Document of
The World Bank
FOR OFFICIAL USE ONLY
Report No: ICR00006655
IMPLEMENTATION COMPLETION AND RESULTS REPORT
Credit No IDA-58820; IDA-58830; IDA-58840; IDA-D1290
Grant No IDA-D1290; IDA-D1300; IDA-D1310; IDA-E1330
ON GRANTS
IN THE AMOUNTS OF SDR 7.1 MILLION (US$10 MILLION EQUIVALENT) TO THE REPUBLIC OF
GUINEA, SDR 7.1 MILLION (US$10 MILLION EQUIVALENT) TO THE REPUBLIC OF SIERRA LEONE
AND SDR 14.2 MILLION (US$20 MILLION EQUIVALENT) TO THE ECONOMIC COMMUNITY OF
WEST AFRICAN STATES
AND CREDITS
IN THE AMOUNTS OF SDR 14.2 MILLION (US$10 MILLION EQUIVALENT) TO THE REPUBLIC OF
GUINEA, EURO26.4 MILLION (US$30 MILLION EQUIVALENT) TO THE REPUBLIC OF SIERRA
LEONE, AND SDR 14.2 MILLION (US$20 MILLION EQUIVALENT) TO THE REPUBLIC OF SENEGAL
AND A MULTI-DONOR TRUST FUND FROM DEPARTMENT OF FOREIGN AFFAIRS, TRADE AND
DEVELOPMENT IN CANADA IN THE AMOUNT OF US$4.06 MILLION TO THE ECONOMIC
COMMUNITY OF WEST AFRICAN STATES
Regional Disease Surveillance Systems Enhancement (REDISSE)
(First Phase in a Series of Projects)
June 4, 2024
Health, Nutrition & Population Global Practice
Western And Central Africa Region
CURRENCY EQUIVALENTS
(Exchange Rate Effective May 30, 2024)
Currency Unit = CFAF, GNF, SLL
604.4 (CFAF); 8600
US$1
(GNF); 22500 (SLL) =
US$ = SDR 1 = 0.76
US$ = EUR 1 = 0.92
FISCAL YEAR
July 1 - June 30
Regional Vice President: Ousmane Diagana
Country Director: Boutheina Guermazi
Regional Director: Juan Pablo Eusebio Uribe Restrepo
Practice Manager: Carolyn J. Shelton
Moussa Dieng, Djibrilla Karamoko, Andre L. Carletto,
Task Team Leaders:
Yohana Dukhan, Zenab Konkobo Kouanda
ICR Main Contributor: Ilias Hamdouch
ABBREVIATIONS AND ACRONYMS
ADM Accountability and Decision Making
AIDS Acquired Immunodeficiency Syndrome
AITA Association International de Transport Aérien
AHM Assembly of Health Ministers
AFENET African Field Epidemiology Network
AM Aide Memoire
ANAFIC Agence Nationale de Financement des Collectivités
CAR Central African Republic
CAHWs Community Animal Health Workers
CCISD Canadien International pour la Santé et le Développement
CDC Center for Disease Control and Prevention
CEDEAO Communauté Économique des États de l’Afrique de l’Ouest
CERC Contingent Emergency Response Component
CES Center for Epidemiologic Surveillance
CCISD Center for International Cooperation in Health and Development
CPF Country Partnership Framework
CPS Country Partnership Strategy
DRC Democratic Republic of Congo
DHIS2 District Health Information Software 2
DSRS Disease Surveillance and Response System
EBS Event-based Surveillance
ECCAS Economic Community of Central African States
ECOWAS Economic Community of West African States
EID Emerging Infectious Diseases
EPT Emerging Pandemic Threats Program
EOC Emergency Operation Center
EROM Emergency Response Operational Manual
ESF Environmental and Social Framework
ESMF Environmental and Social Management Framework
ESMP Environmental and Social Management Plan
EVD Ebola Virus Disease
FETP Field Epidemiology Training Program
FELTP Field Epidemiology and Laboratory Training Program
Programme de Formation en épidémiologie de terrain et en laboratoire
FMx Fondation Mérieux
GEMS Geo-Enabling for Monitoring and Supervision
GHSA Global Health Security Agency
GGE Gross Government Expenditure
GGHE Gross Government Health Expenditure
GRM Grievance Redness Mechanism
HPAI Highly Pathogenic Avian Influenza
HCWMP Health Care Waste Management Plan
H5N1 Influenza Hemagglutinin 5 and Neuraminidase 1 (Highly pathogenic avian influenza)
H1N1 Influenza Hemagglutinin 1 and Neuraminidase 1 (Swine Flu)
H7N9 Influenza Hemagglutinin 7 and Neuraminidase 9 (Bird Flu)
HIV Human Immunodeficiency Virus
ICR Implementation Completion and Results Report
IDA International Development Association
IDSR Integrated Disease Surveillance and Response
IHPAU Integrated Health Project Administration Unit
IHR International Health Regulations (Règlement Sanitaire International)
IPC Infection, Prevention and Control
IPVMP Integrated Pest and Vector Management Plan
INSP Institut National de la Sante Publique
ISM Implementation Support Mission
ISO International Organization for Standardization
ISR Implementation Status Report
JEE Joint External Evaluation
LIMS Laboratory Information Management System
LNERV Laboratoire National de l'Elevage et de Recherches Vétérinaires
(National Livestock and Veterinary Research Laboratory)
MERS-CoV Middle East Respiratory Syndrome Coronavirus
MAF Ministry of Agriculture and Forestry
MOA Ministry of Agriculture
MoHS Ministry of Health and Sanitation
MPA Multiphase Programmatic Approach
MTR Mid-term Review
NPHA National Public Health Agency
NASPH National Action Plan for Health Security
NCD Non-communicable Diseases
NCDC Nigeria Center for Disease Control
NSPRP National Surveillance, Preparedness and Response Plan
OHCM One Health Coordination Mechanism
OIE (WOAH) World Organization for Animal Health), formerly called OIE (Office International
des Epizooties)
OOAS Organisation Ouest Africaine de la Santé (West Africa Health Organization)
OOP Out-of-Pocket
PAD Project Appraisal Document
PAPD Liberia- Pro-Poor Agenda for Prosperity and Development
PIU Project Implementation Unit
PDO Project Development Objective
PEF Pandemic Emergency Financing Facility
PHEIC Public Health Emergency of International Concern
PIU Project Implementation Unit
PIM Project Implementation Manual
PMP Project Management Plan
PoE Points of Entry
PVS Performance of Veterinary Services (Pathway)
RAHC ECOWAS Regional Animal Health Center
RCSDC Regional Center for Surveillance and Disease Control
REDISSE Regional Disease Surveillance Systems Enhancement
RIAS Regional Integration Assistance Strategy
RRT Rapid Response Teams
RSC Regional Steering Committee
RSI Règlement Sanitaire International (International Health Regulations)
RVF Rift Valley Fever
SAMU Service d’Aide Medicale d’Urgence (Medical Emergency Support Service)
SDG Sustainable Development Goals
SOP Series of Interrelated Projects
SOPs Standard Operating Procedures
STEP Systematic Tracking of Exchanges in Procurement
TADs Transboundary Animal Diseases
TEPHINET Training Programs in Epidemiology and Public Health Interventions Network
ToC Theory of Change
TTL Task Team Leader
UHC Universal Health Coverage
UNDP United Nations Development Program
USAID United States Agency for International Development
US CDC United States Center for Disease Control
VS Veterinary Services
WAEMU West African Economic and Monetary Union
West Africa Health Organization (Organisation Ouest Africaine de la Santé)
WARDS West African Regional Disease Surveillance Strengthening Project
Projet Régional de Renforcement des Capacités en Surveillance Épidémiologique et
en Afrique de l’Ouest
WASH Water, Sanitation and Hygiene
WB The World Bank
WHO World Health Organization
WOAH World Organization for Animal Health, formerly called OIE
TABLE OF CONTENTS
DATA SHEET .......................................................................................................................... 1
I. PROJECT CONTEXT AND DEVELOPMENT OBJECTIVES ....................................................... 6
A. CONTEXT AT APPRAISAL .........................................................................................................6
B. SIGNIFICANT CHANGES DURING IMPLEMENTATION (IF APPLICABLE) ..................................... 15
II. OUTCOME .................................................................................................................... 17
A. RELEVANCE OF PDOs ............................................................................................................ 17
B. ACHIEVEMENT OF PDOs (EFFICACY) ...................................................................................... 18
C. EFFICIENCY ........................................................................................................................... 27
D. JUSTIFICATION OF OVERALL OUTCOME RATING .................................................................... 30
E. OTHER OUTCOMES AND IMPACTS (IF ANY) ............................................................................ 31
III. KEY FACTORS THAT AFFECTED IMPLEMENTATION AND OUTCOME ................................ 33
A. KEY FACTORS DURING PREPARATION ................................................................................... 33
B. KEY FACTORS DURING IMPLEMENTATION ............................................................................. 34
IV. BANK PERFORMANCE, COMPLIANCE ISSUES, AND RISK TO DEVELOPMENT OUTCOME .. 36
A. QUALITY OF MONITORING AND EVALUATION (M&E) ............................................................ 36
B. ENVIRONMENTAL, SOCIAL, AND FIDUCIARY COMPLIANCE ..................................................... 38
C. BANK PERFORMANCE ........................................................................................................... 40
D. RISK TO DEVELOPMENT OUTCOME ....................................................................................... 43
V. LESSONS AND RECOMMENDATIONS ............................................................................. 44
ANNEX 1. RESULTS FRAMEWORK AND KEY OUTPUTS ........................................................... 46
ANNEX 2. BANK LENDING AND IMPLEMENTATION SUPPORT/SUPERVISION ......................... 72
ANNEX 3. PROJECT COST BY COMPONENT ........................................................................... 77
ANNEX 4. EFFICIENCY ANALYSIS ........................................................................................... 78
ANNEX 5. BORROWER, CO-FINANCIER AND OTHER PARTNER/STAKEHOLDER COMMENTS ... 86
ANNEX 6. SUPPORTING DOCUMENTS (IF ANY) ..................................................................... 93
ANNEX 7. THE JOINT EXTERNAL EVALUATION (JEE) TOOL ..................................................... 94
ANNEX 8. THE ONE HEALTH APPROACH ............................................................................... 96
ANNEX 9. PDO OUTCOME INDICATORS EVALUATION ........................................................... 98
The World Bank
Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
DATA SHEET
BASIC INFORMATION
Product Information
Project ID Project Name
Regional Disease Surveillance Systems Enhancement
P154807
(REDISSE)
Country Financing Instrument
Western and Central Africa Investment Project Financing
Original EA Category Revised EA Category
Partial Assessment (B) Partial Assessment (B)
Organizations
Borrower Implementing Agency
ECOWAS, Republic of Guinea, Republic of Senegal,
WAHO
Republic of Sierra Leone
Project Development Objective (PDO)
Original PDO
The objectives of the Project are: (i) to strengthen national and regional cross-sectoral capacity for collaborative
disease surveillance and epidemic preparedness in West Africa, thereby addressing systemic weaknesses within the
animal and human health systems that hinder effective disease surveillance and response; and (ii) in the event of an
Eligible Emergency, to provide immediate and effective response to said Eligible Emergency.
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
FINANCING
Original Amount (US$) Revised Amount (US$) Actual Disbursed (US$)
World Bank Financing
10,000,000 9,594,380 9,351,795
IDA-D1290
20,000,000 19,173,534 18,828,042
IDA-58820
20,000,000 19,999,741 19,820,590
IDA-D1310
10,000,000 10,000,000 9,794,325
IDA-D1300
20,000,000 20,000,000 19,692,150
IDA-58830
30,000,000 30,000,000 29,347,555
IDA-58840
4,064,168 3,838,200 3,838,200
TF-A2534
8,960,731 7,032,805 6,433,172
TF-B1239
7,000,000 772,288 868,698
IDA-72270
5,000,000 1,318,935 1,588,969
IDA-E1330
Total 135,024,899 121,729,883 119,563,496
Non-World Bank Financing
0 0 0
Borrower/Recipient 0 0 0
CANADA: Canadian
International Development 4,064,168 0 0
Agency (CIDA)
Total 4,064,168 0 0
Total Project Cost 139,089,067 121,729,884 119,563,498
KEY DATES
Approval Effectiveness MTR Review Original Closing Actual Closing
28-Jun-2016 02-Dec-2016 30-Oct-2020 31-Jan-2023 31-Aug-2023
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
RESTRUCTURING AND/OR ADDITIONAL FINANCING
Date(s) Amount Disbursed (US$M) Key Revisions
30-Jan-2023 110.46 Change in Loan Closing Date(s)
09-Jun-2023 111.60 Reallocation between Disbursement Categories
29-Jun-2023 112.38 Change in Components and Cost
Cancellation of Financing
Reallocation between Disbursement Categories
31-Aug-2023 115.19 Change in Components and Cost
Cancellation of Financing
Reallocation between Disbursement Categories
KEY RATINGS
Outcome Bank Performance M&E Quality
Satisfactory Satisfactory Substantial
RATINGS OF PROJECT PERFORMANCE IN ISRs
Actual
No. Date ISR Archived DO Rating IP Rating Disbursements
(US$M)
01 20-Dec-2016 Satisfactory Satisfactory .50
02 28-Jun-2017 Satisfactory Satisfactory 6.85
03 03-Jan-2018 Moderately Satisfactory Moderately Satisfactory 8.97
04 21-Jun-2018 Moderately Satisfactory Moderately Satisfactory 13.28
05 20-Dec-2018 Moderately Satisfactory Moderately Satisfactory 17.24
06 31-May-2019 Moderately Satisfactory Moderately Satisfactory 28.70
07 16-Dec-2019 Moderately Satisfactory Moderately Satisfactory 40.94
08 15-Jun-2020 Satisfactory Satisfactory 63.26
09 23-Dec-2020 Satisfactory Satisfactory 77.36
10 22-Feb-2021 Satisfactory Satisfactory 82.53
11 20-Oct-2021 Satisfactory Satisfactory 96.02
12 16-Jun-2022 Satisfactory Satisfactory 104.30
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
13 17-Jan-2023 Satisfactory Satisfactory 110.46
14 31-Jul-2023 Satisfactory Satisfactory 112.97
15 07-Sep-2023 Satisfactory Satisfactory 115.19
SECTORS AND THEMES
Sectors
Major Sector/Sector (%)
Agriculture, Fishing and Forestry 8
Agricultural Extension, Research, and Other Support
8
Activities
Health 89
Public Administration - Health 48
Health 41
Social Protection 3
Social Protection 3
Themes
Major Theme/ Theme (Level 2)/ Theme (Level 3) (%)
Human Development and Gender 0
Disease Control 0
Pandemic Response 1
Health Systems and Policies 52
Health System Strengthening 52
Urban and Rural Development 16
Rural Development 16
Rural Infrastructure and service delivery 16
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The World Bank
Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
ADM STAFF
Role At Approval At ICR
Regional Vice President: Makhtar Diop Ousmane Diagana
Country Director: Rachid Ben Messaoud Boutheina Guermazi
Juan Pablo Eusebio Uribe
Director: Timothy Grant Evans
Restrepo
Practice Manager: Trina S. Haque Carolyn J. Shelton
Moussa Dieng, Djibrilla
John Paul Clark, Hadia Nazem Karamoko, Andre L. Carletto,
Task Team Leader(s):
Samaha, Bleoue Nicaise Ehoue Yohana Dukhan, Zenab
Konkobo Kouanda
ICR Contributing Author: Ilias Hamdouch
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The World Bank
Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
I. PROJECT CONTEXT AND DEVELOPMENT OBJECTIVES
A. CONTEXT AT APPRAISAL
Regional and Country Context
1. West Africa has been and continues to be a region where approximately more than one third of the global disease
burden affects the human population. Emerging and re-emerging diseases at the human-animal interface have been
occurring with increased frequency. The region has experienced expansion of human settlements, increased
exploitation of natural resources and intensifying agricultural and livestock production, all of which increase the risk
of outbreaks. Countries in this region are at high-risk for infectious disease outbreaks including those of animal origin
(zoonotic diseases). The World Health Organization (WHO) has documented at the time of REDISSE preparation that
of the 55 disease outbreaks that were reported in Africa over the last decade, 42 took place in West Africa. Some
common outbreaks in the region include cholera, dysentery, hemorrhagic fevers (e.g., Ebola virus disease, Rift Valley
fever, Crimean-Congo hemorrhagic fever, Lassa fever, and Yellow fever), and meningococcal meningitis. West Africa
also bears a disproportionate burden of malaria, tuberculosis, acquired immunodeficiency syndrome (HIV/AIDS) and
neglected tropical diseases, many of which are at risk of resurgence due to drug and insecticide resistance.
2. The 2014 West Africa Ebola outbreak challenged the weak surveillance systems and raged unabated for over
eighteen months in the absence of rapid diagnostic tests, treatment, and vaccine availability. While efforts to
strengthen health surveillance, preparedness and response systems in the West Africa region started in 2010, they
remained very limited. In October 2013, a US$10.75 million trust fund-financed operation known as the West Africa
Regional Disease Surveillance and Capacity Strengthening (WARDS) project1 (P125018) was prepared and approved.
This program was critical in identifying challenges in strengthening surveillance and preparedness capacities in the
region and in developing the West Africa Health Organization (WAHO) capacity as an important regional partner to
collaborate with in future surveillance systems development programs. At the time of the West Africa Ebola
outbreak, the WARDS project was the only pandemic preparedness strengthening project in the region.
3. The Ebola Virus Disease epidemic in West Africa reinforced the critical importance of strengthening national
disease surveillance systems and inter-country collaboration to detect disease outbreaks earlier and respond more
swiftly and effectively to minimize the loss of human lives and economic costs. The World Bank estimated2 the
overall economic impact of the Ebola crisis to be US$2.8 billion (US$600 million for Guinea, US$300 million for Liberia,
and US$1.9 billion for Sierra Leone) between 2014 and 2016. This assessment also highlighted that the economic
and fiscal impact outlasted the epidemiological impact. The outbreak also demonstrated that there can be rapid
spread and large spill-over effects of a disease that can transcend local and national boundaries. In fact, Ebola
emerged in a remote rural area of Guinea but spread rapidly not only to densely populated urban centers within the
country, but also to neighboring nations given the interconnected communities along their borders (Liberia, Sierra
Leone), within the broader sub-region (Mali, Nigeria, Senegal), and then to other parts of the globe given the
interconnectedness of today’s commerce and transport systems.
4. The concept of the Regional Disease Surveillance Systems Enhancement Program (REDISSE) was groundbreaking
and linked to the commitment that the global community made to the countries of West Africa considering the
1https://projects.worldbank.org/en/projects-operations/project-detail/P125018
2https://www.worldbank.org/en/topic/macroeconomics/publication/2014-2015-west-africa-ebola-crisis-impact-
update#:~:text=Summary.,%241.9%20billion%20for%20Sierra%20Leone
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
huge human and economic costs of Ebola. The objective was to strengthen weak human health, animal health, and
disaster response systems to improve the preparedness of the region to handle future epidemics, and thereby
minimize the subnational, national, regional, and potential global effects of such disease outbreaks. Moreover, the
regional approach was essential to ensure cross-learning, joint planning and harmonized capacity building between
countries, sectors and communities. The surveillance and response capacity of the regional system depends on the
strength of the individual national systems and the front-line or community-level capacities that need to be in place
throughout the countries. In other words, REDISSE thus proposed to strengthen the full “value-chain” of disease
surveillance across communities, sectors and nations.
5. Experience with previous outbreaks also cemented the importance of the regional dimension to strengthening
health security. The West Africa Ebola outbreak, which began in an area bordering the three most affected
countries3, highlighted the need for collective action and cross-border collaboration as essential to enhance country,
regional, and global health security. At the time of REDISSE’s preparation, there was already a clear understanding
among the global health community that, because pathogens do not respect country borders, regional dimensions
for effective disease surveillance and response were needed4. While implementation of the International Health
Regulations (IHR) is focused on national compliance, in the years prior to project appraisal, there was increased
recognition of the importance of regional perspectives, in terms of cross sectoral collaboration and identifying locally
appropriate strategies.
6. Over the last four decades, the world has witnessed one to three newly emerging infectious diseases annually . Of
infectious diseases in humans, the majority has its origin in animals, with more than 70 percent of emerging zoonotic
infectious diseases coming from wildlife. Since the beginning of the century, outbreaks such as COVID-19, Ebola viral
disease, H5N1 H1N1 and H7N9 influenza, the Middle East respiratory syndrome (MERS-CoV), the Marburg virus, the
Nipah virus infection provide abundant evidence of the catastrophic health and economic effects of emerging and
re-emerging zoonotic diseases. In this West Africa, emerging and re-emerging infectious diseases at the human-
animal ecosystems interface are occurring with increased frequency, driven by land use changes, forest
fragmentation, urbanization among other factors. As evidenced by the 2014-2016 Ebola outbreak in Guinea, Sierra
Leone, and Liberia, and the re-occurrence and spread of H5N1 Highly Pathogenic Avian Influenza (HPAI), highly
contagious diseases can easily cross borders in the region through the movements of people, animals, and goods.
7. Animal health is critical to public health and to the sustainable growth of the livestock sector. Livestock farming
plays an important role in the Economic Community of West African States (ECOWAS) region, contributing an
average of 44 percent to its agricultural GDP. Livestock farming concerns virtually all rural households are important
assets for vulnerable communities which rely on animals for food, income, and as a store of wealth, collateral or
safety net in times of needs. Locally, livestock are key to social cohesion and stability, in both sedentary and
pastoralist communities, and a crucial factor in combating rural poverty. ECOWAS has a trade deficit in animal
products, which is particularly acute in the coastal countries. Demand for livestock products is expected to continue
to grow significantly in the next decades, based on demographic trends, and propelled by increased urbanization
and incomes. This evolution implies higher risks of occurrence of disease (frequency and/or severity), and higher
impact of these diseases. In addition, food insecurity and other vulnerabilities increase further risk of emerging
infectious diseases. The harvest of wildlife for human consumption is globally valued at several billion dollars
annually and provides an essential source of meat for hundreds of millions of rural people living in poverty. Food
3 Guinea, Liberia, and Sierra Leone
4Insert literature backing this sentence, that was also in the PAD. Katz and Standley BMC Public Health 2019. Regional Approaches
for Enhancing Health Security.
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
insecurity is often a corollary to increased use of wildlife as a source for food, increasing contamination and spillover
risks through contact with infected wild animals. Hence the importance of animal health, both domestic and wildlife.
8. In line with the global agenda on health security, REDISSE was a major opportunity to facilitate the adoption of
One Health Approach, which focuses on cross-sectoral collaboration between the health, agriculture, and
environment sectors. The One Health Approach is a collaborative, multisectoral, and transdisciplinary approach with
the goal of achieving optimal health outcomes, recognizing the interconnection between people, animals, plants,
and their environment. The approach involves policy and regulatory harmonization, cooperation, and coordination,
between animal health, human health, and environment at multiple levels within the country sectors, and across
countries, for earlier detection of infectious diseases, and a more effective response to outbreaks. At the time of
project preparation, the concept of One Health was not yet well established and had not yet been well developed in
practice. The REDISSE program sought to invest in establishing One Health in the countries it covered but the
inclusion of the One Health approach came with challenges, both during project preparation and implementation.
Successful implementation of One Health required commitments at several levels to work in a coordinated manner
across disciplines that had traditionally worked in silos. It involved changing the way sectors work and sharing
approaches and resources, such as information systems. Changes in paradigms such as these take time to be
established. For more information on One Health, see Annex 8.
Sectoral and Institutional Context
9. For most of the Sub-Saharan African countries, at the time of appraisal, national disease surveillance systems and
preparedness infrastructure remained weak, with 61 percent of the general population5 in the region living in rural
areas where basic access of health care was even more limited than in urban centers. Most countries suffered from
chronic shortages of financial and human resources, weak institutional capacity, confined sectoral collaboration
centered around human health, absence of cross-sectoral collaboration, inadequate health information systems,
prevailing inequity and discrimination in availability of services, limited sub-national engagement and absence of
community participation and lack of transparency and accountability, and a need for management capacity building.
In general, public-sector spending on health was generally low. Meanwhile, out-of-pocket (OOP) spending on health
was high throughout the sub-region, and for the REDISSE I countries, the OOP spending ranged from a low of 34
percent in Senegal to a high of 76 percent of total health expenditure in Sierra Leone (see table 1). At the time of
appraisal, none6 of the ECOWAS member states exceeded the 2021 Abuja target of 15 percent of Gross Government
Expenditure (GGE) allocated to health.
Table 1: Comparative analysis of Public Health Expenditure
Country GGHE as % of GGE OOP as % of THE THE Per Capita GGE as % of GDP
Guinea 7 67 32 2
Senegal 10 34 51 3
Sierra Leone 12 76 96 2
Source: WHO, WHO African Region Expenditure Atlas, 2014
Note: GGHE, Gross Government Health Expenditure; GGE, Gross Government Expenditure; OOP, Out of Pocket Payment;
THE, Total Health Expenditure.
5https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS?locations=ZG
6https://documents1.worldbank.org/curated/en/735071472096342073/pdf/108008-v1-REVISED-PUBLIC-Main-report-TICAD-UHC-
Framework-FINAL.pdf
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
10. Important progress was achieved when countries began to assess their health security capacity following the
adoption of the World Health Organization and partners’ Joint External Evaluation (JEE) Tool – International Health
Regulations (2005) (JEE-IHR). This allowed countries to identify their health security needs and to prioritize
opportunities for enhanced preparedness, response and action and through regular evaluations. According to the
2019 Global Health Security Index7, Sierra Leone, Senegal and Guinea were all among second-tier nations and ranked
respectively 92nd, 95th and 125th among 195 nations. It is important to note that JEE scores were dependent on
reaching a specific benchmark which was used as a proxy to determine the level of progression but did not consider
the plethora of related achievements that took place prior to reaching the benchmark. Therefore, a country could
make significant progress and still not meet the criteria for a higher score. Moreover, the JEE scores were dependent
of several other factors including the WHO external evaluators’ judgment and the version of the JEE tool used for
the evaluation. The JEE tool, first launched in 2016, has evolved over the years to address technical limitations and
challenges identified through its application.
11. Due to its size, the REDISSE Program was conceived as a Series of Projects (SOP). The ambitious vision for REDISSE
was to cover all ECOWAS countries, with phases covering groups of countries. REDISSE I started in 2016, with Guinea,
Sierra Leone, and Senegal. It included a regional International Development Association (IDA) grant and donor co-
financing for the WAHO, with a vision that the WAHO would play a role in the entire SOPs. Between phases I and II,
some countries lost motivation to engage in efforts to strengthen national surveillance and response systems and
be part of the program, as the Ebola outbreak had been resolved and the sense of urgency had dissipated. The
preparation team worked diligently to reignite country commitments and was successful. REDISSE II supported
Guinea-Bissau, Liberia, Nigeria and Togo, as the second phase of the program8. REDISSE III supported Mali,
Mauritania, Benin and Niger in the third phase of the program. Finally, REDISSE IV supported the Democratic Republic
of Congo (DRC), Central African Republic (CAR), Chad, the Republic of Congo and the Economic Community of Central
African States (ECCAS) in the last phase of the program. It was always understood that countries in the REDISSE
operation were entering the program at different levels of capacity and with different baseline levels in terms of IHR
capacities or JEE scores.
