The World Bank Implementation Status & Results Report Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) LATIN AMERICA AND CARIBBEAN | Trinidad and Tobago | IBRD/IDA | Investment Project Financing (IPF) | FY 2020 | Seq No: 7 | Archived on 07-Oct-2024 | ISR00208 Implementing Agencies: Ministry of Health 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 29-Oct-2020) To detect and respond to the threat posed by COVID-19 and to strengthen the national health system for the emergency response to the COVID-19 pandemic. Has the Development Objective been changed since Board Approval of the Project Objective? No 2. COMPONENTS Name Support to COVID-19 Vaccination Campaign:(Cost 8,050,000.00) Emergency Response to COVID-19:(Cost 11,700,000.00) Project Management and Monitoring:(Cost 250,000.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Moderate 4. KEY ISSUES & STATUS Oct 08, 2024 Page 1 of 10 The World Bank Implementation Status & Results Report Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) 4.1 Implementation Status and Key Decisions The Trinidad and Tobago COVID-19 Emergency Response Project supported the government’s efforts to detect and respond to the COVID-19 pandemic while strengthening the national health system. Key achievements include the procurement of essential medical equipment, pharmaceuticals, and personal protective equipment (PPE), which significantly improved case management in hospitals and reduced the spread of the virus through the establishment of parallel platforms for routine health services and COVID-19 care. The project also played a critical role in backing the national COVID-19 testing strategy, with over 834,000 people tested by September 2022. In July 2022, the project was restructured to finance the purchase and deployment of vaccines, leading to the successful vaccination of 53 percent of the population. The project closed on June 30, 2024. Some of the remaining key actions are the following; (1) Document the outstanding Designated Account (DA) balances totaling US$7.6 million by October 18, 2024, and (2) Submit the final audit report for the period ended June 30, 2024 to the World Bank (WB) – Dec 31, 2024. 4.2 MPA Program Development Objective Original MPA Program Development Objective (Approved as part of (Seq. ) package on ) Current MPA Program Development Objective (Approved as part of (Seq. ) package on ) 4.3 Multiphase Programmatic Approach (MPA) Status (Public Disclosure) COVID-19 MPA - ISR Write-up as of September 16, 2024 Steady progress continues to be made under the SPRP Program, including under the MPA. As reported in the past months, overall disbursements are being impacted by three main reasons. First, low disbursements in one country operation - Bangladesh (seven country operations three months ago). Second, pausing of disbursements in two countries - Afghanistan, and Myanmar. Third, processing of refunds to the project accounts, which in the past months has increased at this late stage of project implementation. Other reasons that are influencing disbursements, include: (i) amounts of Loans and Credits denominated in SDRs, and Euros have been affected because of fluctuations between the SDRs and Euros against the US dollar; and (ii) refunds processed under various operations before or upon closing. As of September 16, 2024, 88 MPA-projects have been approved with a total commitment of US$4.17 billion (the overall commitment was reduced from $4.25 to $4.17 in the past months due to partial cancellations processed prior/at project closing). One operation (Guatemala) was cancelled in mid-September 2021. Total disbursements as of September 16, 2024, amount to US$4.0 billion or 96% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations or disbursements under PEF grants as commitments do not include PEF Grants. Oct 08, 2024 Page 2 of 10 The World Bank Implementation Status & Results Report Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) In terms of the second reason noted above, which is affecting disbursements, although the Afghanistan and Myanmar operations closed, the remaining funds under the two projects have not been cancelled and therefore affect the overall disbursement profile of MPA operations. If the undisbursed commitments of these two operations are cancelled in the books, overall disbursements under the