The World Bank Implementation Status & Results Report Ecuador COVID-19 Emergency Response and Vaccination Project (P173773) Ecuador COVID-19 Emergency Response and Vaccination Project (P173773) LATIN AMERICA AND CARIBBEAN | Ecuador | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 4 | ARCHIVED on 04-May-2022 | ISR50411 | Implementing Agencies: Ministry of Public Health, Republic of Ecuador Key Dates Key Project Dates Bank Approval Date: 02-Apr-2020 Effectiveness Date: 05-Apr-2020 Planned Mid Term Review Date: -- Actual Mid-Term Review Date: Original Closing Date: 30-Mar-2022 Revised Closing Date: 30-Mar-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To prevent and respond to the threat posed by COVID-19 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 Component 1: Support the National Program to respond to the Covid-19 pandemic:(Cost $19.00 M) Component 2: Project Management and Monitoring:(Cost $1.00 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The Ecuador Covid-19 Emergency Response Project was requested by the Government of Ecuador and was prepared in close coordination with WHO/PAHO, IADB and CAF. The Project was approved by the World Bank's Board of Directors on April 2, 2020 with the objective of preventing and responding to the threat posed by COVID-19 and to strengthen national systems for public health preparedness in Ecuador. The project is part of the World Bank's Multiphase Programmatic Approach (MPA) to support countries affected by the COVID-19 pandemic. The Project was signed and declared effective on April 5, 2020 and project implementation is underway. An Additional Financing for US$150 million was approved on April 1, 2021 with most of the resources allocated to finance COVID-19 vaccines and support the vaccination campaign. MPA Program Development Objective 5/4/2022 Page 1 of 7 The World Bank Implementation Status & Results Report Ecuador COVID-19 Emergency Response and Vaccination Project (P173773) 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 April 18, 2022, 88 MPA-projects had been approved with a total commitment of US$4.3 billion. One operation (Guatemala) was cancelled in mid-September 2021, at the request of the Government. Sixty-six (66) country projects or 76% of projects approved have reached 70-100% disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). Out of the 66 operations, 44 operations or 67% have disbursed over 90% of commitments. Of these, 27 operations are fully disbursed. There are twelve (12) operations with disbursements under 50%. The projects are benefitting around 3.7 billion people or 50% of the global population. Of the 87 active projects: (i) 33 are in Africa – 12 in AFE and 21 in AFW; (ii) 12 in East Asia; (iii) 14 in Europe and Central Asia; (iv) 11 in Latin America and the Caribbean; (v) 8 in Middle East and North Africa; and (vi) 9 in South Asia. Eighty-six (86) or 99% of projects approved are disbursing. Total disbursements as of April 18, 2022, amount to US$3.53 billion or 82% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. Two operations closed last CY and twenty-nine (29) operations have closing dates by the end of FY22. Six parent projects have been restructured to include vaccine-related procurement. 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. Implementation continues to face challenges as several countries are still under different levels of lockdown or mobility restrictions, and counterparts and Bank teams are operating from home or partially from home. Also, countries are dealing with new waves of infections as the Omicron variant is spreading rapidly among populations. Several Bank teams continue to conduct implementation support missions virtually, which is challenging for both Bank teams and counterparts. This “virtual” world poses connectivity challenges as the internet is not reliable in many countries, especially IDA countries. Notwithstanding the challenges, the MPA is on track to achieve its PrDO, which is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. The significant level of disbursements attests to the strong implementation of the Bank' response thanks to the commitment of counterparts supported by Bank country teams. The Additional Financing (MPA AF-V) to the COVID-19 Strategic Preparedness and Response Program utilizing the Multiphase Programmatic Approach (“Global COVID-19 MPA”) was approved by the Board on October 13, 2021. The AF-V is significantly expanding Bank support to client countries for COVID-19 vaccination, with the aim to support vaccination of 1 billion people globally. The AF-V was approved with an envelope of US$12 billion ($6 billion from IDA and $6 billion from IBRD) in financing. On June 30, 2021, President Malpass announced the expansion of financing available for COVID-19 vaccine financing to $20 billion over the next 18 months, adding $8 billion to the previously announced $12 billion. This financing is critical to expand affordable and equitable financing for vaccine purchase and deployment. The AF-V is expected to enable vaccination for up to 750 million people, with potential surge capacity for an additional 250 million people in the poorest countries (depending on the delivered price of approved vaccines) while scaling support to strengthen immunization delivery, with design flexibility at the country level. The AF-V is a scale-up of planned vaccination activities anticipated and supported under the Global COVID-19 MPA and a key contribution to the WBG’s overall COVID-19 response.As of April 18, 2022, the Bank has approved 91 operations (including MPA-V operations) to support vaccine procurement and rollout in 72 countries amounting to $8 billion. The 91 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. Of the 91 approved operations: (i) 50 are in Africa – 24 in AFE and 26 in AFW; (ii) 8 in East Asia and the Pacific; (iii) 10 in Europe and Central Asia; (iv) 8 in Latin America and the Caribbean; (v) 7 in Middle East and North Africa; and (vi) 8 in South Asia. Fifty (50) projects are disbursing. Twenty-seven (27) new operations are under various stages of processing. Total disbursements as of April 18, 2022, under these 5/4/2022 Page 2 of 7 The World Bank Implementation Status & Results Report Ecuador COVID-19 Emergency Response and Vaccination Project (P173773) projects amount to US$2.85 billion or 36% of overall commitments. Disbursements under MPA-V operations are included in this total while disbursements under the six restructured projects are not included in this total as they are counted under parent projects. As with the MPA operations, streamlined procedures, delegated approval, coupled with flexible project design, and intensified efforts across the Bank have contributed to the rapid design and processing of the operations. Eighty-three (83) loan/financing agreements have been signed. Also, seventy-three (73) loan/financing agreements have become effective; several others are expected to become effective in the coming weeks. Implementation of the AF-V operations, as with MPA operations is facing challenges as several countries are still under different levels of lockdown or mobility restrictions and counterparts and Bank teams are operating from home. Countries are dealing with new waves of infections, as the Omicron variant is spreading rapidly among populations. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High Moderate Moderate Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Number of health workers reached by the national communication strategy IN01109100 ►Number of health workers reached with tailored information (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,235.00 2,235.00 10,000.00 Date 01-Apr-2020 12-Jul-2021 12-Jul-2021 30-Jun-2022 The total number of health workers who acknowledge receiving specific messages developed under the Comments: national communication strategy. 5/4/2022 Page 3 of 7 The World Bank Implementation Status & Results Report Ecuador COVID-19 Emergency Response and Vaccination Project (P173773) Percentage of prioritized ICU units that are fully equipped and operational IN01109106 ►Percentage of prioritized ICU units that are fully equipped and operational (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 33.30 33.30 30.00 Date 01-Apr-2020 12-Jul-2021 12-Jul-2021 30-Jun-2022 An ICU unit will be considered fully equipped and operational if two conditions are satisfied: (i) all individual beds in the ICU unit have the necessary equipment (beds with electronic control, patient monitor, respiratory ventilation unit); and (ii) ICU unit (comprising of multiple beds) has all necessary Comments: shared equipment (ultrasound machine, vital signs monitor, intubation equipment). Numerator: Number of prioritized ICU units satisfy conditions (i) and (ii) above. Denominator: Total number of prioritized ICU units. Percentage of diagnosed cases treated per approved protocol in the prioritized hospital IN01109107 ►Percentage of diagnosed cases that need hospitalization per approved protocol treated in the prioritized hospitals, disaggregated by gender (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 19.80 19.80 10.00 Date 01-Apr-2020 12-Jul-2021 12-Jul-2021 30-Jun-2022 Numerator: Number of diagnosed cases that need hospitalization per approved protocols treated in the Comments: prioritized hospitals strengthened by the Project. Denominator: Total number of diagnosed cases that need hospitalization per approval protocols. Percentage of population vaccinated, which is included in the priority population targets IN01109108 ►Percentage of population vaccinated, which is included in the priority population targets defined in the national plan, disaggregated by