Theory of Change (Results Chain)
12. Causality: The Project Development Objectives (PDOs) at appraisal were: (i) to strengthen national and regional
cross-sectoral capacity for collaborative disease surveillance and epidemic preparedness in West Africa, thereby
addressing systematic weaknesses within the animal and human health sector that hindered effective disease
surveillance and response; and (ii) in the event of an Eligible Emergency, to provide immediate and effective response
to said Eligible Emergency. The key expected long-term outcomes of the project were: (a) improve health outcomes
and reduce vulnerability; and (ii) mitigate the human and economic burden of disease outbreaks.
13. The PAD did not include a Theory of Change (ToC) as it was not mandatory before May 2018.. For this
Implementation Completion and Results Report (ICR), the project’s Theory of Change is constructed ex-post and has
7 https://ghsindex.org/report-model/e
8 REDISSE III was under incipient preparation at the time of appraisal to support Benin, Burkina Faso, Cote d’Ivoire and Ghana.
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
been retrofitted from the Project’s Results Framework and its detailed description9,10. The TOC was built on the logic
that activities addressing the weaknesses in the human and animal health systems would strengthen national and
regional capacity for disease surveillance in the four countries. It was also predicated on the logic that activities
would build cross-sectoral and inter-country collaboration, which would strengthen disease surveillance systems,
and preparedness and response capacities. The activities under Component 1 would contribute to strengthen
national surveillance and reporting systems, and their interoperability at national, decentralized, and local levels: (i)
supporting coordinated community-level surveillance systems and processes across the animal and human health
sectors; (ii) developing capacity for interoperable surveillance and reporting systems, and (iii) establishing an early
warning system for infectious disease trends prediction. Activities under Component 2 would contribute to
establishing networks of public health and veterinarian laboratories for diagnosis of infectious human and animal
diseases and a regional networking platform to improve collaboration on research. Activities under Component 3
would enhance preparedness and response capacity, improving local, national, and regional level capacity. The
component also included a sub-component to support the governments’ immediate response in case of an outbreak.
The TOC also included activities under Component 4 to strengthen human resources across the main themes
Components 1, 2 and 3, surveillance, laboratories and preparedness and response, and contributing to strengthen
countries’ capacity to plan for and improve management of human resources. Activities under Component 5 would
provide cross-cutting critical institutional support identified in all three countries. This would also support the
external independent evaluation of critical animal health and human health capacities of national systems using
reference tools (JEE and World Organization of Animal Health (WOAH) formerly known Office International des
Epizooties (OIE) Performance of Veterinary Services (PVS)).
14. For the achieved outcomes to be sustained, identified assumptions in terms of long-term development were as
follows: (a) countries embracing the One Health approach, and figuring out how best to establish this high-level
strategic discussion and collaborative space; (b) governments would allocate national budgetary resources to animal
health and human health sectors to sustain the improved capacities built with REDISSE’s funding; (c) participating
governments’ commitment to the successful achievement of the REDISSE’s outcomes would remain sustained; (d)
relevant government authorities would remain committed to the implementation of their national public health
agendas and international commitments (such as the 2005 IHR); and (e) the WB would remain committed to
providing adequate financial and technical resources to support countries’ efforts towards improving national and
regional capacity for pandemic preparedness and response.
15. Figure 1 presents the Theory of Change for the REDISSE I Project.
9 “Supporting Africa’s Transformation: Regional Integration and Cooperation Assistance Strategy for FY2018-FY2023”. The World Bank Report
No. 121912-AFR
10
REDISSE was aligned with the Regional Integration Assistance Strategy (RIAS) in its goal of building coordinated interventions to provide
regional or global public goods such addressing disease threats.
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
Figure 1: REDISSE - Theory of Change
Activities Intermediate Results Outcomes PDO
Surveillance and information systems: • Collaboration and exchange of
• Establish linkages between information across countries Increased
surveillance information systems improved. collaboration and Strengthen
(human and animal; sub-national, • Community/local-level surveillance integration for national and
national and regional). and response processes are surveillance and regional cross-
preparedness
• Develop/enhance early warning strengthened. sectoral
• Progress towards establishing event- across sectors, capacity for
systems for surveillance, inc. analysis
based surveillance systems. across countries collaborative
and predictions.
• and regional level.
• Implement cross-border surveillance Better integration/ interconnection of disease
collaboration activities. surveillance and surveillance
Increased and epidemic
• Train human and animal health information/reporting systems across
animal and human health sectors. effectiveness in preparedness
community/field level staff for
• Surveillance work and processes disease in West Africa.
detection and reporting.
surveillance, early
• Conduct Field Epidemiology Training across the human and animal health
sectors are improved and better detection, and Provide
Program (FETP) for staff at different
coordinated (progress towards reporting. immediate
levels and across sectors (human and
animal health). operationalizing One Health and effective
approach) Systemic response to
• Improve infrastructure and weaknesses in
equipment of health facilities. • Systems for effective reporting to emergencies.
human and animal
• Harmonize protocols and guidelines. relevant organizations are improved.
health sectors
Laboratory capacity: • Capacity to analyze/predict epidemic
(human resources,
• Improve infrastructure, equipment trends is improved.
quality data,
and supplies of laboratory facilities planning) are
and networks. • Laboratory facilities upgraded, reduced.
• Increase laboratory services. connected as a network (sub-
• Strengthen lab information systems. nationally, nationally and regionally) Increased capacity
• Strengthen integration of lab info • Laboratory testing capacity for for immediate and
systems with disease surveillance and detection of priority diseases effective response
reporting syst. increased. to an eligible public
• Improve sub-national, national and • Specimen management systems health emergency
regional lab specimen referral and improved. at sub-national,
transportation systems. • Regional reference laboratory national and
• Strengthen quality assurance systems networking functions enhanced. regional levels.
and accreditation processes.
Preparedness and Emergency Response:
• Develop/update National Emergency • Multi-hazard emergency
Preparedness and Response Plans. preparedness and response plans Long-term Outcomes
• Strengthen Emergency Operating implemented.
Center infrastructure. • Mechanisms for responding to known Strengthen health systems to
• Strengthen risk communication infectious zoonoses and potential (i) improve health outcomes and reduce
mechanisms. zoonoses established and operational. vulnerability
• Conduct simulation exercises. • EOC Surge capacity and stockpiling (ii) mitigate /reduce human and
• Deploy resources for outbreak mechanisms established at national economic burden of disease outbreaks
response. and regional levels.
HR Management for Surveillance and
Preparedness: • Availability and capacity of human
• Carry out HR mapping and gap resources to implement IHR core
capacities is increased. Inputs Financing, equipment,
analysis. logistics, technical assistance (WB &
• Train human resources at central and • Capacity and competency public
health and veterinary health WAHO), grievance redress
decentralized levels (surveillance,
preparedness, response, one health). workforce increased. mechanism, ESF tools. WBG global
• Recruitment of surveillance and expertise, convening power and
• Cross-border collaboration and reputation as a fair broker.
laboratory staff
information exchange improved.
Institutional Capacity Building, Coordination
and Advocacy: • Regional public health institutions are
strengthened.
• Build capacities in public health
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collaboration mechanism established
• Establish One Health coordination
and functional.
platforms.
The World Bank
Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
Project Development Objectives (PDOs)
16. The PDOs of the REDISSE I were: i) to strengthen national and regional cross-sectoral capacity for collaborative
disease surveillance and epidemic preparedness in West Africa, thereby addressing systemic weaknesses within the
animal, the wildlife and the human health systems that hinder effective disease surveillance and response; and ii) in
the event of an Eligible Emergency, to provide immediate and effective response to said Eligible Emergency.
17. The achievement of the PDOs was to contribute to the higher outcome of building coordinated interventions to
provide regional public goods; and of improving regional collaboration across borders to address disease threats (a
public good). The achievement of the PDOs was expected to contribute to increased growth, ending extreme
poverty, and boosting shared prosperity.
18. Project beneficiaries were the populations of ECOWAS and ECCAS economic communities particularly REDISSE 16
participating countries. REDISSE I was expected to directly benefit 33.3 million people11 whose livelihoods might be
affected by diseases. Moreover, REDISSE I was expected to indirectly benefit 259 million people12 of all 16
participating countries thanks to WAHO regional interventions and technical support to all countries. Secondary
beneficiaries included public and private service providers and national and regional institutions involved in human
and animal health.
Key Expected Outcomes and Outcome Indicators
19. The main expected Project outcomes, as included in the PAD were:
• PDO 1 – Strenghtened capacity at national and regional level, at cross-sectoral level, for collaboratively
surveillance and for epidemic preparedness.
• PDO 2- Improved cacpity to respond immediately and effectively to an eligible emergency.
20. The Project was expected to contribute to the following outcomes and achievements
• Developed capacity (national and regional) to fully implement the Integrated Disease Surveillance and
Response (IDSR).
• Developed capacity (national and regional) to comply with international standards for veterinary services.
• Efficient collaboration and synergies between human and animal epidemiological surveillance and response
networks, at national and regional levels.
21. The PDO-level results indicators for REDISSE I project, were measured primarily drawing on the WHO’s Joint
External Evaluation (JEE) tool, as follows:
PDO 1:
(i) Progress towards establishing an active, functional regional One Health platform (Number Based on 5 point
Likert scale);
11Data from PAD1752: 12.3 million in Guinea, 14.7 million in Senegal and 6.3 in Sierra Leone)
12Data from PAD1752 (REDISSE I), PAD2200 (REDISSE II) , PAD 2595 (REDISSE III) , PIDA26738 (REDISSE IV) and 2015 population figures from
https://data.worldbank.org/
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(ii) Laboratory testing capacity for detection of priority diseases: number of countries that achieve a JEE score
of 4 or higher out of 5;
(iii) Progress in establishing indicator and event-based surveillance systems: number of countries that achieve
a JEE score of 3 or higher out of 5;
(iv) Availability of human resource to implement IHR core capacity requirements: number of countries that
achieve a JEE score of 3 or higher out of 5;
(v) Progress on cross-border collaboration and exchange of information across countries: number of countries
that achieve a score of 4 or higher out of 5.
PDO 2:
(vi) Multi-hazard national public health emergency preparedness and response plan is developed and
implemented: number of countries that achieve a JEE score of 4 or higher out of 5;
22. The REDISSE Program drew most of its RF indicators from the JEE Tool, which assesses country capacities to prevent,
detect, and respond to public health risks, in line with the International Health Regulations (IHR). At appraisal, the
Bank made a conscious decision to use the JEE framework, signaling its alignment, along with all development
partners, to the newly developed tool (the JEE) and its agreement to work together with partners in contributing to
support countries to strengthen their preparedness capacities and progressively achieve higher JEE scores. The
consensus between global, regional and national stakeholders was that JEE indicators were adequate to (i) monitor
the project’s implementation progress and achievement of the PDOS and (ii) facilitate the dialogue between all
relevant partners contributing to the health security agenda in those countries. The choice of JEE indicators also
reflected the synergistic approach of the REDISSE program to complement ongoing efforts by development partners
(see Annex 7 for more details). It is important to note, however, that while the project contributed to improved
scores, the project alone was not responsible for the achievement of the score. Moreover, the JEE scores themselves
were not expected to fully reflect and record all the progress made by countries in improving and strengthening their
preparedness capacities. The JEE measures certain aspects of preparedness and are used as a proxy to measure a
level or preparedness. See section on Outcomes and on Quality of M&E for more details.
Components
23. The project design included five components as follow:
• Component 1. Surveillance and Information Systems (Original cost: US$27.91 million. Actual cost: US$39.03
million). The component aimed to enhance national surveillance systems and processes at the different tiers of the
health systems. This component focused on the regional, national and sub-national surveillance of priority diseases
(including emerging, re-emerging, and endemic diseases) and the timely reporting of human public health and animal
health emergencies in line with the International Health Regulations (IHR -2005) and the World Organization for
Animal Health (OIE) Terrestrial Animal Health Code. The three main sub-components were: (1.1). Support
coordinated community-level surveillance systems and processes across the animal and human health sectors; (1.2).
Develop capacity for interoperable surveillance and reporting systems; and (1.3). Establish an early-warning system
for infectious disease trend tracking and reporting.
• Component 2. Strengthening of Laboratory Capacity (Original cost: US$17.03 million. Actual cost: US$20.38
million). The project sought to address critical laboratory systems weaknesses across countries, fostering cross-
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
country and cross-sectoral (at national and regional levels) collaboration. This component aimed not only to establish
networks of efficient, high quality, accessible public health, veterinary and private laboratories for the diagnosis of
infectious human and animal diseases, but also to setup a regional networking platform to improve collaboration for
laboratory investigation, to align with internationally recognized practices and to ensure prompt and high-quality
results. The three main sub-components were to: (2.1). Develop capacity for interoperable surveillance and reporting
systems; and (2.2). Improve data management and specimen management systems; (2.3). Enhance regional
reference laboratory networking functions.
• Component 3. Preparedness and Emergency Response (Original cost: US$25.96 million. Actual cost: US$27.76
million). This component supported national and regional efforts to enhance infectious disease outbreak
preparedness and response capacity. The project aimed at improving country and regional surge capacity to ensure
a rapid response during an emergency. The three main sub-components were: (3.1). Enhance cross-sectoral
coordination and collaboration for preparedness and response; (3.2). Strengthen capacity for emergency response;
and (3.3). Contingency Emergency Response (CERC). This last sub-component introduced flexibility to the project to
improve Governments’ rapid response capacity in the event an emergency.
• Component 4. Human Resource Management for Effective Disease Surveillance and Epidemic Preparedness
(Original cost: US$14.10 million. Actual cost: US$14.53 million). This component was crosscutting of the previous
three. This aimed to strengthen government capacity and competency to plan, implement, and monitor human
resource interventions. This would be a strategic lever to strengthen surveillance activities and to ensure a rapid
response to disease outbreaks. The two main sub-components were: (4.1). Healthcare Workforce mapping, planning
and recruitment; and (4.2). Enhance Health Workforce training, motivation, and retention.
• Component 5. Institutional Capacity Building, Project Management, Coordination, and Advocacy (Original
cost: US$29.06 million. Actual cost: US$33.43 million). This component focused on all aspects related to project
management. This also provided for critical cross-cutting institutional support, meeting capacity-building and training
needs, in addition to the support provided across the previous four components. In technical terms, this supported
the routine external independent assessment of critical animal health and human health capacities of national
systems using reference tools (JEE and WOAH - OIE PVS) of IHR core capacities to identify weaknesses and monitor
progress. And in institutional terms, this supported the establishment of national and regional One-Health
coordination platforms for the purpose of developing synergies, joint planning, implementation, and communication.
The two main sub-components were: (5.1). Project coordination, fiduciary management, monitoring and evaluation,
data generation and knowledge management and; (5.2). institutional support, capacity building, advocacy, and
communication at the regional level.
• Project Institutional Arrangements were both at regional and national levels. At the regional level, the project
implementation was led by WAHO, which hosted a secretariat for regional coordination and was financed exclusively
through the REDISSE I Project. Country implementation included several institutions (ministries of health, agriculture,
and environment, national laboratories, and centers of health and/or disease control). In all countries, one
implementing unit coordinated implementation by sectoral ministries, departments, agencies (MDAs) and NGOs. As
countries sought to establish the One Health approach, they sought to put in place multi-sectoral national steering
and technical committees that involved other actors (ministries of finance, defense, interior, education and
international development partners) across the health security value chain.
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
B. SIGNIFICANT CHANGES DURING IMPLEMENTATION (IF APPLICABLE)
24. Figure 2 presents the REDISSE I Project timeline and major milestones that took place during the life of the Project.
25. The PDO did not change during the life of the Project. The REDISSE I was restructured six times: (i) November 2019;
(ii) December 2022; (iii) January 2023; (iv) June 2023; and (v) August 2023 in the last two times.
26. Restructuring No. 1 was carried out in November 2019 to introduce the following changes in the Results Framework:
(i) incorporate revised baseline data and targets for project indicators based on the initial JEE assessments carried out
between 2016 and 2018; (ii) eliminate inconsistencies between the regional and the country targets. This involved
changing IRI-14 which initially considered the total number of beneficiaries (country nationals, partner institutions
and providers) was replaced by the number of people trained in intervention epidemiology (front line, intermediate,
advanced) including the percentage of women trained in Field Epidemiology and Laboratory Training Program (FELTP);
(iii) remove an indicator that was not proving to be useful (IRI-12 which measured the timeframe for laboratory
examinations (date of collection – date of receipt of results) for priority diseases (number of countries with a lead
time of 3 days or less); and (iv) add an indicator to monitor access by men and women to training opportunities
financed by the project at the regional and country level.
27. The first restructuring also included additional financing (AF) to the REDISSE MDTF in the amount of US$8.96 million
(TF0B1239) to support ECOWAS. As agreed with the Government of Canada, these funds were made available to
WAHO to cover ongoing activities and to set up an additional 100 Centers for Epidemiologic Surveillance (CES) bringing
the total number of CES to 147 in selected ECOWAS countries. The AF became effective on March 17, 2020.
Subsequently, contracts were signed with the Center for International Cooperation in Health and Development
(CCISD) and Fondation Mérieux (FMx) to implement the next phase of the work (53 CES13).
13 The distribution of CES among countries is: 10 in Benin, 10 in Mali, 10 in Mauritania, 10 in Niger and 13 in Nigeria.
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
28. Restructuring No. 2 provided another AF in the amount of US$12 million (IDA Grant US$5.00 million for WAHO, and
IDA Credit US$7.00 million for Senegal) and was approved by the WB’s Board of Executive Directors on December 6,
2022. This AF allowed WAHO and Senegal to (i) replenish funds used for Covid-19; (ii) complete planned activities
(regional and country level) agreed upon with the clients; (iii) to ensure that the activities introduced in the AF, the
closing date for REDISSE I was extended as follows: (a) Senegal (No. 5884-SN), Guinea (No. 5883-GN and No. D1300)
and ECOWAS (No. D1310, TF0A2534 and TF0B1239) from January 31, 2023 to August 31, 2023; and (b) Sierra Leone
(No. 5882-SL and No. D1290-SL) to June 30, 2023. Given the delays in project implementation and activity completion
due to the Covid-19 pandemic, the extension of the closing date allowed for the completion of several pending
activities and the full utilization of the remaining undisbursed amount of the parent Project as well as the AF.
29. Restructurings No. 3 through 6: The last four restructurings in the final months of the project were necessary to
approve a project extension and to reflect cancellations and reallocation of funds post COVID-19. The third
restructuring extended the project closing date from January 31, 2023 to August 31, 2023 that was aligned with the
closing date of REDISSE II. The last three restructuring were processed to reflect the cancellation of unused funds and
their recommitment to the countries’ national portfolio budget allocation consistent with the Investment Project
Financing Procedures.
Budget Changes to Components
30. In responding to the Covid-19 pandemic crisis, all implementation parties (WAHO and countries) of REDISSE I
reallocated US$16.72 million from component 2 to component 3 to deploy the sub-component 3.3 (CERC). This
flexible mechanism enabled Governments and WAHO to cope with the COVID-19 onset jointly and swiftly until
additional sources of funding become available to further cope with the COVID-19 pandemic.
Rationale for Changes and Their Implication on the Original Theory of Change
31. The restructurings carried out did not have any impact on the theory of change as the PDO or the associated
indicators, and the project intent remained intact. Moreover, the adoption of the JEE among global and regional
health security stakeholders implied a learning phase as the three participating countries carried out their first JEE
self-assessment, which provided preliminary data about country-level capacities. These initial assessments required
adjusting the results framework baselines, targets, and the harmonization of regional and national annual targets14.
As noted above, the results framework was also adjusted to capture outcomes related to gender, incorporating this
cross-cutting dimension of the Project support. The COVID-19 pandemic was a unique chance to test the results chain
in a real-world scenario at regional and national scale.
14Baselines were established and end targets. In hindsight, given countries baselines values, end targets appear to have been overly ambitious
for some indicators.
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
II. OUTCOME
A. RELEVANCE OF PDOs
Assessment of Relevance of PDOs and Rating
Rating: High
32. The PDOs were and remain highly relevant and aligned with the WB mission to end extreme poverty and promote
shared prosperity on a livable planet in the participating countries and across the region. At appraisal, the PDOs
were highly relevant, as the project was prepared in the aftermath of the 2014-2016 West Africa Ebola crisis, which
had emphasized the critical importance of strengthening regional and national disease surveillance systems and cross-
border collaboration to detect disease outbreaks swiftly and respond rapidly and effectively. Considering the lessons
learned from the Ebola outbreak, the PDOs aimed in the long run to improve human health outcomes in the targeted
populations, recognizing and containing outbreaks, reducing morbidity and mortality due to some of the most
prevalent zoonotic diseases, which in turn contribute to the WB mission. Moreover, the One Health approach which
integrated improving animal health and wildlife conditions as these were often the root cause from which zoonotic
diseases tended to originate and to spread. At completion, the PDOs remained highly relevant, as strengthening
regional and national surveillance systems, improving preparedness and response capacity continue to increasingly
pertinent, as proven by the COVID-19 pandemic.
33. At appraisal and completion, the PDOs were aligned with and built on international guidelines and health
regulations. Namely, the WHO International Health Regulations (IHR 2005, revised in 2007), the One Health Agenda,
the Global Health Security Agenda, Universal Health Coverage (UHC), the OIE Terrestrial Animal Health Code and
Manual, and the Sustainable Development Goals (SDG). From the global standpoint, the PDOs were in line with the
US Government Global Health Security Agenda15 that was established in 2014 in partnership with the United States
Center for Disease Control (US CDC), the United States Agency for International Development (USAID) (Emerging
Pandemic Threats Program16 (EPT)) and WHO among others. At the regional level, the PDOs were aligned with the
goals set by the Economic Community of West African States (ECOWAS) Member States to design a robust regional
and national One Health Coordination Mechanism (OHCM)17.
34. The PDO relevance is considered high given the critical need to strengthen the regional health security agenda by
continuing to finance WAHO capacity development drawing on the lessons learned from WB WARDS project.
Through REDISSE phase I, WB financed WAHO to provide technical assistance to participating countries across phases
of the program. The technical assistance was often tailored to the needs of the countries of the ECOWAS and the
ECAAS. Moreover, the WB18 formalized its partnership with WHO and CDC in 2018 among others to collaborate
synergistically, to harmonize the M&E system and to further expand the regional reach of the health security agenda.
15 https://www.cdc.gov/globalhealth/security/what-is-ghsa.htm
16 https://www.usaid.gov/emerging-pandemic-threats-program
17 WHO, Report on One Health Technical and ministerial Meeting to Address Zoonotic Diseases and related Public Health Threats, WHO, 2016.
View: https://www.afro.who.int/sites/default/files/2018-
02/Report%20of%20the%20One%20Health%20Technical%20and%20Ministerial%20Meeting%20--%20Dakar_.pdf
18 https://www.worldbank.org/en/news/press-release/2018/05/24/who-and-world-bank-group-join-forces-to-strengthen-global-health-
security
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Following the COVID-19 pandemic, these formal partnerships have secured19 further financing and technical
assistance for pandemic preparedness and response. Lastly, the PDOs were aligned with the Regional Integration and
Cooperation Assistance Strategy for the period Fiscal Year (FY) FY21-FY23 which explicitly covered pandemic response
and disease surveillance.
35. The PDOs were strongly aligned with the Country Partnership Frameworks (CPF) and Country Partnership
Strategies’ (CPS) main goals and pillars for the period FY 2017 -2023 for all three REDISSE I countries. These key
documents focused on strengthening health systems’ capacity including disease surveillance, to improve health
outcomes and reduce vulnerability. COVID-19 rendered the PDOs even more relevant, as REDISSE’s activities aimed
to strengthened regional and national surveillance systems, enabling better preparedness and response capacity to
quickly contain an outbreak. For Guinea, the PDOs were aligned with all four pillars of the CPF for the period FY18-23
[Report No. 125899-GN], namely these pillars include: (i) promoting good governance for sustainable development;
(ii) sustainable and inclusive economic transformation; (iii) inclusive development of human capital; and (iv) the
sustainable management of natural capital. In the case of Senegal, the PDOs were aligned with the main areas of
focus of the CPF for the period FY20-24 [Report No. 143333-SN], namely these included: Foundation Pillar –
Strengthening Governance Framework and Building Resilience and Pillar 2 to improve service delivery. In the case of
Sierra Leone, the PDOs remained aligned with the second focus area of the CPF for the period FY21-25 [Report No.
148025], namely this tackles human capital acceleration for inclusive growth which aims at addressing advancing skills
development, delivering quality human health services, and expanding safety nets.
B. ACHIEVEMENT OF PDOs (EFFICACY)
Assessment of Achievement of Each Objective/Outcome
Rating: Substantial
Assessment of Measurement of PDOs and Rating
36. The assessment of achievements of outcomes for REDISSE I as well as for the REDISSE Program as a whole, is a
complex exercise. REDISSE I and the REDISSE Program drew most of its Results Framework indicators from the WHO
JEE tool, which was launched in 2016. On the one hand, the decision of adoption the JEE framework was a sound one.
It was a conscious decision to join a global effort to support countries strengthen their national capacities to prevent,
detect, and respond to public health risks in line with the IHR, and progressively improve their JEE scores. As
mentioned in paragraph 22, the project was contributing to, but was not responsible for, the country’s achievement
of a particular score. In addition, the JEE scores alone do not necessarily the real progress made by countries in
strengthening capacities. Significant progress may be achieved without reaching a higher JEE score. This is dependent
on reaching a specific benchmark which is used a proxy to determine the level of progression but does not consider
the abundance of related achievements that take place prior to reaching the benchmark. Simply put, if a country has
made substantial progress but does not meet the specific criteria for a given score, the score given will be one level
below. Moreover, the JEE score, while important, is dependent of several factors including the WHO external
evaluators and the version20 of the JEE tool used for the evaluation. Finally, the JEE specific targets associated with
19https://www.who.int/news/item/09-09-2022-new-fund-for-pandemic-prevention--preparedness-and-response-formally-established
20 The JEE was first released in 2016. In 2018 WHO issued a version 2.0 which made compliance with scores for a few indicators more
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
the particular score have been updated to push the envelope and promote progress in terms of strengthening
preparedness capacity. In some instances the targets at the start of the project did represent the same target that at
the end of the project. Nevertheless, the JEE tool is still well aligned with the spirit of what the REDISSE project was
aiming to achieve: strengthening disease surveillance and epidemic preparedness. Therefore, the ICR team agreed
that assessing the achievement of outcomes mainly by reaching the JEE scores would be misleading, given that
REDISSE II contributed to achievements together with other partners. The ICR reports on the actual progress achieved
by countries in each of the key elements of epidemic preparedness, with REDISSE’s support. Annex 1.C, prepared by
the ICR team, includes the JEE scores, showing the progress in national capacities, towards the achievement of the
scores. The ICR looks at the critical elements in strengthening surveillance, preparedness and response systems and
assesses the achievements in laboratory capacity, capacity building in human and animal health, evidence-based
surveillance systems and the establishment of a cross-sectoral collaboration.
37. The COVID-19 pandemic, and the response efforts needed to address it, shifted the priority between the two
dimensions of the PDO, leaning heavier than originally planned towards response to an eligible emergency . The
emergency response carried out under REDISSE I during the global pandemic meant putting on hold temporarily a
number of planned activities. At the same time, the COVID-19 pandemic provided a unique and timely opportunity
for countries to use the surveillance and preparedness capacity recently built with support from the Project for a real
outbreak situation.
