The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 3 | ARCHIVED on 16-Feb-2021 | ISR45198 | Implementing Agencies: Ministry of Health and Family Welfare, Republic of India, Ministry of Finance Key Dates Key Project Dates Bank Approval Date: 02-Apr-2020 Effectiveness Date: 06-Apr-2020 Planned Mid Term Review Date: 22-Nov-2021 Actual Mid-Term Review Date: Original Closing Date: 31-Dec-2024 Revised Closing Date: 31-Dec-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed project development objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national health systems for preparedness in India. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Emergency COVID-19 Response:(Cost $750.00 M) Component 2: Strengthening National and State health Systems to support Prevention and Preparedness:(Cost $405.00 M) Component 3: Strengthening Pandemic Research and Multi-sector, National Institutions and Platforms for One Health:(Cost $150.00 M) Component 4: Community Engagement and Risk Communication:(Cost $105.00 M) Component 5: Implementation Management, Capacity Building, Monitoring and Evaluation:(Cost $90.00 M) Component 6: Contingent Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions Since the first case in January 30, 2020 India has reported over 10 million COVID-19 cases and over 150,000 deaths. GOI response has been pre- emptive and proactive following a whole of government approach and the COVID-19 pandemic response is unique for its scale, scope, innovations and deployment of technology. The COVID 19 Emergency Response and Health System Preparedness Project was restructured in May 2020 to integrate US$500 million from the Asian Infrastructure Investment Bank (AIIB) to the already approved US$1 billion from the International Bank for Reconstruction and 2/16/2021 Page 1 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Development (IBRD) to ensure financing to support the pandemic response at scale. Supporting the GOI COVID-19 Containment Strategy and with 50% of the funds disbursed - key achievements of the Project include a) enhanced public health infrastructure through development of designated COVID hospitals and COVID health centers, b) strengthened COVID-19 testing laboratory network involving public and private laboratories, c) robust supplies of personal protective equipment (PPE) kits and essential equipment, d) delivering IT solutions like the Arogya Setu to provide users regular updates on COVID -19 and risk assessment, e) strengthened syndromic surveillance and f) behavior change communication through multimedia messaging. Over the last several weeks the pandemic response seems to be turning the corner. In the last week of December 2020, the number of daily new cases of COVID-19 in India hit a six-month low as the active caseload fell below 278,000. India also reports a low case fatality rate of 1.45. Prevention measures supported by the project including testing, tracking, treating and behavior change will continue to be the mainstay of the pandemic preparedness even as vaccines are rolled out. MPA Program Development Objective MPA PDO Table The Program Development Objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness MPA Table Multiphase Programmatic Approach (MPA) Status MPA Table Body The implementation of the MPA-funded projects is progressing well. As of January 18, 2021, 84 MPA-projects have been approved providing a total commitment of US$4.15 billion. In addition, 14 PEF grants have been approved to complement the COVID-19 response. Disbursements have continued to increase at a rapid pace. Thirty (30) country projects or 36% of projects approved have reached 70-100% disbursements. The projects benefit around 3.7 billion people or 50% of the global population. Of the 84 approved projects: (i) 32 are in Africa – 11 in AFE and 21 in AFW; (ii) 12 in East Asia; (iii) 12 in Europe and Central Asia; (iv) 12 in Latin America and the Caribbean; (v) 7 in Middle East and North Africa; and (vi) 9 in South Asia. Seventy-two (72) projects are disbursing. Total disbursements as of January 18, 2021 under these projects amount to US$1.887.6 million or 46% of overall commitments. In addition, $714 million has committed undersigned contracts with UNICEF ($582 million) and BFP ($132 million) representing 63% of the $4.15 billion committed. Streamlined procedures, delegated approval coupled with flexible project design and intensified efforts across the Bank have contributed to the progress. The MPA-Program is on track to achieving its PDO – to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. The significant level of disbursements in just over nine months attest to the strong implementation of the Bank response thanks to the commitment of counterparts supported by country teams. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Moderate Moderate Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Moderate Institutional Capacity for Implementation and Moderate Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial 2/16/2021 Page 2 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Support GoI to prevent, detect and respond & strengthen national HS for pandemic preparedness IN00944320 ►Percentage of district hospitals with isolation capacity (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 98.00 98.00 70.00 Date 20-Mar-2020 30-Sep-2020 30-Sep-2020 29-Jul-2022 Denominator: Number of districts Numerator: Number of districts having at least one hospital with isolation Comments: capacity, defined as a separate room with negative pressure. IN00944326 ►Proportion of specimens submitted for COVID-19 laboratory testing confirmed within WHO-stipulated standard time (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 89.00 92.00 70.00 Date 20-Mar-2020 30-Sep-2020 30-Sep-2020 28-Jul-2022 Denominator: Number of specimens submitted for COVID-19 laboratory testing Numerator: Number of Comments: specimens submitted for COVID-19 laboratory testing confirmed within WHO stipulated standard time IN00944327 ►Proportion of population able to identify three key symptoms of COVID-19 and/or seasonal influenza and three personal prevention measures (as assessed by a representative population survey) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 20-Mar-2020 21-Apr-2020 30-Sep-2020 28-Oct-2022 Denominator: Number of respondents to representative population survey. Numerator: Number of respondents to representative population survey who can accurately identify three key symptoms of Comments: COVID-19 and three personal prevention measures. IN00944328 ►The Government has activated their one health coordination mechanism for COVID-19 (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No nil nil Yes 2/16/2021 Page 3 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Date 20-Mar-2020 21-Apr-2020 30-Sep-2020 28-Aug-2020 One health coordination mechanism to be developed by end of project as defined per the PAD Comments: IN00944329 ►Percentage of district health centers/district hospitals with personal protective equipment and infection control products and supplies, without stock-outs in preceding two weeks (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 20-Mar-2020 21-Apr-2020 30-Sep-2020 30-Nov-2022 Denominator: Number of designated district hospitals Numerator: Number of designated district hospitals with adequate key personal protective equipment* and IPC supplies without stock-outs in preceding two weeks. (* Key PPE will include the following): 1. Latex gloves 2. N95 respirator 3. Surgical/medical mask Comments: 4. Disposable overall/gown 5. Goggles 6. Face shields 7. Nitrilite rubber gloves 8. Gowns with head cover 9. Shoe cover 10. Head cover 11. Rubber boots Data for this indicator is not available IN00944330 ►Number of states with at least 80% of districts having dedicated core surveillance staff in the District Surveillance Unit (District Surveillance Officer, Epidemiologist, and Data Manager) in position (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 28.00 10.00 28.00 65.00 Date 21-May-2020 30-Sep-2020 30-Sep-2020 28-Jun-2024 Overall Comments PDO Overall, out of six PDO indicators, two indicators of system readiness for managing COVID-19 cases at district level and testing turnaround time have exceeded the end project targets. Progress with regard to another system readiness indicator on filling up positions in the district surveillance unit is suboptimal. Only 28% of states have at least 80% districts having core surveillance staff in position as compared to the target of 65%. The indicator on activation of One Health coordination mechanism is only due by the end of the project. Data is not available on one indicator on stock out of PPE and infection control products and supplies due to shifts in program and information system capture difficulties and the project restructuring will address these. Data for the indicator on levels of awareness about key COVID-19 symptoms and prevention measures is not collected and a survey is expected by mid-year. However, information from a phone-based survey by the World Bank in September 2020 in 6 states indicate positive trends. Intermediate Results Indicators by Components 1: Emergency COVID-19 Response IN00944331 ►Proportion of states with sufficient COVID-19 testing capacity within 4 weeks of project implementation (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 70.00 Date 20-Mar-2020 30-Jun-2020 30-Jun-2020 30-Nov-2022 2/16/2021 Page 4 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Denominator: Number of states and union territories. Numerator: Number of states or union territories with sufficient COVID-19 testing capacity defined as: 1000 tests per day in states/UTs with a population ≥100 Comments: million, 500 tests per day in states/UTs with a population of 30-99 million, and 200 tests per day in all other states. IN00944336 ►Proportion of states using a national health information reporting platform that unifies multiple pre-existing platforms. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 20-Mar-2020 21-Apr-2020 30-Sep-2020 30-Nov-2022 Denominator: Number of states/UTs. Numerator: Number of states/UTs using a national health Comments: information reporting platform that unifies multiple pre-existing platforms. IN00944339 ►Proportion of suspected cases who are tested within 2 days of being identified (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 20-Mar-2020 21-Apr-2020 30-Sep-2020 30-Nov-2022 Denominator: Number of suspected cases of COVID-19. Numerator: Number of suspected cases of COVID-19 whose sample is collected for testing within 2 days of being identified. Comments: Data not available 2: Strengthening National and State health Systems to support Prevention and Preparedness IN00944334 ►Proportion of district hospital doctors and nurses who are trained on WHO standards of clinical treatment for COVID-19 within 8 weeks of project implementation (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 20-Mar-2020 21-Apr-2020 30-Sep-2020 30-Sep-2022 Denominator: Number of doctors and nurses working at designated district hospitals. Numerator: Number of doctors and nurses working at designated district hospitals who are trained on WHO standards of clinical treatment for COVID-19. Comments: Data not available IN00944337 ►Proportion of outbreaks where human samples were collected and sent to laboratory for confirmation (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.00 87.00 87.00 65.00 Date 21-May-2020 30-Sep-2020 30-Sep-2020 30-Nov-2022 IN00944340 ►• % of Real Time Polymerase Chain Reaction (RT-PCR) designated laboratories meeting external quality control standards (reflects laboratory system quality, using COVID19 testing as a proxy) (Percentage, Custom) 2/16/2021 Page 5 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Baseline Actual (Previous) Actual (Current) End Target Value 100.00 100.00 100.00 100.00 Date 21-May-2020 21-May-2020 30-Sep-2020 30-Jun-2023 3. Strengthening Pandemic Research and Multi-sector,National Institutions & Platforms for One Health IN00944335 ►Proportion of states with Emerging Infectious Disease Contingency Plans in place with dedicated budget (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 20-Mar-2020 21-Apr-2020 30-Sep-2020 30-Nov-2021 Denominator: Number of states/UTs. Numerator: Number of states/UTs with Emerging Infectious Disease Comments: Contingency Plans in place with dedicated budget. IN00944338 ►Number of new BSL3 labs with biosafety certification (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 5.00 Date 20-Mar-2020 21-Apr-2020 30-Sep-2020 30-Nov-2021 Comments: Count of BSL3 labs with biosafety certification. 4: Community Engagement and Risk Communication IN00944332 ►Proportion of states issuing school closures with state-level distance learning strategies for primary and secondary school students. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 20-Mar-2020 21-Apr-2020 30-Sep-2020 30-Nov-2021 Denominator: Number of states/UTs issuing school closures due to COVID-19 pandemic. Numerator: Comments: Number of states/UTs issuing school closures due to COVID-19 pandemic issuing school closures with state-level distance learning strategies for primary and secondary school students. 5: Implementation Management, Capacity Building, Monitoring and Evaluation IN00944333 ►Number of peer-reviewed publications produced with support of the project funding (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 2/16/2021 Page 6 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Date 20-Mar-2020 21-Apr-2020 30-Sep-2020 30-Nov-2021 Comments: Count of publications in peer-reviewed journals produced with support of the project funding Overall Comments IR Overall, out of ten Intermediate Results (IR) three indicators (IR 1,9 &10) have surpassed end line targets while for two indicators (IR 3 & 4) data is not available. Five IR indicators (IR 2,5,6,7,8) are still not due. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173836 IBRD-90860 Effective USD 1,000.00 1,000.00 0.00 502.50 497.50 50% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173836 IBRD-90860 Effective 02-Apr-2020 03-Apr-2020 06-Apr-2020 31-Dec-2024 31-Dec-2024 Cumulative Disbursements 2/16/2021 Page 7 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level 2 Approved on 01-Jun-2020 Related Project(s) There are no related projects. 2/16/2021 Page 8 of 8