The World Bank
Albania Emergency COVID-19 Response Project (P174101)
REPORT NO.: RES51379
RESTRUCTURING PAPER
ON A
PROPOSED PROJECT RESTRUCTURING
OF
ALBANIA EMERGENCY COVID-19 RESPONSE PROJECT
APPROVED ON JULY 30, 2020
TO
THE REPUBLIC OF ALBANIA
HEALTH, NUTRITION & POPULATION
EUROPE AND CENTRAL ASIA
Regional Vice President: Anna M. Bjerde
Country Director: Linda Van Gelder
Regional Director: Fadia M. Saadah
Practice Manager/Manager: Tania Dmytraczenko
Task Team Leader(s): Lorena Kostallari, Adrien Arnoux Dozol
The World Bank
Albania Emergency COVID-19 Response Project (P174101)
ABBREVIATIONS AND ACRONYMS
COVID-19 Coronavirus disease 2019
IBRD International Bank for Reconstruction and Development
ICU Intensive Care Unit
IDC Infectious Disease Clinic
IPH Institute of Public Health
MoHSP Ministry of Health and Social Protection
PCU Project Coordination Unit
PDO Project Development Objective
UNOPS United Nations Office for Project Services
The World Bank
Albania Emergency COVID-19 Response Project (P174101)
BASIC DATA
Product Information
Project ID Financing Instrument
P174101 Investment Project Financing
Environmental and Social Risk Classification (ESRC)
Moderate
Approval Date Current Closing Date
30-Jul-2020 30-Jun-2022
Organizations
Borrower Responsible Agency
Republic of Albania
Multiphase Programmatic Approach (MPA) Program Development Objective
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
Multiphase Programmatic Approach (MPA) Status (Public Disclosure)
Status and Key Decisions (Public Disclosure)
As of May 16, 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 have been restructured to include vaccine-related procurement.
Total disbursements as of May 16, 2022, amount to US$3.6 billion or 83% of overall commitments. This
amount does not include disbursements under MPA-V operations which are reported together with AF-V
operations. Sixty-seven (67) country projects or 77% of projects approved have reached 70-100%
disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR
against the US$). Out of the 67 operations, 48 operations or 72% have disbursed over 90% of
commitments. Of these, 30 operations are fully disbursed. There are twelve (12) operations with
disbursements under 50%. The projects are benefitting around 3.7 billion people or 50% of the global
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. Two operations closed
The World Bank
Albania Emergency COVID-19 Response Project (P174101)
last CY. Closing dates for several operations have been extended beyond the end of the FY; twelve (12)
operations have closing dates by the end of FY22. Country teams for operations which have been under
implementation for twelve months or more by June 30, 2022, are preparing Mid-Term Review (MTR) ISRs
to inform the Global MPA MTR, which will be prepared early next 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. Implementation continues to face challenges as several countries are
still under different levels of mobility restrictions, and counterparts and Bank teams are operating from
home or partially from home. Some Bank teams continue to conduct implementation support missions
virtually, which is challenging for both Bank teams and counterparts. Bank staff are operating in a hybrid
environment with some days at the office and others at home. 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.
OPS_TABLE_PDO_CURRENTPDO
Project Development Objective (PDO)
Original PDO
The objectives of the Project are to prevent, detect, and respond to the threat posed by COVID-19 and strengthen
national systems for public health preparedness in the Republic of Albania.
OPS_TABLE_PDO_CURRENTPDO
Summary Status of Financing (US$, Millions)
Net
Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed
IBRD-91600 30-Jul-2020 15-Oct-2020 13-Jan-2021 30-Jun-2022 16.80 16.41 .92
Policy Waiver(s)
Does this restructuring trigger the need for any policy waiver(s)?
No
I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING
1. The Albania Emergency COVID-19 Response Project (the Project) was approved on July 30, 2020 and became
effective on January 13, 2021. The Project Development Objective (PDO) is to prevent, detect, and respond to the threat
posed by COVID-19 and strengthen national systems for public health preparedness in the Republic of Albania. The project
The World Bank
Albania Emergency COVID-19 Response Project (P174101)
is being implemented through two components: (i) Component 1 supports the health sectors’ COVID-19 response by
providing support to contain the transmission, enhance disease detection, and treat COVID-19 (EUR 14.5 million); (ii)
Component 2 supports overall project administration (EUR 0.5 million).