gender (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 30.00 Date 10-Feb-2021 06-Aug-2021 06-Aug-2021 29-Mar-2024 Intermediate Results Indicators by Components Support the National Program to respond to Covid-19 IN01109109 ►Number of public health campaign audiovisual materials disseminated (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 28.00 28.00 50.00 5/4/2022 Page 4 of 7 The World Bank Implementation Status & Results Report Ecuador COVID-19 Emergency Response and Vaccination Project (P173773) Date 01-Apr-2020 06-Aug-2021 06-Aug-2021 29-Mar-2024 As part of the national communication strategy, the National Sub-secretariat of Health Promotion and Comments: Equality (Subsecretaria Nacional de Promocion de la Salud e Igualdad) will develop and disseminate audiovisual materials (videos, pamphlets, etc.) to improve population awareness about COVID-19. IN01109110 ►Number of public health messages disseminated through Internet based mediums (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 18.00 18.00 100.00 Date 01-Apr-2020 06-Aug-2021 06-Aug-2021 29-Mar-2024 The public health messages developed through the national communication strategy will be adapted for Comments: Internet sources such as web pages, social media (Facebook, Twitter, etc.) and disseminated. IN01109111 ►Percentage of ICU beds in prioritized ICU units that are fully equipped and operational (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 33.80 33.80 30.00 Date 01-Apr-2020 06-Aug-2021 06-Aug-2021 30-Jun-2022 A ICU bed will be considered fully equipped and operational if the following condition is satisfied: it has the necessary equipment (beds with electronic control, patient monitor, respiratory ventilation unit) for an ICU Comments: bed. Numerator: Number of ICU beds in the prioritized ICU units that satisfy the condition above. Denominator: Total number of ICU beds in the prioritized ICU units. IN01109112 ►Percentage of prioritized ICU units that are fully equipped with shared equipment (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 26.70 26.70 30.00 Date 01-Apr-2020 06-Aug-2021 06-Aug-2021 30-Jun-2022 An ICU unit will be considered fully equipped with shared equipment if it satisfies the following condition: Comments: ICU unit (comprising of multiple beds) has all necessary shared equipment (ultrasound machine, vital signs monitor, intubation equipment). IN01109113 ►Number of cold chain equipment (refrigerator and freezers) installed by the project (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 30.00 Date 10-Feb-2021 06-Aug-2021 06-Aug-2021 29-Mar-2024 IN01109114 ►Number of vaccine doses procured (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 6,000,000.00 6,000,000.00 10,000,000.00 5/4/2022 Page 5 of 7 The World Bank Implementation Status & Results Report Ecuador COVID-19 Emergency Response and Vaccination Project (P173773) Date 01-Apr-2020 06-Aug-2021 06-Aug-2021 29-Mar-2024 IN01109115 ►Number of actions taken in vaccine deployment and distribution based on feedback from beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 10-Feb-2021 06-Aug-2021 06-Aug-2021 29-Mar-2024 IN01109116 ►Percentage of vaccine recipients satisfied with their experience (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 66.00 Date 10-Feb-2021 06-Aug-2021 06-Aug-2021 29-Mar-2024 IN01109117 ►The vaccine eligibility criteria includes temporary/informal health workers (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 05-Mar-2021 06-Aug-2021 06-Aug-2021 30-Dec-2021 IN01109118 ►The communications campaigns developed and disseminated materials aimed to increase the vaccination rate of women (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 05-Mar-2021 06-Aug-2021 06-Aug-2021 31-Dec-2021 IN01109119 ►Percentage of women reached with communication campaign with messages around vaccination (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 Date 05-Mar-2021 06-Aug-2021 06-Aug-2021 29-Mar-2024 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) 5/4/2022 Page 6 of 7 The World Bank Implementation Status & Results Report Ecuador COVID-19 Emergency Response and Vaccination Project (P173773) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173773 IBRD-90870 Effective USD 20.00 20.00 0.00 17.42 2.58 87% P173773 IBRD-92280 Effective USD 150.00 150.00 0.00 146.51 3.49 98% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173773 IBRD-90870 Effective 02-Apr-2020 05-Apr-2020 05-Apr-2020 30-Mar-2022 30-Mar-2024 P173773 IBRD-92280 Effective 01-Apr-2021 26-Apr-2021 20-May-2021 30-Mar-2024 30-Mar-2024 Cumulative Disbursements Restructuring History Level 2 Approved on 29-Jul-2021 ,Level 2 Approved on 07-Oct-2021 Related Project(s) P176326-AF Ecuador COVID-19 Emergency Response and Vaccination Project ,P178247-Second AF Ecuador COVID-19 Emergency Response and Vaccination Project 5/4/2022 Page 7 of 7