The World Bank Implementation Status & Results Report Haiti COVID-19 Response (P173811) Haiti COVID-19 Response (P173811) LATIN AMERICA AND CARIBBEAN | Haiti | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 6 | ARCHIVED on 30-Jun-2023 | ISR56361 | Implementing Agencies: Ministry of Public Health and the Population, Republic of Haiti, UNITE DE GESTION DE PROJET (UGP) Key Dates Key Project Dates Bank Approval Date: 02-Apr-2020 Effectiveness Date: 15-Apr-2020 Planned Mid Term Review Date: 11-Jul-2022 Actual Mid-Term Review Date: 11-Jul-2022 Original Closing Date: 30-Mar-2024 Revised Closing Date: 30-Mar-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Haiti. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Emergency COVID-19 Response:(Cost $16.00 M) Component 2: Health System Strengthening:(Cost $3.00 M) Component 3: Implementation Management and Monitoring and Evaluation:(Cost $1.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Unsatisfactory Overall Risk Rating High High Implementation Status and Key Decisions The Project was approved by the Board on April 2, 2020 and the Credit Agreement was declared effective on April 15th, 2020.An AF grant in the amount of US$35 million was approved in May 2022 and became effective in October 2022 to provide financing to help the Government of Haiti deploy COVID-19 vaccines, purchase additional vaccines if needed, and strengthen relevant health system functions that are necessary for a successful vaccine deployment. As of May 2023, the Project continues to supports key components of the Government's COVID-19 Response Plan, such as provision of personal protective equipment across the health system, oxygen therapy equipment for patient care (501 oxygen concentrators installed to date, throughout the country), as well as improvement of power supplies and electrical systems in health facilities and laboratories. However, there has been less progress with respect to COVID-19 vaccination since the number of COVID-19 cases in the country has been consistently relatively low over the last year, while other urgent public health issues have emerged, in particular the resurgence of Cholera in October 2022. The worsening security, socio-economic and health context is the basis of ongoing discussions between the MSPP, the WB and health partners concerning the most effective use of Project resources. 6/30/2023 Page 1 of 8 The World Bank Implementation Status & Results Report Haiti COVID-19 Response (P173811) 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 COVID-19 MPA - As of June 15, 2023 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) 6/30/2023 Page 2 of 8 The World Bank Implementation Status & Results Report Haiti COVID-19 Response (P173811) 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. COVID-19 MPA AF-V – June 15, 2023 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 6/30/2023 Page 3 of 8 The World Bank Implementation Status & Results Report Haiti COVID-19 Response (P173811) 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 High High High Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Moderate High Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Substantial High High Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other Moderate -- Substantial Overall High High High Results PDO Indicators by Objectives / Outcomes Emergency COVID-19 Response IN01296808 ►Percentage of suspected cases of COVID-19 cases reported and investigated based on national guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 90.00 Date 15-Apr-2020 31-Dec-2021 13-May-2023 31-Mar-2024 34,250 suspected cases of COVID were notified since beginning of the pandemic (as of May 13, 2023, Comments: COVID-19 daily epidemiological bulletin, MSPP). IN01296810 ►Country has activated their public health Emergency Operations Centre or a coordination mechanism for COVID-19 (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/30/2023 Page 4 of 8 The World Bank Implementation Status & Results Report Haiti COVID-19 Response (P173811) Value 0.00 11.00 11.00 11.00 Date 01-Mar-2020 31-Dec-2021 31-May-2023 31-May-2023 IN01296841 ►Population fully vaccinated disaggregated by sex (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 1.90 2.31 10.00 Date 01-Mar-2022 01-Oct-2022 13-May-2023 31-Mar-2024 Health System Strengthening IN01296809 ►Number of designated laboratories with diagnostic equipment, test kits, and reagents for diseases with mandatory immediate notification per MSPP norms (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 12.00 18.00 3.00 Date 01-Mar-2020 31-Dec-2021 31-Mar-2023 31-Mar-2024 For the first 6 months of 2023, 10 major laboratories have been consistently performing PCR testing for COVID-19. An additional 8 laboratories are performing COVID-19 testing through GenExpert and more Comments: than 70 sites continue to perform rapid tests. Intermediate Results Indicators by Components Component 1: Emergency COVID-19 Response IN01296843 ►Individuals reached with tailored information (e.g., individuals and decision makers in different sectors — travel and tourism, food and agriculture, healthcare workers and businesses . . .) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,800,000.00 3,800,000.00 6,000,000.00 Date 01-Mar-2020 31-Dec-2021 31-May-2023 31-Mar-2024 Communication activities implemented with local actors were successfully implemented during the first 2 years of the pandemic. However, to avoid duplication, activities originally planned to be implemented directly by MSPP were delayed as other health partners undertook mass communication Comments: activities. In the current context, communication activities related to COVID-19 are not renewed given the persisting low incidence of COVID-19 and other pressing priorities (in particular the renewed cholera epidemic). IN01296844 ►Mobile units established in rural areas to strengthen the COVID-19 vaccination campaign (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/30/2023 Page 5 of 8 The World Bank Implementation Status & Results Report Haiti COVID-19 Response (P173811) Value 0.00 0.00 0.00 22.00 Date 01-Mar-2022 01-Oct-2022 31-May-2023 30-Apr-2024 Mobile units have not been deployed yet due to the delayed finalization of the COVID-19 vaccination plans as well as a consistently very low COVID-19 incidence and other more pressing public health Comments: needs, including the renewed cholera epidemic and falling vaccination coverages. IN01296845 ►Actions taken in vaccine deployment and distribution based on feedback from beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 5.00 Date 01-Mar-2022 01-Oct-2022 31-May-2023 30-Apr-2024 No vaccine deployment activities have been undertaken yet under the Project. Comments: IN01296846 ►Target areas employing female health care workers to serve women and girls for vaccine delivery (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 75.00 Date 01-Mar-2022 01-Oct-2022 01-Oct-2022 30-Apr-2024 No vaccine deployment activities have been undertaken yet under the Project. Comments: IN01296847 ►Mobile Vaccination Units with a Female Vaccinator (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 75.00 Date 01-Mar-2022 01-Oct-2022 01-Oct-2022 30-Apr-2024 No vaccine deployment activities have been undertaken yet under the Project. Comments: Component 2: Health System Strengthening IN01296842 ►Percentage of specimens of diseases with mandatory immediate notification submitted for laboratory testing confirmed within WHO standard time at reference laboratories supported by the project (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 35.63 42.10 100.00 60.00 Date 01-Mar-2020 31-Dec-2021 31-Mar-2023 31-Mar-2024 Performance-Based Conditions 6/30/2023 Page 6 of 8 The World Bank Implementation Status & Results Report Haiti COVID-19 Response (P173811) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173811 IDA-D6010 Effective USD 20.00 20.00 0.00 19.60 0.43 98% P173811 IDA-E0620 Effective USD 35.00 35.00 0.00 1.35 32.42 4% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173811 IDA-D6010 Effective 02-Apr-2020 03-Apr-2020 15-Apr-2020 30-Mar-2024 30-Mar-2024 P173811 IDA-E0620 Effective 23-May-2022 04-Aug-2022 31-Oct-2022 30-Mar-2024 30-Mar-2024 Cumulative Disbursements 6/30/2023 Page 7 of 8 The World Bank Implementation Status & Results Report Haiti COVID-19 Response (P173811) Restructuring History There has been no restructuring to date. Related Project(s) P178296-AF Haiti COVID-19 Response 6/30/2023 Page 8 of 8