$ Report No: RES00272 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF OECS Regional Health Project APPROVED ON 29-Aug-2019 TO Caribbean Public Health Agency (CARPHA), Commonwealth of Dominica, Grenada, Organisation of Eastern Caribbean States (OECS), Saint Lucia, Saint Vincent and the Grenadines Health, Nutrition & Population Latin America And Caribbean Regional Vice President: Carlos Felipe Jaramillo Regional Director: Jaime Saavedra Country Director: Lilia Burunciuc Practice Manager: Tania Dmytraczenko Task Team Leader(s): Thulani Clement Matsebula, Behnaz Bonyadian Dehkordi The World Bank OECS Regional Health Project (P168539) ABBREVIATIONS AND ACRONYMS CARPHA Caribbean Public Health Agency CD Country Director CERC Contingency Emergency Response Component DHIS District Health Information Software E&S Environmental and social FELTP Field Epidemiology and Laboratory Training Program ICD-11 International Classification of Diseases 11th Revision IDA International Development Association ISR Implementation Status and Results Report OECS Organisation of Eastern Caribbean States PDO Project development objective PEF Pandemic Emergency Financing Facility RPAC Regional Project Advisory Committee WB World Bank The World Bank OECS Regional Health Project (P168539) @#&OPS~Doctype~OPS^dynamics@restrhybridbasicdata#doctemplate BASIC DATA Product Information Operation ID Operation Name P168539 OECS Regional Health Project Product/Financing Instrument Geographical Identifier Investment Project Financing (IPF) OECS Countries Approval Date Current Closing Date 29-Aug-2019 30-Jun-2026 Original EA Category Partial Assessment (B) (PAD Approval Package-29 Aug 2019) Organizations Borrower Responsible Agency Dominica - Ministry of Health, Wellness and New Caribbean Public Health Agency (CARPHA), Health Investment, Grenada - Ministry of Health, Commonwealth of Dominica, Grenada, Social Security and International Business, St Organisation of Eastern Caribbean States Vincent and the Grenadines - Public Sector (OECS), Saint Lucia, Saint Vincent and the Investment Programme Management Unit Grenadines (PSIPMU), St. Lucia - Ministry of Health and Wellness @#&OPS~Doctype~OPS^dynamics@restrhybridoperationstatus#doctemplate OPERATION STATUS Project Development Objective (DO) Original Development Objective The objective of the Project is to (i) improve preparedness capacities of health systems for public health emergencies in the OECS region, and (ii) provide a response in the event of eligible crises or emergencies. i The World Bank OECS Regional Health Project (P168539) Disbursement Summary (in USD million) Source of Funds Net Commitment Disbursed Balance % Disbursed IBRD -- -- -- 0 IDA 40.60 20.40 20.20 50.23 Grants 0.88 0.88 0.00 100.00 Policy Waivers Does this restructuring trigger the need for any policy waiver(s)? No @#&OPS~Doctype~OPS^dynamics@restrhybridmpa#doctemplate @#&OPS~Doctype~OPS^dynamics@restrhybridmpa#doctemplate ii The World Bank OECS Regional Health Project (P168539) TABLE OF CONTENTS I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING ...........................................1 II. DESCRIPTION OF PROPOSED CHANGES ........................................................................4 III. PROPOSED CHANGES ......................................................................................................4 IV. DETAILED CHANGE(S) .....................................................................................................5 The World Bank OECS Regional Health Project (P168539) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Introduction 1. This restructuring paper seeks the approval of the Country Director (CD) for a Level II Restructuring of the Organisation of Eastern Caribbean States (OECS) Regional Health Project (P168539) to extend the closing date of the Caribbean Public Health Agency (CARPHA) grant (International Development Association (IDA) Grant Number D512) by 23 months from July 31, 2024, to June 30, 2026. The implementation arrangements, the Project’s development objective (PDO) and relevant environmental and social (E&S) standards would remain unchanged. If approved, this would be the fourth restructuring1 of the Project and the first extension of the CARPHA’s grant closing date. B. Project Background 2. The OECS Regional Health Project aims to: (a) improve preparedness capacities of health systems for public health emergencies in the OECS region, and (b) provide a response in the event of eligible crises or emergencies. The Project includes participation from four countries (Dominica, Grenada, Saint Lucia, and Saint Vincent and the Grenadines) and two regional agencies (CARPHA and the OECS Commission). The Project was initially financed by four credits totaling US$21 million2 and two grants totaling US$9.6 million3 that were approved by the World Bank (WB)’s Executive Board of Directors on August 29, 2019 and declared effective between January 13, 2020 and March 5, 2020.4 Although the Project is implemented by country recipients, CARPHA plays a pivotal role in ensuring effective coordination among countries. It also focuses on building countries’ capacity in key areas relevant to the OECS Regional Health Project, such as public health surveillance, disease control, laboratory services, and the training of health care workers, among other. The Project consists of four components: (1) Improved Health Facilities and Laboratory Capacity, which is financing enhancements to the resilience and capacity of selected health facilities and laboratories to effectively respond to public health emergencies; (2) Strengthening Public Health Surveillance and 1 The Project was previously restructured on: (1) June 26, 2020 simultaneously with the approval of an additional financing to update the PDO, modify the results framework, and replenish funds to reflect the activation of the Contingency Emergency Response Component (CERC); (2) November 25, 2020 to reallocate funds across disbursement categories and modify Component 4? costing using Bank- administered Pandemic Emergency Financing Facility (PEF) funding following a cost overrun; and (3) May 24, 2024 to extend the closing dates of the IDA credits for Dominica, Grenada, Saint Lucia, and Saint Vincent and the Grenadines by 23 months, from July 31, 2024 to June 30, 2026, adjust the component costing, modify the Project’s results framework, and update the disbursement projections and implementation schedule accordingly. 2 This included SDR 2.2 million (US$3 million equivalent) to the Commonwealth of Dominica; US$6 million to Grenada; US$6 million to Saint Lucia; and US$6 million to Saint Vincent and the Grenadines. 3 This included SDR 4.8 million (US$6.6 million equivalent) to CARPHA and SDR 2.2 million (US$3 million equivalent) to the OECS Commission. 