The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) Project Information Document (PID) Appraisal Stage | Date Prepared/Updated: 24-Nov-2021 | Report No: PIDA32948 Nov 24, 2021 Page 1 of 12 The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) BASIC INFORMATION OPS_TABLE_BASIC_DATA A. Basic Project Data Country Project ID Project Name Parent Project ID (if any) Philippines P177884 Philippines COVID-19 P173877 Emergency Response Second Additional Financing Parent Project Name Region Estimated Appraisal Date Estimated Board Date Philippines COVID-19 Emergency EAST ASIA AND PACIFIC 26-Nov-2021 21-Dec-2021 Response Project Practice Area (Lead) Financing Instrument Borrower(s) Implementing Agency Health, Nutrition & Population Investment Project Republic of the Department of Health Financing Philippines Proposed Development Objective(s) Parent To strengthen the Philippines' capacity to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness Components Strengthening Emergency COVID-19 Health Care Response Strengthening Laboratory Capacity at National and Sub-National Level to Support Emerging Infectious Diseases (EIDs) Prevention, Preparedness, and Response Implementation Management and Monitoring and Evaluation Contingent Emergency Response Component (CERC) PROJECT FINANCING DATA (US$, Millions) SUMMARY -NewFin1 Total Project Cost 300.00 Total Financing 300.00 of which IBRD/IDA 300.00 Financing Gap 0.00 DETAILS -NewFinEnh1 World Bank Group Financing Nov 24, 2021 Page 2 of 12 The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) International Bank for Reconstruction and Development (IBRD) 300.00 Environmental and Social Risk Classification Substantial Other Decision (as needed) B. Introduction and Context Country Context 1. The Philippines is situated in the East Asia and Pacific region, with a population of 110 million spreading across more than 7,000 islands. These diverse tropical islands are grouped into three geographic areas: Luzon, the Visayas and the large southern island of Mindanao. The population has an annual growth rate of 1.4 percent and 47 percent of the population live in urban areas. The population is relatively young, with a 2018 estimate that only 5 percent of the population is aged 65 years and older. Adult literacy is high (98% in 2015) and the average life expectancy in 2018 was estimated at 71 years. 2. The Philippines has been one of Asia’s fastest-growing economies, but is being hit hard by the current COVID- 19 health and economic crisis. Categorized as a newly industrialized country, the Philippines has been transitioning from one based on agriculture to one based more on services and manufacturing. Since 2010, the Philippines registered its strongest and longest stretch of growth acceleration, becoming one of the best growth performers in the region: growth averaged 6.3 percent in 2010-18, second only to China, among large economies in the East Asia and Pacific region. Rapid growth has contributed to poverty reduction, with poverty incidence falling from 26.6 percent in 2006 to 21.6 percent in 2015. During the same period, growth has also been pro-poor. Income growth of households in the bottom 40 percent of the population increased by 2.9 percent compared to the average per capita income, which only rose by 1.6 percent. However, the recent and still ongoing COVID-19 health and economic crisis has led to severe shock, with GDP declining by 9.5 percent in 2020 and with unemployment, poverty and food insecurity rising. While the economy is projected to grow in 2021, the economy will not reach 2019 levels and trajectory of the pandemic make the path of recovery very uncertain. Sectoral and Institutional Context 3. As a lower middle-income country, the Philippines exemplifies the challenges of a health system in transition. The country faces the epidemiological transition from communicable to non-communicable diseases. While the Philippines has comprehensive health strategies and policies developed at the national level, these are not effectively mirrored in local-level program implementation. Coverage of basic health programs lags well behind what would be expected of a country of the Philippines’ level of economic development, with immunization coverage at its lowest point in ten years, poor (but improving) access to maternal health outcomes, and high levels of malnutrition for a middle-income country. The current health system is ill-equipped to manage the rising burden of chronic, non-communicable diseases. At the same time, “traditional� threats – such as vaccine preventable diseases – continue to contribute significantly to the burden of disease. One contributing factor is the highly fragmented and devolved health financing and service delivery arrangements, which results in many variations in program coverage across provinces and municipalities, as well as unpredictability and insufficiency of financing from year to year at the local level. In addition, health care is predominantly Nov 24, 2021 Page 3 of 12 The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) hospital-based with emphasis on curative care. The weak primary care system is generally under-resourced and there is also considerable geographic variation in access to care.1 4. Government expenditure on health as a share of GDP is low by global