FOR OFFICIAL USE ONLY Report No: PAD4038 INTERNATIONAL BANK FOR RECONSTRUCTION AND INTERNATIONAL DEVELOPMENT ASSOCIATION PROJECT APPRAISAL DOCUMENT ON A PROPOSED GRANT IN THE AMOUNT OF US$ 21.99 MILLION TO THE REPUBLIC OF SUDAN FOR A SUDAN COVID-19 EMERGENCY RESPONSE PROJECT SEPTEMBER 30, 2020 Health, Nutrition and Population Global Practice Eastern and Southern Africa Region This document is being made publicly available prior to Board consideration. This does not imply a presumed outcome. This document may be updated following Board consideration and the updated document will be made publicly available in accordance with the Bank’s policy on Access to Information. CURRENCY EQUIVALENTS Exchange Rate Effective August 31, 2020 Sudanese Pounds Currency Unit = (SDG) SDG 55 = US$1 FISCAL YEAR January 1 - December 31 Regional Vice President: Hafez M. H. Ghanem Country Director: Ousmane Dione Regional Director: Amit Dar Practice Manager: Ernest E. Massiah Task Team Leader: Moustafa Abdalla ABBREVIATIONS AND ACRONYMS CDC Centers for Disease Control and Prevention COVID-19 Coronavirus Disease 2019 CPF Country Partnership Framework DA Designated Account DFIL Disbursement and Financial Information Letter EID Emerging Infectious Diseases EOC Emergency Operating Center FCV Fragility, Conflict and Violence FM Financial Management FMOH Federal Ministry of Health FTCF Fast Track COVID-19 Facility GBV Gender-based Violence GDP Gross Domestic Product GoS Government of Sudan GRM Grievance Redress Mechanism GRS Grievance Redress Service HEIS Hands on Expanded Implementation Support HEPR TF Health Emergency Preparedness and Response Trust Fund IDA International Development Association IDP Internally Displaced Person ICWMP Infection Control and Medical Waste Management Plan IHR International Health Regulations IMF International Monetary Fund IPF Investment Project Financing M&E Monitoring and Evaluation MICS Multiple Indicator Cluster Survey MMR Maternal Mortality Ratio MOFEP Ministry of Finance and Economic Planning NAC National Audit Chamber NCD Non-Communicable Disease NTF National Task Force PDO Project Development Objective PIM Project Implementation Plan PMU Project Management Unit POE Points of Entry PPE Personal Protective Equipment PSC Project Steering Committee RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health SDG Sudanese Pounds SEA Sexual Exploitation and Abuse SDR Special Drawing Rights SOE Statement of Expenditures SOP Standard Operating Procedures SPRP Strategic Preparedness and Response Plan SSTL State Sponsors of Terrorism List STARS TF Sudan Transition and Recovery Support Trust Fund STEP Systematic Tracking of Exchanges in Procurement TOR Terms of Reference TPM Third-Party Monitoring UHC Universal Health Coverage UNICEF United Nations Children’s Fund WASH Water Supply, Sanitation and Hygiene WBG World Bank Group WHO World Health Organization The World Bank Sudan COVID-19 Emergency Response Project (P174352) TABLE OF CONTENTS DATASHEET ................................................................................. Error! Bookmark not defined. I. STRATEGIC CONTEXT ...................................................................................................... 7 A. Country Context................................................................................................................................ 7 B. Sectoral and Institutional Context .................................................................................................... 9 C. Relevance to Higher Level Objectives............................................................................................. 10 II. PROJECT DESCRIPTION.................................................................................................. 11 A. Project Development Objective ..................................................................................................... 11 B. Project Components ....................................................................................................................... 11 C. Project Beneficiaries ....................................................................................................................... 14 D. Results Chain .................................................................................................................................. 14 E. Rationale for Bank Involvement and Role of Partners ................................................................... 15 F. Lessons Learned and Reflected in the Project Design .................................................................... 15 III. IMPLEMENTATION ARRANGEMENTS ............................................................................ 16 A. Institutional and Implementation Arrangements .......................................................................... 16 B. Results Monitoring and Evaluation Arrangements......................................................................... 17 C. Sustainability................................................................................................................................... 18 IV. PROJECT APPRAISAL SUMMARY ................................................................................... 19 A. Technical, Economic and Financial Analysis ................................................................................... 19 B. Fiduciary.......................................................................................................................................... 20 C. Legal Operational Policies ............................................................................................................... 23 D. Environmental and Social ............................................................................................................... 23 V. GRIEVANCE REDRESS SERVICES ..................................................................................... 25 VI. KEY RISKS ..................................................................................................................... 25 RESULTS FRAMEWORK AND MONITORING .......................................................................... 27 ANNEX 1: Implementation Arrangements and Support Plan .......................................... 32 ANNEX 2: Project Costs ................................................................................................. 34 ANNEX 3: Government Plan and Areas of World Bank Support by Source of Funding ..... 35 The World Bank Sudan COVID-19 Emergency Response Project (P174352) DATASHEET BASIC INFORMATION BASIC_INFO_TABLE Country(ies) Project Name Sudan Sudan COVID-19 Emergency Response Project Environmental and Social Risk Project ID Financing Instrument Process Classification Urgent Need or Investment Project P174352 Substantial Capacity Constraints Financing (FCC) Financing & Implementation Modalities [ ] Multiphase Programmatic Approach (MPA) [✓] Contingent Emergency Response Component (CERC) [ ] Series of Projects (SOP) [✓] Fragile State(s) [ ] Performance-Based Conditions (PBCs) [ ] Small State(s) [ ] Financial Intermediaries (FI) [ ] Fragile within a non-fragile Country [ ] Project-Based Guarantee [ ] Conflict [ ] Deferred Drawdown [✓] Responding to Natural or Man-made Disaster [ ] Alternate Procurement Arrangements (APA) [✓] Hands-on Enhanced Implementation Support (HEIS) Expected Approval Date Expected Closing Date 30-Sep-2020 31-Dec-2022 Bank/IFC Collaboration No Proposed Development Objective(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 Sudan. Page 1 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) Components Component Name Cost (US$, millions) Emergency COVID-19 Response 20.50 Implementation Management and Monitoring and Evaluation 1.49 Contingent Emergency Response 0.00 Organizations Borrower: Republic of Sudan Implementing Agency: Federal Ministry of Health PROJECT FINANCING DATA (US$, Millions) SUMMARY -NewFin1 Total Project Cost 21.99 Total Financing 21.99 of which IBRD/IDA 0.00 Financing Gap 0.00 DETAILS -NewFinEnh1 Non-World Bank Group Financing Trust Funds 21.99 Trust Funds 21.99 INSTITUTIONAL DATA Practice Area (Lead) Contributing Practice Areas Health, Nutrition & Population Page 2 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) SYSTEMATIC OPERATIONS RISK-RATING TOOL (SORT) Risk Category Rating 1. Political and Governance ⚫ High 2. Macroeconomic ⚫ High 3. Sector Strategies and Policies ⚫ Substantial 4. Technical Design of Project or Program ⚫ Moderate 5. Institutional Capacity for Implementation and Sustainability ⚫ Substantial 6. Fiduciary ⚫ High 7. Environment and Social ⚫ Substantial 8. Stakeholders ⚫ Moderate 9. Other 10. Overall ⚫ High COMPLIANCE Policy Does the project depart from the CPF in content or in other significant respects? [ ] Yes [✓] No Does the project require any waivers of Bank policies? [ ] Yes [✓] No Page 3 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) Environmental and Social Standards Relevance Given its Context at the Time of Appraisal E & S Standards Relevance Assessment and Management of Environmental and Social Risks and Impacts Relevant Stakeholder Engagement and Information Disclosure Relevant Labor and Working Conditions Relevant Resource Efficiency and Pollution Prevention and Management Relevant Community Health and Safety Relevant Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Not Currently Relevant Biodiversity Conservation and Sustainable Management of Living Natural Not Currently Relevant Resources Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Relevant Local Communities Cultural Heritage Not Currently Relevant Financial Intermediaries Not Currently Relevant NOTE: For further information regarding the World Bank’s due diligence assessment of the Project’s potential environmental and social risks and impacts, please refer to the Project’s Appraisal Environmental and Social Review Summary (ESRS). Legal Covenants Sections and Description Schedule 2, Section I.A.1 of the Grant Agreement. Within sixty (60) days after the Effective Date, the Recipient shall establish and thereafter maintain, at all times during the implementation of the Project, the Project Steering Committee, with terms of reference, composition, powers, functions, staffing, facilities and other resources satisfactory to the Bank, to be responsible for inter alia, overseeing overall Project performance, ensuring inter-ministerial coordination, approving Work Plans and Budgets, and providing strategic oversight and guidance for the Project. Sections and Description Schedule 2, Section I.A.2(b) of the Grant Agreement Without limiting the foregoing, within forty-five (45) days after the Effective Date, the Recipient shall recruit a Project focal point, an environmental and social risk management specialist, and a monitoring and evaluation specialist for the Project Management Unit; and in each case, with terms of reference, qualifications and Page 4 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) experience acceptable to the Bank. Sections and Description Schedule 2, Section I.A.3. of the Grant Agreement Within sixty (60) days after the Effective Date, the Recipient shall appoint an independent third party monitoring agency, under terms of reference acceptable to the Bank, to carry out, and report to the Recipient and the Bank on, performance verification and field monitoring of Project activities. Sections and Description Schedule 2, Section I.B.2 of the Grant Agreement For purposes of implementation of the Project, the Recipient shall, by no later than one (1) month after the Effective Date, prepare a draft work plan and budget for Project implementation, setting forth, inter alia: (i) a detailed description of the planned activities, including any proposed conferences and Training, under the Project for the period covered by the plan; (ii) the sources and proposed use of funds therefor; (iii) procurement and environmental and social risk management arrangements therefor, as applicable and; (iv) responsibility for the execution of said Project activities, budgets, start and completion dates, outputs and monitoring indicators to track progress of each activity. Sections and Description Schedule 2, Section I.B.1 of the Grant Agreement Within forty-five (45) days after the Effective Date, the Recipient shall prepare, obtain the Bank's approval of, and adopt a Project implementation manual, which shall include detailed guidelines and procedures for the implementation of the Project, including with respect to: (i) administration and coordination, including monitoring and evaluation, environmental and social risk management, and procurement procedures; (ii) personal data collection and processing in accordance with good international practice; (iii) corruption and fraud mitigation measures, (iv) a grievance redress mechanism; and (v) such other arrangements and procedures as shall be required for the effective implementation of the Project, in form and substance acceptable to the Bank (“Project Implementation Manual�). Conditions Type Description Effectiveness Article IV; 4.01(a) of the Grant Agreement The execution and delivery of this Agreement on behalf of the Recipient have been duly authorized or ratified by all necessary governmental action. Type Description