Annex 2: SUMMARY PROJECT ASSESSMENT, BORROWER EVALUATION October 22, 2024 Basic Information Region: West and Central Africa Country: Togo Project ID: P173880 Project Name: Togo COVID-19 Emergency Response and Systems Preparedness Strengthening Project Financing Instrument: IPF Approval Date: - Parent project: April 17, 2020 - First Additional Financing: June 10, 2021 - Second Additional Financing: Dec 21, 2021 Closing Date: - Parent project: March 31, 2022 - First Additional Financing: Dec 31, 2023 - Second Additional Financing: June 30, 2024 World Bank Financing (Original Amount in US$): $8.1 million World Bank Financing (Revised Amount in US$): $62.6 million World Bank Financing (Actual Disbursed in US$): $56.77 million (90.4 percent disbursement rate) (plus exchange rate loss and committed amount during grace period) Ratings (Highly Satisfactory, Satisfactory, Moderately Satisfactory or Moderately Unsatisfactory) Outcome Rating: Satisfactory Bank Performance Rating: Satisfactory Borrower Performance Rating: Satisfactory Implementing Agency/Agencies: Satisfactory I. PROJECT DEVELOPMENT OBJECTIVES 1. The Project Development Objective (PDO) was to prevent, detect and respond to the threat posed by COVID-19 and strengthen the national system for public health preparedness and response. The PDO and implementation arrangements remained the same till closing. II. OUTCOMES 2. The Project has contributed to enhancing COVID-19 case detection, confirmation, contact tracing, recording, and reporting. The project achieved three main outcomes: (i) Improved vaccine coverage and storage: the COVID-19 vaccine coverage rate increased from 25.25% to 27.5% between June 2022 and end June 2024, facilitated by the provision of J&J COVID-19 vaccines. Additionally, vaccine storage capacity and the cold chain system were significantly enhanced with 100% of immunization sites with functional cold chain, thanks to the procurement of 225 electric refrigerators, 245 solar refrigerators, two cold rooms, and other essential equipment, ensuring; (ii) enhanced healthcare infrastructure: intensive care management capacity was reinforced with 10 complete sets of intensive care equipment, 100 oxygen generators and other critical medical supplies. The medical waste management system was improved through the construction and rehabilitation of Page 1 of 4 Mont Fort incinerators. Health facilities were further strengthened with new medical equipment, including a mobile laboratory, hospital beds, delivery beds, ultrasound machines, and IT equipment; (iii) capacity building and training: the project upgraded the technical capacity of key healthcare actors, including training on vaccine logistics, epidemiology, biosecurity, and data digitization, gender-based violence and sexual harassment prevention. III. KEY FACTORS THAT AFFECTED IMPLEMENTATION AND OUTCOME A. KEY FACTORS DURING PREPARATION 3. With the support of development partners, the Government has formulated its National COVID-19 Preparedness and Response Plan. The design of the COVID-19 project was informed by this plan and was noteworthy for its relevance and coherence driven by the urgent need for a flexible response, to the rapidly evolving pandemic. Key factors for record-time preparation included: • Resource Availability through the existing REDISSE II (P159040). Ensuring the necessary resources were available to support the project's initiatives was fundamental. • Structure Adaptability to Urgency. Establishing appropriate infrastructure/structure quickly to address the pandemic's immediate needs was a cornerstone for population access to emergency care. • Intersectoral Coordination and Collaboration for a Comprehensive Response: effective partnership with technical organizations such as the European Union, WHO, GAVI, UNICEF, GIZ, and civil society organizations was key to enhance the project's effectiveness. B. KEY FACTORS DURING IMPLEMENTATION 4. The implementation of the project was faced with logistical challenges. More specifically, with the fluctuations of the COVID-19 infection rates, the project was faced with logistical constraints, uncertainty in the availability of vaccines and high cost of medical equipment. Collaboration and synergy of actions between different agencies and levels of government was essential to overcome these obstacles. 5. Throughout the implementation phase, two additional financings (AFs) were prepared, and two restructurings were completed. The Project Development Objective (PDO) and implementation arrangements remained consistent until the project's closing date. The Additional Financing (AF) aimed to expand the project's scope to include vaccine purchase, cold chain upgrades, service delivery enhancement, vaccine monitoring, and community engagement. These AFs were also needed for extended testing, PPE, and communication efforts. 6. The project was significantly impacted by key staff turnover at PIU level. The project experiences the departure of several key positions, including the procurement specialist, environmental safeguard specialist, monitoring and evaluation specialist, and accountant which remained vacant for at least six months. This delay hampered the project's implementation speed at various levels. IV. EVALUATION OF BANK PERFORMANCE 7. The World Bank provided regular field and virtual missions support, led by the Project Task Team Leader (TTL), to oversee various aspects of the project implementation. These missions occurred biannually, with seven missions conducted over three and a half years. Additionally, the World Bank held technical meetings between missions to closely monitor recommendations and resolve specific financial or procurement issues, a practice that positively impacted the project's results. Page 2 of 4 8. The efficient processing of project document review submitted for the Bank's no-objection and the fast disbursement of project funds were notable. The project structure, featuring Co-TTLs based in the country, was effective in allowing the World Bank to offer practical, real-time support to the project team. 9. The World Bank team's flexibility, professionalism, and adaptability, under the leadership