The World Bank Montenegro Emergency COVID-19 Response Project (P176492) Project Information Document (PID) Appraisal Stage | Date Prepared/Updated: 08-Apr-2021 | Report No: PIDA31658 Mar 15, 2021 Page 1 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) BASIC INFORMATION OPS_TABLE_BASIC_DATA A. Basic Project Data Country Project ID Project Name Parent Project ID (if any) Montenegro P176492 Montenegro Emergency COVID-19 Response Project Region Estimated Appraisal Date Estimated Board Date Practice Area (Lead) EUROPE AND CENTRAL ASIA 13-Apr-2021 29-Jun-2021 Health, Nutrition & Population Financing Instrument Borrower(s) Implementing Agency Investment Project Financing Montenegro Ministry of Health Proposed Development Objective(s) 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 Montenegro. Components Improving COVID-19 Prevention, Detection and Emergency Response Project Management, Monitoring and Evaluation PROJECT FINANCING DATA (US$, Millions) SUMMARY -NewFin1 Total Project Cost 15.00 Total Financing 15.00 of which IBRD/IDA 15.00 Financing Gap 0.00 DETAILS -NewFinEnh1 World Bank Group Financing International Bank for Reconstruction and Development (IBRD) 15.00 Environmental and Social Risk Classification Mar 15, 2021 Page 2 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) Substantial Decision Other Decision (as needed) B. Introduction and Context 1. This Project information Document (PID) describes the emergency response to Montenegro under the COVID-19 Strategic Preparedness and Response Program (SPRP) using the Multiphase Programmatic Approach (MPA), approved by the World Bank’s Board of Executive Directors on April 2, 2020 (PCBASIC0219761). 2. An outbreak of the coronavirus disease (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) has been spreading rapidly across the world since December 2019 , when the initial cases were diagnosed in Wuhan, Hubei Province, China. Since the beginning of March 2020, the number of cases outside China has increased thirteenfold and the number of affected countries has tripled. On March 11, 2020, the World Health Organization (WHO) declared a global pandemic. As of March 15, 2021, the outbreak has resulted in an estimated 120.25 million cases and 2.66 million deaths in more than 192 countries.1 Country Context 3. Montenegro is a small upper-middle-income country in the Balkan peninsula that aspires to achieve the living standards of the European Union (EU). Montenegro's population is about 622,000, and is aging and shrinking.2 Nearly 25 percent of the population live in the capital, Podgorica, while 40 percent live in rural areas. In 2019, Montenegro's gross domestic product (GDP) per capita was US$8,909, one-fourth of the average for EU member states. Its purchasing power parity (PPP) GDP per capita stood at US$24,036, half of the EU average. 4. During 2015-2019 Montenegro’s economy grew strongly, primarily supported by robust investment in infrastructure, tourism, and energy. Between 2015 and 2019, the GDP grew at an average annual rate of 4 percent, reaching 5.1 percent growth in 2018, the strongest in a decade. 5. The strong economic growth between 2015-2019 is now being reversed by the COVID-19 crisis, which has exposed and exacerbated Montenegro’s vulnerability to shocks. Montenegro is among the hardest hit countries by COVID-19 in the world. This health crisis affects emerging markets through multiple channels including underutilization of human and physical capital, lower commodity prices, a drop in tourism, capital 1 Johns Hopkins University Coronavirus Resource Center, https://coronavirus.jhu.edu/map.html, accessed March 15, 2021. 2 As of 2019, the fertility rate declined to 1.75 while by 2050, it is expected that 30 percent of the population will be over the age of 65. Mar 15, 2021 Page 3 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) outflows, credit rationing, and high uncertainty. Montenegro is particularly affected by the sharp decline in tourism, a critical driver of growth, with tourism receipts accounting for a quarter of GDP. At the same time, weak monetary policy, limited fiscal buffers, and high public debt amplify the country’s vulnerability to external shocks. The fall in tourism pushed the economy into a very deep recession in 2020, with an estimated 15 percent drop in GDP. Despite government support, employment fell to a 9-year low, with the tourism, construction, and trade sectors hit hardest; unemployment went up by 13 percent and poverty increased to an estimated 20.2 percent of the population in 2020. Government response measures focused on bridging the shortfall in cash flow of affected firms and the vulnerable population, but the limited fiscal space has constrained the scale and financing of the measures. Public debt rose to 105 percent of GDP, which will require vigilant fiscal management in the years ahead. The economy is projected to rebound in 2021, but GDP is not expected to fully recover before 2023. Sectoral and Institutional Context 6. Montenegro was successful in containing the first wave of the pandemic. Over March and April 2020, Montenegro suffered a relatively low number of 324 cases and 9 deaths, with no further cases registered for the subsequent 52 days. Successful suppression of the first wave of the pandemic was due to a quick and effective national response: the