The World Bank Implementation Status & Results Report South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) EASTERN AND SOUTHERN AFRICA | South Sudan | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2021 | Seq No: 5 | ARCHIVED on 29-Aug-2023 | ISR57465 | Implementing Agencies: International Committee of the Red Cross, International Committee of the Red Cross, UNICEF, UNICEF, World Health Organization, World Health Organization Key Dates Key Project Dates Bank Approval Date: 28-Jun-2021 Effectiveness Date: 01-Jul-2021 Planned Mid Term Review Date: 15-Feb-2023 Actual Mid-Term Review Date: 19-Sep-2022 Original Closing Date: 31-Jul-2023 Revised Closing Date: 31-Jul-2025 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The objective of the project is to prevent, detect, and respond to the threat posed by COVID-19 in South Sudan, increase access to an essential package of health services in the states of Upper Nile and Jonglei, and develop South Sudan government health sector stewardship and system preparedness capacity. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) To prevent, detect, and respond to the threat posed by COVID-19, increase access to an essential package of health and nutrition services for the target population, develop health sector stewardship and preparedness capacity, and provide an immediate and effective response to an eligible crisis or emergency. Components Table Name Vaccine Acquisition, Deployment, Cold Chain Equipment, and Community Engagement:(Cost $66.50 M) Provision of Essential Health and Nutrition Services in Selected States:(Cost $252.50 M) Building Institutional Capacity and Strengthening Health System Emergency Preparedness:(Cost $7.93 M) Monitoring, Evaluation, and Learning:(Cost $7.00 M) Contingent Emergency Response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating High High Implementation Status and Key Decisions 8/29/2023 Page 1 of 11 The World Bank Implementation Status & Results Report South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) The project is on track to achieve its development objective. The four PDO indicators are on track to be met by the end of the project period. Notably, the percentage of the population to be fully vaccinated against COVID-19 is 66 percent, surpassing the 65 percent target. A restructuring and Second Additional Financing (AF2) of US$70 million to the South Sudan COVID-19 Emergency Response and Health System Preparedness Project (CERHSPP- P176480) were approved on March 16, 2023, and declared effective on March 31, 2023. The purpose of the AF2 is to fill a financing gap that emerged due to the activation of the project’s CERC and to expand the delivery of essential health and nutrition services for the host community and refugees in the Greater Upper Nile Region for an additional five months from July 31, 2024, until December 31, 2024. MPA Program Development Objective MPA PDO Table The Program Development Objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness MPA Table Multiphase Programmatic Approach (MPA) Status MPA Table Body Sustained efforts continue to be made to advance the implementation of the 87 MPA operations. 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. As of August 15, 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 August 15, 2023, amount to US$3.94 billion or 92% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. A large refund from the UN to the project account of the Myanmar operation was processed in late March due to the inability to implement the project. This transaction affected total disbursements. Also, (i) Loans and Credits denominated in SDRs and Euros are being affected because of fluctuations between the SDRs and Euros against the US dollar, and (ii) at this late stage of project implementation, several operations are processing refunds to the project accounts, which have an impact on total disbursements. Ten operations closed by the end of CY22 and nine operations closed on June 30, 2023. While there are seventeen (17) operations with closing dates by the end of CY23, there are plans for several projects to process extensions so this number will change. As with the Mid Term Review (MTR) issued on March 25, 2023, no individual COVID-19 MPA operation will need an ICR. Instead, one ICR will be prepared after the closing date of the SPRP COVID-19 MPA Program, which closes on December 31, 2025. The Global ICR will be based on final ISRs packages prepared by country operations’ teams. A template for the final ISR was issued by OPCS on March 25, 2023. 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% 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 or 57 percent 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 50 percent. The projects are benefitting around 3.7 billion people or 50% of the global population. When countries with AF-V operations are 8/29/2023 Page 2 of 11 The World Bank Implementation Status & Results Report South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) 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 approved 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 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 continues to represent 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. COVID-19 MPA AF-V - ISR Write-up – August 15, 2023 As of August 15, 2023, the Bank has approved 116 operations (including MPA-V operations) to support vaccine procurement and rollout in 78 countries amounting to $9.25 billion. The Senegal AF2 operation for $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 $10 billion, but the: (i) Costa Rica operation ($120 million), and (ii) Peru operation ($500 million) were cancelled at the request of both governments. Also, the Gabon ($12 million) reported last month as closed is in fact in the process of being closed. The Afghanistan operation commitment of $113 million was reduced to $60 million. Partial cancellations have been processed under other operations, thereby the overall commitment has decreased in the past months. Of the 116 approved operations: (i) 66 are in Africa – 30 in AFE and 36 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 116 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 