standards, with high out-of-pocket spending (OOP) on health. OOP spending on health, predominantly for pharmaceuticals, constitutes two-thirds of total health spending, and shows no sign of declining. However, the rapid expansion of enrollment under fully subsidized health insurance from 5.2 million to 14.7 million poor families (funded in part by revenues from the Sin Tax) promises to bring much-needed financial protection – if accompanied by efforts to ensure awareness of benefits, expansion of the benefit package, and efficiency in health service purchasing. Health service delivery in conflict-affected Bangsamoro Autonomous Region of Muslim Mindanao (BARMM) faces a significant challenge due to the fragile political situation and security context. Consequently, health outcomes in BARMM are significantly worse than the rest of the country. 5. COVID-19 Situation: The Philippines remains one of the countries most affected by the COVID-19 pandemic in the East Asia and Pacific region. The country is home to the region’s second highest COVID -19 burden after Indonesia, with 2.8 million cumulative cases as of November 19, 2021, equivalent to 26,913 per million population. The number of confirmed COVID-19 deaths is 46,698. The proposed second additional financing (AF2) to the Philippines COVID-19 Emergency Response Project (PCERP)2 is being prepared at a critical juncture in the country’s public health response to the COVID-19 pandemic. The Delta variant of the SARS-CoV-2 virus resulted in a new wave of infections beginning in July 2021. The number of new COVID-19 cases peaked in September, with 129,842 new cases during the week of September 9-15. Since then, the number of new cases has dropped, with 21,073 cases recorded during the week of October 14-20. Test positivity rates have hovered above 10 percent for the past six months; peaking at 27.9 percent in September. While numbers of new confirmed cases have declined, continued high positivity rates spotlight the country’s limited testing and the continued spread of COVID-19. 6. In response to continued infections, high positivity rates, and the need to relieve enormous pressures on the health system by reducing hospitalization rates, as well as to rebuild the economy and protect livelihoods, the country is intensifying the vaccination campaign it started in March 2021. While following the National COVID-19 Vaccination Deployment Plan (NDVP) approved by Cabinet in February 2021, the GOP prioritized vaccinating metropolitan areas which have been the epicenter of successive waves of infections. As of November 19, 2021, 75 million doses of COVID-19 vaccines have been administered. More than 32.6 million people or 42.2 percent of the country’s adult population have been fully vaccinated, while another 9.1 million or 11.8 percent have been partially vaccinated. The relatively low vaccine coverage has been attributed to the slow delivery of vaccine supply during the second half of 2021; however, as supply improved, the vaccination rates increased significantly, reaching an average of 820,000 per day over the past seven days of November 2021. It is expected that at least 70 percent of adult population, including the poorest and most vulnerable, will be fully vaccinated by the time that the proposed AF2 is effective. On the demand side, vaccine hesitancy remains a challenge, but to actively tackle it, the DOH designed and rolled out three main interventions: i) training of healthcare workers and religious leaders to undertake vaccine demand generation in health facilities and communities; ii) engaging celebrities and community-based peer educators in rural areas to communicate progress of the vaccination program, with a focus on vaccine safety; and iii) rolling out incentives and nudges to drive COVID-19 vaccine uptake; incentives include raffles, free transportation to vaccination sites, and text reminders to those scheduled to receive vaccinations. Targeting 1 Health Financing Systems Assessment for BARMM. DRAFT 2020 World Bank Group 2 World Bank. 2020. Philippines - COVID-19 Emergency Response Project. Washington, D.C.: World Bank Group. https://imagebank2.worldbank.org/search/32002941. World Bank. 2021. Philippines - COVID-19 Emergency Response Project: Additional Financing. Washington, D.C.: World Bank Group. https://imagebank2.worldbank.org/search/32851639. Nov 24, 2021 Page 4 of 12 The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) of groups with high vaccine hesitancy have likewise been explored, including engaging with religious and community leaders, local governments, and private sector partners. 