The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) EASTERN AND SOUTHERN AFRICA | Lesotho | IBRD/IDA | Investment Project Financing (IPF) | FY 2020 | Seq No: 10 | Archived on 14-Nov-2024 | ISR01842 Implementing Agencies: Ministry of Health 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 08-May-2020) To prevent, detect and respond to the threat posed by COVID-19 to the Kingdom of Lesotho. Has the Development Objective been changed since Board Approval of the Project Objective? No 2. COMPONENTS Name Component 1: Emergency COVID-19 Response:(Cost 25,175,000.00) Component 2: Project Implementation and Monitoring & Evaluation:(Cost 3,325,000.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Substantial Substantial 4. KEY ISSUES & STATUS 4.1 Implementation Status and Key Decisions Nov 14, 2024 Page 1 of 11 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) The Lesotho COVID-19 Emergency Preparedness and Response Project aims to support the Government of Lesotho’s (GOL) effort to prevent, detect and respond to the threat posed by SARS-COV-2. The project supported the procurement of critical equipment and medical supplies such as personal protective equipment for hospitals and health care workers, additional human resources and training, both for specialized and for community health workers, and the refurbishment of the Mafeteng COVID-19 treatment center, which provides critical medical care for COVID-19 patients in the district of Mafeteng and the country. In response to GOL’s request for Additional Financing, the World Bank approved on June 1, 2021, US$22 million for the procurement and deployment of COVID-19 vaccines and an additional grant of US$3.5 million from the Health Emergency Preparedness and Response Trust Fund (HEPR TF) to support the scale-up of the COVID-19 response, vaccine deployment and to further strengthen emergency preparedness. Therefore, the total project envelope is US$33 million (US$29.5 million from IDA and US$3.5 million from HEPR TF). The project is aligned to the GOL’s COVID- 19 National Integrated Response Plan and complements support from other development partners in providing a comprehensive response to the GOL to manage the COVID-19 pandemic and implement the COVID 19 vaccination program. 4.2 MPA Program Development Objective Original MPA Program Development Objective (Approved as part of (Seq. ) package on ) Current MPA Program Development Objective (Approved as part of (Seq. ) package on ) 4.3 Multiphase Programmatic Approach (MPA) Status (Public Disclosure) Sustained progress continues to be made under the SPRP Program, including under the MPA. While disbursements were being affected over two months ago under the MPA by, inter alia, low disbursements in seven countries, implementation accelerated in five of them and undisbursed funds in another (Nigeria) were cancelled prior to closing. Only one country, Bangladesh, remains low at 59% disbursements. Since the Bangladesh operation is closing on December 31, 2024, a substantive amount of undisbursed balance is likely to be cancelled. In addition, disbursements are being affected by: (i) the processing of refunds to the project accounts, which in the past months has increased at this late stage of project implementation, and (ii) fluctuations between the SDRs and Euros against the US dollar for operations denominated in SDRs and Euros. Disbursements have also been affected by the pausing of disbursements in Afghanistan and Myanmar. In terms of Afghanistan, the AF operation of $60m closed on March 31, 2024 with $56.26 million undisbursed, while the parent project of $100.4 million will close on June 30, 2025. The original commitment of the AF was $113 million and was reduced to $60 million following a cancellation of $53 million. In terms of Myanmar, which closed in August 2023, there is an undisbursed balance which is in the process of being canceled. Delay in the cancellation has been a result of an exchange rate loss issue which has now been resolved. Nov 14, 2024 Page 2 of 11 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) As of October 15, 2024, 88 MPA-projects were approved with a total commitment of US$4.16 billion (the overall commitment has been reduced from $4.25 to $4.16 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 October 15, 2024, amount to US$4.02 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. 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 on June 30, 2024. Twenty operations are scheduled to close by the end of CY24. However, this number is likely to change as some extensions are being processed. There are at the moment 24 operations with closing dates -- June-December 2025. 