The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) REPORT NO.: RES56899 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT APPROVED ON JUNE 17, 2020 TO THE REPUBLIC OF GUINEA July 20, 2023 HEALTH, NUTRITION AND POPULATION GLOBAL PRACTICE WESTERN AND CENTRAL AFRICA REGION Regional Vice President: Ousmane Diagana Country Director: Marie-Chantal Uwanyiligira Regional Director: Dena Ringold Practice Manager: Gaston Sorgho Task Team Leaders: Zenab Konkobo Kouanda, Teegwende Valerie Porgo 1 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) ABBREVIATIONS AND ACRONYMS AEFI Adverse Event Following Immunization AF Additional Financing AF-V Additional Financing-Vaccines AFE Africa Eastern and Southern AFW Africa Western and Central CHW Community Health Workers COVAX COVID-19 Vaccines Global Access COVID-19 Coronavirus Disease 2019 EAP East Asia and Pacific ECA Europe and Central Asia EPI Expanded Program for Immunization GBV Gender-Based Violence GRM Grievance Redress Mechanism HNP Health, Nutrition, and Population IBRD International Bank for Reconstruction and Development ICR Implementation Completion and Results Report IDA International Development Association LAC Latin America and Caribbean MNA Middle East and North Africa MoH Ministry of Health MPA Multiphase Programmatic Approach MPA-V Multiphase Programmatic Approach-Vaccines OP/BP World Bank Operational Policy/World Bank Procedure PDO Project Development Objective SDR Special Drawing Rights SEA Sexual exploitation and abuse SH Sexual harassment WHO World Health Organization 2 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) BASIC DATA Product Information Project ID Financing Instrument P174032 Investment Project Financing Environmental and Social Risk Classification (ESRC) Substantial Approval Date Current Closing Date 17-Jun-2020 31-Dec-2023 Organizations Borrower Responsible Agency Republic of Guinea 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. A great deal of activity (restructurings and disbursements) was registered at the end of FY23. Several operations were restructured just before or on June 30, 2023. The restructurings reflected: (i) extension of closing dates, (ii) partial cancellation of funds, (iii) reallocations of funds among components, and (iv) expansion/scale down of activities within components. Forty (40) million US dollars in disbursements were processed under the MPA during the week ending June 30, 2023. Disbursements under the AF-V operations reached US$143.2 million for combined disbursements of US$183.2 million. As of July 17, 2023, 88 MPA-projects had 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 July 17, 2023, amount to US$3.94 billion or 92 percent of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. A large refund from the UN to the project account of the Myanmar operation was processed in late March due to the inability to implement the project. This transaction affected total 3 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) disbursements. Also, (i) Loans and Credits denominated in SDRs and Euros are being affected because of fluctuations between the SDRs and Euros against the US$, and (ii) at this late stage of project implementation, several operations are processing refunds to the project accounts, which have an impact on total disbursements. Thirteen operations closed by the end of calendar year 2022 and nine operations closed on June 30, 2023. Twenty operations have closing dates by the end of calendar year 2023. However, there are several projects that are/will be processing extensions so this number will change. As with the Mid-Term Review issued on March 25, 2023, no individual COVID-19 MPA operation will need an ICR. Instead, one ICR will be prepared for the entire COVID-19 MPA Program based on final ISRs packages prepared by country operations’ teams. 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. Further, 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. The MTR also 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 two (72) country projects or 84 percent of projects approved have reached 70-100+ percent disbursement (reasons for >100 percent disbursements relate to fluctuations between the Euro and the SDR against the US$). Out of the 72 operations, 62 operations or 86 percent have disbursed 90+ percent of commitments. Out of the 72 operations, 41 operations are fully disbursed and sixteen (16) operations have disbursed 95-99 percent of commitments. There are four operations with disbursements of 50 percent or less. Out of these four operations, one operation has disbursed 30 percent (AFW), two operations in EAP have disbursed 44-48 percent and one operation in AFE has disbursed 49 percent. The projects are benefitting around 3.7 billion people or 50 percent 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. All projects under implementation are disbursing. ECA has the highest percentage of disbursements at 100 percent, followed by MNA with 99 percent, SAR with 94 percent, LAC with 93 percent, EAP with 86 percent, AFW with 84 percent and AFE with 78 percent. Disbursements for EAP operations are being affected by relatively low disbursements in four countries. 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 low disbursements under one operation. 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 represents 40 percent and IBRD 60 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. 4 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) As of July 17, 2023, the Bank has approved 115 operations (including MPA-V operations) to support vaccine procurement and rollout in 78 countries amounting to US$9.26 billion. The Senegal AF2 operation for US$15 million financed by a Grant from The Global Finance Facility was approved on June 30, 2023. One hundred and eighteen (118) operations had been approved amounting to US$10 billion, but: (i) the Costa Rica operation (US$120 million), (ii) the Peru operation (US$500 million), and the (iii) Gabon (US$12 million) were cancelled at the request of the governments. The Afghanistan operation commitment of US$113 million was reduced to US$60 million. Several other operations have processed partial cancellations, thereby the overall commitment has decreased in the past months. Of the 115 approved operations: (i) 65 are in Africa – 30 in AFE and 35 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. The 115 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. Thirty-two (32) operations are being implemented in Fragile and Conflict-affected situations. IDA represents 45 percent and IBRD 55 percent of disbursements. Total disbursements under these projects as of July 17, 2023, amount to US$6.1 billion or 66 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 have been restructured and more will need to be restructured to reallocate funds allocated for procurement of COVID- 19 vaccines and deployment. Forty (40) AF-V/MPA-V operations or 35 percent of operations approved have disbursed over 70 percent of their commitments. Out of the 40, twelve operations or 30 percent 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 