4 To declare the regional project effective, the IDA credits for both regional entities and at least two countries were required to have been declared effective, (i.e., the Financing Agreement signed, and the legal opinion issued). Page 1 The World Bank OECS Regional Health Project (P168539) Emergency Management, which is financing efforts to strengthen public health preparedness by enhancing surveillance and emergency response capabilities at national and regional levels; (3) Institutional Capacity Building, Project Management and Coordination; and (4) a Contingency Emergency Response Component (CERC), activated in 2020 to respond to the COVID-19 pandemic. C. Project Status and Performance 3. Progress towards achievement of the PDO is rated Moderately Satisfactory, as confirmed in the latest Implementation Status and Results Report (ISR), dated June 25, 2024. As of June 2024, only one PDO indicator (PDO 5 - Designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents) has been achieved, though project entities are making progress towards achievement of the remaining four indicators. Countries have made strides on activities related to the SMARTing of twenty health facilities (design and supervision contracts are underway), with works expected to begin in the next few months (St. Lucia and Saint Vincent and the Grenadines are leading these processes). Activities are also advancing on laboratory and surveillance, as well as on emergency management. These include, for example, activities to support laboratories’ accreditations or improved surveillance (e.g., procurement of laboratory equipment, reagents, and provision of capacity building), construction of a new public health laboratory in Saint Vincent and the Grenadines, improved isolation capacity, and Field Epidemiology and Laboratory Training Program (FELTP) trainings. During the proposed 23- month extension period, CARPHA will focus on achieving the remaining indicator targets that are yet to be met. This includes various indicators related to strengthening surveillance capacities, such as enhancing indicator and event-based surveillance (PDO3 indicator), utilizing electronic tools for surveillance, and developing protocols for gender- specific surveillance. Additionally, CARPHA will concentrate on strengthening the capacities of countries in key project areas. This will involve conducting in-country workshops to increase the number of trained and certified shippers of infectious substances, providing various training sessions on laboratory equipment and services, and boosting overall capacities to meet and measure their indicators’ targets. 4. Overall Implementation Progress is also rated Moderately Satisfactory. As of July 17, 2024, the US$0.88 million Pandemic Emergency Financing Facility (PEF) grant is fully disbursed and US$20.4 million of the US$40.6 million total IDA proceeds (equivalent to 50.2 percent) have been disbursed. Disbursements up to June 30, 2023 (date of CERC closure) primarily focused on CERC-related expenditures. To improve project implementation, between November 2023 and March 2024 all four countries developed detailed, time-bound action plans to accelerate disbursement and activities, now under implementation. These plans, combined with a strategic shift since mid-2022 to focus on Components 1 and 2, and the additional allocation of staff by participating countries, have led to improved performance. CARPHA, in turn, has disbursed US$3.89 million of its US$6.38 million equivalent grant (60.9 percent). The remaining funds are allocated for strengthening laboratory services through procurement and harmonization of equipment and reagents, improving procurement systems, training on equipment maintenance, procuring laboratory equipment and reagents for the Caribbean Reference Laboratory, and enhancing CARPHA and countries' laboratories’ information systems. Funds will also enhance surveillance capacities through FELTP trainings, including mentorship, train-the- trainer courses, and upgrading an e-learning platform. Additional efforts include Page 2 The World Bank OECS Regional Health Project (P168539) strengthening mortality surveillance, supporting the International Classification of Diseases 11th Revision (ICD-11) rollout, implementing District Health Information Software (DHIS) at CARPHA and in participating countries, and developing an online technical platform for data management. Emergency management activities include developing a regional preparedness and response action plan. CARPHA will also provide additional capacity building to participating countries in areas such as monitoring and evaluation and procurement. 5. Project Management. Safeguards performance is rated Satisfactory, and the Project remains in compliance with environmental and social commitments. Other key Project ratings (Financial Management, Project Management, Procurement, Monitoring and Evaluation) remain assessed as Moderately Satisfactory. CARPHA’s interim financial reports are up to date, there are no overdue audit reports, and all audit reports received to date have been considered satisfactory to the Bank. CARPHA remains in compliance with key legal covenants. Considering the challenges of this complex project and the various implementation agencies, the WB team continues to put in place mitigation measures to ensure effective project supervision. For example, the WB has provided additional procurement support to the entities, including to CARPHA, through the hiring of an international Procurement Specialist, utilizing the generous funding of the Canada- Caribbean Resilience Facility Trust Fund. In addition, the team has also ensured monitoring and evaluation of key indicators through support of short-term consultants with expertise in Emergency Management and Surveillance during the first few years of project implementation. As requested by the four participating countries, CARPHA will deploy part of its grant during the 23-months extension to continue enhancing procurement and monitoring and evaluation capacities in them. This effort aims to improve compliance, accelerate project implementation, and build long-lasting capacities in these countries that will extend beyond the life of the project. D. Rationale for Restructuring 6. On July 5, 2024, the CARPHA sent a formal request to the WB to restructure the Project to extend the respective grant closing date by 23 months. The request was initiated following the 10th Regional Project Advisory Committee (RPAC) meeting, held on June 5-6, 2024 in Washington, D.C. The meeting included hybrid participation from all six project entities. At this meeting, the four participating countries highlighted the significance of CARPHA's involvement for the successful execution of the project's regional strategy. CARPHA is instrumental in coordinating the biannual RPAC meetings, enhancing capacity in monitoring and evaluation, surveillance, and laboratory services, and facilitating regular discussions among project stakeholders to make informed decisions on emergency management. As a regional body, CARPHA assists the participating countries in carrying out their respective activities. Despite the proximity of the current closing date and the recent increase in funds availability for similar objectives, CARPHA has indicated its readiness to extend support throughout the proposed 23-month extension period with the available undisbursed grant allocation. The agency is recruiting additional staff to manage its increased workload from other new grant sources available to it. 7. CARPHA developed and shared with the WB a detailed action plan to complement the country-specific action plans for the remainder of the revised project implementation period, addressing specific participating country Page 3 The World Bank OECS