Effectiveness Article IV; 4.01(b) of the Grant Agreement A Project Management Unit (“PMU�) has been established in accordance with Section I.A.2(a) of Schedule 2 to this Agreement and PMU has in place a Project manager, procurement specialist and financial management specialist with terms of reference, qualifications and experience acceptable to the Bank. Page 5 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) Type Description Disbursement Schedule 2; Section III; B.1 of Grant Agreement Notwithstanding the provisions of Part A of this Section no withdrawal shall be made for payments made prior to the Signature Date, except that withdrawals up to an aggregate amount not to exceed USD 6,194,000, with respect to the STARS Grant, may be made for payments made prior to this date but on or after May 14, 2020, for Eligible Expenditures under Category 2. Type Description Disbursement Schedule 2; Section III; B.2 of Grant Agreement For Emergency Expenditures under Category (3), unless and until the Bank is satisfied, and notified the Recipient of its satisfaction, that all of the following conditions have been met in respect of said expenditures: (a) the Recipient has determined that an Eligible Crisis or Emergency has occurred, has furnished to the Bank a request to include the proposed activities in the Emergency Response Part in order to respond to said crisis or emergency, and the Bank has agreed with such determination, accepted said request and notified the Recipient thereof; (b) the Recipient has ensured that all environmental and social instruments required for said activities have been prepared and disclosed, and the Recipient has ensured that any actions which are required to be taken under said instruments have been implemented, all in accordance with the provisions of Section I.E of this Schedule; (c) the entities in charge of coordinating and implementing the Emergency Response Part have adequate staff and resources, in accordance with the provisions of Section I.E(2) of this Schedule, for the purposes of said activities; and (d) the Recipient has adopted the CER Manual, in form and substance acceptable to the Bank, and the provisions of the CER Manual remain or have been updated in accordance with the provisions of Section I.E of this Schedule so as to be appropriate for the inclusion nd implementation of the Emergency Response Part. Type Description Disbursement Schedule 2; Section IV; 1 of Grant Agreement Without limitation upon the Recipient’s other obligations under this Agreement, the Recipient further undertakes that no Grant proceeds or resources may be used for security, military, or paramilitary purposes or for any payments made to any security, military, or paramilitary forces without the Bank’s prior express approval. Page 6 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) I. STRATEGIC CONTEXT A. Country Context 1. Sudan has a small window to seize a once-in-a-generation opportunity to put itself on a path of economic and social renewal. The 2019 revolution led to the establishment of a transitional government with a mandate to carry out sweeping reforms to reverse decades of economic, social, and political decline. The Government of Sudan (GoS) has acted boldly, making steps towards resolving long-standing internal conflicts, unwinding economic distortions, renewing the social contract, and re-engaging with the international community. It has also agreed on a rigorous International Monetary Fund (IMF) Staff Monitored Program to underpin its economic reforms. Notwithstanding a challenging first year in office, the GoS retains the support of the country’s major political forces, including security elements. Most importantly, it also continues to be a source of hope to the population for a better future. But time is short for Sudan to capitalize on the promise of its revolution in the face of mounting pressures. 2. Sudan faces formidable economic, social, and political challenges. Sudan has a fragile economy and social contract owing to a history of violent conflict, long-standing tension between the center and the periphery, and exclusionary governance. A largely agrarian country, Sudan is significantly impacted by climate change and recently has been battered by frequent floods and droughts as well as a locust invasion. On September 7, 2020, the Government declared a state of emergency due to deadly flooding which caused more than 100 deaths and displaced around 0.5 million Sudanese. Prior to this crisis, about 9.6 million1 people are estimated to be in acute food insecurity, and over half of the population is now under the national poverty line. The economy is in recession with budgetary and current account deficits exceeding ten percent of Gross Domestic Product (GDP). Large public sector deficits have been monetized, driving inflation to 136 percent as of July 2020. There are shortages of key commodities and power outages are frequent. Trade in goods and services is limited and remittances are curtailed. Dissatisfaction with the economic hardship and pace of reforms by the new government has led to protests and prompted a recent Government reshuffle. At the same time, the peace process remains incomplete, the political equilibrium fragile, and some states continue to have security challenges. 3. Sudan posts very poor human development indicators for its level of GDP. In 2018 it ranked 139 out of 157 according to the World Bank Human Capital Index (HCI)2 and 167 out of 189 countries based on the Human Development Index (HDI) with a score of 0.507 in 2018.3 It did not meet the 2015 Millennium Development Goals (MDGs), and its progress lags behind its neighbors and Sub-Saharan African averages. Education and health indicators remain low and vary markedly across states, gender, and income level. The primary school enrolment rate is only 70 percent (below the target of universal coverage), with substantial disparities across states, richer and poorer, urban/rural areas, and gender. The under-five mortality rate of 68 deaths per 1,000 births in 2014 is still higher than the 2015 MDG target of 41 per 1,000 births, meaning that a lot of efforts are needed to achieve the 2030 Sustainable Development Goal target of 25 deaths per 1,000 births. Sudan’s education system is characterized by unequal access to basic education services, high drop-out rates, weak and outdated infrastructure. Lack of access to basic water and sanitation is a key contributor to low HDI. More than 40 percent of the population still lacks access to safe drinking water, and more than 60 percent lacks basic sanitation. 1 Sudan: Integrated Food Security Phase Classification Snapshot | June - December 2020. 2 https://databank.worldbank.org/data/download/hci/HCI_2pager_SDN.pdf 3 http://www.hdr.undp.org/en/composite/HDI Page 7 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) 4. The new transitional government is facing one of the most challenging environments in the world. Sudan faces a macroeconomic crisis: rampant inflation, massive currency devaluation, rapidly increasing arrears on international debt, and ostracism from the dollar-based international financial system. Modest economic growth persists, and the country is marked by deep poverty and inequality. Social indicators remain low and vary markedly across states, gender and poverty level. Social indicators are aggravated by the country’s service delivery disfunction, which is characterized by low levels of public expenditure, shortage of relevant personnel and dilapidated infrastructure. 5. The deteriorating economic situation has impacted much of the population’s abilities to cover basic needs. It is estimated that over 50 percent of the population was under the poverty line (of US$3.60) prior to the Coronavirus Disease 2019 (COVID-19) outbreak, compared to the reported 36.1 percent in 2014/2015.4 Poverty in Sudan, including geographic dispersion, severity of deprivation, and its direct linkage with the fragility, conflict and violence (FCV) context, present significant challenges in both the provision of and access to basic services. Yet, implementation of economic stabilization measures is the only sustainable pathway to create fiscal space for investment in essential services in the context of significant indebtedness and lack of foreign direct investment to generate growth. 6. Sudan is experiencing the unprecedented social and economic impact of the COVID-19 pandemic. The economic impact includes increased price of basic foods, rising unemployment, and falling exports. Restrictions on movement are making the economic situation worse, with commodity prices soaring across the country. According to IMF projections, consumer prices are expected to increase by 81.3 percent in 2020. The IMF has already forecasted an overall economic stagnation in 2020 in Sudan. GDP is expected to decrease between 4-10 percent in 2020 due to the combined impact of the economic crisis exacerbated by the social distancing measures to curb the spread of COVID- 19. Slowing growth, activity and COVID-19 policy responses will have a significant negative impact on government revenues. 7. The Government has established a high-level emergency committee to oversee the operations to deal with COVID-19 pandemic. Sudanese authorities attempted to act quickly in the face of the spreading virus. On March 14, 2020, the Government announced closure of schools and prohibition of mass gatherings. Two days later, they closed airports, ports, and land crossings, banned travel between states, and required a one-month quarantine for incoming travelers. On March 25, 2020, authorities released 4,217 prisoners as a precautionary measure to reduce the risk of transmission in detention. A night curfew has been imposed from 6:00 p.m. to 6:00 a.m., while the State of Khartoum has announced a partial lockdown starting April 18 for three weeks. People could move within their districts between 8:00 am and 1:00 pm (which was later further extended to 3:00 pm). The lockdown was further extended until July. Starting July 8, 2020, Sudan began loosening lockdown measures in and around the capital Khartoum after three months of tight restrictions. According to the Multi-hazard Emergency Health Preparedness Plan prepared by the Government and guided by the World Health Organization (WHO), the financing needs to cope with COVID-19 related health care is about US$230 million. The plan is currently under funded and the needs are imminent especially with the expected second wave and the recent deadly flooding in the country. Despite the significant efforts made by the Government and other key partners, progress under the plan has been relatively slow under most of the pillars due to the lack of funding and the delayed procurement of required supplies. 8. Several technical and resource partners are currently supporting the COVID-19 response in the country. So far, the domestic private sector has pledged to contribute US$2 million. The Government reallocated US$3 million, and the United Nations (UN) with other international partners are expected to contribute US$9 million. The United States Government has also announced a grant of US$8 million, while the European Union announced a support package of 4 Sudan: Poverty Assessment Update, 2019. Page 8 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) EUR70 million for Sudan, including EUR11.5 million for health.5 The Islamic Development Bank is also expected to contribute US$35 million. The current available funding mobilized through different sources for the COVID-19 national response plan since the eruption of the pandemic is estimated at around US$70 million. Given the significant financing gaps under the response plan, the proposed project will be complimenting the ongoing support under the identified pillars which is closely coordinated by the National Task Force. B. Sectoral and Institutional Context 9. Sudan’s health system is marked by decades of neglect. Overall, fragmentation of the service delivery, decision making, and financing is a salient feature of the health system in Sudan at both federal and state levels. Sudan continues to have high maternal and child mortality rate (MMR 311 per 100,000 live births, and under-5 child mortality 70 per 1,000 live births, WHO 2015). The leading causes of under 5 mortalities are acute respiratory infection (18 percent), diarrhea (11 percent), prematurity (14 percent) and intrapartum related complications (12 percent). Diphtheria, tetanus toxoid and pertussis coverage has improved significantly over the years (from 62 percent in 2000 to 93 percent in 2013), however, only 43 percent of children between 12-23 months were fully immunized in 2014 (Multiple Indicator Cluster Survey, MICS, 2015). Low access to essential services impedes any major decline in disease burden and causes premature deaths from these diseases. 10. Sudan also suffers from persistently high child malnutrition levels which are among the highest in the world. Despite efforts made by the Government and development partners in the past 25 years, malnutrition rates among children under 5 years old have remained unacceptably high with an estimated 33 percent of children underweight, 38 percent of children stunted, 16 percent of children wasted and 5 percent of children severely wasted UNICEF MICS, 2015). Furthermore, the absolute number of wasted, stunted and underweight children under five years of age has risen significantly (UNICEF, 2014). 