The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) REPORT NO.: RES57527 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF REGIONAL DISEASE SURVEILLANCE SYSTEMS ENHANCEMENT (REDISSE) APPROVED ON JUNE 28, 2016 TO ECOWAS,REPUBLIC OF GUINEA,REPUBLIC OF SENEGAL,REPUBLIC OF SIERRA LEONE HEALTH, NUTRITION & POPULATION WESTERN AND CENTRAL AFRICA Regional Vice President: Ousmane Diagana Country Director: Boutheina Guermazi Regional Director: Dena Ringold Practice Manager/Manager: Trina Haque Task Team Leaders: Moussa Dieng, Andre L. Carletto, Djibrilla Karamoko, Yohana Dukhan, Zenab Konkobo Kouanda The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) ABBREVIATIONS AND ACRONYMS AF Additional Financing AF2 Second Additional Financing CES Centers for Epidemiological Surveillance ECOWAS Economic Community of West African States FELTP Field Epidemiology and Laboratory Training Program GRM Grievance Redress Mechanism ICU Intensive Care Unit IDA International Development Association IP Implementation Progress ISR Implementation Status and Results Report JEE Joint External Evaluation LNERV National Laboratory for Livestock and Veterinary Research Laboratoire National de l'Elevage et de Recherches Vétérinaires MDTF Multi-Donor Trust Fund MSAS Ministry of Health and Social Action PDO Project Development Objective RAHC Regional Animal Health Center REDISSE Regional Disease Surveillance Systems Enhancement SLIPTA Stepwise Laboratory Quality Improvement Process towards Accreditation WAHO West African Health Organization WB World Bank WHO World Health Organization WOAH World Organization for Animal Health The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) BASIC DATA Product Information Project ID Financing Instrument P154807 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 28-Jun-2016 31-Aug-2023 Organizations Borrower Responsible Agency ECOWAS,Republic of Guinea,Republic of Senegal,Republic of Sierra Leone Project Development Objective (PDO) Original PDO The objectives of the Project are: (i) to strengthen national and regional cross-sectoral capacity for collaborative disease surveillance and epidemic preparedness in West Africa, thereby addressing systemic weaknesses within the animal and human health systems that hinder effective disease surveillance and response; and (ii) in the event of an Eligible Emergency, to provide immediate and effective response to said Eligible Emergency. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-72270 06-Dec-2022 30-Dec-2022 28-Feb-2023 31-Aug-2023 7.00 0 7.88 IDA-E1330 06-Dec-2022 03-Jan-2023 22-Feb-2023 31-Aug-2023 5.00 .45 4.89 IDA-58820 28-Jun-2016 04-Aug-2016 02-Dec-2016 30-Jun-2023 19.18 18.83 0 IDA-58830 28-Jun-2016 23-Aug-2016 23-Jan-2017 31-Aug-2023 20.00 19.59 .12 IDA-58840 28-Jun-2016 31-Aug-2016 16-Dec-2016 31-Aug-2023 30.00 28.28 1.29 IDA-D1290 28-Jun-2016 04-Aug-2016 02-Dec-2016 30-Jun-2023 9.59 9.43 0 The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) IDA-D1300 28-Jun-2016 23-Aug-2016 23-Jan-2017 31-Aug-2023 10.00 9.57 .28 IDA-D1310 28-Jun-2016 28-Oct-2016 27-Jan-2017 31-Aug-2023 20.00 19.82 0 TF-B1239 01-Oct-2019 21-Jan-2020 17-Mar-2020 31-Aug-2023 8.96 5.39 3.58 TF-A2534 28-Jun-2016 28-Oct-2016 27-Jan-2017 31-Aug-2023 4.06 3.84 .23 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. BACKGROUND 1. The Regional Disease Surveillance Systems Enhancement (REDISSE) - Phase I Project was approved by the World Bank (WB) Board of Executive Directors on June 28, 2016 for US$114.06 million. This amount includes International Development Association (IDA) Credits, IDA Grants, and a Grant from the Multi-Donor Trust Fund (MDTF) from the Department of Foreign Affairs, Trade, and Development in Canada to three countries and the Economic Community of West African States (ECOWAS) through its specialized institution, the West African Health Organization (WAHO): Republic of Guinea (US$20 million IDA Credit and US$10 million IDA Grant); Republic of Senegal (US$30 million IDA Credit); Republic of Sierra Leone (US$20 million IDA Credit and US$10 million IDA Grant); and WAHO (US$20 million IDA Grant and US$4.06 million MDTF). In November 2019, an MDTF first Additional Financing (AF) in the amount of US$8.96 million to WAHO was approved and a second Additional Financing (AF2) in the total amount of US$12.0 million (US$5.0 to WAHO and US$7.0 to Senegal) was also approved in December 2022 with an extension of the Project closing date to August 31, 2023 for Senegal, Guinea, and WAHO and June 30, 2023 for Sierra Leone. In Sierra Leone, the Project became effective on December 16, 2016. This Restructuring Paper seeks approval to carry out a Level 2 restructuring to (i) cancel funds from the IDA Credit in Senegal and from IDA and MDTF Grants for ECOWAS/WAHO; and (ii) formalize the reallocation of funds between disbursement categories. 