The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) REPORT NO.: RES57528 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF REGIONAL DISEASE SURVEILLANCE SYSTEMS ENHANCEMENT (REDISSE) PHASE II APPROVED ON MARCH 2, 2017 TO FEDERAL REPUBLIC OF NIGERIA,REPUBLIC OF GUINEA BISSAU,REPUBLIC OF LIBERIA,REPUBLIC OF TOGO 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 Leader(s): Carolyn J. Shelton, Chijioke Samuel Okoro, Collins Chansa, Mariam Noelie Hema, Yemdaogo Tougma The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) ABBREVIATIONS AND ACRONYMS CERC Contingent Emergency Response Component E&S Environmental and Social Safeguards FM Financial Management GRM Grievance Redress Mechanism IDA International Development Association IP Implementation Progress JEE Joint External Evaluation MS Moderately Satisfactory MU Moderately Unsatisfactory PDO Project Development Objective REDISSE Regional Disease Surveillance Systems Enhancement Program SDR Special Drawing Rights WAHO West African Health Organization WB World Bank The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) BASIC DATA Product Information Project ID Financing Instrument P159040 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 02-Mar-2017 31-Aug-2023 Organizations Borrower Responsible Agency Federal Republic of Nigeria,Republic of Guinea Bissau,Republic of Liberia,Republic of Togo Project Development Objective (PDO) Original PDO The PDOs 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-59670 01-Mar-2017 05-Apr-2017 27-Jul-2017 31-Aug-2023 14.00 9.57 5.40 IDA-59680 01-Mar-2017 22-May-2017 21-Sep-2017 31-Aug-2023 21.00 13.20 8.88 IDA-59690 01-Mar-2017 16-May-2017 01-Nov-2017 31-Aug-2023 15.00 13.71 1.76 IDA-59700 01-Mar-2017 02-Nov-2017 13-Feb-2018 31-Aug-2023 90.00 66.28 24.23 IDA-D1700 01-Mar-2017 05-Apr-2017 27-Jul-2017 31-Aug-2023 7.00 4.72 2.55 The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) 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 II project was approved by the World Bank (WB) Board of Executive Directors on March 2, 2017 for US$147 million. This amount includes International Development Association (IDA) Credits and an IDA Grant to four countries: Federal Republic of Nigeria (US$90 million IDA Credit); Republic of Liberia (US$15 million IDA Credit), Republic of Guinea Bissau (US$21 million IDA Credit), and Republic of Togo (US$14 million IDA Credit; US$7 million IDA Grant). The REDISSE-II Project became effective on July 27, 2017, and the closing date is August 31, 2023. This Restructuring Paper seeks approval to carry out a Level 2 restructuring to (i) cancel funds from the IDA Credits for Guinea-Bissau and Nigeria and from the IDA Credit and Grant for Togo 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 WAHO and the Economic Community of Central African States (ECCAS), and 16 countries in West and Central Africa including Guinea, Senegal, Sierra Leone (REDISSE Phase I); Guinea-Bissau, Liberia, Togo, Nigeria (REDISSE Phase II); Benin, Niger, Mali, Mauritania (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; (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 II has strengthened health preparedness and response capacities and disease surveillance across sectors in the Participating Countries. The Project has also strengthened regional level collaboration and facilitated knowledge and resource sharing between Participating Countries and regional institutions. To date, 70.43 percent of the total financing of the Project has disbursed: 68 percent in Nigeria, 88.20 percent in Liberia, 57.70 percent in Guinea Bissau, and 63.11 percent in Togo. 4. The overall progress towards the achievement of the Project Development Objective (PDO) and the implementation progress (IP) have been rated Moderately Satisfactory (MS) in the last Implementation Status and The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) Results Report, dated December 2022. A final Implementation Status Report will be archived prior to the scheduled closing of the Project on August 31, 2023. During the last reporting period, progress varied among the Participating Countries — in Nigeria, the targets for five out of six PDO indicators have been achieved; in Liberia, three of the five PDO indicators have been met, and two are partially met; in Togo, four of the six PDO indicators have achieved their targets; and in Guinea Bissau, progress has been made on three of the four PDO indicators. 