The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) REPORT NO.: RES44130 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN APPROVED ON APRIL 2, 2020 TO THE ISLAMIC REPUBLIC OF PAKISTAN February 17, 2021 UNDER THE COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PROGRAM (SPRP) USING THE MULTIPHASE PROGRAMMATIC APPROACH (MPA) WITH A FINANCING ENVELOPE OF UP TO US$ 6 BILLION APPROVED BY THE BOARD ON APRIL 2, 2020 AND UP TO US$ 12 BILLION ADDITIONAL FINANCING APPROVED BY THE BOARD ON OCTOBER 13, 2020 Health, Nutrition and Population Global Practice South Asia Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) CURRENCY EQUIVALENTS (Exchange Rate Effective: January 10, 2021) Currency Unit = PKR PKR 160.25 = US$1 US$1.45 = SDR FISCAL YEAR July 1 – June 30 Regional Vice President: Hartwig Schafer Country Director: Najy Benhassine Regional Director: Lynne D. Sherburne-Benz Practice Manager/Manager: E. Gail Richardson Task Team Leader(s): Aliya Kashif, Amjad Zafar Khan The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) ABBREVIATIONS AND ACRONYMS BISP Benazir Income Support Programme CERC Contingent Emergency Response Component GoP Government of Pakistan IDA International Development Association MoFEPT Ministry of Federal Education and Professional Training MONHSRC Ministry of National Health Services, Regulations and Coordination MPA Multiphase Programmatic Approach NDMA National Disaster Management Authority PBC Performance Based Conditions PDO Project Development Objective PEF Pandemic Emergency Facility PPE Personal Protective Equipment PREP Pandemic Response Effectiveness in Pakistan UNICEF United Nations Children’s Fund The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) PROPOSED PROJECT RESTRUCTURING OF PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN TABLE OF CONTENTS I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING ...................................................................................................7 II. DESCRIPTION OF PROPOSED CHANGES .................................................................................................................................8 Results framework ..........................................................................................................................................................................9 The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) BASIC DATA Product Information Project ID Financing Instrument P173796 Investment Project Financing Environmental and Social Risk Classification (ESRC) Substantial Approval Date Current Closing Date 02-Apr-2020 30-Jun-2023 Organizations Borrower Responsible Agency Ministry of National Health Services Regulations and Coordination,National Disaster Management Islamic Republic of Pakistan Authority,Benazir Income Support Programme,Ministry of Federal Education and Professional Training 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) Sustained efforts continue to be made to advance the implementation of the MPA-funded projects. As of December 14, 2020, 83 MPA-projects have been approved providing a total commitment of US$4.14 billion. In addition, 12 PEF funded projects have been approved to complement the COVID response. Disbursements have continued to increase at a rapid pace. Twenty four (24) country projects or 29% of projects approved have reached 70-100% disbursements. The projects benefit around 3.7 billion people or 50% of the global population. Of the 83 approved projects: (i) 32 are in Africa – 11 in AFE and 21 in AFW; (ii) 11 in East Asia; (iii) 12 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. Seventy (70) projects are disbursing. Total disbursements as of December 14, 2020 under these projects amount to US$1.76 billion or 43% of overall commitments (a 7% increase in the past month). In addition, $465 million have been committed under signed contracts with UNICEF and Bank Facilitated Procurement (BFP), bringing to 53% actual disbursements and committed The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) amounts. Streamlined procedures, delegated approval coupled with flexible project design and intensified efforts across the Bank have contributed to the progress. Implementation faces significant challenges as some countries are still under different levels of lockdown or mobility restrictions and counterparts and Bank teams are operating from home. This creates connectivity challenges. Notwithstanding challenges, the MPA is on track to achieving its PDO – to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. The significant level of disbursements in just nine months attest to the strong implementation of the Bank response thanks to the commitment of counterparts supported by country teams. OPS_TABLE_PDO_CURRENTPDO Project Development Objective (PDO) Original PDO The project development objective is to prepare and respond to the COVID-19 pandemic in Pakistan and strengthen national systems for public health preparedness. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-65900 02-Apr-2020 03-Apr-2020 03-Apr-2020 30-Jun-2023 200.00 79.40 121.20 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Status 1. The Pandemic Response Effectiveness in Pakistan (PREP) [P173796] was approved by the World Bank Board on April 2, 2020 and became effective on April 3, 2020 with an International Development Association (IDA) total project cost of US$ 200 million. The project development objective (PDO) is “to prepare and respond to the COVID-19 pandemic in Pakistan and strengthen national systems for public health preparedness.” PREP comprises four components: Component 1 (Emergency COVID-19 Preparedness and Response) has an allocation of US$155 million. This component aimed to slow down and limit as much as possible the spread of COVID-19 in the country, through providing immediate support to prevention, detection, case management and mitigation of risks and response to health threats and disease epidemics. Component 2, with an allocation of US$42 million, aimed to mitigate the impact of COVID-19 on selected non-health sectors and includes provision for: (i) cash transfers to the poorest households implemented by the Benazir Income Support Program (BISP) using a Performance Based Conditions (PBC) modality with a value of US$25 million; (ii) emergency food supply by the National Disaster Management Authority (NDMA) for quarantined populations and people with limited mobility at an estimated cost of US$12 million; and (iii) comprehensive communication campaign by NDMA for distance learning with technical input from the Ministry Of Federal Education and Professional Training (MoFEPT) at an estimated cost of US$5 million. Component 3 (with an allocation of US$3 million) supports project implementation, coordination, and management, including support for financial management, procurement, environmental and social, monitoring and evaluation. Component 4 is the contingent emergency response component (CERC) with a zero allocation. 2. The project’s progress towards achievement of the PDO and overall implementation progress are rated as moderately unsatisfactory based on the following: As of January 28, 2021, the project has disbursed US$79.4 million (39.7 percent of the total financing), which includes US$25 million to BISP for achievement of the PBC on cash transfers. Implementation progress relating to Component 1 (with an allocation of US$155 million) has not progressed (except for the province of Khyber Pakhtunkhwa [KP]) since project effectiveness in April 2020 due to delays in approval of the required government’s budget document for the health component in other provinces. In parallel to PREP, grant funds of US$15 million through the Pandemic Emergency Facility (PEF) are being used for purchase of laboratory equipment and diagnostic supplies carried out by the United Nations Children’s Fund (UNICEF). With respect to Component 2, there is mixed progress. The PBC target of BISP beneficiaries receiving emergency cash transfers was achieved and verified, and US$25 million were disbursed. Substantial progress has been made to mitigate impact of COVID-19 in education with the MoFEPT implementing all planned activities. The activities executed by NDMA in coordination with MoFEPT have committed most of the funds allocated for the subcomponent. Provision of food rations, originally planned under PREP, was also financed from the government’s own resources. Limited progress is noted with respect to implementing activities under Component 3. Due to the slow implementation of the Bank-financed activities, the project was rated moderately unsatisfactory. B. Rationale for Restructuring 3. Despite the considerable progress made in mitigating the impact of COVID-19 on education outcomes under sub-component 2.2, the need to reach out of school children persists. The activities planned by MoFEPT for which US$5 million was initially allocate have all been implemented. These activities have shown positive results but need to be scaled up as a new phone survey has shown that 20% of the households might not still send kids back to school. If this materializes, this means an additional 4 million kids will be out of school. This will bring Pakistan’s out of school children 7 The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) from 19 to 23 million. TV and radio learning activities that the project is supporting will help mitigate the learning losses and the dropouts that are already materializing., The GoP therefore has requested the Bank to restructure the Project to reallocate funds (US$12 million) from sub-component 2.1 (b) on ‘provision of emergency food supply’ to sub-component 2.2. This will ensure continuity of education activities under subcomponent 2.2 Which by now are well established and showing results. II. DESCRIPTION OF PROPOSED CHANGES 4. The proposed change under this restructuring will not affect the distribution of funding across components. The reallocation of approximately US 12 Million would be from subcomponent 2.1b (“Provision of emergency food supply for quarantined populations and people with limited mobility” to subcomponent 2.2 (“Mitigation of Impacts in Education”), taking the total of subcomponent 2.2. to US 17 Million equivalent. Additional funding for the subcomponent will guarantee the continuity and scale-up of the same activities already under the subcomponent. These are: Comprehensive communications campaign for schools and parents to engage in distance-learning activities and development and implementation of plans to ensure the continuity of learning including remote learning options, at all levels of education. This subcomponent also ensures remote learning to 50 million children whose schools are now shut or that will start to reopen. This will include TV /radio broadcast, virtual networks of teachers, and other means of distance delivery of academic content at all levels: primary, secondary, and tertiary. The primary focus will be on keeping children and teachers engaged with learning activities while maintaining social distancing measures to minimize as much as possible the effects on children’s and youth. 