The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) Ghana COVID-19 Emergency Preparedness and Response Project (P173788) AFRICA WEST | Ghana | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 4 | ARCHIVED on 24-Jan-2022 | ISR48518 | Implementing Agencies: Ghana Health Services, Republic of Ghana, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 02-Apr-2020 Effectiveness Date: 03-Apr-2020 Planned Mid Term Review Date: 29-Mar-2021 Actual Mid-Term Review Date: 12-Mar-2021 Original Closing Date: 30-Jun-2022 Revised Closing Date: 30-Jun-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Ghana Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Emergency COVID-19 Response:(Cost $336.86 M) Strengthening Multi-sector, National Institutions and Platforms for Policy Development and Coordination of Prevention and Preparedness using One Health approach:(Cost $9.40 M) Community Engagement and Risk Communication:(Cost $10.80 M) Implementation management and monitoring and evaluation and project management:(Cost $7.94 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating High Substantial Implementation Status and Key Decisions Operational funds have continuously supported both immediate needs for COVID-19 emergency response, scaling up vaccination, and health systems strengthening with improved equity. The project resources were used to support the identification and testing of more than 2 million persons as of December 12, 2021. The laboratory capacity has been constantly increased to 41 in all the 16 regions and further expands with GeneXpert equipment in preparation for repeated surges. Case management is being performed at 42 treatment centers with increased ICU bed capacity from 44 to 129 in 10 out of 16 regions. The project is reaching out to the vulnerable, including more than 20,000 persons with disabilities, with psychological and medical care and protective gear. Routine health and nutrition services are being made up for the acute disruption at the onset of the COVID-19 pandemic. As of December 16, 2021, 9.2 percent of the total population were fully vaccinated. 1/24/2022 Page 1 of 10 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) 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 January 17, 2022, 87 MPA-projects had been approved with a total commitment of US$4.2 billion. One operation (Guatemala) was cancelled in mid-September 2021, at the request of the Government. Therefore, there are 86 MPA active operations. Fifty-eight (58) country projects or 67% of projects approved have reached 70-100% disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). Out of the 58 projects, 35 operations or 60% have disbursed over 90% of commitments. 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 January 17, 2022, amounted to US$3.30 billion or 78% of overall commitments. Streamlined procedures, delegated approvals, coupled with flexible project design and intensified efforts across the Bank have contributed to the progress. Six parent projects have been 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 Omicron variant is spreading rapidly among populations. The variant which was first identified in South Africa and Botswana has been detected in more than 80 nations by mid-December. 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. 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 anticipated and supported under the Global COVID-19 MPA and a key contribution to the WBG’s overall COVID-19 response. As of January 17, 2022, the Bank has approved 83 operations to support vaccine procurement and rollout in 69 countries amounting to $7.6 billion. The 83 AF-V 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 83 approved operations: (i) 45 are in Africa – 21 in AFE and 24 in AFW; (ii) 8 in East Asia; (iii) 9 in Europe and Central Asia; (iv) 6 in Latin America and the Caribbean; (v) 7 in Middle East and North Africa; and (vi) 8 in South Asia. Forty-three (43) projects are disbursing. Thirty new operations are under various stages of processing. Total disbursements as of January 17, 2022, under these projects amount to US$1.8 billion or 24% of overall commitments. As 1/24/2022 Page 2 of 10 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) 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. Seventy (70) loan/financing agreements have been signed. Also, sixty (60) 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. The variant, which was first identified in South Africa and Botswana, has been detected in more than 80 nations by mid- December 2021. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Moderate Moderate Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Substantial Moderate Sustainability Fiduciary High Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Low Low Low Other -- -- -- Overall Substantial High Substantial Results PDO Indicators by Objectives / Outcomes Emergency COVID-19 Response IN01047144 ►Diagnosed cases treated in the designated treatment centers per approved protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 68.00 100.00 80.00 Date 02-Apr-2020 30-Oct-2020 30-Sep-2021 30-Jun-2023 As of November 30, 2021, the total number of active cases on admission/home care was 699 out of which 26 cases classified as severe and three as critical. A cumulative of 1,209 deaths have been recorded. Comments: Cumulative number of recoveries stands at 129,042 out of 130,920 total confirmed cases. 1/24/2022 Page 3 of 10 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) IN01047145 Diagnosed cases treated in the designated treatment centers per approved protocol (by % female) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 100.00 80.00 Date 02-Apr-2020 30-Jun-2020 30-Sep-2021 30-Jun-2023 IN01047226 ►Designated acute healthcare facilities with isolation capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 15.00 79.00 50.00 Date 02-Apr-2020 30-Oct-2020 30-Sep-2021 30-Jun-2023 IN01047227 ►Confirmed COVID-19 cases that conducted contact tracing (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 60.00 100.00 Date 02-Apr-2020 30-Oct-2020 30-Sep-2021 30-Jun-2023 The Government continues to implement enhanced surveillance and contact tracing. As of November 20, 2021, of 130,920 cumulative confirmed cases, 78,233 cases were detected through the enhanced contact Comments: tracing and 2,981 cases were among international travelers at the Kotoka International Airport (KIA). IN01047228 ►Infected health workers to COVID-19 treated (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 94.00 100.00 Date 02-Apr-2020 02-Apr-2020 30-Sep-2021 30-Jun-2023 IN01047229 Infected health workers to COVID-19 treated (by % female) (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 100.00 100.00 Date 02-Apr-2020 02-Apr-2020 30-Sep-2021 30-Jun-2023 IN01047230 ►Population vaccinated, who are included in the target population groups defined in the National COVID-19 Vaccine Deployment Plan (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 9.20 41.60 Date 01-Mar-2021 01-Mar-2021 16-Dec-2021 30-Jun-2023 Comments: As of November 20, 2021, 4.3 million people received at least one dose of COVID-19 vaccine and 1.3 million people were fully vaccinated, consisting of 6.6 percent of the total population. 1/24/2022 Page 4 of 10 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) IN01047231 Proportion of females among those vaccinated (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 52.10 50.00 Date 01-Mar-2021 01-Mar-2021 03-Nov-2021 30-Jun-2023 Overall Comments PDO Four out of eight PDO indicators have been already achieved and maintain the good progress. Contract tracing was softened after the third wave of COVID-19 pandemic. Yet, as the festive season is approaching, the Government continues to implement enhanced surveillance and contact tracing, especially at the Kotoka International Airport (KIA) where the new variants were detected. The Government is recording outstanding progress in COVID-19 vaccination. While still 9.2 percent of the total population were fully vaccinated, 864,763 doses were administered in the December 2021 alone. With the influx of COVID-19 vaccines into the country with the arrival of 6 million doses in December 2021 alone, the COVID-19 vaccination coverage is expected to significantly increase in the coming six months. Intermediate Results Indicators by Components Emergency COVID-19 Response IN01047232 ►Designated laboratories with COVID-19 diagnostic equipment, test kits and reagents (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 10.00 63.00 14.00 Date 02-Apr-2020 30-Oct-2020 30-Sep-2021 30-Jun-2023 The result does not include health facilities with GeneXpert equipment. Comments: IN01047236 ►Designated laboratories diagnosed suspected COVID-19 cases within 24 hrs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 10.00 63.00 10.00 Date 02-Apr-2020 30-Oct-2020 30-Sep-2021 30-Jun-2023 IN01047240 ►Referral system to care for COVID-19 patients prepared (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 02-Apr-2020 30-Oct-2020 30-Sep-2021 30-Jun-2023 IN01047241 1/24/2022 Page 5 of 10 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) ►Treatment centers completed with ICU beds and providing services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7.00 24.00 12.00 Date 02-Apr-2020 30-Jun-2020 30-Sep-2021 30-Jun-2023 IN01047245 ►Cold chain system functional (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.70 62.70 100.00 100.00 Date 01-Mar-2021 