The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) AFRICA EAST | Malawi | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 4 | ARCHIVED on 29-Nov-2021 | ISR48722 | Implementing Agencies: Ministry of Health, Republic of Malawi Key Dates Key Project Dates Bank Approval Date: 14-Apr-2020 Effectiveness Date: 30-Apr-2020 Planned Mid Term Review Date: -- Actual Mid-Term Review Date: Original Closing Date: 31-May-2022 Revised Closing Date: 31-Dec-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To prevent, detect and respond to the threat posed by COVID-19 in Malawi 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 Emergency COVID-19 Response:(Cost $34.10 M) Supporting National and Sub-national, Prevention and Preparedness:(Cost $0.95 M) Implementation Management and Monitoring and Evaluation:(Cost $1.95 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating High Substantial Implementation Status and Key Decisions The Malawi COVID-19 Emergency Response Project aims to support the Government of Malawi's (GoM) effort to respond to COVID-19. The project is aligned to the GoM COVID-19 Preparedness and Response Plan and complements support from other development partners. The original project became effective on April 30, 2020. In June 15, 2021, Additional Financing (AF) in the amount of US$30 million was approved and was declared effective on August 23, 2021. The AF brings the total financing for the project to US$37 million, of which US5.45 million has been disbursed (14.7% of the total grant) as of October 15, 2021. The AF is primarily to support the GoM’s efforts in procurement and deployment of COVID-19 vaccines as well as selected aspects of health systems strengthening. The GoM has already submitted an order for the procurement of about 1.86 million Johnson and Johnson (J&J) COVID-19 vaccines through African Vaccine Acquisition Trust (AVAT). With the AF, the project period has been extended to December 31, 2023. In addition, the implementation and institutional arrangements have been adjusted to account for 11/29/2021 Page 1 of 8 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) the expanded scope of the project. The project has procured key supplies and equipment needed to contribute to the implementation of the GoM’s COVID-19 response and trained various health worker cadres on COVID-19 case detection, confirmation, management and contact tracing. 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 November 15, 2021, 87 MPA-projects had been approved with a total commitment of US$4.2 billion. One operation (Guatemala) was cancelled in mid-September, at the request of the Government. Therefore, there are 86 MPA active operations. The pace of disbursements during the past month has increased. Fifty-seven (57) country projects or 66% of projects approved have reached 70-100% disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). The projects are benefitting around 3.7 billion people or 50% of the global population. Of the 86 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) 7 in Middle East and North Africa; and (vi) 9 in South Asia. Eighty-five (85) or 99% of projects approved are disbursing. Total disbursements as of November 15, 2021, amounted to US$3.25 billion or 77% of overall commitments. Streamlined procedures, delegated approvals coupled with flexible project design and intensified efforts across the Bank have contributed to the progress. Several projects have/are being restructured to include vaccine-related procurement. 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 Delta variant spreads 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 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 in just over 19 months 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. 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 already anticipated and supported under the Global COVID-19 MPA and a key contribution to the WBG’s overall COVID-19 response. As of November 15, 2021, the Bank has approved 65 operations to support vaccine procurement and rollout in 62 countries amounting to $5.8 billion. The 65 AF-V operations approved, include 4 operations that involved restructuring of parent projects (North Macedonia, Philippines and Pakistan) and in the case of Lebanon, restructuring of the Health Resilience Project. Of the 65 approved operations: (i) 35 are in Africa – 16 in AFE 11/29/2021 Page 2 of 8 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) and 19 in AFW; (ii) 7 in East Asia; (iii) 7 in Europe and Central Asia; (iv) 5 in Latin America and the Caribbean; (v) 5 in Middle East and North Africa; and (vi) 6 in South Asia. Thirty three (33) projects are disbursing. Total disbursements as of November 15, 2021, under these projects amount to US$1,046 million or 18% of overall commitments. 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. Sixty-three (63) loan/financing agreements have already been signed. Also, fifty-three (53) loan/financing agreements have become effective; several others are expected to become effective in the coming days/weeks. Implementation of the AF-V operations, as with MPA operations is facing challenges as many countries are still under different levels of lockdown or mobility restrictions and counterparts and Bank teams are operating from home. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate High Substantial Institutional Capacity for Implementation and Substantial High Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Substantial Substantial Substantial Other -- -- -- Overall Substantial High Substantial Results PDO Indicators by Objectives / Outcomes To strengthen national systems for public health preparedness IN01053381 ►Percentage of designated laboratories with staff trained to conduct COVID-19 diagnosis. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 67.50 110.00 80.00 Date 15-Apr-2020 15-Apr-2021 20-Oct-2021 31-Dec-2023 The allocated budget was able to cover more trainings than initially anticipated Comments: 11/29/2021 Page 3 of 8 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) To prevent, detect and respond to the threat posed by COVID-19 IN01053350 ►Percentage of suspected cases of COVID-19 cases reported and investigated based on national guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 27.00 38.00 80.00 Date 15-Apr-2020 15-Apr-2021 20-Oct-2021 31-Dec-2023 IN01053382 ►Percentage of designated health facilities ready to treat COVID-19 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 Date 15-Apr-2020 15-Apr-2021 20-Oct-2021 31-Dec-2023 IN01053383 ►Percentage of targeted population fully vaccinated based on the targets defined in national plan, disaggregated by gender (Percentage) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 28.00 Date 01-Jun-2021 01-Jun-2021 20-Oct-2021 31-Dec-2023 Since AF activities have not started and no project resources to date have gone towards COVID-19 Comments: vaccine purchase and deployment support activities, all related indicators remain at baseline levels IN01053384 Percentage of females fully vaccinated (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 01-Jun-2021 01-Jun-2021 20-Oct-2021 31-Dec-2023 Intermediate Results Indicators by Components Emergency COVID-19 Response IN01053385 ►Number of health staff trained in infection prevention and control per MOH-approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 948.00 948.00 870.00 Date 15-Apr-2020 15-Apr-2021 20-Oct-2021 31-Dec-2023 Activity completed. The allocated budget was able to cover more trainings than initially anticipated Comments: 11/29/2021 Page 4 of 8 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) IN01053388 ►Oxygen plant installed and functional (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Jun-2021 01-Jun-2021 20-Oct-2021 31-Dec-2023 Since AF activities have not started and no project resources to date have gone towards COVID-19 Comments: vaccine purchase and deployment support activities, all related indicators remain at baseline levels IN01053390 ►Number of health surveillance assistants (HSAs) oriented in contact tracing, by gender. (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7.00 4,049.00 4,500.00 Date 15-Apr-2020 15-Apr-2021 20-Oct-2021 31-Dec-2023 In the parent project this indicator was “Number of teams trained in contact tracing”. This indicator was now revised to be “Number of HSAs oriented in contact tracing”. The Previous value for the revised Comments: indicator is 2894 (as indicated in comment section of the last ISR). The current value is 4,049. IN01053392 Number of female health surveillance assistants (HSAs) oriented in contact tracing (Number) (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1,791.00 2,025.00 Date 01-Jun-2021 01-Jun-2021 20-Oct-2021 31-Dec-2023 IN01053391 ►Healthcare workers training materials were assessed to identify the extent to which Gender-Based Violence (GBV) is addressed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 11-Jun-2021 11-Jun-2021 20-Oct-2021 31-Dec-2023 Since AF activities have not started and no project resources to date have gone towards COVID-19 Comments: vaccine purchase and deployment support activities, all related indicators remain at baseline levels IN01053393 ►Number of healthcare professionals (HCPs) and district investigation officers trained on detection and reporting, or investigation of AEFIs, by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1,475.00 Date 11-Jun-2021 11-Jun-2021 20-Oct-2021 31-Dec-2023 Comments: Since AF activities have not started and no project resources to date have gone towards COVID-19 vaccine purchase and deployment support activities, all related indicators remain at baseline levels 11/29/2021 Page 5 of 8 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) IN01053394 Number of female healthcare professionals (HCPs) and district investigation officers trained on detection and reporting, or investigation of AEFIs. (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 516.00 Date 11-Jun-2021 11-Jun-2021 20-Oct-2021 31-Dec-2023 IN01053395 ►Percentage of targeted population who received at least one dose of a COVID-19 vaccine, by gender (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 28.00 Date 11-Jun-2021 11-Jun-2021 20-Oct-2021 31-Dec-2023 Since AF activities have not started and no project resources to date have gone towards COVID-19 Comments: vaccine purchase and deployment support activities, all related indicators remain at baseline levels IN01053396 Percentage of females who received at least one dose of a COVID-19 vaccine (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 11-Oct-2021 11-Jun-2021 20-Oct-2021 31-Dec-2023 IN01053397 ►CSO representatives are active members of the National Task Force (NTF) responsible for monitoring and guiding the COVID-19 vaccine rollout. (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 11-Jun-2021 11-Jun-2021 20-Oct-2021 31-Dec-2023 Since AF activities have not started and no project resources to date have gone towards COVID-19 Comments: vaccine purchase and deployment support activities, all related indicators remain at baseline levels Supporting National and Sub-national, Prevention and Preparedness IN01053386 ►Number of health staff trained in emerging infectious diseases (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 250.00 180.00 Date 15-Apr-2020 15-Apr-2021 20-Oct-2021 31-May-2022 11/29/2021 Page 6 of 8 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Implementation Management and Monitoring and Evaluation IN01053387 ►Percentage of grievances addressed within 4 weeks of initial complaint being recorded (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 15-Apr-2020 15-Apr-2021 20-Oct-2021 31-May-2022 No grievances have been reported thus far. Comments: IN01053389 ►M&E system established to monitor COVID-19 preparedness and response plan (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 15-Apr-2020 15-Apr-2021 20-Oct-2021 31-Dec-2023 Awaiting to populate the RF for the National COVID-19 Preparedness and Response Plan Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173806 IDA-D6200 Effective USD 7.00 7.00 0.00 6.23 1.11 85% P173806 IDA-D8870 Effective USD 30.00 30.00 0.00 0.00 29.62 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173806 IDA-D6200 Effective 14-Apr-2020 17-Apr-2020 30-Apr-2020 31-May-2022 31-Dec-2023 P173806 IDA-D8870 Effective 15-Jun-2021 02-Jul-2021 23-Aug-2021 31-Dec-2023 31-Dec-2023 Cumulative Disbursements 11/29/2021 Page 7 of 8 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History There has been no restructuring to date. Related Project(s) P176402-Additional Financing for Malawi COVID-19 Emergency Response and Health Systems Preparedness Project ,P178095-Additional Financing for Malawi COVID-19 Emergency Response and Health Systems Preparedness Project 11/29/2021 Page 8 of 8