11. Health care in Sudan is generally under-financed. Total health expenditure per capita remains at US$130 (2015), with a high rate of out-of-pocket payments (75 percent of the total health care expenditures, 2015) which increased vulnerability to health shocks not only among the poor but also among the middle class. Allocation from the Ministry of Finance and Economic Planning (MOFEP) to the system is neither efficient nor based on pre-set priorities and is skewed towards curative services. 12. Shortage and skewed distribution of the health workforce is very evident. Health workforce density is 5.6 for physicians per 10,000 population and 47.6 nurses and midwives per 10,000 of the population. More than two thirds (67 percent) of the staff works in secondary and tertiary care. Geographical distribution of health workers is uneven with the majority in urban settings. For instance, even though over 70 percent of the population resides in rural areas, 70 percent of health workers work in the urban areas with 38 percent in the capital, Khartoum. Moreover, 62 percent of specialist physicians and 58 percent of technicians are based in Khartoum. 13. The COVID-19 crisis has also highlighted the importance of safe water and sanitation and hygiene practices which remain inadequate. About 5.3 million people lack access to improved water sources, 6.2 million people lack access to improved sanitation, and 7.5 million people lack access to hygiene services. This presents significant challenges in containing the virus if there is widespread community transmission. Many people are unable to comply with required water supply, sanitation and hygiene (WASH) and waste management practices for prevention of 5Most of the EU funding is to address the humanitarian situation caused by COVID-19 including food insecurity, health situation, unemployment, and urban mobility. Of which, Euro 11.5 million were dedicated for COVID-19 support through WHO as of June 24, 2020. Page 9 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) human-to-human transmission of the COVID-19 virus, including proper hand hygiene. 14. Although Sudan remains prone to outbreaks, including cholera, chikungunya, dengue, malaria, measles and Rift Valley, the surveillance system doesn’t cover the entire country and is structurally weak with long delays between alert and confirmation of an outbreak. Sudan lacks adequately trained medical staff, isolation units, intensive care units, infection control materials, medicines and medical supplies to address quickly spreading outbreaks including COVID-19 in all states across the country. COVID-19 cases may force health facilities to close to other patients due to isolation procedures. Regular treatments for malnutrition or maternal care may be adversely affected. 15. Transmission of COVID-19 has been evolving quickly in Sudan, and the risk of a second wave is high. As of September 23, 2020, the GoS reported 13,578 confirmed cases and 836 fatalities. The situation evolved from imported cases to local transmission within few days in early April 2020. Despite the relatively smaller number of new reported daily infections6, the risk of the second wave remains high given the recent deadly flooding and the displacement of more than 0.5 million people. According to an analysis undertaken by the Africa Center for Strategic Studies which assess nine of the most important risk factors for the spread of COVID-19 by country, Sudan ranks as one of the top four African countries at highest risk of COVID-197. The weakness of the health system and the population density in cities contribute to the overall ranking. Sudan has limited capacity to control the transmission and contain COVID-19. Without immediate support, the consequences could be catastrophic to Sudan, including the expected spillover transnational effects on the neighboring countries with high traffic to/from Sudan such as Egypt, Gulf Countries, and South Sudan. Accordingly, the proposed project is being processed under the World Bank Policy for Investment Project Financing, paragraph 12: Projects in Situations of Urgent Need of Assistance or Capacity Constraints due to conflict, impending natural disaster and capacity constraints. C. Relevance to Higher Level Objectives 16. The project is aligned with World Bank Group (WBG) strategic priorities, particularly the WBG’s mission to end extreme poverty and boost shared prosperity. The project is focused on preparedness which is also critical to achieving Universal Health Coverage. It is also aligned with the WBG’s support for national plans and global commitments to strengthen pandemic preparedness through three key actions: (i) improving national preparedness plans including organizational structure of the government; promoting adherence to the International Health Regulations (IHR); and utilizing international framework for monitoring and evaluation of IHR. The economic rationale for investing in the interventions is strong, given that success can reduce the economic burden suffered both by individuals and countries. The project complements both WBG and development partner investments in health systems strengthening, disease control and surveillance, and citizen engagement. Additionally, the project is in line with the proposed WBG’s Country Engagement Note (CEN) for the Republic of Sudan for the Period FY21–22 (Report No. 152835-SD) which calls for an immediate response to the COVID-19 crisis. Having the Sudan COVID-19 Emergency Response Project listed under this CEN (Objective 1.4 page 12), highlights its potential significance to support interventions to address the health challenges caused by the pandemic. 17. The project also contributes to the implementation of Integrated Disease Surveillance and Response, the Global Health Security Agenda, the Paris Climate Agreement, the attainment of Universal Health Coverage and of the Sustainable Development Goals, and the promotion of a One Health approach. 6 Partially attributed to the limited investigation and testing capacity in the country 7 https://africacenter.org/spotlight/mapping-risk-factors-spread-covid-19-africa/ Page 10 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) 18. The WBG remains committed to providing a fast and flexible response to the COVID-19 epidemic, utilizing all WBG operational and policy instruments and working in close partnership with government and other agencies. Grounded in One-Health, which provides for an integrated approach across sectors and disciplines, the proposed WBG response to COVID-19 will include emergency financing, policy advice, and technical assistance. The WBG COVID-19 response will capitalize on the National COVID-19 Response Plan, and anchored in the WHO’s COVID-19 global Strategic Preparedness and Response Plan (SPRP) outlining the public health measures for all countries to prepare for and respond to COVID-19 and sustain their efforts to prevent future outbreaks of emerging infectious diseases. II. PROJECT DESCRIPTION A. Project Development Objective PDO Statement 19. 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 Sudan. 20. The specific objectives of the project, aligned with the national COVID-19 Plan, are to: (i) strengthen case detection and confirmation and conduct contact tracing; (ii) improve clinical care capacity; (iii) raise public awareness and promote community engagement; and (iv) bolster coordination, planning, logistical support, and reporting. While the focus is on the coronavirus response and preparedness, the activities to be supported are expected to have cross- cutting benefits for addressing other disease outbreaks. PDO Level Indicators 21. The PDO will be monitored through the following PDO level outcome indicators: PDO Indicators: • Proportion of reported suspected cases of COVID-19 that are investigated based on national guidelines (disaggregated) • Number of designated laboratories with COVID-19 diagnostic equipment, test kits, reagents • Proportion of designated healthcare facilities with isolation capacity B. Project Components 22. The project aims to help Sudan immediately respond to and mitigate the risks associated with COVID-19. Based on the Sudan Preparedness and Response Plan, the project will fill critical gaps in implementing evidence-based interventions such as: points of entry (POE) interventions; leadership and coordination; risk communication and community engagement; national laboratories; infection prevention and control; case management and gender- sensitive isolation; and operational support and logistics. These areas are identified to immediately strengthen the local capacity to respond to and address COVID-19 challenges, while working within Sudan’s existing systems and providing technical assistance as needed for local health institutions at the federal and state levels through a balanced approach. This plan is designed to leverage the capacities of other key stakeholders to engage multiple actors and sectors active in Sudan, such as the Ministries of Social Development and Education. Page 11 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) Component 1: Emergency COVID-19 Response (US$20.5 million) 23. The aim of this component is to prevent and limit, to the extent possible, the spread of COVID-19 in Sudan. This will be achieved by providing immediate support to enhance case detection, testing, case management, recording and reporting, as well as bolster contact tracing and risk assessments. Specific areas to be supported include: (i) rapid detection and screening at critical POEs; (ii) disease surveillance, emergency operating centers (EOC) and rapid response teams to allow timely and adequate detection, tracing, and reporting of suspected cases; (iii) establishment and equipment of isolation and clinical management capacity at a select number of health facilities/hospitals across the country to respond to symptomatic cases; (iv) infection prevention and control at facility and community levels to ensure coordinated supply and demand side hygienic practices; (v) enhanced COVID-19 testing and diagnostic capacity at a targeted number of hospital-based laboratories across the country; (vi) nationwide risk communication and community engagement campaigns to raise awareness of COVID-19 and other pre- existing health priorities; (vii) leadership and coordination across different ministries, departments at the federal and state levels. Specifically, this component will finance the procurement of medical and non-medical supplies, medicines, and equipment8 as well as financing training, systems’ development, and implementation expenses and minor rehabilitation and upgrading/refurbishment of existing facilities to support the COVID-19 response. Table1: Estimated breakdown of funds under Component-1 by pillar Pillar9 Estimate percentage10 Coordination and Leadership 10 percent POEs 5 percent Disease Surveillance and Emergency Operating Centers 15 percent Risk Communication and community engagement 10 percent Infection Prevention and Control 20 percent Testing and Laboratory Capacity 20 percent Case Management 20 percent Sub-Component 1.1: Case Detection, Confirmation and Contact Tracing (US$6.5 million-funded by HEPR RETF) 24. This sub-component will help (i) strengthen disease surveillance systems, public health laboratories, and epidemiological capacity for early detection and confirmation of cases; (ii) combine detection of new cases with active contact tracing; (iii) support epidemiological investigation; (iv) strengthen risk assessment, and (v) provide on-time data and information for guiding decision-making and response and mitigation activities. Support under this sub- component will include but not be limited to the following areas: • Training of core teams and district teams in rapid response and contact tracing • Training of laboratory staff for testing of COVID-19 • Procurement, service and maintenance of COVID-19 diagnostic equipment including purchase of testing kits, reagents, sample collection materials and cartridges, related accessories and equipment. 8 Supplies in line with WHO’s list of disease commodities or any updates will be procured. There are no medicines for COVID-19 yet. Only when WHO or an internally recognized agency approves any medicines and vaccines as applicable and effective, they will be procured. 