Regional Health Project (P168539) requests. The plan specifies adjusted timelines for activities that will not be finalized by the current grant closing date, ensuring alignment with the respective country action plans and full disbursement of the grant. It also incorporates requests from the countries to bolster laboratory, monitoring and evaluation, and procurement capacity building for Ministry of Health personnel. This proposed extension would allow sufficient time to complete CARPHA grant-financed activities, thereby facilitating full utilization of the grant proceeds and giving continuation to the Project’s regional approach. II. DESCRIPTION OF PROPOSED CHANGES 8. The proposed restructuring would extend the closing date of the CARPHA grant (IDA Grant Number D512) under the OECS Regional Health Project by 23 months from July 31, 2024, to June 30, 2026. This extension would align with the closing dates of the IDA credits for the participating countries and is needed to both allow sufficient time to finalize ongoing CARPHA’s activities and to enhance coordination among the four participating countries and bolster their capacity to carry out project activities. 9. The Project’s implementation schedule and disbursement estimates, as well as the end target date for indicators not yet achieved, would be adjusted accordingly to reflect the closing date extension. No other changes are proposed. Disbursement projections will be updated to reflect the extension in timeline for use of grant funds under Component 1-3, as well as projections generated in the action plan, in the next ISR submission following this restructuring. @#&OPS~Doctype~OPS^dynamics@restrhybridsummarychanges#doctemplate Summary changes III. PROPOSED CHANGES Operation Proposed Operation Proposed Information Changes Information Changes Loan Closing Date Results Yes Yes Extension Disbursements Implementation Yes Yes Estimates Schedule Development Objective No Loan Cancellations No Safeguard Policies No Reallocations No Triggered ISDS No Financial Management No Page 4 The World Bank OECS Regional Health Project (P168539) MFD/PCE No Procurement No Institutional Risks No No Arrangement Legal Covenants No Conditions No Implementation No Modalities Disbursements No Arrangements DDO No Clients No Appraisal Summary No Components No @#&OPS~Doctype~OPS^dynamics@restrhybriddetailedchanges-disclose#doctemplate IV. DETAILED CHANGE(S) COSTS & FINANCING Private Capital Facilitation Is this an MFD-Enabling Project (MFD-EP)? Is this project Private Capital Enabling (PCE)? LOANS Loan Closing Proposed Original Revised Proposed Loan/Credit/T Deadline for Status Closing Closing(s) Closing rust Fund Withdrawal Applications IDA-64760-001 Effective 31-Jul-2024 30-Jun-2026 IDA-64770-001 Effective 31-Jul-2024 30-Jun-2026 IDA-64780-001 Effective 31-Jul-2024 30-Jun-2026 IDA-64810-001 Effective 31-Jul-2024 30-Jun-2026 Page 5 The World Bank OECS Regional Health Project (P168539) IDA-67300-001 Effective 31-Jul-2024 30-Jun-2026 IDA-67310-001 Effective 31-Jul-2024 30-Jun-2026 IDA-67320-001 Effective 31-Jul-2024 30-Jun-2026 IDA-D5120-001 Effective 31-Jul-2024 31-Jul-2024 30-Jun-2026 30-Oct-2026 IDA-D5130-001 Effective 31-Jul-2024 31-Jul-2024 TF-B4548-001 Closed 31-Jan-2021 31-Jan-2021 DISBURSEMENTS Operation Dates & Projection Details Reasons to change the full Disbursement date and/or the projection Restructuring, Change in Pace of Implementation Implementation Start Date Operation Closing Date 29-Aug-2019 30-Jun-2026 Projected Date for Full Disbursement 30-Oct-2026 Expected Disbursements (in US $) (Absolute) Original Estimation at Actual Preparation Year Revised Estimation (Approval Package – 29 Aug 2019) FY2020 110,251.80 4,675,000.00 5,077,577.68 FY2021 3,237,051.60 9,342,857.00 7,032,646.52 FY2022 6,050,323.80 11,200,000.00 3,080,796.52 FY2023 8,450,128.80 9,300,000.00 2,968,439.53 FY2024 8,508,483.00 5,300,000.00 3,115,700.33 FY2025 3,022,637.40 1,300,000.00 0.00 FY2026 0.00 0.00 0.00 FY2027 0.00 0.00 0.00 Page 6 The World Bank OECS Regional Health Project (P168539) RESULTS COUNTRY: Dominica, Grenada, St. Lucia, St. Vincent and the Grenadines OECS Regional Health Project @#&OPS~Doctype~OPS^dynamics@restrannexpolicyandresult#doctemplate PDO Indicators by PDO Outcomes Public health emergency preparedness Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 4.00 Jun/2026 Comments on **As of June 2024, design and supervision consultancies to contribute to achieving targets progress on this indicator have started in the four countries. Civil works required in order to contribute to progress on this indicator will be starting soon, with some countries advancing with their procurement. In Dominica, D&S consultancy is underway, detailed designs and other Number of countries with bidding documents expected to be finalized in July/August 2024 for health system capacity to launching of the works bidding process. withstand extreme weather events based on A-70 rating In Grenada: D&S consultancy started in April, first detailed designs are on Smart Health Facility expected to be ready in August 2024. standards (Number) In St Lucia – 11 health facilities are being refurbished. All detailed designs have been prepared, with preparation of bidding documents by packages for works being underway. The process was already launched for Delcer and Canaries, and techncial and financial proposals are under evaluation. The Bid Evaluation Report for one facility has been completed and approved by the CPPB. The bid evaluation for one more facility is underway. A combined package for three facilities is being finalized to be Page 7 The World Bank OECS Regional Health Project (P168539) launched for procurement of SMART retrofitting works. Works may start in Q1 FY25. SVG: One health facility to be retrofitted out of the 3 selected due to budget shortage and prioritization of the public health lab construction. Bidding process was relaunched due to lack of proposals received. Contract signature is expected in August for works. ** This indicator reflects a combined value of the Hospital Safety Index (HSI) and Green Score based on the Smart Hospital/Health Facilities Index developed by PAHO. HSI category A reflects a facility that is able to continue functioning following a disaster. A Green Score of 70 reflects achievement of 70 percent on the Green checklist. This reflects the total number of countries that have Smart Health Facilities supported by the OECS Regional Health Project. Dominica: Health 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 3.00 Jun/2026 system capacity to Comments on Indicator based on Smart Hospital/Health Facilities Index. This reflects the number of withstand extreme achieving targets health facilities Smarted under the OECS Regional Health Project. weather events based on Smart Health Facility standards (Number) Grenada: Health system 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 4.00 Jun/2026 capacity to withstand Comments on Indicator based on Smart Hospital/Health Facilities Index. This reflects the number of extreme weather events achieving targets health facilities Smarted under the OECS Regional Health Project. based on Smart Health Facility standards (Number) Saint Lucia: Health 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 11.00 Jun/2026 system capacity