The World Bank Implementation Status & Results Report Fiji COVID-19 Emergency Response Project (P173903) Fiji COVID-19 Emergency Response Project (P173903) EAST ASIA AND PACIFIC | Fiji | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 6 | ARCHIVED on 27-Oct-2023 | ISR57692 | Implementing Agencies: Ministry of Health & Medical Services, Republic of Fiji Key Dates Key Project Dates Bank Approval Date: 24-Jun-2020 Effectiveness Date: 23-Jul-2020 Planned Mid Term Review Date: 01-Apr-2022 Actual Mid-Term Review Date: 20-Apr-2022 Original Closing Date: 30-Jun-2023 Revised Closing Date: 30-Jun-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in the Republic of Fiji. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Emergency COVID-19 Response:(Cost $4.85 M) Component 2: Health Systems Strengthening:(Cost $1.40 M) Component 3: Implementation Management, Monitoring and Evaluation:(Cost $1.10 M) 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 Moderate Moderate Implementation Status and Key Decisions Progress towards achievement of the project development objective (PDO) is satisfactory, as the two PDO indicators related to the COVID-19 preparedness and response have been achieved. A significant increase in disbursements from 44% in June to 80% in October is commendable, nevertheless, the procurement rating was proposed for a downgrade to moderately unsatisfactory in August, as procurement deadlines are consistently missed by significant delays. The Environment and Social (E&S) rating remains moderately unsatisfactory. The Project Management Unit (PMU) will need to pay close attention to the remaining procurements, the completion of ongoing civil works and E&S risks and actions, to avoid putting at risk the full implementation of remaining activities by the project closing date, which has been extended by a year to June 30th, 2024. Project activities under Component 1 have been completed or are nearing completion. Intermediate results indicators have been met and exceeded. Project activities under component 2 are advanced but need to accelerate to ensure completion by project closing date. The extension of the Fiji Pharmaceutical and Biomedical Services (FPBS) warehouse is nearing completion alleviating Fiji's shortage of storage facilities 10/27/2023 Page 1 of 7 The World Bank Implementation Status & Results Report Fiji COVID-19 Emergency Response Project (P173903) for essential medicines. Imprudent excavation at the project site has been noted. To remedy the potential harm of the imprudent excavation, the PMU is consulting with the Ministries of Waterways and Infrastructure to draw up an acceptable long-term solution for the excavated drainage and clearance, aligned with Fiji laws and the Project Environmental and Social Management Plan (ESMP). A medical waste incinerator with capacity to treat medical waste from the Central division has been purchased, however, work to complete its installation at the Naboro landfill needs to accelerate. The incinerator house is expected to be completed by March 2024. A memorandum of understanding between MHMS and the Naboro landfill operator, must also be signed as a condition set by the Department of the Environment. 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. After a great deal of activity (restructurings and disbursements) processed at the end of FY23 when several operations were restructured just before or on June 30, 2023, the past two months have seen a slower period of disbursements. The overall level of disbursements is being affected by three main reasons: (i) low disbursements in six countries, (ii) pausing of disbursements in three other countries – Afghanistan, Myanmar, and Sudan, and (iii) processing of refunds to the project accounts at this late stage of project implementation. In addition, (i) 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, and (ii) Loans and Credits denominated in SDRs and Euros have been affected because of fluctuations between the SDRs and Euros against the US dollar. As of October 16, 2023, 88 MPA-projects had been approved with a total commitment of US$4.27 billion. One operation (Guatemala) was cancelled in mid-September 2021, at the request of the Government. Total disbursements as of October 16, 2023, amount to US$3.96 billion or 93% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. Ten operations closed by the end of CY22 and nine operations closed on June 30, 2023. While there are sixteen (16) operations with closing dates by the end of CY23, there are plans for several projects to process extensions so this number will change. As with the