The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Central African Republic COVID-19 Preparedness and Response Project (P173832) WESTERN AND CENTRAL AFRICA | Central African Republic | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 6 | ARCHIVED on 14-Jul-2022 | ISR51870 | Implementing Agencies: Central African Republic, Ministry of Health and Population Key Dates Key Project Dates Bank Approval Date: 20-Apr-2020 Effectiveness Date: 27-Apr-2020 Planned Mid Term Review Date: 03-Mar-2022 Actual Mid-Term Review Date: 02-Mar-2022 Original Closing Date: 30-Jun-2022 Revised Closing Date: 30-Jun-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To prepare for and respond to the threat posed by COVID-19 in the Central African Republic. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Preparedness and Response:(Cost $31.60 M) Project Coordination and management:(Cost $1.40 M) Contingent Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions An additional financing (AF) of $25.5 million approved by the World Bank on February 25, 2022 became effective on May 5 2022, and will support the purchase and deployment of COVID19 vaccines, expand vaccine storage and cold chain coverage, and strengthen the overall immunization system. The project annual workplan 2022 for the COVID19 AF was prepared in March 2022 by the various departments of the Ministry of Health in coordination with GAVI, WHO and UNICEF. The national COVID19 coverage is 24% of the total population as of June 2022, which is a noteworthy achievement within the region. MPA Program Development Objective MPA PDO Table 7/14/2022 Page 1 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) 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 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. On June 30, 2021, President Malpass announced the expansion of financing available for COVID-19 vaccine financing to $20 billion over the next 18 months, adding $8 billion to the previously announced $12 billion. This financing is critical to expand affordable and equitable financing for vaccine purchase and deployment. The AF-V is expected to enable vaccination for up to 750 million people, with potential surge capacity for an additional 250 million people in the poorest countries (depending on the delivered price of approved vaccines) while scaling support to strengthen immunization delivery, with design flexibility at the country level. The AF-V is a scale-up of planned vaccination activities anticipated and supported under the Global COVID-19 MPA and a key contribution to the WBG’s overall COVID-19 response. As of June 15, 2022, the Bank has approved 105 operations (including MPA-V operations) to support vaccine procurement and rollout in 77 countries amounting to $9.6 billion. The 105 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 105 approved operations: (i) 56 are in Africa – 26 in AFE and 30 in AFW; (ii) 9 in East Asia and the Pacific; (iii) 11 in Europe and Central Asia; (iv) 11 in Latin America and the Caribbean; (v) 9 in Middle East and North Africa; and (vi) 9 in South Asia. Fifty-three (53) projects are disbursing. Total disbursements as of June 15, 2022, under these projects amount to US$3.4 billion or 35% 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. Sixteen (16) operations have disbursed over 70% of their commitments. Out of the 16, seven have disbursed 90%. Retroactive Financing represents 44% of overall commitments. Thirteen (13) new operations are under various stages of processing. As with the MPA operations, streamlined procedures, delegated approval, coupled with flexible project design, and intensified efforts across the Bank have contributed to the rapid design and processing of the operations. Eighty-eight (88) loan/financing agreements have been signed. Also, eighty-six (86) 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 mobility restrictions and counterparts and Bank teams are operating in a hybrid environment with some days at the office and some at home. Countries are dealing with new waves of infections, as the Omicron variant continues to spread rapidly among populations. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance High High High Macroeconomic High Substantial Substantial Sector Strategies and Policies Substantial Moderate Moderate 7/14/2022 Page 2 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Technical Design of Project or Program High Moderate Moderate Institutional Capacity for Implementation and High Moderate Moderate Sustainability Fiduciary High Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Substantial Moderate Moderate Other -- -- -- Overall High Substantial Substantial Results PDO Indicators by Objectives / Outcomes To prepare for and respond to the threat posed by COVID-19 in the Central African Republic. IN01153936 ►Health staff trained in infection prevention per MOH-approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 516.00 516.00 500.00 Date 27-Apr-2020 04-Mar-2022 04-Mar-2022 30-Jun-2022 IN01153937 ►Personal protective equipment (PPE) kit (masks, face shield, gloves, gown) delivered to targeted health facilities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 17,250.00 17,250.00 9,000.00 Date 27-Apr-2020 04-Mar-2022 04-Mar-2022 30-Jun-2022 The PPE distributed to the health facilities beyond January 2021 were not distributed as a kit (see definition used). As of August 2021, 195,000 gloves and 13,250 masks of all types acquired by the project Comments: were distributed. There are currently 3000 gown left in stock IN01153938 ►COVID-19 risk communication messages broadcasted to communities (number of days) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 474.00 474.00 90.00 Date 27-Apr-2020 04-Mar-2022 04-Mar-2022 30-Jun-2022 Mobile COVID-19 voice messages began being transmitted since April 27, 2020, and has been active for Comments: everyday. IN01153939 ►Population vaccinated (Percentage, Custom) 7/14/2022 Page 3 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Baseline Actual (Previous) Actual (Current) End Target Value 13.00 15.00 24.00 52.00 Date 08-Feb-2022 04-Mar-2022 17-Jun-2022 30-Jun-2024 IN01153940 Proportion of women among those vaccinated (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 40.00 46.00 50.00 Overall Comments PDO The PDO and interrnediate indicators of the parent COVID19 project are already met, so they will not be further reported or updated. Intermediate Results Indicators by Components Component 1: Preparedness and response IN01153942 ►Additional patient "beds" made available in designated care centers and hospitals (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 73.00 73.00 70.00 Date 27-Apr-2020 04-Mar-2022 04-Mar-2022 30-Jun-2022 73 beds and sleeping mattresses have been purchased for the initial patients needing care. Comments: IN01153944 ►Laboratories with trained staff and consumables for collecting COVID-19 samples and transporting to Pasteur Institute laboratory (IBP) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 91.00 91.00 15.00 Date 27-Apr-2020 04-Mar-2022 04-Mar-2022 30-Jun-2022 A large number of health facilities in CAR are now also collecting COVID-19 samples, in addition to Comments: smaller laboratories. IN01153945 ►Risk comminication strategy developed and disseminated (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 27-Apr-2020 04-Mar-2022 04-Mar-2022 30-Jun-2022 Comments: Strategy has been elaborated and the govt is starting to use it in parts. 