste management plan, ensuring incinerators are appropriately built and managed. In addition, AF3 was expected to conduct a water, sanitation and hygiene evaluation to understand and fill gaps in the availability of water and electricity where needed and enhance care and treatment by expanding oxygen production capacity and securing additional ambulances. 3. The number of new cases has stabilized since the third quarter of 2022, with a positivity rate averaging 0.25 percent for a cumulative total of 25,202 infections. The overall case fatality rate from the first case identified in March 2020 to-date has been 1.5 percent, with the most recent weeks reporting no hospitalizations or deaths (Epidemiological Bulletin3 week 24, June 12-18, 2023). On October 18, 2022, the country’s National COVID-19 Coordination Team dissolved all coordination bodies set-up within the COVID-19 response framework. COVID-19 response management is now integrated into the health system in line with national protocols for notifiable infectious diseases. Supporting health system resilience as well as prevention and preparedness per the MPA objectives is therefore subsumed under broader health systems strengthening interventions and operations. 4. The project’s progress towards achievement of the PDO remains Moderately Satisfactory due to slowly progressing project activities. The Implementation Status and Report (ISR) dated March 8, 2023 reflects the outcomes of a comprehensive implementation support mission, followed by a portfolio review mission. Early progress was attributable to the Project’s initial emergency response efforts providing support to prevent new COVID-19 cases, limit local transmission through containment strategies, purchase vaccines and strengthen the health care system. This has included the procurement of emergency response supplies, including essential medicines, diagnostic test kits and reagents, personal protective equipment, and other equipment and consumables that have been critical to the initial and ongoing COVID-19 response. The Project also supported early and rapid COVID-19 vaccine acquisition through AVAT,4 as well as information technology equipment and communication materials to support the fixed and mobile vaccination teams. However, progress has been slower than initially anticipated, with the revised indicators reflecting achievement under 2 of the 6 PDO indicators. 5. Implementation Progress (IP) also remains Moderately Unsatisfactory reflecting the failure of some key aspects of the Project to advance adequately. The results framework was revised as part of AF3, though only 1 of the 15 IP indicators has been achieved at less than one year to closing. As of June 23, 2023, disbursements amounted to US$15.86 million, or 28.3 percent of the total project commitment, with only 6 percent (US$2.26 19-Emergency-Response-Project-Additional-Financing.pdf 3 Replaces Situation Report, SITREP as of August 2022. 4 The contract to acquire 933,695 doses through AVAT was signed between the Government of Congo and UNICEF on November 27, 2021. The World Bank Republic of Congo COVID-19 Emergency Response Project (P173851) million) disbursed in FY23. Disbursement has mostly been driven by two contracts with UNICEF that supported the procurement of emergency response supplies and vaccine acquisition. Only a quarter of activities under the 2021 Annual Workplan and Budget (AWPB) were carried out, however this included significant vaccination efforts such as the Government’s “Operations Coup de Point” campaign launched in October 2021 led to an increase in vaccine uptake during the two-month campaign period. Almost no Project activities were implemented in 2022, however progress has been recorded against safeguards activities in 2023. 6. The Project's environment and safeguard performance remains Moderately Unsatisfactory at this stage. The World Bank recognizes the efforts made by the project implementation unit (PIU) since the last mission, particularly to meet the effectiveness conditions for AF3 and the finalization of the Stakeholder Engagement Pan, including the grievance redress mechanism. Also, the AWPB for AF3 includes mitigation measures to address environmental and social safeguards, as required in the financial agreement. 7. The rating is maintained since not all required safeguards instruments have been finalized and disclosed in accordance with the action plan issued following the environmental and social safeguards audit conducted for the Parent project and subsequent AFs. The following safeguards instruments are still pending finalization: Environment and Social Management Plan, Labor Management Plan, Indigenous Peoples Framework, and updated gender-based violence action plan. II. DESCRIPTION OF PROPOSED CHANGES 8. Despite the early momentum and intensive implementation support (including a detailed and fully endorsed Action Plan), the Government of Congo will not be able to fully absorb AF3 funds. As the project closes in less than a year, on April 30, 2024, RoC has requested on June 29, 2023, to cancel US$21.28 million (equivalent), roughly half of the undisbursed balance of US$40.57 million5 (equivalent). The main reasons for this request are: (i) the short time left for the implementation of activities prior to the project’s closure; (ii) the dissolution of COVID response mechanisms and halting of COVID-19 vaccination; and (iii) the potential to reallocate these funds to other priorities in the Congo health portfolio if these funds are cancelled prior to project closure. 