first confirmed COVID-19 case was reported on March 17, 2020 and the government formally declared a public health emergency on March 26, 2020. A National Response and Preparedness Plan for COVID-19 was published, and the government effectively introduced several containment measures including mandatory self-isolation for people returning from abroad; closure of schools, universities, restaurants, shopping malls, sport centers and other places where people can gather; restricted movement; mandatory social distancing; a ban on travel abroad; and, closure of most of border crossings. This was accompanied by broad compliance from society, and high levels of trust in the government’s measures. The Ministry of Health (MoH) also started a risk communication campaign using social media, TV and other media, including the creation of a dedicated website where citizens can access all information related to COVID- 19.3 7. On the health front, the country worked hard to ensure widespread testing, contact tracing and hospital capacity to manage potential surges in cases. Some 200 additional medical and operational staff were recruited and trained to perform testing and contact tracing, with a network of epidemiologists supporting case-detection at local and regional level, coordinated by the Institute of Public Health (IPH). The capacity of the medical laboratory of the IPH was substantially increased, allowing the laboratory to handle around 1,200 polymerase chain reaction (PCR) tests and about 50-70 antibodies tests per day, with two microbiologists trained to perform real-time PCR tests. A call center was established, staffed by professionals, and trained volunteers and medical students, to provide patients and health care professionals with information, decisions on triage, advice for home quarantine, and to transfer information to local epidemiologists and health-sanitary inspectors. Hospital capacity was also increased: six out of 11 public hospitals with the overall capacity of 600 beds were designated to receive COVID-19 patients, and a new temporary hospital for patients with mild symptoms was created in the Bemax Arena in Podgorica with 144 beds. Sport halls in Berane, Bijelo Polje and Bar were also equipped to provide 600 additional beds. 8. Montenegro has been less successful, however, at containing subsequent waves of the pandemic and now reports one of the highest incidence rates in the world. A large number of imported cases during the 3 https://www.covidodgovor.me/ Mar 15, 2021 Page 4 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) 2020 summer tourism season triggered the second wave of the pandemic. As a result, new cases have continued to increase and there are now on average some 550 new cases per day. The incidence rate and death rate in Montenegro are higher than in other Western Balkan countries. With 653 new daily confirmed cases per million population (7-day average), Montenegro is in the midst of a third wave and is among the top ten countries worldwide in terms of new cases, though this is down from a peak of 887 new cases a month ago. 9. Several factors explain Montenegro’s loss of control of the pandemic, the most important being structural weaknesses in the health care system that result from chronic underinvestment. While Montenegro’s initial response to the pandemic was successful, the prolonged nature of the crisis has revealed serious underlying weaknesses in the health system’s capacity to prevent, detect and respond to COVID -19, outlined below: • Case prevention and detection: The primary health care sector, which plays an important role in pandemic surveillance, case investigation and contact tracing, suffers from shortage of personnel, staff burn-out and inadequate or outdated equipment. For a long time, there was only one public laboratory that could formally diagnose COVID-19 through PCR tests, resulting in prolonged wait times for results (the government has recently added one public lab for PCR tests and started to contract with private labs, but quality control of the latter remains a challenge). The Health Sanitary Inspectorate, who issues documents for mandatory quarantine is also overburdened, and hampered by the lack of digital equipment for data sharing with epidemiological services and laboratories. As a result, cases of COVID-19 and their contacts are not being identified or self- isolating according to guidelines. • Emergency response services: Although hospital bed capacity has been expanded, care cannot always be provided to the recommended standard. Diagnostic imaging is a particular bottleneck, due to low quality X-ray, computed tomography (CT) and magnetic resonance imaging equipment and a lack of personnel to read images and report findings. Both the Clinical Center of Montenegro (CCM) and the Center for Lung Diseases face the problem of reading images on CDs from other clinics due to a lack of digital image exchange or connection to the CCM central information system. The capacity of Montenegro’s Emergency Medical Services has also suffered significantly, due to the surge in patients with critical conditions, the country’s unique geographical features, and shortage of personnel. Reserves of blood are critically low: 2,500 less units of blood were collected in 2020 compared to 2019, representing a 30 percent reduction, due to