to Comments on Indicator based on Smart Hospital/Health Facilities Index. This reflects the number of withstand extreme achieving targets health facilities Smarted under the OECS Regional Health Project. weather events based on Smart Health Facility standards (Number) 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 1.00 Jun/2026 Page 8 The World Bank OECS Regional Health Project (P168539) Saint Vincent and the Comments on Indicator based on Smart Hospital/Health Facilities Index. This reflects the number of Grenadines: Health achieving targets health facilities Smarted under the OECS Regional Health Project. system capacity to withstand extreme weather events based on Smart Health Facility standards (Number) Public health emergency preparedness Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year 1.00 Apr/2019 1.00 05-Mar-2024 1.00 05-Mar-2024 5.00 Jun/2026 Comments on *** Updates as of June 2024: Countries continue advancing in various achieving targets processes for the stregenthening of lab capacities. Specifically: - Dominica: Ultra low temperature freezers and equipment procurement is underway to enhance lab capacities, and bidding documents for the accreditation of the national lab are being prepared. - Grenada: Grenada is pursuing lab accreditation (contract underway) and Number of countries/regional procurement of diagnostic equipment for labs (contract signature expected entities with laboratory in June/July), IT equipment procurement for labs is in evaluation phase. The testing capacity for detection of priority diseases based on procurement processes for various other lab strengthening activities may achievement/sustainment of a be starte in the next few months, depending on progress in defining the JEE score of 4.0 or higher specifications. These involve: procurement of furniture and equipment for (Number) labs and to strengthen LMIS operations, consultancy to deliver short term training for medical lab technicians, consultancy to develop a national training programme for lab technicians, STC to support lab accreditation processes, the development of the medteh curriculum. - Saint Lucia: Accreditation of two labs is ongoing, as well as the procurement of equipment for entomology lab (contract underway). In the next six months, the procurement of refrigerators for storage of specimen will be advanced, as this is currently under evaluation of quotes. Page 9 The World Bank OECS Regional Health Project (P168539) - Saint Vincent and the Grenadines: the country main initiative under the project to strengthen lab capacity is to build a new public health lab (PHL) for the expansion of lab services. Detailed designs are under devlopment, with the Bank having already provided feedback. Procurement of lab equipment, computer software and hardware, and reagents for the PHL will be done under the project, in coordination with the construction timeline. Other activities for the enhancement of detection capacities relate to the supply of labs equipment (such as Molbio equipment for the detection of food and water bourne pahogens), for which the procurement process is underway, and the lab data management and interoperabiliuty with health and surveillance system (specifications being developed). An activity for Training and capacity building for laboratory services as well as an activity to strenghten LQMS through lab accreditation, will be launched in the next six months.*** JEE Question D.1.1. Capacity graded on a scale of 1-5 where: 1 = no capacity (laboratory surveillance system is not capable of conducting any core tests) 2 = limited capacity (laboratory system is capable of conducting 1-2 out of 10 core tests) 3 = developed capacity (laboratory system is capable of conducting 3-4 of 10 core tests) 4 = demonstrated capacity (laboratory system is capable of conducting 5 or more of 10 core tests) 5 = sustainable capacity (laboratory system is capable of conducting 5 or more of 10 core tests and quality assurance systems are in place and tested) Dominica: Laboratory 2.00 Apr/2019 2.00 05-Mar-2024 2.00 05-Mar-2024 4.00 Jun/2026 testing capacity for Comments on Capacity graded as described in JEE Question D.1.1. detection of priority achieving targets diseases based on JEE score (Number) 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 Page 10 The World Bank OECS Regional Health Project (P168539) Grenada: Laboratory Comments on Capacity graded as described in JEE Question D.1.1. testing capacity for achieving targets detection of priority diseases based on JEE score (Number) Saint Lucia: Laboratory 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 testing capacity for Comments on Capacity graded as described in JEE Question D.1.1. detection of priority achieving targets diseases based on JEE score (Number) Saint Vincent and the 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 Grenadines: Laboratory Comments on Capacity graded as described in JEE Question D.1.1. testing capacity for achieving targets detection of priority diseases based on JEE score (Number) CARPHA: Laboratory 4.00 Apr/2019 4.00 05-Mar-2024 4.00 05-Mar-2024 4.00 Jul/2024 testing capacity for Comments on Capacity graded as described in JEE Question D.1.1. It is important to note that while the detection of priority achieving targets baseline and targets are the same, IHR capacities also refer to maintaining all essential diseases based on JEE public health functions needed to apply and comply with the IHR. In other words, efforts score (Number) need to continuously be made to maintain higher scores achieved. Public health emergency preparedness Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year 1.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 5.00 Jun/2026 Comments on *** Updates as of June 2024: Gains continue to be made across countries Number of countries/regional achieving targets entities with indicator and for this indicator – moving closer to a “4” target for each country. FETP event-based surveillance training has been conducted in all countries (and continues), with the established based on support from CARPHA, which is the training provider. achievement/sustainment of Grenada: surveillance strengthening activities include the training to JEE score of 4.0 or higher (Number) provide morbidity and mortality surveillance; Consultancy on ICD 10; cancer registry activity. In the next six months, a consultancy to optimize HMIS will be developed. Saint Lucia: In the last six months, the country has Page 11 The World Bank OECS Regional Health Project (P168539) developed the TORs for the improvement of the online functiona lity of the National Communicable Disease Surveillance Manual, to be launched in the next six months. Two additional activities will bedvanced to enhance the surveillance capacity in the country: a) The country is developing the specifications for a consultancy to support the Event-based Surveillance Strategy; b) procurement of electronic surveillance system (PIU working with the health information unit to develop specifications). Saint Vincent and the Grenadines: in the last six months, the country has focu sed on producing the bidding documents to enhance surveillance through a consultancy to Develop Port Health Protocols and Environmental Health Surveillance System Manuals. By the next ISR the project would have been launched and advanced these activities. Training on Vector Control management is ongoing. **** JEE Question D.2.1. Capacity graded on a scale of 1-5 where: 1 = no capacity (no indicator or event-based surveillance system exists) 2 = limited capacity (indicator or event-based surveillance system established in next year) 3 = developed capacity (indicator or event-based surveillance system in place) 4 = demonstrated capacity (indicator and event-based surveillance system in place) 5 = sustainable capacity (indicator and event-based surveillance system in place and regularly evaluated and updated, and country/regional entity contributes to regional/international surveillance networks) Dominica: Indicator and 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 event-based Comments on Capacity graded as described in JEE Question D.2.1. surveillance established achieving targets based on JEE score (Number) Grenada: Indicator and 2.