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 laid the groundwork for more robust disease surveillance and response systems in the Participating Countries prior to the pandemic, which enabled them to quickly respond to several outbreaks that emerged during the project’s lifetime, including COVID-19. The REDISSE-II project was at the forefront of Participating Countries’ responses to the COVID-19 pandemic and allowed a rapid mobilization of funds to address the countries’ initial prevention and response activities. In Liberia, the CERC was activated for US$8 million in March 2020, in addition to US$1.5 million which was initially reprogrammed to support COVID-19 activities. In Guinea Bissau, Nigeria, and Togo, funds in the amount of US$7 million, US$40 million, and US$9 million, respectively, were reprogrammed from REDISSE-II to directly implement COVID-19 related activities without activating the CERC. 6. Financial Management (FM) and Procurement have consistently been rated as MS. Despite minor FM shortcomings including late submission of external audit reports and Interim Financial Reports, 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. Procurement related activities are being implemented optimally in all Participating Countries. 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 WB post-review processes. 7. The overall Environmental and Social Safeguards (E&S) performance is rated Satisfactory. All Participating Countries are implementing E&S requirements in compliance with E&S instruments developed. All four participating countries have Grievance Redress Mechanisms (GRM) in place, albeit with varying degrees of functionality. 8. In February 2020, the project underwent a Level 2 restructuring following the activation of a CERC on April 6, 2018, in response to the Lassa Fever outbreak in Nigeria. This restructuring included: (i) formalization of the reallocation of US$2.5 million from Sub-components 1.1, 1.2, and 1.3 to Sub-component 3.3 with respect to the IDA Credit for Nigeria; and (ii) revision of the Results Framework to align regional and country targets, include indicators to measure CERC performance, remove select indicators that were no longer valid; and add new indicators to monitor gender disparities in accessing training opportunities. C. PROJECT PERFORMANCE AND RATIONALE FOR RESTRUCTURING – GUINEA-BISSAU, NIGERIA AND TOGO Project Performance 9. Guinea-Bissau. The overall Progress towards the achievement of PDO and IP are both rated Moderately Unsatisfactory (MU). Until the last supervision mission to Guinea-Bissau, carried out in May 2023, progress towards the PDO and IP were rated MS. However, after the last mission (May 2023), performance was assessed at MU given the number of activities not yet started, limited implementation capacity due to high staff turnover, and more The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) recently data reported on for the Results Framework. On July 16, 2023, the Government, officially submitted a request for cancellation of US$7,257,876. 10. Nigeria. Despite initial delays in project effectiveness, the overall progress towards the achievement of the PDO and IP are rated MS. From the latest assessment conducted in July 2023 (using Joint External Evaluation - JEE 2.0), the project has met five of the six project targets and reported no change in one (Laboratory testing capacity for the detection of priority diseases). On the other hand, six of the eight intermediate indicators performed below target, one reported no change, and one target (Applied Epidemiology Training such as FETP in place), was met. Project implementation was slowed by the initial delays in project effectiveness and the COVID-19 pandemic. As of August 25, 2023, disbursement was 68%. 