7/14/2022 Page 4 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) IN01153946 ►Targeted facilities that have received selected drugs required to respond to the surge in patients due to COVID-19 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 90.00 Date 27-Apr-2020 04-Mar-2022 04-Mar-2022 30-Jun-2022 All treatment centers (4 in Bangui and 32 in the rest of the country) have received medication by August 2021. The number of treatment centers increased, where in all centers, selected medication to care for the Comments: COVID19 patients were supplied: July 2020: 9 out of 9 health facilities; January 2021: 15 out of 15 health facilities; August 2021: 36 out of 36 health facilities. IN01153947 ►Targeted communities informed on hygiene behavior (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 90.00 Date 27-Apr-2020 04-Mar-2022 04-Mar-2022 30-Jun-2022 Hygiene promotion were promoted at the health facility and community levels in the country. Over 250,000 soaps were distributed, in addition to hygiene kits, masks and food stamps, along with hygiene sanitation Comments: campaigns with strong community sensitization of COVID19 risk and prevention, in addition to provision and treatment of potable water in 10 districts in the country. IN01153948 ►Doses of COVID-19 vaccines administered as a percentage of doses received (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 35.00 39.40 60.00 60.00 Date 25-Feb-2022 12-Apr-2022 27-May-2022 28-Jun-2024 IN01153949 ►Community health workers engaged as vaccinators (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 660.00 Date 25-Feb-2022 04-Mar-2022 27-May-2022 28-Jun-2024 IN01153950 ►Share of vaccinators who are female (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 3.00 3.00 30.00 Date 31-Jan-2022 04-Mar-2022 27-May-2022 28-Jun-2024 IN01153951 7/14/2022 Page 5 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) ►Districts in which the vaccination deployment strategy targets areas where women congregate (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 25-Feb-2022 04-Mar-2022 27-May-2022 28-Jun-2024 IN01153952 ►Targeted sites where solar-powered cold chain equipment has been installed and functional (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 25-Feb-2022 04-Mar-2022 27-May-2022 28-Jun-2024 IN01153953 ►Districts reached by gender-sensitive messages/materials disseminated of public communications and advocacy on COVID-19 vaccination (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 25-Feb-2022 04-Mar-2022 27-May-2022 28-Jun-2024 IN01153954 ►Districts with community engagement plan implemented for increasing demand for COVID-19 vaccines by the population (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 25-Feb-2022 04-Mar-2022 27-May-2022 28-Jun-2024 IN01153955 ►Districts with a mobile or out-reach facility to administer vaccines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 25.00 Date 25-Feb-2022 04-Mar-2022 27-May-2022 28-Jun-2024 IN01153956 ►Consultation workshops with citizen groups and the media to overcome vaccine hesitancy and enable equitable access to vaccination services (per year) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2.00 Date 25-Feb-2022 04-Mar-2022 27-May-2022 28-Jun-2024 Feedback received during these consultations will be used to inform and adjust activities aiming at overcoming vaccine hesitancy and enabling equitable access to vaccination services. As the Ministry Comments: obtains feedback from these consultation processes, adjustments of the content of the activities, communication materials or any other adjustments will be made to incorporate the feedback. 7/14/2022 Page 6 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Component 2: Project Implementation, Monitoring and Supervision IN01153941 ►M&E system established to monitor COVID-19 preparedness and response (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 27-Apr-2020 04-Mar-2022 04-Mar-2022 30-Jun-2022 Surveillance data on COVID19 cases are collected and reports are disseminated through the Emergency response committee (COUSP) of the Ministry of Health and WHO. So a surveillance system is operating (which started before Project effectiveness), but this is the surveillance of COVID-19 itself, and not a more Comments: comprehensive Monitoring & Evaluation of overall preparedness and response. There are two initiatives underway to put in place systems for disease surveillance overall, which are not yet completed. IN01153943 ►Standard operational procedures (SOP) for collection and disposal of medical waste developed and shared with relevant stakeholders (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 31-Jan-2022 04-Mar-2022 27-May-2022 28-Jun-2024 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173832 IDA-D6170 Effective USD 7.50 7.50 0.00 7.66 0.00 100% P173832 IDA-D9790 Effective USD 25.50 25.50 0.00 0.00 24.68 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173832 IDA-D6170 Effective 20-Apr-2020 22-Apr-2020 27-Apr-2020 30-Jun-2022 30-Jun-2024 P173832 IDA-D9790 Effective 25-Feb-2022 09-Mar-2022 05-May-2022 30-Jun-2024 30-Jun-2024 Cumulative Disbursements 7/14/2022 Page 7 of 8 The World Bank Implementation Status & Results Report Central African Republic COVID-19 Preparedness and Response Project (P173832) Restructuring History There has been no restructuring to date. Related Project(s) P177554-Central African Republic COVID19 AF Vaccine Deployment ,P177618-Central African Republic COVID-19 Preparedness & Response Additional Financing 7/14/2022 Page 8 of 8