2. Both progress towards achievement of the PDO and overall implementation progress is rated Moderately
Satisfactory. The Project Coordination Unit (PCU) continues to make strong progress despite initial supply chain delays
caused by the pandemic. Several large activities have been contracted and are currently under implementation, including:
(i) procurement and supply of swabbing materials (for COVID-19 tests); (ii) reproduction of communication materials for
the COVID-19 outreach campaign; (iii) rental of materials for the COVID-19 campaign and vaccinations (tents, chairs,
tables, etc.); and (iv) implementation of the contract with the United Nations Office for Project Services (UNOPS). The
UNOPS contract accounts for approximately 70 percent of total project funds and supports a significant part of project
activities, including (i) procurement of medical equipment and refurbishment for selected hospitals, the Institute of Public
Health, and laboratories network; (ii) procurement of medical ambulances for the tertiary hospital in Tirana and all regions;
and (iii) completion of civil works at Mother Teresa Infectious Disease Clinic (IDC). To date 20 ambulances have been
purchased and delivered to hospitals, testing equipment has been procured and delivered and staff has been trained, and
procurement for CT scanners, digital X-ray machines, an angiography system, mobile X-rays, and ultrasounds are nearing
completion. However, rehabilitation of the civil works at the Mother Teresa IDC will not be able to be completed by the current
closing date.
3. The Financial Management arrangements continue to be adequate and there are no outstanding audits.
4. The Mother Teresa IDC is the only infectious department in the country. Despite the close supervision of the Ministry
of Health and Social Protection (MoHSP) and the World Bank, the contract for its rehabilitation was only signed on March
18, 2022. Previous waves of infection required the continued use of the IDC as a treatment facility, delaying the initiation
of civil works for the planned rehabilitation. On May 9, 2022, the Government requested a 6-month extension of the
project closing date mainly to allow additional time for the completion of these civil works. As of April 2022, the IDC has
been sufficiently emptied of patients to allow for the initiation of civil works.
II. DESCRIPTION OF PROPOSED CHANGES
5. Closing Date Extension & Implementation Schedule. The loan closing date will be extended by six months, from
June 30, 2022, to December 31, 2022, to allow for the completion of the remaining activities and full absorption of loan
proceeds. The new closing date will allow the MoHSP to fully complete the ongoing rehabilitation works at the Mother
Teresa IDC. The disbursement estimates and implementation schedule have also been revised to reflect these changes.
The delivery and installation of the equipment will take place before the closing date, with the disbursement of the
remaining proceeds expected to happen within the Grace Period (May 2023).
6. Revision of the Results Framework. The Results Framework has been revised to better reflect project activities.
The project was designed and prepared at a time of uncertainty. In navigating multiple waves of the pandemic, activities
originally planned have been modified to meet the needs of the government and the population. The below changes have
been introduced to ensure that the Results Framework appropriately reflects the results of project activities.
PDO Indicator 1: Number of designated laboratories with diagnostic equipment, test kits, and reagents, as per MoHSP
guidelines.
The target value has been revised downward, from five to four. The Project was designed and prepared at a time
of uncertainty, when the Government was planning to have another new main laboratory, to be able to respond
The World Bank
Albania Emergency COVID-19 Response Project (P174101)
to the pandemic situation. However, during Project implementation, the decision has changed to keep the four
existing main laboratories and use a primary care system. Hence, the target will be revised to four main
laboratories (instead of five), including two laboratories at the Institute of Public Health (IPH); 1 laboratory at
Mother Tereza Hospital; one laboratory at Shefqet Ndroqi hospital (the second COVID-19 hospital). The
Government has also supplied all 413 primary health centers and 36 local Health Care units with test kits, and
reagents.
Intermediate results indicator: Number of medical ambulances provided to Tirana tertiary hospital, regional hospitals,
and IPH.
The end target has been revised downward from 32 to 20 ambulances. Twenty have been already purchased and
are being used. The MoHSP has supplied a number of ambulances last year, supported by other sources of funding,
hence the target will be revised to reflect the changing country needs.
The intermediate results indicator: Establishment of an information system among key laboratories and training of lab
specialists.
This indicator has been dropped due to the fact that the World Health Organization financed this activity and
there is no longer a need for Project funds. The activity is already completed.
