The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) EASTERN AND SOUTHERN AFRICA | Malawi | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 8 | ARCHIVED on 20-Sep-2023 | ISR56376 | Implementing Agencies: Ministry of Health, Republic of Malawi Key Dates Key Project Dates Bank Approval Date: 14-Apr-2020 Effectiveness Date: 30-Apr-2020 Planned Mid Term Review Date: 30-Jun-2022 Actual Mid-Term Review Date: 24-Jun-2022 Original Closing Date: 31-May-2022 Revised Closing Date: 31-Dec-2025 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To prevent, detect and respond to the threat posed by COVID-19 in Malawi and strengthen national systems for public health preparedness. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Emergency COVID-19 Response:(Cost $89.20 M) Supporting National and Sub-national, Prevention and Preparedness:(Cost $3.25 M) Implementation Management and Monitoring and Evaluation:(Cost $4.45 M) Contingent Emergency Response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The project continues to strengthen disease surveillance systems, public health laboratories and epidemiological capacity. Key achievements in the reporting period are completion of training of non-lab staff on COVID-19 testing and strengthened laboratory commodity supply chain management, improved capacity of and service delivery in the laboratories through procurement of equipment, renovation of infrastructure, and completion of preparatory work for the procurement of various medical equipment. The technical specifications and maintenance service contracts for all medical equipment, including the oxygen plant, Magnetic Resonance Imaging (MRI), digital x-rays, ultrasound scanning machines, one data center at the Zomba Central Hospital, smartphones (tablets), and computed tomography (CT) scanner, have also been developed. The procurement of COVID-19 vaccines supported by the project has been completed and 35 percent of the medicines and supplies procured through UNICEF have been delivered in country. The MOH has engaged he World Health Organization (WHO) for the procurement and delivery of 9/20/2023 Page 1 of 10 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) medicines using the US$12 million equivalent of uncommitted funds that were deployed to cover CERC activities, including US$9 million for essential medicines and supplies, and US$3 million for the cholera response activities. 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 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. 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. 9/20/2023 Page 2 of 10 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) 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 Substantial Substantial Substantial Macroeconomic Substantial High High Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Substantial Substantial Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes To prevent, detect and respond to the threat posed by COVID-19 IN01297169 ►Percentage of designated health facilities ready to treat COVID-19 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 Date 15-Apr-2020 31-Oct-2022 15-Aug-2023 31-Dec-2023 IN01297170 ►Percentage of targeted population fully vaccinated based on the targets defined in national plan, disaggregated by sex (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.50 30.10 30.00 Date 01-Jun-2021 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297171 9/20/2023 Page 3 of 10 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Percentage of females fully vaccinated (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 53.00 54.70 50.00 Date 01-Jun-2021 31-Oct-2022 15-Aug-2023 31-Dec-2023 IN01297172 ►Number of OPD visits per 1000 population (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 930.00 0.00 1,162.00 1,100.00 Date 14-Mar-2022 31-Oct-2022 15-Aug-2023 30-Jun-2024 To strengthen national systems for public health preparedness IN01297168 ►Percentage of designated laboratories with staff trained to conduct COVID-19 diagnosis. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 25.00 25.00 80.00 Date 15-Apr-2020 31-Oct-2022 15-Aug-2023 31-Dec-2023 Intermediate Results Indicators by Components Emergency COVID-19 Response IN01297175 ►Number of health staff trained in infection prevention and control per MOH-approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 948.00 948.00 1,448.00 Date 15-Apr-2020 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297177 ►Oxygen plant installed and functional (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Jun-2021 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297179 ►Number of health surveillance assistants (HSAs) oriented in contact tracing, by gender. (Number) (Number, Custom) 9/20/2023 Page 4 of 10 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,598.00 4,598.00 4,500.00 Date 15-Apr-2020 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297180 Number of female health surveillance assistants (HSAs) oriented in contact tracing (Number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,385.00 2,340.00 2,025.00 Date 01-Jun-2021 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297181 ►Healthcare workers training materials were assessed to identify the extent to which Gender-Based Violence (GBV) is addressed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 11-Jun-2021 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297182 ►Number of healthcare professionals (HCPs) and district investigation officers trained on detection and reporting, or investigation of AEFIs, by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 990.00 1,424.00 1,475.00 Date 11-Jun-2021 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297183 Number of female healthcare professionals (HCPs) and district investigation officers trained on detection and reporting, or investigation of AEFIs. (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 