7. The GOP has made substantial progress in negotiating and securing COVID-19 vaccines, but uncertainties associated with a tight global supply market remain. The GOP has successfully secured 171 million doses, estimated to cover 85 million population, which already exceeds the originally planned 70 percent of total eligible population. Approximately 125 million doses have been delivered in the Philippines as of November 19, with more than 30 million additional doses expected to arrive by December 2021. The country’s vaccine supply was sourced from: (i) COVAX facility donations, (ii) direct procurement through tripartite agreements between government and private sector, and (iii) direct procurement by the government using GOP funds and project loans from the World Bank, Asian Development Bank (ADB), and Asian Infrastructure Investment Bank (AIIB). The remaining doses will be delivered in the fourth quarter of 2021 and the first quarter of 2022. While the GOP has procured 171 million doses of COVID-19 vaccine, these will only enable the country to cover the adult population with the first single or two-doses of the primary vaccination series. The GOP seeks to negotiate advance agreements with suppliers for vaccines to administer primary doses to 12–17-year-olds and to administer additional doses to at risk population sub-groups. As the global vaccine supply market remains supplier driven with many uncertainties for LMICs, the AF2 will enable the GOP to negotiate supply agreements with suppliers ahead of its planned scale-up of the vaccination program in 2022. C. Proposed Development Objective(s) Original PDO 8. To strengthen the Philippines' capacity to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. Current PDO 9. The PDO for the proposed additional financing remains unchanged: to strengthen the Philippines' capacity to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. Key Results 10. PDO indicators, including proposed new ones, are the following: - Percentage of hospitals with personal protective equipment and infection control products and supplies according to DOH requirements, without stock-outs in preceding one month; - Percentage of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents, without stock-outs in preceding one month; - Number of acute healthcare facilities with isolation capacity according to DOH-established standards; - Percentage of project-targeted health workers that received primary doses of the COVID-19 vaccines; - Percentage of project-financed vaccines administered and reported in line with the DOH’s protocol (new indicator). D. Project Description 11. The Philippines COVID-19 Emergency Response Project (PCERP), in the amount of US$100 million, was prepared as part of the emergency response support provided to the Government of the Philippines (GOP) under the COVID-19 Strategic Preparedness and Response Program (SPRP), using the Multiphase Programmatic Approach (MPA). The PCERP was approved on April 22, 2020. The project aims to strengthen the capacity of the Philippines to prevent, detect, and respond to COVID-19, and national systems for public health preparedness. The project comprises four components: (1) Nov 24, 2021 Page 5 of 12 The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) Strengthening Emergency COVID-19 Health Care Response; (2) Strengthening Laboratory Capacity at National and Sub- national Level to Support Emerging Infectious Diseases (EIDs) Prevention, Preparedness, and Response; (3) Implementation Management and Monitoring and Evaluation; and (4) Contingent Emergency Response Component (CERC). 12. On March 11, 2021, an additional loan for the PCERP in the amount of US$500 million was approved by the World Bank’s Board of Executive Directors. The purpose of the additional financing was to help the GOP purchase and deploy COVID-19 vaccines that meet the World Bank’s vaccine approval criteria (VAC), and to strengthen relevant health systems necessary for successful vaccine deployment and preparation for the future. At the time, the Board also approved modification of the Bank’s VAC to finance vaccine procurement and deployment under the PCERP as follows: (i) the vaccine has been approved by three stringent regulatory authorities (SRAs) (including by Emergency Use Authorization) in two regions; or (ii) the vaccine has received WHO Emergency Use Listing (EUL), and has been produced under a licensing or similar arrangement from a manufacturer of a parent/bioequivalent vaccine that has received a SRA approval (including Emergency Use Authorization). 13. In light of rapid developments in the COVID-19 vaccine market and approval landscape, the World Bank’s Board of Executive Directors approved a revision to the VAC on April 16, 2021. Accordingly, the Bank will accept either of the following as threshold for eligibility of IBRD/IDA resources in COVID-19 vaccine acquisition and/or deployment under all Bank-financed projects: (i) the vaccine has received regular or emergency licensure or authorization from at least one of the SRAs identified by WHO for vaccines procured and/or supplied under the COVAX Facility, as may be amended from time to time by WHO; or (ii) the vaccine has received WHO Prequalification or WHO EUL. On September 1, 2021, the GOP has requested that the revised VAC be applied to the PCERP. The request was approved through a restructuring on September 10, 2021.The revised VAC expands the options of safe and effective vaccines that may be acquired or deployed under the PCERP. 