August 15, 2023, amount to US$6.11 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/are being restructured and more will need to be restructured to reallocate funds allocated for procurement of COVID-19 vaccines and deployment. Guidance was issued under an EM from Juan Pablo Uribe of July 7, 2023 to provide direction for the use of undisbursed funds under COVID-19 operations. The EM provides guidance on eligibility for the use of funds under the SPRP MPA, and specifically on financing under vaccine projects. HNP is monitoring progress with the implementation of the guidelines and presented an update on progress on the compliance with the guidelines on August 3, 2023. A second update will be presented on September 6, 2023. Forty-one (41) AF-V/MPA-V operations or 36 percent of operations approved have disbursed over 70 percent of their commitments. Out of the 41, seventeen (17) operations or 41 percent have disbursed 90+. Out of the 17, four operations are fully disbursed (Argentina, Indonesia, Sri Lanka AF- V 1, and Ukraine AF-V 3). Five operations have disbursed 97-99 percent of commitments (Ecuador AF-V 1, Gambia, Iraq, Sierra Leone AF-V 1, and Yemen). Eight operations have disbursed 95-99 percent. Ninety-three (93) operations or 82 percent of total operations approved are disbursing. ECA has the highest percentage of disbursements at 86 percent, followed by SAR at 77 percent, MNA at 75 percent, EAP and LAC at 73 percent, AFW at 56 percent, and AFE at 55 percent. As of August 1, 2023, the World Bank had purchased 635.4 million doses of the COVID- 19 vaccine of which 506.8 million had been delivered to client countries and 500.7 million administered. 8/29/2023 Page 3 of 11 The World Bank Implementation Status & Results Report South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) Retroactive Financing (RF) represents 37 percent of overall commitments. High levels of RF have been authorized under different operations - Ukraine (100%), Panama and Turkey (90%), Argentina and Guyana (80%), and Belize, and Sri Lanka (70%). One hundred and fifteen (115) loan/financing agreements or 99 percent of projects approved have been signed and 114 or 99 percent have become effective. As with the COVID-19 MPA operations, streamlined procedures, delegated approval, wide use of Bank Facilitated Procurement, coupled with flexible project design, and intensified efforts across the Bank have contributed to the rapid design, processing, and implementation of the AF-V operations. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic High High High Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and High High High Sustainability Fiduciary Substantial Substantial Substantial Environment and Social High High High Stakeholders High High High Other Substantial Substantial Substantial Overall High High High Results PDO Indicators by Objectives / Outcomes To support COVID-19 vaccine deployment, provision of services, and build institutional capacity IN01329677 ►Percentage of eligible population fully vaccinated against COVID-19, based on the targets defined in national plan (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7.20 66.01 65.00 Date 01-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 Comments: IN01329679 Female (Percentage, Custom Supplement) 8/29/2023 Page 4 of 11 The World Bank Implementation Status & Results Report South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3.90 66.70 65.00 IN01329681 Refugee population (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 32.40 65.00 IN01329682 Host communities population (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 150.00 65.00 IN01329683 ►People who have received essential health, nutrition, and population (HNP) services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,295,991.00 1,878,674.00 3,000,000.00 Date 01-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 The indicator measures the actual utilization of the services. This would be reflected through the number of the project beneficiaries, who have received services supported by the project, i.e. number of direct Comments: project beneficiaries. IN01329684 Host communities population (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 92,593.00 100,000.00 IN01329685 Female (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 744,504.00 1,005,035.00 1,500,000.00 IN01329686 Refugee population (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 24,110.00 270,000.00 IN01329687 ►Completed tailored training/coaching for MOH staff on identified project management aspects (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes No Yes Date 15-Feb-2022 18-Aug-2022 07-Aug-2023 31-Jul-2025 8/29/2023 Page 5 of 11 The World Bank Implementation Status & Results Report South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) To provide an immediate and effective response to an eligible crisis or emergency IN01329678 ►Number of people affected by the food insecurity crisis in the targeted areas who received nutrition services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 19,928.00 1,500,000.00 Date 10-Oct-2022 07-Feb-2023 07-Aug-2023 31-Jul-2025 IN01329680 Female (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 16,230.00 750,000.00 Date 10-Oct-2022 07-Feb-2023 07-Aug-2023 31-Jul-2025 Intermediate Results Indicators by Components Vaccine Acquisition, Deployment, Cold Chain Equipment, and Community Engagement IN01329694 ►Climate-friendly and energy-efficient cold chain is adopted by the client (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 56.00 71.00 126.00 Date 01-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 targeted sites have functional climate-friendly cold chain equipment, which are used for COVID-19 vaccinations, routine vaccinations, and / or other health products needing refrigeration. Comments: IN01329696 ►Standard operating procedures (SOPs) or guidelines updated for collection and disposal of medical waste for COVID-19 (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 IN01329698 ►Comprehensive Emergency Obstetric and Newborn Care centers (CEmONC) have adequate solar power (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 