The World Bank Turkey Emergency COVID-19 Health Project (P173988) REPORT NO.: RES59546 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF TURKEY EMERGENCY COVID-19 HEALTH PROJECT APPROVED ON APRIL 24, 2020 TO MINISTRY OF TREASURY AND FINANCE HEALTH, NUTRITION & POPULATION EUROPE AND CENTRAL ASIA Regional Vice President: Antonella Bassani Country Director: J. Humberto Lopez Regional Director: Michal J. Rutkowski Practice Manager/Manager: Rekha Menon Task Team Leader(s): Nadwa Rafeh The World Bank Turkey Emergency COVID-19 Health Project (P173988) BASIC DATA Product Information Project ID Financing Instrument P173988 Investment Project Financing Environmental and Social Risk Classification (ESRC) Substantial Approval Date Current Closing Date 24-Apr-2020 31-Dec-2023 Organizations Borrower Responsible Agency Ministry of Treasury and Finance Multiphase Programmatic Approach (MPA) Program Development Objective 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 Multiphase Programmatic Approach (MPA) Status (Public Disclosure) Status and Key Decisions (Public Disclosure) COVID-19 MPA - ISR Write-up as of December 18, 2023 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 The World Bank Turkey Emergency COVID-19 Health Project (P173988) 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 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 The World Bank Turkey Emergency COVID-19 Health Project (P173988) 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 The World Bank Turkey Emergency COVID-19 Health Project (P173988) 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. 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 OPS_TABLE_PDO_CURRENTPDO Project Development Objective (PDO) Original PDO The Project development objective is to prevent, detect, and respond to the threat posed by COVID-19 in Turkey. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed COFN-C2110 29-Jun-2022 04-Jul-2022 01-Aug-2022 31-Dec-2023 240.99 239.96 0 IBRD-93930 26-May-2022 27-May-2022 27-May-2022 31-Dec-2023 500.00 476.05 0 IBRD-91030 24-Apr-2020 04-May-2020 27-May-2020 31-Dec-2023 100.00 108.63 0 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No The World Bank Turkey Emergency COVID-19 Health Project (P173988) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING Background 1. The EUR 91.4 million Türkiye Emergency COVID-19 Health Project, prepared under the COVID-19 Strategic Preparedness and Response Program, was approved on April 24, 2020. A EUR 450.7 million Additional Financing (AF) was approved on May 26, 2022, to support the procurement of COVID-19 vaccines. An additional EUR 225.3 million (US$ 250 million equivalent) is provided as co-financing from the Asian Infrastructure and Investment Bank (AIIB). The Project Development Objective (PDO) is to prevent, detect, and respond to the threat posed by COVID-19 in Türkiye. 2. Progress towards achieving the PDO and overall implementation progress (IP) have consistently been rated Moderately Satisfactory. Overall, the Project has made significant achievements in supporting Türkiye’s pandemic preparedness strengthening efforts. Two of the three PDO-level indicators have been met and exceeded their end targets. The Specifically, (i) 9,357,600 people have been tested for COVID-19 (target: 300,000); and (ii) 69.04 percent of the population has been vaccinated (target: 66 percent). The third indicator (diagnosed cases treated per approved protocol under the Project) has been partially achieved (actual: 14.93 percent; target: 25 percent). Partial achievement of this indicator is due to the fact that the Ministry of Health (MoH) opted to increase investment of its own resources in treatment equipment, thus reducing the share of equipment financed (and treatment covered) attributable to Project financing. In addition, all seven intermediate results indicators surpassed or met their end targets. 3. Overall disbursement is currently at 100% percent. However, the designated account has an outstanding balance yet to be documented as eligible expenditures. Specifically, the original loan (9103-TR) is fully disbursed, but with an undocumented advance of EUR 11,179,189.55, while the AF loan (9393-TR) is fully disbursed, but with an undocumented advance of EUR 500,000. 