11. Togo. Based on the last implementation support mission carried out in May 2023, project performance in Togo was rated MS both for PDO and IP. After five years of implementation, the REDISSE Project in Togo has made solid progress, namely in laboratories analysis capacities for the detection of priority diseases and availability of human resources to implement the core capacities required by the International Health Regulation (IHR). Four out of the six PDO indicators and seven out of the nine intermediate results indicators have been achieved. The weak ownership of the project by the Ministry of Health and frequent changes in the members of the PIU team contributed to delayed implementation, especially during the COVID-19 pandemic. Rationale For Restructuring 12. Guinea-Bissau. Select priority activities in the Annual Work Plan & Budget (AWPB) 2023 have been identified and other activities will be cancelled. Given implementation delays partially brought about by the COVID-19 response, instability in the country, and insufficient time for remaining activities to be implemented before project closing, the Ministry of Finance requested, in a letter received by the WB on July 26, 2023 (Ref. No. 518/GMF/2023), the cancellation of unused funds in the amount of US$7,257,876 and their recommitment to the country’s national portfolio budget allocation. 13. Nigeria. The Federal Ministry of Finance of Nigeria has requested to cancel a total of US$26 million in project funds. The first request was received through a letter dated July 10, 2023 (Ref. No. F11373/S.34/C.1798/T/17) for US$12.5 million, the second request dated August 11, 2023 (Ref. No. F11373/S.34/C.1798/T/22), requesting to cancel US$3.0 million, and the third request dated August 25, 2023 (Ref. No. F11373/S.34/C.1983/361), requested to cancel US$10.5million in project funds. The Government does not anticipate utilizing the remaining balance of resources available and based on the team’s assessment, the project will not be able to implement the remaining project activities before the scheduled closing date of August 31, 2023, as result of the delay in commencement of project implementation due to a one-year delay in effectiveness of the project. In the 2023 AWPB, the Government developed a set of priority activities to be completed before the closing date, e.g., completion of four Isolation and Treatment Centers. However, given implementation delays partially brought about by the COVID-19 response, an effectiveness delay, and insufficient time for remaining activities to be implemented before project closing, the Government requested funds to be cancelled under the project. 14. Togo. The approved activities in the AWPB 2023 which are not yet scheduled and signed contracts that cannot be executed before project closing on August 31, 2023, have been cancelled by mutual agreement with the Project Coordination Unit (PCU) and the REDISSE Steering Committee on May 9, 2023. Given the uncommitted balance of approximately US$6.72 million and the impossibility of using the funds before the closing date due to implementation delays partially brought about by the COVID-19 response, the Ministry of Economy and Finance (MEF) requested, in The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) a letter received by the WB on August 1, 2023 (Ref. No. 2862/MEF/SG/DGTCP/DDPF/DOF), the cancellation of the unused funds and their recommitment to the country’s national portfolio budget allocation. II. DESCRIPTION OF PROPOSED CHANGES 15. This Level 2 restructuring proposes to formalize the (a) cancellation and reallocation of funds and (b) changes in costs of components for the Guinea-Bissau IDA Credit, Nigeria IDA Credit, and Togo IDA Credit and Grant, consistent with the Investment Project Financing Procedures. (a) Reallocation