cancellation of a large number of voluntary blood donations related to COVID-19. Montenegro, however, does not have mobile blood collection units that could reach potential donors who do not live near blood donation centers. • Information systems: COVID-19 has exposed the fragmentation of the health sector’s information management systems. These mainly rely on platforms managed by the Health Insurance Fund (HIF) and CCM. Other institutions have developed their own information systems, but these have limited capability and are not integrated with those of the CCM and HIF. The Institute for Medicines and Medical Devices of Montenegro’s (CinMED) information system, for example, does not allow for integrated regulation and management of drugs and medical supplies, including products used to counteract COVID-19. Overall, the lack of an integrated health information system to continuously update information on the distribution of human resources, beds, equipment, and drugs has hindered a nationally coordinated response to the pandemic. 10. The public’s inconsistent compliance with social distancing and other COVID-related guidance further Mar 15, 2021 Page 5 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) weakens Montenegro’s capacity to contain the pandemic. “Pandemic fatigue� and increased politicization of the decision-making process around tightening or loosening restrictions is adding to Montenegro’s difficulties in containing the spread of COVID-19. Previous measures to enforce requirements around social distancing, wearing of masks, avoidance of travel and other essential steps to limit transmission of COVID-19 have proved to be poorly effective during the third wave, especially among youth and Roman population. 11. On January 29, 2021 the Government of Montenegro (GoM) adopted the National Strategy for Immunization Against COVID-19, based on strategic guidance of the WHO and other public health institutions. The Strategy envisages vaccination of around 20 percent of the most vulnerable population groups and employees in essential services in the first instance, with extension to the rest of the population by summer. Relying mainly on domestic resources, Montenegro is participating in the COVAX initiative and has entered into negotiations with several vaccine producers. In parallel, the European Commission has approved a package of EUR 70 million to help fund Western Balkan states’ access to COVID-19 vaccines procured by EU member states. The government has also developed its storage and distribution capacity and, being a small country, does not expect significant difficulty in this area. To date, 68,000 doses have been delivered to Montenegro—sufficient to vaccinate 14% of the population 16 and older—by AstraZeneca through the COVAX (24,000 doses), Sinopharm (30,000 doses) and Sputnik V (14,000 doses). It is expected that 200,000 additional doses of Sinopharm will be delivered by April 20, with additional deliveries of 64,000 doses later in the month (24,000 from AstraZeneca and 40,000 from Sputnik V). Another 386,000 doses are expected in the coming months. Though the pace of vaccination was slow at the start, it has ramped up in the last month and now stands at 5% of the population having received the first dose. C. Proposed Development Objective(s) Development Objective(s) (From PAD) 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 Montenegro. Key Results • Strengthened Government capacity to prevent COVID-19 • Strengthened Government capacity to detect COVID-19 • Strengthened Government capacity to treat COVID 19 and minimize impact on other essential health services D. Project Description 2. The Project focuses on activities and investments that will equip Montenegro’s health system to mount a sustained and definitive response to the COVID-19 emergency. As the pandemic has persisted and evolved, critical gaps in the health system’s capacity to prevent, detect and respond to cases of COVID-19 have been exposed, as well as gaps in the health system’s ability to ensure continuity of other essential services such as blood transfusion. This Project is designed to address these shortcomings and improve the country’s ability to Mar 15, 2021 Page 6 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) prevent, detect and respond to COVID-19. The Project will also support Montenegro’s efforts to encourage and enforce public compliance with measures to reduce transmission of the virus. Areas where Montenegro is well resourced, such as vaccination procurement and deployment, will not be supported by the Project. Component 1: Improving COVID-19 Prevention, Detection and Emergency Response 3. Component 1 will support efforts to minimize the transmission of COVID-19, strengthen government’s capacity to detect and treat COVID-19 cases, and minimize the negative impact of COVID-19 in the provision of other essential health services. This component will enhance disease prevention through risk communication and community engagement targeting priority groups. Detection capacities will be strengthened through the provision of technical expertise and other critical inputs to ensure prompt testing, confirmation, and contact tracing. The component will also help mobilize surge response capacity by training selected categories of frontline health workers critical for rapid response