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-eight (38) final ISR packageshave 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 October 15, 2024, sixty-four (64) operations or 74% of projects approved are fully disbursed, four have reached 98- 99%, and nine have reached 92-97%. Overall disbursements under the MPA are $4,017 million or 96% of commitments. All MPA projects in AFW, ECA, and MNA are fullyn disbursed. Disbursements for the other four regions are: (i) LAC 98%, (ii) SAR 95%, (iii) EAP 89%, and (iv) AFE 85%. Disbursements in EAP are being affected by relatively low disbursements in one country while in AFE, disbursements are being affected by relatively low disbursements in two countries. 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 Nov 14, 2024 Page 3 of 11 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) 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. 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 – October 15, 2024 Considerable efforts continue to be made to accelerate the implementation of AF operations and the SPRP Program in general. The past month has seen an acceleration of implementation of AF-V operations. Total disbursements as of October 15, 2024,amount to US$6.98 billion or 84 percent of overall commitments ($8.32 billion). EAP has the highest percentage of disbursements at 97%, followed by LAC at 95%, ECA at 94%, MNA at 90%, SAR at 83%, AFW at 78%, and AFE at 73%. AFW disbursements are likely to increase considerably by the end of the CY as disbursements under the Niger operation should become fully disbursed with the procurement of equipment expected to be delivered and installed in the selected facilities by the closing date of December 31, 2024. As of October 15, 2024, there are 114 Bank-financed operations (including MPA-V operations) to support vaccine procurement and rollout in 78 countries amounting to $8.32 billion. 121 operations had been approved amounting to $10.1 billion, but five operations were cancelled: (i) Costa Rica loan ($120 million), (ii) Peru loan ($500 million), (iii) Gabon loan ($12 million) - the loan agreement lapsed, (iv) Philippines AF2 loan of $300 million, and (v) Guinea credit of $25.44 million. Also, a couple of TFs have been cancelled. The Afghanistan operation commitment of $113 million was reduced to $60 million. Several operations have processed partial cancellations, thereby decreasing the overall commitments in the past months. Also, when operations close, undisbursed funds are returned to the Bank and small adjustments causing overall commitments to reduce. Of the 114 approved operations: (i) 65 are in Africa – 32 in AFE and 33 in AFW; (ii) 10 in East Asia and the Pacific; (iii) 11 in Europe and Central Asia; (iv) 11 in Latin America and the Caribbean; (v) 8 in Middle East and North Africa; and (vi) 9 in South Asia. The 114 operations approved, include 6 operations that involved restructuring of parent projects (Bhutan, Cameroon, North Macedonia, Philippines, and Pakistan) and in the case of Lebanon, restructuring of the Health Resilience Project. 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, Lebanon, 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 originally allocated to procurement and deployment of COVID- 19 vaccines. Nov 14, 2024 Page 4 of 11 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) Guidance was issued on July 7, 2023, under an Email from the Global HNP Director, which provided direction for the use of undisbursed funds under COVID-19 operations. Thanks to this guidance, the restructurings have allowed in some cases adding as an activity under Component 1 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. Seventeen (17) operations are fully disbursed (Argentina, Cambodia, El Salvador AF1 and AF2, Honduras, 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-four (34) operations have disbursed 90%+ and seventeen (17) operations have disbursed 80%+. One hundred and twelve (112) operations or 98 percent of total operations approved are disbursing. Operations that have not yet initiated disbursements include: (i) Niger AF2, and (v) Senegal 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. 09 - 28 Jun Proposed Rating 09 May 2020 2024 Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Substantial Low Low Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Moderate Moderate Environment and Social Substantial Substantial Substantial Nov 14, 2024 Page 5 of 11 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) Stakeholders Moderate Moderate Moderate Other   Low Overall Substantial Substantial Substantial Nov 14, 2024 Page 6 of 11 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes Emergency COVID-19 Response Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Diagnosed cases treated per 0.00 Apr/2020 93.00 28-Jun-2024 93.00 21-Oct-2024 90.00 Dec/2024 approved protocol Comments on Target achieved and surpassed before closing date of June 30 2024. (Percentage) achieving targets 0.00 Apr/2021 48.00 28-Jun-2024 48.00 21-Oct-2024 50.00 Dec/2024 Total population vaccinated Comments on Substantially achieved. This maybe under under reporting of the achievement as the entire (Percentage) achieving targets population does not reflect the true population at risk Total female population 0.00 55.00 55.00 50.00 vaccinated Comments on Target surpassed. More females were