between disbursement categories:  Guinea-Bissau (IDA Credit 59680-GW): Cancellation of a total of EUR 6,548,952 as follows: (i) EUR 4,848,966 from Category 1; and (ii) EUR 1,699,986 from Category 2. Subsequently, the allocations under Category 1 and Category 2 will be reduced (see Table 1 for additional details): TABLE 1: GUINEA-BISSAU CANCELLATION AND REALLOCATION OF FUNDS PER DISBURSEMENT CATEGORY Category Amount of the Credit IDA-59680 Allocated (Expressed in EUR) 1 Goods, non-consulting services, consultants’ services, Training, and Operational Costs under Parts 1, 2.2, 2.3 (i), 3.1 (i), 3.2 (i) and (iii), 4 and 12,951,034 5.1 of the Project 2 Goods and works under Part 2.1 of the Project 400,014 3 Emergency Expenditures under Part 3.3 of the Project - Amount cancelled on July 26, 2023 6,548,952 Original total amount 19,900,000  Nigeria (IDA Credit No. 59700-NG): Cancellation of a total of SDR 19,486,907 as follows: (i) SDR 17,486,907 from Category 1; and (ii) SDR 2,000,000 from Category 2. Subsequently, the allocations under Category 1 and Category 2 will be reduced and category 3 will remain unchanged (see Table 2 for additional details): TABLE 2: NIGERIA CANCELLATION AND REALLOCATION OF FUNDS PER DISBURSEMENT CATEGORY Category Amount of the Credit IDA-59700 Allocated (Expressed in SDR) 1 Goods, non-consulting services, consultants’ services, Training, and Operational Costs under Parts 1, 2.2, 2.3 (i), 3.1 (i), 3.2 (i) and (iii), 4 and 41,693,194 5.1 of the Project 2 Goods and works under Part 2.1 of the Project 4,600,000 3 Emergency Expenditures under Part 3.3 of the Project 719,899 Total Amount cancelled on July 10, August 11, and August 25, 2023 19,486,907 The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) Original total amount 66,500,000  Togo: Cancellations of a total of (i) EUR 4,645,298 from IDA Credit 59670-TG as follows: EUR 4,645,040 from Category 1 and EUR 258 from Category 2; (ii) SDR 1,275,240 from IDA Grant D1700-TG as follows: SDR 1,128,960 from Category 1 and SDR 146,280 from Category 2. Subsequently, the allocations under Category 1 and 2 will be reduced (See Table 3 for additional details): TABLE 3: TOGO CANCELLATION AND REALLOCATION OF FUNDS PER DISBURSEMENT CATEGORY Category Amount of the Credit IDA- Amount of the Grant IDA- 59670 Allocated D1700 Allocated (Expressed in EUR) (Expressed in SDR) 1 Goods, non-consulting services, consultants’ services, Training, and Operational Costs under Parts 7,754,960 3,771,040 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 899,742 253,720 3 Emergency Expenditures under Part 3.3 of the - - Project Amount cancelled on August 1, 2023 4,645,298 1,275,240 Original total amount 13,300,000 5,300,000 (b) Changes in Costs of Components: Given the above-mentioned cancellations, changes in the components will be processed through this Restructuring. Namely, the partial cancellations of the IDA Credits and IDA Grant will reduce the total envelope of each Component. See Table 4 for additional details. Table 4: REDISSE II - COST OF COMPONENTS GUINEA- GUINEA- LIBERIA LIBERIA NIGERIA NIGERIA TOGO TOGO TOTAL TOTAL BISSAU BISSAU Original Revised Original Revised Original Revised Original Revised Original Revised amount Amount amount Amount amount Amount amount Amount Cost of Cost of Project Budget (US$ (post- (US$ (post- (US$ (post- (US$ (post- components Componen by component million) cancellation) million) cancellation) million) cancellation) million) cancellation) (US$ ts (US$ million) (US$ million) (US$ million) (US$ million) million) (post- cancellatio n) (US$ million) C1: 4.65 2.86 1.48 - 35.0 27 4.2 2.80 45.33 34.14 Surveillance and The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) Information Systems C2: Strengthening 6.72 3.70 2.53 - 19.0 14.0 2.64 1.80 30.89 22.03 of Laboratory Capacity C3: Preparedness and 2.33 1.14 2.55 - 10.5 10.5 10.7 6.74 26.08 20.93 Emergency Response C4: Human Resources Management for Effective 3.98 2.82 2.96 - 14.5 6.5 1.2 1.18 22.64 13.46 Disease