9 Pillars as per the WHO Global pillars of COVID-19 response and in line with the National Response Plan 10 This is an estimate based on the current situation and subject to change as the situation evolves Page 12 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) Sub-Component 1.2: Health System Strengthening (US$14.0 million-funded by STARS) 25. The health system strengthening sub-component includes the following five mutually reinforcing areas: (a) First, it will strengthen Sudan’s health system to provide optimal medical care to COVID -19 patients while minimizing risks for other patients and health personnel. The project will support Sudan’s clinical care capacity, the adoption of measures and protocols to treat COVID-19 patients and investments to ensure appropriate Infection Prevention and Control measures. Activities to be supported under this sub-component include (i) establishing isolation capacity in hospitals designated to treat COVID-19 patients, (ii) adapting existing structures to enable triaging, (iii) procuring and distributing personal protective equipment, (iv) providing drugs, medical equipment and supplies to comply with WHO standards for COVID-19 supportive treatment, (v) developing and validating treatment guidelines, and (vi) providing clinical training of health personnel to treat COVID-19 patients. (a) Second, the project will enhance the system preparedness for future COVID-19 waves along with other disease outbreaks such as cholera and acute watery diarrhea. This will cover supporting the EOC and information systems. through (i) specialized training to EOC staff, and ii) strengthening call/hotline centers and upgrading information systems equipment. (b) Third, it will support nationwide risk communication and community engagement campaigns to raise awareness of COVID-19 and other pre-existing health priorities. The project will support risk communication and community engagement with key decision makers and stakeholders, including community and opinion leaders. Various methods for community sensitization including mass media and social media will be key in bringing the message to individual households. The activities to be supported under this include: (i) community engagement activities, (ii) conducting risk assessment to identify hot spots, (iii) social media review to identify rumors and target messages, (iv) the development of broadcast messages and communication support materials including billboards, epidemiological bulletins and TV documentaries, and (v) airtime payment for broadcast of informercials and civic education. (c) Fourth, the project will support leadership and coordination activities across different ministries and departments at the federal and state levels. This includes provision for (i) the development of guidelines, regulations and laws, (ii) costs of periodic multi-stakeholder meetings and information exchange, and (iii) operational costs incurred in coordinating actions and reporting mechanisms between health, security, customs and immigration authorities. (d) Fifth, the project will support laying the foundations for managing the supply and cold chains along with the distribution of COVID-19 effective and internationally approved vaccines. Component 2: Implementation Management and Monitoring and Evaluation (US$1.49 million-funded by STARS) 26. This component will support administration and monitoring and evaluation (M&E) activities to ensure smooth and satisfactory project implementation. The component will finance: (i) direct cost for staffing and establishment of the Project Management Unit (PMU) at the Federal Ministry of Health (FMOH); and (ii) hiring of Third-Party Monitoring (TPM) agent and auditor, with terms of reference (TOR) satisfactory to the Bank. Page 13 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) Component 3: Contingent Emergency Response (CERC) 27. A zero cost CERC will provide support for future emergency responses. Following an eligible crisis or event, clients may request the Bank to re-allocate project funds to support an additional emergency response. The CERC would draw from the uncommitted grant resources under the project to cover emergency response. CERCs can be activated without needing to first restructure the original project, thus supporting rapid implementation. To facilitate a rapid response, formal restructuring is deferred to within three months after the CERC is activated. 28. These components will be complemented by a World Bank executed Trust Fund which will cover operational support and analytical and technical assistance provided by the World Bank throughout project implementation. C. Project Beneficiaries 29. The expected project beneficiaries will be the population at large given the nature of the disease, infected people, at-risk populations, particularly the elderly and people with chronic conditions, and medical and emergency personnel working at the health facilities and national laboratories. D. Results Chain 30. Swift detection of an outbreak and rapid emergency response can reduce avoidable mortality and morbidity and prevent the high socio-economic costs associated with disease outbreaks. Delays in the mobilization of financing and inadequate coordination result in unnecessary casualties and significant socioeconomic costs. By focusing on rapid containment, diagnosis and treatment of patients, the project aims to control the outbreak and limit socioeconomic losses. As shown in Figure 1, the project will support urgent response activities to strengthen the supply chain, clinical care and laboratory capacity; bolster human resources; and enhance awareness. Together, these activities will improve the timely detection and response to COVID-19 and other infectious disease outbreaks. Figure 1: Project Results Chain Page 14 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) E. Rationale for Bank Involvement and Role of Partners 31. The World Bank is well placed to support the COVID-19 response in Sudan. The significant needs in the country under the COVID-19 response plan are calling for an urgent support from the international community to ensure a coordinated and tailored approach. Through its significant engagement in support of the COVID-19 response in International Development Association (IDA) and IBRD countries, the World Bank is well positioned to operationally and technically support the ongoing efforts to address the COVID-19 challenges in the country. 32. The World Bank has been engaged in the health sector in Sudan for more than two decades. Among development partners engaged in the sector, the World Bank has been providing strategic leadership in policy dialogue with a focus on health financing, nutrition, and demographic dividend in addition to the ongoing support on Human resources and pandemic preparedness. This has provided lessons on the opportunities and the challenges to be addressed given the country’s implementation environment, particularly understanding of the ability to respond to the Government’s implementation strengths and weaknesses. 33. The World Bank’s convening authority is well recognized and will be of a particular value given the need for broad-based consensus and alignment among stakeholders for ensuring a balanced system-oriented approach. The World Bank will bring significant value added through its global technical and operational expertise in managing the COVID-19 response in similar contexts in partnership with the government, local actors, along with the international community. This includes a strong focus on in-country capacity building and close implementation support, particularly to ensure sound fiduciary functioning and management. The World Bank has carried out extensive analytical work on Sudan’s health sector, the findings of which have been considered in the proposed project’s design. F. Lessons Learned and Reflected in the Project Design Lessons Learned 34. The project has taken into consideration the lessons learned from World Bank�wide experience with COVID -19 emergency response operations in similar contexts, along with lessons learned from past World Bank responses to global crises and outbreaks, including the Ebola outbreaks, the Avian Influenza Crises in 2007, and the 2017 Food Price Crisis Response, among others. The key lessons considered in the project design include: (a) There is a need to invest in underlying health systems during the emergency response to minimize the risk of gains being reversed. This includes a surge in medical personnel, ramping up diagnostic capacity and ensuring patients safety, including isolation facilities. The West African Ebola Virus Disease (EVD-WA) outbreaks have shown the importance of ensuring adequate training of frontline health workers to quickly diagnose and triage patients and put in place interventions to support both COVID-19 health services as well as non-COVID-19 health services. (b) There are important lessons learned in other FCV contexts as well as in Sudan to guide this project. Tackling COVID-19 is doubly hard in countries where social and economic conditions were already unstable because of weak governance and state institutions, unequal access to services for vulnerable populations and, very often, community mistrust of government. These countries may also face compounding challenges, including climate change shocks, forced displacement and food insecurity. It is important that countries’ immediate response and Page 15 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) longer-term investments address these realities to avoid exacerbating existing sources of fragility and instead help build resilience, both to this crisis and future shocks. (c) Swift detection of an outbreak, assessment of its epidemic potential and rapid emergency response can reduce avoidable mortality and morbidity and reduce the economic, social, and security impacts. Failure in the rapid mobilization of financing and coordination of response can result in unnecessary casualties and significant socioeconomic consequences. As highlighted by the SARS and the EVD-WA outbreak, the cost of outbreak control and socioeconomic losses rises exponentially with delayed detection, reporting, and action. Close technical coordination is needed across countries to prevent and control the transboundary spread of the disease. (d) Promote resilience through strengthening local institutions. World Bank experience in various countries indicates that relying on local�level resilience and recovery mechanisms existing on the ground can pay dividends by contributing to service delivery restoration and expansion, and serve as a springboard for larger scale service delivery programs, where these remain the most cost effective and efficient way of delivering services. However, given the weaknesses in local capacity and the importance of maintaining service delivery, helping develop resilient state institutions and strengthen local capacity is essential to maintain service delivery. (e) Ensuring a quick disbursing mechanism and appropriate use of resources and working with government and non-government actors for an effective emergency response. The capacity of PMUs in planning, procurement and execution is critical to quickly disburse resources in emergency situations. Lessons from early COVID-19 emergency operations have also shown the need to instill mechanisms to ensure the use of resources for their intended purposes. Extensive implementation support, provision for building capacity of the implementing agency and the third-party monitoring mechanism will address these concerns. Moreover, lessons learned from similar contexts reflect the critical importance of the World Bank’s inclusive and multi-stakeholders’ approach to ensure a coordinated delivery of services at different levels. Inter-ministerial coordination for COVID-19 response is another critical dimension in this regard. (f) Focusing on quick wins and flexibility when responding to an emergency context. Experience in emergency context indicates the crucial need for design flexibility to ensure adequate response to the various and emerging needs on the ground particularly with the limited knowledge on COVID-19 across the world. In addition, investing in the information system and quality data collection is probably one of the major and early lessons learned from other COVID-19 response operations. (g) A significant focus will be given to tailor-made risk communication and community engagement interventions to ensure the most vulnerable communities and populations are empowered to protect themselves and be part of the containment efforts. III. IMPLEMENTATION ARRANGEMENTS A. Institutional and Implementation Arrangements 35. The FMOH will be the recipient and implementing agency for the project. A dedicated PMU will be established with a project manager, procurement specialist and financial management specialist prior to effectiveness to manage the daily activities supported by the project and will include adequate staffing covering the skill mix required for the daily management of the project. The PMU will be working directly with the National Task Force (NTF) at the FMOH and will establish clear coordination mechanisms with the relevant departments at the Federal and State Ministries of Health. The overall planning, coordination, resource allocation, financial management and procurement are Page 16 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) centralized at the federal level, while stakeholders at the state level are supporting the implementation of activities in coordination with the federal level. In addition, the PMU will work closely with the UN agencies including WHO, UNICEF, WFP, and UNFPA as needed to facilitate smooth procurement and distribution of some needed supplies under the project. The TORs for the PMU have been agreed and shared with the FMOH who is familiar with similar arrangements under different projects with other development financial institutions. 