2. The REDISSE Program is an interdependent Series of Projects to strengthen national, regional, and multisectoral capacity for integrated disease surveillance and response in West and Central Africa. The REDISSE Program was developed jointly by the Health, Nutrition, and Population and the Agriculture Global Practices under the One Health approach to ensure that the human-animal-environment interface is addressed in strengthening regional and country-specific disease surveillance systems. Overall, the REDISSE Program supports regional institutions such as the WAHO and the Economic Community of Central African States, and 16 countries in West and Central Africa including Guinea, Senegal, Sierra Leone (REDISSE Phase I); Guinea-Bissau, Liberia, Nigeria, Togo (REDISSE Phase II); Benin, Mali, Mauritania, Niger (REDISSE Phase III); and Angola, Chad, Central African Republic, the Democratic Republic of Congo, and the Republic of Congo (REDISSE Phase IV). The REDISSE Program has five components: (i) surveillance and information systems; (ii) strengthened laboratory capacity; (iii) health emergencies preparedness and rapid response; The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) (iv) workforce training, deployment and retention, and (v) institutional capacity building for project management, coordination and advocacy. B. PROJECT STATUS 3. After six years of implementation, REDISSE Phase I has strengthened health preparedness, response capacities, and disease surveillance across sectors in the Participating Countries and strengthened regional level collaboration and facilitated knowledge and resource sharing between Participating Countries and regional institutions. To date, 85.36 percent of the total financing of the Project has been disbursed (86.59 percent of IDA resources and 69.19 percent of the MDTF funds): 97.35 percent in Guinea, 74.36 percent in Senegal, 93.62 percent in Sierra Leone, and 87.46 percent in WAHO. 4. The overall progress towards the achievement of the Project Development Objective (PDO) and the implementation progress have been rated Satisfactory in the last Implementation Status and Results Report (ISR), dated July 2023. During the last reporting period, progress measured by PDO indicators varied among the Participating Countries — in Guinea, three out of the five PDO indicators has been achieved; in Senegal, four out of the five PDO indicators have been met; and in Sierra Leone, two out the five PDO indicators have been met. Three out of the six regional aggregate indicators have been met. It is noteworthy to mention that countries are in the process of finalizing their self-assessment of Joint External Evaluation (JEE) indicators, an update to the indicators and an increase in some of their performances are expected soon and will be reported in the last final ISR. Despite the program’s inherent focus on disease surveillance and health emergency preparedness and response in the region, in most Participating Countries of all REDISSE phases, the program experienced implementation delays due to the impact of the COVID-19 pandemic including the burden on health service delivery and public health systems across participating countries, and the competing and multilayered priorities that resulted from the crisis. 5. Nonetheless, project activities have laid the groundwork for more robust disease surveillance and response systems in the participating countries, which enabled them to quickly respond to several outbreaks that emerged during the project’s lifetime, including the COVID-19 pandemic. The impact of the Project in strengthening disease surveillance and response systems had positive roll-over externalities on the participating countries, resulting in an early and robust response against COVID-19. In addition, the Project was at the forefront of participating countries’ responses and allowed a rapid mobilization of funds to address the countries’ initial prevention and response activities. REDISSE Phase I reallocated US$25.28 million of its funds to support the countries’ response against COVID- 19, in line with its objective of responding to eligible health emergencies. 6. Financial Management (FM) and Procurement have consistently been rated as Satisfactory. Despite minor FM shortcomings, there are no major issues that would prevent the timely and reliable provision of information and fiduciary systems required to manage and monitor the implementation of the project. Similarly, procurement related activities are being implemented optimally in all Participating Countries and agreed procurement arrangements remain in place. However, there is a need for continued support to ensure that procurement processes are expedited as the Project’s closing date approaches, particularly, when it relates to updating and presenting the procurement activities’ documentation, that will ensure all post-review processes are performed by the WB. 7. The overall Environmental and Social Safeguards (E&S) performance is rated Moderately Satisfactory. All Participating Countries are implementing E&S requirements in compliance with E&S instruments developed. All three participating countries have Grievance Redress Mechanisms (GRM) in place. GRM has been operationalized and functional in all three countries. Since the inception of the Project, no occupational health and safety incidents have The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) been reported. 