14. The project’s progress toward the achievement of the PDO has been satisfactory, and overall implementation progress is moderately satisfactory. Results of the PDO indicators have improved overtime, with the majority of the PDO indicators having achieved 2021 targets, and one vaccine PDO indicator already achieved the end-project target. Out of 14 intermediate results indicators, 11 have achieved the 2021 targets. Overall progress of project implementation is positive but mixed, with the vaccine deployment under the project having progressed well, with high satisfaction rates from surveyed clients. The DOH has significantly increased the pace of COVID-19 vaccination interventions supported by the project. To strengthen health system capacity to diagnose and manage COVID-19 cases, most medical equipment and supplies supported under the project have been procured and distributed to frontline health facilities, with satisfactory feedback from beneficiary facilities. However, there have been delays with regard to civil works procurement for isolation rooms and quarantine facilities. There have also been delays with the delivery of the reverse transcription polymerase chain reaction (RT-PCR) machines and test kits procured under the contract with the WHO, which has impacted DOH’s plan to expand testing capacity. WHO has confirmed to deliver these by November 30, 2021. 15. Under sub-component 1.2 (Provision of medical supplies, including PPE, COVID-19 vaccines, medicines, and ambulances), the Bank supported the GOP in negotiating and executing a contract with Moderna to supply 13 million vaccine doses, the first batch of which arrived in Manila on June 27, 2021. The roll-out of project financed vaccines, driven by the National Vaccination Operations Committee, has been satisfactory so far. The DOH and Local Government Units (LGUs) have established implementation and monitoring mechanisms that enable the Bank and other stakeholders to track vaccine deployment and outcomes. To date, Moderna has delivered 4.73 million doses to the Philippines under the PCERP supply agreement. The remaining 8.27 million doses are expected to arrive by the end of December 2021. The project-financed Moderna vaccines have been distributed to 17 regions across the Philippines, including the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM). Approximately 30 % of the vaccines went to people with co- morbidities and senior citizens, 44 % went to frontline personnel in essential sectors, and 13 % went to the poor. Nov 24, 2021 Page 6 of 12 The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) 16. The proposed additional $300 million loan will support a scale up of activities, introduced to the project by the AF1. The PCERP-AF2 will cover the procurement and deployment of additional COVID-19 vaccines that meet the Bank’s VAC to support the GOP’s efforts to expand vaccination coverage as follows: (i) primary doses to individuals aged 12-17; (ii) additional doses, as part of primary vaccination series, for at-risk population sub-groups, including senior citizens who were not fully protected with the initial two dose or single dose regimens; and (iii) booster doses for health workers, and the wider population in 2022. The AF2 may also finance primary doses for children under 12 should the vaccines receive regulatory approvals to meet the Bank’s VAC and based on data on safety. Approxim ately 90 percent of the loan will finance vaccine procurement, while the remaining will support end-to-end logistics and necessary supplies to support vaccination deployment (Table 4). Specifically, under sub-component 1.2: Provision of medical supplies, including personal protective equipment (PPE), COVID-19 vaccines, medicines, and ambulances, the proposed AF2 will finance procurement of vaccines (including boosters), syringes, safety boxes and end-to-end logistics (brokering, warehousing, hauling). Given the expanding scope and scale of the vaccination program, the AF2 will finance interventions to strengthen the VIMS to strengthen the likelihood of the Project to achieve the PDO. Allocation of sub-component 1.2 will be increased from US$521.3 million to US$821.3 million. 17. In addition, the results framework will be restructured to reflect the increase in financing for vaccines, including adjusting existing indicators, as well as adding new indicators with their respective targets. 18. The AF entails expanding the scope and scale of activities under the PCERP, with no changes to the overall design. The total amount of the loan will be allocated under sub-component 1.2 to finance vaccine purchase, including boosters, and deployment. The PDO will remain unchanged given that the proposed activities to be funded under the AF align with the original PDO. The closing date of the AF will remain aligned with the closing date of the parent project, i.e., December 29, 2023. Results Framework 19. The results framework will be modified to reflect the changes in the scale and scope of the parent project and AF 1. The modifications will reflect the new activities proposed under the AF2 to measure overall progress in the coverage and deployment of the additional and booster doses of COVID-19 vaccine for the general population, and individuals aged 12 to 17. Proposed changes to the results framework are summarized below. 