06-Apr-2022 _____________, 2022 Dr. Uzziel Ndagijimana Minister Ministry of Finance and Economic Planning 12 KN 3 Avenue P.O Box 158 Kigali, Rwanda Republic of Rwanda: COVID-19 Emergency Response Project Credit Nos. 6615-RW, 6871-RW, Grant No. D805 and GFF TF0B6226 Amendment to the Legal Agreements Honorable: We refer to the following legal agreements (“Legal Agreements”) between the Republic of Rwanda (“Recipient”) and the International Development Association (“Association”): (a) Financing Agreement dated April 9, 2020, extending Credit No. 6615-RW, as amended (“Original FA”); (b) Financing Agreement dated April 22, 2021, extending Credit No. 6871-RW and Grant No. D805 (“AF2 Financing Agreement”); and (c) Grant Agreement dated September 2, 2021, extending GFF Grant No. TF0B6226 (“AF2 Grant Agreement”). We refer to your letter dated February 4, 2022 requesting additional financing for the Project. In view of the above, the Association proposes to amend the Legal Agreements as follows: 1. Schedule 1 to the Legal Agreements is hereby deleted in its entirety and replaced to read in accordance to the Annex to this Letter. 2. Section III.B.2 of Schedule 2 to the Legal Agreements is hereby deleted in its entirety and replaced to read as follows: “2. The Closing Date is June 30, 2025.” 3. The following definition is added to the Appendix to the Original FA and the AF2 Grant Agreement, and to Section I of the Appendix to the AF2 Financing Agreement, in alphabetical order, and the rest of the definitions are renumbered accordingly, as follows: ““Nyamata Emerging Infectious Disease Isolation and Treatment Center” means the Recipient’s center located at the Recipient’s Bugesera district (Eastern Province).” All other terms of the Legal Agreements remain in full force and effect. Dr. Uzziel Ndagijimana -2- [Date] Please confirm your agreement with the foregoing amendment, on behalf of the Recipient, by signing and dating this amendment letter in the spaces provided below. The provisions set forth in this amendment letter will become effective as of the date of the countersignature, upon receipt by the Association of one fully executed original of this amendment letter. Please also note that the Project Paper dated March 24, 2022, a copy of which is enclosed herewith, will be disclosed on the Association’s external website as per the Association’s policy on access to information. Sincerely, INTERNATIONAL DEVELOPMENT ASSOCIATION for the purpose of the Original FA and the AF2 Financing Agreement for the purpose of the AF2 Grant Agreement, acting as administrator of the Global Financing Facility for Women, Children and Adolescents (“GFF”) By ____________________ Rolande Pryce Name :____________ Country Manager Title:______________ AGREED: REPUBLIC OF RWANDA By _________________________ Authorized Representative Minister of Finance and Economic Planning Title: _________________________ 07-Apr-2022 Date: _________________________ Enclosure Dr. Uzziel Ndagijimana -3- [Date] ANNEX SCHEDULE 1 Project Description The objective of the Project 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 Rwanda. The Project constitutes a phase of the MPA Program, and consists of the following parts: Part 1: Case Detection, Confirmation and Contact Tracing Enhancing case detection, disease surveillance, sample collection and ensuring rapid laboratory diagnoses and carrying out contact tracing for COVID-19 and other disease outbreaks through financing and support for: (a) enhancement of case detection through: (i) screening travelers at ports of entry as well as in priority communities and targeted health facilities; (ii) diagnosing cases and referring them for treatment as needed; (iii) carrying out contact tracing to minimize risk of transmission; (iv) conducting risk assessments to identify hot spot areas of transmission and provide timely information to policymakers including digital maps that can help in visualization of transmission; and (v) carrying out multi-sectoral simulation exercises for COVID-19 and other disease outbreaks; and (b) strengthening the health system through; inter alia: (i) providing medical supplies and equipment (e.g. thermo scanners; test kits; drugs; lab equipment and supplies, personal protective equipment); (ii) Training and capacity building for frontline workers; and (iii) Operating Costs for rapid response teams and recruitment of additional personnel. Part 2: Public Health Measures and Clinical Care Capacity Strengthening of public health policies and measures and establishment of critical clinical care capacity including promotion of digital solutions through financing and support for: (a) public health policies regarding: (i) social distancing measures (such as restrictions on border crossings, work-at-home policies, restricting public gatherings); (ii) personal hygiene promotion, including handwashing and proper cooking; (iii) risk communication and community engagement using local channels to disseminate messages about the risks associated with COVID-19 and other disease outbreaks and applying innovative digital solutions such as mobile apps for sending out messages; (iv) production and dissemination of communication materials (including in digital form) and national and local campaigns to raise awareness; and (v) enhancement of data analytics capability to improve targeting and measure effectiveness; (b) provision of clinical care through: (i) establishment of isolation capacity at a selected number of national and district hospitals including the rehabilitation of existing structures and leveraging of isolation units established for other infectious Dr. Uzziel Ndagijimana -4- [Date] diseases; (ii) providing health personnel with appropriate protective equipment and hygiene materials; (iii) support for provision of medical and laboratory equipment