percent of commitments (Ecuador AF-V 1, Indonesia, Iraq, Sierra Leone AF-V 1, and Yemen). Seven operations have disbursed 95-99 percent. Ninety-three (93) operations or 82 percent of total operations under implementation are disbursing. ECA has the highest percentage of disbursements at 85 percent, followed by SAR at 77 percent, EAP and LAC at 73 percent, MNA at 72 percent, AFE and AFW at 55 percent. As of June 1, 2023, the World Bank had purchased 635.4 million doses of the COVID-19 vaccine of which 506.7 million had been delivered to client countries. Retroactive Financing (RF) represents 37 percent of overall commitments. High levels of RF have been authorized under different operations - Ukraine (100 percent), Panama and Turkey (90 percent), Argentina and Guyana (80 percent), and Belize, and Sri Lanka (70 percent). One hundred and fourteen (114) loan/financing agreements or 99 percent of projects approved have been signed and 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. OPS_TABLE_PDO_CURRENTPDO 5 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) Project Development Objective (PDO) Original PDO To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Guinea. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-71910 23-Jun-2022 05-Jul-2022 14-Dec-2022 31-Dec-2023 12.72 0 12.82 IDA-E1080 23-Jun-2022 05-Jul-2022 14-Dec-2022 31-Dec-2023 12.72 0 12.82 IDA-69700 29-Jun-2021 01-Jul-2021 17-Aug-2021 31-Dec-2023 14.10 3.57 9.67 IDA-D8940 29-Jun-2021 01-Jul-2021 17-Aug-2021 31-Dec-2023 14.10 12.20 1.17 IDA-67350 17-Jun-2020 25-Jun-2020 28-Jul-2020 31-Jul-2022 5.45 5.31 .40 IDA-D6870 17-Jun-2020 25-Jun-2020 28-Jul-2020 31-Jul-2022 5.45 5.64 .09 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No 6 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Project status 1. Guinea has benefitted from three financing from the International Development Association (IDA) to prepare for and respond to COVID-19, as summarized in Table 1. The Project Development Objective (PDO) - to prevent, detect, and respond to threat posed by COVID-19 and strengthen national systems for public health emergency preparedness in Guinea - has remained unchanged since the parent project. The parent project supported the prevention of and emergency response to the pandemic through the strengthening of the COVID-19 surveillance. Thus, it has helped enhance and maintain effective the disease surveillance system at the border and in the country through the (i) activation of the 22 emergency operation centers; (ii) equipment and payment of per diems for the emergency response teams (which have been operating from the central to the commune level); and (ii) acquisition of 35 4x4 vehicles for the National Health Security Agency (Agence Nationale de Sécurité Sanitaire) for contact tracing and supervision missions. In addition, laboratories’ capacity was upgraded for swift testing through the (i) purchase of essential supplies, including 385,000 antigen tests, laboratory reagents, consumables; and (ii) training of laboratory staff. Furthermore, management of severe and minor cases of COVID-19 was improved through the (i) hiring and payment of per diems for medical staff; (ii) purchase, installation and commissioning of two additional treatment centers in Conakry (medical tents); (iii) purchase of emergency drugs and equipment, including the setup of four oxygen production systems and seven intensive ventilators, and other medical materials for intensive care in epidemic treatment centers; and (iv) procurement of five ambulances. Infection prevention and control were also improved with the procurement of 20,000 personal protective equipment kits, sanitation, and hygiene materials and the procurement, installation, and commissioning of medical waste disposal systems (eight climate-friendly incinerators) in treatment centers. Finally, the project supported the implementation of the Government’s risk communication, social mobilization, and citizen engagement strategy, including the setup of a COVID-19 call center that operates 24/7 to provide daily remote information and guidance on COVID-19. The parent project closed on July 31, 2022 with a disbursement rate of 96 percent. Table 1. Key project data Key data Parent project First Additional Second AF Financing (AF) Approval date June 17, 2020 June 29, 2021 June 23, 2022 Effectiveness date July 28, 2020 August 17, 2021 December 14, 2022 Closing date July 31, 2022 December 31, 2023 December 31, 2023 Commitment (million) US$10.9 US$28.2 US$25.43 Disbursement rate* 96.24% 55.91% 0% *As of July 10, 2023. 2. The first AF has been supporting the roll out of the National Vaccination and Deployment Plan. It became effective on August 17, 2021. Nonetheless, following a coup d’Etat that occurred on September 5, 2021, the World Bank halted all pending payments and withdrawal applications as of September 5, 2021, in accordance with World Bank Policy on Dealings with De Facto Governments (World Bank Operational Policy/World Bank Procedure (OP/BP) 7.30). On November 4, 2021, a waiver of OP/BP 7.30 was obtained to resume disbursements to support World Bank COVID-19- related activities in Guinea. Thus, activities resumed under the first AF in November 2021 and the first disbursement was made on January 28, 2022. As a result of the delays caused by the application of the OP/BP 7.30, the closing date of the first AF was extended from December 31, 2022, to December 31, 2023 during the approval of the second AF, on June 23, 2022. The first AF has procured 1,300,000 doses of the Sinopharm vaccine and its related products and 7 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) supported the (i) operational costs of vaccination, including the per diems for vaccinators, risk communication, awareness campaigns and citizen engagement; and (ii) operational cost for the functioning of the COVID-19 call center. In addition, this first AF has supported the production of one million vaccination cards, the purchase of IT equipment, the operating cost of the pass vaccinal electronic platform, the purchase of IT equipment to enhance the vaccination data management and information system, as well as vaccination waste management. As of May 22, 2023, only 53 percent of the first AF was disbursed. 3. The second AF did not add new activities or components, it only expanded activities of the first AF. The initial effectiveness deadline for the second AF was September 3, 2022. After two extensions of this deadline to meet the effectiveness conditions (recruitment of a gender-based violence (GBV) consultant in the project coordination unit and legal ratification of the project), it became effective on December 14, 2022. This AF has not yet disbursed, and its closing date is December 31, 2023. 