8. In November 2019, the Project underwent a Level 2 Restructuring concurrently with the MDTF first Additional Financing to (i) address weaknesses in the results framework by adjusting baseline and target values to reflect baseline JEE results; (ii) remove indicators not needed for an effective Project monitoring; and (iii) add indicators to monitor gender disparities in access to training opportunities. This process also included an AF in the amount of US$8.96 million (TF0B1239) for the benefit of ECOWAS/WAHO. This AF became effective on March 17, 2020, and contracts were signed with the Centre for International Cooperation in Health and Development and Fondation Mérieux (Merieux Foundation), on March 4, 2020, and March 6, 2020, respectively, to implement the next phase of WAHO’s implementation. 9. An AF2 in the amount of US$12.00 million (IDA Grant US$5.00 million for WAHO, and IDA Credit US$7.00 million for Senegal) was approved by the WB’s Board of Executive Directors on December 6, 2022 and included the extension of the closing date for REDISSE I as follows: (i) Senegal (No. 5884-SN), Guinea (No. 5883-GN and No. D1300) and ECOWAS (No. D1310, TF0A2534 and TF0B1239) from January 31, 2023, to August 31, 2023; and (ii) Sierra Leone (No. 5882-SL and No. D1290-SL) to June 30, 2023. Given the delays in Project implementation and activity completion due to the COVID-19 pandemic, this extension of closing date has allowed for the completion of the overall pending activities and the full utilization of the remaining undisbursed amount of the parent Project as well as the AF. C. PROJECT PERFORMANCE AND RATIONALE FOR RESTRUCTURING — SENEGAL AND ECOWAS/WAHO Project Performance 10. Senegal. The Project has been well implemented by the Ministry of Health and Social Action (MSAS), with a close collaboration with the Ministry of Livestock and Animal Production (MEPA), Ministry of Agriculture and Rural Equipment (MAER) and the Ministry of Environment and Sustainable Development (MEDD). Other Ministries (such as the Ministry of Armed Forces and the Ministry of Interior and Public Safety) have also supported the project and facilitated implementation. Overall governance of the REDISSE I was provided through the Prime Minister’s office by the multi-sector steering committee of the Global Health Security Program in Senegal with its executive secretariat and its multisectoral technical One Health committee. The Project has been performing in a satisfactory manner for the overall progress towards the achievement of PDO and Implementation Progress (IP). The satisfactory rating reflects the increase of disbursement rate, achievement of indicator targets and improvements in the project planning process. Of the five PDO indicators, three have been met and two have not met their target but have presented positive trends. Out of the twelve intermediate results indicators, seven have been met, four have not reached their targets, and one has partially reached its objective (“Number of people trained in applied epidemiology such as Field Epidemiology and Laboratory Training Program (FELTP) – 190 people trained out of 192 planned”). Given the upcoming closing date of the Project, a new updated version of the Results Framework will be included as part of the country-specific inputs to the next and final regional ISR. 11. ECOWAS/WAHO. At the regional level, project implementation has been led successfully by ECOWAS/WAHO, which hosted the regional secretariat of the project. The overall progress towards the achievement of the PDO and the IP have been rated Satisfactory. WAHO has been implementing, in a satisfactory manner, region-wide activities to support Member States technical and operational capacities, while also coordinating cross-border and knowledge sharing activities. Among the activities that have been more heavily supported from a regional standpoint are: (i) health information systems strengthening across the West African region; (ii) training of human, animal, and environmental health professionals from different countries at a Master’s degree level; (iii) the provision of technical The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) assistance to Member States in the development of their National Action Plans for Health Security; (iv) training of country health professionals on the implementation of the new version of the Integrated Diseases Surveillance Systems modules, with the support of the World Health Organization; and (v) support and supervision of the implementation of the One Health approach through country-specific and regional One Health platforms. 