38. By completion, REDISSE I had succeeded in strengthening disease surveillance, preparedness, and response
capacities across human health and animal health sectors in the three participating countries. By completion, with
REDISSE I support, participating countries had strengthened their laboratory capacity, their surveillance capacity, their
preparedness capacity, the capacity of their human resources for IHR requirements and had strengthened regional-
level collaboration (facilitating knowledge and information sharing and exchange), regional coordination (common or
aligned policies and technical strategies) and resource sharing (training institutions and reference laboratories). While
not all countries fully met their target JEE scores, there was substantial progress across most of them. Also, progress
continued under the subsequent and ongoing REDISSE operations which provide strong sustainability for the results
attained.
39. The achievement of outcomes of REDISSE I was assessed across the two dimensions of the PDO : (i) Strengthen
national and regional cross-sectoral capacity for collaborative disease surveillance and epidemic preparedness in
West Africa, and (ii) in the event of an Eligible Emergency, provide immediate and effective response. While the first
dimension of the PDO has a national and regional element, and REDISSE I countries benefited from regional-level
activities, financing to support the implementation of regional activities (led by WAHO) was channeled exclusively
through the REDISSE I project. In addition, the assessment of the two elements of the first dimension, disease
surveillance and epidemic preparedness, is also done jointly. The reason for the joint assessment is that these two
elements are intertwined. Strengthening epidemic preparedness includes a combination of multiple elements, such
as surveillance, laboratories, human resources, information systems, referral systems, etc. Strengthening all of these
elements results in a stronger epidemic preparedness.
stringent. The 3rd edition was launched in 2021.
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
PDO 1: To strengthen national and regional cross-sectoral capacity for collaborative disease surveillance and epidemic
preparedness in West Africa. Rating: Substantial
40. The achievement of the PDO 1 was measured by five outcome indicators and fifteen IRIs.
41. Surveillance capacity at regional level was significantly strengthened. By completion, under WAHO leadership and
with its support of individual countries, surveillance systems for preparedness and response had been significantly
strengthened with REDISSE’s support. Regular regional collaboration around health security was established which
resulted in 28 joint missions between WAHO and WB to provide technical support of all 16 participating countries
across REDISSE phases. This enabled cross-pollination between countries to take hold particularly to lift weaker
countries and to improve cross-sectoral collaboration and knowledge sharing among the stronger countries. For all
participating countries, significant progress was achieved on cross- border collaboration and exchange of information
across countries (PDO indicator 6). This materialized in modernization of equipment (laboratory, digital computing,
logistics, etc.) and harmonization of strategies, policies and operational guidelines and tools (laboratory standards,
One Health Secretariat establishment, capacity building, etc.). Moreover, it enabled the mainstreaming of technical
expertise acquired through regional collaboration at the national level. WAHO and all REDISSE I countries actively
participated in regional meetings and followed up on the main strategic recommendations and action plans. By
completion, WAHO was significantly strengthened in its role as the regional surveillance coordinator thanks to the
achievement of interoperable and interconnected real-time reporting systems (IRI 1), surveillance systems in place
for priority zoonotic diseases (IRI 3), applied epidemiology training programs in place such as FETP (IRI 6) and
established mechanisms for responding to infectious zoonoses (IRI 8).
42. Surveillance capacity at national level was significantly strengthened. By completion, participating countries had
strengthened their human and animal health surveillance systems at the national and sub-national levels, especially
at the community level (PDO Indicator 3). With REDISSE’s support, national stakeholders were much better equipped
and trained which drastically improved the capacity to ensure early detect health events, report them quickly,
investigate them promptly and respond swiftly. Participating countries successfully implemented interoperable and
interconnected real-time reporting systems (IRI 1), except Senegal. With REDISSE’s support, the participating
countries successfully established indicator and event-based surveillance systems (PDO indicator 3) except Guinea.
However, all participating countries reached their target to strengthen surveillance systems for priority zoonotic
diseases and pathogens (IRI 3). By completion, countries also successfully setup systems for efficient reporting to
WHO, OIE/FAO on health events across sectors (IRI 7).
43. PDO Indicator 1: Progress towards establishing an active functional regional One-Health platform - Substantially
Achieved. Major progress was made with most the requirements achieved to establish and to sustain the national
cross-sectoral Permanent Secretariat and all three countries have organizational structures which are increasingly
becoming an integral part of the national healthcare infrastructure21. At the regional level, the REDISSE I supported
WAHO to define an action plan for cross-border collaboration and technical assistance which was endorsed by the
participating countries. At the national level, the REDISSE I supported countries to transition to the One Health
paradigm starting with no capacity at baseline to having a governance structure established, endorsed and
decentralized at the provincial and district level. The project supported the national establishment of OneHealth
Permanent Secretariats, OneHealth inter-ministerial committees, OneHealth technical working groups and focal
points in each sector to advance the One Health agenda. At project closure, it is important to highlight: (i) A regional
21https://www.afro.who.int/countries/sierra-leone/news/sierra-leone-launches-national-public-health-agency-strengthen-healthcare-
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OneHealth platform has been established in 2017 as ECOWAS’s human, animal and environmental health sectors
institutional planning and decision-making body. In addition, WAHO provided support to operationalize the Regional
Animal Health Center (RAHC), the ECOWAS agency responsible for animal health, which should play a key role
supporting One Health in the region; (ii) Guinea has developed a National Strategic Health Plan22 (2019-2023) and a
governance manual that established the One Health platform hosted at the Ministry of Health with rotating leadership
from different sectors; (iii) Senegal has also defined a National Strategic Health Plan (2019-2023) that integrates the
One Health approach. In September 2022, a decree23 established a One Health High Council at the Prime Minister’s
office that coordinates planning with development partners24 and facilitates technical working groups across key
issues;( iv) In 2017, Sierra Leone established a One Health platform and One Health Secretariat hosted at the Ministry
of Health and Sanitation. Moreover, the government of Sierra Leone defined the National One Health Strategic Plan25
2019-2023 as a key pillar of the 2018 National Action Plan for Health Security. The One Health platform and its
institutional governance served to mainstream the cross-sectoral surveillance and preparedness at the district level
across the national territory.
44. PDO Indicator 2: Laboratory testing capacity for detection of priority diseases – Fully Achieved. WAHO supported
national laboratories across sectors with upgraded their equipment, improved their service quality and processing
time and trained their staff. Moreover, the collaboration among these national laboratories has improved as they
have organized themselves as a regional network of both human and animal health laboratories, including two
Research Institutes (Pasteur Institute in Dakar and Abidjan). National laboratory systems across REDISSE I countries
are performing core tests for human health priority diseases including Measles, Yellow fever, Cholera, Influenza, PCR
and HIV, in additional to regional laboratories that detect Ebola, Lassa fever, Zika and Monkey pox. Additional projects
have been established including a reference laboratory accreditation program, a regional observatory to monitor
antimicrobial resistance and a biobank in Institut Pasteur Abidjan with the support of WAHO in collaboration with
Africa CDC, FAO, USAID and WHO. In Guinea, with the support of REDISSE and other partners (Expertise France,
USAID/IDDS/FAO and AFD/LABOGUI), the laboratory system’s capacities have highly achieved the detection and
surveillance of priority diseases. In most cases, the diagnostic takes 48 to 72 hours unlike previously when samples
had to be shipped out of the country and the results required several weeks. In Guinea and Senegal, the national
veterinary laboratories have not been upgraded due respectively to land ownership issue and to a limited contractor’s
delivery capacity.
45. PDO Indicator 3: Progress in establishing indicator and event-based surveillance systems – Fully Achieved. This has
contributed largely to strengthening regional, national and sub-national surveillance systems and provided continuity
to scale this successful pilot systems which was initiated in 2011 as part of the WARDS project. In collaboration with
WHO and the University of Oslo, WAHO indeed accelerated the implementation a regional Datawarehouse, the
District Health Information Software 2 (DHIS-2) just-in-time for the Covid-19 pandemic. In fact, this platform was
interconnected to the national epidemiology surveillance databases in the first three years across REDISSE
participating countries and began to harmonize and to systematically consolidate outbreak data since 2020 at a
national and sub-national level. Despite some discrepancies with the WHO Situational Reports this critical information
could be shared in user-friendly dashboards on a weekly basis regionally and worldwide which proved valuable
especially for neighboring countries to swiftly contain the evolution of the Covid-19 spread. As the emergency of the
22 https://portail.sante.gov.gn/wp-content/uploads/2023/02/Plan_National-de-D%C3%A9veloppement-Sanitaire-2015-2024-Ao%C3%BBt-2015.pdf
23 https://www.sec.gouv.sn/publications/lois-et-reglements/decret-ndeg-2022-1777-portant-repartition-des-services-de-letat-et
24 These development partners include the Food and Agriculture Organization (FAO), the United States Centers for Disease Control and Prevention (CDC), the
United States Agency for International Development (USAID), WHO and WB (where REDISSE AWBP activities are linked to this global national plan).
25 https://dhse.gov.sl/wp-content/uploads/2019/08/Communication_Sierra-Leone-One-Health-Communication-Strategic-Plan_May_2019-1.pdf
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pandemic settled, WAHO, WHO and countries pursued further harmonization and automatic data transfer process
improvements for 12 out of 15 countries currently covered. WAHO also expanded the data collection for all epidemic
prone diseases to strengthen the surveillance system in the region. REDISSE also supported Senegal, Sierra Leone
and Guinea with: (i) developing the 3rd edition26 of the Technical guidelines for Integrated Diseases Surveillance and
Response (IDSR 3); (ii) training surveillance focal points throughout the countries’ health pyramid on IDSR to detect
public health threats; (iii) supervising and ensuring quarterly coordination meetings across sectors; and (iv)
operationalizing community-based surveillance of priority diseases and zoonoses under the One Health approach
including specific surveillance protocols for wildlife, animal health and the construction and equipment of border
inspection posts.
46. PDO Indicator 4: Availability of human resources to implement IHR core capacity requirements. Partially achieved.
The supply of skilled workers was significantly increased through the training and hiring of resources in human and
animal health (IRI 6, 9, 11-14). At project completion, all three countries had demonstrated capacity in terms of
availability of human resources to implement IHR core capacity requirements (IRI 6) with FETP training programs in
place which fostered interuniversity and cross-sectoral collaboration to better understand the One Health Approach.
These aimed at building competency across key primary and secondary sectors to better coordinate and prepare for
health security interventions. Under REDISSE I, WAHO supported countries training of heads of CES and associated
laboratories with CCISD and FMx as implementing partners and supported countries with various FELTP frontline
training levels (basic, intermediate, and advanced) of national epidemiology and laboratory trainers and technicians.
For the FELTP Advanced training, one hundred human and animal health professionals recruited under REDISSE of
which 22 percent women also benefited from graduate programs financing in Burkina Faso and Ghana. In Guinea and
Sierra Leone, REDISSE contributed greatly to strengthening core IHR core capacities related to veterinary laboratory
teams and managers. All countries progressed and demonstrated capacity related to veterinary human health
workforce (IRI 9). However, a shortage of trained veterinary workers across these countries was driven by an aging
workforce that began to retire following the COVID-19 pandemic and could not be replaced fast enough. It is
important to note that there were also demand-side specifics in each country that the JEE could not take into
consideration. For instance, in Senegal REDISSE contributed to strengthening core IHR core capacities related to
military doctors and maritime health and food safety personnel to support the regional and national integration of
the One Health approach especially that Senegal plays an important trade partner role for the sub-region. Lastly, the
JEE version 2 introduced new requirements in 2018. The definition and implementation of a workforce strategy (IRI
4) became an integral part of this PDO which impacted its full achievement. All countries made significant progress
on drafting a public workforce strategy that included health professions. These evolving JEE requirements coupled
with rapidly shifting priorities at the onset of COVID-19 delayed progress of a workforce strategy.
47. PDO Indicator 6. Progress on cross-border collaboration and exchange of information across countries - Partially
achieved. With the support of the REDISSE I, WAHO facilitated an effective ramp-up of interoperability of monitoring
and reporting systems with exchange of outbreak data across countries by operationalizing its District Health
Information Software 2 (DHIS2) Datawarehouse in 12 out of 15 countries. This along with other harmonized
approaches (point of entry policy, sample collection, laboratory processing capacity, vaccination supply, beneficiary
communication, etc.) across countries achieved a more coordinated response that was instrumental at the onset of
the Covid-19 pandemic. In addition, key actions including specific trainings with WHO and Association International
de Transport Aérien (AITA) ensured that all countries have at least one AITA-trained and certified person with the
authority to approve air transportation of medical samples. This alone resulted in major reduction of processing time
26https://www.afro.who.int/publications/technical-guidelines-integrated-disease-surveillance-and-response-african-region-
third
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for samples to reach regional reference laboratories. At the country level, the REDISSE I built upon the Ebola project
among others to enable Sierra Leone and Guinea to make significant improvements in cross-border collaboration and
response to disease outbreaks by leading the development of six POE Standard Operation Procedures (SOPs) and
Point of Entry policy between both countries and Liberia. Quarterly cross border collaboration exercises in 7 Points
of entry (PoE) improved information sharing and preparedness for epidemic-prone diseases. In Senegal, significant
trainings and equipment upgrades took at place at border crossings (air, sea, and land) which fostered more effective
collaboration and control of epidemic transmission which was timely soon before the Covid-19 onset. Overall, the JEE
may not represent the full extent of progress made on cross-border collaboration as it focused on a national
perspective rather than the sub-national perspective of two regions that collaborated regularly as is the case of
several regions along the Guinean border. Moreover, the JEE scope is limited to bilateral collaboration rather than
multilateral collaboration that took place through WAHO.
48. Having a multi-hazard national public health emergency preparedness and response plan (PDO indicator 5) also
contributes to strengthening epidemic preparedness. However, since the PAD linked this PDO indicator to the second
dimension of the PDO, the assessment of achievements related to the indicators are discussed under the second
dimension of the PDO. It is important to note that having preparedness and response plans in place also contribute to
effective response to health emergencies (preparedness for response).
PDO 2: To provide immediate and effective response in the event of an Eligible Emergency is rated Substantial.
49. By completion, with REDISSE’s support, WAHO and all participating countries succeeded in providing immediate
and effective response for COVID-19 onset and other eligible health emergencies27. REDISSE I was critical to all three
countries and to all countries that WAHO was supporting as it provided the emergency financing to prepare for and
respond to the pandemic as soon as it was confirmed by WHO. REDISSE I served as a crucial bridge financing until the
approval and effectiveness of the COVID-19 Strategic Preparedness and Respond Program (SPRP) in each client
country. WAHO and the participating countries built their initial response to COVID-19 on the physical and institutional
capacity achieved through the REDISSE project prior to the crisis. With REDISSE’s support, WAHO and the countries
had enhanced infectious disease outbreak preparedness and response capacities. Across all countries and
stakeholders interviewed during the ICR missions, on the key highlights that was emphasized was the timeliness of
not only having REDISSE I technical assistance that prepared capacity to begin dealing with the crisis at hand, but also
that the REDISSE I has the necessary design flexibility which allowed a rapid shift of funding between Components to
reduce the rapid spread of COVID-19.The ICR findings were in line with IEG’s findings in their analysis of the WB
support to respond to COVID-1928. Prior cross-sectoral engagement, collaboration and previous engagement support
were also key in the timeliness and effectiveness of the COVID-19 response.
Preparedness for Immediate and Effective Response
50. The achievement of the PDO 2 was measured by two outcome indicators and two IRIs: (i) PDO Indicator 5: a multi-
hazard national public health emergency preparedness and response plan is developed and implemented; (ii) PDO
Indicator 6: progress on cross-border collaboration and exchange of information across countries; (iii) IRI 8.
Mechanisms for responding to infectious zoonoses and potential zoonoses are established and functional; (iv) IRI 15.
Regional surge capacity and stockpiling mechanism established.
27
Outbreaks during implementation in participating countries included Lassa, rabies and avian flu.
28
Independent Evaluation Group. 2019. IDA’s Crisis Response Window: Lessons from Independent Evaluation Group Evaluations,
World Bank, Washington, DC. 5
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51. PDO Indicator 5: Multi-hazard national public health emergency preparedness and response plan is developed and
implemented –Substantially Achieved. At a regional level, the target for PDO Indicator 5 was achieved. At a country
level, the target was achieved except in Guinea where significant progress was made although it was impacted by a
series of external setbacks including the coup of 2021 that triggered an OP7.30 which was outside of the project’s
control. Overall, REDISSE has effectively supported regional, national and subnational efforts to enhance infectious
disease outbreak preparedness and response capacity, which was evidenced by aligning most project activities with
each country’s National Action Plan for Health Security (NAPHS) which supported the quality and the adequacy of
countries and WAHO coordinated response to COVID-19 onset. REDISSE also contributed significantly to WAHO’s
development of a regional strategic preparedness and response plan for public health emergencies 2020-2024 to
build regional capacities for disease surveillance, prevention, and response. As part of this plan, the Regional Rapid
Response team has been established and the Manual of standard procedures developed and validated in 2018. The
plan was validated at the 20th Ordinary Assembly of Health Ministries of ECOWAS in 2019. At project closure, the
Regional Centre for Surveillance and Disease Control (RCSDC) is staffed, albeit not fully. At the national level, REDISSE
supported the strengthening of the coordination of responses and multi-sectoral collaboration in preparing for and
responding to public health emergencies. In Guinea, two simulation exercises were conducted to manage epidemic
alerts (Yellow Fever and Lassa Fever). Cholera sentinel sites have also been setup in high-risk areas. In Senegal, annual
simulation exercises were carried out to national multi-risk plans in case of an emergency or a disaster. In Sierra
Leone, an “All Hazard Plan” has been established and is regularly updated to address all forms of hazards including
flooding, land/mudslide, fire outbreaks and disease outbreaks.
52. IRI 8. Mechanisms for responding to infectious zoonoses and potential zoonoses are established and functional is
Fully Achieved. REDISSE I effectively supported regional and national efforts to enhance infectious disease outbreak
response capacity, which was evidenced by aligning key project activities with each country’s National Action Plan for
Health Security (NAPHS), carrying out field simulation exercises in different contexts to test the plan and
strengthening the One Health approach with the creation of Integrated Rapid response teams at national, subnational
and community level. WAHO supported and reminded countries to define and to implement these response
mechanisms. Sierra Leone, 4 table-top simulation exercises and one full scale rapid deployment of Interim Treatment
Facilities (RDITF) with the Military were held. In Guinea, emergency simulation exercises on Lassa fever and yellow
fever were carried out to test the level of the Regional, Prefectoral and Communal Epidemic Alert and Response
Teams. In Senegal, a field simulation exercise was held with the deployment of a mobile field hospital to assess the
rapid response capacity of the army health service to respond to an epidemic or during disasters requiring mass
casualty management (95 health professionals participated, including 15% women).
53. PDO Indicator 6: Progress on cross-border collaboration and exchange of information across countries - Partially
achieved. For more details, please refer to paragraph 45 in the previous page.
54. The project supported strengthening of Public Health Emergency Operations Centers across all countries. All
countries allocated resources to strengthen these capacities before the COVID-19 pandemic hit. The Regional Center
for Surveillance and Disease Control (RCSDC) at regional level is functional at decentralized level and around 100
hundred centers at national level were made operational and strengthened. REDISSE I provided support for managing
the emergency operating operation centers across all participating countries. In collaboration with other partners, it
also provided support for rolling out the implementation of the then new WHO Integrated Disease Surveillance and
Response (IDSR) across all countries. For example, REDISSE I funded the finalization of the third version of the IDSR
guidelines. IRI 15 on regional surge capacity and stockpiling mechanism was not achieved primarily due to the COVID-
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19 that not only diverted a large portion of the resources but also, disrupted global supply chains resulting in several
medications (ex: Rabies) becoming limited in the market.
Actual Response to Eligible Emergencies
55. REDISSE I was instrumental in the response to the COVID-19 pandemic. It allowed participating countries to
operationalize a fast response, given the availability of resources for health emergency response and the systems and
processes that were already in place through the ongoing work to strengthen surveillance and preparedness
capacities. For COVID-19, the response from all 3 countries was timely, as funds and human resources were available
and already working on preparedness. WAHO coordinated with countries during the early period of COVID-19 to
closely monitor the situation and to share information. With REDISSE funds channeled to the response, the country’s
health systems continued to be strengthened throughout all core capacities: surveillance, diagnosis, emergency
response, human resources, and institutional framework. In fact, because of the response to COVID-19 many of the
activities aimed to strengthen pandemic preparedness and response capacities were accelerated in the early days of
the emergency. In February 2020, there were only two labs with capacity in West Africa to test for COVID-19, at the
outset of the pandemic. By September 2020, all countries had established several laboratories (bringing the capacity
to 236 in all of ECOWAS).
56. WAHO response to COVID-19: REDISSE I contributed to a regional strategy to provide all 15 ECOWAS member states
and all 16 participating countries in West and Central Africa region the capacities and resources to ensure prevention
and early detection of COVID-19 including managing infectious cases and risk communication, fostering cross-border
and cross-border collaboration through systematic reporting regionally, nationally and sub-nationally as the One
Health approach was being established. Moreover, WAHO ensured the prompt procurement of laboratory equipment
and reagents, providing protective gears, viral transport media and HR training and pursuing increasing technical
support especially the REDISSE II and III countries29 as evidenced by the joint supervision missions that took place
between February 2020 and June 2022. Through REDISSE I intervention, the project also ensured that each member
state has at least one intensive care unit specifically dedicated to the treatment of critical cases of COVID-19 and all
the associated equipment including adequate ambulatory services, ventilators as well as adequate inventory of
testing kits and medicine.
57. Guinea response to COVID-19: REDISSE I was instrumental in developing the capacities of the newly established
Agence National de la Sécurité Sanitaire in 2016. The project also supported to acquisition of key equipment to ensure
an early detection of the COVID-19 pandemic. The new laboratory capacity reached 1,000 PCR tests a day in 12
laboratories, including 5 capable of sequencing. Nationally, strengthened coordination and multi-sector collaboration
was instrumental to cope with a public health emergency like COVID-19. At the sub-national level, the project
strengthened the surveillance activities through the ramp up of Regional, Prefectorial and Communal Alert and
Response Teams during the time of the COVID-19. In addition, the Project secured access to medicine to treat COVID-
19 cases and provided logistical means among response teams to expand their geographical reach.
58. Sierra Leone response to COVID-19: REDISSE I supported the development of Pandemic Influenza continuity plan
which was the basis an initial plan for the COVID-19 response. The project enabled activities across the six pillars of
29Between February 2020 and June 2022, the following country specific technical mission took place: REDISSE I (Sierra Leone and Senegal
(February 2020)), REDISSE II (Guinea Bissau (February 2020), Nigeria (March 2020), Liberia (Virtual, October 2020), Togo, (Virtual, March
2021), Togo, (Virtual, November 2021), Liberia (February 2022) and Togo (April and June 2022).
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the National Coronavirus Immediate Preparedness Plan (January 2020) including the acquisition of crucial equipment
to ensure an early detection of the COVID-19 pandemic. Nationally, the project rehabilitated emergency centers and
drastically improved laboratory capacities to ensure timely clinical and surveillance process thanks to a newly
established national network of 960 COVID-19 sample collectors (260 female and 700 male) trained to cover all district
laboratories. Moreover, the project contributed to significant improvement of cross-border collaboration and
response to disease outbreaks with the development of Point of Entry policy between Sierra Leone, Guinea and
Liberia. At sub-national level, a pilot project for an Integrated Laboratory Specimen Referral System made significant
improvement in sample referral, especially during COVID-19. The project also enhanced mobility (4 all terrain vehicles
and 149 motor bikes) for chiefdom surveillance officers.
59. Senegal response to COVID-19: REDISSE I supported Senegal in developing an integrated multi-sectoral preparedness
and response plan for natural disasters and public health emergencies such as COVID-19. This also enabled at the
national and sub-national level, the implementation of outbreak action plans that triggered a series of interventions
focused on strengthening coordination in disease surveillance and rapid response across the territory. REDISSE I was
crucial in developing the capacities of the recently established Centre des Opérations d'Urgence Sanitaire (COUS) in
2014. Just-in-time for COVID-19 onset, the project supported cross-border health risks management by training 158
Border Police officers and 121 border services field agents on strategies. REDISSE I also ensured the timely
procurement across the country of critical equipment for logistics to prevent and control infection, laboratory
diagnostic and biomedical waste management. Moreover, the project ensured risk communication management and
community engagement to best control infection during the evolution of rising cases at COVID-19 onset.
60. REDISSE I supported the response of other outbreaks. Across countries and diseases, the significant improvement of
laboratory capacities was a major factor to detect, to contain and to reduce disease outbreaks as it ensured national
self-sufficiency and reduced processing time to 48 to 72 hours unlike the Ebola Crisis when it took about 3 months to
get diagnostic results from overseas. WAHO and countries’ role in drastically improving data collection and analysis
was another important factor to ensure early detection of epidemic prone diseases. Nevertheless, several outbreaks
were observed and contained. In Senegal, the project was crucial in early detection and rapid response protocols
based on the type of disease outbreak. For instance, the project established bird flu control action plans in infected
regions (Dakar, St Louis, Louga, Ziguinchor, Fatick, etc.) and Crimy-Congo Hemorrhagic Fever action plans in infected
regions (Dakar, Louga, etc.). In Guinea, REDISSE I supported the national response to several outbreaks including
Avian Flu, Lassa Fever and rabies among others. The project helped conduct mass anti-rabies vaccination with the
acquisition of 100,000 doses of rabies vaccine for veterinary use and 6,427 doses of rabies vaccine for human use.
This effort included vaccination support (including vaccinator training, communication, and deployment) aimed at
95,000 dogs in 11 high-risk localities.
61. It is important to note that the first dimension of the PDO (strengthening disease surveillance and epidemic
preparedness) significantly contributed to the second dimension of the PDO (immediate and effective response to
an emergency). As discussed above, prior to the Covid-19 pandemic, participating countries had implemented (to
different degrees) activities to strengthen surveillance systems, including multi-sector national and sub-national
coordination and planning, hiring and training staff and community workers, acquiring logistical and digital
equipment. In addition, several activities related to developing the laboratory capacities included acquiring diagnostic
equipment and consumables such as laboratory reagents and improving quality of laboratory services from upstream
specimen referral and transportation to downstream processing time that were drastically reduced to mostly 48 to
72 hours. While achievements were different in each country, there was common progress on strengthening of
capacities and competencies to effectively respond to Covid-19 pandemic and other outbreaks (avian flu, Lassa fever,
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rabies among others) during the project implementation. As to the One Health collaboration in an emergency
response, it proved effective sub-nationally because of the authority governors have the power to direct resources
across regional representation of Ministries, Departments and Agencies.
Justification of Overall Efficacy Rating
Rating: Substantial
62. The overall rating for efficacy is deemed Substantial, given the significant achievements on both dimensions of the
PDO as summarized below:
a. Strengthened capacity at national and regional level, at cross-sectoral level, for collaboratively surveillance and
for epidemic preparedness, with substantial results at WAHO and in all three REDISSE I countries.
b. Improved capacity to respond immediately and effectively to an eligible emergency, with the response to not only
COVID-19 pandemic but also, Avian Flu in Senegal, Lassa fever and Rabies in Guinea among other outbreaks.