and to address the chronic shortage of epidemiologists and laboratory specialists. Finally, support to strengthen health system capacity to treat COVID-19 patients while minimizing the impact of COVID-19 on other essential health services will be provided at all levels of care, including hospitals, primary health care (PHC), emergency medical services, and blood transfusion services. Special efforts to enhance the use of information technology will be supported throughout the spectrum of prevention, detection, and response to COVID-19. Sub-component 1.1: Strengthening risk communication and community engagement to prevent the transmission of COVID-19 4. Risk communication and community engagement activities are critical measures to prevent the spread of COVID-19. Since the early days of the pandemic, non-pharmaceutical interventions have been playing a crucial role in curbing the surge of cases and lessening the burden on the health system. Global experience to- date has revealed a strong correlation between community vigilance and success in preventing the spread of the disease. Even with the arrival of vaccines, global experts continue to stress the importance of cost-effective prevention measures, including community engagement with clear communication, assessment with feedback loop and adapted approach to promote risk reduction behaviours such as social distancing, hand washing, mask wearing, and increasing ventilation in public spaces. 5. Built on the lessons to-date and experience from other countries, this sub-component will support the GoM in its efforts to improve the effectiveness of communication and community engagement. In addition to helping the existing platforms to reach wider audience, supported activities will be more nuanced and targeted. The sub-component will mobilize political leaders, influencers, and medical professionals as role models for the public to ensure greater awareness among the key population groups about building resilience against infectious diseases including climate-related infectious diseases. Specific messages will be developed to target vulnerable and high-risk groups, such as the Roma population, the youth, the elderly, and disabled individuals. Preventive measures will be strengthened at healthcare institutions and other public establishments. This sub-component will also establish the mechanism to ensure that all community members are able to voice their needs and priorities and to enable government actions that respond to localized concerns. As such, this sub-component will support the establishment of a monitoring process to report on beneficiaries’ perceptions of whether their needs are being met and assist the government in developing channels for feedback from all parts of society. The sub-component will help government to strengthen its communication through setting up a digital communication team and improvement of its digital platform for citizen engagement (through five channels: information sharing and disclosure, outreach and awareness Mar 15, 2021 Page 7 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) building, needs assessment and participatory planning, participatory management and implementation, and participatory monitoring and oversight). Examples of key activities supported by this sub-component include: • Training government officials and public health professionals in risk communication, digital acceptance, and community engagement; • Implementing quantitative and qualitative polling (among the priority groups) in order to better understand and address the sources of distrust and reasons for rejection of preventive measures; • Developing tailored education materials and communication messages on preventive measures targeted at priority groups, such as youth, Roma population, the elderly, and healthcare workers; and • Enhancing the existing digital platform to include citizen engagement, monitor population’s perception, and measuring public engagement. Sub-component 1.2: Strengthening surveillance and rapid response to suspected cases of COVID-19 6. This sub-component will support strengthening of surveillance and rapid response to suspected cases of COVID-19 through enhanced case detection, confirmation, contact tracing, recording, and reporting. An effective national surveillance system is critical to understanding the epidemiology of COVID-19 in Montenegro and informing the national response plan. The Project will help meet immediate needs, while addressing systemic weaknesses. In the short term, it will help in temporarily retaining, through payments, health and operational staff mobilized to perform contact tracing. It will also support upgrading existing public labs to perform PCR and antibody tests, by financing small civil works and procurement of essential laboratory equipment. Support may also include vehicles and communication equipment for epidemiology department of the IPH and in the regions. These will include climate-smart investments in labs, medical supply and vehicles to reduce the carbon footprint of the procurement process, thereby mitigating climate change, in alignment with the EU Directive 2014/24/EU4 and Montenegro’s commitment to the Paris Agreement. Long term investments to strengthen laboratory operations may also include developing/updating guidelines and standard operating