MPA would increase from 96 to 98%. Closing dates for MPA operations have been as follows: (i) ten operations closed by the end of CY22; (ii) nine operations closed on June 30, 2023; (iii) thirteen operations closed on December 31, 2023; (iv) twelve operations closed by April 2024; and (v) fourteen operations closed June 30, 2024. Twenty three operations are scheduled to close by the end of CY24. However, this number is likely to change as some extensions are planned. As with the Mid Term Review (MTR) issued on March 25, 2023, no individual ICR is required for COVID-19 MPA operations. Only one Global ICR will be prepared upon completion of the SPRP COVID-19 MPA Program, which closes on December 31, 2025. The Global ICR will be informed by final ISRs packages prepared by country operations’ teams. A template for the final ISR package was issued by OPCS on March 21, 2023. Final ISR packages include a Summary Project Assessment – Annex 1 and a Borrower’s Evaluation – Annex 2, which is optional. So far, thirty-four (34) final ISR packages have been prepared; some others are under preparation. The overall conclusion of the MPA MTR was that: (i) the COVID-19 MPA Program embodied a rapid, innovative approach to new lending for human health response; (ii) the COVID-19 MPA has been successful, notwithstanding considerable uncertainty and multiple constraints in the early stages of the pandemic; (iii) the Bank’s emergency response was remarkably swift in the most vulnerable countries facing human capital losses and development setbacks; and (iv) notwithstanding the challenges, the MPA is on track to achieve its PrDO, "prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness." As of September 16, 2024, sixty-two (62) operations or 71% of projects approved are fully disbursed, four have reached 98-99%, and nine have reached 92-97%. As of September 16, 2024, disbursements under the MPA are $4.0 billion or 96% of commitments. All projects in AFW, ECA and MNA are fully disbursed. The percentage of disbursements for the other regions is: (i) LAC 98%, (ii) SAR 95%, (iii) EAP 89%, and (iv) AFE 85%. There is one operation with disbursements under 80 percent (Samoa – 78 percent) and one operation with disbursements of 59 percent (Bangladesh). Eight of the 12 country projects in AFE have disbursed fully and one has disbursed 96%. The Uganda operation has disbursed 86 percent of commitments while the Zambia operation has disbursed 84 percent. Overall disbursement percentage for AFE is 85 percent; two percentage points higher than three months ago. The overall disbursement for AFW is 100 percent (85 percent three months ago). The 100 percent Disbursements for AFW reflect cancellation of undisbursed funds from the Nigeria operation. Disbursements for EAP operations – 89 percent, are being affected by low disbursements in Samoa (78 percent). The projects are benefitting about 4.01 billion people or 50 percent of the global population. When countries with AF-V operations are counted, the projects are benefitting about 4.26 billion or 54 percent of the global population. This is because some countries that do not have a parent project have AF-V operations. All projects approved are disbursing. Retroactive Financing (RF) continues to represent 20 percent of commitments. SAR has the highest percentage of RF at 38 percent, followed by ECA at 18 percent. Direct Payment (DP) disbursements represent 22 percent of commitments. EAP has the highest level of disbursements using DP – 80 percent, followed by AFW at 38 percent. IDA continues to represent 40 percent while IBRD represents 60 percent of disbursements. Oct 08, 2024 Page 3 of 10 The World Bank Implementation Status & Results Report Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) Streamlined procedures, delegated approvals, coupled with flexible project design and intensified efforts by counterparts and Bank teams have contributed to the progress. Implementation is being guided by Bank teams working in parallel with other health related projects, including Additional Financing operations which are supporting vaccine procurement and deployment efforts. COVID-19 MPA AF-V - ISR Write-up – September 16, 2024 Sustained efforts continue to be made to accelerate the implementation of AF operations and the SPRP Program in general. The past weeks has seen