The World Bank Implementation Status & Results Report El Salvador COVID-19 Emergency Response Project (P173872) El Salvador COVID-19 Emergency Response Project (P173872) LATIN AMERICA AND CARIBBEAN | El Salvador | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 7 | ARCHIVED on 29-Dec-2023 | ISR59078 | Implementing Agencies: Ministry of Health, Republic of El Salvador Key Dates Key Project Dates Bank Approval Date: 17-Apr-2020 Effectiveness Date: 26-Aug-2020 Planned Mid Term Review Date: -- Actual Mid-Term Review Date: 03-Oct-2022 Original Closing Date: 29-Jul-2022 Revised Closing Date: 30-Jun-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To respond to and mitigate the threat posed by COVID-19 and strengthen the national system for public health preparedness in El Salvador. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Emergency COVID-19 response to prevention, detection and treatment :(Cost $166.40 M) Component 2. Project Management and Monitoring:(Cost $3.60 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Highly Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The El Salvador COVID-19 Emergency Response Project was approved by the World Bank Board of Executive Directors on April 17, 2020 with the objective of responding to and mitigating the threat posed by COVID-19 and strengthening the national system for public health in the country. This Project is part of a World Bank Multi-Phase Programmatic Approach to support countries affected by the COVID-19 pandemic. The original loan in the amount of US$20 million was signed on June 4, 2020 and effectiveness was declared on August 26, 2020. An additional loan in the amount of US$50 million was approved by the Board on April 16, 2021, and signed on June 25, 2021. A third loan in the amount of US$100 million was approved on June 15, 2022, and signed on July 6, 2022. The total Project cost is now US$170 million. On December 12, 2023, the World Bank approved a restructuring to extend the Closing Date of the mentioned loans from December 31, 2023, to June 30, 2024. As of December 2023, the Project has supported the Government of El Salvador with its response to the COVID-19 pandemic by financing: (i) medicines, vaccines, medical supplies, equipment, temporary personnel and works as well as (ii) preparedness, capacity building, communication and training activities. Project implementation remains underway. The Project is scheduled to close on June 30, 2024. 12/29/2023 Page 1 of 7 The World Bank Implementation Status & Results Report El Salvador COVID-19 Emergency Response Project (P173872) 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 Considerable efforts continue to be made to advance the implementation of the 87 MPA operations. The past month has seen good efforts to accelerate implementation reflected in disbursements processed. However, as noted in the past months, the overall level of disbursements is being affected by three main reasons: (i) low disbursements in six countries, (ii) pausing of disbursements in two other countries – Afghanistan, and Myanmar, 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) the amounts of 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 December 18, 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 December 18, 2023, amount to US$3.99 billion or 93% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. Ten operations closed by the end of CY22 and nine operations closed on June 30, 2023. Sixteen operations had closing dates by the end of CY23. However, closing dates for seven operations were extended, leaving nine (9) operations with closing dates by the end of CY23. As with the Mid Term Review (MTR) issued on March 25, 2023, no individual COVID-19 MPA operation will need an ICR. Only one ICR will be prepared upon completion of the SPRP COVID-19 MPA Program, which closes on December 31, 2025. The Global ICR will be based on final ISRs packages prepared by country operations’ teams. A template for the final ISR was issued by OPCS on March 21, 2023. Several operations have/are preparing final ISR packages. The overall conclusion of the MTR was that: (i) the COVID-19 MPA Program embodied a rapid, innovative approach to new lending for human health response; (ii) the COVID-19 MPA has been successful, notwithstanding considerable uncertainty and multiple constraints in the early stages of the pandemic; (iii) the Bank’s emergency response was remarkably swift in the most vulnerable countries facing human capital losses and development setbacks; and (iv) notwithstanding the challenges, the MPA is on track to achieve its PrDO, “prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness.“ Seventy-five (75) country projects or 86 percent of projects approved have reached 70-100+ percent disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). Out of the 75 operations, 66 operations or 87 percent have disbursed 90+ percent of commitments. Out of the 75 operations, 49 operations or 65 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 50 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, disbursements have reached: (i) LAC 97 percent, (ii) SAR 95 percent, (iii) EAP 87 percent, (iv) AFW 85 percent, and (v) AFE 79 percent. Disbursements for EAP operations are being affected by low disbursements in three country projects that have disbursed between 48 and 12/29/2023 Page 2 of 7 The World Bank Implementation Status & Results Report El Salvador COVID-19 Emergency Response Project (P173872) 57 percent. AFE lower disbursements compared to other regions are a result of low disbursements under two operations, which have disbursed 57- 66 percent respectively. In the case of AFW low overall disbursements are a result of low disbursements under one operation (35 percent). Retroactive Financing (RF) continues to represent 20 percent of commitments. SAR has the highest percentage of RF at 37 percent, followed by ECA at 18 percent. Direct Payment (DP) disbursements represent 22 percent of commitments. EAP has the highest level of disbursements using DP – 80 percent, followed by AFW at 38 percent. IDA continues to represent 40 percent while IBRD represents 60 percent of disbursements. Streamlined procedures, delegated approvals, coupled with flexible project design and intensified efforts by counterparts and Bank teams have contributed to the progress. Implementation is being guided by Bank teams working in parallel with other health related projects, including Additional Financing operations which have supported vaccine procurement and deployment efforts. COVID-19 MPA AF-V - ISR Write-up – December 18, 2023 Good progress is being made in the implementation of AF-V operations. As of December 18, 2023, the Bank has approved 117 operations (including MPA-V operations) to support vaccine procurement and rollout in 78 countries amounting to $9.25 billion. Four operations have been approved in the past six months including: (i) Senegal AF2 operation for $15 million financed by a Grant from The Global Finance Facility (GFF) approved on June 30, 2023; (ii) a Second AF (IDA Grant of $1.50 million) approved on August 31, 2023 for Sao Tome and Principe, (iii) a Grant of $3.94 approved for Chad on July 23, 2023; and (iv) Zimbabwe AF2 operation for $15 million financed by a Grant from the GFF approved on December 7, 2023. 121 operations had been approved amounting to $10 billion, but four operations have been cancelled: (i) Costa Rica loan ($120 million), (ii) Peru loan ($500 million), (iii) Gabon loan ($12 million), which loan agreement lapsed, and (iv) Philippines AF2 loan of $300 million. The Afghanistan operation commitment of $113 million was reduced to $60 million. Several operations have processed partial cancellations, thereby the overall commitment has decreased in the past months. Other operations are also in the process of cancelling funds. Of the 117 approved operations: (i) 67 are in Africa – 32 in AFE and 35 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 117 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 December 18, 2023, amount to US$6.43 billion or 73 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 or partially cancel funds allocated to procurement of COVID-19 vaccines and deployment. Guidance was issued under an Email from Juan Pablo Uribe of July 7, 2023, which provided direction for the use of undisbursed funds under COVID-19 operations. Four (4) operations are fully disbursed (Argentina, Indonesia, Sri Lanka AF-V 1, and Ukraine AF-V 3). Fifty (50) operations or 43 percent of operations approved have disbursed over 70 percent of their commitments. Out of the 50, nineteen (19) operations have disbursed 90+ percent. Ninety-five (95) operations or 82 percent of total operations approved are disbursing. EAP has the highest percentage of disbursements at 94 percent, followed by ECA at 87 percent, LAC at 84 percent, SAR at 80 percent, MNA at 79 percent, AFE at 60 percent, and AFW at 59 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. 12/29/2023 Page 3 of 7 The World Bank Implementation Status & Results Report El Salvador COVID-19 Emergency Response Project (P173872) Retroactive Financing (RF) represents 37 percent of overall commitments. ECA has the highest level of RF at 74 percent, followed by SAR at 68 percent, LAC at 59 percent, MNA and AFE at 29 percent and AFW at 13 percent. Disbursements to UN agencies represent 22 percent of overall disbursements. AFW has the highest percentage of disbursements to UN agencies -- 66 percent, while AFE has disbursed 40 percent to UN agencies. Direct Payment (DP) represents 16 percent of disbursements. EAP has the highest level of disbursements using DP - 43 percent, followed by LAC at 29 percent. As with the COVID-19 MPA operations, streamlined procedures, delegated approval, wide use of Bank Facilitated Procurement (BFP), coupled with flexible project design, and intensified efforts from counterparts and Bank staff 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 Moderate Moderate Macroeconomic Substantial Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Low Moderate Moderate Other Substantial Substantial Substantial Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes To respond to and mitigate the threat posed by COVID-19 and strengthen national system IN01386302 ►Confirmed cases of COVID-19 reported and investigated based on national guidelines. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 100.00 70.00 12/29/2023 Page 4 of 7 The World Bank Implementation Status & Results Report El Salvador COVID-19 Emergency Response Project (P173872) Date 02-Apr-2020 02-Apr-2020 18-Dec-2023 30-Jun-2024 IN01386304 ►ICU beds in prioritized ICUs that are fully equipped and operational in the COVID-19 network health care facilities. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 21.00 0.00 79.00 70.00 Date 02-Apr-2020 02-Apr-2020 18-Dec-2023 30-Jun-2024 IN01386321 ►Population vaccinated, based on the targets defined by El Salvador's National COVID-19 Vaccination Plan (total and disaggregated by gender) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 76.00 85.00 80.00 Date 29-Jan-2021 30-Jun-2022 18-Dec-2023 30-Jun-2024 Intermediate Results Indicators by Components Component 1: Emergency COVID-19 response to prevention, detection and treatment IN01386303 ►Health network units with personal protective equipment and infection control products and supplies. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 70.00 Date 02-Apr-2020 30-Jun-2022 09-Mar-2023 30-Jun-2024 Numerator: Total number of hospitals that belong to the public health system and receive personal Comments: protective equipment and infection control products and supplies financed under the Project Denominator: Total number of hospitals that belong to the public health system. IN01386305 ►COVID-19 communication activities which promote the prevention of illness, the acceptance of the vaccine and the role of the health care workers (male and female) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6,927.00 8,390,288.00 6,314,000.00 Date 02-Apr-2020 30-Jun-2022 18-Dec-2023 30-Jun-2024 Number of COVID-19 related communication products (radio, press, television, digital, external) Comments: IN01386322 ►User Satisfaction Survey applied and reported (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes 12/29/2023 Page 5 of 7 The World Bank Implementation Status & Results Report El Salvador COVID-19 Emergency Response Project (P173872) Date 29-Jan-2021 30-Jun-2022 09-Mar-2023 30-Jun-2024 IN01386323 ►Health staff trained in provision of COVID-19 vaccination per MoH-approved protocols differentiated by gender. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 450.00 3,520.00 1,300.00 Date 29-Jan-2021 30-Jun-2022 09-Mar-2023 30-Jun-2024 IN01386324 ►Vaccination sites targeted by the Project with energy efficient equipment (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 29-Jan-2021 30-Jun-2022 09-Mar-2023 30-Jun-2024 IN01386325 ►Increased share of female health workers that report they are better equipped to handle mental and emotional stress during the pandemic. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 62.00 82.27 80.00 Date 26-Feb-2021 30-Jun-2022 18-Dec-2023 30-Jun-2024 IN01386326 ►Number of hospitals strengthened with diagnostic imaging equipment (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 11.00 12.00 Date 02-Apr-2020 -- 05-Dec-2023 30-Jun-2024 Number of hospitals that were reinforced with diagnostic imaging equipment (e.g. MRI, CT scan, X ray, Comments: ultrasound) financed by the Project. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173872 IBRD-91000 Effective USD 20.00 20.00 0.00 19.16 0.84 96% 12/29/2023 Page 6 of 7 The World Bank Implementation Status & Results Report El Salvador COVID-19 Emergency Response Project (P173872) P173872 IBRD-92290 Effective USD 50.00 50.00 0.00 40.13 9.88 80% P173872 IBRD-94290 Effective USD 100.00 100.00 0.00 88.27 11.73 88% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173872 IBRD-91000 Effective 17-Apr-2020 04-Jun-2020 26-Aug-2020 29-Jul-2022 30-Jun-2024 P173872 IBRD-92290 Effective 16-Apr-2021 25-Jun-2021 23-Sep-2021 31-Jul-2023 30-Jun-2024 P173872 IBRD-94290 Effective 15-Jun-2022 06-Jul-2022 01-Aug-2022 31-Dec-2023 30-Jun-2024 Cumulative Disbursements Restructuring History Level 2 Approved on 01-Dec-2021 ,Level 2 Approved on 11-Dec-2023 Related Project(s) P176033-AF El Salvador COVID-19 Emergency Response Project ,P178315-Second Additional Financing to El Salvador COVID-19 Emergency Response Project 12/29/2023 Page 7 of 7