Mid Term Review (MTR) issued on March 25, 2023, no individual COVID-19 MPA operation will need an ICR. Only one ICR will be prepared upon completion of the SPRP COVID-19 MPA Program, which closes on December 31, 2025. The Global ICR will be based on final ISRs packages prepared by country operations’ teams. A template for the final ISR was issued by OPCS on March 25, 2023. Several operations have/are preparing final ISR packages. The overall conclusion of the MTR was that: (i) the COVID-19 MPA Program embodied a rapid, innovative approach to new lending for human health response; (ii) the COVID-19 MPA has been successful, notwithstanding considerable uncertainty and multiple constraints in the early stages of the pandemic; (iii) the Bank’s emergency response was remarkably swift in the most vulnerable countries facing human capital losses and development setbacks; and (iv) notwithstanding the challenges, the MPA is on track to achieve its PrDO, “prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness.“ Seventy three (73) country projects or 86 percent of projects approved have reached 70-100+ percent disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). Out of the 73 operations, 63 operations or 86 percent have disbursed 90+ percent of commitments. Out of the 73 operations, 49 operations or 67 percent are fully disbursed and ten (10) 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 35 percent (AFW), two operations in EAP have disbursed 46-48 percent and one operation in SAR has disbursed 49 percent. The projects are benefitting about 3.7 billion people or 50% of the global population. When countries with AF-V operations are counted, the projects are benefitting about 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. Operations in ECA and MNA are fully disbursed. In other regions, 10/27/2023 Page 2 of 7 The World Bank Implementation Status & Results Report Fiji COVID-19 Emergency Response Project (P173903) operations have reached: (i) SAR 94 percent, (ii) LAC 93 percent, (iii) EAP 86 percent, (iv) AFW 84, and (v) AFE 78 percent. Disbursements for EAP operations are being affected by low disbursements in three countries. AFE lower disbursements compared to other regions are a result of low disbursements under two operations, which have disbursed 54-66 percent respectively. In the case of AFW low overall disbursements are a result of low disbursements under one operation. Retroactive Financing (RF) represents 19 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. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Moderate Moderate Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and High Substantial Substantial Sustainability Fiduciary Moderate Moderate Moderate Environment and Social Substantial Substantial Substantial Stakeholders Substantial Moderate Moderate Other Moderate Moderate Moderate Overall Substantial Moderate Moderate Results PDO Indicators by Objectives / Outcomes To prevent, detect and respond to the threat posed by COVID-19 IN01337367 ►Proportion of identified at-risk population investigated with laboratory testing for COVID-19 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 100.00 100.00 95.00 Date 25-Mar-2020 16-Dec-2022 28-Sep-2023 31-May-2023 10/27/2023 Page 3 of 7 The World Bank Implementation Status & Results Report Fiji COVID-19 Emergency Response Project (P173903) Like other countries, testing protocols continued be revised and adopted to reflect the changing COVID-19 disease transmission during the height of the pandemic. Initially, testing for COVID-19 was only done at the Fiji CDC laboratory, Testing was later decentralized and implemented across the country as Comments: GeneXpert machines kits became available. As demand for testing increased, private laboratories were also involved in testing. IN01337368 ►Proportion of suspected and diagnosed cases treated as per approved protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 80.00 100.00 100.00 100.00 Date 27-Apr-2020 16-Dec-2022 16-Dec-2022 31-May-2023 Fiji’s success was attributed to the early investment in testing capacity. This enabled the MoHMS to test, trace, and isolate cases, and to quickly limit local transmission. 