procedures, developing a structured plan for laboratory scaling up, and training lab specialists for which the country has a chronic shortage (microbiologists, molecular biologists, laboratory technicians, and bioinformatic experts). The Project will build on existing track and trace management digital systems, enhancing their capabilities and integrating them to clinical systems to get a holistic communicable disease surveillance system to support the decision-making and case management that will also increase resilience to climate-induced diseases from flooding. In addition, the integration of the track and trace system with clinical information management systems will establish data streams of hospital resources to decision makers that will enable better distribution of needed human resources, beds, equipment (ventilators, oxygen units), and drugs. A range of training activities will also be carried out to address critical gaps in knowledge and skills in pandemic response among public health specialists, thereby enhancing the ability of the health system to detect future outbreaks, including climate-related diseases. 4 https://ec.europa.eu/environment/gpp/index_en.htm Mar 15, 2021 Page 8 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) Examples of key activities supported by this sub-component include: • Providing medical equipment and related civil works as needed, for central public health lab and regional epidemiological labs to increase the capacity for PCR testing; • Developing/updating lab standard operating procedures and connectivity with the rest of the health systems; • Training of public health specialists, epidemiologists, and microbiologists; and • Enhancing and integrating the track and trace management information and response systems. Sub-component 1.3: Improving health system preparedness and resilience to respond to COVID-19 and ensure continuity of other essential health services 7. This sub-component will strengthen health system preparedness and resilience by expanding capacity for treating COVID-19 cases and improving emergency care and blood transfusion services for the provision of non-COVID-19 essential health services. Diagnosis of COVID-19 cases will be strengthened by the procurement of digital X-Ray machines and CT scanners, utilizing climate-smart, low carbon, sustainable procurement and energy efficient devices to mitigate climate change in support of Montenegro’s commitments to the Paris Agreement. The Project will use this investment to make scans digitalization and centralization to support triage by artificial intelligence based technology to first reading of an X-ray or CT scan of the lungs for diagnosis of lung damage. The Project will also expand long-term system capacity and preparedness of the MoH by embedding service delivery models based on the use of technology and telemedicine into care pathways and clinical protocols. Introduction of teleconsultation services for the elderly and for those with long-term health conditions will reduce the vulnerability of these groups to the impacts of climate change, in particular from extreme heat. System capacity to manage drugs and medical supplies will be improved through the integration of information systems to allow monitoring of compliance of prescribing practice with official guidelines and approved reference information for medicines used in COVID-19 and other treatments, monitoring of adverse reactions of medicines and optimization of supply, logistics and stock management of drugs and medical supplies. The emergency medical services system will be supported by the procurement of vehicles for transporting COVID-19 confirmed and suspected patients and of tablets for emergency teams to allow online access to the PHC medical records. A bloodmobile will be procured to help achieve stable blood supplies for the treatment of patients in critical conditions. Procurement of vehicles and tablets will include climate-smart and energy efficient considerations to reduce the carbon footprint thereby mitigating climate change. The Project will also support staff training in COVID-19 and Severe Acute Respiratory Infection management, preparation and updating of clinical guidelines, to ensure that COVID-19 and Severe Acute Respiratory Infection management remains in line with international best practice. 8. To support the government’s commitment to tackle domestic violence and mental health issues associated with the prolonged pandemic, the Project with organize special training sessions to sensitize health workers of these issues. The training will target PHC providers, who are the first point of contact of the population to the health system and who perform outreach activities to the community. Training materials will reflect the sensitive nature of domestic violence issue and its gender aspect, with women being the predominant victims. 9. The Project will improve the overall data analytics for policy making, surveillance and prevention. Building on existing IPH health statistical system, technical assistance will be provided to feed the data from Mar 15, 2021 Page 9 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) other databases to provide comprehensive analytics and visualization capabilities including dashboards and real time mapping. The system will also provide smart analytics to provide feedback and actionable recommendations to improve the effectiveness of the national and regional response to COVID-19 and other communicable diseases. To make such analytics sustainable, it will be accompanied with the revision of the overall health data governance and analytics. New health data analytics framework will be developed to move forward from statistics and descriptive analytics to modern methods and tools for predictive and prescriptive analytics. 