20. To measure overall progress in the coverage and deployment of the COVID-19 vaccine, the following new PDO and intermediate indicators are added: - PDO 6: Percentage of project-financed vaccines administered and reported in line with the DOH’s protocol - baseline is 0, end target is 95 percent; - Intermediate indicator 10: Number of vaccine doses procured by the project – baseline is 0, end target is 38,000,000. - Intermediate indicator 11: Percentage of project-targeted individuals aged 12-17 who received primary dose vaccines as per the government plan and the Bank’s VAC, disaggregated by sex – baseline is 0, end target is 60 percent; - Intermediate indicator 12: Percentage of project-targeted vulnerable population that received additional/booster doses of COVID-19 vaccine as per the government plan, disaggregated by sex and age – baseline is 0, end target is 70 percent; - Intermediate indicator 13: Percentage of project-targeted health workers that received booster doses as per the government plan, disaggregated by sex and age – baseline is 0, end target is 70 percent; - Intermediate indicator 14: Percentage of the population willing to get vaccinated, disaggregated by sex – baseline Nov 24, 2021 Page 7 of 12 The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) is 23 percent (Social Weather Stations), end target is 70 percent. 21. In addition, two intermediate indicators will be revised to measure scaled up activities under component 1. The revised indicators are as follows: - Intermediate indicator 5: Percentage of project-targeted vaccinated population and parents/guardians of individuals aged 12-17 who rated as satisfactory the COVID-19 vaccination services received (Percentage) - the indicator is revised to include parents/guardians of individuals aged 12-17; - Intermediate indicator 6: Percentage of serious AEFI cases who have received treatment according to DOH’s protocol, disaggregated by adults and individuals aged 12-17- The indicator is revised to reflect disaggregation. 22. The wording of the following PDO and intermediate indicators are revised slightly to align with the wording of new indicators; their respective baseline and end target values remain unchanged: - PDO 4: Percentage of project-targeted health workers that received primary doses of COVID-19 vaccines; - Intermediate indicator 4: Percentage of hospitals designated as vaccination sites in project areas having adequate and functioning cold chain equipment (CCE) maintaining the temperature required for the COVID-19 vaccine assigned. 23. The following PDO indicator is removed due to the change in the government’s deployment plan: - PDO 5: Percentage of project-targeted population given full dose of COVID-19 vaccine. . Legal Operational Policies Triggered? Projects on International Waterways OP 7.50 Projects in Disputed Areas OP 7.60 Summary of Assessment of Environmental and Social Risks and Impacts . 24. The overall environmental and social risk rating remains substantial. COVID-19 uncertainty combined with the complexity and requisite capacity to deliver COVID-19 emergency response and vaccination in a swift and yet safe, inclusive and equitable manner justifies the rating. The project’s outcome is positive since strengthening the GOP’s public health measures and vaccination are expected to mitigate public health impacts and curb further spread of COVID-19. The AF2 is expected to further enhance the DOH’s capacity to achieve such positive outcomes through additional investments in the procurement, deployment, system strengthening, including public health and risk communication and AEFI management. The AF2 is financing scale up of the COVID-19 vaccination and its deployment systems, including procurement of supporting equipment. No additional investments for civil works are envisaged under the AF2. 25. The existing mitigation measures, as encapsulated in the project’s Environmental and Social Management Framework (ESMF) and Stakeholder Engagement Plan (SEP), remain relevant for the AF2. Relevant environmental and social risks considered under the AF2 are similar to those of the parent project. Such risks stem from the implementation capacity amongst implementing entities both at the national and sub-national levels to deliver intended interventions in a manner consistent with the applicable Environmental and Social Standards (ESSs). These include i) Occupational Health Nov 24, 2021 Page 8 of 12 The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) and Safety (OHS) and public health safety for civil work activities; ii) COVID-19 transmission risks due to poor adherence to Infection Prevention Control (IPC) measures for activities being supported by the project; iii) increased volumes of health care wastes; iv) environmental and safety risks associated with end-to-end logistics; v) equitable access to COVID- 19 services and vaccination; vi) Adverse Effects following Immunization (AEFIs). Concerns associated with data protection and privacy, as well as application of voluntary consent become increasingly relevant in the context of scale up. Risks associated with Sexual Exploitation and Abuse/Sexual Harassment (SH) are assessed as low since the project does not envisage major labor influx. Depending on the future scope, mobilization of security forces and mandatory quarantine in government designated facilities may heighten SEA/SH risks. These risks were assessed earlier under the parent project and the first AF, for which corresponding mitigation measures have been incorporated into the project’s S EP and ESMF. Further, since pediatric vaccination and boosters are included within the scope of AF2, enhanced oversight to ensure proper implementation of consent protocols for the former and prevent distortion of equitable access for the