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 event-based Comments on Capacity graded as described in JEE Question D.2.1. surveillance established achieving targets based on JEE score (Number) Page 12 The World Bank OECS Regional Health Project (P168539) Saint Lucia: Indicator 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 and event-based Comments on Capacity graded as described in JEE Question D.2.1. surveillance established achieving targets based on JEE score (Number) Saint Vincent and the 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 Grenadines: Indicator Comments on Capacity graded as described in JEE Question D.2.1. and event-based achieving targets surveillance established based on JEE score (Number) Revise CARPHA: Indicator 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 and event-based Comments on Capacity graded as described in JEE Question D.2.1. It is important to note that while the surveillance established achieving targets baseline and targets are the same, IHR capacities also refer to maintaining all essential based on JEE score public health functions needed to apply and comply with the IHR. In other words, efforts (Number) need to continuously be made to maintain higher scores achieved. Public health emergency preparedness Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 4.00 Jun/2026 Comments on **Update as of June 2024: While, all countries have an HEOC in place, achieving targets capacity must be at least at a score of 4 to be recorded here. All countries are advancing on this regard: Number of countries with emergency operations center Dominica: Dominica has made advances in terms of emergency (EOC) capacities, procedures, management under the project, thus upgrading their EM indicators. A and plans in place based on Multi-Hazards Plan and Concept of Operations was completed and achievement/sustainment of approved by Cabint following assistance received from World Bank JEE score of 4.0 or higher (Number) consultants. Socialization, through a stakeholders engagement event will be needed and pursued in the next six months (note: government has requested the TA from the WB funded emergency management consultant for this activity). In addition, in the next six months, the procurement of equipment for HEOC will be advanced (bidding documents prepared Page 13 The World Bank OECS Regional Health Project (P168539) already). PAHO is supporting EM activities in the country, with WB supporting the logistics in some of these activities. Grnada: an AAR has been completed. A training workshop for the Health Disaster Committee and key stakeholders to present the updated Multi- Hazard Plan and procedures will be pursued; the recruitment of a short- term consultant/consulting firm to train a cadre of EMT's for EOC operation will advance in the next six months (client is identifying possible suppliers to define specifications); specifications for comms equipment for HEOC are being identified to advance the procurement in the next six months, among others. Saint Lucia: the country advanced in the last six months with the reports on an AAR and the assessment of risk using the STAR assessment. Also, a radio communications network assessment has been started under the project and the consultancy is expected to be completed in the next six months. Also, in the next six months, the following activities will be kicked off: the development of an emergency management training syllabus, training and simulation exercise in the use of the EOCs; updating the national health sector multi-haard emergency/disaster management plan. Saint Vincent and the Grenadines: In the next six months, the following will be a dvanced: the update of the National One Health All- Hazard Management Plan (bidding process started, evaluation ongoing); procurement of EOC equipment (specifications being prepared). ** JEE Question R.2.2. Capacity graded on a scale of 1-5 where: 1 = no capacity (no EOC structure or plans/procedures in place) 2 = limited capacity (EOC structure in place and responds to emergencies on ad hoc basis) 3 = developed capacity (EOC structures, plans, resources and trained staff in place. Not yet capable of responding to an alert within 120 minutes) 4 = demonstrated capacity (National EOC system in place and able to respond to emergency within 120 minuts, functions have been tested and updated in past 2 years. Structures and plans available at sub- national level.) 5 = sustainable capacity (All national and sub-national Page 14 The World Bank OECS Regional Health Project (P168539) systems tested and updated regularly. EOC operations can be sustained for large-scale or concurrent emergencies.) Dominica: Emergency 1.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 operations center (EOC) Comments on Capacity graded as described in JEE Question R.2.2. capacities, procedures, achieving targets and plans in place based on JEE score (Number) Grenada: Emergency 1.00 Apr/2019 2.00 05-Mar-2024 2.00 05-Mar-2024 4.00 Jun/2026 operations center (EOC) Comments on Capacity graded as described in JEE Question R.2.2. capacities, procedures, achieving targets and plans in place based on JEE score (Number) Saint Lucia: Emergency 3.00 Apr/2019 5.00 05-Mar-2024 5.00 05-Mar-2024 4.00 Jun/2026 operations center (EOC) Comments on Capacity graded as described in JEE Question R.2.2. capacities, procedures, achieving targets and plans in place based on JEE score (Number) Saint Vincent and the 1.