5. Reallocation across categories. As a result, a total of 8,742,000 SDR will be reallocated from Category 2 “Food Expenditure under Part 2(a)(ii) of the Project,” to Category 1 “ Goods, works, non-consulting services, consulting services, Training and Incremental Operating Costs under Parts 1, 2(b), and 3 of the Project.” The Table below reflects this change. Indicative allocation, by disbursement category (in SDR) Disbursement category Original Revised (1) Goods, works, non-consulting services, consulting services, Training and 118,745,500.00 127,487500.00 Incremental Operating Costs under Parts 1, 2(b), and 3 of the Project (2) Food Expenditure under Part 2(a)(ii) of the Project) 8,742,000.00 0.00 (3) Eligible Expenditure Programs under Part 2(a)(i) of the Project 18,212,500 18,212,500.00 (4) Emergency Expenditures under Part 4 of the Project 0.00 0.00 Total Amount of Financing 145,700,000.00 145,700,000.00 8 The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) Results framework COUNTRY: Pakistan PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN Project Development Objectives(s) The project development objective is to prepare and respond to the COVID-19 pandemic in Pakistan and strengthen national systems for public health preparedness. Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 District health center/hospital with pandemic preparedness and response plans per MONHSRC guidelines Proportion of district health centers/hospitals with pandemic 0.00 70.00 preparedness and response plans per MONHSRC guidelines (Percentage) Proportion of laboratory confirmed cases of COVID-19 responded to within 48 hours Proportion of laboratory confirmed cases of COVID-19 responded to within 48 0.00 50.00 60.00 70.00 hours (Percentage) Diagnosed cases treated per approved protocol Proportion of diagnosed cases treated 0.00 50.00 60.00 70.00 per approved protocol (Percentage) BISP beneficiaries receiving support in cash or kind Number of beneficiaries or persons receiving support in cash or kind 0.00 4,010,000.00 (Number) 9 The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) PDO Table SPACE Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target 1. Emergency COVID-19 Preparedness and Response Proportion of target hospitals (district health centers/hospitals) with personal protective equipment and infection control 0.00 70.00 products and supplies without stock-outs in preceding two weeks (Percentage) Proportion of target hospitals (district health centers/hospitals) 0.00 70.00 with triage and isolation capacity (Percentage) Proportion of population able to identify three key symptoms of 0.00 70.00 COVID-19 and three personal prevention measures (Percentage) Proportion of suspected cases of COVID-19 reported and 0.00 80.00 investigated as per approved national protocols (Percentage) Proportion of designated laboratories with COVID-19 diagnostic equipment, test kits and reagents per national guidelines 0.00 80.00 (Percentage) Proportion of target health care workers who are trained on 0.00 70.00 WHO standards of clinical treatment for COVID-19 (Percentage) Contextualized risk communication and community engagement None One strategy developed (Text) 2. Mitigation of Disruptive Impacts Number of BISP beneficiaries receiving emergency cash transfers PBC 1 0.00 4,000,000.00 (Number) Percentage of crisis affected persons receiving basic food rations 0.00 20.00 (Percentage) 10 The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Number of grade - subject programs broadcasted through 0.00 40.00 television, radio, and all other platforms (Number) 3. Implementation Management and Monitoring and Evaluation Proportion of target hospitals who have submitted complete monthly reports on COVID-19 as per the national protocol 0.00 80.00 (Percentage) IO Table SPACE Performance-Based Conditions Matrix DLI IN00926867 ACTION PBC 1 Number of BISP beneficiaries receiving emergency cash transfers Type of PBC Scalability Unit of Measure Total Allocated Amount (USD) As % of Total Financing Amount Outcome No Number 25,000,000.00 0.00 Period Value Allocated Amount (USD) Formula Baseline 0.00 FY2021 25,000,000.00 Verification Protocol Table: Performance-Based Conditions DLI_TBL_VERIFICATION PBC 1 Number of BISP beneficiaries receiving emergency cash transfers Description 11 The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) MIS data report verifying the number of beneficiaries who have been paid Rs 4000 as emergency cash transfer as a top up Data source/ Agency to the regular safety net cash grant. These numbers to also match with the PSPs Payment Record for the respective beneficiaries. Verification Entity Third Party Independent Verification Agency (IVA). MIS report for beneficiaries paid by matching with the Payroll database. Once matched, the information will be sent to the IVA (Independent Verification Agency) for verification. BISP will submit to the Bank a formal confirmation of the verification Procedure of the DLI along with the relevant evidence. Click here to enter text. 12 The World Bank PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) 13