36. In addition, an inter-ministerial project steering committee (PSC) consisting of the MOFEP, FMOH, and other ministries will be formed to oversee the project progress towards its objectives and facilitate its smooth implementation at the strategic level. The NTF is responsible for the overall response in the country with representation from the majority of stakeholders to coordinate any nationwide precautionary measures. The PSC is project specific and will be established to address the potential bottlenecks of the project during implementation given the limited institutional capacity and inter-ministerial coordination. 37. The Coronavirus NTF will coordinate the national response and provide strategic guidance for the implementation of the national program. The taskforce includes representatives of key ministries and government agencies, international and national organizations, UN agencies; as well as the main development partners active in the health sector, hence it is well placed to provide general oversight and advice. The taskforce is assisted by an Expert Advisory Team and technical working groups for each pillar of the National COVID-19 Response Plan. The Expert Advisory Team provides timely scientific advice for coordinated and informed decision-making process. The COVID-19 technical working groups consist of multi-disciplinary teams from different departments/divisions of the Federal and State Ministries of Health responsible for the implementation and operationalization of the COVID-19 Plan. The working groups report to the NTF with respect to overall workplan implementation status, results framework update, procurement plan status, risk management plan, and escalates implementation bottlenecks for immediate decision and remedial actions. 38. The PMU at the FMOH will handle the following functions: (i) financial management, including flow of funds to different stakeholders; (ii) procurement of goods, medical and laboratory equipment, and supplies to ensure economies of scale and efficiencies; (iii) securing consultant services; and (iv) oversight of social and environmental risk management provisions. The Bank team has done a review of the current capacity of the FMOH and found it satisfactory. To handle the additional workload from the project, the PMU will appoint the following within forty-five days after project effectiveness: (i) Project Focal Point; (ii) Environmental and Social Risk Management Specialist; and (iii) Monitoring and Evaluation Specialist. A simple Project Implementation Manual (PIM) will be prepared within forty- five days of effectiveness, describing the main project activities and implementation modalities. B. Results Monitoring and Evaluation Arrangements 39. For their respective activities, FMOH will use data collected by the ministry and other implementing partners (international and local NGOs) as per the standard reporting formats for all interventions at different levels on services and supplies. Databases for each are maintained at federal and state levels. PMU will be responsible for data collection and consolidation through FMOH existing structures at the state and federal levels. The information management officer/s at the PMU will support this process. Given the overall fiduciary high risks and building on the experiences from comparable contexts where reliability of data is an issue, an independent technical verification (TPM) mechanism on the effectiveness and quality of undertaken activities would be important to complement the existing sources of information. Regular technical and financial verification will be undertaken during visits by PMU staff, and TPM agencies, using an agreed protocol. The project will have an independent TPM/technical verification mechanism in Page 17 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) place to undertake quarterly performance verification and field monitoring of the program activities. The TPM agent will provide quarterly reports to FMOH and the World Bank on the outputs as well as the delivery of services to the intended beneficiaries. The PMU at FMOH will submit to the World Bank technical and financial reports on a six- monthly basis on the progress of the project activities according to a template agreed with the World Bank. To the extent possible, all data collected and reported on will be done in a gender- and age-disaggregated manner to contribute to a better understanding of the demographic profile of the affected population. Specifically, PMU will be responsible for: (i) compiling data; (ii) monitoring and tracking results and proposing cross corrections; and (iii) reporting results to the FMOH and the World Bank. 40. The World Bank will conduct monthly meetings to discuss the project progress based on agreed work and procurement plans to supervise progress, check on implementation arrangements and staffing, geographical targeting and selection/prioritization criteria for each service of the agreed upon pillars, and action plans. The World Bank will rely on the TPM reports submitted directly to FMOH and the Bank. The TOR for the TPM agent will be agreed and cleared by the World Bank. 41. Large volumes of personal data, personally identifiable information and sensitive data are likely to be collected and used in connection with the management of the COVID-19 outbreak under circumstances where measures to ensure the legitimate, appropriate and proportionate use and processing of the data may not feature in national law or data governance regulations or be routinely collected and managed in health information systems. In order to guard against abuse of personal data, the project will follow specific guidelines and procedures for dealing with such data in those circumstances to be highlighted in the PIM. These measures may include, by way of example, data minimization (collecting only data that is necessary for the purpose); data accuracy (correct or erase data that are not necessary or are inaccurate), use limitations (data are only used for legitimate and related purposes), data retention (retain data only for as long as they are necessary), informing data subjects of use and processing of data, and allowing data subjects the opportunity to correct information about them, etc. In practical terms, operations will ensure that these principles apply through assessments of existing or development of new data governance mechanisms and data standards for emergency and routine healthcare, data sharing protocols, rules or regulations, revision of relevant regulations, training, sharing of global experience, unique identifiers for health system clients, strengthening of health information systems, etc. C. Sustainability 42. The sustainability of the project supported activities will hinge on continued strong government commitment; enhanced institutional capacity; and predictable financing. The commitment of the GoS to protecting the health and well-being of the population and putting in place strong public health measures has been strong and sustained and augurs well for sustainability. Key stakeholders at the national and decentralized levels continue to demonstrate strong ownership to contain outbreaks swiftly. Institutional capacity shall be built over time with the proposed project further strengthening critical disease outbreak response and preparedness capacity, such as: (i) maintaining public awareness of the threat of COVID-19 and other rapidly spreading infectious diseases; (ii) supporting surveillance and prevention and control activities, particularly in high risk regions; and (iii) bolstering country capacity to manage risk factors associated with the spread of COVID-19 and other infectious diseases at national and local levels. Further work is needed to ensure the financial sustainability of these activities, including greater levels of domestic financing. Page 18 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) IV. PROJECT APPRAISAL SUMMARY A. Technical, Economic and Financial Analysis 43. Although there are significant gaps in knowledge of the scope and features of the COVID-19 pandemic, it is apparent that one main set of economic effects will derive from increased sickness and death among humans and the impact this will have on the potential output of the global economy. In the Spanish Influenza pandemic (1918-19) 50 million people died - about 2.5 percent of the then global population of 1.8 billion. The most direct impact would be through the impact of increased illness and mortality on the size and productivity of the world labor force. The loss of productivity as a result of illness which, even in normal influenza episodes is estimated to be ten times as large as all other costs combined will be quite significant. 44. Another significant set of economic impact will result from the uncoordinated efforts of private individuals to avoid becoming infected or to survive the results of infection. The SARS outbreak of 2003 provides a good example. The number of deaths due to SARS was estimated at “only� 800 deaths and it resulted in economic losses of about 0.5 percent of annual GDP for the entire East Asia region, concentrated in the second quarter. The measures that people took resulted in a severe demand shock for services sectors such as tourism, mass transportation, retail sales, and increased business costs due to workplace absenteeism, disruption of production processes and shifts to more costly procedures. Prompt and transparent public information policy can reduce economic losses. 45. A last set of economic impacts are those associated with governments’ policy efforts to prevent the epidemic, contain it, and mitigate its harmful effects on the population. These policy actions can be oriented to the short, medium or long-term or, in spatial terms to the national, regional or global levels. 46. COVID-19 is rapidly engulfing the whole world. The rate of transmission and the spread of cases across countries have been dramatic. Around 215 countries and territories in the world have reported cases so far and some health systems in developed countries could not cope with the demand for screening, testing, tracing, and case management. The consequences of this transmission in Sudan, if it takes a wider scale, would be catastrophic in a country already struggling with social unrest, food insecurity and soaring malnutrition, and cholera. The project was designed with a vision for supporting the immediate response to COVID-19 pandemic while building the capacity of the country to prevent and address future outbreaks. The project adopts horizontally and vertically integrated spectrum of activities under each pillar of the plan under Component 1. 47. The horizontal integration is demonstrated through the incremental response to the pandemic with parallel and sequential prevention and control approach. In the short run, up to six months after effectiveness, activities are geared to prevent and contain the pandemic, halt spread and cater for case management. On the vertical integration, activities were grouped to target the national, facility-based and community and household levels, respectively. 48. The project focuses on best buy interventions and evidence-based approaches to disease outbreak preparedness and response and incorporates lessons learned from the national, regional and global level. The design has been guided by best practice in terms of the minimum package of interventions that countries should strive to attain for a comprehensive approach in line with the WHO guidelines. Strong and rapidly deployed Rapid Response Teams which are well trained can swiftly detect cases; well-equipped and staffed laboratories can ensure rapid and accurate confirmation of cases; and well trained and adequately protected clinical staff can triage and treat urgent cases. The proposed set of interventions will enable teams to respond quickly and reliably to COVID-19 and other Page 19 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) public health threats, reducing the risk of transmission, and assisting health care providers to deal more efficiently with patients, ultimately reducing morbidity and mortality. B. Fiduciary (i) Financial Management 49. The financial management (FM) functions for the project will be conducted by the PMU in the FMOH which has adequate capacity and basic facilities. The PMU manages several funds received from other partners including Gavi, the Vaccine Alliance and Global Fund. The project will prepare a budget based on agreed Work and Procurement Plans to cover the period from the project effectiveness date to its closing date. The budget will be approved by the PSC and submitted to the World Bank for no objection within the first month after project effectiveness. Budget monitoring will be undertaken using quarterly Interim unaudited Financial Reports (IFRs) submitted to the World Bank. The project will rely on the existing accounting capacity at the PMU which comprises an experienced FM team. Project financial transactions will be recorded in the current FMIS used by the PMU. 50. The PMU will prepare quarterly IFRs for the project in form and content satisfactory to the World Bank. The IFRs will be submitted to the World Bank within 45 days