an acceleration of implementation of AF-V operations. Total disbursements as of September 16, 2024, amount to US$6.93 billion or 83 percent of overall commitments ($8.32 billion). EAP has the highest percentage of disbursements at 97%, followed by ECA and LAC at 94%, MNA at 90%, SAR at 83%, AFW at 77%, and AFE at 71%. Combined disbursements under the MPA and AF amount to $10.94 billion or 89 percent of overall commitments of $12.3 billion. As of September 16, 2024, the Bank has approved 116 operations (including MPA-V operations) to support vaccine procurement and rollout in 78 countries amounting to $8.32 billion. One hundred and twenty-one (121) operations had been approved amounting to $10.1 billion, but with cancellation of five operations and partial cancellations of funds processed in the past months under several operations, commitments today amount to $8.32 billion. The five operations that were cancelled are: (i) Costa Rica loan ($120 million); (ii) Peru loan ($500 million); (iii) Gabon loan ($12 million), which loan agreement lapsed; (iv) Philippines AF2 loan of $300 million; and (v) Guinea AF2 credit of $25.44 million. The Afghanistan operation commitment of $113 million was reduced to $60 million. Of the 116 approved operations: (i) 66 are in Africa – 32 in AFE and 34 in AFW; (ii) 10 in East Asia and the Pacific; (iii) 11 in Europe and Central Asia; (iv) 11 in Latin America and the Caribbean; (v) 9 in Middle East and North Africa; and (vi) 9 in South Asia. The 116 operations approved, include 6 operations that involved restructuring of parent projects (Bhutan, Cameroon, North Macedonia, Philippines, and Pakistan) and in the case of Lebanon, restructuring of the Health Resilience Project. Cancellations/partial cancellations have been processed under thirty-one (31) operations -- Afghanistan, Bangladesh, Belarus, Benin, Bhutan, Cabo Verde, Cameroon, Central Africa Republic, Comoros, Côte d'Ivoire AF2, Ethiopia, Gabon, Georgia, Guinea, Guinea Bissau, Jordan, Lao, Madagascar, Mali, Mozambique, Nepal, Nigeria, Pakistan, Philippines, PNG, Sierra Leone, South Africa, Sudan, ROC AF2, and Togo. Thirty-two (32) operations are being implemented in Fragile and Conflict-affected situations. IDA represents 45 percent and IBRD 55 percent of disbursements. With less than planned demand for IDA/IBRD funds for vaccine procurement because, inter alia, over supply of vaccines from donations from various sources, several projects have been/are being restructured to reallocate funds or partially cancel funds (see above) originally allocated to procurement and deployment of COVID-19 vaccines. Guidance was issued on July 7, 2023, under an Email from the Global HNP Director, which provided direction for the use of undisbursed funds under COVID-19 operations. Thanks to this guidance, the restructurings have included in some cases adding as an activity under Component 1 of the country projects, the procurement of Routine Immunization given that the program for immunization in many countries has suffered as funds and human resources have been directed to finance the pandemic. Oct 08, 2024 Page 4 of 10 The World Bank Implementation Status & Results Report Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) Sixteen (16) operations are fully disbursed (Argentina, Cambodia, El Salvador AF1 and AF2, Indonesia, Iraq, Jordan, Mauritania, Nigeria, ROC F1 and AF2, Sri Lanka AF-V 1, Tunisia, Ukraine AF-V 3, West Bank and Gaza, and Zimbabwe). Thirty-three (33) operations have disbursed 90%+ and nineteen (19) operations have disbursed 80%+. One hundred and eleven (111) operations or 96 percent of total operations approved are disbursing. Operations that have not yet initiated disbursements include: (i) Lebanon AF2, (ii) Nepal AF2, (iv) Niger AF2, (v) Senegal AF2, and (vi) Zimbabwe AF2. Retroactive Financing (RF) continues to represent 34 percent of overall commitments. ECA has the highest level of RF at 71 percent, followed by SAR at 68 percent, LAC at 51 percent, AFE and MNA at 28 percent, and AFW at 11 percent. Disbursements to UN agencies continue to represent 24 percent of overall disbursements, while Direct Payment represents 17 percent of disbursements. As with the COVID-19 MPA operations, streamlined procedures, delegated approval, wide use of Bank Facilitated Procurement (BFP), coupled with flexible project design, and intensified efforts from counterparts and Bank staff, have contributed to the rapid design, processing, and implementation of AF-V operations. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 06 - 06 Dec Proposed Rating 30 Oct 2020 2023 Political and Governance Moderate Moderate Moderate Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Substantial Moderate Sustainability Fiduciary Substantial Moderate Moderate Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Overall Substantial Substantial Moderate Oct 08, 2024 Page 5 of 10 The World Bank Implementation Status & Results Report Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes Detect and respond to COVID-19 and to strengthen the health system for the emergency response Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Percentage of COVID-19 90.00 Jun/2020 90.00 03-Nov-2020 100.00 03-Nov-2020 100.00 Dec/2021 patients hospitalized in critical care units that are treated as per national clinical practice guideline (Percentage) (Percentage) Percentage of the persons 50.00 Jun/2020 100.00 30-Nov-2023 100.00 30-Nov-2023 95.00 Dec/2023 included in the Government’s COVID-19 testing strategy who receive a virology test for COVID-19 (Percentage) (Percentage) Population vaccinated, based 50.00 May/2022 53.00 30-Nov-2023 53.00 30-Nov-2023 70.00 Dec/2023 on the targets defined by Comments on The availability of vaccines was delayed due to factors beyond the control of the government, Trinidad and Tobago's achieving targets ultimately contributing to the low vaccine uptake. National COVID-19 Vaccination Plan (total and disaggregated by gender) (Percentage) Page 6 of 10 The World Bank Implementation Status & Results Report Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) 6.2 Intermediate Results Indicators by Components Support to COVID-19 Vaccination Campaign Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 1. Grievance redressal in 0.00 May/2022 0.00 31-May-2022 0.00 31-May-2022 100.00 Dec/2023 progress within 2 weeks of Comments on This indicator was not measured as Trinidad and Tobago has an extensive legal framework in initial complaint being achieving targets place that allows for grievance redressal and given the national scope of the project, the recorded (Percentage) government preferred to utilize that mechanism. User feedback survey No May/2022 Yes 30-Nov-2023 Yes 30-Nov-2023 Yes Dec/2023 implemented and results Comments on Exit survey applied following people’s vaccination shared with the public achieving targets through the project’s communication methods (Yes/No) Emergency Response to COVID-19 Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Health facilities with an 75.00 Nov/2020 100.00 30-Nov-2023 100.00 30-Nov-2023 100.00 Dec/2023 Accident and Emergency Service (A&E) and hospitals designated to treat COVID-19 patients are equipped with PPE as per protocol (Percentage) (Percentage) Staff in the health system, 75.00 Jun/2020 100.00 30-Nov-2023 100.00 30-Nov-2023 100.00 Dec/2023 required to wear PPE, trained Page 7 of 10 The World Bank Implementation Status & Results Report Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) in Infection Prevention Control (IPC), including use of PPE, as per IPC training plan (Percentage) (Percentage) Page 8 of 10 The World Bank Implementation Status & Results Report Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) 7. DATA ON FINANCIAL PERFORMANCE 7.1 Cumulative Disbursements 7.2 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed Historical Disbursed IBRD-91570 Closed 20.00 20.00 0.00 19.93 0.00 99.63% 20.00 7.3 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing IBRD-91570 Closed 30-Jun-2020 22-Feb-2021 15-Mar-2021 31-Dec-2021 30-Jun-2024 8. KEY DATES Oct 08, 2024 Page 9 of 10 The World Bank Implementation Status & Results Report Republic of Trinidad and Tobago: COVID-19 EMERGENCY RESPONSE PROJECT (P173989) Key Events Planned Actual Approval 30-Jun-2020 30-Jun-2020 Effectiveness 15-Mar-2021 15-Mar-2021 Mid-Term Review No. 01 30-Jun-2022 Operation Closing/Cancellation 30-Jun-2024 9. RESTRUCTURING HISTORY Restructuring Level 2 Approved on 18-Oct-2022 Restructuring Level 2 Approved on 07-Jul-2022 Restructuring Level 2 Approved on 12-Nov-2020 10. ASSOCIATED OPERATION(S) There are no associated operations Oct 08, 2024 Page 10 of 10