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 Grenadines: Emergency Comments on Capacity graded as described in JEE Question R.2.2. operations center (EOC) achieving targets capacities, procedures, and plans in place based on JEE score (Number) Response to eligible public health emergencies Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Designated laboratories with 1.00 May/2020 2.00 13-Dec-2023 2.00 13-Dec-2023 2.00 Dec/2021 COVID-19 diagnostic Comments on Indicator's target achieved. equipment, test kits, and achieving targets reagents (Number) Page 15 The World Bank OECS Regional Health Project (P168539) Grenada - Designated 0.00 May/2020 1.00 13-Dec-2023 1.00 13-Dec-2023 1.00 Dec/2021 laboratories with COVID- 19 diagnostic equipment, test kits, and reagents (Number) SVG - Designated 1.00 Jun/2020 1.00 13-Dec-2023 1.00 13-Dec-2023 1.00 Dec/2021 laboratories with COVID- 19 diagnostic equipment, test kits, and reagents (Number) Intermediate Results Indicators by Components Improved Health Facilities and Laboratory Capacity Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Number of countries with 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 100.00 Jun/2026 100% of proposed facility Comments on *** See updates by country regarding the SMARTing of health facilities in upgrades completed to achieving targets withstand extreme weather respective PDO indicator comments. *** events based on Smart Health Percentage of facilities completed according to program plans Facility standards (Percentage) Dominica: Completed 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 100.00 Jun/2026 proposed facility Comments on Percentage of facilities completed according to program plans upgrades to withstand achieving targets extreme weather events based on Smart Health Facility standards (Percentage) 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 100.00 Jun/2026 Page 16 The World Bank OECS Regional Health Project (P168539) Grenada: Completed Comments on Percentage of facilities completed according to program plans proposed facility achieving targets upgrades to withstand extreme weather events based on Smart Health Facility standards (Percentage) Saint Lucia: Completed 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 100.00 Jun/2026 proposed facility Comments on Percentage of facilities completed according to program plans upgrades to withstand achieving targets extreme weather events based on Smart Health Facility standards (Percentage) Saint Vincent and the 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 100.00 Jun/2026 Grenadines: Completed Comments on Percentage of facilities completed according to program plans proposed facility achieving targets upgrades to withstand extreme weather events based on Smart Health Facility standards (Percentage) Number of countries/regional 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 5.00 Jun/2026 entities that complete 100 Comments on **** See updates by country regarding the lab upgrades in respctive PDO percent of proposed achieving targets laboratory upgrades indicator comments. *** (Percentage) Percentage of facilities completed according to program plans Dominica: Completed 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 100.00 Jun/2026 proposed laboratory Comments on Percentage of facilities completed according to program plans upgrades achieving targets (Percentage) Grenada: Completed 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 100.00 Jun/2026 proposed laboratory Comments on Percentage of facilities completed according to program plans upgrades achieving targets (Percentage) 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 100.00 Jun/2026 Page 17 The World Bank OECS Regional Health Project (P168539) Saint Lucia: Completed Comments on Percentage of facilities completed according to program plans proposed laboratory achieving targets upgrades (Percentage) Saint Vincent and the 0.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 100.00 Jun/2026 Grenadines: Completed Comments on Percentage of facilities completed according to program plans proposed laboratory achieving targets upgrades (Percentage) CARPHA: Completed 0.00 Apr/2019 60.00 05-Mar-2024 100 19-Jul-2024 100.00 Jul/2024 proposed laboratory Comments on Percentage of facilities completed according to program plans upgrades achieving targets (Percentage) 0.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 5.00 Jun/2026 Comments on *** See updates by country in respective PDO indicator comments. achieving targets Dominica and Grenada are the two countries that still need to achieve the target for this indicator. On this regard: a) Dominica: Ultra low temperature freezers to enhance specimen referral and transportation; lab accreditation procurement process will be launched shortly; b) Grenada is pursuing lab accreditation (contrct underway) and procurement of equipment for labs, Number of countries/regional which may influence in their specimen referral and transportation systems entitites with specimen (more information to be provided in the next ISR). *** referral and transportation systems based on JEE Question D.1.2. Capacity graded on a scale of 1-5 where: 1 = no achievement/sustainment of capaciy (no system in place to transport specimens from sub-national to JEE score of 4.0 or higher national labs; transportation is ad hoc) 2 = limited capacity (system is in (Number) place to transport specimens to national labs from <50% of sub-national labs for advanced diagnostics) 3 = developed capacity (system is in place to transport specimens to national labs from 50-80% of sub-national labs for advanced diagnostics) 4 = demonstrated capacity (system is in place to transport specimens to national labs from at least 80% of sub-national labs for advanced diagnostics) 5 = sustainable capacity (systems in place to transport specimens to/from other labs in the region and funded from hos country budget) Page 18 The World Bank OECS Regional Health Project (P168539) Dominica: Specimen 2.00 Apr/2019 2.00 05-Mar-2024 2.00 05-Mar-2024 4.00 Jun/2026 referral and Comments on Capacity graded as described in JEE Question D.1.2. transportation systems achieving targets based on JEE score (Number) Grenada: Specimen 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 referral and Comments on Capacity graded as described in JEE Question D.1.2. transportation systems achieving targets based on JEE score (Number) Saint Lucia: Specimen 1.00 Apr/2019 4.00 05-Mar-2024 4.00 05-Mar-2024 4.00 Jun/2026 referral and Comments on Capacity graded as described in JEE Question D.1.2. transportation systems achieving targets based on JEE score (Number) Saint Vincent and the 3.00 Apr/2019 4.00 05-Mar-2024 4.00 05-Mar-2024 4.00 Jun/2026 Grenadines: Specimen Comments on Capacity graded as described in JEE Question D.1.2. referral and achieving targets transportation systems based on JEE score (Number) CARPHA/OECS: 3.00 Apr/2019 4.00 05-Mar-2024 4.00 05-Mar-2024 4.00 Jul/2024 Specimen referral and Comments on Capacity graded as described in JEE Question D.1.2. transportation systems achieving targets based on JEE score (Number) 1.00 Apr/2019 1.00 05-Mar-2024 1.00 05-Mar-2024 5.00 Jun/2026 Comments on ***See updates on lab quality systems in respective PDO indicators. Most Number of countries/regional achieving targets countries under the project have lab accreditation processes underway for entitites with quality improvement of lab quality systems.