after the end of each quarter. The project will also prepare Annual Financial Statements in compliance with International Accounting Standards and World Bank requirements. The annual Project Financial Statements will be prepared within two months of the close of the fiscal year to which it relates and will be submitted to the National Audit Chamber for audit. Audit of project financial statements will be conducted by the National Audit Chamber (NAC) which is the Supreme Audit Institution, and the audit report and management letter will be submitted to the Bank within six months after the financial year end. 51. For ensuring adequate controls over the project resources, independent parties will be involved in the review of the project FM performance. The Internal Audit Chamber will assign an internal auditor for the project to conduct post review internal audit functions at the PMU and will also conduct periodic visits to the states to conduct sample reviews and confirmation of receipt of the disbursed funds by the intended beneficiaries. The findings by the Internal Audit Chamber team will be reported every quarter to the project management. The internal Audit departments at the states and localities levels will also conduct independent review of project activities to confirm receipt of the disbursed funds by the beneficiaries and their reports will also be submitted to the project management on quarterly basis. The reports from the Internal Audit Chamber and the States and localities internal audit departments will be available for the Bank’s FM team review during the periodic FM supervision missions which will be conducted at least twice a year. The National Audit Chamber will conduct annual audits on the payments of funds to the beneficiaries and their receipt by them and any noncompliance will be reported to the project management in the management letter which will be submitted together with the annual audit report. An independent Monitoring Agent will be appointed by the project and will submit reports simultaneously to the PMU and the Bank in line with a detailed TOR. 52. The World Bank reviewed the report of the joint FM assessment mission on the FMOH which was conducted in 2016 by the World Bank and other development partners. The review sought to determine the adequacy FMOH’s FM capacity and systems to support the implementation of the COVID-19 emergency project. The Bank team also conducted virtual meetings with the FMOH staff during the COVID-19 lockdown period. Based on the joint FM mission report and the reviews made with the Ministry’s staff, it was noted that there are some key FM risks that could impact the implementation of the proposed project. This includes challenges of ensuring effective coordination of project activities due to its decentralized nature at the state level, difficulty of project supervision in diverse places due to Page 20 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) insecurity and inaccessibility and potential loss of project funds due to inadequate oversight. Further, there are COVID- 19 related challenges that could impact project implementation. This includes challenges of ensuring regular project supervision due to COVID-19-related travel restrictions for World Bank and government staff and delayed funds flow, audit reports and IFRs, due to alternative work modalities. In order to respond to these FM risks, payment processing under the proposed project will be conducted in line with the regular government approval systems. Detailed FM arrangements will be documented within the PIM, to be prepared and approved within forty-five days of project effectiveness. The Internal Audit Chamber will conduct quarterly internal audit of project activities and submit report to the project and to the World Bank. In addition, the annual audit of project by NAC will cover its decentralized activities and report on any identified FM weaknesses and irregularities. In view of the potential supervision challenges brought about by COVID-19 restrictions, the World Bank will conduct desk review of IFR’s and audit reports. Flexible alternative arrangements will be made for delayed IFRs and audit reports in line with World Bank policy. Further, the project will ensure independent verification and confirmation of receipt of the benefits by internal or external auditors, use of technology to verify decentralized project activities, and enhanced social accountability and grievance redress mechanisms through communities. Direct payment of suppliers and contracted service providers will be used as much as possible to boost the level of disbursements and mitigate the risks associated with holding funds in the DA especially when there are movement restrictions. Based on the analysis above, the initial FM risk rating for the project is assessed as High (H) while the residual FM risk rating is considered Substantial (S). 53. Disbursement, banking and fund flow arrangements: The following disbursement methods may be used under the project: reimbursement, advance, direct payment, and special commitment as will be specified in the Disbursement and Financial Information Letter (DFIL) and in accordance with the World Bank Disbursement Guidelines for Projects, dated February 1, 2017. Disbursements will be transactions-based whereby withdrawal applications will be supported by Statement of Expenditures (SOE). The DFIL will provide details of the disbursement methods, required documentation, Designated Account (DA) ceiling, and minimum application size. The PMU will open a segregated DA for the grant denominated in Euro at a commercial bank acceptable to the World Bank. Local currency account(s) will also be opened to receive transfer from the Euro account. The details of both accounts (the designated and project account) along with the details of account signatories will be communicated to the World Bank within one month after effectiveness. No disbursements will be made from the World Bank until the segregated bank accounts are opened for the project. The World Bank will make an initial advance disbursement into the DA for the project managed by PMU in Euro upon receiving a withdrawal application. Subsequent replenishment of funds from the World Bank to the DA will be made upon evidence of satisfactory utilization of the advance, reflected in SOEs and/or on full documentation for payments above SOE thresholds. Replenishment applications would be required to be submitted regularly (preferably monthly). 54. The project will envisage retroactive financing for withdrawals up to an aggregate amount of US$6.194 million made on or after May 14, 2020, prior to signing date of the Grant Agreement for eligible expenditures under Component-1. (ii) Procurement 55. Procurement activities under the project shall be carried out in accordance with the World Bank’s Procurement Regulations for IPF Recipients: ‘Procurement in Investment Project Financing, Goods, Works, Non-Consulting, and Consulting Services’, dated July 1, 2016; revised November 2017 and August 2018 (Procurement Regulations); and the World Bank’s Anticorruption guidelines ‘Guidelines on Preventing and Combating Fraud and Corruption in Projects Financed by IBRD Loans and IDA Credits and Grants’, revised as of July 1, 2016; and the provisions stipulated in the Page 21 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) Legal Agreement. The project will use the Systematic tracking of Exchanges in Procurement (STEP) to plan, record and track procurement transactions. 56. The major planned procurement is expected to include: (i) medical/laboratory equipment and consumables, (ii) personal protective equipment (PPE) in health facilities and triage, (iii) clinical management equipment, (iv) refurbishment and equipment of medical facilities, (v) technical assistance for updating or reviewing national plans and costs, (vi) human resources for response, and (vii) expertise for development and training of front-line responders. The project will prepare streamlined Project Procurement Strategies for Development and Procurement Plan which will be agreed with the World Bank. 57. Country procurement approaches will utilize the flexibility provided by the World Bank’s Procurement Framework for fast track emergency procurement by the countries. Key measures to fast track procurement include: (i) use of simple and fast procurement and selection methods fit for an emergency situation including direct contracting, as appropriate, (ii) streamlined competitive procedures with shorter bidding time, (iii) use of framework agreements including existing ones, (iv) procurement from UN Agencies enabled and expedited by World Bank procedures and templates, (v) use of procurement agents, (vi) force account, as needed, and (vii) increased thresholds for Requests For Quotations and national procurement, among others. If requested by the Recipient, the World Bank will provide procurement hands-on expanded implementation support (HEIS) to help expedite all stages of procurement. 58. Country projects may be significantly constrained in purchasing critically needed supplies and materials due to significant disruption in the supply chain, especially for PPE. The supply problems that have initially impacted PPE are emerging for other medical products (e.g. reagents and possibly oxygen) and more complex equipment (e.g. ventilators) where manufacturing capacity is being fully allocated by rapid orders from developed countries. 59. Recognizing the significant disruptions in the usual supply chains for medical consumables and equipment for COVID-19 response, in addition to the above country procurement approach options available to countries, the Bank might provide, at Recipient’s request, World Bank Facilitated Procurement (BFP) to proactively assist FMOH in accessing existing supply chains. Once the suppliers are identified, the World Bank could proactively support the Recipient with negotiating prices and other contract conditions. Recipients will remain fully responsible for signing and entering into contracts and implementation, including assuring relevant logistics with suppliers such as arranging the necessary freight/shipment of the goods to their destination, receiving and inspecting the goods and paying the suppliers, with the direct payment by the World Bank disbursement option available to them. The BFP would constitute additional support to Recipients over and above usual HEIS which will remain available. If needed, the World Bank could also provide HEIS to Recipients in contracting to outsource logistics. 60. BFP in accessing available supplies may include aggregating demand across participating countries, whenever possible, extensive market engagement to identify suppliers from the private sector and UN agencies. The World Bank is coordinating closely with the WHO and other UN agencies (specifically WHO and UNICEF) that have established systems for procuring medical supplies and charge a fee which varies across agencies and type of service and can be negotiated (around 5 percent on average.) In addition, the World Bank may help recipients access governments’ available stock. 61. In providing BFP the World Bank will remain within its operational boundaries and mandate which already include expanded HEIS to help Recipients achieve the project’s development objectives. Page 22 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) 62. All the procurement approach options mentioned above remain available depending on Sudan’s preference in order to provide the most efficient and effective support given the specific circumstances. Procurement implementation will be undertaken by FMOH. 63. A procurement capacity assessment of the Implementing Agency, FMOH, was carried out as part of the preparation of the proposed operation. The major risks related to capacity limitations include (i) lack of systematic procurement planning and follow-up, (ii) poor record keeping, (iii) lack of skill development schemes for procurement personnel and unattractive pay scale to attract qualified procurement personnel, (iv) weak internal control for procurement processes, (v) lack of experience in contract management. To mitigate the risks, it is recommended that the FMOH hires one qualified senior Procurement Expert with experience in handling World Bank financed projects to implement project procurement activities. Further, the World Bank will closely monitor activities through close engagement and ensuring all activities will be planed and approved in STEP. After getting the World Bank’s agreement to the plan all documents at each stage of the procurement process will be uploaded in STEP for the World Bank’s post review. The World Bank’s oversight of procurement will be done through increased implementation support, and increased procurement post review on 100 percent of activities. The overall project procurement risk factor is “High�, which will improve to “Substantial� with the application of mitigating measure mentioned above. 