The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Central African Republic COVID-19 Preparedness and Response Project (P173832) Western and Central Africa | Central African Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 5 | ARCHIVED on 10-May-2022 | ISR50878 | Implementing Agencies: Central African Republic, Ministry of Health and Population Key Dates Key Project Dates Bank Approval Date: 20-Apr-2020 Effectiveness Date: 27-Apr-2020 Planned Mid Term Review Date: 03-Mar-2022 Actual Mid-Term Review Date: 02-Mar-2022 Original Closing Date: 30-Jun-2022 Revised Closing Date: 30-Jun-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To prepare for and respond to the threat posed by COVID-19 in the Central African Republic. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Preparedness and Response:(Cost $31.60 M) Project Coordination and management:(Cost $1.40 M) Contingent Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions A Mid-term review was conducted during the in-person mission of February 28 to March 4, 2022. All key targets have been met, and the PDO and IP ratings are satisfactory. Overall disbursement of the parent project (not including the Additional Financing) was 100 percent as of March 31, 2022. Additional Financing for the project (US$25.5 million) was approved on April 20, 2022, and the financing agreement signed on March 9, 2022. This will support the procurement and deployment of COVID19 vaccines, the extension of the cold chain and vaccine storage capacity, strengthening the technical partnership for the operationalization of the revised National Vaccination Deployment Plan 2 for COVID19, with much communication with communities and high-risk populations (with strong focus on ensuring women, minorities and remote populations) to ensure uptake of the COVID19 vaccines and to overcome vaccine hesitancy, the installation of an efficient biomedical waste management system, and the strengthening of the vaccination system as a whole. In addition, digitalized means of monitoring, evaluation and governance are encouraged, in particular the continued and expanded use of the geolocated monitoring and supervision tool and other existing digital monitoring mechanisms. 5/10/2022 Page 1 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) 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 As of March 15, 2022, 88 MPA-projects had been approved with a total commitment of US$4.3 billion. One operation (Guatemala) was cancelled in mid-September 2021, at the request of the Government. Therefore, there are 87 MPA active operations. Sixty-three (63) country projects or 72% of projects approved have reached 70-100% disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). Out of the 63 operations, 39 operations or 62% have disbursed over 90% of commitments. Of these, 25 operations are fully disbursed. 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 March 15, 2022, amount to US$3.43 billion or 80% of overall commitments. Two operations closed last CY and twenty-seven (27) 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. Many 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. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic High Substantial Substantial Sector Strategies and Policies Substantial Moderate Moderate Technical Design of Project or Program High Moderate Moderate Institutional Capacity for Implementation and High Moderate Moderate Sustainability 5/10/2022 Page 2 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Fiduciary High Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Substantial Moderate Moderate Other -- -- -- Overall High Substantial Substantial Results PDO Indicators by Objectives / Outcomes To prepare for and respond to the threat posed by COVID-19 in the Central African Republic. IN01123604 ►Health staff trained in infection prevention per MOH-approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 516.00 516.00 500.00 Date 27-Apr-2020 21-Dec-2021 04-Mar-2022 30-Jun-2022 IN01123605 ►Personal protective equipment (PPE) kit (masks, face shield, gloves, gown) delivered to targeted health facilities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 17,250.00 17,250.00 9,000.00 Date 27-Apr-2020 21-Dec-2021 04-Mar-2022 30-Jun-2022 The PPE distributed to the health facilities beyond January 2021 were not distributed as a kit (see definition used). As of August 2021, 195,000 gloves and 13,250 masks of all types acquired by the project Comments: were distributed. There are currently 3000 gown left in stock IN01123631 ►COVID-19 risk communication messages broadcasted to communities (number of days) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 474.00 474.00 90.00 Date 27-Apr-2020 21-Dec-2021 04-Mar-2022 30-Jun-2022 Mobile COVID-19 voice messages began being transmitted since April 27, 2020, and has been active for Comments: everyday. IN01123632 ►Population vaccinated (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 13.00 13.00 15.00 52.00 5/10/2022 Page 3 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Date 08-Feb-2022 08-Feb-2022 04-Mar-2022 30-Jun-2024 IN01123633 Proportion of women among those vaccinated (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 40.00 40.00 50.00 Intermediate Results Indicators by Components Component 1: Preparedness and response IN01123635 ►Additional patient "beds" made available in designated care centers and hospitals (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 73.00 73.00 70.00 Date 27-Apr-2020 21-Dec-2021 04-Mar-2022 30-Jun-2022 73 beds and sleeping mattresses have been purchased for the initial patients needing care. Comments: IN01123637 ►Laboratories with trained staff and consumables for collecting COVID-19 samples and transporting to Pasteur Institute laboratory (IBP) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 91.00 91.00 15.00 