The project also contributed to the following achievements:
c. National and regional capacity developed capacity to implement the Integrated Disease Surveillance and
Response (IDSR), strengthened at community and decentralized level.
d. National and regional capacity developed to a certain degree to comply with international standards for
veterinary services30 despite being impacted by COVID-19.
e. Progress in implementing effective collaboration and synergies between human and animal epidemiological
surveillance and response networks, at national and regional levels successfully implemented, with a notable
learning curve reached and observable collaborative attitudes adopted regionally, nationally and sub-nationally.
C. EFFICIENCY
Assessment of Efficiency: Rating – Substantial
63. The cost of pandemics is on par with other high-profile economic threats that concern heads of state and policy
makers, such as climate change and natural disasters. The COVID-19 pandemic sent shock waves through the world
economy and triggered the largest global economic crisis in more than a century. The economic impacts of the
pandemic were especially severe in emerging economies where income losses caused by the pandemic revealed and
worsened preexisting economic fragilities31 . The economic toll of the COVID-19 pandemic is probably incalculable.
The World Bank estimated that the world economy shrank by 4.3% in 2020, a setback matched only by the Great
Depression and the two world wars32. The World Bank estimates that the pandemic pushed nearly 100 million more
people into extreme poverty in 2020 alone33. The following are some of the economic effects of COVID-19, which are
also true of many smaller outbreaks: (i) decreased agricultural production and exchange, which lowers domestic
30With special focus on early detection and rapid response capacity, as adopted by the OIE member states in the Terrestrial Animal Health
Code, and utilize findings and recommendations from the OIE PVS pathways.
31 World Bank. 2022. World Development Report 2022: Finance for an Equitable Recovery. Washington, DC: World Bank.
doi:10.1596/978-1-4648-1730-4
32 https://www.economist.com/finance-and-economics/2021/01/09/what-is-the-economic-cost-of-covid-19
33 World Bank. 2022. World Development Report 2022: Finance for an Equitable Recovery. Washington, DC: World Bank.
doi:10.1596/978-1-4648-1730-4
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supply and raises food prices and food insecurity; (ii) decreased public revenues as a result of lower tax compliance
and less economic activity; (iii) increased unemployment and income loss from shutdowns; and (iv) decreased tourism
as a result of border closures and travel restrictions (an estimated US$ 1.3 trillion was lost in international tourism
expenditures34 in 2020).
64. Prior to the COVID-19 pandemic, the West Africa Ebola crisis of 2014-2016 in West Africa was a stark reminder that
responding to outbreaks is “far more expensive” in lives and money – than investing in preparedness35. By the end
of 2015, US$ 3.6 billion had been spent fighting the epidemic, and Liberia, Sierra Leone and Guinea collectively
sustained an estimated loss of US$ 2.8 billion in GDP that year36. On the other hand, Nigeria already had an epidemic
response infrastructure in place when Ebola struck. They had an established contact tracing method, a highly-skilled
virology laboratory, experienced epidemiologists, and strong clinical governance, which helped prevent substantial
loss of human lives, limit the costs of responding to the outbreak and lessen the financial losses and impacts on the
country’s economy. The economic cost of US$ 186 million incurred by Nigeria was much lower than other affected
countries in the region37.
65. The economic losses from infectious disease outbreaks emphasize the substantial potential returns on investment
in improving preparedness. Investing in pandemic preparedness is crucial for the following reasons:
• Impact on Health Outcomes: First and foremost, investing in preparedness significantly improves the lives of
people and their overall livelihoods by decreasing mortality and morbidity, as well as social and psychological
impacts which can lead to serious health threats. This in turn directly impacts people’s productivity, averting
potential disruptions in their work and reducing the likelihood of caregiving for sick family members.
• Economic Impact: The costs associated with pandemics far exceed those of preventive measures. The COVID-19
pandemic, for instance, has resulted in trillions of dollars in losses, whereas investments in preparedness are
measured in billions. It's estimated that an additional USD 4 per person annually could significantly enhance global
preparedness, protecting economies from severe downturns38.
• Health System Response: Investing in pandemic preparedness ensures that health systems can respond swiftly
and effectively to emerging threats, safeguarding lives and livelihoods. A well-prepared health system can
maintain essential services and mitigate economic disruptions during a pandemic, reducing long-term societal
impacts.
• Global Health Security: Such investments enhance global and regional health security, with all countries
contributing to and benefiting from improved health security measures.
• Healthcare Sector Benefits: Investments in pandemic preparedness provide significant co-benefits for the
healthcare sector. The synergistic relationship between pandemic preparedness and overall health system
34 https://preventepidemics.org/preparedness/financing/
35 From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level. Report from
the International Working Group on Pandemic Preparedness. World Bank. May 2017
36 WTTC, 2018. Impact of Ebola Epidemic in Travel & Tourism.
https://wttc.org/Portals/0/Documents/Reports/2018/Impact%20of%20the%20Ebola%20epidemic%20on%20Travel%20and%20
Tourism%202018.pdf?ver=2021-02-25-182521-103
37 RSLS. Why preparedness is a smart investment. https://resolvetosavelives.org/wp-content/uploads/2024/05/ROI-Why-
Preparedness-is-a-Smart-Investment.pdf
38 Chawla M, Schmunis R, Zindel M. Strategic prioritisation: Three principles for an affordable and essential preparedness
package. J Glob Health 2023;13:03052.
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investment reinforces the need for dedicated resources to strengthen public health capabilities, which are often
overlooked in favor of investments with more immediate and visible returns39.
66. The economic justification for all the REDISSE projects of which REDISSE I was the trailblazer proved highly cost-
effective. These projects emphasized the important role in reinforcing both regional and national health security,
enhancing national capabilities to prevent, detect, and respond to major disease outbreaks. The project's regional
strategy underscored the importance of collective action and cross-border cooperation. This emphasis facilitated
information sharing, policy and procedure harmonization, and collaborative planning, implementation, and
evaluation of program activities. This form of interaction proved especially crucial for countries with limited capacity,
such as Guinea and Sierra Leone. These nations gained substantial benefits from engaging with counterparts from
other countries addressing similar issues, providing a valuable learning experience. In countries where capacity is less
extensive, such exchanges nurture a sense of aspiration to match the capabilities of nations with greater resources.
Consequently, this dynamic contributed to the establishment of essential capacity standards that all countries in the
region should strive to achieve. See Annex 4 for details on the cost-benefit analysis. For example, the cost-benefit
ratio for REDISSE investments made to reduce the Case-Fatality Ratio caused by Lassa fever in Nigeria was found to
be 1/43.12, i.e., each US$1 invested through the project yielded an expected (discounted) benefit equivalent to
US$43.12 in terms of averted human and economic losses. The same calculation could not be done for COVID-19
given its rarity and consequently no comparable before/after data.
67. The investments made by the REDISSE program provided significant benefits by enhancing preparedness and
readiness at both national and regional levels. The upfront costs associated with training, infrastructure
development, and preparedness measures are outweighed by the long-term benefits of a region better equipped to
handle and mitigate the impact of infectious diseases. The enhanced regional public health goods resulting from this
program not only contribute to the well-being of individual nations but also foster a more resilient and interconnected
West African health landscape. Through REDISSE I, WAHO and participating countries were actively integrating and
modernizing their disease surveillance systems, upgrading laboratory diagnostic and research capabilities,
establishing a resilient and well-trained health security workforce, implementing emergency response frameworks,
drastically improving specimen referral and transport systems, strengthening national public health institutions, and
effectively responding to real-time public health emergencies, including the challenges posed by COVID-19.
68. The project's impact on emergency response coordination was also substantial, improving institutional capacities
at both national and regional levels. These enhancements were critical during the COVID-19 response, as countries
could utilize and expand their newly acquired capacities, supported by project financing. Regional coordination
mechanisms established by the project were effectively activated, facilitating information sharing and the use of
standardized protocols, which bridged knowledge gaps and reduced response times.
69. In light of the COVID-19 emergency, the REDISSE I achievements provide compelling evidence for public financing
of pandemic preparedness as a global and regional public good. The experience of participating countries confirmed
the importance of enhanced cross-border surveillance and information-sharing in containing outbreaks, particularly
when viruses are easily transportable across borders. It built the case for regional information sharing to alert, to
prepare, to respond and to contain potential outbreaks where the market tended to fail. By coordinating regional
procurement efforts through WAHO, REDISSE I demonstrated that economies of scale benefited all countries. The
collective provision of public goods is more efficient and cost-effective than if individual countries attempted to
39From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level. Report from
the International Working Group on Pandemic Preparedness. World Bank. May 2017
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produce them independently. Despite the disruptions in planned activities by the COVID-19 pandemic, REDISSE I has
made substantial contributions to strengthening public goods in the region.
70. Overall, the Project demonstrated Substantial implementation efficiency. There are positive elements of
operational efficiency in all three countries and at WAHO: (i) The REDISSE I was timely and pivotal as its initial
investments in preparedness capacities and measures helped mitigate the social and economic burden of the once-
in a century pandemic; (ii) the Project overcame the vast majority of the challenges of implementation and achieved
a substantial level of results with an 8-month extension , even in the context of COVID-19, with approximately 95
percent of the original project resources thanks to rapid technical guidance and regular supervision from the WB
teams; (iii) regional coordination led by WAHO helped set standards for the region, by developing and sharing regional
guidelines, regulations and policy frameworks, which likely contributed to efficiency during implementation. WAHO,
for instance, coordinated some aspects of the COVID-19 response (such as training for laboratory technicians and
vaccine inventory management); iv) the high levels of operational efficiency are even more noteworthy considering
the significant challenges the project faced due to high turnover among the PIU staff and in dealing with new
procurement processes. In fact, the project faced slow procurement due to the need to familiarize both the involved
countries and the Bank with the new STEP system. This learning curve slowed procurement processes as stakeholders
required time to understand and effectively use the new system. Moreover, existing procurement procedures had to
be significantly adjusted to align with the new system, impacting the speed and efficiency of procurement activities
during this transition period.
D. JUSTIFICATION OF OVERALL OUTCOME RATING
71. The overall outcome is considered Satisfactory based on the ratings of high for relevance and substantial for both
efficacy and efficiency. This was a unique operation in that it was designed specifically to address disease
preparedness which ended up being implemented during a once in a century pandemic. This project saw a remarkable
performance of WAHO and all three countries given the steep learning curve associated the One Health approach that
required institutional changes and multi-sectoral collaboration regionally, nationally and sub-nationally, the persistent
socio-economic fragility specific to each country. This was all the more impressive given the disruptive onset of the
COVID-19 global pandemic that shifted financial and technical resources for most of the second half of the REDISSE
program.
Relevance of PDO High
Efficacy Substantial
Efficiency Substantial
Overall Outcome Satisfactory
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E. OTHER OUTCOMES AND IMPACTS (IF ANY)
Gender
72. The Project contributed to making progress on gender gaps even though the design of the original REDISSE I project
did not focus on gender as the final beneficiary was the general population. In 2019, the restructuring introduced
four intermediate indicators related to human resources capacity for IHR and all levels of the FELTP trainings to best
track progress of female inclusion in the project results framework. By project completion, females represented 24
percent of total beneficiaries across applied epidemiology training levels and countries which did not meet the target
set for 35 percent. While the project has integrated the gender dimension training programs provided at the CES and
FELTP, gender disaggregated data collection remained very limited during project activities planning, implementation
and reporting which hindered the analysis of the main factors that influence gender disparities. Prior to the project
closure, a two-day workshop was organized by the World Bank and Global Affairs Canada to introduce a Gender
Toolkit to country representatives of the Ministry of Health of ECOWAS member countries, Mauritania and all REDISSE
Phases (I, II, III and IV) Project National Coordinators as well as representatives of health security partner
organizations40. WAHO presented the epidemiological situation in West Africa and the gender strategy developed by
the ECOWAS Gender Development Center based on experiences from countries such as Sierra Leone and the
Democratic Republic of Congo (DRC) on integrating gender in health emergencies. WAHO is expected to continue to
engage with regional and national stakeholders to mainstream gender issues in the ECOWAS region including sharing
the gender toolkit.
Institutional Strengthening
73. REDISSE I was pivotal in establishing regional and national One Health platforms to strengthen and to harmonize
surveillance, preparedness and response interventions and competencies of human, animal, and environmental
health sectors in all three countries. In addition, the Project contributed to the reinforcement of the capacities and
competencies of WAHO as the regional umbrella that supported all ECOWAS countries and all REDISSE participating
countries. This enabled it to provide a variety of trainings ranging from basic to advanced skills and to create several
regional specialists’ networks41 ranging from reagents and specimen transportation to medical inventory
management to biosecurity and biosafety. In continuity of the WARDS project investments in WAHO, it has been
strengthened to effectively become the leading regional agency for disease surveillance and response. Over the
course of the REDISSE project, WAHO’s expansion in its support to ECOWAS countries in developing regional strategic
documents is evidenced by supporting the establishment of regional laboratory network, ramping up a digital
platform to track diseases outbreak across the region just in time for the COVID-19 crisis management, facilitating
human resource capacity development, carrying out advocacy and continued partnership with the World Bank on
additional regional projects42.
40 WAHO, United Nations Children’s Fund (UNICEF), the Regional Centre for Surveillance and Disease Control (RSCDC), the ECOWAS Gender Development
Center, the University of Ghana, the University Ouagadougou, Foundation Mérieux and Santé Monde.
41 Regional networks included establishing an Antibiotic Resistance Observatory (including its strategic development roadmap), the West Africa Biosecurity
Network (with 55 trained), the biosafety association based in Benin with at least one person/country that is certified by AITA to approve air transportation of
medical samples and a West Africa biobank based in Ivory Coast among others.
42 Sahel Women’s Empowerment and Demographic Dividend Project – SWEDD, Sahel Malarial and Neglected Tropica Diseases – SMNTD and West African
Medicines Regulatory Harmonization Project.
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74. The REDISSE project catalyzed cross sectoral and district-level collaboration that prepared the countries to establish
the One Health platform contributing to institutional strengthening. Moreover, the Project significantly contributed
to develop existing and new43 capacities of national government agencies in terms of provision of logistics to expand
their geographical reach, access to digital tools to enhance collaboration and systematic data collection, and targeted
trainings to harmonize competency across sectors and across geography.
Mobilizing Private Sector Financing
Not applicable
Poverty Reduction and Shared Prosperity
75. REDISSE I enabled countries to swiftly respond and contain disease outbreaks including COVID-19. In the first two
and half years of implementation, many key achievements44 in preparedness and response ensured adequate levels
of capacities and competencies to track and to diagnose disease, to mitigate outbreak impacts including the
pandemic, hence reducing morbidity and mortality. By Project completion, all three countries had mechanisms and
systems to contain disease outbreaks at the district level. The One Health approach and associated activities provided
more integration and capacities of the animal health and wildlife ecosystem. This resulted in better health and
increased productivity of the general population of all 3 countries of REDISSE I, and all ECOWAS and REDISSE countries
that WAHO supported. As REDISSE I supported response to the region outbreaks (such as Lassa fever, Crimean-Congo
hemorrhagic fever, Avian influenza, and rabies) and contributed to save out-of-pocket costs on medication as well.
Overall, as the economic analysis concluded, this Project supported ease of economic burden on all countries, reduced
impact of disease outbreaks when they occurred and improved both human and animal health. In addition, better
health improved trade, investments and cooperation among neighboring countries and further supported socio-
economic development regionally, nationally, and sub-nationally.
Other Unintended Outcomes and Impacts
Not applicable
43 The capacity development of national institutions also resulted in the establishment of the Centre des Opérations d'Urgence Sanitaire
(COUS) in Sénégal, the Agence Nationale de la Sécurité Sanitaire in Guinea and the National Public Health Agency in Sierra Leone which
carried out important REDISSE activities that shaped the national health security agenda.
44 These included improved laboratory capacities, adopted digital platforms and tools, exchanged data tracking, purchased logistical means,
and targeted trainings.
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III. KEY FACTORS THAT AFFECTED IMPLEMENTATION AND OUTCOME
A. KEY FACTORS DURING PREPARATION
76. The Health Security was not yet a priority on the global development agenda in 2010: An initial REDISSE project was designed
and proposed with US$190 million investment prepared in 2010. However, other important priorities resulted in the WB board
postponing the initial project. Moreover, the complexity of a participatory and an inclusive consultation process with each
candidate country and with development partners in the region would become daunting with a compressed timeline.
Considering these challenges, a “pilot” version, the WB WARDS project (P125018) was approved on October 22, 2013 by the
Board and implemented with a $10.75 million budget as an intermediate step to focus primarily on the capacity development
of the nascent regional organization, WAHO and much needed technical resources to ECOWAS countries.
77. The West Africa Ebola outbreak provided more evidence that health security is a strategic priority and that a more objective
assessment of country preparedness capacities had to be developed: During the EVC crisis, most countries in the region were
ill prepared to adequately prevent, detect and response to infectious disease outbreaks. While the Bank was supporting the
Ebola response project, the rapid devastation provided concrete socio-economic evidence45 that health security is a top
priority on the global, regional and national agenda. In this context, an ambitious project like REDISSE became more urgent to
contribute to building the foundational capacities for prevention, preparedness and response. In parallel, the international
community coalesced around the notion that a more comprehensive and objective measure of country preparedness
capacities had to be developed and rolled out. Hence the Joint External Evaluation was defined and was adopted worldwide
as the standard methodology and tool to measure and monitor progress of country compliance with IHR core capacities. This
widespread adoption meant that the JEE and its indicators would become the REDISSE Project M&E system. At that time, the
spirit of the indicators aligned with the spirit of the PAD.
78. REDISSE phased approach allowed for countries to join at each phase while WAHO would be included from the first phase
to support all countries regardless of phases. REDISSE was designed as a Series-of-Projects to allow for country-level
consultations and let countries join at their own discretion. An important challenge ensued to determine how to best finance
WAHO across all phases and countries. After multiple discussions and internal reviews, it was recommended that a single
agreement under the first phase would be the most effective legal arrangement. The financial support would then be
increased as additional countries joined the REDISSE program. This arrangement adopted the phased approach of the REDISSE
program, and it prevented fragmenting the funding and the Bank’s implementation support. In fact, it enabled WAHO to
engage a single team as counterpart rather than multiple ones across the phases. The only downside to this arrangement is
that it would limit the technical assistance to REDISSE III and IV countries once REDISSE I closed on August 31, 2023.
79. Emphasizing the importance of a regional approach: Capitalizing on the experience of the robust investments in 42 malaria
national projects in Africa and ongoing regional projects including the WARDS46 (P125018), the Sahel Malaria and Neglected
Tropical Diseases Project (P149526) and the Ebola Emergency Response Project (P152359), the World Bank, WAHO and
participating countries in close cooperation with international partners e.g. WHO, CDC, USAID among others sought to further
pursue the regional approach following the crippling impact of the EVD crisis in most the Sub-Saharan African region. With
45 https://www.worldbank.org/en/topic/macroeconomics/publication/2014-2015-west-africa-ebola-crisis-impact-update
46 https://www.fondation-merieux.org/en/projects/wards/
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the frequency of disease outbreaks and the magnitude of the EVD crisis, the REDISSE became increasingly relevant and timely
as regional, national, and subnational institutions needed urgent capacity and competency development for diseases
surveillance and epidemic preparedness. Moreover, the borders were porous, and a collaboration, methods and systems
harmonization and response synchronization were paramount to contain ongoing and emerging outbreaks.
80. Adopting the One Health paradigm shift provided opportunities and challenges. On the one hand, it supported chronically
underfunded sectors such as animal health and wildlife to ensure positive benefits and externalities for human, animal and
environmental health across the region. On the other hand, it added to the complexity of the project that brought together
Ministries that had not yet collaborated and mutualized resources. This required a cultural shift from competition for budget
to cooperation for impact especially around the notion of mutualizing outside and inside the country ranging from hosting a
regional laboratory to taking into consideration animal health and wildlife sectors that required much needed upgrades of
computing tools to operate digitally, transportation means to expand reach throughout the country and overall capacities and
competencies to collaborate on One Health sub-nationally, nationally and regionally.
B. KEY FACTORS DURING IMPLEMENTATION
81. The integration of the One Health approach slowed down the start of the project implementation as it implied complexities
to coordinate, to compete and to cooperate across sectors and across sub-national regions for resources. While a highly
participatory work was observed during preparation to bring, in each country, the key sectors (Ministry of Health, Ministry of
Agriculture and Ministry of Environment) and some support sectors (Ministry of Interior, Ministry of National Education or
Ministry of Higher Education), the discussions continued during Negotiations and in the early stages implementation as to the
priority activities and areas of collaboration across components. As the One Health approach was a steep learning curve for
all stakeholders including the WB and international development partners, a great deal of competition ensued among sectors
to defend their needs and priorities during each yearly planning exercise. Because the fiduciary responsibility fell within the
Financial Administration Directorate of each Ministry or Agency, the yearly planning request was also extended to
departments that were not directly concerned by the REDISSE PDOs and voluntarily accepted this invitation to upgrade their
technical equipment. The recurring message during the ICR missions was that the planning exercise became overly ambitious
and regularly contentious delaying annual plans and budgets approval typically by about 3 to 4 months into the new year.
The PDO indicators and the One Health approach required a paradigm shift in terms of resource mutualization and cross-
sectoral collaboration which improved over the course of the COVID-19 pandemic and recurring disease outbreaks such as
the Avian Flu in St. Louis, Senegal.
82. The evolution of the national enabling environments to adapt to the One Health paradigm and its implication on cross-
sectoral collaboration posed challenges throughout the Project’s life. Despite Institutional Capacity for Implementation and
Sustainability being rated High at appraisal, this new approach meant mutualization of resources which became a struggle for
most institutions. One the one hand, the Ministries of Health were funded by multiple projects and REDISSE was one project
among others until the onset Covid-19 pandemic. On the other hand, the Ministries in charge of animal health, the
environment, natural disaster management and border protection were highly motivated from the preparation stages of the
REDISSE project as these stakeholders have historically been under funded. Regardless of the positioning of the One Health
platform housed at the Ministry of Health in Sierra Leone and Guinea and at the Prime Minister’s Office in Senegal, there
existed challenges to further operationalize centrally the One Health enabling environment with a Secretariat, a project team
and an established public budget to guarantee the government ownership, the development and the sustainability of the core
prevention, preparedness and response activities for which for the most part REDISSE was a pivotal catalyst. The main
challenges appear to be mostly at the national level. At the regional level, as evidenced by the number of regional network
initiatives that WAHO established the collaboration has improved between countries where Benin will host the regional
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biosafety network while Institut Pasteur in Ivory Coast will host the regional biobank.
83. Weak governance and the PIU (Project Implementation Unit) team development and management impacted the project
progress. At a regional level, WAHO experienced several organizational challenges including priority conflicts between the
permanent team and the PIU team as these related to key REDISSE project activities formal approval and launch. Moreover,
the limited development of the Regional Center for Surveillance and Disease Control since its creation in 2015 signals
governance challenges as this Center should play a pivotal role to sustain the achievements of REDISSE and future projects
given its long-standing cooperation that existed with the Ministries of Health. At the national level, reinforcing coordination
unit teams was necessary over time as most of these PIUs had to manage 2 to 3 projects including REDISSE, Covid-19 and
others. The ICR country missions noted that despite the adequate competency building of PIU teams: some of the common
thread that contributed to the PIU turnover both at WAHO and in country PIUs included: (i) the leadership style of the
coordinator that did not foster a collegial environment, (ii) the ever increasing workload often in an emergency context with
additional WB projects to manage; and (iii) the lack of recognition in the form of incentives were highlighted including salaries
that were not adjusted to inflation on a yearly basis since the project effectiveness.
84. The regional reach of the project brought advantages and disadvantages to WAHO and countries during implementation .
Being part of a regional movement included countries that may not have benefited from this project on their own especially
the weakest countries which not only had the additional technical assistance of the WB and WAHO teams, but also the
opportunity to learn from their peer countries during the periodic regional workshops or for specific activities which at times
enabled cross-border collaboration across sectors as necessary. All countries captured significant value in participating in this
regional effort and in sharing their progress and their challenges with their peers and with WAHO and implementation
partners (CDC, USAID, FMx among others.) that ultimately benefited the African region’s capacities for health security. All i n
all, the REDISSE Project provided a sense of collective ownership and catalyzed cross-pollination between countries, between
similar sectors of different countries, between different sectors of the same country and between sub-national regions across
countries. However, given that each country had its own REDISSE Financing Agreement with the WB some countries were not
as responsive to WAHO’s regional leadership mission and its impartial broker role when it came to sharing progress reports
and data or planning country visits. Jointly with WAHO, the WB team regularly facilitated this technical information sharing
and planned regional workshops to foster cooperation between countries and between sectors.
85. The COVID-19 pandemic tested the very foundation of the Project. Overall, WAHO and countries absorbed this COVID-19
shock well as evidenced disbursement rates of 90.7 percent for WAHO, 98.3 percent for Guinea, 98.9 percent for Senegal,
99.6 percent for Sierra Leone. PIU and TTL teams worked diligently to catch up on key activities between 2021 and 2023.
COVID-19 was on the one hand a major disruption that slowed implementation of core REDISSE activities across components.
On the other hand, the pandemic reinforced regional, national and sub-national collaboration in a real-world simulation
scenario where daily and weekly data trends became paramount and preventive measures were crucial to contain the
pandemic especially after the lessons learned from the EVD crisis. COVID-19 stressed the system in this real-life simulation,
and naturally halted planned activities that were part of the first dimension of the PDO, especially those that had to do with
animal health and wildlife. Moreover, the funding was reallocated from component 2 related to laboratory capacity
development to component 3 to deal with an Eligible Emergency. This clearly had an impact on many human health activities
that could not start due the ongoing health emergency activities 47that became the priority for most of 2020 through mid-
2022. These challenges made the achievements of this project all the more meaningful.
47Some of these activities included information systems, rapid response teams strengthening, capacity and competency of laboratories,
referral and transportation of specimen, medical supply chains and inventory management.
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IV. BANK PERFORMANCE, COMPLIANCE ISSUES, AND RISK TO DEVELOPMENT OUTCOME
A. QUALITY OF MONITORING AND EVALUATION (M&E)
M&E Design
86. The REDISSE I Project and the overall program M&E system design aligned with the WHO JEE tool, which was widely
adopted as the country-level standard to assess national capacities to prevent, detect, and respond to public health
emergencies, in line with the International Health Regulations. As previously highlighted, the REDISSE program drew
most of its Results Framework (RF) indicators from the JEE tool and its indicators that have been widely accepted as
a mechanism to measure preparedness capacities at the national level and used by many development partners. The
REDISSE Program was designed to complement other projects at country level (by national governments and
development partners) that sought to urgently upgrade their health security preparedness and response capacities
following the consequences Ebola crisis and just-in-time for the COVID-19 pandemic. The JEE indicators were very
much aligned with the spirit of the Program and its development objectives. In that regard, the Program opted to
adopt several of the JEE indicators as Project indicators, considering them appropriate to monitor the project’s
achievement of the PDOs.
87. The M&E design is considered to be adequate in evaluating the achievement of the PDOs and it required minor
improvements. At appraisal, the project included a set of indicators in the results framework to be tracked and
documented to assess progress and performance. The RF included annual targets for each participant country and a
regional target that captured the number of countries (out of 4) that achieved a target score. During preparation
estimated values48 of baseline and target scores were defined, acknowledging that countries had not completed their
JEE. The 2019 project restructuring addressed minor improvements including incorporating revised baseline data and
targets for project indicators. By then, only Senegal and Guinea had completed their first JEE respectively in December
2016 and in April 2017. During the preparation, the PAD did not include an explicit ToC, as it was not required at the
time of preparation. The PAD clearly defined the possible activities, results and outcomes under each component that
would contribute to the achievement of the PDOs. In addition, there were other ongoing projects (by national
governments and development partners) that were also contributing to improving the JEE scores. This made the
assessment of achievements of outcomes a complex exercise, requiring the ICR team to focus more on the numerous
project’s contributions rather than attributability in achieving the targets for the indicators.
