The World Bank Implementation Status & Results Report Liberia COVID-19 Emergency Response Project (P173812) Liberia COVID-19 Emergency Response Project (P173812) WESTERN AND CENTRAL AFRICA | Liberia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 5 | ARCHIVED on 23-Dec-2022 | ISR54012 | Implementing Agencies: Ministry of Health, Republic of Liberia Key Dates Key Project Dates Bank Approval Date: 09-Apr-2020 Effectiveness Date: 13-Apr-2020 Planned Mid Term Review Date: 30-Sep-2022 Actual Mid-Term Review Date: 24-Jun-2022 Original Closing Date: 30-Apr-2022 Revised Closing Date: 30-Sep-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The development objective is to prepare and respond to the COVID-19 pandemic in Liberia Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Emergency Preparedness Response:(Cost $20.75 M) Component 2: Program Management and Coordination, Monitoring and Evaluation:(Cost $3.12 M) Unallocated:(Cost $0.63 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions Over the past year, there has been significant progress in the implementation of planned activities. With support from the project and other development partners, the country has fully vaccinated 77% of the target population (12 years and older) and 69% of the total population, as of October 31, 2022. This makes Liberia one of the leading countries in COVID-19 vaccination coverage in Africa. These successes can be attributed to concerted efforts by the Ministry of Health (MoH) and the National Public Health Institute of Liberia (NPHIL) during the past year, in which the country has seen a steep increase in COVID-19 vaccination coverage and a deep decline in new confirmed cases and deaths. Funds from the project are being used to strengthen the broader vaccination system through the procurement of equipment for the transportation and storage of vaccines. Furthermore, the country has continued to strengthen surveillance and detection capacities through the (i) training of healthcare providers; (ii) equipping of laboratories and training of laboratory personnel; (iii) community-based sensitization and risk communication; and (iv) equipping of isolation and treatment centers. These measures have contributed to achieving near-zero transmission rates, and reduced hospitalization and mortality due to COVID-19. Overall, the project is on track to achieving its development objective. 12/23/2022 Page 1 of 11 The World Bank Implementation Status & Results Report Liberia COVID-19 Emergency Response Project (P173812) 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 Sustained efforts continue to be made to advance the implementation of the 87 MPA operations. As of November 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. Six parent projects were restructured to include vaccine-related procurement. Total disbursements as of November 15, 2022, amount to US$3.74 billion or 87% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. Loans and Credits denominated in SDRs and Euros are being affected because of fluctuations between the SDRs and Euros against the US dollar. To ensure that commitments are not made beyond available funds, teams task-managing these operations are carefully monitoring payments as projects reach the end of their implementation period. At this late stage of implementation, several operations are processing refunds to the special accounts and therefore, total disbursements are affected. Four country operations closed by the end of FY22. Some operations are processing extension of closing dates. At present, however, nine operations are scheduled to close by the end of the CY. Sixty-seven (67) country projects or 77% of projects approved have reached 70-100% disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). Out of the 67 operations, 51 operations or 76% have disbursed over 90+% of commitments. Out of the 67 operations, 33 operations or 49% are fully disbursed. There are 12 operations with disbursements under 50%, which is worrisome. Out of these 12 operations, one has not disbursed (AFW), and two have disbursed 30 percent or less. The projects are benefitting around 3.7 billion people or 50% of the global population. If countries that have AF-V operations are counted, the projects are benefitting 4.1 billion of 51 percent of total world 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. MNA has the highest percentage of disbursements, followed by SRA, EAP, ECA, LAC, AFW, and AFE. Retroactive Financing continues to represent 26% of commitments. Country teams for operations, which have been under implementation for twelve months or more or have disbursed 50% or more of commitments by June 30, 2022, have prepared Mid-Term Review (MTR) ISRs and other documentation to inform the Global MPA MTR, which is being prepared by the EOC this FY. 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. Notwithstanding challenges of implementation, 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. It is clear that the flexibility of project design has played an important role in achieving the PrDO as many projects have taken advantage of this to restructure operations to allow, inter alia, reallocation of funds among components and activities according to the country's evolving needs. The high level of disbursements attests to the strong implementation of the Bank' response thanks to the commitment of counterparts supported by Bank country teams. 