4. Progress towards achievement of the PDO, overall implementation progress, components, financial management, project management, procurement, and monitoring and evaluation were rated satisfactory in the last Implementation Status and Results Report archived on May 22, 2023, and the project continues to make good progress. The parent project included three PDO indicators whose targets were all attained as of the closing date of the parent project. The PDO indicator “Percentage of population fully vaccinated, which is included in the priority population targets defined in the national plan” was added to the first AF. As of May 22, 2023, this indicator was on track, with a value of 35.8 percent, compared to a target of 38.3 percent. Of those, 44 percent were women, compared to an end-target of 50 percent. As for the financial management system, accounts were up to date, the project steering committee was functional, interim financial reports were submitted on time, and the internal audit function was operational. Regarding the procurement contracts, as of May 22, 2023, out of the 25 contracts in the procurement plan, 23 had been completed and two were in progress. 5. Environmental and social safeguards were downgraded from Moderately Satisfactory to Moderately Unsatisfactory but strong measures were proposed to improve the situation. Details on the environmental and social safeguards are presented in paragraphs 22, 23, and 24. B. Rationale for restructuring 6. On March 15, 2023, the Government of Guinea sent a letter to the World Bank to request (i) an extension of the closing date of the AFs and (ii) additional activities, which necessitate a reallocation of funds. This request is driven by the decrease in the incidence rates of COVID-19 and the delays in implementing the AFs. Indeed, a large amount of the funds under the AF1 (US$18.5 million) and the AF2 (US$8.5 million) was planned to be allocated to the purchasing of COVID-19 vaccines and vaccine deployment. Yet, the COVID-19 epidemic in Guinea has been curtailed. At the time of the second AF approval (June 23, 2022), 37,021 confirmed cases of COVID-19, 442 confirmed hospital deaths, and 338 confirmed community deaths were recorded nationally (cumulative numbers as of June 13, 2022).1 As of June 27, 2023, only an additional 1,542 confirmed cases and 26 hospital deaths, and 1 community confirmed death were recorded nationally.2 Moreover, on May 5, 2023, the World Health Organization (WHO) declared that COVID-19 no longer constituted a Public Health Emergency of International Concern3 following a one-year downgrade trend of the 1 Republic of Guinea. Ministry of Health and Public Hygiene. COVID-19 Epidemiological Status Report. June 13, 2022. 2 Republic of Guinea. Ministry of Health and Public Hygiene. COVID-19 Epidemiological Status Report. June 2, 2023. 3 World Health Organization (WHO). Statement on the fifteenth meeting of the IHR (2005) Emergency Committee on the COVID-19 pandemic. May 5, 2023. 8 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) pandemic. Additionally, after the approval of the second AF, the Government received a large number of donations of vaccine doses from the COVID-19 Vaccines Global Access (COVAX) Facility and other multilateral and bilateral partners. The number of vaccines that are currently available is enough to meet the Government’ medium-term needs. Nevertheless, although WHO declared the end of the emergency phase of the COVID-19 outbreak, it clarified that COVID-19 is still a global threat and warned that new variants could still emerge. Therefore, it is desirable for the country to have funds available to purchase vaccines in the event of a new resurgence of incident cases. Hence, activities under AF1 will be maintain with the flexibility to purchase or not COVID-19 vaccine depending on the country’s actual needs. 7. Like many other countries, Guinea adjusted its COVID-19 response strategy to reflect the status of the pandemic. In this new strategy, Guinea aims to vaccinate 40 percent of the population by the end of 2023. Thus, the country developed an operational plan for routinization and intensification of the COVID-19 vaccination in July 2022. This plan aims to boost the vaccination coverage by integrating it into routine activities of the Expanded Program for Immunization (EPI) and strengthening the multi-sectoral approach implementation of vaccination. This plan is in line with the latest guidance of the WHO. Indeed, WHO’s 2023-2025 COVID-19 Strategic Preparedness and Response Plan4 provides guidance to countries in transitioning to long-term management of COVID-19. This plan outlines important actions for countries to consider in five areas: (i) collaborative surveillance; (ii) community protection; (iii) safe and scalable care; (iv) access to countermeasures; and (v) emergency coordination. 8. Furthermore, Guinea direly needs to strengthen its capacity to face other future epidemics. The country faces multiple, simultaneous epidemics every year (Yellow Fever, Lassa fever, Marburg, Polio, rabies, avian flu, etc.). This is mainly due to the insufficiency of qualified human resource at the peripherical level, the shortage of some children’s vaccines (Bacille Calmette-Guérin (BCG), measles), the insufficient and inadequate health infrastructure and equipment, particularly in the epidemic treatment centers, and the absence of a dedicated public budget line for public health emergencies. These shortfalls have undermined the functioning of the One Health approach and the performance of the EPI (with only 24 percent of children under two years of age fully immunized according to national standards (2018)). The Government and the World Bank agreed to reallocate the funds of AF2 currently allocated to the purchase of COVID-19 vaccines (US$14.6 million) and part of the funds allocated to the deployment of the vaccines to strengthen the health system (US$7.83 million). This will enable the Government to (i) improve its capacity to prepare for and respond to epidemics, including COVID-19, according to the “One Health” approach; (ii) better deploy the COVID-19 vaccines already available; (iii) build the country’s capacity in technical areas of the International Health Regulations; (iv) strengthen the EPI; and (v) improve the supply of health services through the rehabilitation of the Matoto Enta-Nord Regional Hospital among others. The choice of this rehabilitation was motivated by (i) the importance of this hospital’s impact on the health of the population (around 2 million people in the catchment area); (ii) the availability of all the architectural plans; and (ii) the availability of some environmental and social studies. 9. Furthermore, it was agreed that a Deputy Coordinator will be hired to oversee the implementation of the project. Indeed, the current coordinator oversees the Guinea COVID-19 Preparedness and Response Project (P174032), the Health Service and Capacity Strengthening Project (P163140) and the Regional Disease Surveillance Systems Enhancement Program, Phase I (REDISSE I; P154807) – Guinea. Having a Deputy Coordinator dedicated to the project will facilitate its implementation. The recruitment for this position is underway. 4World health Organization (WHO). From emergency response to long-term covid-19 disease management: sustaining gains made during the covid-19 pandemic. Strategic preparedness and response plan: April 2023–April 2025. May 3, 2023. 