M&E Implementation
88. By aligning with the JEE, the M&E arrangements reduced the need for extra data collection requirements on
countries and M&E. Since the JEE is a national process, conducted under the guidance of WHO, countries established
arrangements at national level to conduct yearly self-evaluations on their IHR core capacities49 and undertake JEEs
every four to five years. This national process started just a few months prior to the REDISSE I project effectiveness in
48 Based on self-assessments, which were considered preliminary hence not to be fully reliable.
49 Reported every year to the World Health Assembly
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December 2016 and Senegal was one of the first countries to conduct a JEE assessment that same month. These
arrangements functioned independently of the REDISSE Project but were aligned to it and informed the Project’s
M&E. This arrangement limited the burden on the country of setting up another M&E system to monitor project
implementation especially that there was alignment between the JEE and the REDISSE Project PDOs as previously
explained.
89. At a regional level, the M&E implementation was mostly digitalized. WAHO developed dashboards to capture
internal and external M&E processes under a clear implementation timeline. On the one hand, the internal process
included: (i) weekly, monthly and annual work planning and monitoring; (ii) mid-yearly and yearly review; (iii) weekly
and monthly PIU achievements reporting, mid-yearly and yearly progress reporting, including countries and project
implementation partners (WHO, OIE, CCISD, FMx, and Universities of Ouagadougou, Ghana and Olso). On the other
hand, the external process focused on biannual project supervision mission to countries as well as WB supervision
missions to WAHO and evaluation of the project implementing partners interventions.
90. At the country level, PIUs regularly monitored the RF indicators and provided updates to the Bank during the
supervision missions. While PIUs had an M&E specialist, responsible for the Project M&E system, the World Bank
team strengthened supervision with country-level co-TTL in each country soon after the MTR. The World Bank and
WAHO joint supervision mission were organized to assess the level of implementation of activities, gather data,
document difficulties encountered and make recommendations to improve results. Reports and supporting
documents were sent to the PIU. Similarly, joint supervision missions (human, animal and environmental health) were
organized at all levels. The WB sponsored Geo-Enabling for Monitoring and Supervision – GEMS tool50 – has been also
used for the georeferencing of the Project interventions through forms elaborated, validated and deployed in
smartphones or tablets. This tool allowed all stakeholders to track REDISSE project interventions and facilitate
supervisions under restricted mobility imposed by the Covid-19 pandemic.
91. Although the adoption of JEE indicators was appropriate in the context of the JEE global roll out and alignment
between countries, the Bank and other development, it presented some limitations for the Project M&E. As
previously explained, the JEE scores alone did not always reflect the real progress made by countries in strengthening
capacities. Scores are dependent on reaching a specific benchmark which is used as a proxy to determine the level of
progression without considering many related achievements that take place prior to reaching the benchmark.
Thereby, the significant progress made by countries did not systematically meet the criteria for a higher score. The
JEE tool, first launched in 2016, has evolved over the years to address technical limitations and challenges identified
through its application. In early 2018 WHO issued a 2nd edition of the tool (JEE 2.0)51, which introduced changes to
the indicators (introduction of some and merging of others) and, in some cases, the benchmarks used to determine a
level of capacity were made more stringent. Although the changes were not monumental, they did present some
complications for the measurement of a few Results Framework indicators, which countries had to manage. While
these changes represented a “moving target” for the Project itself, all countries and development partners, including
the Bank, understood the need to stand behind and support the “upgraded indicators” of JEE 2.0. Regardless of the
changes, the JEE and its indicators remain well aligned with the spirit of the REDISSE I Project. During the ICR
50 https://www.worldbank.org/en/topic/fragilityconflictviolence/brief/geo-enabling-initiative-for-monitoring-and-supervision-gems
51 The JEE was updated again in 2021 to incorporate lessons from COVID-19. The tool is currently in its 3rd edition (JEE 3.0)
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preparation country counterparts highlighted the important contribution of REDISSE I in advancing towards the
achievements of results and building of capacities.
M&E Utilization
92. Data collected across sectors, sub-national regions and diseases was used throughout the project to track progress,
to present the regional, national and sub-national stakeholders the evolving situation, to mitigate risks and to address
the ongoing challenges. The benchmarking that took place between countries allowed for some of the weakest ones
to begin building some of the institutional, digital systems and logistical foundations and aspire to meet the PDO
objectives of this Project. Moreover, the M&E utilization supported the steep learning curve that was necessary for
all sectoral stakeholders compelling them to opt for collaborative approaches and to improve mutualization of
resources regionally, nationally, and sub-nationally.
93. Besides reporting on project results, the project’s greatest impacts were: (i) the regional, the national and the sub-
national preparedness for real world events including the COVID-19 pandemic as well as other health outbreaks
including avian flu, Lassa fever, rabies among others; (ii) the importance of the health security among top priorities
on the global and regional economic agenda among international development partners and governments; (iii) the
long-term commitment necessary to invest in institutions, systems and human resources for prevent and
preparedness to further operationalize the One Health approach not the regional and national level, but also the
district and community level in the most remote and vulnerable areas that may be along borders among countries.
Justification of Overall Rating of Quality of M&E
94. The overall Project’s M&E is Substantial. The M&E system improved over the life of the project, and particularly
during the last three years of the project following the 2019 project restructuring that addressed limitations and
yielded better indicators’ measurement. In addition, data collection was inherently challenging in most countries
given the coordination complexity of regional data harmonization, cross-sectoral information capture, multiple layers
of subnational coverage, a wide range of zoonotic diseases to track and in some cases a rapidly shifting institutional
landscape due to external forces such as government changes and the COVID -19 pandemic.
B. ENVIRONMENTAL, SOCIAL, AND FIDUCIARY COMPLIANCE
Environmental and Social Safeguards:
95. Guinea, Senegal and WAHO fully complied with the Bank’s safeguards policies and procedures, as set at
appraisal. REDISSE I was classified as category B operation due to the low scale and site-specific nature and
amplitude of its foreseen risks and impacts on both the natural and physical environment. At appraisal, the
following safeguard policies were triggered: a HCWMP, an Integrated Pest and Vector Management Plans (IPVMP)
and an ESMF were developed. In the case of Sierra Leone, three instruments Environmental and Social
Management Frameworks (ESMF), Health Waste Management Plans (HCWMP) and a Project Management Plan
(PMP) were prepared. A site specific Environmental and Social Management Plan (ESMPs) was needed which put
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the project as partially compliant. However, as this construction activity was cancelled prior to the project closure,
the site specific ESMPs are no longer needed. At project closure in August 2023, Sierra Leone was also fully
compliant as rated during the ISM (Implementation Support Mission) of September 2022.
96. The Grievance Redness Mechanism (GRM), introduced during implementation, was developed and is fully
operational in all three countries (Guinea, Senegal and Sierra Leone). In Sierra Leone, the GRM implementation
lagged. At project closure, it is already being operationalized. The monitoring of the project has shown that the
majority of the activities related to the GRM operationalization have been completed. Sierra Leone established a
dedicated safeguards unit within the project implementation unit (PIU) that implements World Bank projects,
staffed with environmental, gender and social specialist, including an international Technical Assistance. Through
this unit, a GRM has been established for both the COVID-19 Emergency Preparedness and Response and the
REDISSE project. For Guinea, the project has a validated GRM strategy. This strategy involves employing the
services of the GRM committees of the National Agency for Finance (Agence Nationale de Financement des
Collectivités (ANAFIC) and a toll-free number. The PIU has trained five regional GRM committees out of eight. A
cascade training was planned to reach the GRM committees at the prefecture level by end of January 2023. For
Senegal, the GRM is functional and the PIU has established a GRM mechanism for the three health projects
(REDISSE, Investing in Maternal, Child and Adolescent Health – ISMEA, and COVID-19 Response Project) through a
digital platform. In addition, a toll-free (Numero Vert) was established and is contributing to the operationalization
of the GRM.
97. At WAHO, the main achievements were the dissemination and the regulatory adoption of a regional roadmap
for the operationalization of the sustainable management of healthcare waste in West Africa. This roadmap was
developed during a regional workshop organized by WAHO with the support of the World Bank in November 2018
in Ouagadougou in Burkina Faso. Two major activities of the roadmap were initiated at a regional level in 2019: i)
the development of a regional strategic plan to strengthen the management of healthcare waste; and ii) the
development of a directive for the harmonization of regulations on the sustainable management of healthcare
waste in West Africa. The latter directive was adopted as a regulation by the 22nd Ordinary Meeting for Assembly
of Health Ministers (AHM) in ECOWAS in 2021.
Procurement:
98. Overall, the procurement processes are well conducted and comply with the Banks rules and procedures. The
procurement arrangements agreed with the Borrowers continued to be in place until project closure. We noticed
an improvement in the use of STEP. However, contract management continued to be the bottleneck of the project
due to the weak institutional capacity, lack of previous experience working with the WB and staff turnover issues
(see paragraph 69 in section on Factors that Affected Project Implementation). Participant countries mentioned
delays in procurement processes with the introduction of STEP, but these were overcome with training and time.
While approval of the procurement plan was often timely, procurement processes were slow, due to the
intersectoral consultations in country and at the WB to prepare and to approve procurement documents. The
shortage of qualified human resources and the availability of technical staff among public stakeholders also
affected the quality of the terms of references which often required additional technical support from PIUs and
WB staff.
99. Most challenges were overcome through prioritization and collaboration across intersectoral and cross-
functional teams at the client’s and at the WB. Several PIUs and public stakeholders suggested the necessity of
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additional procurement training and technical assistance by the WB procurement teams. Client stakeholders also
expressed their sentiment that the Bank was at times slow and redundant in providing non-objectives for both the
yearly plan and for each activity of that without any electronic workflow that provides estimated WB standard
processing times. From the WB procurement team standpoint, contract management continued to be the
bottleneck of the project due to the partial registration of procurement documents in STEP.
Financial Management:
100. Overall audit reports were presented on time, without auditor’s observations, for all three countries and WAHO.
All countries complied with loan covenants. In addition, formal financial management (FM) assessment was
conducted in December 2022. A follow up mission took place in May of 2023 to track progress on the December
2022 action plan and particularly address an issue related to fixed assets inventory allocations. Supervisory
missions noted several strengths such as: (i) Financial team is in place and interim financial reports are deemed
acceptable; (ii) supervision of cashless through formal procedures; and (iii) External audit exist were completed
and as of May 2023, internal audits of executing agencies had been partially implemented which contributed to a
Moderately Satisfactory rating.
C. BANK PERFORMANCE
Quality at Entry
Rating: Highly Satisfactory
101. The World Bank project team carried out a comprehensive and an innovative project preparation. The team led the
preparation process in an inclusive and participatory fashion by ensuring adequate engagement of all major global,
regional national and stakeholders. The team worked closely with WAHO and all participating country government to
involve sectoral stakeholders and ensure engagement from inception. With REDISSE being a regional project, the
return on experience and the lessons learned from the then-ongoing WARDS project and the 2014 EVD outbreak in
West Africa were incorporated in the project design including the institutional arrangement that was necessary at a
regional level in the case of WAHO and at a national level based on the context of each participating country to
mitigate risks. In the Project design, the Bank emphasized the importance of a regional project to reinforce access to
shared resources to support achieving “regional public good” as it sought to build upon the pilot experience of the
WARDS project. The Bank ensured WAHO’s pivotal role as the main catalyst in the development of the health security
agenda and a provider of technical support that ensured that none of the ECOWAS countries would be left behind.
102. The World Bank team led the cross-sectoral dialogue internally and externally to reinforce the innovative approach
that One Health offered at the time. In fact, the collaboration between human health, animal health and the
environment was not yet commonplace. Internally, the REDISSE project concept was jointly developed by the Health,
Nutrition, and Population and the Agriculture Global Practices to ensure PDO cohesiveness across countries and
sectors. The design phase of the REDISSE program involved investment trade-offs between sectors especially that
animal health and wildlife were chronically underfunded and needed to catch up to human health competencies and
capacities. Led by the World Bank and its Ministry of Health counterparts, the project design sought to emphasize
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institutional governance to mitigate risks, to focus resources on the PDO indicators and to foster collaboration and
mutualization of resources regionally, nationally, and sub-nationally.
103. The project design was comprehensive in the definition of PDOs and exhaustive in the definition of components
and associated activities to achieve each component’s goals. In addition, the project offered flexibility both in terms
of resource allocation to cope with eligible emergency response and in terms of addressing gaps specifics to each
participating country. The Bank team carried out an adequate assessment of risks and proposed mitigation measures.
At the time of appraisal, most risk categories were deemed substantial, except for institutional capacity risks, deemed
high. REDISSE I incorporated activities to strengthen capacity regionally and nationally across all project components.
Quality of Supervision
Rating: Satisfactory
104. The REDISSE supervision sought to consistently support regional and national stakeholders to maximize the
development impact. Thereby, supervision proactively focused on supporting WAHO and participating countries to
overcome challenges be they organizational and institutional or tied to external forces that negatively impacted the
project including the COVID-19 pandemic, the change of the government in Sierra Leone in 2019 and the Coup d’Etat
in Guinea in 2021 and the OP7.30 process that ensued. The Bank team adapted systematically to the countries’
emerging situations and requests to either reallocate project funds, to revisit annual plan priorities, to propose
technical assistance across functions and to cope with major human resources challenges at WAHO, at the countries’
PIU level, or at key government stakeholders ranging from the One Health platforms to primary agencies in charge of
the REDISSE project core activities.
105. The Bank adapted its supervision from a central global team to a distributed team as the project implementation
scaled up across countries. Originally REDISSE had a team of 2 Task Team Leaders (TTLs) in headquarters. As the
number of countries and activities multiplied it became necessary to decentralize supervision with local TTLs. This
shift enabled stronger presence of the Bank in the field which offered additional technical support, supervision team
cohesiveness, proactive coordination at WAHO and cross-fertilization between participating countries. Supervision
became challenging at the onset COVID-19. However, the global and local teams worked closely together to shift most
of the supervisory activities online with weekly virtual support. During this phase, the Bank team was also attentive
to WAHO’s need to urgently shift to a digital operation. Until travel was allowed, Bank regularly recommended digital
tools and provided virtual training and technical assistance to PIU teams, as deemed necessary. Moreover, the
supervision and support on fiduciary, environmental and social safeguards was adequate and specific to the needs of
each PIU.
106. The Bank remained in close dialogue with WAHO and countries and was careful in its reporting of the project
performance. Back-to office reports, ISRs, Aide memoires after supervision missions provided sound assessment of
implementation challenges as they pertain to achieving the PDOs. The Mid-Term Review was an opportunity to
engage in candid dialogue with WAHO and each country, to cope with the Covid-19 response, to swiftly address
bottlenecks and to reassess priorities given the time left to project closure. In addition, the Bank continued to
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cooperate with international development partners to work in complementary fashion and in some case to mutualize
resources to achieve the program PDOs and the higher-level objectives of the global security agenda.
107. Most PIUs considered the Bank non-objection process to be tedious and to take longer than expected at times.
Several factors affected this process: 1) in the early stages of the implementation, the supervision concentrated on a
single TTL ADM for both REDISSE I and II projects: 2) Country PIUs wanted a general non-objection based on the
approved yearly national plan. However, the Bank also needed a non-objection for each activity to verify budgets and
to mitigate risks associated with each activity. 3) The client’s terms of reference were often in need of improvements
which delayed the non-objection process especially when technical sector experts needed to be consulted. 4) the
complexity of the activity or the timing the requests of non-objection came with a lag especially when TTLs needed
to double check with internal technical experts or go to the field. There were also exceptional situations such as the
additional financing (AF) of 2022 which consisted partly in replenishing the emergency response funding of Covid-19
and in finishing ongoing rehabilitation projects. By the time it became effective, countries such as Senegal were left
with 8 months which drastically limited the type of activities that could be carried out including certain important and
urgent activities such as the rehabilitation of the Laboratoire National de l’Elevage et de Recherches Veterinaires
(LNERV) which would take longer than the remaining project duration. At project closure, this national veterinary
laboratory remained partially operational due to facilities that were in a state of halted construction and for which
REDISSE purchased laboratory equipment that could not be unpacked and tested within the warranty period until the
rehabilitation of these laboratory facilities would be completed.
Justification of Overall Rating of Bank Performance
Rating: Satisfactory
108. The overall Bank performance is rated Satisfactory based on the following criteria:
a. High relevance of the PDO in conjunction with the flexibility and adaptability of the project’s design to eligible
emergency response;
b. Sound risk assessment and mitigation measures at appraisal and implementation during supervision;
c. Participatory and consultative approaches at the project design stage with global, regional and national
stakeholders;
d. Proactive restructuring of the project in 2019 to update the Results Framework based on the JEE evaluations
and to approve additional financing in 2020 for WAHO to expand CCISD and replenish in 2022 some of the
emergency funding for COVID-19 that shifted financing some Component 2 activities to Component 3 ones;
e. Regular and comprehensive supervision missions to WAHO and jointly with WAHO to REDISSE I and II
countries throughout these projects’ life despite the restrictions that the COVID-19 pandemic imposed.
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D. RISK TO DEVELOPMENT OUTCOME
Rating: Substantial
109. There are several factors supporting the sustainability of the development outcomes achieved: (i) development
and implementation of a regional approach with continued strengthening of WAHO’s technical and financial
capacity to coordinate, to supervise and to support and to train countries with methodologies, tools and best
practices; (ii) capacity and competency building of key country-level institutions in charge of carrying out the cross-
border cooperation and the cross-sectoral collaboration at the national and the sub-national level; (iii) progress
made in strengthening the national surveillance systems and the preparedness as exemplified by the COVID-19
response (coordinated weekly meetings, data updates and information sharing, etc.) and additional outbreaks
contained and simulations carried out; (iv) the motivation and the ownership of trained human resources eager to
operationalize further the One Health approach; (v) the Bank’s rapid deployment of the Health Security Program
in Western and Central Africa (P179078) Project signaling a continued commitment to invest in health security
throughout the region.
110. Nevertheless, the main factors undermining the continuity of the project’s achievements is the lack of national
budgetary resources to pursue recurrent activities financed by the Project and a limited cross-sectoral authority.
The mid-term review could be an important junction to ensure effective financial and technical transition by the
government from the project to the sustained public services activities. In general, most countries complained
about lack of funding related to keeping project teams functional and maintaining equipment acquired be it
logistical, scientific or digital in nature. At sub-national level, the ICR team observed that governors of regions have
more authority across sectors given that they represent a whole government within their region. A great example
of this was St. Louis in Senegal where the governor managed to marshal resources and to ensure collaborative
efforts across sectors is taking place to contain the yearly avian flu outbreak three years in a row.
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V. LESSONS AND RECOMMENDATIONS
111. Having a regional approach is vitally important for health security. Since the REDISSE original conception and
postponement in early 2010s, the region has been plagued by multiple disease outbreaks with the Ebola epidemic
being the most devastating one. The EVC emphasized the importance of prevention, preparedness and response to
rapidly contain disease outbreaks across country and across country borders. By capitalizing on WB regional health
project experiences particularly the Ebola’s project, the Sahel Malaria and Neglected Tropical Diseases and the
WARDS project, the REDISSE design was updated as a Series of Project to cover as many countries as possible in the
West and Central Africa region, to introduce cross-sectoral collaboration based on the One Health approach and to
provide flexibility to respond to an Eligible Emergency. Under REDISSE, this flexibility was crucial to rapidly and
adequately provide each participating country an early response mechanism to the global Covid-19 pandemic. The
regional coordination and the cross-sectoral collaboration were instrumental in coping with the Covid-19 crisis by
following minimum standards, implementing best methods and tools, mutualizing inventory management of critical
medical supplies including vaccines, and harmonizing crucial data at the national and the regional level to
systematically share it. Overall, the regional approach was essential to learn together, to adopt best approaches, to
mutualize limited resources and to strengthen capacities of the most vulnerable countries and sub-national regions.
112. One Health requires a full-fledged technical organization to be a steward at the implementation level to
operationalize One Health. This required a paradigm shift for most institutions across countries. As discussed in the
Factors that affected implementation, the enabling environment is crucial the facilitate the capacity development of
One Health organization and to manage the operational changes that One Health required across sectors and
particularly in human health. More than a level of planning or effort, it is in (i) clarifying the roles of each key
institutions; (ii) encouraging the cooperative learning by doing through pilot activities before looking to scale them
and opting for a phased approach of change management rather than a big bang approach to the modus operandi
that each sector is used to. At national level, the rotating leadership between Ministries from one sector to another
in the Guinean Steering Committee was effective as it fostered a collegial culture that was more about the team
rather than the team captain or the Ministry in charge. At a sub-national level, the leadership was clearly defined and
more effective as there was no competition between Ministries, Departments or Agencies. The governor had indeed
the authority to direct resources across sectors especially in an emergency response context like the St Louis Avian
case in Senegal that became an annual opportunity for improved One Health collaboration between 2021 and 2023.
113. Health Security requires investments tradeoffs between regional and national, between sectors and between sub-
national regions. Significant amount of time and effort during the REDISSE project preparation and early
implementation aimed to engage regional and national cross-sectoral stakeholders on the PDOs. For instance, in
several countries the national yearly activity planning exercise often became a contentious period mainly where
sectoral budget contests arose that required further reviews to prioritize the annual activities delaying the start of
the implementation well into the second quarter of the year. As part of the One Health paradigm shift that the project
required, learning by doing in pilot projects was important before considering scaling. Moreover, mutualization when
it comes laboratory capacity, training, and R&D activities is sometimes necessary to ensure more effective regional
integration, national specialization, cross-border and cross-sectoral collaboration.
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114. Regional and national data collection and harmonization was an important achievement of the project for 12 out
of 16 countries covered across the REDISSE phases. In future projects, more granular data and real-time data will be
necessary to effectively contain outbreaks across borders, sectors, and sub-national regions. This will be important
to not only support a culture of information sharing and constant and never-ending improvements, but also to setup
the foundations of a real-time digital platform that will ensure regional, national, and sub-national alert system
provision.
115. Sustainability planning needs to be considered throughout the early stages of the project and should be settled by
the MTR. Even though the REDISSE project design integrated sustainability of key activities and the supervision
missions suggest that this was addressed over the course of policy dialogue with country governments, it seems that
clients have grown accustomed to development partners financially and technically assisting. This might be a broader
challenge project portfolio that would require the support of the WB local and regional management to reset
expectations and communicate more effectively the project impacts and the line budget requirements over time to
prevent situations where activities collapse soon after the project closure undermining the progress and the impacts
made as , In the case of the REDISSE, the Covid phase was an important timing on the policy dialogue as the Ministries
of Finance were witnessing firsthand the economic devastations and were receptive at the time to consider line
budgets for strategic activities related to the sustainability of some of the REDISSE project activities including One
Health operationalization from the national to the district level.
116. Strengthening the supply of and demand for health security professionals across IHR core capacity requirements is
essential to sustain the development of the regional, national, and sub-national ecosystem and to include more
women and youth in this important field. While REDISSE provided numerous training opportunities including 3 level
of field epidemiology trainings, WAHO and governments need to conduct a skills assessment both from a supply and
demand perspective to upgrade curricula, to train the trainers, to provide incentives to join the health security field,
and to build awareness by educating the general population at the district and community level as a first line of
intervention.
117. Measuring results of regional interventions were not addressed in the JEE and became challenging to attribute to
the REDISSE project. While choosing these globally accepted indicators was valuable to focus on the higher objectives
and to align among countries and development partners. However, the evolution of the JEE versions implied ongoing
changes to the M&E which becomes a downside as the Project is no longer in control its M&E system. This also affects
the attribution of core activities on which REDISSE had a direct impact on countries and WAHO as highlighted in the
M&E section. The adoption of the JEE made sense for REDISSE to focus on the higher objectives and to setup the core
foundations of prevention, preparedness and response at the regional, the country and sub-national level. However,
this adoption should be reconsidered to improve regional intervention measurement, to measure specific cross-
sectoral collaboration effectiveness and to cover the attributability factors of the project.
.
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ANNEX 1. RESULTS FRAMEWORK AND KEY OUTPUTS
A. RESULTS INDICATORS
A.1 PDO Indicators
Objective/Outcome: To strengthen national and regional cross-sectoral capacity for collaborative disease surveillance
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Progress towards establishing Number 1.00 4.00 3.00
an active, functional regional
One Health platform 27-Jun-2016 31-Aug-2023 31-Jul-2023
(Number based on 5 point
Likert scale)
Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Laboratory testing capacity Number 0.00 3.00 2.00 3.00
for detection of priority
diseases: Number of 27-Jun-2016 31-Aug-2023 31-Aug-2023 31-Jul-2023
countries that achieve a JEE
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score of 4 or higher (Number)
Guinea Number 3.00 4.00 4.00
Senegal Number 3.00 4.00 4.00
Sierra Leone Number 3.00 4.00 4.00
Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Progress in establishing Number 1.00 3.00 2.00 3.00
indicator and event-based
surveillance systems: Number 27-Jun-2016 31-Aug-2023 31-Aug-2023 31-Jul-2023
of countries that achieve a
JEE score of 4 or higher
(Number)
Guinea Number 3.00 4.00 4.00
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Senegal Number 3.00 4.00 4.00
Sierra Leone Number 4.00 4.00 4.00
Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Availability of human Number 2.00 3.00 2.00
resources to implement IHR
core capacity requirements: 27-Jun-2016 31-Aug-2023 31-Jul-2023
Number of countries that
achieve a JEE score of 3 or
more (Number)
Guinea Number 3.00 4.00 3.00
Senegal Number 3.00 4.00 3.00
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Sierra Leone Number 2.00 3.00 2.00
Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Progress on cross-border Number 0.00 2.00 1.00
collaboration and exchange
of information across 27-Jun-2016 31-Aug-2023 31-Jul-2023
countries: Number of
countries that achieve a score
of 4 or higher (Number)
Guinea Number 1.00 4.00 4.00
Senegal Number 2.00 4.00 2.00
Sierra Leone Number 1.00 4.00 2.00
Comments (achievements against targets):
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Objective/Outcome: In the event of an Eligible Emergency, to provide immediate and effective response to said Emergency
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Multi-hazard national public Number 0.00 3.00 2.00 2.00
health emergency
preparedness and response 27-Jun-2016 31-Aug-2023 31-Aug-2023 31-Jul-2023
plan is developed and
implemented: Number of
countries that achieve a JEE
score of 4 or higher (Number)
Guinea Number 1.00 4.00 3.00
Senegal Number 2.00 4.00 4.00
Sierra Leone Number 1.00 4.00 4.00
Comments (achievements against targets):
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A.2 Intermediate Results Indicators
Component: Component 1: Surveillance and Information Systems
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Interoperable, Number 0.00 3.00 2.00 2.00
interconnected, electronic
real-time reporting system: 27-Jun-2016 31-Aug-2023 31-Aug-2023 31-Jul-2023
number of countries that
achieve a JEE score of 4 or
higher (Number)
Guinea Number 2.00 4.00 4.00
Senegal Number 3.00 4.00 3.00
Sierra Leone Number 2.00 4.00 3.00 4.00
Comments (achievements against targets):
Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target Formally Revised
Completion
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Target
Surveillance Systems in place Number 0.00 3.00 2.00
for priority zoonotic
diseases/pathogens: number 27-Jun-2016 31-Aug-2023 31-Jul-2023
of countries that achieve a
JEE score of 3 or higher
(Number)
Guinea Number 2.00 4.00 4.00
Senegal Number 2.00 4.00 4.00
Sierra Leone Number 1.00 3.00 4.00 4.00
Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Systems for efficient Number 0.00 3.00 0.00
reporting to WHO, OIE/FAO:
number of countries that 27-Jun-2016 31-Aug-2023 31-Jul-2023
achieve a JEE score of 5
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(Number)
Guinea Number 3.00 4.00 4.00
Senegal Number 3.00 4.00 4.00
Sierra Leone Number 3.00 4.00 4.00
Comments (achievements against targets):
Component: Component 2: Strengthening of Laboratory Capacity
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Laboratory systems quality: Number 0.00 3.00 2.00 0.00
number of countries that
achieve a JEE score of 4 or 27-Jun-2016 31-Aug-2023 31-Aug-2023 31-Jul-2023
higher (Number)
Guinea Number 2.00 4.00 2.00
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Senegal Number 3.00 4.00 3.00
Sierra Leone Number 2.00 3.00 4.00 2.00
Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Specimen referral and Number 0.00 3.00 2.00 2.00
transport system: number of
countries that achieve a JEE 27-Jun-2016 31-Aug-2023 31-Aug-2023 31-Jul-2023
score of 4 or higher
(Number)
Guinea Number 3.00 4.00 4.00
Senegal Number 3.00 4.00 4.00
Sierra Leone Number 3.00 4.00 3.00
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Comments (achievements against targets):
Component: Component 3: Preparedness and Emergency Response
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Mechanisms for responding Number 0.00 3.00 2.00 3.00
to infectious zoonoses and
potential zoonoses are 27-Jun-2016 31-Aug-2023 31-Aug-2023 31-Jul-2023
established and functional:
number of countries that
achieve a JEE score of 4 or
higher (Number)
Guinea Number 2.00 4.00 4.00
Senegal Number 1.00 4.00 4.00
Sierra Leone Number 1.00 3.00 4.00
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Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Regional surge capacity and Number 1.00 3.00 2.00
stockpiling mechanisms
established (capacity based 27-Jun-2016 31-Aug-2023 31-Jul-2023
on 5 point likert scale)
Guinea Number 1.00 3.00 1.00
Senegal Number 1.00 3.00 1.00
Sierra Leone Number 1.00 3.00 1.00
Comments (achievements against targets):
Component: Component 4: Human Resource Management for Effective Disease Surveillance and Epidemic Preparedness.