10. To ensure sustainability of all information management solutions under the Project, more systemic integration of health data and systems will be required. The Project will support activities to improve planning of long-term interventions that aim at integrating and unifying digital systems into one common digital health system to support strategic health care reforms. The global trend in modern computing platforms is to concentrate the computing power and storage into common infrastructures to optimize the use of resources, provide generally more secure, climate-smart and energy efficient environments and, reduce the need for IT personnel in government sectors/institutions. The MoH will establish a comprehensive healthcare computing platform that will host all systems to be supported under this component, and will also allow for integration and further development of existing systems. Examples of key activities supported by this sub-component include: • Procuring diagnostic equipment for PHC and hospitals (X-ray machines and CT devices); • Procuring vehicles and related equipment for emergency care and blood collection service; • Providing training to PHC providers on domestic violence and mental health issues associated with COVID-19; • Implementing X-Ray and CT scans digitalization and centralization to enable early detection and diagnosis of COVID-19 and related lung damage; • Developing and adopting care pathways and clinical protocols to enable service delivery models based on the use of technology and telemedicine; • Improving CinMED information system to allow for integrated management of drugs and medical supplies; and • Upgrading the IPH information system to improve COVID-19/communicable diseases data analytics. Component 2: Project Management, Monitoring and Evaluation This component will support overall project administration, including project management, fiduciary functions, environmental and social compliance, and regular monitoring of and reporting on implementation. Being mindful of the objective of this operation and a need for rapid response, the MoH will use the services of the Project Implementation Unit (PIU) already established for the World Bank Montenegro Second Energy Efficiency Project (MEEP2), which is currently hosted under the Ministry of Capital Investment. This component will also support overall project monitoring and evaluation, including staff training in participatory monitoring and evaluation (and other citizen engagement activities) at all administrative levels of the MoH. The PIU will be responsible for: (i) the collection of data from relevant entities involved in project implementation; (ii) the compilation of data for progress reports; and, (iii) the submission of reports to the Commission for the Protection of the Population from Coronavirus chaired by the MoH. Technical audits will Mar 15, 2021 Page 10 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) be conducted at the facility level to verify project indicators as may be needed. This component will finance: (a) PIU staff expected to consist of a PIU manager (shared with MEEP2), an Environmental specialist (shared with MEEP2), 4 technical experts/coordinators: digitalization/information system expert, social specialist/citizen engagement, digital communication, and public health/health system; (b) lump-sum payments to the Government’s Technical Service Unit (TSU) responsible for procurement and financial management functions (for all World Bank-financed operations); (c) project-related operating costs; and (d) financial audits. . . Legal Operational Policies Triggered? Projects on International Waterways OP 7.50 No Projects in Disputed Areas OP 7.60 No Summary of Assessment of Environmental and Social Risks and Impacts . 11. Environmental and social risks are rated as substantial. The major risk areas for the project revolve around (a) risks related to medical waste management and disposal; (b) accentuated risk to human health in the social and economic interaction, exposure to the virus of front-line health workers, project workers and public at large due to the global and in country unpredictable effects of the pandemic. Another central social risk is around vulnerable and disadvantaged groups (elderly, disabled, chronically diseased, people with no health insurance, migrants, economically marginalized and disadvantaged groups especially residing in geographically challenging areas, Roma, residents of shelters/care facilities, prisoners) who could experience inequitable access to project supported facilities and services because of their qualifying characteristics which could lead to possible increase of their vulnerabilities. To mitigate the risk the GoM is committed to taking the measures indicated in the Environmental and Social Commitment Plan, Stakeholders Engagement Plan and develop an Environmental and