latter, particularly in the context where the majority of the population have not been vaccinated. The project’s Environmental and Social Commitment Plan (ESCP) has incorporated relevant operationalization and system strengthening measures particularly in anticipation for the COVID-19 vaccination scale up. 26. The DOH has demonstrated a strong capacity to monitor and supervise the implementation of Environmental, Social, Health, and Safety (ESHS) requirements, particularly for civil work activities as well as COVID-19 vaccine rollout. The DOH has successfully completed the transition of the project’s environmental and social coordinator and recruited a full team of environmental and social specialists to support the DOH in the day-to-day implementation of the project’s ESMF, supervision and reporting. Regular supervision and monitoring of the environmental and social requirements under the project have been performed. Specific activities include a) regular site visits for on-going civil work and construction activities; b) development and deployment of relevant manuals and sourcebooks, including among others: healthcare waste management (HCWM), green building standards, and guidance on vaccine rollout to third party logistics firms; c) mainstreaming oversight protocols through the use of electronic survey platforms; d) multi-stakeholder coordination and communication and capacity building. The DOH piloted a self-assessment baseline on the capacity of services for vulnerable groups in HCFs in 76 HCFs, which inform relevant measures to enhance accessibility features and universal design in Healthcare Facilities (HCFs). On vaccine logistics management, the third-party logistic provider, Zuellig Pharma Corporation (ZPC) conducted an ESS compliance assessment of vaccination deployment where findings indicate overall ESS compliance. Under the AF2, the DOH is pilot testing a similar assessment across vaccine implementing entities through a National Vaccine Operation Center (NVOC) memo. 27. Although the overall environmental and social monitoring is adequate, the DOH is still facing some challenges in enforcing civil work contractors with the ESHS requirements, particularly in implementing IPC measures on site. The DOH shall enhance its capacity to enforce proper handling of medical and vaccination wastes at HCFs, especially as the COVID- 19 vaccination is being scaled-up. In August 2021, the DOH reported a COVID-19 infection cluster among workers attributed to the ongoing civil works at one of the health facilities supported by the project. No fatalities were reported. Immediate suspension of construction activities was enforced, followed by implementation of remedial measures based on an incident investigation by the contractor and the PIU environmental and social management team. Taking stock of the lessons learnt from the incident, the DOH is enhancing oversight and capacity building support across on-going and planned civil works and contractors’ compliance to their Construction-Environmental and Social Management Plan (C- ESMP). As of October 8, 2021, a COVID-19 Waste Management Sourcebook was released by the DOH and will serve as a complementary guideline to the existing HCWM Manual (fourth edition). Going forward, the HCFs will be required to submit their self-audit reports using the checklist in the sourcebook. 28. The DOH is integrating social inclusion measures as part of the COVID-19 vaccination scale up strategy. These include outreach, demand generation and public communication to promote equitable access to COVID-19 vaccines, particularly in lagging and underserved areas and amongst the poor and marginalized groups. While COVID-19 vaccine Nov 24, 2021 Page 9 of 12 The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) roll-out is progressing positively, with more than 23.7 million people or equivalent of 21.5 percent of the country’s population being covered, vaccine deployment will likely be strained in rural and lagging regions due to supply-side constraints associated with the cold chain infrastructure, including dry storage capacities. To date, deployment has prioritized regions with high burdens of the Delta variant, resulting in higher vaccination coverage in urban areas. Coverage is low in peri-urban and rural areas, notably in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) where only 9.11 percent of the target population has been vaccinated so far. The Cordillera Administrative Region (CAR), with a concentration of Indigenous Peoples approximately 33% of the regional population, has shown a positive trend. Although CAR has one of the lowest populations in terms of number and density in the country, nearly 40 percent of the target population received the first dose, and 30 percent are fully vaccinated. Under the AF2, CAR presents important lessons and a case study regarding vaccination deployment systems in rural and lagging regions. In addition, the forthcoming study on the vaccine roll out amongst Indigenous Peoples can potentially generate lessons learnt for future deployment. 