516.00 Date 11-Jun-2021 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297184 ►Number of districts conducting monthly community dialogues on COVID-19 vaccination and prevention measures (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 29.00 Date 14-Mar-2022 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297185 ►Number of districts with the required climate-sensitive/energy-efficient ultra-low temperature freezer to store COVID-19 vaccines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 29.00 9/20/2023 Page 5 of 10 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Date 14-Mar-2022 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297186 ►Number of central hospitals rehabilitated for COVID-19 case management (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 14-Mar-2022 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297187 ►Number of incinerators that are functional (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 15.00 15.00 Date 14-Mar-2022 31-Oct-2022 15-Aug-2023 31-Dec-2025 All 15 incinerators are functional. No maintenance activities have commenced. Comments: IN01297188 ►Percentage of users of modern contraceptive methods (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.00 0.00 71.00 70.00 Date 14-Mar-2022 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297189 ►Percentage of pregnant women who made their first ANC visit within the first three months of pregnancy (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 24.00 0.00 16.90 30.00 Date 14-Mar-2022 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297190 ►Percentage of surviving infants receiving the last (i.e., third) recommended dose of Pentavalent vaccine at the national level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 93.00 0.00 76.00 97.00 Date 14-Mar-2022 31-Oct-2022 15-Aug-2023 30-Jun-2024 IN01297191 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 631,885.00 1,250,867.00 9/20/2023 Page 6 of 10 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Date 30-May-2022 31-Oct-2022 15-Aug-2023 30-Jun-2024 IN01297192 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 461,629.00 1,250,867.00 IN01297193 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 340,511.00 690,867.00 Date 30-May-2022 31-Oct-2022 15-Aug-2023 30-Jun-2024 IN01297194 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 291,374.00 560,000.00 Date 30-May-2022 31-Oct-2022 15-Aug-2023 30-Jun-2024 Supporting National and Sub-national, Prevention and Preparedness IN01297174 ►Number of health staff trained in emerging infectious diseases (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 250.00 250.00 180.00 Date 15-Apr-2020 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297176 ►Number of district where Event- Based Surveillance system is functional (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 14-Mar-2022 31-Oct-2022 15-Aug-2023 31-Dec-2025 Implementation Management and Monitoring and Evaluation IN01297173 ►Percentage of grievances addressed within 4 weeks of initial complaint being recorded (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 71.00 80.00 9/20/2023 Page 7 of 10 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Date 15-Apr-2020 31-Oct-2022 15-Aug-2023 31-Dec-2025 IN01297178 ►Percentage of health care facilities adhering to health care waste management as per the national IPC minimum standards (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 30.00 100.00 Date 14-Mar-2022 31-Oct-2022 15-Aug-2023 31-Dec-2025 Contingent Emergency Response Component IN01306683 ►Case Fatality Rate (CPR) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.27 -- 3.00 1.00 Date 01-Feb-2023 -- 15-Aug-2023 31-Jul-2023 IN01306684 ►Number of districts reporting zero cholera cases for the past 14 days (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 -- 9.00 29.00 Date 01-Feb-2023 -- 15-Aug-2023 31-Jul-2023 IN01306685 ►Number of Vibrio Cholera genomic sequencing tests conducted (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 100.00 Date 01-Feb-2023 -- 15-Aug-2023 31-Jul-2023 Procurement of reagents is ongoing. Comments: IN01306896 ►Percentage of CTC/CTUs at the district level adhering to cholera case management guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 100.00 Date 01-Feb-2023 -- 15-Aug-2023 31-Jul-2023 IN01306782 ►Percentage of CTC/CTUs at the district level adhering to waste management protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 9/20/2023 Page 8 of 10 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Value 0.00 -- 0.00 100.00 Date 01-Feb-2023 -- 15-Aug-2023 31-Jul-2023 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173806 IDA-71770 Effective USD 25.40 25.40 0.00 1.60 23.71 6.3% P173806 IDA-D6200 Effective USD 7.00 7.00 0.00 7.16 0.14 98% P173806 IDA-D8870 Effective USD 30.00 30.00 0.00 13.19 14.81 47% P173806 IDA-E0980 Effective USD 24.50 24.50 0.00 2.60 21.87 11% P173806 TF-B8719 Effective USD 10.00 10.00 0.00 5.11 4.89 51% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173806 IDA-71770 Effective 21-Jun-2022 01-Aug-2022 13-Sep-2022 31-Dec-2025 31-Dec-2025 P173806 IDA-D6200 Effective 14-Apr-2020 17-Apr-2020 30-Apr-2020 31-May-2022 31-Dec-2023 P173806 IDA-D8870 Effective 15-Jun-2021 02-Jul-2021 23-Aug-2021 31-Dec-2023 31-Dec-2023 P173806 IDA-E0980 Effective 21-Jun-2022 01-Aug-2022 13-Sep-2022 31-Dec-2025 31-Dec-2025 P173806 TF-B8719 Effective 28-Jul-2022 01-Aug-2022 13-Sep-2022 30-Jun-2024 30-Jun-2024 Cumulative Disbursements 9/20/2023 Page 9 of 10 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Restructuring History There has been no restructuring to date. Related Project(s) P176402-Additional Financing for Malawi COVID-19 Emergency Response and Health Systems Preparedness Project ,P178095-Second Additional Financing for Malawi COVID-19 Emergency Response and Health Systems Preparedness Project 9/20/2023 Page 10 of 10