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
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Workforce Strategy: number Number 0.00 3.00 2.00 0.00
of countries that achieve a
JEE score of 4 or higher 27-Jun-2016 31-Aug-2023 31-Aug-2023 31-Jul-2023
(Number)
Guinea Number 2.00 4.00 3.00
Senegal Number 2.00 4.00 3.00
Sierra Leone Number 1.00 4.00 3.00
Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Applied epidemiology Number 1.00 3.00 3.00
training program in place
such as FETP: number of 27-Jun-2016 31-Aug-2023 31-Jul-2023
countries that achieve a JEE
score of 4 or higher
(Number)
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Guinea Number 3.00 4.00 4.00
Senegal Number 4.00 4.00 4.00
Sierra Leone Number 3.00 3.00 4.00 4.00
Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Veterinary human health Number 0.00 3.00 2.00 0.00
workforce: number of
countries that achieve a JEE 27-Jun-2016 31-Aug-2023 31-Aug-2023 31-Jul-2023
score of 4 or higher
(Number)
Guinea Number 2.00 4.00 3.00
Senegal Number 3.00 4.00 3.00
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Sierra Leone Number 1.00 3.00 2.00
Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Percentage female, of people Percentage 0.00 35.00 24.00
trained in applied
epidemiology (All categories) 28-Jun-2016 31-Aug-2023 31-Jul-2023
Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Percentage female, of people Percentage 0.00 40.00 27.00
trained in applied
epidemiology (Basic) 28-Jun-2016 31-Aug-2023 31-Jul-2023
Guinea Percentage 0.00 40.00 19.00
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Senegal Percentage 0.00 40.00 42.00
Sierra Leone Percentage 0.00 40.00 25.00
Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Percentage female, of people Percentage 0.00 35.00 19.00
trained in applied
epidemiology (Intermediate) 28-Jun-2016 31-Aug-2023 31-Jul-2023
Guinea Percentage 0.00 35.00 13.00
Senegal Percentage 0.00 35.00 8.00
Sierra Leone Percentage 0.00 35.00 25.00
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Comments (achievements against targets):
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Percentage female, of people Percentage 0.00 25.00 22.00
trained in applied
epidemiology (Advanced) 28-Jun-2016 31-Aug-2023 31-Jul-2023
Guinea Percentage 0.00 25.00 13.00
Senegal Percentage 0.00 25.00 0.00
Sierra Leone Percentage 0.00 25.00 15.00
Comments (achievements against targets):
Component: Component 5: Institutional Capacity Building, Project Management, Coordination, and Advocacy
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
Formally Revised Actual Achieved at
Indicator Name Unit of Measure Baseline Original Target
Target Completion
Citizens and/or communities Yes/No No Yes Yes
involved in
planning/implementation/ev 27-Jun-2016 31-Aug-2023 31-Jul-2023
aluation of development
programs (Yes/No)
Guinea Yes/No N Yes Yes
Senegal Yes/No N Yes Yes
Sierra Leone Yes/No N Yes Yes
Comments (achievements against targets):
Note to Task Teams: End of system generated content, document is editable from here. Please delete this note when finalizing the document.
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B. KEY OUTPUTS BY COMPONENT
Note to Task Teams: Organize the indicators and outputs around each Objective/Outcome captured in the PDO statement. Please delete this note
when finalizing the document.
Objective/Outcome 1 – Strengthen national and regional cross-sectoral capacity for collaborative disease surveillance and epidemic
preparedness in West Africa.
PDO 1. Progress towards establishing an active, functional OHP.
PDO 2. Laboratory testing capacity for detection of priority diseases.
Outcome Indicators PDO 3. Progress in establishing indicator and event-based surveillance systems.
PDO 4. Availability of human resources to implement IHR core capacity requirements.
PDO 6. Progress on cross-border collaboration and exchange of information across countries.
IRI 1. Interoperable, interconnected, electronic real-time reporting system.
IRI 3. Surveillance systems in place for priority zoonotic diseases/pathogens.
IRI 7. Systems for efficient reporting to WHO, OIE/FAO
IRI 2. Laboratory systems quality
IRI 5. Specimen referral and transport systems.
IRI 4. Workforce strategy
Intermediate Results Indicators IRI 6. Applied epidemiology training program in place such as FELTP/FEPT
IRI 9. Veterinarian human health force
IRI 11. Percentage female of people trained in epidemiology – all categories.
IRI 12. Percentage female of people trained in epidemiology – Basic.
IRI 13. Percentage female of people trained in epidemiology – Intermediate.
IRI 14. Percentage female of people trained in epidemiology – Advanced.
IRI 10. Citizens, communities involved in planning/implementation/evaluation of development.
WAHO:
Key Outputs by Component
(linked to the achievement of
- 28 joint WB missions to the 16 participating countries across REDISSE phases to provide technical
the Objective/Outcome 1)
assistance through workshops and supervision.
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- Development of a regional laboratory strategy and a regional emergency response strategy.
- Provision of master's level training in regional Field Epidemiology and Laboratory Training Programs
(FETP) benefiting over 100 students in two centers of excellence.
- Establishment of 40 additional Epidemiological Surveillance Centers to integrate laboratory and
surveillance units in health districts.
- Establishment of a network of biosafety associations, with an office in Benin.
- Establishment of a network of biobank in the Institut Pasteur of Ivory Coast.
- Partnership with WHO and Association International de Transport Aérien (AITA) to ensure that all
countries have at least one AITA-trained and certified person to approve air transportation of medical
samples.
- Implementation of a laboratory certification process for 14 laboratories within the region, incorporating
ISO1589 for human health and ISO7025 for animal health.
- Access to health expertise that might otherwise have been unavailable.
- Organization of cross-border simulation exercises.
Sierra Leone:
- Weekly epidemiological report and bulletin disseminated to all key stakeholders and improved
surveillance of 47 priority diseases.
- Improved data collection and analysis from the livestock sector, production of weekly epidemiology
bulletin and early detection of epidemic prone diseases.
- Complete migration from paper-based to electronic platform reporting from all government owned and
government assisted health facilities across the country with an average of 95% completeness and
timeliness. In addition, significant improvement in data quality from Health Facilities.
- Provision of Laboratory Reagents and consumables for Epidemic Prone diseases including Screening Kits
to Six molecular diagnostic testing labs and blood banks across the country. Improved Turn Around Time
for characterization of epidemic prone diseases and response time, thereby breaking the chain of
transmission and disease control.
- Improved clinical diagnosis in 8 public health laboratory facilities thanks upgraded equipment.
- 24-hour service thanks to the procurement and installation of inverter battery back-up system at Central
Public Health Reference Laboratory and in 4 sub-national laboratories.
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- Strengthened laboratory quality assurance and controls at all tiers in various labs across the country.
- Development of eLIMS (Laboratory Information Management System ) and training 20 (6 women and 14
men) officers in all public laboratories incorporated into the Ministry’s DHIS2 platform with improved
reporting across stakeholders.
- Supply Chain and Inventory Management tracking tools to monitor stock level at facility level.
- Establishment of Laboratory Cold Rooms in Five Facilities to provide appropriate storage for laboratory
reagents and ensure potency that produces reliable and accurate data.
- Establishment and operations of Public Health Emergency Operation Centre (EOC)at National and
Districts (DEOCs) to coordinate disease outbreak responses structurally and effectively at all levels.
- Support the development of Pandemic Influenza and business continuity plan. This resulted in a plan
used to develop the initial plan for the COVID-19 response.
- Training of 55 One Health risk communication officers on emergency risk communication in all districts to
improve compliance and response.
- Support the popularization of One Health risk communication strategy across sectors and at sub-national
levels.
- Major improvement of district-level reporting thanks to livestock training (210 trainees (23 female and
187 male)) and Community Animal Health Workers (CAHWs) supervisors (50 (5 women, 45 men)).
- Significant improvement of veterinary services in the country with better animal disease control (six
MAFS staff (2 female, 4 male) in Veterinary Medicine at the Kwame Nkrumah University of Science and
Technology (Ongoing started in 2019/2020 academic year –end in 2024/2025 academic year).
- Improved disease incident management systems in all districts thanks 80 EOC staff training.
- Improved Rapid Response coordination and response thanks to training to 240 members (5/district)
- Improved institutional coordination (Ministry of Health and Sanitation (MoHS), Ministry of Agriculture
and Forestry (MAF), Integrated Health Project Administration Unit (IHPAU), EOC etc), mobility and
communication.
- Public Health Bill presented to parliament and enacted on 23rd November 2022, which establishes the
National Public Health Agency (NPHA)
- Establishment and operationalization of the One-Health Secretariat and enhanced multi-sectoral
coordination in the response to COVID-19 with remarkable success
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Guinea:
- Improved multi-sector collaboration (information sharing, joint investigation of suspected epidemic
event) through the operationalization of the One Health National Platform with its decentralized
structures (regional, prefectural and community levels).
- Strengthened disease surveillance systems in the human, animal health and wildlife sectors thanks to
updated definitions of priority zoonotic diseases and standard operating procedures for surveillance.
- Improved early detection of unusual health events in communities and real-time feedback of surveillance
data. This is the case, for example, in the detection of Foot and Mouth Disease, Rabies in animal health,
Avian Influenza, Marburg, Lassa Fever and the resurgence of Measles and Ebola.
- Reinforced logistical capabilities for Veterinary Services thanks to the procurement of of 2 4x4 vehicles
and 390 motorcycles.
- Training of 350 Veterinary Station Managers in sample collection, packaging and dispatch techniques.
- Support for the canine rabies vaccination campaign.
- Continued support for Avian Influenza surveillance;
- Printing of 700 copies of a newly defined Wildlife Monitoring Manual.
- Improved detection of priority diseases with epidemic potential by laboratories with reduced turnaround
time for results (within 72 hours) thanks to equipment, staff training and the supply of reagents and
consumables at all levels of the health pyramid;
- Development of a multi-sectoral National Plan to combat Antimicrobial Resistance and support for AMR
surveillance in laboratories;
- Improved training and research by equipping the microbiology laboratory at the country's Institut
Supérieur des Sciences et Médecine Vétérinaire (Dalaba).
- Training of laboratory managers in laboratory inspection and quality management based on the One
Health approach (across human and animal health both at the national and the sub-national levels).
- Contribution to improving the availability of human resources capable of implementing the key capabilities
of RSI 2005;
- Training of 34 front-line FELTP agents and 14 Master-level FELTP managers in Ouagadougou (Human and
Animal Health);
- Training of 6 Master's-level managers, including 1 in Public Health and 5 in Health Logistics Chain
Management;
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- Strengthening of the institutional capacities of the three ministries and the implementing departments
through the provision of rolling stock (motorcycles and vehicles), IT equipment, internet connection,
financing of the beneficiary ministries' policy documents.
- Financing of annual self-evaluation workshops (2018-2022) and the Joint External Evaluation (EEC May
2023).
- Acquisition of 100,000 doses of rabies vaccine for veterinary use and 6,427 doses of rabies vaccine for
human use.
- Vaccination support (including vaccinator training, communication and deployment) aimed at 95,000 dogs
in 11 high-risk localities.
Senegal:
- Strengthened national epidemiological surveillance network for animal diseases, including zoonoses,
through training/supervision missions.
- Integrated disease surveillance and response system (DSRS) strengthened through training supervision at
community level.
- Strengthened operation of syndromic sentinel surveillance network from collection to transport to
samples processing.
- Support for active avian flu surveillance at ornithological sites and satellite villages through the acquisition
of equipment/logistics and intervention missions.
- Effective ramp-up of interoperability of monitoring and reporting systems (human and animal health).
- Buildup of the early warning system for forecasting infectious health trends re-emerging diseases (RVF,
bovise tuberculosis and brucellosis, Shiga toxin-producing E.coli, antibiotic resistance in Escherichia coli
and salmonella strains in the livestock and environmental sectors …) and the development of an
operational plan to combat diseases linked to the environment and climate change.
- Strengthening wildlife surveillance by developing practical guides for monitoring wildlife species
implicated in zoonotic diseases, and supplying wildlife surveillance equipment and detection materials.
- Upgraded laboratory facilities for animal and human health.
- Accreditations of LNERV to ISO CEI 17025 version 2017 to reinforce its status as an international reference
laboratory and ISO quality standards (ISO 15189 and 9001) for many national and sub-national
laboratories.
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- Improved data and standard operating procedures for sample transport and handling for national and sub-
national public laboratories.
- Acquisition of laboratory reagents and consumables for epidemiological surveillance (human and animal
health).
- Strengthened laboratory network with the acquisition of two mobile laboratories and additional laboratory
equipment to strengthen hospital laboratories.
- Improved intersectoral coordination and collaboration in preparedness and response at national and sub-
national level.
- Development of the Ebola preparedness plan and revision of SOPs.
- Revision of standard operating procedures for the type 2 emergency medical team.
- Updated Senegal's health risk map and resource map;
- Elaboration and printing of a community organization guide and epidemic intervention sheets;
- Elaboration of a Communication Plan on priority zoonotic/pathogenic diseases.
- Strengthening of laboratory network with 4 field stations with diagnostic and evaluation equipment.
- Epidemic response capacities strengthened through the acquisition of personal protective equipment and
ambulances, and completion of the rehabilitation of the Kaolack Service d’Aide Medicale d’Urgence
(SAMU).
- Effective deployment of the Armed Forces Health Services mobile hospital in the Diourbel region.
- Acquisition of intervention products and networking of the entire national ambulance fleet and
interconnection of sites (sub-national SAMU Kaolack, Fatick and Kaffrine) to the Dakar site.
- Rehabilitation of 124 livestock vaccination sites.
- Provision of biomedical waste management materials and equipment to health facilities.
- Acquisition of PPE for the Fire Brigade and the Army Health Service.
- Support for the operationalization of the interministerial crisis management center (COGIC).
- Rehabilitation of the PAFA pharmacies in Dakar and Thiès (increased storage capacity for epidemic
response).
- Increased medical supply storage with the completion of the rehabilitation of Armed Forces medical
storage facility.
- Support bird flu control action plans in infected regions (Dakar, St Louis, Louga, Ziguinchor, Fatick, etc.).
- Support action plans to combat Crimy-Congo Hemorrhagic Fever in infected regions (Dakar, Louga, etc.).
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- Training of 146 public and private agents (including 17% women) in epidemiology and reporting of animal
diseases to strengthen the national epidemiological surveillance system.
- Strengthening of community-based surveillance with the training of 48 trainers and 369 community
livestock relays (18% women).
- 25 agents trained in field epidemiology for better management of animal diseases, including zoonoses.
- 40 livestock agents (40% women) trained in zoonosis control methods.
- 646 teachers (21% women) (Inspectors of Education and Training, student teachers and teachers
representing Pedagogical Animation Units) trained on the "One Health" concept, human diseases and
priority zoonoses in Senegal, at elementary school level, including the production of a training guide and
06 IEC/CCC booklets adapted to the school.
- 20 army and gendarmerie nurses (10% women) trained in disease surveillance and response to strengthen
epidemiological surveillance in army health.
- 335 environmental agents or eco-guards trained in biosafety measures and wildlife diseases to strengthen
environmental disease surveillance;
- 26 agents (42% women) from LNERV trained in sample and data management and traceability.
- 22 agents (40% women) across Ministries trained in database creation, R software, basic statistical tests
and data visualization.
- 59 laboratory technicians from health districts in 14 regions trained in the diagnosis of priority diseases.
- 206 agents trained in epidemiology to better ensure integrated disease surveillance or response to
epidemic emergencies.
- 223 health workers (29% of whom are women) trained in infection prevention and control (IPC).
- 140 health professionals (25% of whom are women) trained in the management of poisoning caused by
household products, pesticides, and envenomation.
- Strengthening the effective operation of the one health platform (meetings, COPIL, thematic groups,
sectoral committees, review/planning of the PAN SSM, etc.).
- Support for implementation of the One Health approach by the various support sectors (communication,
awareness-raising, operational missions, capacity-building, etc.).
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Objective/Outcome 2 – In the event of an eligible emergency, provide immediate and effective response to said Eligible Emergency.
PDO 5. Multi-hazard national public health emergency preparedness and response plan developed and
Outcome Indicators implemented.
PDO 6. Progress on cross-border collaboration and exchange of information across countries.
IRI 8. Mechanisms for responding to infectious zoonoses and potential zoonoses are established and
Intermediate Results Indicators functional.
IRI 15. Regional surge capacity and stockpiling mechanism established.
WAHO:
- Achievement of a more coordinated response to the COVID-19 pandemic and harmonized approaches
across countries from minimum standard for testing to travel bans.
- Sharing of high-cost specialized assets such as regional reference laboratories, training institutions, and
emergency stockpiles.
Sierra Leone:
- Quarterly cross border collaboration in 7 Points of entry (PoE) with improved information sharing and
Key Outputs by Component
preparedness for epidemic-prone diseases.
(linked to the achievement of
- Significant improvement of cross-border collaboration and response to disease outbreaks thanks to the
the Objective/Outcome 2)
development of six POE Standard Operation Procedures (SOPs) and Point of Entry policy between Sierra
Leone, Guinea and Liberia.
- 4 table-top simulation exercises, one Full Scale Rapid Deployment of Interim Treatment Facilities (RDITF)
with the Military.
- Pilot for an Integrated Laboratory Specimen Referral System for a period of 12 months at sub-national
level with significant improvement in sample referral, especially during COVID-19.
- Development of a software system for coordinating emergency response for disease outbreak. This
resulted in enhancing capacity to coordinate disease outbreaks from national to district level.
- Timely Clinical and Surveillance Decisions thanks to 960 COVID-19 sample collectors (260 female, 700
male) trained to cover all district laboratories.
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- Enhanced mobility for effective implementation (4 vehicles ,149 motor bikes for chiefdom surveillance
officers and 10 motorbikes for POE staff).
Guinea:
- Early detection of epidemics, including COVID-19 since 2020 thanks to new laboratory capacity;
- 1,000 PCR tests a day, and 12 laboratories are available, including 5 capable of sequencing.
- Strengthened response coordination and multi-sector collaboration in preparing for and responding to
public health emergencies.
- Effective control of the Covid-19, Lassa fever, Foot and Mouth disease and Avian influenza epidemics.
- Emergency simulation exercises on Lassa fever and yellow fever were carried out to test the level of the
Regional and Prefectoral/Communal Epidemic Alert and Response Teams.
Senegal:
- Development and validation of an integrated multi-sectoral preparedness and response plan for public
health emergencies and disasters.
- Training 158 Border Police officers and 121 border services field agents (11%) on strategies for combating
health risks at borders (air, sea and land), and cross-border management of public health threats which
was timely just before Covid-19.
- A field simulation exercise held on the deployment of the mobile field hospital to assess the rapid response
capacity of the army health service to respond to an epidemic or during disasters requiring mass casualty
management (95 health professionals, including 15% women, took part).
- 23 maritime sanitary personnel (34% women) trained in event-based surveillance to strengthen sanitary
surveillance at Senegal's maritime gateways.
- 34 officers (34% women) from border inspection posts (BIP) trained in epidemic prevention and control.
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
ANNEX 2. BANK LENDING AND IMPLEMENTATION SUPPORT/SUPERVISION
A. TASK TEAM MEMBERS
Name Role
Preparation
John Paul Clark, Hadia Nazem Samaha, Bleoue Nicaise Task Team Leader(s)
Ehoue
Elzbieta Sieminska, Daniel Rikichi Kajang Procurement Specialist(s)
Bella Diallo Financial Management Specialist
Aissatou Chipkaou Team Member
Abdoulaye Toure Team Member
Francois G. Le Gall Team Member
Salamata Bal Social Specialist
Amadou Alassane Team Member
Ibrahim Magazi Team Member
Vololoniaina N Andrianaivo A Team Member
Salimatou Drame-Bah Team Member
Cheick Traore Team Member
Isabella Micali Drossos Counsel
Benjamin P. Loevinsohn Team Member
Shiyong Wang Team Member
Jean-Philippe Tre Team Member
Francisca Ayodeji Akala Team Member
Elhadji Adama Toure Team Member
Cheikh A. T. Sagna Social Specialist
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Adetunji A. Oredipe Team Member
Abimbola Adubi Team Member
Ayodeji Oluwole Odutolu Team Member
Patrick Lumumba Osewe Peer Reviewer
Patrick Piker Umah Tete Team Member
Hardwick Tchale Team Member
Rianna L. Mohammed-Roberts Team Member
Akinrinmola Oyenuga Akinyele Team Member
Haidara Ousmane Diadie Team Member
Christophe Lemiere Team Member
Stephane Forman Peer Reviewer
Shunsuke Mabuchi Team Member
Amos Abu Social Specialist
Upulee Iresha Dasanayake Social Specialist
Sydney Augustus Olorunfe Godwin Team Member
Brahim Sall Team Member
Oluwayemisi Busola Ajumobi Team Member
Erick Herman Abiassi Team Member
Enias Baganizi Team Member
Ngor Sene Team Member
Michael Sexton Team Member
Caroline Aurelie Plante Team Member
Edson Correia Araujo Team Member
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Moussa Dieng Team Member
Faly Diallo Team Member
Abou Gueye Social Specialist
Edson Sergio Correia Team Member
Nicole Hamon Team Member
Supervision/ICR
Moussa Dieng, Djibrilla Karamoko, Andre L. Carletto, Task Team Leader(s)
Yohana Dukhan, Zenab Konkobo Kouanda
Haoussia Tchaoussala, Ibrah Rahamane Sanoussi, Procurement Specialist(s)
Mamadou Mansour Mbaye
Kadiatou Balde Financial Management Specialist
John David Sydney Hodge Financial Management Specialist
Seynabou Sarr Financial Management Specialist
Tahirou Kalam Financial Management Specialist
Yeo Yenemanyan Financial Management Specialist
Sydney Augustus Olorunfe Godwin Financial Management Specialist
Eucharia Nonye Osakwe Financial Management Specialist
Fatou Fall Samba Financial Management Specialist
Fatoumata Toure Financial Management Specialist
Gloria Malia Mahama Social Specialist
Gina Cosentino Social Specialist
Nicolas Rosemberg Team Member
Mame Safietou Djamil Gueye Social Specialist
Kazumi Inden Team Member
Mariama Altine Mahamane Team Member
Marie Thiawa Fall Team Member
Mamady Kobele Keita Environmental Specialist
Teegwende Valerie Porgo Team Member
Luis Camilo Osorio Florez Team Member
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Sophie Lo Diop Environmental Specialist
Aissatou Tidiane Diallo Team Member
Amath Diop Procurement Team
Nohra Eugenia Posada Pacheco Team Member
Allan Dunstant Odulami Cole Procurement Team
Bouraima Diaite Procurement Team
Vololoniaina N Andrianaivo A Procurement Team
Mohammad Ilyas Butt Procurement Team
Mohamed I. Diaw Team Member
Anta Tall Diallo Procurement Team
Bolong Landing Sonko Social Specialist
Rahmoune Essalhi Procurement Team
Kofi Amponsah Team Member
Patrick Piker Umah Tete Team Member
Thierno Hamidou Diallo Procurement Team
Abdoulaye Ka Team Member
Amba Denise Sangara Team Member
Luis Corrales Team Member
Kadir Osman Gyasi Team Member
Alpha Mamoudou Bah Procurement Team
Djeneba Bambara Sere Procurement Team
Ilias Hamdouch Team Member
Fisseha Tessema Abissa Environmental Specialist
Caroline Aurelie Plante Team Member
Abib Samb Team Member
Cesaire Damien Ahanhanzo Team Member
Fatoumata Binta Maama Barry Team Member
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Regional Disease Surveillance Systems Enhancement (REDISSE) (P154807)
B. STAFF TIME AND COST
Staff Time and Cost
Stage of Project Cycle
No. of staff weeks US$ (including travel and consultant costs)
Preparation
FY15 6.775 36,716.96
FY16 170.621 836,241.73
FY17 14.719 126,385.66
FY18 1.171 33,351.44
FY19 8.841 23,594.24
FY20 5.579 11,518.29
FY24 0 -3,541.72
Total 207.71 1,064,266.60
Supervision/ICR
FY16 .900 -45,014.36
FY17 129.980 659,054.76
FY18 146.243 1,296,698.15
FY19 99.243 1,022,114.51
FY20 212.059 1,726,719.67
FY21 179.379 1,720,897.75
FY22 198.901 1,669,203.96
FY23 250.057 2,136,806.73
FY24 37.754 420,613.15
Total 1254.52 10,607,094.32
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ANNEX 3. PROJECT COST BY COMPONENT
Amount at Approval Actual at Project Percentage of Approval
Components
(US$M) Closing (US$M) (%)
Component 1: Surveillance
27.91 39.03 139.84 %
and Information Systems
Component 2: Strengthening
17.03 20.38 119.67 %
of Laboratory Capacity
Component 3: Preparedness
25.96 27.76 106.93 %
and Emergency Response
Component 4: Human
Resource Management for
14.1 14.53 103.05 %
Effective Disease Surveillance
and Epidemic Preparedness.