29. The AF2 will strengthen risk communication, community mobilization, data protection measures, citizen engagement, grievance handling and relevant capacity building for LGUs and HCFs and other implementing stakeholders to enhance public confidence and demand for COVID-19 vaccines. To ensure vaccine safety and mitigate the potentially AEFIs, the project will enforce stringent criteria as defined in the World Bank’s Vaccine Approval Criteria and enhance the GOP’s pharmacovigilance system. The AF2 will continue to support the DOH to increase its human resources and operational capacities to monitor AEFIs associated with the World Bank-procured vaccines and track cases, particularly whether such cases are given free of charge medical treatments. In addition, public health risk communication and information dissemination, including grievance reporting for AEFIs will also be enhanced with support from the project. As vaccination is covering conflict-affected areas, the DOH will be required to improve safety and security measures amongst health personnel as well as beneficiaries for vaccine deployment in such areas. 30. The DOH has taken proactive measures to capture public perceptions of the overall vaccination program. In August 2021, DOH conducted a public satisfaction survey on the overall implementation of the COVID-19 vaccine program among 17 LGUs. Out of the 2,896 participating in the survey, 98.13 percent were satisfied with the program. In the future, the DOH will outsource implementation of satisfaction surveys to a third-party/firm. Public engagement has also capitalized on the existing channels, including feedback and grievance redress mechanisms (FGRMs) relevant to the project. Within the broader COVID-19 emergency response, a national COVID-19 hotline has been established as of 17 March 2020, and is equipped with toll free numbers (i.e., 1555 and (02)894COVID (26843). Stakeholder consultations were conducted between 24 and 25 June 2021 to solicit inputs on the project’s FGRM channels. In addition, monthly coordination meetings, involving the project’s implementing entities, have also been used to assess effectiveness of such channels. E. Implementation 31. Implementation arrangements under the parent project, AF1 and AF2 remain unchanged. The DOH is the implementing agency for the parent project and AF1 and will lead implementation of the proposed AF2. Project implementation uses mainstream DOH structures, and does not involve a parallel project implementation unit or secretariat. The DOH has assigned management, technical, and administrative staff to oversee day-to-day project implementation. Given the increased scope of the project, DOH’s human resources have been expanded to provide adequate implementation support. A deputy team leader was hired under the first additional financing, as well as an environmental specialist, social specialist, ESF coordinator, M&E project assistant, and finance analyst. In addition, the DOH hired a vaccine specialist. Under AF2, a risk communication specialist will be hired under the PCERP and will report directly to the DOH Communications Management Unit and the Project Team Leader. The DOH will further reinforce the staff to support the AF2 based on emerging needs and demands from expanding the scale and scope of the COVID-19 vaccination program. Nov 24, 2021 Page 10 of 12 The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) 32. The DOH project team will work closely with the COVID-19 Vaccine Cluster of the Inter-Agency Task Force on the Management of Emergency Diseases (IATF) as well as NITAG and NAEFIC. The COVID-19 Vaccine Cluster, led by the Vaccine Czar, include six Task Groups (TG): (i) Vaccine Evaluation and Selection; (ii) Vaccine Cold Chain and Logistic Management; (iii) COVID-19 Immunization Program; (iv) Diplomatic Engagement and Negotiation; (v) Procurement and Finance; (vi) Demand Generation and Communication. Procurement of vaccine will be carried out in accordance with the World Bank’s Procurement Framework. The Bank’s procurement rules will, however, not apply to certain expenditures or upfront payments, such as speed premia, made to secure a country’s participation in an advance participation mechanism for vaccines as described in Global COVID-19 MPA Additional Financing Paper. 33. The guiding documents for the project will be an updated Project Operations Manual, including a Vaccine Delivery and Distribution Manual, standard project fiduciary, environmental and social risk management, implementation, and M&E requirements, as well as relevant official documents. In addition, Annual Work Plan and Budget will be submitted for no-objection to the World Bank no later than October 31 of each year, detailing the project work program and budget for each government fiscal year and specifying the allocation and sources of funding for all project components. . CONTACT POINT World Bank Sutayut Osornprasop Senior Health Specialist Ronald Upenyu Mutasa Practice Leader Borrower/Client/Recipient Republic of the Philippines Rommel Herrera Director rherrera@dof.gov.ph Implementing Agencies Department of Health Maria Soledad Antonio Director msqantonio@doh.gov.ph Nov 24, 2021 Page 11 of 12 The World Bank Philippines COVID-19 Emergency Response Second Additional Financing (P177884) FOR MORE INFORMATION CONTACT The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects APPROVAL Sutayut Osornprasop Task Team Leader(s): Ronald Upenyu Mutasa Approved By Practice Manager/Manager: Country Director: Ndiame Diop 25-Nov-2021 Nov 24, 2021 Page 12 of 12