37 fever clinics were set up around the country to receive patients suspected of having contracted COVID-19. However, it should be noted that Comments: reports of deaths at homes increased exponentially during the COVID waves. These may be attributed to local health seeking behaviors and the fear of being isolated from family members and dying alone if they presented at health facilities. Intermediate Results Indicators by Components Component 1: Emergency COVID-19 Response IN01337681 ►Number of health facilities with improved connectivity for case reporting and public health surveillance (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 48.00 55.00 35.00 Date 25-Mar-2020 16-Dec-2022 28-Sep-2023 31-May-2023 55 health facilities have benefitted through this project, 32 of which already had low-band internet access Comments: that has been upgraded, while 23 facilities had no prior internet connectivity at all. IN01337683 ►Number of health workers responding to surge receiving overtime and per diem payments (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 401.00 401.00 100.00 Date 27-Apr-2020 16-Dec-2022 28-Sep-2023 31-May-2023 A total of 300 health workers involved in COVID contact tracing (49 teams) and 101 health workers for the Comments: Fiji Emergency Medical Assistance Team (FEMAT) Field Hospital. Component 2: Health Systems Strengthening IN01337369 ►Number of health facilities with access to improved health care waste management facilities (Number, Custom) 10/27/2023 Page 4 of 7 The World Bank Implementation Status & Results Report Fiji COVID-19 Emergency Response Project (P173903) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 3.00 Date 25-Mar-2020 16-Dec-2022 28-Sep-2023 29-Mar-2024 Procurement of the incinerator completed. Earthworks and contracting for the build of the incinerator Comments: house, as well as an MOU with the landfill operator for the management of the incinerator, underway. Component 3: Implementation Management, Monitoring and Evaluation IN01337370 ►Monitoring and evaluation system established to monitor COVID-19 preparedness and response plan (No/yes) (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 25-Mar-2020 16-Dec-2022 28-Sep-2023 31-May-2023 MHMS has implemented command centers that track infectious outbreaks including but not limited to COVID-19. They also serve to document health systems and operational needs, with a view to Comments: decentralize decision making and rapid response. IN01337682 ►Beneficiaries who expressed satisfaction with the project interventions, including on delivery and communication modalities (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 94.00 94.00 80.00 Date 01-Oct-2020 16-Dec-2022 28-Sep-2023 31-May-2023 Seven Beneficiary Satisfaction Surveys have been conducted with its respective findings summarised below: 6.1.1 Risk Communication: The communication channels preferred by respondents via this online survey were mostly Facebook and social media (73%) as well as Government websites (63%). Television (34%) and Radio (29%) were third and fourth preferred communication channels respectively. 6.1.2 Provision of meals to SWAB and FEMAT Teams: 85% of the recipients indicated they were very satisfied with the provision of hot meals while 15% did not respond. 6.1.3 Accommodation: 98% confirmed that it was helpful in performing their roles and safety as part of the FEMAT team; 2% did not respond. Comments: 6.1.4 Provision of Hand Sanitizers: 100% indicated they were satisfied with handsantizers accessibility in the wards and at their work place as a whole. 6.1.5 Provision of Gene Xperts Machines: 95% indicated that they were satisfied with the machines usefulness. 6.1.6 Provision of FCDC Testing equipments: 100% indicated that they were very satisfied with the equipments purchased and assisted FCDC greatly in its testing turnaround time. 6.1.7 Provision of Infection Prevention Control (IPC) Training in the Divisions: 100% indicated that they were satisfied with the content and quality of the training held and in return have made positive changes such as the implementation of colour coding in their workplaces. Performance-Based Conditions Data on Financial Performance 10/27/2023 Page 5 of 7 The World Bank Implementation Status & Results Report Fiji COVID-19 Emergency Response Project (P173903) Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173903 IDA-67330 Effective USD 6.40 6.40 0.00 4.95 1.49 77% P173903 TF-B3100 Closed USD 0.95 0.94 0.01 0.94 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173903 IDA-67330 Effective 24-Jun-2020 20-Jul-2020 23-Jul-2020 30-Jun-2023 30-Jun-2024 P173903 TF-B3100 Closed 24-Jun-2020 20-Jul-2020 23-Jul-2020 31-Jan-2021 01-Mar-2021 Cumulative Disbursements Restructuring History Level 2 Approved on 30-Jan-2021 ,Level 2 Approved on 22-Jun-2023 Related Project(s) 10/27/2023 Page 6 of 7 The World Bank Implementation Status & Results Report Fiji COVID-19 Emergency Response Project (P173903) There are no related projects. 10/27/2023 Page 7 of 7