Social Framework (inclusive of Labor Management Procedures) and make an adequate Grievance Redress Mechanism available to mitigate these risks to the extent possible. Strict adherence to established COVID-19 infection prevention and control guidelines and to standard procedures for medical waste management and disposal. All of these will be coupled with improved effectiveness of communication and community engagement which are critical measure contributing to prevention of spread of COVID-19 in general but also to behavioral change. E. Implementation Institutional and Implementation Arrangements 12. As the lead agency accountable for the health of the population, oversight of the health system and of the quality of health services in the country, the MoH will be responsible for the overall coordination and oversight of the Project during implementation. On December 10, 2020, the Government of Montenegro has Mar 15, 2021 Page 11 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) established the Council for the Fight Against the Coronavirus chaired by the Minister of Health. The Council is an independent expert body for the implementation of activities on the removal and eradication of infectious diseases caused by the new coronavirus COVID-19 in Montenegro. The members of the Council include: Minister of Defense, Minister of Finance and Social Welfare, Minister of Economic Development, Minister of Education, Science, Culture and Sports, Minister of Public Administration, Digital Society and Media, and the Director of the Institute of Public Health (IPH). While the Council will not have a role per se under the Project, other agencies and partners involved in project implementation may report from time to time to the Council on progress in project activities. 13. A Commission for the Protection of the Population from Coronavirus, led by the Minister of Health with representations from various entities and agencies under the MoH, was established in December 2020. The Commission reports on the fulfillment of obligations undertaken by Montenegro, including those supported by the Project, to stop and prevent infectious diseases caused by the novel coronavirus COVID-19, in accordance with the recommendations of the WHO, the European Commission and the European Center for Disease Prevention and Control, and the Law on Protection of the Population from Infectious Diseases. The Commission will play an oversight role on all COVID-related activities, oversees project implementation, decides on strategies and guides on overall project framework. 14. Directorate for Digital Health of MoH: The Head of the Directorate for Digital Health, also a member of the Commission, will be the focal point for the project and will provide (i) oversight and strategic guidance during project implementation; (ii) coordinate and facilitate the PIU working relationships with directorates and agencies involved in technical implementation; and (iii) lead the development of a medium to long�term sustainable investment framework in health information management system, among others. 15. Project Implementation Unit (PIU): The PIU will be responsible for day�to�day operations of the project, including (i) preparation, implementation, and supervision of project investment in close coordination with project beneficiaries; (ii) management of capacity building activities supported by the Project; (iii) monitoring, evaluating, and reporting on project results and outcomes; (iv) serves as secretariat to the Commission when discussing matters on the Project; and (v) ensuring compliance with the environmental and social framework documents (Stakeholders Engagement Plan, Environmental and Social Commitment Plan, etc.). The PIU will be composed of a PIU manager (shared with MEEP2), five technical experts/coordinators: digitalization/information system expert, social specialist/citizen engagement, environmental specialist, digital communication, and public health/health system. 16. Technical Services Unit (TSU): Fiduciary responsibilities, including procurement and financial management and disbursement, will be carried out by the existing central TSU for IBRD funds. Expenses incurred by the TSU will be financed out of the loan on a pro rata basis with other World Bank�financed projects in Montenegro. The TSU will be responsible for the preparation of quarterly unaudited financial reports and annual audited financial statements; and the procurement related to all works, goods, and consulting and non� consulting services. The TSU has sufficient capacity and experience given its fiduciary role for all World Bank� supported projects. . Mar 15, 2021 Page 12 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) CONTACT POINT World Bank Sevil Kamalovna Salakhutdinova Senior Health Specialist Ha Thi Hong Nguyen Senior Economist Borrower/Client/Recipient Montenegro Implementing Agencies Ministry of Health Aleksandar Sekulic Director of the Directorate for Digital Health aleksandar.sekulic@mzd.gov.me 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 Sevil Kamalovna Salakhutdinova Task Team Leader(s): Ha Thi Hong Nguyen Approved By Practice Manager/Manager: Country Director: Emanuel Salinas Munoz 13-Apr-2021 Mar 15, 2021 Page 13 of 14 The World Bank Montenegro Emergency COVID-19 Response Project (P176492) Mar 15, 2021 Page 14 of 14