Date 27-Apr-2020 21-Dec-2021 04-Mar-2022 30-Jun-2022 A large number of health facilities in CAR are now also collecting COVID-19 samples, in addition to Comments: smaller laboratories. IN01123638 ►Risk comminication strategy developed and disseminated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 27-Apr-2020 21-Dec-2021 04-Mar-2022 30-Jun-2022 Strategy has been elaborated and the govt is starting to use it in parts. Comments: IN01123639 ►Targeted facilities that have received selected drugs required to respond to the surge in patients due to COVID-19 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 90.00 Date 27-Apr-2020 21-Dec-2021 04-Mar-2022 30-Jun-2022 5/10/2022 Page 4 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) All treatment centers (4 in Bangui and 32 in the rest of the country) have received medication by August 2021. The number of treatment centers increased, where in all centers, selected medication to care for the Comments: COVID19 patients were supplied: July 2020: 9 out of 9 health facilities; January 2021: 15 out of 15 health facilities; August 2021: 36 out of 36 health facilities. IN01123640 ►Targeted communities informed on hygiene behavior (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 90.00 Date 27-Apr-2020 21-Dec-2021 04-Mar-2022 30-Jun-2022 Hygiene promotion were promoted at the health facility and community levels in the country. Over 250,000 soaps were distributed, in addition to hygiene kits, masks and food stamps, along with hygiene sanitation Comments: campaigns with strong community sensitization of COVID19 risk and prevention, in addition to provision and treatment of potable water in 10 districts in the country. IN01123641 ►Doses of COVID-19 vaccines administered as a percentage of doses received (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 35.00 35.00 39.40 60.00 Date 25-Feb-2022 25-Feb-2022 12-Apr-2022 28-Jun-2024 IN01123642 ►Community health workers engaged as vaccinators (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 660.00 Date 25-Feb-2022 25-Feb-2022 04-Mar-2022 28-Jun-2024 IN01123643 ►Share of vaccinators who are female (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 3.00 3.00 30.00 Date 31-Jan-2022 31-Jan-2022 04-Mar-2022 28-Jun-2024 IN01123644 ►Districts in which the vaccination deployment strategy targets areas where women congregate (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 25-Feb-2022 25-Feb-2022 04-Mar-2022 28-Jun-2024 IN01123645 ►Targeted sites where solar-powered cold chain equipment has been installed and functional (Percentage, Custom) 5/10/2022 Page 5 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 25-Feb-2022 25-Feb-2022 04-Mar-2022 28-Jun-2024 IN01123646 ►Districts reached by gender-sensitive messages/materials disseminated of public communications and advocacy on COVID-19 vaccination (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 25-Feb-2022 25-Feb-2022 04-Mar-2022 28-Jun-2024 IN01123647 ►Districts with community engagement plan implemented for increasing demand for COVID-19 vaccines by the population (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 25-Feb-2022 25-Feb-2022 04-Mar-2022 28-Jun-2024 IN01123648 ►Districts with a mobile or out-reach facility to administer vaccines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 25-Feb-2022 25-Feb-2022 04-Mar-2022 28-Jun-2024 IN01123649 ►Consultation workshops with citizen groups and the media to overcome vaccine hesitancy and enable equitable access to vaccination services (per year) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2.00 Date 25-Feb-2022 25-Feb-2022 04-Mar-2022 28-Jun-2024 Feedback received during these consultations will be used to inform and adjust activities aiming at overcoming vaccine hesitancy and enabling equitable access to vaccination services. As the Ministry Comments: obtains feedback from these consultation processes, adjustments of the content of the activities, communication materials or any other adjustments will be made to incorporate the feedback. Component 2: Project Implementation, Monitoring and Supervision IN01123634 ►M&E system established to monitor COVID-19 preparedness and response (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes 5/10/2022 Page 6 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Date 27-Apr-2020 21-Dec-2021 04-Mar-2022 30-Jun-2022 Surveillance data on COVID19 cases are collected and reports are disseminated through the Emergency response committee (COUSP) of the Ministry of Health and WHO. So a surveillance system is operating (which started before Project effectiveness), but this is the surveillance of COVID-19 itself, and not a more Comments: comprehensive Monitoring & Evaluation of overall preparedness and response. There are two initiatives underway to put in place systems for disease surveillance overall, which are not yet completed. IN01123636 ►Standard operational procedures (SOP) for collection and disposal of medical waste developed and shared with relevant stakeholders (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 31-Jan-2022 25-Feb-2022 04-Mar-2022 28-Jun-2024 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173832 IDA-D6170 Effective USD 7.50 7.50 0.00 7.66 0.00 100% Not P173832 IDA-D9790 USD 25.50 25.50 0.00 0.00 25.43 0% Effective Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173832 IDA-D6170 Effective 20-Apr-2020 22-Apr-2020 27-Apr-2020 30-Jun-2022 30-Jun-2024 Not P173832 IDA-D9790 25-Feb-2022 09-Mar-2022 -- 30-Jun-2024 30-Jun-2024 Effective Cumulative Disbursements 5/10/2022 Page 7 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Restructuring History There has been no restructuring to date. Related Project(s) P177554-Central African Republic COVID19 AF Vaccine Deployment ,P177618-Central African Republic COVID-19 Preparedness & Response Additional Financing 5/10/2022 Page 8 of 8