12. Recent achievements across each component are provided below:  Component 1: Surveillance and Information Systems. Key activities have been achieved under this component that led to the strengthening of their surveillance and information systems capacities and have been instrumental in the prompt and effective response against a number of epidemics and disease outbreaks they have experienced over the past five years. However, additional efforts remain to be made both by countries and WAHO to further strengthen the implementation of the One Health approach, with the development and deployment at all levels of operational guidelines and tools to ensure effective collaboration among technical working groups and render operational and effective event-based and community-based surveillance as well as the active zoonotic diseases surveillance. (i) Senegal: Key actitivities achieved are: the establishment of Rift Valley Fever (RVF) virus vectors surveillance, as well as bovine tuberculosis and brucellosis, Shiga toxin-producing E. coli in foodstuffs of animal origin, antibiotic resistance of Escherichia coli and salmonella strains in the livestock sector and in the environment; the development and dissemination of practical guides for the surveillance of wildlife species involved in zoonotic diseases; support to the operation of the “4S” network sites: collection, transportation and processing of samples; and the setting up of the new epidemiology surveillance form in DHIS2 with the TRACKER functionality. In addition, with the outbreak of the avian flu epidemic, the project supported active surveillance for avian flu at birdwatching sites and surrounding communities. (ii) WAHO: WAHO contributed to REDISSE I participating countries’ achievements by providing support to member states in the field, such as: continuous daily administration of ECOWAS regional data warehouse for health information sharing and continuous daily data collection on COVID-19 and other epidemic diseases, contribution in the development and maintenance of ECOWAS scorecard, and ECOWAS Outbreaks’ dashboard for the Regional Health Observatory (RHO); automatic data transfer from countries to the regional Data Warehouse is now effective in thirteen out of fifteen ECOWAS countries: Benin and Liberia have not started the process yet; ongoing design and integration of Anti-Microbial Resistance data to ECOWAS regional platform; field assessment of the existing system for the implementation of the digital One Health platform of Togo with REDISSE II, and in establishing an additional 60 Centers for Epidemiological Surveillance (CES) in Benin, Mali, Mauritania, Niger, and Nigeria for a total of 107 centers. WAHO also signed agreements with the World Health Organization (WHO), the World Organization for Animal Health (WOAH), and the Regional Animal Health Center (RAHC) to provide technical assistance to all REDISSE countries. As part of this collaboration, WHO provided support to countries on the NAPHS development and implementation, including support to implementing the JEE Assessment. Similarly, WOAH under the agreement signed with WAHO assisted Benin, Mauritania, and Sierra Leone to strengthen their Performance of Veterinary Services (PVS) and they were able to undertake twinning projects between veterinary laboratories on zoonotic diseases jointly with WHO. RAHC has alo contributed to strengthen PVS in several countries and were able to undertake capacity building for Regional epidemiological surveillance networks in West Africa (RESEPI) and conduct stakeholder mapping to identify key players in the zoonotic diseases sector.  Component 2: Strengthening of Laboratory Capacity. Disease diagnostics and epidemic detection capacity has The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) improved across countries, due to the important investments made by each REDISSE country. (i) Senegal: Important investments made by Senegal to reinforce its laboratory capacity for pathogens detection range from the renovation of bacteriology, virology and parasitology units’ capacities of the National Laboratory for Livestock and Veterinary Research (Laboratoire National de l'Elevage et de Recherches Vétérinaires, LNERV), supply of equipment, reagents and consummables for laboratories, development and dissemination of national laboratory procedures and sample and transportation guidelines. These efforts have resulted in the accreditation of the LNERV to ISO IEC 17025 version 2017 in order to reinforce its status as an international reference laboratory and the early detection and containment of numerous epidemics recorded over the five past years by the country such as COVID-19, Crimean Congo fever, Dengue fever, Rift valley fever, Measles, Yellow fever, West Nile fever, and Avian flu. (ii) WAHO: The Stepwise Laboratory Quality Improvement Process towards Accreditation (SLIPTA) process initiated in 2020 is still ongoing with the planning of the second round of SLIPTA mentoring sessions using ECOWAS Certified Experts. WAHO has established its support to the improvement of laboratory quality systems and strengthen diagnostic capacity of national reference laboratories in West Africa. Specifically, WAHO has trained 24 certified SLPITA auditors and 18 mentors that have been deployed and involved in the mentoring support to improve quality processes in 13 national reference laboratories in five countries (Burkina Faso, Ghana, Ivory Coast, Niger, Nigeria and Senegal). Similarly, onsite mentorship missions were carried out in 11 ECOWAS Reference Laboratories, including in two REDISSE countries (Niger and Senegal). In addition,as part of the establishment of the 60 CES by WAHO, special attention was given to the laboratory component, where sessions on training of trainers and training of staff responsible for laboratory activities were organized in Benin, Mali, Mauritania, Niger, and Nigeria.  