The World Bank Burundi COVID19 Preparedness and Response Project (P173845) REPORT NO.: RES48026 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF BURUNDI COVID-19 PREPAREDNESS AND RESPONSE PROJECT APPROVED ON APRIL 10, 2020 TO REPUBLIC OF BURUNDI APPROVED ON SEPTEMBER 9, 2020 Health, Nutrition & Population Global Practice East and Southern Africa Regional Vice President: Hafez M. H. Ghanem Country Director: Jean-Christophe Carret Regional Director: Amit Dar Practice Manager/Manager: Francisca Ayodeji Akala Task Team Leader(s): Omer Ramses Zang Sidjou The World Bank Burundi COVID19 Preparedness and Response Project (P173845) ABBREVIATIONS AND ACRONYMS ESCP Environmental and Social Commitment Plan ESMF Environmental and Social Management Framework FM Financial Management FTCF Fast Track COVID-19 Facility GoB Government of Burundi IPC Infection, Prevention and Control MoH Ministry of Health PDO Project Development Objective PIU Project Implementation Unit RSA Regional Safeguards Advisor SEA/SH Sexual Exploitation and Abuse/Sexual Harassment SEP Stakeholder Engagement Plan The World Bank Burundi COVID19 Preparedness and Response Project (P173845) BASIC DATA Product Information Project ID Financing Instrument P173845 Investment Project Financing Environmental and Social Risk Classification (ESRC) Substantial Approval Date Current Closing Date 10-Apr-2020 30-Sep-2021 Organizations Borrower Responsible Agency Ministère de la Santé Publique et de la Lutte contre le Republic of Burundi Sida,Ministère des Finances, du Budget et de la Coopération au Développement Economique 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) The implementation of the MPA-funded projects continues to progress well. As of August 16, 2021, 87 MPA- projects have been approved providing a total commitment of US$4.2 billion. Disbursements during the past month have increased at a rapid pace. Forty-nine (49) country projects or 56% of projects approved have reached 70-100% disbursements. The projects benefit around 3.7 billion people or 50% of the global population. Of the 87 approved 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) 12 in Latin America and the Caribbean; (v) 7 in Middle East and North Africa; and (vi) 9 in South Asia. Eighty-one (81) or 93% projects are disbursing. Total disbursements as of August 16, 2021, amount to US$2.80 billion or 66% of overall commitments. Streamlined procedures, delegated approval coupled with flexible project design and intensified efforts across the Bank have contributed to the progress. Several projects have/are being restructured to include vaccine related The World Bank Burundi COVID19 Preparedness and Response Project (P173845) procurement. Implementation is being guided by Bank teams working in parallel in other health related projects, including Additional Financing operations supporting vaccine procurement and deployment efforts in countries. Implementation continues to face challenges as many countries are still under different levels of lockdown or mobility restrictions and counterparts and Bank teams are operating from home or partially from home. Also, several countries are phasing new waves of infections with the Delta variant spreading rapidly among populations. Most Bank teams continue to conduct implementation support missions virtually, which is challenging for both Bank teams and counterparts. This “virtual” world poses connectivity challenges as internet is not reliable in many countries, especially IDA countries. Notwithstanding challenges, the MPA is on track to achieving its PrDO – to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. The significant level of disbursements in just over 16 months attest to the strong implementation efforts of the Bank response thanks to the commitment of counterparts supported by Bank country teams. OPS_TABLE_PDO_CURRENTPDO Project Development Objective (PDO) Original PDO To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Burundi. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-D6160 10-Apr-2020 14-Apr-2020 08-Jul-2020 30-Sep-2021 5.00 5.20 .06 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Project Background 1. The Burundi COVID-19 Preparedness and Response Project was approved by the World Bank Board on April 10, 2020 and became effective on July 8, 2020. The total project amount is SDR 3.7 million (US$ 5 million equivalent). The project’s current closing date is September 30, 2021. The project was prepared under the COVID-19 Strategic Preparedness and Response Program (SPRP) using the Multiphase Programmatic Approach (MPA), approved by the Board on April 2, 2020. The World Bank Burundi COVID19 Preparedness and Response Project (P173845) 2. The Project Development Objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Burundi. 3. This is the second restructuring of the project based on a request for extension dated August 27, 2021 in which the closing date is proposed to be extended by twelve months, from September 30, 2021 to September 30, 2022. The request for this second extension is in order for the teams to process an additional financing (AF) for COVID 19 vaccines purchase and deployment, and expansion of support to national COVID 19 response’s plan and in order to adapt the technical design of the parent project to the evolving epidemiological context of the pandemic, including the emergence of new variants. 