4.00 12.00 8/29/2023 Page 6 of 11 The World Bank Implementation Status & Results Report South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) Date 26-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 Provision of Essential Health and Nutrition Services in Selected states IN01329689 ►Number of health facilities providing at least 75 percent of the essential package of health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 132.00 179.00 190.00 Date 01-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 IN01329692 ►Number of deliveries attended by skilled health personnel (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6,274.00 31,657.00 42,000.00 Date 01-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 Number of deliveries attended by skilled health personnel in targeted sites. Comments: IN01329697 Host communities population (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1,660.00 1,500.00 Date 02-May-2022 18-Aug-2022 07-Aug-2023 31-Jul-2025 IN01329699 Refugee population (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 5,944.00 1,500.00 IN01329700 ►Proportion of disease outbreaks detected and responded to within 72 hours of confirmation (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 100.00 100.00 60.00 Date 01-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 IN01329701 ►Number of pregnant women receiving ANC four visits (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 11,691.00 60,033.00 90,000.00 Date 01-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 8/29/2023 Page 7 of 11 The World Bank Implementation Status & Results Report South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) Number of pregnant women receiving ANC four visits in targeted sites. Comments: IN01329702 Refugee population (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 20,089.00 2,500.00 Date 02-May-2022 18-Aug-2022 07-Aug-2023 31-Jul-2025 IN01329703 Host communities population (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 2,286.00 2,500.00 IN01329704 ►Number of health care workers trained in-service (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 257.00 6,374.00 5,000.00 Date 01-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 IN01329705 ►Number of CERHSPP flood affected facilities rehabilitated. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 60.00 Date 15-Apr-2022 18-Aug-2022 07-Aug-2023 31-Jul-2025 Building Institutional Capacity and Strengthening Health System Emergency Preparedness IN01329688 ►Development of integrated human health and animal health policies (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 01-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 Developing integrated human health and animal health policies to prevent health emergencies through development of One Health Plan that addresses preparedness and response to priority zoonotic diseases Comments: identified. IN01329691 ►Number of people trained in Integrated Disease Surveillance and Response (IDSR) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 8/29/2023 Page 8 of 11 The World Bank Implementation Status & Results Report South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) Value 0.00 214.00 621.00 1,000.00 Date 20-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 Comments: IN01329695 ►Development of disease surveillance data reporting and management system at the national and state level (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 26-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 Data reporting and management system on disease surveillance data are in place at the national and state levels. Comments: Monitoring, Evaluation and Learning IN01329690 ►Number of monitoring reports submitted (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 8.00 12.00 Date 01-Jul-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 IN01329693 ►Percentage of complaints to Grievance Redress Mechanisms satisfactorily addressed in a timely manner (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 30.00 46.00 46.80 70.00 Date 30-Apr-2021 18-Aug-2022 07-Aug-2023 31-Jul-2025 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P176480 IDA-D8830 Effective USD 8.00 8.00 0.00 7.79 0.00 100% P176480 IDA-D8840 Closed USD 51.50 51.50 0.00 49.48 0.08 100% 8/29/2023 Page 9 of 11 The World Bank Implementation Status & Results Report South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) P176480 IDA-D8850 Effective USD 0.50 0.50 0.00 0.54 0.01 99% P176480 IDA-E0040 Effective USD 5.00 5.00 0.00 2.52 2.28 52% P176480 IDA-E0050 Effective USD 13.50 13.50 0.00 7.31 5.60 57% P176480 IDA-E0110 Effective USD 181.50 181.50 0.00 170.07 0.04 100% P176480 IDA-E1610 Effective USD 70.00 70.00 0.00 55.00 14.72 79% P176480 TF-B6004 Effective USD 2.00 2.00 0.00 2.00 0.00 100% P176480 TF-B6005 Effective USD 1.93 1.93 0.00 1.93 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P176480 IDA-D8830 Effective 28-Jun-2021 01-Jul-2021 01-Jul-2021 31-Jul-2023 31-Jul-2025 P176480 IDA-D8840 Closed 28-Jun-2021 01-Jul-2021 01-Jul-2021 31-Jul-2023 31-Jul-2023 P176480 IDA-D8850 Effective 28-Jun-2021 01-Jul-2021 01-Jul-2021 31-Jul-2023 31-Jul-2025 P176480 IDA-E0040 Effective 31-Mar-2022 27-Apr-2022 27-Apr-2022 31-Jul-2025 31-Jul-2025 P176480 IDA-E0050 Effective 31-Mar-2022 25-Apr-2022 25-Apr-2022 31-Jul-2025 31-Jul-2025 P176480 IDA-E0110 Effective 31-Mar-2022 10-May-2022 10-May-2022 31-Jul-2025 31-Jul-2025 P176480 IDA-E1610 Effective 27-Mar-2023 29-Mar-2023 31-Mar-2023 31-Jul-2025 31-Jul-2025 P176480 TF-B6004 Effective 01-Jul-2021 01-Jul-2021 01-Jul-2021 30-Jun-2023 31-Oct-2023 P176480 TF-B6005 Effective 01-Jul-2021 01-Jul-2021 01-Jul-2021 30-Jun-2023 30-Jun-2024 Cumulative Disbursements 8/29/2023 Page 10 of 11 The World Bank Implementation Status & Results Report South Sudan COVID-19 Emergency Response and Health Systems Preparedness Project (P176480) Restructuring History There has been no restructuring to date. Related Project(s) P178102-South Sudan COVID-19 Emergency Response and Health Systems Preparedness Additional Financing ,P180277-South Sudan COVID- 19 Emergency Response and Health Systems Preparedness Project Second Additional Financing 8/29/2023 Page 11 of 11