Component 5: Institutional
Capacity Building, Project
29.06 33.43 115.04%
Management, Coordination,
and Advocacy
Total 114.06 135.13 118.47%
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ANNEX 4. EFFICIENCY ANALYSIS
A. The Context
A succession of major disease outbreaks, including SARS, MERS, Avian Influenza, Ebola Virus Disease, Zika,
and COVID-19, has inflicted widespread devastation on both societies and economies. Several factors
intricately connected to various aspects of contemporary living contribute to the “evolution of microbes
and humans coming to a collision course”,52 including the pervasive nature of global travel, the expanding
intrusion of humanity into previously untouched natural habitats, and the effects of modernization, such
as climate change, urbanization, and overcrowding. These outbreaks have differed from one another in
many ways, including their clinical presentation, their degree of severity, and their means of transmission
– but all have had one notable thing in common: the outbreaks caught most countries off-guard and
exposed huge vulnerabilities in the capacities of countries and regions to respond quickly.
Microbes know no borders and aided by large scale movements in an interconnected world, easily
transcend national boundaries and cause significant health, social, and economic repercussions that affect
multiple countries and regions.53 The recent outbreaks underscore the folly of relying solely on national
health capacities and measures, and present a compelling case for strengthening regional and global
preparedness in addition to bolstering national capacities to respond rapidly and effectively to disease
outbreaks.
The World Bank's characterization of healthcare-related entities and actions as “goods” mirrors its
economic perspective on human health, wherein healthcare provision is influenced by market dynamics
of demand and supply. Economists commonly classify such entities into four types: private goods (e.g.,
food, medicine, books), club goods (e.g., toll roads, movie theaters), common goods (e.g., natural
resources, universal healthcare), and public goods (e.g., environment, culture, pandemic preparedness),
depending on specific characteristics related to “excludability” (i.e., the ability to prevent someone from
using them) and “rivalry” (i.e., whether their consumption affects availability for others) (figure 1). 54,55
The scope of public goods can be local, national, or global. By extension, global public goods are those
whose benefits affect all citizens of the world.56 This approach was initially outlined in 1993 when the
World Bank articulated its rationale for engaging in health matters, highlighting the control of infectious
diseases as a highly efficient and cost-effective “investment” focus.57 Considering pandemic preparedness
to be a global public good and viewing health as a catalyst for economic prosperity further justified the
52 Payne, Tom (2023) “Infectious Diseases: Are Humans the Dominant Risk?” Alesco Risk Management Services. Accessed on
11/11/23 at https://www.alescorms.com/news/infectious-diseases
53 Osterholm, Michael T and Mark Olshaker (2020): “Chronicle of a Pandemic Foretold: Learning From the COVID-19 Failure—
Before the Next Outbreak Arrives,” Foreign Affairs, July/August 2020
54 Kaul I, Grunberg I, Stern MA, eds. Public goods: international cooperation in the 21st century. Oxford University Press,
1999doi: 10.1093/0195130529.001.0001.Google Scholar
55 Moon S, Røttingen J-A, Frenk J. Global public goods for health: weaknesses and opportunities in the global health system.
Health Econ Policy Law2017; 358:195-205. doi:10.1017/S1744133116000451 pmid:28332461.
56 Chin, Moya (2021): “What are Global Public Goods?”, Finance and Development, A Quarterly Publication of the International
Monetary Fund, December 2021, Volume 58, Number 4
57 World Bank Group. Development report 1993: investing in health. 1993.
https://openknowledge.worldbank.org/handle/10986/5976?show=full
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substantial financial commitments of over US$16 billion made by the World Bank in combating Ebola.58,59
Figure 1: Categorization of goods
For a variety of reasons, public goods are undersupplied. Individuals cannot be charged for consumption
of public goods, and once supplied, no one can be prevented from consuming it. Individual producers of
public goods cannot profit from it and thus have no incentives to invest in its production. The production
of global public goods poses an even greater challenge since it involves additional layers of cross-border
coordination. The consequences of underinvestment in global health functions became very evident in
the West African Ebola epidemic of 2014-2016, which challenged the weak surveillance systems and raged
unabated for over eighteen months in the absence of rapid diagnostic tests, treatment, and vaccine
availability. This episode highlighted the world’s unpreparedness to effectively combat multi-country
disease outbreaks and laid the foundation for the Regional Disease Surveillance Systems Enhancement
(REDISSE) projects.
B. The Regional Disease Surveillance Systems Enhancement (REDISSE) projects – Phase I and II
REDISSE is a regional multi-sectoral program that aims to strengthen national and regional capacities in
West Africa (and select Central African countries) to address disease threats at the human, animal, and
environmental interface. It also includes a contingent emergency response component to improve a
government’s response capacity in the event of an emergency. Implemented in phases as an
interdependent series of projects, it currently covers all 11 countries in West Africa that comprise the
Economic Community of West African States (ECOWAS), and five countries in Central Africa.60 REDISSE I,
the first in the series of projects, was approved in 2016 for three countries – Guinea, Sierra Leone and
Senegal, each of which received US$30 million – and one regional entity – the West African Health
Organization (WAHO),61 a regional health institution established in 1998 by the heads of the 15 ECOWAS
58 World Bank. 2016. World Bank Annual Report 2016. Washington, DC: World Bank. doi: 10.1596/978-1-4648-0852-4.
59 Kim JY. Speech by World Bank Group President Jim Yong Kim at the annual meetings plenary. 2016.
http://www.worldbank.org/en/news/speech/2016/10/07/plenary-speech-by-world-bank-group-president-jim-yong-kim-2016
60 The REDISSE program was approved in four phases in 2016, 2017, 2018, and 2019 respectively with a total financing from the
World Bank of U$688.13 million. Countries covered by the REDISSSE program of projects include Angola, Benin, Chad, Central
Africa Republic, Congo Republic, Democratic Republic of Congo, Guinea, Guinea Bissau, Liberia, Mali, Mauritania, Niger, Nigeria,
Sierra Leone, Senegal, and Togo.
61 Aidam, J., Sombié, I. The West African Health Organization’s experience in improving the health research environment in the
ECOWAS region. Health Res Policy Sys 14, 30 (2016). https://doi.org/10.1186/s12961-016-0102-7
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States to improve health systems and address the common health challenges faced in the region through
coordination, collaboration and cooperation among the member states, which received US$20 million
from IDA and US$8.6 million62 in trust fund co-financing from the government of Canada. Except for
country-specific nuances, the different phases of REDISSE have the same development objective and
share the same scope and salience. The review of adherence and compliance with the economic
justifications envisaged at the time of appraisal could be relevant to the different phases of the program
given the similar PDO and scope and the fact that WAHO played a pivotal across all participating countries.
C. Economic Justification in REDISSE I
The REDISSE I project documents emphasize that a compelling economic argument exists for investing in
the strengthening of integrated disease surveillance and response systems in three ECOWAS countries:
Guinea, Sierra Leone, and Senegal (all Phase I countries). Using the West Africa Ebola epidemic as a case
in point, the PAD contends that given the economic losses in the region, estimated at $7.35 billion in 2014,
and considering the relatively modest investments needed to establish a robust global disease
surveillance and response system, the potential returns on investment are remarkably high, potentially
reaching up to 123% annually. Furthermore, given the ease with which viruses cross borders, it concludes
that there is a strong economic rationale for enhancing cross-sectoral and inter-country capabilities in
integrated disease surveillance and response to rapidly detect and address public health threats.
The REDISSE I project document primarily present three rationales for a publicly provided approach to
strengthening disease surveillance and response network in the three countries:
First, infectious diseases impose a substantial economic burden on the region, hindering both regional
and national economic development. The economic losses from pandemics are estimated to be at least
US$60 billion annually, and diseases disrupt trade and commerce globally. The interconnected nature of
the world allows pathogens to spread rapidly from remote areas to major cities, impacting economies.
Second, disease surveillance is considered a global public good, with benefits extending beyond national
borders. The non-excludable and non-rivalrous nature of these benefits necessitates collective funding to
address the “free rider” problem. Additionally, the externalities of disease outbreaks, such as discouraging
foreign investment and limiting international livestock trade, justify public financing.
The third rationale emphasizes resource sharing for efficiency, avoiding duplication of costly high-level
resources across countries. Coordinated regional responses, especially in the face of resurgent diseases,
enhance efficiency and cost-effectiveness. Delays in implementing control measures during epidemics
incur significant costs, emphasizing the need for timely detection and response to prevent exponential
growth in contagion and mitigation costs.
To strengthen coordination and execute and manage regional activities, all REDISSE phases relied on
WAHO, which is financed through REDISSE I only.
D. Cost-Benefit Analysis
62 US$3.8 initially, followed by US$4.8 during mid-term review.
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The economic analysis presented in the REDISSE I project appraisal document conducted a cost-benefit
analysis (CBA), which concluded that each US$1 invested through the project would yield an expected
return of US$108.73. The computation of this CBA ratio was based on theoretical costs of $217 million to
bring the surveillance and response systems up to WHO/OIE(WOAH) standards in 15 West Africa countries
(not the countries covered by the project) and an expected benefit of this investment of $36 billion over
a five-year period. The analysis covers 15 diseases, which include thirteen diseases that caused at least
one outbreak between 1996 and 2009 as well as Ebola and HIV. Naturally, the analysis did not include
COVID-19..
A simulation model was used to measure the impacts of disease outbreaks based on an annual probability
of an outbreak in West Africa within a range 0.01 to 0.03. The cumulative sum of the economic and health
impacts of simulated events was calculated under the scenarios of status quo (no disease surveillance)
and intervention, i.e. the REDISSE program. The number of cases and deaths averted were estimated using
historical data from previous outbreaks. Potential health benefits included benefits derived from averting
cases and deaths, as well as social and psychological benefits stemming from less apprehension and
greater peace of mind when large outbreaks of serious infectious diseases are rare or non-existent.
Economic impact was inferred from loss in economic output due to reduction in the labor force
participation (temporarily or permanently through workers being ill, dying, or caring for the sick), and
disruptions in trade, travel, and commerce due to restrictions and shutdowns. Total economic impact was
assumed to be within a range of -0.07 to -4.8 percent of GDP. The total annual benefit of controlling an
outbreak in West Africa is, on average, equal to US$7.2 billion. The net present value of the project costs
was estimated at US$313 million. By applying the estimated average annual impact constant for the five
first years of the project and using a discount rate of 3%, the analysis estimated a benefit-cost ratio equal
to US$108.73.
Since the REDISSE (phases 1 and 2) projects have closed, an ex-post cost-benefit analysis has been
conducted for this ICR. Building upon the ex-ante analysis described in the preceding paragraph, the ex-
post analysis assesses actual data and results. The retrospective approach allows for a more accurate
understanding of the project's impact, as it considers unforeseen factors and real-world complexities that
may have influenced outcomes and provides valuable insights for future decision-making and policy
development by informing stakeholders about the effectiveness and efficiency of past projects.
Health benefits are measured in terms of averted mortality (AM) due to disease “”" in country “j” in year
“y” due to investments in strengthening preparedness through the REDISSE projects, as follows:
AMi,j,y>2017 = Number of Casesi,j,y>2017 * (CFRi,j,y<2017 – CFRi,j,y>2017)
CFR refers to the Case Fatality Ratio, which is a measure used in epidemiology and public health to quantify
the proportion of people diagnosed with a particular disease who die from that disease within a specified
period.
Total health benefit (BH) is determined as the sum of the benefit from Averted Mortality from all diseases
during the REDISSE project period.
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BH������,������,y = ∑i,yBH(AM������,j,y)
The economic benefits (BE) are calculated as in the original BCA:
BE =∑(BE������,������)
where “t” refers to economic sectors (agriculture, transport, manufacturing, and services).
Two major disease outbreaks occurred during the REDISSE project period 2017-23. In terms of impact, the
most severe outbreak during this period was the COVID-19 pandemic. The first case in the region was
recorded in Nigeria at the end of February 2020, and within a month, all countries in the region came to
be affected by the pandemic. By the end of 2022, the number of cases recorded had increased to over
950,000 with over 12,000 deaths. The economic consequences were also huge. Extreme poverty in
countries of Western Africa increased by nearly 3 percent in 2022, and the proportion of people in the
region living with less than US$1.90 a day increased from 2.3 per cent in 2020 to 2.9 per cent in 2021. The
debt burdens of countries in the region increased due to slow economic recovery, shrinking fiscal space
and weak resource mobilization. This worsening economic situation adversely affected the food security
and nutrition situation in the region, leaving more than 25 million people unable to meet their basic food
needs in the region, an increase of 34% compared to 2020.
Since COVID-19 a once in a century outbreak, there is no CFR data for the years before 2016. Therefore,
Averted Mortality attributable to the REDISSE investments cannot be estimated. Therefore, it is useful to
look at other disease outbreaks for which there is a before/after data.
The other major outbreak that occurred during the REDISSE project period 2016-23 in one of the project’s
countries was Lassa Fever, a viral hemorrhagic fever caused by the Lassa virus. It is primarily found in West
Africa and is transmitted to humans through contact with food or household items contaminated with
rodent urine or feces, particularly from the multimammate rat (Mastomys species). Lassa Fever was
recorded in Nigeria in seven out of eight years between 2016 and 2023 (2021 being the only exception).
Table 1 presents the number of cases and CFR in each year.
Table 1: Lassa outbreaks in Nigeria (2016-2023)
Date Suspected cases Confirmed cases Deaths Case Fatality Ratio (CFR)
January 26, 2016 159 82 51.6
May 27, 2016 273 165 149 56.2
June 28, 2017 501 175 104 59.4
March 1, 2018 1081 317 90 28.4
March 23, 2018 1495 376 119 31.6
April 20, 2018 1849 413 114 27.6
February 14, 2019 327 324 72 22.2
February 20, 2020 472 70 14.8
February 14, 2022 211 40 19.0
May 1, 2023 4702 877 152 17.3
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Since Nigeria was part of the second phase of the REDISSE program, we relied on the same approach as in
the BCA computation presented in the REDISSE II project document, but using actual project costs instead
of estimated costs, we compute the benefit-cost ratio to be equal to 43.12, i.e., each US$1 invested
through the project yielded an expected (discounted) benefit equivalent to US$43.12 in one country
(Nigeria) in terms of averted human and economic losses due to outbreaks caused by one pathogen
(Lassa).
E. Economic Evaluation of REDISSE I
The REDISSE I project aims to strengthen cross-sectoral and inter-country capacity, contributing to the
rapid detection and response to public health threats in three ECOWAS member states. By reducing the
burden of diseases, especially among vulnerable populations, the project aims to mitigate public health
and economic risks and foster stronger growth and development prospects in the region. Additionally, the
first phase of the REDISSE program positions ECOWAS member states and WAHO to contribute to global
health security as a vital public good.
The REDISSE I project became active in January 2017 in Guinea, December 2016 in Senegal, and December
2016 in Sierra Leone. However, the implementation of the project was impacted by the COVID-19
pandemic which reached all three countries in March 2020. First, in accordance with the PDO and project
components, project resources were redeployed away from planned preparedness activities to surge
response. And second, in all countries, varying amounts of the original credit was canceled due to the
disruptions caused by the pandemic. Table 2 summarizes63 the impacts of the COVID-19 which contributed
to 5 percent reduction of original credit due to cancelled activities.
Table 2: REDISSE I Distribution of Original Credit Amount (US$, millions)
Original Revised Credit Funds used for Funds Percent Funds Percent Funds
Credit (after Planned used for used for used for
Amount cancellations) Preparedness Response Planned Planned
Activities Activities Preparedness Preparedness
(% original) (% revised)
Guinea 30 29 16 13 53 55
Senegal 30 28 22 7 73 79
Sierra 30 28 22 6 73 79
Leone
WAHO 29 28 26 1 90 93
TOTAL 119 113 86 27 72 76
Despite the unforeseen disruption unleashed by the COVID-19 pandemic, REDISSE I project significantly
validates the economic rationale for cross-border investments in the global public good of strengthening
63Some funds used for response could be counted as preparedness, especially the spending on purchase of laboratory
equipment, ambulances, etc. However, in the absence of details, a precise determination is not possible.
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pandemic preparedness.64 First, REDISSE I project played a pivotal role in reinforcing both regional and
national health security, enhancing national capabilities to prevent, detect, and respond to major disease
outbreaks. The project's regional strategy underscored the importance of collective action and cross-
border cooperation. This emphasis facilitated information sharing, policy and procedure harmonization,
and collaborative planning, implementation, and evaluation of program activities. This form of interaction
proved especially crucial for countries with limited capacity, such as Guinea and Sierra Leone (Phase I
countries). These nations gained substantial benefits from engaging with counterparts from other
countries addressing similar issues, providing a valuable learning experience. In countries where capacity
is less extensive, such exchanges nurture a sense of aspiration to match the capabilities of nations with
greater resources. Consequently, this dynamic contributed to the establishment of essential capacity
standards that all countries in the region should strive to achieve.
Second, WAHO facilitated the development of a regional laboratory strategy and a regional emergency
response strategy. These frameworks were employed as models for nations to formulate their individual
national strategies. By utilizing the regional strategy as a foundation for national strategy development,
countries guaranteed that their approaches adhered to a predefined minimum standard. Additionally,
WAHO extended technical assistance to aid countries in aligning their strategies with these established
standards.
Third, the adoption of a one-health approach, emphasizing the interconnectedness of human and animal
health, has improved the efficiency and coordination of surveillance efforts. Strengthening laboratory
capacity, including the acquisition of cold chain logistics for animal health, has contributed not only to
elevated diagnostic capabilities but has also to the overall improvement of health infrastructure in the
region.
Fourth, under the auspices of WAHO, master's level training in regional Field Epidemiology and Laboratory
(FELTP) was undertaken. This specialized training was tailored for a select group of senior epidemiologists,
a category with limited representation and poor training opportunities at the national level. By
orchestrating a regional training program, WAHO successfully gathered enough students from multiple
countries to facilitate the training. The inception of the Advanced Field Epidemiology and Laboratory
Training Program in 2018 marked the initiation of master's level training at regional institutions, benefiting
over 100 students in two centers of excellence in Abuja (for English speaking candidates) and Bamako (for
French speaking candidates). The inaugural cohort of 50 students successfully graduated in 2020.
Additionally, WAHO supported the establishment of a network of biosafety associations, with an office in
Benin. Additional training with WHO and Association International de Transport Aérien (AITA) was
organized to ensure that all countries have at least one AITA-trained and certified person who had the
stamp of authority to approve air transportation of medical samples. This resulted in huge reduction of
processing time, since DHL was not accepting medical samples unless the person was Institut Pasteur,
OOAS or AITA-certified.
Fifth, working closely with Fondation Mérieux teams and Santé Monde (Canadian NGO implementing
partner in charge of surveillance), under the REDISSE I project WAHO coordinated the establishment of 40
Epidemiological Surveillance Centers (10 in Benin, 20 in Nigeria and 10 in Togo) to integrate laboratory and
64In many ways, REDISSE I was a learning project, with lessons learned from its implementation helping develop subsequent
projects in the program across all phases.
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surveillance units in health districts. This effort significantly strengthened surveillance data analysis and
management capabilities.
Sixth, REDISSE projects resources played a pivotal role in instituting a laboratory certification process
within the region, incorporating ISO1589 for human health and ISO7025 for animal health. Supported by
WAHO, training sessions were conducted for laboratory personnel in 14 facilities across the region,
initiating the Process System Adaptation Program. Special emphasis was placed to enhance quality in the
14 laboratories and move them from 0 and 1 to 4 and 5 stars under a process improvement program
known as the Process System Adaptation Program. Upon reaching the 4-star status, the accreditation
process was initiated, resulting in accreditation of 1 laboratory in Senegal, 3 in Nigeria and 1 in Ghana.
Seventh, WAHO facilitated the exchange of technical assistance among countries, maintaining a roster of
health security experts across the region. By promoting and funding the provision of technical assistance
between countries, WAHO enabled participating countries to access expertise that might otherwise have
been unavailable. Additionally, WAHO organized cross-border simulation exercises, such as the yellow
fever simulation between Nigeria and Benin. Following the simulation exercise, these two countries
established collaborative mechanisms for cross-border cooperation.
Eighth, REDISSE ensured that participating countries gained swift and early access to World Bank funding
for COVID-19 preparedness and response. Concurrently, additional financing tailored to each country was
mobilized through the World Bank's COVID-19 Fast-Track Facility. REDISSE provided comprehensive
support for various facets of COVID-19 management, covering surveillance, entry point screening,
laboratory testing and diagnosis, infection prevention and control, case management (inclusive of
essential medical equipment and materials), and effective risk communication. With backing from WAHO,
REDISSE I countries achieved a more coordinated response to the COVID-19 pandemic. Several
laboratories in all REDISSE I countries were enhanced and equipped to conduct a large number of PCR
tests and genome sequencing. Regular weekly meetings enabled WAHO to stay abreast of the situation in
each country, facilitating the provision or coordination of necessary technical assistance. Additionally,
WAHO played a pivotal role in harmonizing approaches across countries, including the establishment of a
minimum standard for testing and travel bans. Furthermore, the organization facilitated the sharing of
high-cost specialized assets such as regional reference laboratories, training institutions, and emergency
stockpiles.
One of the least appreciated but significant impacts of these projects lies in the training initiatives, which
have empowered hundreds of health professionals in all seven countries in surveillance and information
systems. By focusing on training human and animal health staff across multiple countries, including
Senegal, Sierra Leone, Guinea, Guinea Bissau, Togo, Nigeria, and Liberia, these projects have played a
pivotal role in building the capacity to rapidly detect and respond to infectious disease outbreaks. This
concerted effort, supported by WAHO with coordination and collaboration, has not only bolstered the
individual capacities of the participating countries but has also enhanced the regional public health
infrastructure.
The proactive response to the COVID-19 pandemic, with staff trained and equipped weeks before the
outbreak, exemplifies the preparedness instilled by these projects. Additionally, the training modules
covering a spectrum of outbreaks, including Lassa Fever, Rift Valley Fever, Monkeypox, Dengue, Avian Flu,
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Rabies, and Foot and Mouth disease, have contributed to the creation of a robust and versatile public
health workforce capable of responding to a wide range of threats.
The investment in human resource management for effective disease surveillance and outbreak
preparedness, with hundreds of health personnel trained in field epidemiology and laboratory programs
at national and regional levels, has contributed to the fortification of the foundation for sustained and
effective response mechanisms. The emphasis on capacity building for regional project coordination and
regional health security partnership management through WAHO reflects a strategic approach to
sustainability and regional collaboration. By strengthening the coordination mechanisms, REDISSE I and II
have laid the groundwork for continued collaboration, ensuring the longevity and effectiveness of regional
health security efforts.
ANNEX 5. BORROWER, CO-FINANCIER AND OTHER PARTNER/STAKEHOLDER COMMENTS
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A. WAHO - Summary of Key Messages from the Final Project Report
Main findings
1. Project Relevance. REDISSE I remained relevant given the critical need to expand the regional health
security agenda by continuing to finance WAHO capacity development drawing on the lessons learned
from WB WARDS project. Moreover, the current Project’s PDOs aligned with ECOWAS’ priorities and
needs at closing. The technical assistance was often tailored to the needs of the countries of the ECOWAS
and the ECAAS. Moreover, the WB formalized its partnership with WHO and CDC in 2018 among others
to collaborate synergistically and to further expand the regional reach of the health security agenda.
Following the COVID-19 pandemic, these formal partnerships have secured further financing and technical
assistance for pandemic preparedness and response. Lastly, the PDOs were aligned with the Regional
Integration and Cooperation Assistance Strategy for the period Fiscal Year (FY) FY21-FY23 which explicitly
covered pandemic response and disease surveillance.
2. Project’s Efficacy: By August 31, 2023, almost all project activities had been carried out and completed.
After 6 years of implementation, the REDISSE I project for WAHO closed with a satisfactory rating, having
achieved the PDOs. Overall, there was substantial progress, measured by the PDO indicators and the
intermediate results indicators. The activities carried over the final months included: i) providing support
to countries to strengthen the capacity of veterinary services; ii) Creating 40 new CES in Benin, Nigeria
and Togo; iii) Evaluation of training programs supported by WAHO REDISSE; iv) Ensuring the
harmonization of training curricula and coordinating regional capacity-building strategy for effective
disease surveillance and epidemic preparedness; completing the final country project evaluation, the
technical audits (including environmental and social) and the final financial management matters (over
the grace period).
3. Assessment of the Efficacy of Stakeholders. Overall, all the stakeholder performed their roles during and
in the implementation of REDISSE I, despite the challenges faced during implementation, due to external
factors, out of their control. Their performance is deemed satisfactory.
Main challenges affecting implementation at WAHO PIU level:
• A significant time lag between the Project's effective date and the actual start-up of activities in
the field (effective date January 23, 2017 and actual start-up of activities in the second half of
2018);
• Systems Interoperability for monitoring human and animal diseases, in line with the “One Health”
approach;
• Cross-border collaboration on surveillance (including active/event-based, passive and syndromic
surveillance) for early case detection remains difficult without formal, legally binding agreements.
• No clear positioning for RAHC, resulting in a lack of coordination with technical partners and
limited operationalization of its capacity building;
• The Regional Center for Surveillance and Disease Control is understaffed and under-resourced,
hampering the implementation of project activities to function as a leading regional agency for
epidemic preparedness and response;
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• WAHO has not yet been able to develop a regional strategy for workforce development in line
with the recommendations of the FETP consultation workshop held in 2019. Such a strategy
should include guidance to ensure that FETP standards and quality are met across the region.
• The occurrence of the COVID-19 pandemic, which slowed or even halted project activities;
• The pool of animal health and environmental health workers eligible as trainees, particularly
female health workers for intermediate and advanced FELTP, is limited in some of the REDISSE
countries;
• The process of requesting and granting the World Bank's no-objection opinion takes quite a long
time, thus impacting on the execution time of planned activities;
• Staffing challenges stemming from Executive Management and permanent staff changes among
other issues including limited benefits for PIU staff workers;
• The low technical and financial capacity of local service providers has been a limiting factor.
Lessons Learned
• REDISSE's intervention model articulated around the “One Health” concept and based on a
multisectoral approach, is innovative and has been instrumental in improving Health Security across
the region. However, the growing number of regional and international organizations supporting
various “One Health” activities in West Africa calls for better coordination to ensure synergy of efforts
toward an optimal implementation of the “One Health” approach in health security;
• A decentralized approach to operationalize the “One Health” Platform from the central to the
deconcentrated level has improved the coordinated management of public health emergencies; and
justifies all the relevance of multisectoral collaboration to ensure health security;
• The REDISSE project has helped to better prepare the Defense and Security Forces (MFA) in
emergency preparedness, and response through activities including: i) the rehabilitation armed
forces supply pharmacies; ii) the acquisition of emergency response equipment (mobile truck, PPE);
iii) the deployment of the mobile field hospital (following a simulation exercise); iv) the training of
army and gendarmerie personnel in epidemiological surveillance; and v) the development of an
emergency response plan;
• The project's support in upgrading laboratory capacities has enabled some of them to become
regional reference laboratory like Senegal’s LNERV to be accredited ISO CEI 17025 version 2017;
• The project's support in strengthening the operation of syndromic sentinel surveillance network sites
in Senegal (4S), has been decisive in improving the forecasting of infectious health trends in Senegal;
• Timely information exchanges with border countries and epidemic management has significantly
improved countries’ capacity like Guinea to prepare for and respond to health emergencies;
• Availability of quality HR is essential for surveillance and epidemic preparedness and response
affected the capacity development and the sustainability plans in the short- to medium-term;
• Realistic annual planning aligned with the national health sector action plan (PANSS) is a performance
factor.
