The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) Tunisia COVID-19 Response project (P173945) MIDDLE EAST AND NORTH AFRICA | Tunisia | IBRD/IDA | Investment Project Financing (IPF) | FY 2020 | Seq No: 10 | Archived on 16-Jan-2025 | ISR02549 Implementing Agencies: Ministry of Health 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 30-Apr-2020) To improve COVID-19 detection and infection control in Tunisia through increasing the availability of COVID-19 equipment and supplies. Has the Development Objective been changed since Board Approval of the Project Objective? Yes Current Development Objective (Approved as part of Additional Financing package Seq. 2 on 24-May-2022) To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. 2. COMPONENTS Name Emergency COVID-19 Response:(Cost 77,780,000.00) Implementation Management and Monitoring and Evaluation:(Cost 200,000.00) Support Health Systems Strengthening:(Cost 65,470,000.00) Contingency Emergency Response Component:(Cost 0.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Jan 16, 2025 Page 1 of 11 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) 4. KEY ISSUES & STATUS 4.1 Implementation Status and Key Decisions The Tunisia COVID-19 Response project Parent project was approved by the World Bank's Executive Board on April 30, 2020, and was declared effective on June 1st, 2020. The project is financed by a US$20 million loan under the Multiphase Programmatic Approach supported by the Fast Track COVID-19 Facility. An additional financing of a US$100 million loan was approved by the World Bank’s Executive Board on March 26, 2021, and was declared effective on May 26, 2021. A second additional financing of a US$22 million loan and a US$1.8 million grant was approved by the Regional Vice President on May 24, 2022, and was declared effective on October 12, 2022. The project was restructured on April 4, 2024, to finance emerging health sector priorities and strengthen health system capacity. The project has enabled purchase and deployment of COVID-19 vaccines to contribute to Tunisia’s high vaccination rate (over 60 percent of adults), as well as the purchase of medical equipment to expand care capacity. 4.2 MPA Program Development Objective Original MPA Program Development Objective (Approved as part of (Seq. ) package on ) Current MPA Program Development Objective (Approved as part of (Seq. ) package on ) 4.3 Multiphase Programmatic Approach (MPA) Status (Public Disclosure) Sustained efforts continue to be made to accelerate the implementation of AF operations and the SPRP Program in general. As in the previous month, acceleration of implementation of AF-V operations has continued. Total disbursements as of December 16, 2024, amount to US$7.15 billion or 86 percent of overall commitments ($8.29 billion). Disbursements in mid-November 2024 were $7.07 billion. EAP has the highest percentage of disbursements at 97%, followed by ECA and LAC at 95, MNA at 91%, SAR at 85%, AFW at 82%, and AFE at 76%. In the case of AFE, disbursements are likely to accelerate in the coming weeks with civil works contracts being completed under the Uganda operation, which closes on December 31, 2024. Likewise, AFW disbursements are likely to increase considerably as disbursements under the Niger operation should become fully disbursed with the procurement of equipment expected to be delivered and installed in the selected facilities by the closing date of December 31, 2024. As of December 16, 2024, there are 114 Bank-financed operations (including MPA-V operations) to support vaccine procurement and rollout in 78 countries amounting to $8.29 billion. 121 operations had been approved amounting to $10.1 billion, but five operations were cancelled: (i) Costa Rica loan ($120 million), (ii) Peru loan ($500 million), (iii) Gabon loan ($12 million) - the loan agreement lapsed, (iv) Philippines AF2 loan of $300 million, and (v) Guinea credit of $25.44 million. Also, a couple of TFs were cancelled. The Afghanistan operation commitment of $113 million was reduced to $60 million. Many operations have processed partial cancellations, thereby decreasing the overall commitments in the Jan 16, 2025 Page 2 of 11 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) past months. Also, when operations close, undisbursed funds are returned to the Bank and small adjustments causing overall commitments to reduce. In the past several months, partial cancellations amounting to $1,151 million have been processed under 32 operations. Out of the $1,151 million cancelled, $751 million were from IDA and $400 million from IBRD. Partial cancellations have been mainly a result of evolving needs in countries given the stage of the pandemia and donations of vaccines, which reduced the need for IBRD/IDA funds for