64. The government has put in place streamlined procurement decision making arrangement. An all empowered procurement committee has been formed by expanding the committee constituted for normal situation. This committee formed by the Undersecretary of the FMOH includes representation of the MOFEP, FMOH, Internal Audit, Economic Security Representative, technical experts etc. The committee does not need to go to MOFEP for the preliminary approval to initiate the procurement process as required in normal cases. The committee needs to only take final approval from MOFEP to secure funds before contract is signed. .C. Legal Operational Policies . Triggered? Projects on International Waterways OP 7.50 No Projects in Disputed Areas OP 7.60 No . D. Environmental and Social 65. The project will have positive impacts as it should improve COVID-19 surveillance, monitoring and containment. However, the project could also cause significant environmental, health and safety risks due to the dangerous nature of the pathogen (COVID-19) and reagents and other materials to be used in the project-supported laboratories and quarantine facilities. Healthcare associated infections due to inadequate adherence to occupational health and safety standards can lead to illness and death among health and laboratory workers. The laboratories and relevant health facilities which will be used for COVID-19 diagnostic testing and isolation of patients can generate biological waste, chemical waste, and other hazardous biproducts. As the laboratories to be supported by the project will process COVID-19 that can have the potential to cause serious illness or potentially lethal harm to the laboratory staff and to the community, effective administrative and containment controls should be put in place to minimize these risks. Environmentally and socially sound healthcare including laboratory operation will require adequate provisions for avoiding/reducing occupational health and safety risks, proper management of hazardous waste and sharps, use of appropriate disinfectants, proper quarantine procedure for COVID-19, appropriate chemical and infectious substance Page 23 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) handling and transportation procedure, institutional/implementation arrangement for environmental and social risks, etc. In line with WHO Interim Guidance (February 12,2020) on Laboratory Biosafety Guidance related to the novel coronavirus (2019-nCoV), COVID-19 diagnostic activities and non-propagative diagnostic laboratory work (e.g. sequencing) could be undertaken in BSL2 labs with appropriate care. Any virus propagative work (e.g. virus culture, isolation or neutralization assays) will need to be undertaken at a containment laboratory with inward directional airflow (BSL-3 level). As the project will finance procurement of drugs, supplies and medical equipment, the environmental risks will be mainly associated with the operation of the labs, the quarantine and isolation centers, and screening posts at land crossings, as well as with the appropriateness of the medical waste management system to be put in place by the client. Given that Sudan has limited experience in managing highly infectious medical wastes such as COVID-19, the project can be judged to have a substantial environmental risk and will require that appropriate precautionary measures are planned and implemented. The key social risks related to the operation are public and occupational health risks deriving from engagement with people and samples contaminated with COVID-19. Accordingly, provisions need to be in place for proper safety systems, particularly within quarantine and isolation centers, screening posts, and laboratories to be funded by the project; encompassing all occupational health and safety and waste management procedures. 66. In order to manage the anticipated environmental and social risks and impacts, as agreed in the ESCP, the client will prepare an Environmental and Social Management Framework (ESMF) along with the Social Assessment, Labor Management Plan, and Infection Control and Medical Waste Management Plan (ICWMP) in line with the agreed ESCP, which will serve as a basis for preparation of site specific environmental and social risk management tools. The FMOH/PMU will prepare an ESMF so that the laboratories and quarantine facilities to be supported by the project will apply international best practices in COVID-19 diagnostic testing and other COVID-19 response activities. The ESMF will have an exclusion list for COVID-19 lab activities that may not be undertaken unless the appropriate capacity and infrastructure are in place. 67. International best practice is outlined in the WHO Operational Planning Guidelines to Support Country Preparedness and Response, annexed to the WHO COVID-19 Strategic Preparedness and Response Plan (February 12, 2020). Further guidance is included in the WHO Key considerations for repatriation and quarantine of travelers in relation to the outbreak of novel coronavirus 2019-nCoV (February 11, 2020). 68. Stakeholder Engagement: The GoS has prepared and disclosed a draft Stakeholder Engagement Plan (SEP). This draft SEP was disclosed on the World Bank’s website on September 24, 2020 and on the FMOH’s website on September 28, 2020. The SEP will be updated within one month following project effectiveness to include a risk communication and community engagement strategy in line with WHO guidance on ‘Risk Communication and community engagement readiness and response to the 2019 novel coronavirus (2019-nCoV)’ (January 26, 2020). 69. Gender: The SEP has identified vulnerable groups including women. The project will consider gender sensitive planning, through systematic gender analysis, action, monitoring and reporting. The analysis will consider gender disparities under the COVID-19 response interventions. To address concerns, attitudes, beliefs, and barriers to following health guidance, the FMOH will engage through social media to proactively inform audiences and collect and answer questions and identify community influencers and networks – including women’s groups – to assist with community engagement. The project will ensure gender sensitive and tailored messages under the risk communication and community engagement to improve the awareness among women of the COVID-19 disease along with the prevention, laboratory and treatment services available in the country. The PDO as well as some intermediate indicators will be disaggregated by gender to ensure timely monitoring and response to any arising issues. Page 24 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) 70. Gender-Based Violence (GBV): Throughout implementation, the risks of Sexual Exploitation, Harassment, and Abuse (SEA) will be assessed, and mitigation measures put in place. The project will support health-centered based caseworkers to deal with SEA/Sexual Harassment (SH) related grievances. As movement of people is limited, and efforts are focused on supporting healthcare systems, basing a caseworker at a health center is an appropriate option in the Sudanese context to dealing with GBV. The caseworker will be available at health centers to support both women and girls who are infected with COVID-19 and survivors who report to the hospital. The project will also operate hotlines and WhatsApp communication. This will facilitate communication with survivors and case workers in various parts of the country and help to ensure confidentiality. 71. Grievance Redress Mechanism: The project will ensure the establishment of functional Grievance Redress Mechanism (GRM), including the establishment of a hotline. Grievances will be handled at locality level by the locality grievance Officers (committees) in charge of grievances and at state and federal level by state MoH and FMOH General Directors, including via a free dedicated hotline linked with a call center to be established. The GRM will address each area of the feedback cycle: (i) uptake, (ii) sort and process, (iii) acknowledge and follow up, (iv) verify, investigate, and act, (v) monitor and evaluate, and (vi) provide feedback to the complainant as well as to project management and the World Bank. V. GRIEVANCE REDRESS SERVICES 72. Communities and individuals who believe that they are adversely affected by a World Bank (WB) supported project may submit complaints to existing project-level grievance redress mechanisms or the WB’s Grievance Redress Service (GRS). The GRS ensures that complaints received are promptly reviewed in order to address project-related concerns. Project affected communities and individuals may submit their complaint to the WB’s independent Inspection Panel which determines whether harm occurred, or could occur, as a result of WB non- compliance with its policies and procedures. Complaints may be submitted at any time after concerns have been brought directly to the World Bank's attention, and Bank Management has been given an opportunity to respond. For information on how to submit complaints to the World Bank’s corporate Grievance Redress Service (GRS), please visit http://www.worldbank.org/en/projects-operations/products-and-services/grievance-redress-service. For information on how to submit complaints to the World Bank Inspection Panel, please visit www.inspectionpanel.org. VI. KEY RISKS 73. The overall risk rating is High. This rating stems from the exceptional context of the ongoing political transition in Sudan. The key risks that may affect the achievement of the PDO and results are (i) political and governance; (ii) sector strategies and policies; (iii) macroeconomic; (iv) environmental and social; (vi) institutional capacity for implementation and sustainability; and (vii) fiduciary. 74. Political and governance risks are high. The ongoing transition in Sudan can negatively affect PDO achievement. This challenging environment also poses sector strategies/policies risks with the long transitional period in the country and several political replacements. Maintaining an inclusive government led approach which focuses on the technical and operational levels of the federal and state health institutions will ensure a timely response to the evolving political situation. In addition, a strong focus on procurement of necessary supplies and equipment and training of health and non-health workers at targeted facilities and laboratories while working with implementing partners at different levels Page 25 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) for timely monitoring and data sharing are additional key mitigation measures. 75. Macroeconomic risk is high. The economic impact of the recent revolution has been detrimental for Sudan, aggravating an already weak pre-conflict economic performance, which could be further exacerbated by a COVID-19 epidemic. The Government is unable to fully fund the required operational costs of the COVID-19 targeted health facilities. While this project cannot mitigate risks associated with macroeconomics, the project does contribute to maintaining urgently needed health services and local capacities required under COVID-19 response. 76. Sector strategies and policies risks are substantial. The current political transition is significantly affecting the sectoral strategies and policies. The continued change in the FMOH leadership over the last year along with the COVID- 19 outbreak in the country continued to disrupt the development of medium to long term sectoral strategies. The COVID-19 response, however, is a priority for the GoS and FMOH and fully aligned with the National Response Plan. 77. Institutional capacity for implementation and sustainability risks are substantial. Despite the World Bank engagement with the MOH at the technical aspects, there was no operational engagement for the World Bank in the sector since 2013. This constitutes a substantial risk for the operation given the lack of familiarity of the FMOH with the World Bank-financed operations. Risks will be mitigated by keeping the design simple in line with the scope of the National Response Plan and global Bank’s experience of the World Bank’s COVID-19 response in similar contexts. In addition, closely supervising the project activities through frequent meetings with the FMOH. 78. Fiduciary risks are high. The FM risks include (i) challenges of ensuring effective coordination of project activities due to its decentralized nature at the state level, and (ii) difficulty of project supervision in diverse places due to insecurity and inaccessibility and potential loss of project funds due to inadequate oversight. To mitigate those risks, payment processing under the proposed project will be conducted in line with the regular government approval systems. Detailed FM arrangements will be documented in the project FM manual which will be prepared within one month from effectiveness. The Internal Audit Chamber in the Ministry of Finance will conduct bi-annual internal audit of project activities and submit report to the PMU and to the World Bank. In addition, the annual audit of project by NAC will cover its decentralized activities and report on any identified FM weaknesses and irregularities. On procurement, the major risks related to capacity limitations include (i) lack of systematic procurement planning and follow-up, (ii) poor record keeping, (iii) lack of skill development schemes for procurement personnel and unattractive pay scale to attract qualified procurement personnel, (iv) weak internal control for