and supplies, waste management equipment and supplies and video conferencing equipment for tele-medicine; (iv) minor civil works (mainly refurbishments); and (v) including recruitment of additional clinical personnel; (c) purchase of Project COVID-19 Vaccines including assistance to support the Recipient’s advance purchase mechanisms; (d) deployment of Project COVID-19 Vaccines including support for: (i) Training of health providers, and other personnel responsible for the delivery, storage, handling, transportation, tracking and safety of Project COVID-19 vaccines; (ii) conducting assessments to inform the deployment of Project COVID-19 vaccines; (iii) strengthening the policy environment through production of guidelines, standard operating procedures and protocols; (iv) reinforcing the regulatory capacity of the Rwanda FDA to expedite the registration and approval processes in line with acceptable procedures and requirements; (v) planning and coordination of the Project COVID-19 vaccine deployment; and (vi) strengthening health care waste management and occupational health; (e) vaccine communication campaign including support to the PIE to: (i) conduct well targeted communication campaigns to increase awareness, foster demand, and address hesitancy through mass media, social media and community outreach campaigns; (ii) track and monitor correct knowledge of COVID-19 vaccines, and identify views, perceptions, attitudes in order to continually improve implementation strategies and tailor communications; and (iii) facilitate citizen engagement mechanisms for feedback, accountability, grievance, citizen and community engagement; (f) screening high-risk groups through support for: (i) conducting community sensitization and mobilization to encourage people to be screened and vaccinated; (ii) screening for conditions that elevate the risk of COVID-19; and (iii) referral and initial treatment for these conditions; (g) oxygen therapy through purchase of: (i) basic respiratory therapy equipment and supplies that support climate safe technologies; and (ii) climate-smart technologies for district hospitals located in remote, rural areas and medicalized health centers operating in high population density locations; and (h) health system strengthening through: (i) acquisition of an international vaccination status monitoring system; (ii) acquisition of cold chain equipment; (iii) acquisition of mechanical ventilation system for vaccines warehouse; (iv) acquisition of refrigerated vehicles to support countrywide vaccine distribution; (v) acquisition of smoke-free incinerators for COVID-19 and vaccination waste management; (vi) acquisition and installation of a solar energy system to support continuous energy supply to the Nyamata Emerging Infectious Disease Isolation and Treatment Center; and (vii) acquisition of preventive and curative medical equipment. Dr. Uzziel Ndagijimana -5- [Date] Part 3: Implementation Management and Monitoring and Evaluation Financing and support for: (a) Project management including: (i) strengthening of public structures for the coordination and management of the Project, including central and local (decentralized) arrangements for the coordination of Project activities (this will include support for the COVID-19 Incident Management System Coordination Structure); (ii) the carrying out of financial management and procurement requirements of the Project; and (iii) Project coordination activities; and (b) monitoring and evaluation of the Project including: (i) assessment of implementation progress and review of operational plans; (ii) technical assistance; and (iii) COVID-19 vaccination specific monitoring and evaluation, including: (A) training CHWs on surveillance activities and related COVID-19 testing; (B) strengthening capacity of districts and sectors to conduct vaccine related surveillance activities; (C) conducting disease surveillance to monitor the impact of the vaccination program and make corrections during implementation; (D) monitoring coverage and safety; (E) evaluating effectiveness and impact; and (F) providing vaccination certificates to all people vaccinated. Part 4: Contingency Emergency Response Component (CERC) Providing immediate response to an Eligible Emergency, as needed. Part 5: Protecting Essential Health Services Strengthening and protecting essential health and nutrition services through financing and support for: (a) outreach activities and catch up campaigns for immunization and reproductive, maternal and child health services; (b) nutrition commodities; (c) organizing transport systems for patients and health providers; (d) Performance-based Payments to Eligible Community-based Health Workers (CHWs) to incentives CHWs to enhance awareness, mobilize the population and conduct basic screening for both reproductive, maternal, newborn and child health (RMNCH) and COVID-19; (e) building capacity of health providers and CHWs to use innovative technologies and approaches for delivering essential health services; (f) testing a new multi-disciplinary competence-based approach to the delivery of services by CHWs; (g) strengthening the health resources tracking system and promote interoperability for improved data visualization and analytics and enhanced data for decision making, including Geographical Information System tools; Dr. Uzziel Ndagijimana -6- [Date] (h) screening for chronic conditions (such as hypertension and diabetes) using innovative strategies that leverage RMNCH services, including during community mobilization campaigns, couple screening during antenatal care visits or pre- conception care visits and/or workplace programs; and (i) performing periodic monitoring of the impact of COVID-19 on essential health and nutrition services and institutionalize the production of monthly and quarterly reporting.