their purchase. Guidance was issued on July 7, 2023, under an Email from the Global HNP Director, which provided direction for the use of undisbursed funds under COVID-19 operations. Thanks to this guidance, the restructurings have allowed in some cases adding as an activity under Component 1, the procurement of Routine Immunization vaccines given that the program for immunization in most countries suffered as funds and human resources were redirected to finance the pandemic. Of the 114 approved operations: (i) 65 are in Africa – 32 in AFE and 33 in AFW; (ii) 10 in East Asia and the Pacific; (iii) 11 in Europe and Central Asia; (iv) 11 in Latin America and the Caribbean; (v) 8 in Middle East and North Africa; and (vi) 9 in South Asia. The 114 operations approved, include 6 operations that involved restructuring of parent projects (Bhutan, Cameroon, North Macedonia, Philippines, and Pakistan) and in the case of Lebanon, restructuring of the Health Resilience Project. Thirty-two (32) operations are being implemented in Fragile and Conflict-affected situations. IDA represents 45 percent and IBRD 55 percent of disbursements. Eighteen (18) operations are fully disbursed (Argentina, Cambodia, El Salvador AF1 and AF2, Honduras, Indonesia, Iraq, Jordan, Nigeria, Panama, ROC F1 and AF2, S. Sudan AF2, Sri Lanka AF-V 1, Tunisia, Ukraine AF-V 3, West Bank and Gaza, and Zimbabwe). Thirty-nine (39) operations have disbursed 90%+ and sixteen (16) operations have disbursed 80%+. All 114 operations approved are disbursing. Retroactive Financing (RF) continues to represent 34 percent of overall commitments. ECA and SAR have the highest level of RF at 68 percent, LAC at 50 percent, AFE at 29 percent, and MNA at 28 percent. Disbursements to UN agencies represent 23 percent of overall disbursements, while Direct Payment represents 18 percent of disbursements. As with the COVID-19 MPA operations, streamlined procedures, delegated approval, wide use of Bank Facilitated Procurement (BFP), coupled with flexible project design, and intensified efforts from counterparts and Bank staff, have contributed to the rapid design, processing, and implementation of AF-V operations. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 09 - 12 Jun Proposed Rating 30 Apr 2020 2024 Political and Governance Moderate High Moderate Macroeconomic Substantial High High Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Jan 16, 2025 Page 3 of 11 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Moderate Substantial Moderate Overall Moderate Substantial Substantial Jan 16, 2025 Page 4 of 11 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes To prevent, detect and respond to the threat posed by COVID-19 Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Number of health facilities 0.00 Apr/2020 228.00 18-Jun-2022 228.00 10-Dec-2024 228.00 Jun/2021 and laboratories provided with personal protective equipment under the project (Number) Percentage of priority 0.00 Feb/2021 54.00 18-Jun-2022 54.00 10-Dec-2024 50.00 Mar/2025 populations vaccinated based on targets defined in national plan, total (Percentage) Percentange of priority 0.00 Feb/2021 54.00 18-Jun-2022 54.00 10-Dec-2024 50.00 Mar/2025 populations vaccinated based on targets defined in national plan by gender (Percentage) Number of hospitals 0.00 May/2022 0.00 18-Jun-2022 0.00 10-Dec-2024 25.00 Jun/2023 equipped with chronic case management equipment (Number) Number of hospitals with 0.00 May/2022 0.00 18-Jun-2022 0.00 10-Dec-2024 10.00 Jun/2023 strengthened emergency care capacity (Number) Jan 16, 2025 Page 5 of 11 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) 6.2 Intermediate Results Indicators by Components Emergency COVID-19 Response Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Percentage of Project 0.00 Apr/2020 100.00 18-Jun-2022 100.00 10-Dec-2024 100.00 Jun/2021 supported health facilities and laboratories confirming receipt of equipment within 14 days of in-country delivery of such equipment (Percentage) Support Health Systems Strengthening Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year No committee Feb/2021 Committee 18-Jun-2022 Committee 18-Jun-2022 Committee Mar/2025 Functional National with clear established established established Coordinating Committee (or terms of and and and the engagement of an reference, operational operational operational existing committee) for roles, COVID-19 vaccine responsibilities introduction is in place and regular (Text) meetings defined COVID-19 vaccine delivery No specific Feb/2021 Operational 18-Jun-2022 Operational 18-Jun-2022 Operational Mar/2025 strategies to reach identified strategies strategies strategies strategy target groups are defined defined defined to defined to defined to Jan 16, 2025 Page 6 of 11 