Component 3: Preparedness and Emergency Response. This component has been the most active component among the five components, mostly as a result of the response to the Covid-19 pandemic and many other outbreaks recorded by countries over the past years. The REDISSE operation was the first to rapidly respond when the first COVID-19 case was registered in several countries, by supporting, for example, the establishment of Rapid Response Teams; setting up and capacity strengthening of points of entry at borders, the organization of simulation (tabletop, Drill, Functional, Full-scale) exercises of outbreaks as well as cross-border meetings. (i) Senegal: The country has revised its standard operating procedures (SOPs) for the Ebola Virus Disease (EVD) response; rehabilitated 127 livestock vaccination parks; developed and disseminated the community organization and intervention guide and epidemic response sheets; finalized the rehabilitations of the Armed Forces supply pharmacies in Dakar and Thiès with increased storage capacity for stock piling in the event of epidemic response; updated the mapping of health risks and resource in Senegal; acquired the appropriate equipment for the interconnection of the regional Emergency Medical Services (Service d'aide médiale d'urgence-SAMU) sites (regional SAMU Kaolack, Fatick and Kaffrine) to the Dakar site; developed and validated the integrated plan for preparation and multisectoral response in case of public health emergencies and disasters; organized a field simulation exercise for the deployment of the mobile field hospital; and developed a communication plan of priority zoonotic diseases and pathogens. (ii) WAHO: All five activities planned in WAHO’s 2022 and 2023 annual work plans under this component are ongoing and expected to be completed by the closing date: (i) implementation of the emergency operations centre network; (ii) capacity building of regional rapid response team members; (iii) The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) development of training materials and behaviour change communication materials (including fact sheets, training kits, tips, frequently asked questions, pamphlets); (iv) organization of a regional training for journalists on the COVID-19 vaccine and dispelling rumours about immunization; and (v) developed, conducted, and delivered communication activities.  Component 4: Human Resource Management for Effective Disease Surveillance and Epidemic Preparedness. Owing that quality and human resource in health is paramount in disease surveillance, detection, preparedness and response, REDISSE countries have made important investments to address the existing gaps. The project has contributed to the training of personnel in human, animal and environmental health in order to effectively ensure the implementation of the One Health approach. Training activities include three tiers of FELTP, laboratory technicians, risk communication and community engagement specialists, journalists, socio-scientists, rapid response teams, veterinarians, wildlife staff, etc. The key human resource management activities carried out are highlighted below. (i) Senegal: Recruitment of administrative staff to support the functionality of the One Health platform and several training sessions have been organized to strengthen the capacity of health staff across all the One Health approach implementing sectors. These ranged from training of health professionnals on the rational ecological management of pesticides used in the fight against vectors of diseases such as dengue, yellow fever and Chikungunya; Field Epidemiology for surveillance agents in Animal, Human and Environmental Health; training of border police officers on site on the fight against epidemics, zoonoses and Chemical, Biological, Radiological and Nuclear (CBRN) risks; eco-guards, guides and landowners and the peripheral community of protected areas on bio-security measures; training on managing epidemics linked to highly infectious pathogens and epidemiological surveillance in human and animal health. (ii) WAHO: WAHO has supported FELTP training for member states at the University of Ghana and Joseph Ki- Zerbo University of Ouagadougou where two cohorts, one in each university, were trained for their second year of master’s degree and they are contributing to the response against COVID-19 and other potential epidemics in their respective countries. The second cohort of the University of Ghana graduated in December 2021, and that of the University Joseph Ki-Zerbo of Ouagadougou in April 2022. The following activities ongoing and to be completed before the closing date of the project: (i) harmonization of training programs and coordination of a regional capacity-building strategy for effective disease surveillance and epidemic preparedness, with the view of ensuring that training is provided at frontline and intermediate levels to include a strategy for integrating private sector staff; (ii) providing technical assistance and expertise to countries to accelerate implementation and ensure smooth and successful closure; and (iii) conducting the evaluation of training programs supported by WAHO REDISSE, namely the FELTP and the CES.  