01-Mar-2021 30-Sep-2021 30-Jun-2023 IN01047246 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 13,649,140.00 34,800,000.00 Date 02-Apr-2020 30-Jun-2020 30-Sep-2021 31-Dec-2022 The result presented is the cumulative number of OPD visits at the PHC facilities from January 2020 to Comments: September 2021. IN01047247 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 8,435,632.00 17,400,000.00 IN01047248 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 1,206,807.00 2,475,000.00 Date 02-Apr-2020 30-Jun-2020 30-Sep-2021 31-Dec-2022 IN01047249 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 4,973,642.00 2,700,000.00 Date 02-Apr-2020 30-Jun-2020 30-Sep-2021 31-Dec-2022 IN01047250 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target 1/24/2022 Page 6 of 10 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) Value 0.00 0.00 359,787.00 690,000.00 Date 02-Apr-2020 30-Jun-2020 30-Sep-2021 31-Dec-2022 Strengthening Multi-sector, National Institutions and Platforms IN01047233 ►Designated facilities for COVID-19 received monitoring and supportive supervision in preceding quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 Date 02-Apr-2020 30-Oct-2020 30-Sep-2021 30-Jun-2023 All designated facilities were visited by the Case Management Team during the quarter and a report was Comments: submitted. IN01047237 ►Designated highly fuel-efficient, low-carbon fuels or electric powered vehicles procured (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 12.00 Date 02-Apr-2020 30-Jun-2020 30-Sep-2021 30-Jun-2023 The procurement plan for highly fuel-efficient, low-carbon fuels was approved in the STEP. The Comments: procurement processes are underway. Community Engagement and Risk Communication IN01047234 ►People having adequate knowledge on Infection Prevention and Control (IPC) measures (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 70.00 70.00 81.00 90.00 Date 01-Mar-2021 01-Mar-2021 30-Sep-2021 30-Jun-2023 IN01047239 Women having adequate knowledge on Infection Prevention and Control (IPC) measures (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 83.00 90.00 Date 01-Mar-2021 01-Mar-2021 30-Sep-2021 30-Jun-2023 IN01047242 ►All the regions have functional COVID-19 information centers (Number) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 1/24/2022 Page 7 of 10 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) Value 2.00 16.00 16.00 16.00 Date 02-Apr-2020 30-Jun-2020 30-Sep-2021 30-Jun-2022 IN01047243 ►People are willing to take up COVID-19 vaccination (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 83.00 80.00 Date 01-Mar-2021 01-Mar-2021 30-Sep-2021 30-Jun-2023 The national survey showed 81 percent of men and 85 percent of women were willing to take COVID-19 Comments: vaccine. IN01047244 Women are willing to take up COVID-19 vaccination (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 85.00 80.00 Date 01-Mar-2021 01-Mar-2021 30-Sep-2021 30-Jun-2023 Implementation Management, Monitoring and Evaluation and Project Management IN01047235 ►Quarterly reports with IDSR data submitted in a timely manner (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 951.00 90.00 Date 02-Apr-2020 30-Jun-2020 30-Sep-2021 30-Jun-2023 IN01047238 ►Complaints received and addressed within one week through the project GRM (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 96.00 100.00 Date 02-Apr-2020 30-Oct-2020 30-Sep-2021 30-Jun-2023 To date, the call centers received and responded to 134,850 calls and complaints with 96 percent Comments: complaint resolution rate. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) 1/24/2022 Page 8 of 10 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173788 IDA-66020 Effective USD 35.00 35.00 0.00 33.86 1.92 95% P173788 IDA-67950 Effective USD 130.00 130.00 0.00 77.72 52.28 60% P173788 IDA-69230 Effective USD 200.00 200.00 0.00 60.97 139.03 30% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173788 IDA-66020 Effective 02-Apr-2020 03-Apr-2020 03-Apr-2020 30-Jun-2022 30-Jun-2022 P173788 IDA-67950 Effective 10-Nov-2020 12-Nov-2020 14-Dec-2020 30-Jun-2022 30-Jun-2022 P173788 IDA-69230 Effective 10-Jun-2021 13-Jul-2021 15-Jul-2021 30-Jun-2023 30-Jun-2023 Cumulative Disbursements PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC 1/24/2022 Page 9 of 10 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) Restructuring History There has been no restructuring to date. Related Project(s) P174839-GHANA COVID-19 EMERGENCY PREPAREDNESS AND RESPONSE PROJECT ADDITIONAL FINANCING ,P176485-Ghana COVID- 19 Emergency Preparedness and Response Project Second Additional Financing ,P178054-Ghana COVID-19 Emergency Preparedness and Response Project Third Additional Financing 1/24/2022 Page 10 of 10