4. The first restructuring of the project was on June 9, 2021, the World Bank received and approved a request, from the Government of Burundi, for a no-cost extension of the closing date of the project from June 30 to September 30, 2021. This request for an extension was approved due to the following: (i) delays in implementation of borehole water supply and electrification of the Ebola/COVID-19 treatment Centre of Mudubugu; (ii) need for the contractor (REGIDESO) to import certain equipment for the electrification of the Mudubugu treatment center; (iii) delays in producing/updating the Environmental and Social Management Framework (ESMF); and (iv) delays in the receipt of COVID-19 rapid diagnostic tests purchased by the project. All delayed activities are on track to be completed. Additionally, the ESMF has been updated, cleared by the Regional Safeguards Advisor, and accordingly disclosed on June 12, 2021. Closing date extension will be mostly needed to prepare for Additional Financing to support COVID19’s vaccine purchase and deployment and scale up of other pillars of the COVID19 response plan. B. Project Status 5. Key achievements/results to date: The project is rated Satisfactory both for progress towards the Project Development Objective (PDO) and overall implementation progress, with 99 percent of the total project cost having been disbursed. On the progress towards the PDO, under Component 1: Emergency COVID-19 response (US$3.05 million equivalent; Revised: US$3.75 million), almost all the activities have been implemented. These include: (i) finalization of the construction of the Ebola/COVID 19 treatment center; (ii) purchase of drugs, Personal Protective Equipment (PPE) and medical equipment; and (iii) support to COVID 19 screening campaign. Previously delayed activities (i.e. the completion of boreholes for potable water supply as well as the electrification of the Ebola/ COVID- 19 treatment center in Mudubugu, the installation of air conditioning equipment and provision of laundry amenities for the same center) will be completed before current closing date of September 30, 2021. Additionally, personal protective equipment (PPE) and hand sanitizers, intended to be delivered by the Chinese company MEHECO, could not be delivered because the Chinese government has classified them as dangerous goods that cannot be delivered by air. As other transport modalities were deemed to be lengthy, the MoH abandoned the procurement of these items and replaced them with the local purchase of rapid tests for COVID-19, now fully delivered. MEHECO has refunded the funds. 6. Under Component 2: Supporting national and subnational, prevention and preparedness (US$1 million equivalent), all the activities have been implemented (purchase of laboratory equipment for COVID 19 testing, COVID 19 testing kits and reagents, support to coordination activities). Under Component 3: Community engagement and risk communication (US$0.7 million equivalent; Revised: 0), none of the planned activities on strengthening disease surveillance at health facility and community level have been implemented. This is because the resources under this component were reallocated to Component 1 to cover cost-overruns. The cost overruns were caused by: (i) an increase in unit cost for some equipment and PPE purchased through the World Bank Facilitated Procurement (BFP); (ii) an increase in cost estimates for the drilling and electrification of Ebola/COVID-19 treatment center; and (iii) The World Bank Burundi COVID19 Preparedness and Response Project (P173845) inclusion of new priority activities by MoH not foreseen in the initial annual budgeted work plan. The planned activities under Component 3 have since been funded by the MoH with funds from other partners. Under Component 4: Implementation management monitoring and evaluation (US$ 0.25 million equivalent), all the activities planned have been implemented. It bears mentioning that the Project Implementation Unit (PIU) of the Burundi COVID19 Preparedness and Response Project, located at the Ministry of Finance, also manages the Africa Great Lakes Region Trade Facilitation Project (P155329). The PIU is responsible for day-to-day management of the project and handles fiduciary functions: (i) financial management (FM), including flow of funds to different stakeholders; (ii) procurement of goods to ensure efficiencies; (iii) securing consultant services; as well as oversight of safeguard provisions. The Great Lakes Region Trade Facilitation’s project is seeking additional financing and could obtain Project Preparation Advance to secure PIU staff’s wage bill till effectiveness in February 2022. 7. Project implementation status has been rated Satisfactory. After eleven months of implementation of project activities, the disbursement rate is 99%. This despite a national and global crisis linked to COVID-19, and difficulty in accessing goods and services at the local and international level, all project components experienced a high completion rate. All five project development indicators have been achieved. Likewise, all intermediate result indicators met or exceeded their end line targets. 