Component 5: Institutional Capacity Building, Project Management, Coordination, and Advocacy. As part of the implementation of the REDISSE project, REDISSE I countries have reinforced their institutional capacities for project management and coordination with the recruitment of several staff with various expertise in project management, monitoring and evaluation, financial management and procurement as well as in environmental ans social safeguards. They have also hired or built the capacities of health personnel in several areas such as in the One Health approach, disease diagnostic and laboratory quality control, supply of equipment, infrastructure, vaccines, medicines, reagents and consumables, project steering committee meetings, and participation in supervision missions. (i) Senegal: The project has respectively sponsored the organization of two results self-assessment The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) workshops using the e-SPAR tool, coordination meetings of the One Health platform (Streering Committee, Task Force, sectoral committees), as well as the implementation of the One Health approach by the various support sectors (communication, awareness-raising, operational missions, capacity- building, etc.); and has also financed the development and implemention of the project's communication plan. (ii) WAHO: WAHO has conducted several activities aimed at strengthening its own capacities or those of the REDISSE countries, ranging from the organization of joint field WAHO/WB supervision missions in REDISSE countries; conduct of a monitoring and evaluation support mission to REDISSE IV countries in Libreville from 16-20 May 2022; virtual missions on justifying indicator scores, how to use the Monitoring & Evaluation template adapted in 2020, collection of FELTP data, supported REDISSE Guinea in preparing International Health Regulations (IHR) workshop; oganization of regional technical and steering committee meetings; and coordination of the implementation of the Mid Term Review (MTR) of REDISSE I, II and III countries, with fortnightly meetings to follow up the implementation of the MTR recommendations. Rationale For Restructuring 13. Senegal. The approved Annual Work Plan & Budgets (AWPB) 2023 has a low execution rate of the planned activities. All funds were committed. With project imminent closure, a roadmap was prepared to ensure that activities would be completed before project closing date, particularly with regard to rehabilitation works. Among the activities that pose a risk, there are three contracts (CFAF 3,777,323,093; US$6.23 million; EUR 5.76 million) with delivery times that could exceed the project closing date: (i)procurement of laboratory equipment (CFAF 2,982,430,760;US$4.92 million; EUR 4.55 million); (ii) procurement of one of the two mobile laboratory trucks for the Ministry of the Armed Forces for CFAF 565,640,163 (US$932,333; EUR 862,310); and (iii) procurement of biomedical waste management materials for the Ministry of Health and Social Action for CFAF 229,252,570 (US$377,872; EUR 349,492). Despite multiple efforts from the MSAS and the project implementation unit to identify different pathways to expedite the purchase and delivery, the procurement process could not be finalized before Project closing. Therefore, given the limitations and challenges and the high risk of becoming an ineligible expenditure, the activity was eventually cancelled in July 2023 and is expected to be procured under the COVID-19 operation (P173838) currently being implemented. 14. Given the uncommitted balance of US$6.23 million that was released after the procurement of equipment above was dropped, and the impossibility of using these funds before the Project’s closing date of August 31, 2023, the Ministry of Finance (MoF) requested, in a letter received by the WB on August 28, 2023 (Ref. No. 4722/MFB/DGB/DODP/DOC/ein), the cancellation of the unused funds and their recommitment to the country’s national portfolio budget allocation. The request includes: (i) a cancellation of a total of EUR 5.76 million (equivalent to US$6.23 million) from IDA Credit 72270-SN; and (ii) a recommitment of the proceeds to the country portfolio to address the constraint of financing the operations in the pipeline of the IDA-20 cycle. 