9 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) 10. The proposed restructuring comprises a range of interventions that will be aligned with the World Bank health operations in Guinea. The health portfolio is composed of the Guinea Health Service and Capacity Strengthening Project (P163140), REDISSE I (P154807), and the Sahel Women Empowerment and Dividend Demographic Project (P150080). Based on the lessons learned from the implementation of REDISSE I, which will close on August 31, 2023, this restructuring will continue to reinforce the prevention, preparedness, and response capacity of Guinea against epidemics, including COVID-19, using a One Health approach, as well as strengthening the health system for improved health services delivery. II. DESCRIPTION OF PROPOSED CHANGES 11. The project will be restructured to expand the scope of the AF2s’ activities and strengthen the health system for a better health service delivery and improved preparedness and response capacity to epidemics while there will be no new activities under AF1. Thus, the proposed changes are as follows:  An 18-month extension of the closing date of AF1 (Credit No. 6970-GN) and AF2 (Credit No. 7191-GN) from December 31, 2023 to June 30, 2025 to allow enough time for Government to implement its work plan and close the gap of the national vaccination target coverage. The proposed closing date extension meets the requirements of the World Bank Investment Project Financing Directive regarding extension of closing dates, specifically: (i) the project objectives remains achievable; (ii) the performance of the Recipient remains satisfactory; (iii) the World Bank and the Recipient agree on actions that will be undertaken by the Recipient to complete project critical activities; and (iv) there are no outstanding audits and/or interim financial reports.  Under AF2: (i) realignment, expansion, and introduction of new activities; (ii) reallocation of costs across components; (iii) revision of and reallocation of funds across disbursement categories; (iv) change in disbursement estimates; (v) change in implementation schedule; and (iv) adjustment of the results framework to revise some indicators and targets. These changes are detailed below. 12. Realignment, expansion, and introduction of new activities. The following changes will be introduced: a) Under Component 1: Emergency COVID-19 response (US$44.80 million). This component will continue investments for vaccines service delivery, which includes (i) training; (ii) treatment of adverse events following immunization (AEFI; operating costs of the national and regional AEFI committees; (iii) procurement of 21 ambulances in addition to the procurement of 40 ambulances initially planned under AF2 for all regions; and (iv) strengthening of cold chain (refrigerated trucks, power generators, and six additional cold rooms). These activities have been added to Sub-component 1.5 (“Procurement of Vaccines, Related Products, and Equipment and Deployment”). Additionally, since COVID-19 vaccination will be integrated into the EPI, vaccinators’ per diems initially planned under AF2 will be provided for a reduced number of vaccinators (only those in mobile and advanced vaccination strategy) and financing for these per diems will be provided under AF1. b) Under a new Component 2 (US$17.00 million): Health system strengthening. A new component will be added. This component will be Component 2 and the current Component 2 will become Component 3. This new Component 2 will finance health system strengthening activities. It will include two sub-components as follows: (i) Sub-component 2.1: Prevention, preparedness, and response to epidemics. This sub-component will contribute to build Guinea’s capacity in technical areas of the International Health Regulations (2005) through the One Health approach to control both COVID-19 and other epidemics, particularly vaccine-preventable, epidemic-prone diseases. Therefore, the main investments entail two kinds of activities. The first kind of activities pertain to 10 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) enhancing quality human resources for effective disease surveillance and epidemic prevention, preparedness and response, including hiring and training professional staff (human, animal and environmental health) for central, intermediate, and peripherical levels and community health workers (CHW) who will play a critical role in the implementation of the community-based surveillance approach, especially in epidemic-prone health zones. The hiring of the CHW will be based on a needs assessment and aligned with the national community health strategy. Newly hired CHW will complement those hired under the other World Bank’s projects. Moreover, additional support will be funded for the expansion of the community health strategy especially the expansion of a real-time surveillance at the community and health facilities levels. This will include support to the operational cost of the deployment (equipment, IT devices and material, technical assistance to ensure coordination of partners and harmonization of interventions). The second kind of activities pertain to improving the management of health emergency services. These include the purchase of emergency equipment and medicines for hospital and health centers, including the procurement and installation of oxygen supply system, and training of biomedical technicians to produce and manage these systems. A continuous training program in emergency health and resuscitation care will be provided to medical staff. (ii) Sub-component 2.2: Improving essential health services. Under this sub-component, the project will improve existing healthcare infrastructures and the availability of essential medicines equipment and logistics for primary health centers. Hence, it will finance the expansion and rehabilitation of the Enta Nord Region Hospital. The civil works will include an inpatient ward with an 80-bed capacity, administration building, patients screening department, guard shelter, the borehole, wastewater and biomedical waste management facilities accompanying wards, and laundry rooms. The new facilities will be equipped, and their initial six-month operational costs will be covered. Moreover, this sub-component will (i) purchase drugs, medical commodities, and 37 hearses; (ii) purchase of eight vehicles for regional hospitals; and (iii) provide water supplies and electricity connectivity. c) Under Component 3 (originally Component 2) (US$2.73 million): Project implementation management and monitoring and evaluation. Activities under this component will be scaled-up to improve the monitoring and evaluation capacity of the Ministry of Health (MoH). In this regard, this component will: (i) reinforce and systematize the chain of supervision; (ii) strengthen monitoring and research activities; (iii) speed up the operationalization of the grievance redress mechanism (GRM) at the peripherical level, continue the support to the COVID-19 call center, and intensify citizen engagement activities; and (iv) speed up the implementation of the Environmental and Social Commitment Plan and supervision and management of safeguard requirements. 