*** laboratory systems based on achievement/sustainment of JEE Question D.1.4. Capacity graded on a scale of 1-5 where: 1 = no JEE score of 4.0 or higher capacity (no national laboratory standards) 2 = limited capacity (quality (Number) standards developed but no system for verifying their implementation) 3 = developed capacity (system of licensing laboratories including conformity to national standards exists but is voluntary or is not a requirement for all Page 19 The World Bank OECS Regional Health Project (P168539) laboratories) 4 = demonstrated capacity (mandatory licensing of all laboratories is in place and conformity to national standards is required) 5 = sustainable capacity (mandatory licensing of all laboratories is in place and conformity to an international standard is required) Dominica: Quality 2.00 Apr/2019 2.00 05-Mar-2024 2.00 05-Mar-2024 4.00 Jun/2026 laboratory systems Comments on Capacity graded as described in JEE Question D.1.4. based on JEE score achieving targets (Number) Grenada: Quality 2.00 Apr/2019 2.00 05-Mar-2024 2.00 05-Mar-2024 4.00 Jun/2026 laboratory systems Comments on Capacity graded as described in JEE Question D.1.4. based on JEE score achieving targets (Number) Saint Lucia: Quality 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 laboratory systems Comments on Capacity graded as described in JEE Question D.1.4. based on JEE score achieving targets (Number) Saint Vincent and the 3.00 Apr/2019 2.00 05-Mar-2024 2.00 05-Mar-2024 4.00 Jun/2026 Grenadines: Quality Comments on Capacity graded as described in JEE Question D.1.4. laboratory systems achieving targets based on JEE score (Number) 4.00 Apr/2019 5.00 05-Mar-2024 5.00 05-Mar-2024 4.00 Jul/2024 CARPHA: Quality laboratory systems Comments on Capacity graded as described in JEE Question D.1.4. It is important to note that while the based on JEE score achieving targets baseline and targets are the same, IHR capacities also refer to maintaining all essential (Number) public health functions needed to apply and comply with the IHR. In other words, efforts need to continuously be made to maintain higher scores achieved. 3.00 May/2019 4.00 05-Mar-2024 4.00 05-Mar-2024 4.00 Jul/2024 Comments on ***Updates to be provided in the next ISR *** CARPHA/OECS: System in achieving targets place for activating and JEE Question R.4.1. Capacity graded on a scale of 1-5 where: 1 = no coordinating medical capacity (no national countermeasure plans in place) 2 = limited capacity countermeasures during a (plans have been drafted, but no exercises have been conducted) 3 = public health emergency developed capacity (plans are in place, and tabletop exercises have been (Number) conducted to demonstrate sending or receiving of medical countermeasures during a public health emergency) 4 = demonstrated Page 20 The World Bank OECS Regional Health Project (P168539) capacity (plans are in place, and at least one response/formal exercise/simulation within the previous year in which medical countermeasures were sent or received) 5 = sustainable capacity (Country participates in a regional/international partnership or has formal agreement with another country or international organization that outlines criteria and procedures for sending and receiving medical ountermeasures and has participated in an exercise or response within the past year to practice deployment or receipt of medical countermeasures) Strengthening Public Health Surveillance and Emergency Management Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Revise Number of public health 0.00 Apr/2019 1.00 05-Mar-2024 1.00 05-Mar-2024 4.00 Jun/2026 emergency plans that document incorporation of feedback from key populations (Number) ReviseCARPHA: Protocols No May/2019 No 05-Mar-2024 No 05-Mar-2024 Yes Jun/2026 developed for gender-specific surveillance of priority infectious diseases (Yes/No) Revise OECS: Number of 1.00 May/2019 4.00 05-Mar-2024 4.00 05-Mar-2024 4.00 Jul/2024 countries with training in the Minimum Initial Service Package for sexual and reproductive health in emergencies and disasters (Number) Number of countries/regional 1.00 Apr/2019 0.00 05-Mar-2024 0.00 05-Mar-2024 5.00 Jun/2026 entities that use electronic Comments on ***** Updates as of June 2024: tools for surveillance based on achieving targets achievement/sustainment of - Grenada: In the next six months, the procurement process for a JEE score of 4.0 or higher consultancy to optimize HMIS will be developed, taking into account the (Number) results of assessments recently completed by PAHO. - Saint Lucia: the PIU Page 21 The World Bank OECS Regional Health Project (P168539) is wo rking with the health information unit to develop the specifications for the procurement of an electronic surveillance system. - Saint Vincent and the Grenadines: EOC equipment to be procured under the project will be used to improve electronic survei llance. In addition, surveillance systems will be improved through updates manuals and protocols (consultancy to Develop Port Health Protocols and Environmental Health Surveillance System Manuals), as well as training (Vector Control management training ongoing). **** JEE Question D.2.2. Capacity graded on a scale of 1-5 where: 1 = no capacity (no electronic tool to collect, report or analyze surveillance data) 2 = limited capacity (ad hoc electronic tools have been developed to collect, report or analyze surveillance data or the country is developing an integrated electronic real-time reporting system for public health surveillance) 3 = developed capacity (integrated electronic real-time reporting system for public health surveillance in place at all levels of health system, but system is not able to share data in real time) 4 = demonstrated capacity (integrated electronic real-time reporting sysem for public health surveillance in place at all levels of health system, and data can be shared in real time) 5 = sustainable capacity (integrated electronic real-time reporting system for public health surveillance in place at all levels of health system, and system is linked to with other regional and/or international systems to promote data sharing) Dominica: Use of 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 electronic tools for Comments on Capacity graded as described in JEE Question D.2.2. surveillance based on achieving targets JEE score (Number) Grenada: Use of 2.00 Apr/2019 3.00 12-Jun-2024 3.00 12-Jun-2024 4.00 Jun/2026 electronic tools for Comments on Capacity graded as described in JEE Question D.2.2. surveillance based on achieving targets JEE score (Number) 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 Page 22 The World Bank OECS Regional Health Project (P168539) Saint Lucia: Use of Comments on Capacity graded as described in JEE Question D.2.2. electronic tools for achieving targets surveillance based on JEE score (Number) Saint Vincent and the 3.00 Apr/2019 2.00 05-Mar-2024 2.00 05-Mar-2024 4.00 Jun/2026 Grenadines: Use of Comments on Capacity graded as described in JEE Question D.2.2. electronic tools for achieving targets surveillance based on JEE score (Number) Revise 4.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 CARPHA: Use of Comments on Capacity graded as described in JEE Question D.2.2. It is important to note that while the electronic tools for achieving targets baseline and targets are the same, IHR capacities also refer to maintaining all essential surveillance based on public health functions needed to apply and comply with the IHR. In other words, efforts JEE score (Number) need to continuously be made to maintain higher scores achieved. 