15. ECOWAS/WAHO. Delays in AF approval and effectiveness have impacted negatively on WAHO’s capacity to implement the AWPB 2023 funded with IDA resources before the project closing date. In addition, resources allocated from the MDTF for the implementation of additional Centers of Epidemiological Surveillance were not fully employed as originally planned due to limited time for processing procurement contracts and carrying out the activity. 16. Facing these challenges and given the impossibility of using these funds before the Project’s closing date, the Director General of WAHO requested, in a letter received by the WB on August 24, 2023 (Ref. The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) ROG/DPIS/PROJ/UGP/REDISSE/D/2023/328/ssc), the cancellation of the unused funds. The request includes: (i) a cancellation of a total of SDR 194.50 (US$258.66 equivalent) from IDA Grant D1310 and SDR 2,767,968 (US$3,681,065 equivalent) from IDA Grant E1330; and (ii) a cancellation of a total of US$225 967,60 from MDTF TF0A2534 and US$1,927,926 from MDTF TF0B1239. II. DESCRIPTION OF PROPOSED CHANGES 17. This Level 2 restructuring proposes to formalize the cancellation and reallocation of funds for the Senegal IDA Credits and ECOWAS/WAHO IDA and MDTF Grants, consistent with the Investment Project Financing Procedures. a. Senegal: Reallocation between disbursement categories: Cancellation of a total of EUR 5.76 million from Category 1 of IDA Credit 72270-SN. Subsequently, the allocation under Category 1 will be reduced, while the allocations under Categories 2 and 3 will remain unchanged (See Table 1 for additional details): TABLE 1: SENEGAL CANCELLATION AND REALLOCATION OF FUNDS PER DISBURSEMENT CATEGORY Category Amount of the AF Credit IDA-7227 allocated (expressed in EUR) 1 Goods, non-consulting services, consultants’ services, training, and Operational Costs 1,440,000 under Parts 1, 2.2, 2.3 (i), 3.1 (i), 3.2 (i) and (iii), 4 and 5.1 of the Project 2 Goods and Works under Part 2.1 of the Project - 3 Emergency Expenditures under Part 3.3 of the Project - Amount cancelled on August 28, 2023 5,760,000 Total amount 7,200,000 b. ECOWAS/WAHO: Reallocation between disbursement categories: (i) Cancellation of a total of SDR 194.50 (US$258.66 equivalent) from Category 1(c) of IDA Grant D1310 and SDR 2,767,968 (US$3,681,065 equivalent) from Category 1 of IDA Grant E1330; and (ii) cancellation of a total of US$225,967.60 from Categories 1 and 2 of MDTF TF0A2534 and US$1,927,926 from Category 1 of MDTF Grant TF0B1239. Subsequently, the allocations under Category 1 of both IDA Grants will be reduced and Categories 1 and 2 of MDTF Grants will be reduced (See Table 2 for additional details). TABLE 2: ECOWAS/WAHO CANCELLATION AND REALLOCATION OF FUNDS PER DISBURSEMENT CATEGORY Category Amount of the Grant Amount of the AF Grant IDA-D1310 allocated IDA-E1330 allocated (expressed in SDR) (expressed in SDR) 1 Goods, non-consulting services, consultants’ services, Training, and 1,232,032 Operational Costs: 5,101,961.75 The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) (a) under Parts 1.1 (i) of the Project (excluding centers for epidemiological surveillance) 1,796,240.11 (b) under Part 1.3 of the Project 7,301,603.64 (c) under Parts 2.3 (ii) and (iii), 3.1 (ii), 3.2 (ii) and (iii) and 5.2 (i), (ii), (iii) and (iv) 2 Works under Part 5.2 (iii) of the Project 0 - 3 Refund of Preparation Advance. No. V0150 0 - Amount cancelled on August 24, 2023 194.50 2,767,968 Total amount 14,200,000 4,000,000 Category Amount of the Grant Amount of the AF Grant TF0A2534 allocated TF0B1239 allocated (expressed in USD) (expressed in USD) 1 Goods, non-consulting services, consultants’ services, Training, and 2,781,390.28 7,032,805 Operational Costs under Part 1.1 (i) of the Project (including centers for epidemiological surveillance) 2 Goods, non-consulting services, consultants’ services, Training, and 1,056,810.12 Operational Costs under Parts 1.3 of the Project Amount cancelled on August 24, 2023 225,967.60 1,927,926 Total amount 4,064,168 8,960,731 c. Changes in Costs of Components: Given the above-mentioned cancellation, changes in the components will be processed. Namely, the cancellation to the Credit and Grants will reduce the total envelope of Components. See Table 3 for additional details. Table 3: REDISSE I - COST OF COMPONENTS The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) SENEGAL SENEGAL GUINEA GUINEA SIERRA SIERRA ECOWAS/ ECOWAS/ TOTAL TOTAL LEONE LEONE WAHO WAHO Original Revised Original Revised Original Revised Original Revised Original Cost Revised Cost +AF Amount amount Amount amount Amount +AF Amount of of Project Budget by component amount (post- (US$ (post- (US$ (post- amount (post- components Components (US$ cancellati million) cancellat million) cancellat (US$ cancellati (US$ million) (post- million) on) ion) ion) million) on) cancellation) (US$ (US$ (US$ (US$ (US$ million) million) million) million) million) C1: Surveillance and Information 7.82 7.82 11.70 - 5.33 5.33 14.18 13.44 39.03 38.29 Systems C2: Strengthening