8. Financial Management: The financial management of the project is rated Moderately Satisfactory, and the financial risk is moderate. There is no outstanding audit report. 9. Procurement: The overall procurement performance is rated Moderately Satisfactory, and the procurement risk is substantial. 10. Safeguards: Given limited project resources, only one out of three targeted health facilities for COVID-19 treatment was equipped with efficient incinerators (Montfort type). Incinerators to be installed in the two other facilities were transferred to the second additional financing of the Health System Support Project (“Kira”) (P173252). The SEA/SH sensitive Grievance Redress Mechanism (GRM) is annexed to the ESMF document and has been cleared by the RSA on June 12, 2021.The environmental and social assessment of the project is rated Moderately Satisfactory. C. Rationale for Restructuring 11. On August 27, 2021, the World Bank received a request, from the Government of Burundi, for an extension of the current closing date of the project. The closing date is proposed to be extended by twelve months, from September 30, 2021 to September 30, 2022. The request for extension is justified by: (i) the need to process an additional financing (AF) for COVID 19 vaccines purchase and deployment, and expansion of support to national COVID 19 response’s plan; and (ii) adapt the technical design of the parent project to the evolving epidemiological context of the pandemic, including the emergence of new variants. 12. In addition to extending the project’s closing date, project costs will be reallocated across components to address cost overruns experienced during implementation. In particular, the remaining funds of about US$60 thousand will contribute to PIU operating cost during the period leading to the effectiveness of the planned Additional Financing. Accordingly, the AF will increase Component 4: Implementation management monitoring and evaluation’s budget from US$ 0.25 million, to US$ 1.34 million to keep key staff who will be needed for AF implementation after its approval. The World Bank Burundi COVID19 Preparedness and Response Project (P173845) II. DESCRIPTION OF PROPOSED CHANGES A. Grant closing date 13. The twelve-month extension will result in changing the Grant Closing Date from September 30, 2021 to September 30, 2022. B. Results Framework 14. For this proposed restructuring, the project’s Results Framework will not be revised. However, it will be revised when developing the Project Paper for the proposed additional financing, which will include a more extensive restructuring. C. Implementation schedule 15. Changes to the implementation schedule, as a result of the modifications to the project’s closing date will be reflected in the project paper of the proposed AF. D. Changes in Component and Costs 16. This restructuring reallocates costs from Component 3 (US$0.7 million) to Component 1. The reallocation is to address cost overruns in Component 1 incurred in the procurement of some equipment and PPE, drilling and electrification of Ebola/COVID-19 treatment center, and some other minor unforeseen costs in some activities. The revised cost of Component 1 is US$3.75 million, and Component 3 remains unfunded. Resources from the proposed AF may be allocated to Component 3. This will be further explored during preparation of the AF. III. SUMMARY OF CHANGES Changed Not Changed Components and Cost ✔ Loan Closing Date(s) ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ MPA Program Development Objective ✔ MPA Expected Results and Indicators ✔ Results Framework ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ The World Bank Burundi COVID19 Preparedness and Response Project (P173845) Disbursements Arrangements ✔ Disbursement Estimates ✔ Overall Risk Rating ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ 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; The World Bank Burundi COVID19 Preparedness and Response Project (P173845) • 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); • 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_COMPONENTS_TABLE COMPONENTS Current Current Proposed Proposed Cost Action Component Name Component Name Cost (US$M) (US$M) Emergency COVID-19 Response 3.05 Revised Emergency COVID-19 Response 3.75 Supporting National and Sub- Supporting National and Sub- national, Prevention and 1.00 No Change national, Prevention and 1.00 Preparedness Preparedness Community Engagement and Community Engagement and 0.70 Revised 0.00 Risk Communication Risk Communication Implementation Management Implementation Management 0.25 No Change 0.25 and Monitoring and Evaluation and Monitoring and Evaluation TOTAL 5.00 5.00 OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-D6160 Effective 30-Jun-2021 30-Sep-2021 30-Sep-2022 30-Jan-2023 The World Bank Burundi COVID19 Preparedness and Response Project (P173845) . 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