13. Reallocation of costs across components. A total of US$18.43 million from Component 1 will be reallocated to the new Component 2 (US$17.00 million) and Component 3 (originally Component 2; US$1.43 million). See Table 2 for details. 14. Revision and reallocation of funds across disbursement categories. To implement the abovementioned changes under AF2, the following changes will be made: a) Transfer of all the funds of Category 3 (SDR 800,000) to Category 1 “Goods, works, non-consulting services, and consulting services, Training and Operating Costs for the Project, except Part 1.5” because no payment will be made for vaccinators’ per diems under AF2 (only under AF1); b) Transfer SDR 7,600,000 from Category 2 to Category 1; c) With the two transfers of funds (changes b and d), Category 1, which had no funds, will have a total amount of SDR 8,400,000 (see Table 3). 15. Disbursement estimates will be revised with respect to the new closing date. Hence, the disbursement end date will be extended from April 30, 2024 to October 30, 2025. 11 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) 16. Implementation schedule. The implementation schedule will be revised and aligned with the new closing date. To ensure a smooth implementation of the remaining and new activities, an implementing action plan developed by Government was approved by the World Bank (Annex 1). 17. Adjustment of the project’s results framework. The following revisions will be made to results to adequately assess the progress of the project in light of the revised activities: a) Increase of the target value of all PDO indicators and Intermediate Results Indicators (IRI) used under the AFs whose end target have been attained or surpassed by an estimate of the additional number of beneficiaries that the project can reach in approximately two years; b) Renaming of the IRI indicator “Health regions with an AEFI monitoring committee” as “Health regions with a functional AEFI monitoring committee” to emphasize the operational character of these committees beyond their mere existence; c) Extension of the end target dates of indicators used under the AFs to June 30, 2025; d) Addition of the following three indicators to capture investments made under the new Component 2: (i) PDO indicators: “Enta Nord Regional Hospital completed and operational”; (ii) Intermediaries Results Indicators (IRI): (i) “Health facilities including CT-EPI fully equipped” and (ii) “Community health workers trained in community-based surveillance.” Table 2. Proposed reallocation of the funds across components Project Components Current New allocation Changes Parent + AF1 + AF2 Cost Parent + AF1 + AF2 (US$ million) Cost (US$ million) Component 1: Emergency COVID-19 Response 63.23 44.80 -18.43 Sub-component 1.1: Case Detection, 5.40 7.20 +1.80 Confirmation, Contact Tracing, Recording, and Reporting Sub-component 1.2: Case Management 2.30 3.50 +1.20 Sub-component 1.3: Social Distancing Measures 1.70 1.70 No changes Sub-component 1.4: Communication 2.30 3.30 +1.00 Preparedness Sub-component 1.5: Procurement of Vaccines 51.53 29.10 -22.43 and Related Products and Equipment and Deployment Component 2: Health System Strengthening N/A 17.00 +17.00 Sub-component 2.1: Prevention, Preparedness, N/A 4.00 04.00 and Response to epidemics Sub-component 2.2: Improving Essential Health N/A 13.00 +13.00 Services Component 3: Project Implementation 1.30 2.73 +1.43 Management and Monitoring and Evaluation Sub-component 3.1: Project Management and 0.50 1.50 +1.00 Coordination Sub-component 3.2: Monitoring and Evaluation 0.80 1.23 +0.43 Total Cost 64.53 64.53 No changes Table 3. Proposed reallocation of the funds across disbursement categories for Credit No. 7191-GN and Grant No. E108-GN 12 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) Category Current Amount of Current Amount of New Amount of the New Amount of the Credit Allocated the Grant Credit Allocated the Grant (expressed in SDR) Allocated (expressed in SDR) Allocated (expressed in SDR) (expressed in SDR) (1) Goods, works, non-consulting 0 0 8,400,000 8,400,000 services, and consulting services, Training and Operating Costs for the Project, except Part 1.5 (2) Goods, works, non-consulting 8,700,000 8,700,000 1,100,000 1,100,000 services, and consulting services, Training, and Operating Costs under Part 1.5 of the Project, except vaccinators per diems under Part 1.5(vi) (3) Vaccinators per diems under Part 800,000 800,000 00 00 1.5(vi) TOTAL AMOUNT 9,500,000 9,500,000 9,500,000 9,500,000 18. The new activities proposed under Component 2 of this restructuring package are aligned with the Paris Agreement on both adaptation and mitigation. Guinea is considered the 24th most vulnerable country in the world to climate change due to the country’s high vulnerability and lack of climate-readiness.5 The new activities that are being proposed under Component 2 are consistent with the country’s Nationally Determined Contribution, although health is not considered a sectoral priority. However, Guinea identifies climate change as a key factor for communicable and non-communicable diseases in its National Health Development Plan (2015-2024) and therefore, measures are being taken to address the impact of climate change on the health sector. 19. Assessment and reduction of adaptation risks: New activities being proposed under Component 2 contribute to climate resilience, and adaptation design considerations limit the exposure to a low level of residual risk. The main climate and disaster risks likely to affect the new activities include flooding and extreme temperatures. The project design takes into consideration the extreme heat, precipitation and flooding risks that threaten the outcomes of the project. Specifically, climate change risks and vulnerability to floods and extreme heat will be managed and mitigated through targeted adaptation measures such as natural ventilation, solar protection, thermal inertia, and rainwater and greywater management in the expansion/rehabilitation of the regional hospital, and training/sensitization of healthcare workers and communities on preparedness and response in case of a climatic event. 20. Assessment and reduction of mitigation risks: The program design will have little to no impact on greenhouse gas emissions and has a low risk of preventing Guinea’s transition to low-carbon development pathways. The operation is also considered economically viable based on an assessment that determined that the transition risks to a low carbon development pathway are considered low. Carbon lock-in is expected to be low due to the sustainability design that is being put in place to expand and rehabilitate the Enta-Nord Regional Hospital. Moreover, expansion and rehabilitation are small-scale, and they are not expected to be carbon intensive. The project will support the adoption of mitigation measures/lower-carbon alternatives and practices, such as sustainable building design and solar power for the construction of the regional hospital, energy efficient and low-emitting equipment for laundry facilities and waste 5 Notre Dame Global Adaptation Initiative (ND-GAIN). 