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) and include women in hard identify and identify and identify and to reach areas and frontline deliver deliver deliver health workers (Text) vaccines to vaccines to vaccines to targeted targeted targeted groups to groups to groups to ensure high ensure high ensure high coverage coverage coverage Percentage of people 0.00 Feb/2021 97.00 18-Jun-2022 97.00 18-Jun-2022 70.00 Mar/2025 reached by messages and/or Comments on According to the Iterative Beneficiary Monitoring (IBM) survey finalized in May 2022, 97 materials to explain the achieving targets percent of the sample has reported having received sufficient information regarding the vaccination campaign, total vaccination campaign. (Percentage) Percentage of people 0.00 Feb/2021 97.00 18-Jun-2022 97.00 18-Jun-2022 70.00 Mar/2025 reached by messages and/or materials to explain the vaccination campaign by gender (Percentage) Percentage of beneficiaries 0.00 Feb/2021 39.00 18-Jun-2022 39.00 18-Jun-2022 70.00 Mar/2025 reporting that community Comments on According to the Iterative Beneficiary Monitoring (IBM) survey, 39 percent of the population engagement processes were achieving targets was aware of engagement processes, including on reporting of grievances. effective (transparent, inclusive, responsive), total (Percentage) Percentage of 0.00 Feb/2021 39.00 18-Jun-2022 39.00 18-Jun-2022 70.00 Mar/2025 beneficiaries reporting that community engagement processes were effective (transparent, inclusive, Jan 16, 2025 Page 7 of 11 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) responsive), by gender (Percentage) Functional health No functional Feb/2021 Information 18-Jun-2022 Information 18-Jun-2022 Information Mar/2025 management and health system for system for system for information system to deploy management COVID-19 COVID-19 COVID-19 the COVID-19 vaccine is in and vaccine vaccine vaccine place, including information deployment is deployment is deployment is identification, registration system for in place and in place and in place and and follow up with recipients COVID-19 functional functional functional by gener age and locality vaccine in (Text) place Percentage of female 0.00 Feb/2021 60.00 02-Aug-2021 60.00 02-Aug-2021 60.00 Mar/2025 community workers (as a Comments on No new data was available on this since August 2021. share of total community achieving targets workers) providing vaccine information compared to baseline (Percentage) 41.00 Feb/2021 75.00 18-Jun-2022 75.00 18-Jun-2022 70.00 Mar/2025 Comments on A Facebook survey which was implemented in December 2021 - January 2022 demonstrated achieving targets 85 percent of the population agreeing with the importance of the vaccine, the rate being Share of people agreeing with the importance of the identical for men and women; ie no gender gap regarding coverage. Results from the Iterative vaccine, total (Percentage) Beneficiary Monitoring (IBM) survey conducted in May 2022 point to a slight decline in this, with 78 percent of women and 72 percent of men agreeing with the importance of the vaccine (75 percent overall). Share of people 41.00 Feb/2021 78.00 18-Jun-2022 78.00 18-Jun-2022 70.00 Dec/2025 agreeing with the importance of the vaccine, by gender (Percentage) Jan 16, 2025 Page 8 of 11 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) Number of public 0.00 Dec/2025 0.00 31-Dec-2025 0.00 10-Dec-2024 40.00 Dec/2025 laboratories with improved pathogens detection capacity (Number) Jan 16, 2025 Page 9 of 11 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) 7. DATA ON FINANCIAL PERFORMANCE 7.1 Cumulative Disbursements 7.2 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed IBRD-94110 Effective 22.00 22.00 0.00 22.57 0.00 100.00 % IBRD-91120 Effective 20.00 20.00 0.00 20.52 0.00 100.00 % IBRD-92230 Effective 100.00 100.00 0.00 92.36 0.25 99.73% TF-B8616 Effective 1.80 1.80 0.00 1.80 0.00 100.00 % Jan 16, 2025 Page 10 of 11 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) 7.3 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing IBRD-91120 Effective 30-Apr-2020 11-May-2020 01-Jun-2020 30-Jun-2021 31-Dec-2025 IBRD-92230 Effective 26-Mar-2021 31-Mar-2021 26-May-2021 31-Mar-2025 31-Dec-2025 IBRD-94110 Effective 24-May-2022 13-Jun-2022 12-Oct-2022 31-Mar-2025 31-Dec-2025 TF-B8616 Effective 10-May-2022 13-Jun-2022 13-Jun-2022 31-Mar-2025 31-Dec-2025 8. KEY DATES Key Events Planned Actual Approval 30-Apr-2020 30-Apr-2020 Effectiveness 01-Jun-2020 01-Jun-2020 Mid-Term Review No. 01 01-Jun-2022 01-Jun-2022 Operation Closing/Cancellation 31-Dec-2025 9. RESTRUCTURING HISTORY Restructuring Level 2 Approved on 10-Jun-2021 Restructuring Level 2 Approved on 21-Mar-2024 10. ASSOCIATED OPERATION(S) There are no associated operations Jan 16, 2025 Page 11 of 11