procurement processes, and (v) lack of experience in contract management. To mitigate the risks, it is recommended that the FMOH assigns or hires qualified staff, minimum one senior Procurement Expert and one Contract management expert, to implement project procurement activities. Further, the World Bank will closely monitor activities through close engagement and ensuring all activities will be planed and approved in STEP. 79. Environmental and social risks are substantial. Environmental risks and impacts that are envisaged under this project would be related to: medical waste management and disposal; and occupational health and safety aspects. The ESMF, the ICWMP, and the SEP will be prepared to address any anticipated risks and impacts. Overall, the direct benefits and positive externalities of project interventions are significant compared to risks and impacts envisaged; nonetheless, the challenging environment in which the project is implemented translates into significant residual risk. . . Page 26 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) RESULTS FRAMEWORK AND MONITORING Results Framework COUNTRY: Sudan Sudan COVID-19 Emergency 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 Sudan. Project Development Objective Indicators RESULT_FRAME_TBL_ PD O Indicator Name PBC Baseline End Target To prevent, detect and respond to the threat posed by the COVID-19 pandemic Proportion of reported suspected cases of COVID-19 that are investigated based on national guidelines (disaggregated) 0.00 75.00 (Percentage) Number of designated laboratories with COVID-19 diagnostic 0.00 4.00 equipment, test kits, and reagents (Number) Proportion of designated healthcare facilities with isolation 8.00 100.00 capacity (Percentage) PDO Table SPACE Page 27 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) Intermediate Results Indicators by Components RESULT_FRAME_TBL_ IO Indicator Name PBC Baseline End Target Emergency COVID-19 Response Number of health staff trained in infection prevention and control (disaggregated) (Number) 0.00 500.00 Number of laboratory staff trained to conduct COVID-19 0.00 60.00 diagnosis (disaggregated) (Number) Number of awareness campaign messages broadcast per week 0.00 6.00 (Number) Proportion of targeted healthcare facilities with clinical capacity 0.00 90.00 for COVID-19 patients (Percentage) Implementation Management and Monitoring and Evaluation M&E system established to monitor COVID-19 preparedness and No Yes response plan (Yes/No) Proportion of patients or their care takers satisfied with the received treatment of COVID-19 (Percentage) 0.00 60.00 Percentage of grievances addressed within the time specified in 0.00 60.00 the project implementation manual (Percentage) IO Table SPACE UL Table SPACE Monitoring & Evaluation Plan: PDO Indicators Methodology for Data Responsibility for Data Indicator Name Definition/Description Frequency Datasource Collection Collection Proportion of reported suspected cases of Denominator is the number FMOH to aggregate 6 months FMOH FMOH COVID-19 that are investigated based on of reported suspected reports from States national guidelines (disaggregated) COVID-19 cases and the Page 28 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) numerator is the number of those cases investigated according to the national guidelines. Suspected COVID-19 cases refer to: a person with at least one COVID-19 symptom (fever, cough, shortness of breath, sore throat), or a close contact within 14 days of onset of symptoms with a person under investigation for COVID-19, or a person with a recent travel history to a COVID-19 affected country. Designated laboratories Number of designated laboratories with equipped with supplies for FMOH to aggregate 6 months FMOH FMOH COVID-19 diagnostic equipment, test kits, COVID-19 such as diagnostic reports from States and reagents equipment, test kits, and reagents Numerator: Number of designated health facilities with isolation unit within FMOH to aggregate Proportion of designated healthcare 6 months FMOH FMOH the facility, trained reports from States facilities with isolation capacity personnel, and equipment. Denominator: Number of designated health facilities ME PDO Table SPACE Page 29 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) Monitoring & Evaluation Plan: Intermediate Results Indicators Methodology for Data Responsibility for Data Indicator Name Definition/Description Frequency Datasource Collection Collection Health staff receiving infection prevention and FMOH to aggregate Number of health staff trained in infection 6 months FMOH FMOH control training which reports from States prevention and control (disaggregated) follows the protocols developed by WHO Laboratory staff receiving Number of laboratory staff trained to training on COVID-19 FMOH to aggregate 6 months FMOH FMOH conduct COVID-19 diagnosis diagnosis which follows the reports from States (disaggregated) protocols developed by WHO Number of broadcast FMOH to aggregate Number of awareness campaign COVID-19 awareness 6 months FMOH FMOH reports from States messages broadcast per week messages delivered per week Denominator is the number of healthcare facilities identified by FMOH for Proportion of targeted healthcare managing the COVID-19 FMOH to aggregate 6 months FMOH FMOH facilities with clinical capacity for COVID- cases, while the numerator reports from States 19 patients is the number of healthcare facilities with clinical capacity as per the national guideline. Establishment of monitoring M&E system established to monitor FMOH to aggregate and evaluation system for Ongoing FMOH FMOH COVID-19 preparedness and response reports from States the COVID-19 preparedness plan and response plan Page 30 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) Numerator: Number of patients that test positive to COVID-19 or their care Proportion of patients or their care takers FMOH to aggregate takers (if deceased) that are 6 months FMOH FMOH satisfied with the received treatment of reports from States satisfied with the treatment COVID-19 received. Denominator: Patients that test positive to COVID-19. Numerator: Number of grievances addressed within the time specified in the Percentage of grievances addressed FMOH to aggregate project implementation 6 months FMOH FMOH within the time specified in the project reports from States manual. implementation manual Denominator: Total number of grievances received through the GRM. ME IO Table SPACE Page 31 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) ANNEX 1: Implementation Arrangements and Support Plan COUNTRY: Sudan Sudan COVID-19 Emergency Response Project Strategy and Approach for Implementation Support 1. A strategy for implementation support has been developed based on lessons learned from previous World Bank experience in Northern Africa and past and ongoing projects in Sudan and based on this project’s specific challenges and risks. The FMOH, with support from a PMU, is responsible for project implementation. The strategy for implementation support aims to provide continuous targeted support and technical advice from the World Bank to the FMOH and the PMU on implementation and ensuring compliance to World Bank guidelines and procedures on fiduciary and E&S aspects. The project, however, will support the TPM, and the organizations’ monitoring and evaluation activities of the project. 2. The project will require substantial support from the World Bank’s task team. The World Bank will work with the FMOH, MOFEP, and the PMU to ensure that effective coordination is established. The World Bank will work with the FMOH and the PMU and agree on regular reporting formats. The reports will include updates on technical and financial progress and on monitoring indicators. The World Bank will also advise the FMOH and PMU on environmental due diligence to ensure that the Environmental and Social Framework tools prepared for the project are adhered to. The World Bank will work with the Recipient to identify underperforming areas (if any) and address any constraints. Additional implementation support will include monitoring changes in risks and compliance with legal covenants. 3. The World Bank’s implementation support will broadly consist of (see Table 1.1) (a) Institutional capacity-building activities covering technical, fiduciary, and social and environmental dimensions; (b) Technical advice and implementation support geared to the attainment of the PDO; (c) Ongoing monitoring of implementation progress, including regular review of key outcome and intermediate indicators; (d) Monitoring of risks and identifying the corresponding mitigation measures; and (e) Close coordination with other development partners to leverage resources to ensure coordination of efforts and avoid duplication. 4. The World Bank’s implementation support team will consist of a Health, Nutrition, and Population Global Practice Task Team Leader, field-based, and headquarters-based staff in the areas of health, FM, procurement, environmental and social, and operations. Expert consultants may also support the project in specific subject areas. Task team members will be responsible for supporting the implementation of project-specific elements in their areas of expertise (Table 1.2). Page 32 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) Table 1.1. Implementation Support Plan Time Focus Skills Needed Resource Estimate First 12 months Technical advice to Technical, At least two implementation support visits support project fiduciary, (virtual if necessary) by technical implementation operational, specialists focused on capacity building, (procurement, M&E, FM) environment and monitoring, E&S social 12–24 months Continued technical Technical, At least two implementation support visits support for project fiduciary, by technical, fiduciary, M&E and social implementation and environment, /environmental specialists focused on identification of social and fiduciary and implementation support necessary midcourse operational adjustments Table 1.2. Task Team Skills Mix Requirements for Implementation Support Skills Needed Estimated Number of Staff Weeks Per Fiscal Year Program Management (Task Team Leader) 16 Health Specialist 10 M&E Specialist 6 FM Specialist 5 Procurement Specialist 5 Environmental Specialist 5 Social Specialist 5 Operations Officer 8 Administrative Support 3 5. Fiduciary arrangements. FM and procurement arrangements will build on and use the existing capacity at the FMOH and MOFEP. The World Bank FM and procurement specialists are based in the World Bank’s country office in Khartoum and will support project implementation through regular reviews and on-time training and capacity building of staff of the client. Formal supervision of fiduciary processes and procedures will be conducted biannually, and implementation support will be provided as required by the World Bank. 6. Social and environmental risk management. The World Bank environmental and social development specialists will provide regular implementation support to the Government in the implementation of the ESMF. Page 33 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) ANNEX 2: Project Costs COUNTRY: Sudan, Republic of the Sudan COVID-19 Emergency Response Project COSTS AND FINANCING OF THE COUNTRY PROJECT Project IBRD or IDA Trust Counterpart Program Components Cost Financing Funds Funding Component 1: Emergency COVID-19 Response US$20.5m $20.5 Component 2: Implementation Management and US$1.49m $1.49 Monitoring and Evaluation Component 3: Contingent Emergency Response US$0.0 US$0.0 Total Costs (US$) $21.99m $21.99 Total Costs $21.99m $21.99 Front End Fees Total Financing Required $21.99m $21.99 Page 34 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) ANNEX 3: Government Plan and Areas of World Bank Support by Source of Funding PA Aspects Is it in GOV. Plan? Supported by CERP Source of funding11 Emergency COVID-19 Response MPA Component-1 WHO Pillar 1: Country- Yes Yes STARS level coordination, Component 1.2 planning, and monitoring WHO Pillar 2: Risk Yes Yes STARS communication and Component 1.2 community engagement WHO Pillar 3: Yes Yes HEPR Surveillance, rapid Component 1.1 response teams, and case investigation WHO Pillar 4: Points of Yes Yes HEPR entry Component 1.1 WHO Pillar 5: National Yes Yes HEPR laboratories Component 1.1 WHO Pillar 6: Yes Yes STARS Infection prevention Component 1.2 and control WHO Pillar 7: Case Yes Yes STARS management Component 1.2 WHO Pillar 8: Partially Yes STARS/HEPR for their respective Operational support activities and logistics 11 Funds under STARS will be also used to support the activities under HEPR in case of identified financing gaps and availability of additional financings. Page 35 of 36 The World Bank Sudan COVID-19 Emergency Response Project (P174352) MPA Component-2 Strengthening Multi- No No NA sector, National Institutions and Platforms for One Health MPA Component-3 Supporting National No No NA and Sub-national, Prevention and Preparedness, including social assistance and education support MPA Component-4 Community Partially Yes STARS Engagement and Component 1.2 Participation MPA Component-5 Implementation Yes Yes STARS Management and Component 2 Monitoring and Evaluation Page 36 of 36