B. Guinea- Summary of Key Messages from the Country Final Project Report
Main findings
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1. Project Relevance. REDISSE I remained relevant considering the Country Partnership Framework (CPF)
and the Project’s PDOs, which aligned with Guinea’s priorities and needs at closing. The PDOs indeed aligned
with all four pillars of the CPF for the period FY18-23 [Report No. 125899-GN], namely these pillars include: (i)
promoting good governance for sustainable development; (ii) sustainable and inclusive economic
transformation; (iii) inclusive development of human capital; and (iv) the sustainable management of natural
capital.Lastly, the Project is aligned as well with the World Bank strategic role.
2. Project’s Efficacy: By August 31, 2023, almost all project activities had been carried out and completed.
After 6 years of implementation, the REDISSE I project for Guinea closed with a satisfactory rating for
achievements, having achieved the PDOs. There was substantial progress, measured by the PDO indicators
and the intermediate results indicators. The activities carried over the last months included: i) acquisition of
laboratory equipment, consumables and reagents for the Institut National de la Sante Publique (INSP); ii)
purchase of 2 4x4 vehicles and 390 motorcycles to improve response to Avian Influenza; iii) supporting
national rabies vaccination campaign iv) finalizing a waste management plan for veterinary services and
getting deliveries the remaining incinerators; v) leading the final country project evaluation, the technical
audits (including environmental and social) and the final financial management matters (over the grace
period).
3. Assessment of the Efficacy of Stakeholders. Overall, all the stakeholder performed their roles during and
in the implementation of REDISSE I, despite the challenges faced during implementation, due to external
factors, out of their control. Their performance is deemed satisfactory.
Main challenges affecting implementation:
• A delayed start of project activities in the field;
• The COVID 19 pandemic, which caused delays in the execution of certain activities. This situation led
to border closures, travel restrictions and regroupings, all of which resulted in the reallocation of 42%
of project resources to the fight against this pandemic;
• Tedious administrative procedures for processing and approving files submitted by the management
unit (approving and registering contracts, obtaining administrative documents);
• Delays in the issuance of administrative documents by the central administration, enabling work on
the selected infrastructure to begin;
• Delays in the transmission by central technical departments of documents required for the
implementation of activities (terms of reference, protocol and technical specifications);
• The disruption of disbursements following the change of regime with the activation of OP 7.30;
• Weak technical and financial capacities of local service providers, often resulting in unsuccessful calls
for tender and failure to meet contractual deadlines);
• Lack of interoperability between human and animal health surveillance systems (DHIS2 & EMPRES-i);
• Inadequacies in the functionality of the “One Health” platform, with little implementation of mission
recommendations at central, regional and prefectural levels;
• Massive wave of retirement of public workers following the change of government. This impacted the
implementing stakeholders which found themselves with very limited staff and no possibility for
recruitment.
Lessons Learned
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• The management of recent epidemics (Covid-19, Avian flu, Ebola, Lassa fever, Marburg, Yellow fever
and Meningitis) has shown that Guinea has significantly improved its capacity to prepare for and
respond to public health emergencies;
• Exchanges of health information between border countries, regular cross-border meetings and
simulation exercises enable early control of unusual public health phenomena in the sub-region;
• Multi-sectoral and multi-disciplinary collaboration through the establishment and operation of the
One Health platform from the central to the community level enable coordinated management of
public health emergencies;
• The timely transmission of preliminary and quality files by the directorates, the processing of files at
PIU level within the deadlines, central services, the IDA No Objection Notice on time and the stability
of the PIU team are determining factors for the performance of the Project;
• The timely signature and approval of contracts by central departments is a key performance factor.
C. Senegal - Summary of Key Messages from the Country Final Project Report
Main findings
4. Project Relevance. REDISSE I remained relevant considering the Country Partnership Framework (CPF)
and the Project’s PDOs, which aligned with Senegal’s priorities and needs at closing. The PDOs were indeed
aligned with the main areas of focus of the CPF for the period FY20-24 [Report No. 143333-SN], namely these
included: Foundation Pillar – Strengthening Governance Framework and Building Resilience and Pillar 2 to
improve service delivery. Lastly, the Project is aligned as well with the World Bank strategic role.
5. Project’s Efficacy: By August 31st, 2023, almost all project activities had been carried out and completed.
Unfortunately, the effectiveness of the second restructuring in December 2022 did not allow enough time for
the LNERV rehabilitation to take especially that a new construction company would have had to be selected.
Overall, the REDISSE I project for Senegal closed with a satisfactory rating for achievements, having achieved
the PDOs over the six years of implementation. There was substantial progress, measured by the PDO
indicators and the intermediate results indicators. The activities carried over the last weeks were the final
country project evaluation, the technical audits (including environmental and social), the a and the final
financial management matters including the effective transfer of capital expenditures for each stakeholders
and the adoption of the procedures manual.
6. Assessment of the Efficacy of Stakeholders. Overall, all the stakeholder performed their roles during and
in the implementation of REDISSE I, despite the challenges faced during implementation, due to external
factors, out of their control. Their performance is deemed satisfactory.
Main challenges affecting implementation:
• COVID-19 pandemic impact with delayed many activities;
• Interoperability: human health had a head start over animal and environmental health. While the
REDISSE project reduced the gap, there are still activities to be implemented, especially for
environmental health;
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• The rehabilitation of key laboratories is not yet complete, which is a cause for concern given that as
the project is closed;
• Difficulty in defining technical specifications which impacted the time it takes for the World Bank to
validate no-objection opinions (requiring additional reviews and improvements);
• Delays due to staff turnover as new staff requires time with the learning curve, which slows down the
progress of activities;
• Procurement impacted the full implementation of rapid diagnostic tools;
• Improve equity in the distribution of materials within a ministry, but also equity in the supported
activity packages;
• Cross-border collaboration remained limited especially for systematic information sharing with
neighboring countries;
• Community animal health surveillance remains a proof of concept rather than a fully implemented
activity.
Lessons Learned
• Integration of the project steering committee into the multi-sector One Health Committee;
• Effective operation of 3 sub-accounts by key sectoral Ministries;
• Improve communication, particularly with regard to explanations of budget modifications
submitted by the stakeholders involved in the implementation;
• Improve collaboration between procurement professionals at the Ministry of Health and the
sectoral ministries to ensure the specificity of the equipment requested;
• Support laboratories more effectively, some suggested developing laboratories of excellence by
region, considering the three quality components of a lab: human resources, infrastructure and
reagents;
• Tackling fundamental problems for greater efficiency in adopting the One Health approach, i.e.
the project focused on zoonoses and overlooking ecosystem health. For example, support
prevention activities: monitoring water and air quality, etc.;
• Provide for emergency procedures even for animal health.
D. Sierra Leone - Summary of Key Messages from the Country Final Project Report
Main findings
7. Project Relevance. REDISSE I remained relevant considering the Country Partnership Framework (CPF)
and the Project’s PDOs, which aligned with Sierra Leone’s priorities and needs at closing. The first objective of
the second CPF Focus Area (human capital acceleration for inclusive growth) emphasizes the need to deliver
quality and inclusive education and health. This includes support for the country’s capacity to prevent and
respond to disease outbreaks. also surrounding potentially epidemic diseases. The support linked to disaster
risk management also includes support for strengthening disease surveillance systems for early detection and
prevention of epidemics. The project is aligned with Sierra Leone’s Medium-term National Development Plan
(NDP) (2019-2023) which emphasizes human capital development. For the Sierra Leone NDP, under cluster 1
(human capital development) both sub-sections 1.3 and 1.4 are highly relevant to the REDISSE I project as
they respectively focus on “accelerating health care delivery” and on “enhancing environmen tal sanitation
and hygiene”. Lastly, the Project is aligned as well with the World Bank strategic role.
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8. Project’s Efficacy: By June 30, 2023, almost all project activities had been carried out and completed.
After 6 years of implementation, the REDISSE I project for Sierra Leone closed with a satisfactory rating for
achievements, having achieved the PDOs. There was substantial progress, measured by the PDO indicators
and the intermediate results indicators. The activities carried over the last weeks were the final country
project evaluation, the technical audits (including environmental and social) and the final financial
management matters (over the grace period).
9. Assessment of the Efficacy of Stakeholders. Overall, all the stakeholder performed their roles during and
in the implementation of REDISSE I, despite the challenges faced during implementation, due to external
factors, out of their control. Their performance is deemed satisfactory.
Main challenges affecting implementation:
• The delay in developing an operational plan from the beginning hindered the implementation of initial
activities. Limited capacity of the component technical leaders contributed to a slow start of project
activities;
• COVID-19 outbreak affected all programs and led to reprogramming construction activities planned
for animal health interventions;
• The involvement of the Sierra Leone Environmental Protection Agency was limited. The engagement
of the environmental dimension of the One Health approach should be emphasized in future projects;
• Despite the recruitment of a staff to support the safeguards activities of the project at level of the
PIU, there was insufficient authority, coordination and collaboration with the relevant Ministry of
Health and Sanitation staff that are critical for the implementation of safeguard activities. This led to
less optimal implementation of the safeguards recommendations of the projects;
• Limited presence of global and regional organizations such as WHO and WAHO in-country resulted in
limited effectiveness of national preparedness and response;
• Sustainability of activities at REDISSE I project closure posed a major challenge at national and district
level. The Public Health Agency has not ramped up fast enough to take over and sustain most of the
project activities.
Lessons Learned
• Adequate human resources are essential component for implementing activities and developing
synergies among key actors in the surveillance, preparedness, and response against potentially
epidemic diseases;
• The experience from the COVID-19 outbreak has demonstrated the need to strengthen surveillance
capacity as a cornerstone of preparedness and response;
• Capacity-building of implementing entities is necessary to optimize the key steps of the project
implementation from planning to procurement;
• Engaging stakeholders across key sectors including the environmental sector is essential to ensure a
comprehensive implementation of the One Health approach.
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ANNEX 6. SUPPORTING DOCUMENTS (IF ANY)
1. Project Appraisal Document (PAD)
2. Restructuring Documents
3. Financing Agreements
4. Aide Memoires 2016-2023
5. Mid-term Review Report February 2022
6. Implementation Status Reports 1-15
7. Country Progress Reports
8. JEE reports 2017-2023
9. Country Presentations. July 2023. Abidjan
10. WAHO - Final Implementation Report. December 2023.
11. Sierra Leone - Country Final Implementation Report. December 2023
12. Senegal - Country Final Implementation Report. December 2023
13. Guinea - Country Final Implementation Report. December 2023
14. Report on One Health Technical and Ministerial Meeting. Dakar, Senegal. November 2016.
15. Rapport de l’évaluation interne. Finale du programme de formation en FELTP-master mis en œuvre
par les universités de Ouagadougou et du Ghana sur financement de REDISSE-OOAS. 2018-2023.
16. The World Bank’s Early Support to Addressing COVID-19: Health and Social Response (An Early-Stage
Evaluation).
17. https://onehealthoutlook.biomedcentral.com/articles/10.1186/s42522-020-00033-4#Sec1
18. CEDEAO. REDISSE. Bobo Dioulasso. Mai-Aout 2023.
19. World Bank. 2022. The World Bank’s Early Support to Addressing COVID-19: Health and Social
Response. An Early-Stage Evaluation. Independent Evaluation Group. Washington, DC: World Bank
20. Vanlangendonck, C., Mackenzie, J. & Osterhaus, A. Highlights from Science Policy Interface sessions
at the One Health Congress 2020. One Health Outlook 3, 1 (2021). https://doi.org/10.1186/s42522-
020-00033-4
21. Putting Pandemics Behind Us Investing in One Health to Reduce Risks of Emerging Infectious
Diseases. October, 2022. One Health. World Bank, Technical Report.
22. Empowering global health security and policy in Africa
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ANNEX 7. The Joint External Evaluation (JEE) Tool
Considering the growth in international travel and trade, the emergence and reemergence of
international disease threats, and other public health risks, the World Health Assembly adopted revisions
to the International Health Regulations (IHR 2005) that went into effect in June 2007 with the stated goal
that all member states would self-assess and report, on an annual basis, on their progress towards
complying with the 13 core IHR capacities and that all member states would fully achieve compliance
within 5 years (i.e., by mid-year 2012)65. The IHR core capacities for preparedness, detection, and response
represent essential national public health functions, which provide health protection for domestic
populations and collectively also provide the basis for regional and global health security. Despite two 2-
year extensions (2012 and 2014), by 2016, most member states had failed to report annually on their
progress toward compliance. Moreover, national self-assessments proved to be unreliable estimates of
true country capability66,67. Due to the identified deficiencies and limitations of the self-assessment-based
reporting, calls for external assessment of capabilities had been raised several times both by the WHO68
and other actors.
In parallel, at the time when the Ebola epidemic was spreading through West African and the wider region
and due to the frustration with lack of progress towards IHR implementation, the Global Health Security
Agenda (GHSA) was launched in 2014 at the US Department of Health and Human Services. It comprised
representatives of 26 nations, WHO, the Food and Agriculture Organization of the United Nations (FAO),
and the World Organization for Animal Health (WOAH), to prevent, detect, and respond to serious
infectious disease threats with the capacity for rapid spread and to galvanize national efforts toward IHR
2005 compliance to prevent such diseases. In 2015 the GHSA developed a health security external
assessment tool and process, which was piloted in 5 volunteer countries (Georgia, Peru, Uganda, Portugal,
and the UK). That same year the IHR Review Committee recommended that the WHO Secretariat
“develop, through regional consultative mechanisms, options to move from exclusive self-evaluation to
approaches that combine self-evaluation, peer review and voluntary external evaluations involving a
combination of domestic and independent experts”. The Executive Board at its 136th session and the 68th
World Health Assembly approved implementation of the recommendation. As a result, a global technical
consultation meeting on the IHR Monitoring and Evaluation Framework launched an exercise which
produced an evaluation tool and process called the Joint External Evaluation (JEE), developed based on
the experience of national self-assessments, the WOAH Evaluation of Performance of Veterinary Services
(PVS), the GHSA external assessment pilots, the CDC’s Public Health Emergency Preparedness
Performance Measures, among others.
65 World Health Organization. International Health Regulations (2005). 3rd ed.
http://apps.who.int/iris/bitstream/10665/246107/1/9789241580496-eng.pdf
66 World Health Organization, Regional Committee for the Eastern Mediterranean. Global health security—challenges and opportunities with
special emphasis on the International Health Regulations (2005).
http://applications.emro.who.int/docs/RC61_Resolutions_2014_R2_15554_EN.pdf?ua=1
67 Vong S, Samuel R, Gould P, El Sakka H, Rana BJ, Pinyowiwat V, et al. Assessment of Ebola virus disease preparedness in the WHO South-East
Asia Region. Bull World Health Organ. 2016;94:913–24. 10.2471/BLT.16.174441
68 World Health Organization. Implementation of the International Health Regulations (2005). Report of the Review Committee on Second
Extensions for Establishing National Public Health Capacities and on IHR Implementation.
http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_22Add1-en.pdf
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The JEE was developed as a standardized, independent, transparent, objective, and multisectoral
assessment that enables countries to determine their ability to be prepared for and address infectious
disease risks through a coordinated response. The JEE examines capacities across 19 technical areas to
establish an objective baseline assessment, enabling countries to have a greater understanding of their
gaps and weaknesses in health security, so they can focus efforts to improve in these areas69. The JEE was
first launched in 2016 and within a year more than 50 countries had completed an evaluation. The JEE
process brings together a multisectoral approach (e.g., animal and human health, food and agriculture,
and security and law enforcement), enabling engagement and cooperation, often for the first time, of
these disparate but health-related country experts and policy makers. Strengths, vulnerabilities, scores,
and 3–5 priority actions for each of the 19 technical areas are jointly developed based on the standards
in the JEE tool. The country is expected to use the JEE report to develop a national action plan for health
security with associated costs so that compliance gaps can be addressed through domestic resources in
collaboration with donors, partners, multilateral agencies, and the private sector through technical
assistance, funding support, or both70. Within this context, countries and development partners embraced
the JEE as the globally accepted tool, methodology and process to monitor, measure and strengthen
health security.
When the REDISSE series of projects (SOP) were under preparation, which involved extensive
consultations with countries and partners working in health security, there was a decision to use several
of the JEE indicators to develop the SOP’s results framework. This reconfirmed the commitment of the
World Bank and other development partners to collectively support countries in improving their JEE
scores.
The JEE tool has evolved over the years to address technical limitations and challenges identified through
the first round of assessments and to incorporate the lessons of the COVID-19 pandemic. In January of
2018, WHO issued the second edition of the JEE tool with relatively minor adjustments. This edition
introduced new indicators and merged some other indicators into one. The third edition of the JEE was
launched in 2021. This edition introduced changes in technical areas and indicators and integrated equity
considerations across several areas. Compared to the original JEE, versions 2 and 3 also adjusted in the
description of different levels (scores) across several indicators, making them more stringent to comply
with. Countries have been encouraged by WHO and partners alike to rely on the latest version of the JEE
to assess their capacities. Since the REDISSE results framework is based on indicators of JEE version 1.0,
for countries that used JEE 2.0 or 3.0 to assess their capacities, the scores obtained using the more
stringent measurement represent a greater capacity than what is considered in the results framework of
the project (using version 1.0 of the JEE).
69https://www.cdc.gov/globalhealth/healthprotection/stories/global-jee-process.html
70Bell E, Tappero JW, Ijaz K, Bartee M, Fernandez J, Burris H, et al. Joint External Evaluation—development and scale-up of global multisectoral
health capacity evaluation process Emerg Infect Dis. 2017 Suppl. https://doi.org/10.3201/eid2313.170949
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ANNEX 8. The One Health Approach
Although the linkages between human and veterinary medicine have been recognized since the mid-
1800s, the term ‘One Health’ was first used by the series of strategic goals known as the ‘Manhattan
Principles’ derived at a meeting of the Wildlife Conservation Society in 2004, which recognized the link
between human and animal health. These principles were a vital step in recognizing the critical
importance of collaborative, cross-disciplinary approaches for responding to emerging and resurging
diseases, and in particular, for the inclusion of wildlife health as an essential component of global disease
prevention, surveillance, control, and mitigation71. The term One Health continued to be used and
promoted as a concept in the years to follow. Since 2007 a series of strategic frameworks, declarations,
roadmaps, and action plans for One Heath have been developed, multiple congresses on the topic have
been held, and most countries have committed to advance the concepts of One Health72. While in recent
years the One Health concept gained a lot of recognition in the public health and animal health
communities, implementation of the One Health Approach in countries is still at a nascent stage.
The WHO defines One Health as an integrated, unifying approach that aims to sustainably balance and
optimize the health of people, animals, and ecosystems. The One Health approach recognizes that the
health of humans, animals (both wild and domestic), plants, and the wider environment are closely linked
and interdependent and changes in these relationships can increase the risk of human and animal diseases
developing and spreading. Therefore, to address the full spectrum of disease control – from prevention
to detection, preparedness, response and management, an approach that relies on shared governance,
communication, collaboration, and coordination among all relevant sectors is needed73.
However, collaboration in an integrated manner across sectors and disciplines that have traditionally
worked in silos does not come free of challenges. Major structural changes, in addition to substantial
behavioral change, are required to integrate the human, animal and environmental health fields to
effectively work together. This involves, among other things, integrated databases, and information
systems; mechanisms for routine coordination; a shared understanding of the risks of spillover of
pathogens in the human-animal-environment interface; standardized approaches, frameworks, and
methods; and most importantly, the willingness and know-how of relevant actors who have traditionally
worked within their own disciplines to work jointly across sectors.
A 2019 review of literature found that the most challenging factor in performing One Health initiatives is
promoting collaboration between a wide diversity of stakeholders, which is a fundamental aspect of the
One Health approach74. This included challenges in collaboration between multiple actors, multiple
71 Mackenzie JS, Jeggo M. The One Health Approach-Why Is It So Important? Trop Med Infect Dis. 2019 May 31;4(2):88. doi:
10.3390/tropicalmed4020088. PMID: 31159338; PMCID: PMC6630404.
72 https://www.cdc.gov/onehealth/basics/history/index.html
73 https://www.who.int/health-topics/one-health
74 Carolina dos S. Ribeiro, Linda H.M. van de Burgwal, Barbara J. Regeer, Overcoming challenges for designing and
implementing the One Health approach: A systematic review of the literature, One Health, Volume 7, 2019, 100085, ISSN 2352-
7714, https://doi.org/10.1016/j.onehlt.2019.100085 (https://www.sciencedirect.com/science/article/pii/S2352771418300223)
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domains and at multiple levels. Another important challenge identified was the difficulty to acquire and
establish the necessary conditions to start operating under the One Health approach. This included policy
support, access to funding, and ability to understand and implement the One Health approach.
Successful implementation of the One Health approach involves a paradigm shift in the way of working
that requires changes in cultural, social ,and institutional practices and breaking down the interdisciplinary
barriers that still separate human, animal and environmental health. These fundamental changes take
time to become established, for them to take root and to become the new norm.
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ANNEX 9. PDO Outcome Indicators Evaluation
Table 1: PDO 1 Outcome Indicators
PDO Indicators Baseline At Closing End Target ET at closing
1. Progress towards establishing
an active, functional regional Regional 1 3 4 Partially
One Health platform: (Number achieved
based on 5 point Likert scale)
(Number, Custom)
2. Laboratory testing capacity for Regional 0 3 2 Exceeded
detection of priority diseases: Guinea 3 4 4 Achieved
Number of countries that Senegal 3 4 4 Achieved
achieve a JEE score of 4 or Sierra Leone 3 4 4 Achieved
higher (Number, Custom)
3. Progress in establishing Regional 1 3 2 Exceeded
indicator and event-based Guinea 3 3 4 Unmet
surveillance systems Number of Senegal 3 4 4 Achieved
countries that achieve a JEE Sierra Leone 4 4 4 Achieved
score of 4 or higher (Number,
Custom)
4. Availability of human resources Regional 2 2 3 Unmet
to implement IHR core capacity Guinea 3 3 4 Unmet
requirements: Number of Senegal 3 3 4 Unmet
countries that achieve a JEE Sierra Leone 2 2 3 Unmet
score of 3 or higher (Number,
Custom)
5. Progress on cross-border Regional 0 1 2 Unmet
collaboration and exchange of Guinea 1 4 4 Achieved
information across countries: Senegal 2 2 4 Unmet
Number of countries that Sierra Leone 1 2 4 Unmet
achieve a JEE score of 4 or
higher (Number, Custom)
Table 2: PDO 2 Outcome Indicator
PDO Indicator Baseline At Closing End Target ET at closing
Multi-hazard national public health Regional 0 2 2 Achieved
emergency preparedness and Guinea 1 3 4 Unmet
response plan is developed and Senegal 2 4 4 Achieved
implemented Sierra Leone 1 4 4 Achieved
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Table 3: IRI Indicators
IRI Indicators Baseline At Closing End Target ET at closing
Component 1: Surveillance and Information Systems
1. Interoperable, interconnected,
electronic real-time reporting Regional 0 2 2 Achieved
system: number of countries that Guinea 2 4 4 Achieved
achieved a JEE score of 4 or higher Senegal 3 3 4 Unmet
(Number, Custom) Sierra Leone 2 4 3 Exceeded
2. Surveillance Systems in place for Regional 0 3 3 Achieved
priority zoonotic Guinea 2 4 4 Achieved
diseases/pathogens: number of Senegal 2 4 4 Achieved
countries that achieved a JEE score Sierra Leone 1 4 4 Achieved
of 3 or higher (Number, Custom)
3. Systems for efficient reporting to Regional 0 0 3 Unmet
WHO, OIE/FAO: number of countries Guinea 3 4 4 Achieved
that achieve a JEE score of 5 Senegal 3 4 4 Achieved
(Number, Custom) Sierra Leone 3 4 4 Achieved
Component 2: Strengthening of Laboratory
4. Laboratory systems quality: Regional 0 0 2 Unmet
number of countries that achieve a Guinea 2 2 4 Unmet
JEE score of 4 or higher (Number, Senegal 3 3 4 Achieved
Custom) Sierra Leone 2 2 4 Unmet
5. Specimen referral and transport Regional 0 1 2 Unmet
system: number of countries that Guinea 3 4 4 Achieved
achieve a JEE score of 4 or higher Senegal 3 4 4 Achieved
(Number, Custom) Sierra Leone 3 3 4 Unmet
Component 3 : Preparedness and Emergency Response
6. Mechanisms for responding to Regional 0 3 2 Exceeded
infectious zoonoses and potential Guinea 2 4 4 Achieved
zoonoses are established and Senegal 1 4 4 Achieved
functional: number of countries that Sierra Leone 1 4 4 Exceeded
achieve a JEE score of 4 or higher
(Number, Custom)
7. Regional surge capacity and Regional 1 2 3 Unmet
stockpiling mechanisms established Guinea 1 1 3 Unmet
(capacity based on 5 point Likert Senegal 1 1 3 Unmet
scale) (Number, Custom) Sierra Leone 1 1 3 Unmet
Component 4: Human Resource Management for Effective Disease Surveillance and Epidemic Preparedness
8. Workforce Strategy: number of Regional 0 0 2 Unmet
countries that achieve a JEE score of Guinea 2 3 4 Unmet
4 or higher (Number, Custom) Senegal 2 3 4 Unmet
Sierra Leone 1 3 4 Unmet
9. Applied epidemiology training Regional 1 3 3 Achieved
program in place such as FELTP: Guinea 3 4 4 Achieved
number of countries that achieve a Senegal 4 4 4 Achieved
JEE score of 4 or higher (Number, Sierra Leone 3 4 4 Achieved
Custom)
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10. Veterinary human health Regional 0 0 2 Unmet
workforce: number of countries that Guinea 2 3 4 Unmet
achieved a JEE core of 4 or hicher Senegal 3 3 4 Unmet
(Number, Custom) Sierra Leone 1 2 3 Unmet
Percentage female, of people Regional 0% 24% 35% Unmet
trained in applied epidemiology
(All categories) (Percentage, Custom)
Percentage female, of people Regional 0% 27% 40% Unmet
trained in applied epidemiology Guinea 0% 19% 40% Unmet
(Basic) (Percentage, Custom) Senegal 0% 42% 40% Unmet
Sierra Leone 0% 25% 40% Unmet
Percentage female, of people Regional 0% 24% 35% Unmet
trained in applied epidemiology Guinea 0% 13% 35% Unmet
(Intermediate) (Percentage, Custom) Senegal 0% 8% 35% Unmet
Sierra Leone 0% 25% 35% Unmet
Percentage female, of people Regional 0% 22% 25% Unmet
trained in applied epidemiology Guinea 0% 13% 25% Unmet
(Advanced) (Percentage, Custom) Senegal 0% 8% 25% Unmet
Sierra Leone 0% 25% 25% Unmet
Component 5: Institutional Capacity Building, Project Management, Coordination and Advocacy
11. Citizens and/or communities Regional No Yes Yes Achieved
Involved in planning/ Guinea No Yes Yes Achieved
implementation/evaluation of Senegal No Yes Yes Achieved
development programs Sierra Leone No Yes Yes Achieved
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