9. Reallocations between disbursement categories are presented in Section IV below. The proposed IDA credit amount to be cancelled under AF3 (IDA-71940) is US$21.28 million equivalent split as follows: Category 1: US$1.54 million; and Category 2: US$7.56 million equivalent. 5 Including the US$3 million Health Emergency Preparedness and Response Trust Fund. The World Bank Republic of Congo COVID-19 Emergency Response Project (P173851) III. SUMMARY OF CHANGES Changed Not Changed Components and Cost ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursement Estimates ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ MPA Program Development Objective ✔ MPA Expected Results and Indicators ✔ Results Framework ✔ Loan Closing Date(s) ✔ Disbursements Arrangements ✔ Overall Risk Rating ✔ 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) The World Bank Republic of Congo COVID-19 Emergency Response Project (P173851) MPA PROGRAM DEVELOPMENT OBJECTIVE Current MPA Program Development Objective The Program Development Objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness EXPECTED MPA PROGRAM RESULTS Current Expected MPA Results and their Indicators for the MPA Program Progress towards the achievement of the PDO would be measured by outcome indicators. Individual country-specific projects (or phases) under the MPA Program will identify relevant indicators, including among others: • Country has activated their public health Emergency Operations Centre or a coordination mechanism for COVID-19; • Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents; • Number of acute healthcare facilities with isolation capacity; • Number of suspected cases of COVID-19 reported and investigated per approved protocol; • Number of diagnosed cases treated per approved protocol; • Personal and community non-pharmaceutical interventions adopted by the country (e.g., installation of handwashing facilities, provision of supplies and behavior change campaigns, continuity of water and sanitation service provision in public facilities and households, schools closures, telework and remote meetings, reduce/cancel mass gatherings); • Policies, regulations, guidelines, or other relevant government strategic documents incorporating a multi- sectoral health approach developed/or revised and adopted; • Multi-sectoral operational mechanism for coordinated response to outbreaks by human, animal and wildlife sectors in place; • Coordinated surveillance systems in place in the animal health and public health sectors for zoonotic diseases/pathogens identified as joint priorities; and • Mechanisms for responding to infectious and potential zoonotic diseases established and functional; and • Outbreak/pandemic emergency risk communication plan and activities developed and tested The World Bank Republic of Congo COVID-19 Emergency Response Project (P173851) OPS_DETAILEDCHANGES_COMPONENTS_TABLE COMPONENTS Current Current Proposed Proposed Cost Action Component Name Component Name Cost (US$M) (US$M) Emergency COVID-19 Response Emergency COVID-19 Response 43.31 Revised and Health System 27.31 and Health System Strengthening Strengthening Communication Campaign, Communication Campaign, Community Engagement, and 7.00 Revised Community Engagement, and 4.00 Behavior Change Behavior Change Implementation Management Implementation Management 5.67 Revised 3.39 and M&E and M&E TOTAL 55.98 34.70 OPS_DETAILEDCHANGES_CANCELLATIONS_TABLE CANCELLATIONS Value Reason Current Cancellation New Ln/Cr/Tf Status Currency Date of for Amount Amount Amount Cancellation Cancellation IDA-66340- Disburs EUR 10,400,000.00 0.00 30-Jun-2023 10,400,000.00 001 ing IDA-69530- Disburs EUR 10,300,000.00 0.00 30-Jun-2023 10,300,000.00 001 ing BORROWER' S REQUEST IDA-71940- Effectiv EUR 27,800,000.00 19,473,613.65 30-Jun-2023 8,326,386.35 FOR 001 e COUNTRY REASONS OPS_DETAILEDCHANGES_REALLOCATION _TABLE REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Financing % Current Allocation Actuals + Committed Proposed Allocation (Type Total) Current Proposed IDA-71940-001 | Currency: EUR iLap Category Sequence No: 1 Current Expenditure Category: G(incl.vaccines)W,NCS,CS,OC,TR P1.4 The World Bank Republic of Congo COVID-19 Emergency Response Project (P173851) 4,700,000.00 0.00 1,407,991.00 100.00 100 iLap Category Sequence No: 2 Current Expenditure Category: G,W,N/CS,HAZRD PAY, OC&T EXCPT P1.4 23,100,000.00 0.00 6,918,395.35 100.00 100 Total 27,800,000.00 0.00 8,326,386.35 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Year Current Proposed 2020 0.00 0.00 2021 9,157,439.29 9,157,439.29 2022 4,437,182.51 4,437,182.51 2023 24,000,000.00 10,000,000.00 2024 18,385,378.20 5,431,764.55 2025 0.00 0.00 .