being vaccinated than males possibly reflecting a high (Percentage) achieving targets female ownership of health interventions Total male population 0.00 42.00 42.00 50.00 vaccinated Comments on Target substantially achieved (Percentage) achieving targets COVID-19 PCR tests processed 15.00 Apr/2021 100.00 28-Jun-2024 100.00 21-Oct-2024 70.00 Dec/2024 within two days Comments on Target achieved and surpassed. This was part of MoH policy to ensure prompt treatment and (Percentage) achieving targets facilitate transfer for serious cases. Achieved before June 2024 initial closing date. Page 7 of 11 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) 6.2 Intermediate Results Indicators by Components Component 1: Emergency COVID-19 Response Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Grievances addressed on time 0.00 Dec/2020 84.00 28-Jun-2024 84.00 21-Oct-2024 100.00 Dec/2024 (as specified in the Comments on Target achieved All grievances were addressed on time. these include adverse events, labor Stakeholder Engagement achieving targets issues. Cumulatively Plan) (Percentage) 892,800.00 May/2022 741,600.00 28-Jun-2024 1,382, 408 21-Oct-2024 800,000.00 Dec/2024 Doses of eligible COVID-19 Comments on Target surpassed. Takes into account doses paid for by Government due for destruction. Base vaccines procured (Number) achieving targets line was zero. Need to be fixed in system Health staff trained in COVID- 0.00 Apr/2021 270.00 28-Jun-2024 270.00 21-Oct-2024 400.00 Dec/2024 19 vaccination deployment Comments on Partially achieved. This indicator was impacted by MoH using other partners support for per MOH-approved protocols achieving targets training around the country (Number) Female health staff 0.00 Apr/2021 211.00 28-Jun-2024 211.00 21-Oct-2024 300.00 Dec/2024 trained in COVID-19 Comments on Partially achieved. More females s involved in care delivery than males vaccination deployment achieving targets per MOH-approved protocols (Number) Male health staff 0.00 Apr/2021 59.00 28-Jun-2024 59.00 21-Oct-2024 100.00 Dec/2024 trained in COVID-19 Comments on Partially achieved. Impacted as for females. Less males in health activities. vaccination deployment achieving targets per MOH-approved protocols (Number) A patient feedback No Apr/2021 Yes 28-Jun-2024 Yes 21-Oct-2024 Yes Dec/2024 mechanism for COVID-19 Comments on Achieved. MoH has developed a ministry wide patient feed back mecahnism and this also Page 8 of 11 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) vaccinations is in place and achieving targets support the project as part of sustainable feedback efforts. functional (Yes/No) COVID-19 related information 0.00 Apr/2021 773.00 28-Jun-2024 773.00 21-Oct-2024 500.00 Dec/2024 and education sessions Comments on Surpassed. targeting women (Number) achieving targets Serious AEFI after COVID-19 0.00 Apr/2021 92.00 28-Jun-2024 92.00 21-Oct-2024 95.00 Dec/2024 vaccination investigated Comments on Substantially achieved. This was a policy recommendation from MoH and PHOC to ensure that (Percentage) achieving targets all AAEFI were reported and treated as per national guidelines 1.00 Apr/2021 2.00 28-Jun-2024 2.00 21-Oct-2024 3.00 Dec/2024 Intensive Care Units Comments on Achieved. All ICU renovated or developed fully functional refurbished (Number) achieving targets National Reference No Apr/2021 No 28-Jun-2024 Yes 21-Oct-2024 Yes Dec/2024 Laboratory is expanded, Comments on Achieved All works and supplies installation completed. . Facility functional equipped and functional achieving targets (Yes/No) Health staff trained in COVID- 0.00 Apr/2021 60.00 28-Jun-2024 60.00 21-Oct-2024 85.00 Dec/2024 19 case management per Comments on Partially achieved . This was similarly impacted by other partner support MOH-approved protocols achieving targets (Number) 0.00 Apr/2021 2.00 28-Jun-2024 2.00 21-Oct-2024 2.00 Dec/2024 Oxygen plants established Comments on Achieved. All plants fully operational (Number) achieving targets Page 9 of 11 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) 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 TF-B5779 Effective 3.50 3.50 0.00 3.50 0.00 100.00 3.50 % IDA-66770 Effective 7.50 7.50 0.00 7.50 0.00 100.00 7.50 % IDA-69300 Effective 22.00 22.00 0.00 14.33 6.62 68.38% 22.00 7.3 Key Dates (by loan) Nov 14, 2024 Page 10 of 11 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing IDA-66770 Effective 09-May-2020 12-May-2020 27-May-2020 30-Jun-2022 31-Dec-2024 IDA-69300 Effective 01-Jun-2021 11-Jun-2021 30-Jun-2021 30-Jun-2024 31-Dec-2024 TF-B5779 Effective 02-Jun-2021 11-Jun-2021 30-Jun-2021 30-Jun-2024 31-Dec-2024 8. KEY DATES Key Events Planned Actual Approval 01-May-2020 09-May-2020 Effectiveness 27-May-2020 27-May-2020 Mid-Term Review No. 01 31-May-2022 03-May-2022 Mid-Term Review No. 02 31-May-2022 03-May-2022 Operation Closing/Cancellation 31-Dec-2024 9. RESTRUCTURING HISTORY Restructuring Level 2 Approved on 12-Jun-2024 10. ASSOCIATED OPERATION(S) There are no associated operations Nov 14, 2024 Page 11 of 11