2022. ND-GAIN Country Index. https://gain.nd.edu/our-work/country-index/rankings/ 13 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) management in the hospitals/health centers, and use of renewable energy sources (i.e., solar) and fuel-efficient vehicles, where technically feasible, economically viable, and developmentally appropriate. Best management practices for energy-efficiency will be used for the installation of water and irrigation systems, including rainwater and greywater management. Waste from health facilities will be adequately treated, segregated and recycled as needed. Incinerators that will be procured will use microwave technology, which is the most ecological solution for the treatment of medical waste since no emissions are expected, and a clinical waste treatment center will also be established. Vehicles that will be acquired will most likely be powered by gasoline or diesel due to the unavailability of spare parts and mechanics’ unfamiliarity with hybrid technology. Considering these limitations, the project plans to purchase a new generation of cars, which are highly efficient and energy-saving, consuming around 7.9L/100km. This is significantly lower than the fuel consumption of older generation vehicles, which is around 15-20L/100km. While hearses, which will be used to transport deceased persons, will most likely be powered by gasoline or diesel due to the lack of electric vehicle charging stations and lack of knowledge on maintenance of hybrid vehicles, they will not have a significant impact on greenhouse gas emissions. 21. The Environmental and Social Management Framework was updated and disclosed for the first and second AF with (i) provisions for handling, storing, transporting, and disposing of contaminated medical waste; and (ii) guidance in line with (a) international good practice and WHO standards on COVID-19 response on limiting viral contagion in health facilities; (b) Environmental and Social Standards; and (c) the Environmental, Heath, and Safety Guidelines. A full Infection Prevention Control and Waste Management Plan was also developed. The Project Implementation Unit (PIU) is coordinating and supervising activities of the project and is staffed with environmental safeguards, social development, communication, and GBV specialists. Communication, social mobilisation, and community engagement strategies were developped with a particular emphasis on vulnerable groups, in collaboration with MoH partners. These strategies have allowed to disseminate reliable, timely, accurate, and transparent information about COVID-19. This has helped to curtail the rumors that were circulating via social media and therefore to reduce apprenhension and reluctance for behavior change within communities. 22. At the time of the last mission, held from April 3 to 7, 2023, most of the recommendations formulated during the mid-term review, held in April 2022, had not been implemented. For example, the environmental quarterly reports were not sent in time and those sent were suboptimal; complaint committees were not operational; training of stakeholders on medical waste management was not complete; and simplified envirionment and social impact assessments were not conducted for all incinerators. Therefore, the rating for the overall safeguards performance of the project was downgraded from Moderately Satisfactory to Moderately Unsatisfactory. Moreover, the World Bank recommended the replacement of the environmental and social development specialists of the PIU if the project safeguards aspects did not improve by July 15, 2023 (in addition to the hiring of the deputy coordinator of the PIU who will oversee the technical implementation of the project) and established an action plan to address the issues identified and fully implement the GRM by the end of September 2023. The action plan includes, among other things, (i) the setting up of complaint committees and complaints registries, and signature of codes of conduct by the PIU staff and health workers in vaccination centers involved in the project; (ii) strengthening activities related to the documentation, collection, sorting, transportation, and disposal of biomedical waste (including periodic air quality analyses of incinerator sites); (iii) environmental and social screening of key sites; (iv) workplace safety and health activites; and (v) capacity-building activities, with a specific training plan, for all project stakeholders, including the environmental, social development, and GBV specialists. The plan is frequently monitored by the World Bank environmental safeguards and social development specialists, including a social development consultant, recruted in Mars 2023 in the Conarky office to closely support the PIU. 23. On July 15, 2023, the task team assessed the performance of the PIU’s environmental and social development specialists and concluded that enough progress was made to maintain them and that another assessment will be made 14 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) in three months, based on key performance indicators drawn from the action plan of the restructuring, to decide whether to replace them. ES NOTE TABLE III. SUMMARY OF CHANGES Changed Not Changed Results Framework ✔ Components and Cost ✔ Loan Closing Date(s) ✔ Reallocation between Disbursement Categories ✔ Disbursement Estimates ✔ Implementation Schedule ✔ Implementing Agency ✔ DDO Status ✔ 15 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) Project's Development Objectives ✔ MPA Program Development Objective ✔ MPA Expected Results and Indicators ✔ PBCs ✔ Cancellations Proposed ✔ Disbursements Arrangements ✔ Overall Risk Rating ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) 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; 16 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) • 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 OPS_DETAILEDCHANGES_COMPONENTS_TABLE COMPONENTS Current Current Proposed Proposed Cost Action Component Name Component Name Cost (US$M) (US$M) Emergency COVID-19 Response 63.23 Revised Emergency COVID-19 Response 44.80 Project Implementation Project Implementation Management and Monitoring 1.30 Revised Management and Monitoring 2.73 and Evaluation and Evaluation 0.00 New Health System Strengthening 17.00 TOTAL 64.53 64.53 OPS_DETAILEDCHANGES_LOANCLOSING_TABLE 17 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-67350 Closed 31-Jul-2022 IDA-69700 Effective 31-Dec-2022 31-Dec-2023 30-Jun-2025 30-Oct-2025 IDA-71910 Effective 31-Dec-2023 30-Jun-2025 30-Oct-2025 IDA-D6870 Closed 31-Jul-2022 IDA-D8940 Effective 31-Dec-2022 31-Dec-2023 30-Jun-2025 30-Oct-2025 IDA-E1080 Effective 31-Dec-2023 30-Jun-2025 30-Oct-2025 OPS_DETAILEDCHANGES_REALLOCATION _TABLE REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Financing % Current Allocation Actuals + Committed Proposed Allocation (Type Total) Current Proposed IDA-71910-001 | Currency: XDR iLap Category Sequence No: 1 Current