12/23/2022 Page 2 of 11 The World Bank Implementation Status & Results Report Liberia COVID-19 Emergency Response Project (P173812) 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 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 October 7, 2022, 630.5 million doses had been procured with Bank financing out of which 467.1 million doses have been delivered and 414.3 doses had been administered or 65.7 percent of those procured. As of November 15, 2022, the Bank has approved 116 operations (including MPA-V operations) to support vaccine procurement and rollout in 80 countries amounting to $10.1 billion. The 116 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 116 approved operations: (i) 64 are in Africa – 29 in AFE and 35 in AFW; (ii) 10 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-five (35) operations have been approved so far this Calendar Year; two other operations are being processed for approval later in the calendar year. Seventy-two (72) projects or 62 percent of total operations approved are disbursing. IDA continues to represent 44 percent and IBRD 56 percent of disbursements. Total disbursements as of November 15, 2022, under these projects amount to US$4.93 billion or 49% 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, twelve operations or 43% 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%). One hundred and eight (108) loan/financing agreements or 93 percent of project approved have been signed. Ninety-nine (99) loan/financing agreements or 85 percent of projects approved have become effective. 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, processing, and implementation of the operations. 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 Substantial Substantial Technical Design of Project or Program Low Moderate Moderate Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability 12/23/2022 Page 3 of 11 The World Bank Implementation Status & Results Report Liberia COVID-19 Emergency Response Project (P173812) Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Low Moderate Moderate Other -- -- Substantial Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes The development objective is to prepare and respond to the COVID-19 pandemic in Liberia IN01220650 ►Country has activated its Public Health Emergency Operations Center or a coordination mechanism for COVID-19 (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 30-Jun-2022 31-Mar-2022 28-Oct-2022 30-Sep-2024 Indicator respond to country country readiness for coordinating the COVID-19 response Comments: IN01220831 ►Suspected cases of COVID-19 reported and investigated based on national guidelines, segregated by gender (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 5,578.00 7,999.00 8,000.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 Cases of suspected COVID cases reported and investigated Comments: IN01220832 Suspected cases of COVID-19 in women reported and investigated based on national guidelines (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2,580.00 3,923.00 3,000.00 IN01220833 ►Designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 3.00 3.00 3.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 Designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents Comments: IN01220834 12/23/2022 Page 4 of 11 The World Bank Implementation Status & Results Report Liberia COVID-19 Emergency Response Project (P173812) ►Acute health care facilities with isolation capacities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 6.00 6.00 6.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 Acute health care facilities with isolation capacities Comments: IN01220835 ►Counties with pandemic preparedness and response plans per MOH guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 80.00 100.00 100.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220836 ►Facilities with healthcare workers trained in COVID-19 emergency preparedness and other emergency response (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 60.00 100.00 80.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220837 Facilities with female healthcare workers trained in COVID-19 emergency preparedness and other emergency response (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 60.00 60.00 80.00 IN01220838 ►Country has developed and operationalized a referral system to care for COVID-19 patients (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220839 ►Population completely vaccinated against COVID-19 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 13.40 69.00 65.60 Date 01-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220840 Population completely vaccinated who are women (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target 12/23/2022 Page 5 of 11 The World Bank Implementation Status & Results Report Liberia COVID-19 Emergency Response Project (P173812) Value 40.00 46.00 49.00 50.00 IN01220841 Population between 12 to 17 years of age completely vaccinated (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 12.90 13.27 IN01220842 Population over 60 years completely vaccinated (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 54.00 4.92 IN01220843 ►Population that have received at least one booster shot in addition to the complete initial protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.04 0.30 15.00 Date 01-Jan-2022 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220844 Female population that have received at least one booster shot in addition to the complete initial protocol (Percentage) (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 IN01220845 ►Counties with at least two facilities providing COVID-19 vaccination services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 50.00 100.00 100.00 Date 15-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 Intermediate Results Indicators by Components Component 1: Emergency Preparedness Response IN01220847 ►Counties that have activated EOC inline with the national EOC activation as part of COVID-19 response (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220849 12/23/2022 Page 6 of 11 The World Bank Implementation Status & Results Report Liberia COVID-19 Emergency Response Project (P173812) ►At least one multi-sectoral simulation exercise conducted with results incorporated into national COVID-19 preparedness and response plans (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 2.00 2.00 3.