of the TTL, facilitated ongoing and constructive dialogue with the government, including the Ministry of Health. The World Bank's willingness to approve the government request to restructure the additional financings (AFs) was pivotal for the optimal project's implementation. The extensions of the closing dates for AF1 and AF2 allowed the country to finalize the procurement processes for several major contracts critical to the project's performance. V. EVALUATION OF BORROWER PERFORMANCE 10. Borrower performance is considered as satisfactory from the design to the implementation stage of the project. The decisions and/or actions that have contributed to the successful completion of the project are summarized below: a. Effective utilization of Initial Funds from the REDISSE II (P159040) project: t he availability of project funds allowed for initial emergency disbursements, ensuring immediate action while awaiting the COVID-19 project's effectiveness. b. Effective preparation and implementation of the project with an existing experienced piu and regular oversight: the presence of the experienced REDISSE PIU team facilitated the immediate implementation of COVID-19 project activities. Establishment of the project Steering Committee and other committees at all administrative level, with regular meetings and reporting was critical to ensure continuous oversight and to provide timely strategic guidance. c. Strategic resource reallocation of the project: The government exercised due diligence and formally requested the World Bank to reallocate the remaining $5 million from the AF2 towards the procurement of additional equipment and materials for health facilities supported by the existing IDA operations, Togo Essential Quality Health Services for Universal Health Coverage Project (P174266). 11. Although several constraints affected the overall procurement process, hands-on support has been instrumental in overcoming these challenges. The Ministry of Health's implementing agencies faced significant challenges due to their limited capacity to manage technical documentation, including drafting Terms of Reference (ToRs), identifying technical specifications for project equipment and materials, and analyzing consultant-prepared documents. Direct access to World Bank specialists was crucial for the PIU in overcoming these constraints and enhancing its capacity. VI. LESSONS LEARNED AND RECOMMENDATIONS Lessons Learned 12. Rethinking of the institutional arrangement for government ownership. The frequent resignations of key personnel recruited through competitive processes, coupled with the last-minute dependence on equivalent civil servant staff to handle unexpected challenges, present a significant issue for the ministries' capacity building in project management. 13. UN agencies procurement process challenges. Managing projects with complex and varied supplies poses significant logistical challenges, even for well-known organizations. The delays experienced by UNICEF and UNOPS underscore the difficulty of managing large-scale procurement, in terms of timeline and transparent communication on the UN procedures. Page 3 of 4 14. Enhancing resilience in the healthcare system requires strengthening the responsiveness capacity of the healthcare workforce. Providing healthcare personnel with proper training and equipment is essential for enhancing early case detection and effective clinical management. Continuous investment in training and rapid diagnostic tools can shorten diagnostic times and lead to better health system outcomes. 15. Community mobilization and local engagement are essential to ensure increased vaccination coverage. Engaging community leaders and local organizations fosters trust and acceptance of vaccination programs. Clear, transparent, and accessible communication is essential to counter misinformation and increase vaccine uptake. Customizing messages to the specific needs and concerns of different communities enhances engagement and promote active participation in vaccination initiatives. Recommendations 16. Strengthen the project management capacity of the government entity to be able to assume the role of a project management unit. To enhance the capacity of ministries in managing donor-funded projects, it is essential to transform their planning units into fully-fledged technical departments staffed with competent personnel. Additionally, investing in the training and professional development of technical and fiduciary ministry staff will ensure ownership and sustainable project management. Finally, measures should be implemented to guarantee the continuity and optimal utilization of project achievements and learning experiences, after project completion, preserving valuable insights and data for future use. 17. In the context of procurement with UN agencies like UNICEF and UNOPS, ensuring regular and transparent communication will facilitate the swift resolution of issues and minimize delays. Procurement processes with UN agencies have faced prolonged delivery times in acquiring supplies. It is essential to establish effective coordination mechanisms between all stakeholders, including UN agencies, suppliers, and governments. 18. Strengthening Preparedness and Resilience and investing in robust healthcare systems and crisis preparedness can minimize the impact of future epidemics. This involves creating emergency preparedness plans, regularly performing simulation exercises, and setting up coordination mechanisms among different health stakeholders. A well-prepared health system can respond swiftly and efficiently to crises, reducing their impact on the population. 19. Implementing effective human resource management policies are critical to sustain acquired skills. To ensure the long-term sustainability of skills acquired during the project, it is crucial to implement effective human resource management policies. These policies should promote ongoing training, professional development, and the retention of skilled health personnel, particularly in difficult to reach areas, in order to ensure that the essential skills and knowledge remain within the health system. Page 4 of 4