Surveillance and Epidemic Preparedness C5: Institutional Capacity Building, 3.32 3.22 5.48 - 11.0 6 2.26 1.63 22.06 16.33 Project Management, Coordination and Advocacy Total 21 13.74 15 - 90 64 21 14.15 147 106.89 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 ✔ The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) Loan Closing Date(s) ✔ Disbursements Arrangements ✔ 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 45.26 Revised 34.14 Information Systems Information Systems Component 2: Strengthening of Component 2: Strengthening 30.17 Revised 22.03 Laboratory Capacity of Laboratory Capacity Component 3: Preparedness and Component 3: Preparedness 29.95 Revised 20.93 Emergency Response and Emergency Response Component 4: Human Resource Component 4: Human Management for Effective Resource Management for 20.62 Revised 13.46 Disease Surveillance and Effective Disease Surveillance Epidemic Preparedness and Epidemic Preparedness The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) Component 5: Institutional Component 5: Institutional Capacity Building, Project Capacity Building, Project 21.00 Revised 16.33 Management, Coordination and Management, Coordination Advocacy and Advocacy TOTAL 147.00 106.89 OPS_DETAILEDCHANGES_CANCELLATIONS_TABLE CANCELLATIONS Value Reason Current Cancellation New Ln/Cr/Tf Status Currency Date of for Amount Amount Amount Cancellation Cancellation Disburs UNDISBURSE IDA-59670- ing&Re EUR 13,300,000.00 4,645,298.00 01-Aug-2023 8,654,702.00 D BALANCE 001 paying AT CLOSING Disburs UNDISBURSE IDA-59680- ing&Re EUR 19,900,000.00 6,548,952.00 26-Jul-2023 13,351,048.00 D BALANCE 001 paying AT CLOSING Disburs IDA-59690- ing&Re XDR 11,200,000.00 0.00 11,200,000.00 001 paying Disburs UNDISBURSE IDA-59700- ing&Re XDR 66,500,000.00 19,486,907.00 10-Jul-2023 47,013,093.00 D BALANCE 001 paying AT CLOSING UNDISBURSE IDA-D1700- Disburs XDR 5,300,000.00 1,275,240.00 01-Aug-2023 4,024,760.00 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 IDA-59670-001 | Currency: EUR iLap Category Sequence No: 1 Current Expenditure Category: GD,NCS,CS,TR,OP Pt1-5 ex 2.1,3.3 12,400,000.00 6,355,843.05 7,754,960.00 67.00 67.00 iLap Category Sequence No: 2 Current Expenditure Category: Goods,Works Part 2.1 The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) 900,000.00 536,027.63 899,742.00 67.00 67.00 iLap Category Sequence No: 3 Current Expenditure Category: Emergency expenditures Part 3.3 0.00 0.00 0.00 100.00 100.00 Total 13,300,000.00 6,891,870.68 8,654,702.00 IDA-59680-001 | Currency: EUR iLap Category Sequence No: 1 Current Expenditure Category: GD,NCS,CS,TR,OP Diverse P Parts 17,800,000.00 5,858,639.64 12,951,034.00 100.00 100.00 iLap Category Sequence No: 2 Current Expenditure Category: Goods,Works Part 2.1 2,100,000.00 0.00 400,014.00 100.00 100.00 iLap Category Sequence No: 3 Current Expenditure Category: Emergency expenditures Part 3.3 0.00 0.00 0.00 100.00 100.00 Total 19,900,000.00 5,858,639.64 13,351,048.00 IDA-59700-001 | Currency: XDR iLap Category Sequence No: 1 Current Expenditure Category: GD,NCS,CS,TR,OP Pt1-5 ex 2.1,3.3 59,180,101.00 41,187,852.36 41,693,194.00 100.00 100.00 iLap Category Sequence No: 2 Current Expenditure Category: Goods,Works Part 2.1 6,600,000.00 151,446.74 4,600,000.00 100.00 100.00 iLap Category Sequence No: 3 Current Expenditure Category: Emergency expenditures Part 3.3 719,899.00 305,457.77 719,899.00 100.00 100.00 The World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) Phase II (P159040) Total 66,500,000.00 41,644,756.87 47,013,093.00 IDA-D1700-001 | Currency: XDR iLap Category Sequence No: 1 Current Expenditure Category: GD,NCS,CS,TR,OP Pt1-5 ex 2.1,3.3 4,900,000.00 2,564,514.35 3,771,040.00 33.00 33.00 iLap Category Sequence No: 2 Current Expenditure Category: Goods,Works Part 2.1 400,000.00 218,077.31 253,720.00 33.00 33.00 iLap Category Sequence No: 3 Current Expenditure Category: Emergency expenditures Part 3.3 0.00 0.00 0.00 100.00 100.00 Total 5,300,000.00 2,782,591.66 4,024,760.00 .