Expenditure Category: GD,WK,NCS,CS,TR, OC EXC PT1.5 0.00 0.00 8,400,000.00 100.00 100.00 iLap Category Sequence No: 2 Current Expenditure Category: G,W,NCS,CS,TR,OC PT1.5 EXCPT 1.5vi 8,700,000.00 0.00 1,100,000.00 100.00 100.00 iLap Category Sequence No: 3 Current Expenditure Category: VACCINATORS PER DIEMS PT. 1.5(vi) 800,000.00 0.00 0.00 100.00 100.00 Total 9,500,000.00 0.00 9,500,000.00 IDA-E1080-001 | Currency: XDR iLap Category Sequence No: 1 Current Expenditure Category: GD,WK,NCS,CS,TR, OC EXCPT PT1.5 18 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) 0.00 0.00 8,400,000.00 100.00 100.00 iLap Category Sequence No: 2 Current Expenditure Category: G,W,NCS,CS,TR,OC PT1.5 EXCPT 1.5vi 8,700,000.00 0.00 1,100,000.00 100.00 100.00 iLap Category Sequence No: 3 Current Expenditure Category: VACCINATORS PER DIEMS PT. 1.5(vi) 800,000.00 0.00 0.00 100.00 100.00 Total 9,500,000.00 0.00 9,500,000.00 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Year Current Proposed 2020 25,887.74 2,846,003.00 2021 4,984,864.89 8,202,381.00 2022 9,652,465.10 11,181,682.00 2023 7,778,655.55 17,018,318.00 2024 2,988,126.72 17,000,000.00 2025 0.00 8,430,000.00 2026 0.00 0.00 . 19 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) . Results framework COUNTRY: Guinea GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT Project Development Objectives(s) To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Guinea. Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline End Target To prevent, detect and respond to COVID-19 and strengthen national systems for public health emergen Suspected cases of COVID-19 cases reported and investigated 400.00 1,000.00 based on national guidelines (Number) Designated laboratories with COVID-19 diagnostic equipment, 4.00 8.00 test kits, and reagents (Number) Acute healthcare facilities with isolation capacity (Percentage) 7.90 90.00 Population fully vaccinated, which is included in the priority population targets defined in the national plan, by gender 0.21 50.00 (Percentage) Rationale: End target increased from 38.30 percent to 50 percent. Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. Women fully vaccinated, which is included in the priority 40.00 50.00 population targets defined in the national plan (Percentage) 20 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline End Target Rationale: Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. Enta Nord Regional Hospital completed and operational (Yes/No) No Yes Action: This indicator is New PDO Table SPACE Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Emergency COVID-19 Response Health staff trained in infection prevention and control per MOH- 0.00 1,400.00 approved protocols (Number) Rationale: This indicator was measured until the closing of the parent project (on July 31, 2022). It will now be measured under the Action: This indicator has been Revised additional financing 1 and 2. So it's end target is increased from 1,000 to 1,400 and it's end target date is extended to June 30, 2025. Designated laboratories with staff trained to conduct COVID-19 4.00 8.00 diagnosis (Number) Country has prepared guidelines to care for COVID-19 patients No Yes (Yes/No) 21 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Start-ups recruited for the development of innovative and digital technology solution for accelerated COVID-19 prevention and 0.00 5.00 response (Number) Grievances addressed within the time specified in the project 0.00 80.00 implementation manual (Percentage) Rationale: Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. Key gender-responsive messages and materials developed for public communications and advocacy, in alignment with demand No Yes plan (Yes/No) Rationale: Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. Cold rooms fully equipped (Number) 0.00 8.00 Rationale: End target increased from 2 to 8. Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. Health regions with a functional AEFI monitoring committee 0.00 100.00 (Percentage) Rationale: "Functional" added in the name of the indicator. Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. 22 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Beneficiaries reporting that community engagement and 0.00 50.00 outreach meet their needs (Percentage) Rationale: Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. Adolescents fully vaccinated, which is included in the priority 1.40 15.00 population targets defined in the national plan (Percentage) Rationale: End target increased from 5 to 15. Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. Population receiving a booster, which is included in the 0.00 30.00 population targets defined in the national plan (Percentage) Rationale: End target increased from 10 to 30. Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. Implementation Management and Monitoring and Evaluation M&E system established to monitor COVID-19 preparedness and No Yes response plan (Yes/No) Rationale: Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. Vaccination sites that transmit their data via DHIS2 (Percentage) 0.00 100.00 23 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target HMIS collecting sex and age disaggregated data on COVID-19 No Yes indicators for testing, treatment, and vaccines (Yes/No) Rationale: Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. Vaccinators trained on GBV/SEA/SH (Percentage) 0.00 95.00 Rationale: Action: This indicator has been Revised End target date extended from December 31, 2023 to June 30, 2025. health system strengthening (Action: This Component is New) Number of health facilities including CT-EPI equipped (Number) 0.00 30.00 Action: This indicator is New Number of community health staff trained in community-based 0.00 3,000.00 surveillance (Number) Action: This indicator is New IO Table SPACE 24 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) Annex 1. Guinea COVID-19 Preparedness and Response PROJECT - Action Plan Activities Implementing entities Cost Estimates Timeline (US$) (fiscal years) Component 1: Emergency COVID-19 response Production of 2,000,000 COVID-19 vaccination cards PIU/Ministry of Health 200,000 Q2 2024 (MoH) Procurement and installation of climate-sensitive cold chain PIU/MoH 4,500,000 Q3 2024 equipment, low-carbon waste management equipment, material and consumables (41,000 syringes, 5,077 safety boxes, 838 vaccine carriers, 76 coolers, 549 isothermal boxes (2°C to 8°C), eight cold rooms, refrigerated trucks, generators, coolers, 38 isothermal boxes at -80°C and vaccine carriers) through a Memorandum of Understanding with the United Nations Children's Fund (UNICEF) Maintenance service and operational cost (fuel) for the vehicles PIU/MoH 450,000 To be and generators purchased under the project maintained until Q4 2025 Training of civil society and community-based organizations in PIU/MoH 60,000 Q2 2024 communication and social mobilization for social behavior change for COVID-19 vaccination uptake Support to the communication and community engagement for PIU/MoH 2,800,000 To be COVID-19 vaccination uptake (broadcast radio and TV spots, and maintained