The World Bank Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) REPORT NO.: RES53390 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF THE REPUBLIC OF TRINIDAD AND TOBAGO: COVID-19 EMERGENCY RESPONSE PROJECT APPROVED ON JUNE 30, 2020 TO THE REPUBLIC OF TRINIDAD AND TOBAGO October 27, 2022 HEALTH, NUTRITION & POPULATION LATIN AMERICA AND CARIBBEAN Regional Vice President: Carlos Felipe Jaramillo Country Director: Lilia Burunciuc Regional Director: Luis Benveniste Practice Manager/Manager: Michele Gragnolati Task Team Leader(s): Marvin Ploetz, Jeremy Henri Maurice Veillard The World Bank Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) ABBREVIATIONS AND ACRONYMS COVID-19 Coronavirus disease 2019 E&S Environmental and Social ESF Environmental and Social Framework ESMF Environmental and Social Management Framework GoRTT Government of the Republic of Trinidad and Tobago IBRD International Bank for Reconstruction and Development LAC Latin America and the Caribbean MOH Ministry of Health MPA Multiphase Programmatic Approach PAHO Pan American Health Organization PDO Project Development Objective PPE Personal Protective Equipment SORT Systematic Operations Risk-rating Tool TTO Trinidad and Tobago WB World Bank WHO World Health Organization RVP Regional Vice President The World Bank Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) BASIC DATA Product Information Project ID Financing Instrument P173989 Investment Project Financing Environmental and Social Risk Classification (ESRC) Substantial Approval Date Current Closing Date 30-Jun-2020 30-Jun-2023 Organizations Borrower Responsible Agency Republic of Trinidad and Tobago 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) 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 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. The World Bank Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) As of October 17, 2022, the Bank has approved 115 operations (including MPA-V operations) to support vaccine procurement and rollout in 79 countries amounting to $10.1 billion. The 115 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 115 approved operations: (i) 64 are in Africa – 29 in AFE and 35 in AFW; (ii) 9 in East Asia and the Pacific; (iii) 11 in Europe and Central Asia; (iv) 13 in Latin America and the Caribbean; (v) 9 in Middle East and North Africa; and (vi) 9 in South Asia. Thirty-four (34) operations have been approved so far this Calendar Year; two other operations are being processed for approval later in the calendar year. Seventy (70) projects or 61 percent of total operations approved are disbursing. Total disbursements as of October 17, 2022, under these projects amount to US$4.73 billion or 47% of overall commitments. Disbursements under MPA-V operations are included in this total while disbursements under the six restructured projects are counted under parent projects. Twenty-eight (28) or 24% AF-V and MPA-V operations have disbursed 70% or more of their commitments. Out of the 28, eleven operations or 39% have disbursed 90%. Retroactive Financing (RF) represents 45% of overall commitments. High RF has been authorized under different operations - Indonesia and Ukraine (100%), Panama and Turkey (90%), Argentina and Guyana (80%), and Belize, Iraq and Sri Lanka (70%). Two (2) new operations are under various stages of processing. As with the MPA operations, streamlined procedures, delegated approval, coupled with flexible project design, and intensified efforts across the Bank have contributed to the rapid design and processing of the operations. One hundred-seven (107) loan/financing agreements have been signed. Also, ninety-six (96) loan/financing agreements have become effective. OPS_TABLE_PDO_CURRENTPDO Project Development Objective (PDO) Original PDO To detect and respond to the threat posed by COVID-19 and to strengthen the national health system for the emergency response to the COVID-19 pandemic. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IBRD-91570 30-Jun-2020 22-Feb-2021 15-Mar-2021 30-Jun-2023 20.00 .05 19.95 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No The World Bank Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Introduction 1. This Restructuring Paper seeks the approval of the Regional Vice President (RVP) on a proposed Level II Restructuring of the Trinidad and Tobago: COVID-19 Emergency Response Project (P173989, the Project). The proposed restructuring would extend the loan closing date by 12 months, for a cumulative extension of 30 months from the original closing date. There would be no changes to the Project Development Objective (PDO), and no other changes to the Project are proposed. 2. The Project, financed by an IBRD loan in the amount of US$20 million, was approved on June 30, 2020, and declared effective on March 15, 2021. The Project supports the Government of Trinidad and Tobago to detect and respond to the threat posed by COVID-19 and to strengthen the national health system for the emergency response to the COVID-19 pandemic. The Project comprises two components: Component 1 aims to strengthen COVID-19 case detection, recording, and treatment (US$11.70 million); and Component 2 aims to support to the COVID-19 vaccination campaign (US$8.05 million). 3. This would be the Project’s third restructuring and the loan’s second closing date extension. The Project was first restructured in December 2020 to clarify that the primary procurement agent for the project would be Pan-American Health Organization (PAHO) rather than the United Nations Development Programme. The second restructuring: (a) extended the loan closing date by 18 months to June 30, 2023 to address implementation delays; and (b) revised the scope of the Project to include vaccine financing. This second restructuring was approved in July 2022 and countersigned by the Government of the Republic of Trinidad and Tobago (GoRTT) on August 23, 2022. B. Project Status 4. The Project is rated Satisfactory for progress towards the achievement of the PDO, and Moderately Satisfactory for overall implementation progress. Under Component 1, The Ministry of Health (MOH), PAHO and the World Bank (WB) prepared a procurement package for medical equipment, pharmaceuticals, and Personal Protective Equipment. The contract to be signed (worth US$11.54 million) between the MOH and PAHO has been authorized by the Government Cabinet of TTO and the Attorney General, and also received the WB’s No Objection. However, due to delays in obtaining all needed clearances, the original contract end date of May 31, 2023, is insufficient for PAHO to finish all procurement activities and implement the contract as planned. Accordingly, on October 11, 2022, the Ministry of Finance sent a letter1 to the WB requesting the extension of the loan’s closing date by 12 months from June 30, 2023, to June 30, 2024. With respect to Component 2, the MOH is in the process of preparing all needed information such that the WB can conduct the required assessment and authorize the use of the available financing related to vaccine procurement and deployment (US$8.05 million) to retroactively finance vaccines purchased by the GoRTT from Sinopharm. 5. The Environmental and Social Management Framework (ESMF) (the adoption of which is a disbursement condition for vaccine-related activities) has already been prepared. The Environmental and Social (E&S) assessment 1 F(DMD): 16/5/43. The World Bank Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) needed for the retroactive financing of vaccines has been conducted and submitted to the WB. The WB team has reviewed the ESMF and the E&S assessment and shared comments with the GoRTT. Once these comments have been addressed, the ESMF will be consulted and re-disclosed. 6. Audits: There are no outstanding audit reports. C. Rationale for Restructuring 7. A twelve-month extension of the loan closing date is being requested to allow TTO and PAHO sign a critical procurement contract under Component 1 of the Project. These twelve months are necessary to ensure an adequate timeframe for contract execution, and therefore achievement of the PDO. The contract signing, expected in November 2022, would result in a project disbursement of nearly 60 percent of the total loan proceeds. II. DESCRIPTION OF PROPOSED CHANGES 8. The Project would be restructured to extend the Project closing date from June 30, 2023 to June 30, 2024. No other changes are proposed. 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 ✔ The World Bank Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) 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 ✔ 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 The World Bank Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) 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 LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IBRD-91570 Effective 31-Dec-2021 30-Jun-2023 30-Jun-2024 31-Oct-2024 .