of Laboratory - 10.75 4.90 6.8 2.48 1.25 0.35 0.81 20.38 13.76 Capacity C3: Preparedness and Emergency - 9.14 8.75 3.89 13.93 13.93 0.80 5.4 27.76 31.97 Response C4: Human Resources Management - for Effective Disease Surveillance and 4.83 4.83 4.11 5.16 5.16 0.43 0.0 14.10 14.10 Epidemic Preparedness C5: Institutional Capacity Building, - Project Management, Coordination 4.46 4.46 3.50 3.1 3.1 22.37 8.9 33.43 19.96 and Advocacy Total 37.00 30.76 30 - 30 28.77 38.13 28.55 135.13 118.08 III. SUMMARY OF CHANGES Changed Not Changed Components and Cost ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ Results Framework ✔ Loan Closing Date(s) ✔ Disbursements Arrangements ✔ The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) Disbursement Estimates ✔ Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_COMPONENTS_TABLE COMPONENTS Current Current Proposed Proposed Cost Action Component Name Component Name Cost (US$M) (US$M) Component 1: Surveillance and Component 1: Surveillance and 39.03 Revised 38.29 Information Systems Information Systems Component 2: Strengthening of Component 2: Strengthening 20.38 Revised 13.76 Laboratory Capacity of Laboratory Capacity Component 3: Preparedness and Component 3: Preparedness 27.76 Revised 31.97 Emergency Response and Emergency Response Component 4: Human Resource Component 4: Human Management for Effective Resource Management for 14.53 Revised 14.10 Disease Surveillance and Effective Disease Surveillance Epidemic Preparedness. and Epidemic Preparedness. Component 5: Institutional Component 5: Institutional Capacity Building, Project Capacity Building, Project 33.43 Revised 19.96 Management, Coordination, and Management, Coordination, Advocacy and Advocacy The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) TOTAL 135.13 118.08 OPS_DETAILEDCHANGES_CANCELLATIONS_TABLE CANCELLATIONS Value Reason Current Cancellation New Ln/Cr/Tf Status Currency Date of for Amount Amount Amount Cancellation Cancellation Disburs IDA-58820- ing&Re XDR 13,582,113.48 0.00 13,582,113.48 001 paying Disburs IDA-58830- ing&Re XDR 14,200,000.00 0.00 14,200,000.00 001 paying Disburs IDA-58840- ing&Re EUR 26,400,000.00 0.00 26,400,000.00 001 paying UNDISBURSE IDA-72270- Effectiv EUR 7,200,000.00 5,760,000.00 28-Aug-2023 1,440,000.00 D BALANCE 001 e AT CLOSING IDA-D1290- Disburs XDR 6,795,667.83 0.00 6,795,667.83 001 ing IDA-D1300- Disburs XDR 7,100,000.00 0.00 7,100,000.00 001 ing UNDISBURSE IDA-D1310- Disburs XDR 14,200,000.00 194.50 24-Aug-2023 14,199,805.50 D BALANCE 001 ing AT CLOSING UNDISBURSE IDA-E1330- Disburs XDR 4,000,000.00 2,767,968.00 24-Aug-2023 1,232,032.00 D BALANCE 001 ing AT CLOSING UNDISBURSE TF-A2534- Disburs USD 4,064,168.00 225,967.60 24-Aug-2023 3,838,200.40 D BALANCE 001 ing AT CLOSING UNDISBURSE TF-B1239- Disburs USD 8,960,731.00 1,927,926.00 24-Aug-2023 7,032,805.00 D BALANCE 001 ing AT CLOSING OPS_DETAILEDCHANGES_REALLOCATION _TABLE REALLOCATION BETWEEN DISBURSEMENT CATEGORIES Financing % Current Allocation Actuals + Committed Proposed Allocation (Type Total) Current Proposed The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) IDA-72270-001 | Currency: EUR iLap Category Sequence No: 1 Current Expenditure Category: G,N/CS,T,O P1,2.2&3i,3.1i&2i 7,200,000.00 0.00 1,440,000.00 100.00 100.00 iLap Category Sequence No: 2 Current Expenditure Category: G,W P2.1 0.00 0.00 0.00 100.00 100.00 iLap Category Sequence No: 3 Current Expenditure Category: EMERG.EXP P3.3 0.00 0.00 0.00 100.00 100.00 Total 7,200,000.00 0.00 1,440,000.00 IDA-D1310-001 | Currency: XDR iLap Category Sequence No: 1A Current Expenditure Category: GDS,NCS,CS,TRG,OC part 1.1 (i) 5,101,961.75 4,297,431.06 5,101,961.75 100.00 100.00 iLap Category Sequence No: 1B Current Expenditure Category: GDS,NCS,CS,TRG,OC part 1.3 1,796,240.11 1,796,240.11 1,796,240.11 100.00 100.00 iLap Category Sequence No: 1C Current Expenditure Category: GDS,NCS,CS,TR,OC pt 2.3,3.1,3.2,5.2 7,301,798.14 7,291,046.53 7,301,603.64 100.00 100.00 iLap Category Sequence No: 2 Current Expenditure Category: WKS under part 5.2(iii) 0.00 0.00 0.00 100.00 100.00 iLap Category Sequence No: 3 Current Expenditure Category: PPF REFINANCING 0.00 0.00 0.00 Total 14,200,000.00 13,384,717.70 14,199,805.50 The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807) IDA-E1330-001 | Currency: XDR iLap Category Sequence No: 1 Current Expenditure Category: G,W,N/CS,T,OC 4,000,000.00 339,067.87 1,232,032.00 100.00 100.00 Total 4,000,000.00 339,067.87 1,232,032.00 TF-A2534-001 | Currency: USD iLap Category Sequence No: 1 Current Expenditure Category: GD, NCS, CONS, TR, OC PART 1.1 (i) 2,884,168.00 2,781,390.28 2,781,390.28 100.00 100.00 iLap Category Sequence No: 2 Current Expenditure Category: GD, NCS, CONS, TR, OC PART 1.3 1,180,000.00 1,056,810.12 1,056,810.12 100.00 100.00 Total 4,064,168.00 3,838,200.40 3,838,200.40 TF-B1239-001 | Currency: USD iLap Category Sequence No: 1 Current Expenditure Category: Consulting Serv pt 1.1i & 1.3 8,960,731.00 5,385,113.51 7,032,805.00 100.00 100.00 Total 8,960,731.00 5,385,113.51 7,032,805.00 .