1.00 Nov/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 5.00 Jun/2026 Comments on **** All countries have received FETP training from CARPHA, which are still achieving targets advancing. This indicator will be updated in the next ISR, as more training may be upcoming in the next few months, considering that St Lucia and Dominica are the two countries that have not achieved the indicator. *** Number of countries/regional entitites receiving FETP or JEE Question D.4.4. Capacity graded on a scale of 1-5 where: 1 = no other applied epidemiology capacity (no FETP or applied epidemiology training established at national training based on level) 2 = limited capacity (no FETP or applied epidemiology training achievement/sustainment of established at national level, but staff participate in training in other JEE score of 4.0 or higher (Number) countries) 3 = developed capacity (one level of FETP – basic, intermediate or advanced - or applied epidemiology training in place at national level or in another country through an existing agreement) 4 = demonstrated capacity (two levels of FETP – basic, intermediate or advanced - or applied epidemiology training in place at national level or in another country through an existing agreement) 5 = sustainable capacity (three levels of FETP – basic, intermediate or advanced - or applied epidemiology training Page 23 The World Bank OECS Regional Health Project (P168539) in place at national level or in another country through an existing agreement, and there is sustainable national funding) Dominica: 2.00 Apr/2019 2.00 05-Mar-2024 2.00 05-Mar-2024 4.00 Jun/2026 Basic/frontline FETP Comments on Capacity graded as described in JEE Question D.4.4. training or other applied achieving targets epidemiology training received based on JEE score (Number) Grenada: Basic/frontline 4.00 Apr/2019 4.00 05-Mar-2024 4.00 05-Mar-2024 4.00 Jun/2026 FETP training or other Comments on Capacity graded as described in JEE Question D.4.4. It is important to note that while the applied epidemiology achieving targets baseline and targets are the same, IHR capacities also refer to maintaining all essential training received based public health functions needed to apply and comply with the IHR. In other words, efforts on JEE score need to continuously be made to maintain higher scores achieved. (Number) Saint Lucia: 3.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 Basic/frontline FETP Comments on Capacity graded as described in JEE Question D.4.4. training or other applied achieving targets epidemiology training received based on JEE score (Number) Saint Vincent and the 2.00 Apr/2019 4.00 05-Mar-2024 4.00 05-Mar-2024 4.00 Jun/2026 Grenadines: Comments on Capacity graded as described in JEE Question D.4.4. Basic/frontline FETP achieving targets training or other applied epidemiology training received based on JEE score (Number) CARPHA: Regional 2.00 Apr/2019 4.00 05-Mar-2024 4.00 05-Mar-2024 4.00 Jul/2024 (intermediate/advanced) Comments on Capacity graded as described in JEE Question D.4.4. FETP training or other achieving targets applied epidemiology training provided based on JEE score (Number) 0.00 Apr/2019 1.00 05-Mar-2024 1.00 05-Mar-2024 5.00 Jun/2026 Page 24 The World Bank OECS Regional Health Project (P168539) Comments on *** Updates by June 2024: All countries are advancing in their EM achieving targets capacities. Please see updates on respective EM PDO indicator above. Dominica has a Cabinet-vetted plan which is pending stakeholders socialization; Grenada has completed an AAR under the project with support from PAHO, and the update of the multi hazards plan will be kicked off (activity to be launched) in the next six months. SVG has a similar activity is already in evaluation phase. STL has completed an AAR and STAR assessment, and among others, will pursue the updating the national health sector multi-hazard emergency/disaster management plan and training and simulation exercise in the use of the EOCs, even if the indicator target has already been achieved. **** Number of countries/regional JEE Question R.1.2. Capacity graded on a scale of 1-5 where: 1 = no entities with multi-sectoral, capacity (no national multi-sectoral, multi-hazard emergency preparedness multi-hazard emergency plan in place) 2 = limited capacity (national multi-sectoral, multi-hazard preparedness measures, incl emergency response plans emergency preparedness plan is in place. SOPs for core emergency based on response coordination functions have been developed in past two years) 3 achievement/sustainment of = developed capacity (emergency preparedness measures are JEE score of 4.0 or higher implemented at nationa level including points of entry and mass gathering (Number) events. Response plans have been exercised or used in actual response operations in past two years.) 4 = demonstrated capacity (preparedness measures are implemented at national, sub-national and local levels. Multi- sectoral, multi-hazard response plans in place at sub-national and local levels as well as points of entry. Response plans have been exercised or used in actual response operations in past two years) 5 = sustainable capacity (dedicated human resources and reglar budget funding to support coordination and implementation of emergency preparedness measures. Dedicated resources in place form implementation of multi-sectoral, multi- hazard response plans, contingency plans and SOPs at national, sub- national and local level. Systems are regularly tested, reviewed and updated.) 1.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 Page 25 The World Bank OECS Regional Health Project (P168539) Dominica: Multi-sectoral, Comments on Capacity graded as described in JEE Question R.1.2. multi-hazard emergency achieving targets preparedness measures, incl emergency response plans, based on JEE score (Number) Grenada: Multi-sectoral, 2.00 Apr/2019 2.00 05-Mar-2024 2.00 05-Mar-2024 4.00 Jun/2026 multi-hazard emergency Comments on Capacity graded as described in JEE Question R.1.2. preparedness measures, achieving targets incl emergency response plans, based on JEE score (Number) Saint Lucia: Multi- 1.00 Apr/2019 4.00 05-Mar-2024 4.00 05-Mar-2024 4.00 Jun/2026 sectoral, multi-hazard Comments on Capacity graded as described in JEE Question R.1.2. emergency achieving targets preparedness measures, incl emergency response plans, based on JEE score (Number) Saint Vincent and the 1.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 Grenadines: Multi- Comments on Capacity graded as described in JEE Question R.1.2. sectoral, multi-hazard achieving targets emergency preparedness measures, incl emergency response plans, based on JEE score (Number) CARPHA/OECS: Multi- 2.00 Apr/2019 3.00 05-Mar-2024 3.00 05-Mar-2024 4.00 Jun/2026 sectoral, multi-hazard Comments on Capacity graded as described in JEE Question R.1.2. emergency achieving targets preparedness measures, incl emergency response plans, based Page 26 The World Bank OECS Regional Health Project (P168539) on JEE score (Number) Contingency Emergency Response Component (CERC) Indicator Name Baseline Actual (Previous) Actual (Current) Closing Period Result Month/Year Result Date Result Date Result Month/Year Equipped health facilities with 2.00 May/2020 4.00 21-Jun-2024 4.00 21-Jun-2024 4.00 Jul/2024 isolation capacity (Number) Dominica - Equipped 1.00 May/2020 1.00 13-Dec-2023 1.00 13-Dec-2023 1.00 Jul/2024 health facilities with isolation capacity (Number) Grenada - Equipped 0.00 May/2020 1.00 13-Dec-2023 1.00 13-Dec-2023 1.00 Jul/2024 health facilities with isolation capacity (Number) SVG - Equipped health 1.00 May/2020 2.00 13-Dec-2023 2.00 13-Dec-2023 2.00 Jul/2024 facilities with isolation capacity (Number) Page 27