4. Procurement, financial management, and Environmental and Social Standards are all rated Satisfactory. There are no outstanding audits. The project is in compliance with all legal covenants. Rationale for Restructuring 5. The Government (Ministry of Treasury and Finance) formally requested the restructuring on December 29, 2023. The proposed restructuring seeks to extend the closing date of the loans by three months to complete the delivery and/or installation of 10 X-ray devices. Specifically, seven devices (US$ 373,450) are in transit to Türkiye, but delivery has been delayed. The delivery delays were difficult to predict and, thus, take effective mitigation actions against. Specifically, the route of the container ship carrying the devices originally planned to transit the Suez Canal but was forced to reroute in order to ensure safety of the shipment due to threats of safe passage in the Arabian and Red Seas. The ship is now in transit around the Cape of Good Hope and the estimated arrival in has been revised from the originally planned date of December 20, 2023 to January 14, 2024. 6. The X-ray devices were added to the Project’s procurement plan in the aftermath of the February 2022 earthquakes to ensure continued diagnostic capability in the face of the dramatic devastation and loss of infrastructure. These devices are important for activities under Component 1 of the project. The Bank and the Borrower agree on actions that will be undertaken by the Borrower to complete delivery and/or installation of the remaining medical equipment by the extended Project closing date. The World Bank Turkey Emergency COVID-19 Health Project (P173988) II. DESCRIPTION OF PROPOSED CHANGES 7. An extension of the Project closing date is needed to provide the necessary additional time for the delivery and installation of the equipment that was shipped but is not expected to arrive in Türkiye until early January 2024. The extension will allow eligibility of these expenditures under the original loans. No other changes to Project’s scope or scale, PDO, cost, results framework, or other elements are being sought. III. SUMMARY OF CHANGES Changed Not Changed Loan Closing Date(s) ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ MPA Program Development Objective ✔ MPA Expected Results and Indicators ✔ Results Framework ✔ Components and Cost ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Disbursement Estimates ✔ Overall Risk Rating ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ The World Bank Turkey Emergency COVID-19 Health Project (P173988) IV. DETAILED CHANGE(S) MPA PROGRAM DEVELOPMENT OBJECTIVE Current MPA Program Development Objective 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 EXPECTED MPA PROGRAM RESULTS Current Expected MPA Results and their Indicators for the MPA Program Progress towards the achievement of the PDO would be measured by outcome indicators. Individual country-specific projects (or phases) under the MPA Program will identify relevant indicators, including among others: • Country has activated their public health Emergency Operations Centre or a coordination mechanism for COVID-19; • Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents; • Number of acute healthcare facilities with isolation capacity; • Number of suspected cases of COVID-19 reported and investigated per approved protocol; • Number of diagnosed cases treated per approved protocol; • Personal and community non-pharmaceutical interventions adopted by the country (e.g., installation of handwashing facilities, provision of supplies and behavior change campaigns, continuity of water and sanitation service provision in public facilities and households, schools closures, telework and remote meetings, reduce/cancel mass gatherings); • Policies, regulations, guidelines, or other relevant government strategic documents incorporating a multi- sectoral health approach developed/or revised and adopted; • Multi-sectoral operational mechanism for coordinated response to outbreaks by human, animal and wildlife sectors in place; • Coordinated surveillance systems in place in the animal health and public health sectors for zoonotic diseases/pathogens identified as joint priorities; and • Mechanisms for responding to infectious and potential zoonotic diseases established and functional; and • Outbreak/pandemic emergency risk communication plan and activities developed and tested OPS_DETAILEDCHANGES_LOANCLOSING_TABLE The World Bank Turkey Emergency COVID-19 Health Project (P173988) LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications COFN-C2110 Effective 31-Dec-2023 IBRD-91030 Effective 31-Dec-2022 31-Dec-2023 29-Mar-2024 29-Jul-2024 IBRD-93930 Effective 31-Dec-2023 31-Dec-2023 30-Apr-2024 .