other outreach activities, including through a Memorandum of until Q3 2025 Understanding with UNICEF) Procurement of emergency equipment, medicines, and PIU/MoH 1,000,000 Q3 2024 consumables for Epidemiological Treatment Centers (ETCs) Transport and installation of four oxygen plants and four PIU/MoH 410,000 Q3 2024 generators for four ETCs through a Memorandum of Understanding with the World Health Organization (WHO) Maintenance service and operational costs (fuel) for oxygen PIU/MoH 150,000 Q3 2024 plants Operational cost for routine COVID-19 vaccination using an PIU/MoH 400,000 To be advanced strategy (transportation, data collection, social maintained mobilization) until Q4 2025 Per-diems for COVID-19 vaccinators for the advanced strategy PIU/MoH 1,500,000 To be (under Additional Financing 1) maintained until Q4 2025 Training of vaccinators and administrative staff on the efficient PIU/MoH 90,000 To be management of COVID-19 vaccines maintained until Q4 2026 Acquisition of IT equipment for the coordination of vaccination PIU/MoH 300,000 Q4 2024 activities, including data management Consultant service for the evaluation and revision of the national PIU/MoH 25,000 Q2 2024 strategic waste management plan Consultant service for the development of the COVID-19 internal PIU/MoH 23,000 Q4 2025 waste management plans of health facilities 25 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) Training of 200 health workers in infection prevention and control PIU/MoH 95,500 Q3 2024 Procurement and installation of eight climate-friendly incinerators PIU/MoH 550,000 Q4 2024 with glass crushers and accessories Purchase of equipment and consumables for COVID-19 PIU/MoH 50,000 Q4 2024 vaccination waste management Support to the operational cost for waste management (storage, PIU/MoH 100,000 To be transport, fuel, and disposal) maintained until Q4 2025 Procurement of five boats and 10 pirogues for vaccination of PIU/MoH 80,000 Q3 2024 disadvantaged communities in hard-to-reach areas (islands) Operational cost for the vaccine PASS PIU/MoH 70,000 To be maintained until Q4 2025 Care of Adverse Events Following Immunization and functioning of PIU/MoH 260,000 To be their related committees through a Memorandum of maintained Understanding with WHO until Q4 2026 Internet connection service fees for the National Agency for PIU/MoH 280,000 To be Health Security (central level/Conakry) and the other seven maintained regions until Q4 2025 Sub-total component 1 13,393,500 Component 2 (new): Health system strengthening Sub-component 2.1: Prevention, preparedness, and response to epidemics Salary for 10 health workers PIU/MoH/Ministry of 100,500 Q3 2024 Agriculture and Livestock (MoAL)/Ministry of Environment and Sustainable Development (MoESD) Bonus for 1200 community health workers PIU/MoH/MoAL/MoESD 1,000,000 Q3 2024 Training of community health workers and health workers on PIU/MoH/MoAL/MoESD 387,385 Q3 2024 epidemic-prone diseases surveillance Scaling-up of the community-based epidemics surveillance PIU/MoH/MoAL/MoESD 200,000 Q4 2024 strategy (IT equipment and operational cost) Training of three cohorts (total of 150 participants) in frontline- PIU/MoH/MoAL/MoESD 450,000 Q2 2024, Q4 level field epidemiology/One Health approach 2024, and Q2 2025 Training of one cohort (20 participants) on the intermediate-level PIU/MoH/MoAL/MoESD 240,000 Q3 2024 field epidemiology/One Health approach Scaling-up the digitalized follow-up of sample transport PIU/MoH/MoAL/MoESD 306,708 Q1 2025 Acquisition of laboratory equipment, reagents and consumables PIU/MoH/MoAL/MoESD 450,000 Q3 2024 for the National Public Health Institute, the National Veterinary Laboratory, the Viral Hemorrhagic Fevers Laboratory and the Conakry Regional Hospital Maintenance service for the purchased laboratory equipment PIU/MoH/MoAL/MoESD 150,000 26 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) Consultant service for the assessment of the current veterinary PIU/MoAL 20,000 Q4 2024 public health plan and the development of the 2024-2028 one Acquisition of cold chain equipment for 20 livestock centers and PIU/MoAL 260,000 Q4 2024 the eight regional directorate of the MoAL Regular table-top simulation exercises and drills of infectious PIU/MoH/MoAL/MoESD 150,800 Q2 2024, Q4 disease outbreaks control 2024, Q2 2025, and Q3 2025 Training of biomedical technicians to produce and manage oxygen PIU/MoH 25,000 Q4 2024 plants Support to the intensified routine vaccination (including PIU/MoH 200,000 Q2 2024 transportation and collection data tools) Sub-total subcomponent 2.1 3,940,393 Sub-component 2.2: Improving essential health services Procurement of 61 ambulances PIU/MoH 2,500,000 Q3 2024 Procurement of 37 hearses PIU/MoH 700,000 Q4 2024 Procurement and installation of emergency medical equipment PIU/MoH 4,000,000 Q4 2024 (oxygen plants, respirators, electric syringe, cardiac monitors, resuscitation beds…) for eight regional hospitals Procurement of eight 4x4 fuel efficient vehicles for regional PIU/MoH 300,000 Q4 2024 hospitals Provision of water supplies and electricity to the Enta Nord PIU/MoH 200,000 From Q2 Hospital 2024 to Q4 2025 Rehabilitation of and provision of equipment to the Enta Nord PIU/MoH 5,000,000 From Q2 Hospital 2024 to Q4 2025 Training of 40 health workers in emergency healthcare PIU/MoH 200,000 Q2 and Q3 2024 Sub-total subcomponent 2.2 12,900,000 Sub-total component 2 16,840,393 Component 3 (originally Component 2): Project implementation management and monitoring and evaluation PIU operational cost (salaries, equipment, transportation, PIU 1,070,680 To be communication, internet, vehicles maintenance, office supplies, maintained security service, and office cleaning) until Q4 2025 Financial auditing PIU 64,000 To be maintained until Q4 2025 Research activities PIU/MoH 400,000 To be maintained until Q4 2025 27 The World Bank GUINEA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P174032) Outreach of stakeholders in national languages on the grievance PIU/MoH 50,000 To be redress mechanism (radio and TV broadcasts, field missions, etc.) maintained until Q4 2025 Support to the functioning of the vaccination call center PIU/MoH 105,000 To be maintained until Q4 2025 Training of the members of the complaints management PIU/MoH 16,100 Q2 2024 committees Training of vaccinators on gender-based violence/sexual PIU/MoH 246,761 Q1 2024 exploitation and abuse/sexual harrassment (GBV/SEA/SH) Training of stakeholders at the regional level on the management PIU/MoH 80,000 Q2 2024 of GBV/SEA/SH aspects Implementation of GBV/SEA/SH aspects PIU/MoH 35,000 Q2 2024 Monitoring and reports of the activities of the complaints PIU/MoH 50,000 To be management committees maintained until Q4 2025 Production and provision of complaints management toolkits PIU/MoH 15,000 Q1 2024 Quarterly joint supervision missions of the project's PIU/MoH 100,000 To be environmental and social safeguards performance maintained until Q4 2025 Monitoring, evaluation, and reporting of project activities PIU/MoH 300,000 To be maintained until Q4 2025 Sub-total component 3 2,532,541 Total 32,766,434 28