ES NOTE TABLE
III. SUMMARY OF CHANGES
Changed Not Changed
Results Framework ✔
Loan Closing Date(s) ✔
Implementation Schedule ✔
Implementing Agency ✔
DDO Status ✔
Project's Development Objectives ✔
MPA Program Development Objective ✔
MPA Expected Results and Indicators ✔
PBCs ✔
Components and Cost ✔
Cancellations Proposed ✔
Reallocation between Disbursement Categories ✔
Disbursements Arrangements ✔
Disbursement Estimates ✔
Overall Risk Rating ✔
Legal Covenants ✔
The World Bank
Albania Emergency COVID-19 Response Project (P174101)
Institutional Arrangements ✔
Financial Management ✔
Procurement ✔
Other Change(s) ✔
Economic and Financial Analysis ✔
Technical Analysis ✔
Social Analysis ✔
Environmental Analysis ✔
IV. DETAILED CHANGE(S)
MPA PROGRAM DEVELOPMENT OBJECTIVE
Current MPA Program Development Objective
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
EXPECTED MPA PROGRAM RESULTS
Current Expected MPA Results and their Indicators for the MPA Program
Progress towards the achievement of the PDO would be measured by outcome indicators. Individual country-specific
projects (or phases) under the MPA Program will identify relevant indicators, including among others:
• Country has activated their public health Emergency Operations Centre or a coordination mechanism for
COVID-19;
• Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents;
• Number of acute healthcare facilities with isolation capacity;
• Number of suspected cases of COVID-19 reported and investigated per approved protocol;
• Number of diagnosed cases treated per approved protocol;
• Personal and community non-pharmaceutical interventions adopted by the country (e.g., installation of
handwashing facilities, provision of supplies and behavior change campaigns, continuity of water and sanitation service
provision in public facilities and households, schools closures, telework and remote meetings, reduce/cancel mass
gatherings);
The World Bank
Albania Emergency COVID-19 Response Project (P174101)
• Policies, regulations, guidelines, or other relevant government strategic documents incorporating a multi-
sectoral health approach developed/or revised and adopted;
• Multi-sectoral operational mechanism for coordinated response to outbreaks by human, animal and wildlife
sectors in place;
• Coordinated surveillance systems in place in the animal health and public health sectors for zoonotic
diseases/pathogens identified as joint priorities; and
• Mechanisms for responding to infectious and potential zoonotic diseases established and functional; and
• Outbreak/pandemic emergency risk communication plan and activities developed and tested
OPS_DETAILEDCHANGES_LOANCLOSING_TABLE
LOAN CLOSING DATE(S)
Original Revised Proposed Proposed Deadline
Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal
Applications
IBRD-91600 Effective 30-Jun-2022 31-Dec-2022 30-Apr-2023
.
The World Bank
Albania Emergency COVID-19 Response Project (P174101)
.
Results framework
COUNTRY: Albania
Albania Emergency COVID-19 Response Project
Project Development Objectives(s)
The objectives of the Project are to prevent, detect, and respond to the threat posed by COVID-19 and strengthen national systems for public health
preparedness in the Republic of Albania.
Project Development Objective Indicators by Objectives/ Outcomes
RESULT_FRAME_TBL_PDO
Indicator Name PBC Baseline End Target
Health care delivery and health system strengthening
Number of designated laboratories with diagnostic equipment,
0.00 4.00
test kits, and reagents, as per MoHSP guidelines (Number)
Action: This indicator has been Revised
Percentage of COVID-19 cases that are health care workers
3.50 2.00
(Percentage)
PDO Table SPACE
Intermediate Results Indicators by Components
RESULT_FRAME_TBL_IO
Indicator Name PBC Baseline End Target
Health care delivery and health system strengthening
The World Bank
Albania Emergency COVID-19 Response Project (P174101)
RESULT_FRAME_TBL_IO
Indicator Name PBC Baseline End Target
Upgraded infrastructure of the Infectious Disease Clinic in
No Yes
Mother Teresa Hospital completed (Text)
Number of volunteer healthcare staff covered with salaries for at
0.00 300.00
least 3 months (Number)
Number of medical ambulances provided to Tirana tertiary
0.00 20.00
hospital, regional hospitals, and IPH (Number)
Action: This indicator has been Revised
Establishment of an information system among key laboratories 7 (IPH, Tirana University, Shefqet Ndroqi, and 4 regional
0.00
and training of lab specialists (Text) hospitals) / 80 laboratory specialists
Action: This indicator has been Marked for Deletion
Number of medical staff in public health laboratories, trained to
0.00 100.00
undertake field epidemiology (Number)
Number of ICU beds supplied for the Infectious Disease Hospital
18.00 58.00
(Number)
Number of green zones, in a given month, in which the number
tbd pending project effectiveness 0.00
of new cases on any day exceeds 12 (Text)
Number of social media events/interactions (e.g. Facebook,
Twitter) which have facilitated citizen feedback and government 0.00 1,000.00
response (Number)
IO Table SPACE
.
The World Bank
Albania Emergency COVID-19 Response Project (P174101)