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220851 ►Counties with EOCs functioning according to standard operating procedures (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220853 ►COVID-19 vaccine doses procured (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 381,600.00 381,600.00 300,000.00 Date 01-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220855 ►National, subnational, facility-based and mobile staff trained in COVID-19 vaccine cold chain storage and handling (by gender) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 375.00 1,353.00 1,000.00 Date 01-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220857 National, subnational, facility-based and mobile female staff trained in COVID-19 vaccine cold chain storage and handling (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 135.00 406.00 400.00 IN01220859 ►Facilities equipped (installation complete) with energy-efficient storage facilities for storing specimens and temperature sensitive medical supplies (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 72.00 50.00 Date 01-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220860 ►Pharmacovigilance system adapted to detect AEFI following administration of the COVID-19 vaccine (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/23/2022 Page 7 of 11 The World Bank Implementation Status & Results Report Liberia COVID-19 Emergency Response Project (P173812) Value No Yes Yes Yes Date 01-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220861 ►AEFIs reported via the electronic notification system (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.00 100.00 100.00 Date 01-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220862 ►Community engagement plan developed to increase the population's demand for the COVID-19 vaccine (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220863 ►Counties where radio stations broadcast awareness campaigns on COVID-19 and the COVID-19 vaccination campaign (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 15.00 15.00 Date 01-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220864 ►Vaccinators trained on SEA/SH (by gender) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1,000.00 Date 01-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220865 Female vaccinators trained on SEA/SH (Number, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 300.00 IN01220866 ►Health centers reporting no stock-out of tracer IPC materials on the first day of each month (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 30.00 43.00 50.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220867 12/23/2022 Page 8 of 11 The World Bank Implementation Status & Results Report Liberia COVID-19 Emergency Response Project (P173812) ►Laboratories established/upgraded to support diagnosis of COVID-19 and other major infectious diseases (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 3.00 3.00 3.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220868 ►Laboratory staff trained to conduct COVID-19 diagnosis (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 20.00 20.00 10.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 Component 2: Project Management and Coordination, Monitoring & Evaluation IN01220846 ►Point of entry that report having received a supervisory visit during the preceding month (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 80.00 80.00 80.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220848 ►Prioritized facilities reporting supervisory visits on the first day of each month (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 6.00 5.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220850 ►EOC organized as part of COVID-19 response (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20.00 20.00 20.00 Date 31-Mar-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220852 ►Refurbished/upgraded health facilities implementing customer satisfaction survey (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 5.00 Date 14-Apr-2020 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220854 12/23/2022 Page 9 of 11 The World Bank Implementation Status & Results Report Liberia COVID-19 Emergency Response Project (P173812) ►Counties with budgeted micro-plans for COVID-19 vaccination campaign (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8.00 15.00 15.00 Date 01-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220856 ►Training of Project Implementation Unit (PIU) staff (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 15.00 10.00 Date 01-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 IN01220858 ►Grievances addressed within the stipulated timeframe (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 30-Jun-2021 31-Mar-2022 28-Oct-2022 30-Sep-2024 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173812 IDA-66090 Effective USD 3.75 3.75 0.00 3.20 0.55 85% Not P173812 IDA-71990 USD 2.80 2.80 0.00 0.00 2.77 0% Effective P173812 IDA-D6080 Effective USD 3.75 3.75 0.00 3.20 0.61 84% P173812 IDA-D9000 Effective USD 7.00 7.00 0.00 5.09 1.54 77% Not P173812 IDA-E1140 USD 6.20 6.20 0.00 0.00 6.06 0% Effective P173812 TF-B6141 Effective USD 1.00 1.00 0.00 0.00 1.00 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date 12/23/2022 Page 10 of 11 The World Bank Implementation Status & Results Report Liberia COVID-19 Emergency Response Project (P173812) P173812 IDA-66090 Effective 09-Apr-2020 10-Apr-2020 13-Apr-2020 30-Apr-2022 30-Sep-2024 Not P173812 IDA-71990 30-Jun-2022 04-Jul-2022 -- 30-Sep-2024 30-Sep-2024 Effective P173812 IDA-D6080 Effective 09-Apr-2020 10-Apr-2020 13-Apr-2020 30-Apr-2022 30-Sep-2024 P173812 IDA-D9000 Effective 30-Jun-2021 06-Jul-2021 03-Aug-2021 30-Sep-2024 30-Sep-2024 Not P173812 IDA-E1140 30-Jun-2022 04-Jul-2022 -- 30-Sep-2024 30-Sep-2024 Effective P173812 TF-B6141 Effective 30-Jun-2021 06-Jul-2021 03-Aug-2021 30-Sep-2022 30-Sep-2023 Cumulative Disbursements Restructuring History Level 2 Approved on 23-Sep-2022 Related Project(s) P176336-Additional Financing on Vaccines for the Liberia COVID-19 Emergency Response Project ,P178479-Liberia COVID-19 Emergency Preparedness and Response Project Second Additional Financing 12/23/2022 Page 11 of 11