The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) EASTERN AND SOUTHERN AFRICA | Malawi | IBRD/IDA | Investment Project Financing (IPF) | FY 2020 | Seq No: 11 | Archived on 31-Dec-2024 | ISR02637 Implementing Agencies: Ministry of Health 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 16-Jun-2020) To prevent, detect and respond to the threat posed by COVID-19 in Malawi and strengthen national systems for public health preparedness. Has the Development Objective been changed since Board Approval of the Project Objective? Yes Current Development Objective (Approved as part of Restructuring package Seq. 1 on 16-May-2024) To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness and provide immediate and effective response to an eligible crisis or emergency. 2. COMPONENTS Name Emergency COVID-19 Response:(Cost 76,800,000.00) Supporting National and Sub-national, Prevention and Preparedness:(Cost 3,250,000.00) Implementation Management and Monitoring and Evaluation:(Cost 4,650,000.00) Contingent Emergency Response:(Cost 12,200,000.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Dec 31, 2024 Page 1 of 12 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) 4. KEY ISSUES & STATUS 4.1 Implementation Status and Key Decisions The project continues to support the Ministry of Health (MoH) in responding to the COVID-19 pandemic, strengthening the health systems for emergency preparedness, and responding to the Cholera outbreak. The progress towards achievement of the Project Development Objective (PDO) remains Satisfactory and overall implementation progress is Moderately Satisfactory. The project has made significant progress in the period between May and November 2024. To date, all the designated laboratories have staff trained to conduct COVID-19 diagnosis; 43 percent of the target population has been fully vaccinated (against the target of 30 percent); and outpatient patient department visits per 1,000 population have totaled 1,163, above the target of 1100. 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) Considerable efforts continue to be made to accelerate the implementation of AF operations and the SPRP Program in general. As in the previous month, acceleration of implementation of AF-V operations has continued. Total disbursements as of November 16, 2024, amount to US$7.07 billion or 85 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 85%, AFW at 79%, and AFE at 74%. In the case of AFE, disbursements are likely to accelerate in the coming weeks with civil works contracts being implemented under the Uganda operation, which closes on December 31, 2024. 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 November 16, 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 were cancelled. The Afghanistan operation commitment of $113 million was reduced to $60 million. Many operations have processed partial cancellations, thereby decreasing the overall commitments in the past Dec 31, 2024 Page 2 of 12 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) months. Also, when operations close, undisbursed funds are returned to the Bank and small adjustments causing overall commitments to reduce. In the past several months, partial cancellations amounting to $1,108 million have been processed under 31 operations. Out of the $1,108 million cancelled, $708 million were from IDA and $400 million from IBRD. Partial cancellations have been mainly a result of evolving needs in countries given the stage of the pandemic and donations of vaccines, which have reduced the need for IBRD/IDA funds for their purchase. Guidance was issued on July 7, 2023, under an Email from the Global HNP Director, which provided direction for the use of undisbursed funds under COVID-19 operations. Thanks to this guidance, the restructurings have allowed in some cases adding as an activity under Component 1, the procurement of Routine Immunization given that the program for immunization in most countries has suffered as funds and human resources have been directed to finance the pandemic. Of the 114 approved operations: (i) 65 are in Africa – 32 in AFE and 33 in AFW; (ii) 10 in East Asia and the Pacific; (iii) 11 in Europe and Central Asia; (iv) 11 in Latin America and the Caribbean; (v) 8 in Middle East and North Africa; and (vi) 9 in South Asia. The 114 operations approved, include 6 operations that involved restructuring of parent projects (Bhutan, Cameroon, North Macedonia, Philippines, and Pakistan) and in the case of Lebanon, restructuring of the Health Resilience Project. Thirty-two (32) operations are being implemented in Fragile and Conflict-affected situations. IDA represents 45 percent and IBRD 55 percent of disbursements. 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-eight (38) operations have disbursed 90%+ and seventeen (17) operations have disbursed 80%+. One hundred and thirteen (113) operations or 99 percent of total operations approved are disbursing. The only operation that has not yet initiated disbursements is Senegal AF2, but this is expected to change in the coming weeks. 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. 010 - 27 Jun Proposed Rating 16 Jun 2020 2024 Political and Governance Substantial Substantial Substantial Macroeconomic Substantial High High Sector Strategies and Policies Moderate Moderate Moderate Dec 31, 2024 Page 3 of 12 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) Technical Design of Project or Program Moderate Substantial Substantial Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Moderate Environment and Social Substantial Substantial Substantial Stakeholders Substantial Substantial Substantial Overall Substantial Substantial Substantial Dec 31, 2024 Page 4 of 12 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes To prevent, detect and respond to the threat posed by COVID-19 Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Percentage of designated 0.00 Apr/2020 100.00 31-May-2024 100.00 11-Nov-2024 80.00 Dec/2025 health facilities ready to treat COVID-19 (Percentage) Percentage of targeted 0.00 Jun/2021 39.50 31-May-2024 43.20 11-Nov-2024 30.00 Dec/2025 population fully vaccinated based on the targets defined in national plan (Percentage) (Percentage) Percentage of females 0.00 Jun/2021 53.00 31-May-2024 53.00 11-Nov-2024 50.00 Dec/2025 fully vaccinated (Percentage) Number of OPD visits per 930.00 Mar/2022 1,061 31-May-2024 1,163 11-Nov-2024 1,100.00 Dec/2025 1000 population (Number) To strengthen national systems for public health preparedness Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Percentage of designated 0.00 Apr/2020 110 31-May-2024 100 11-Nov-2024 80.00 Dec/2023 laboratories with staff trained to conduct COVID-19 Page 5 of 12 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) diagnosis. (Percentage) 6.2 Intermediate Results Indicators by Components Emergency COVID-19 Response Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Number of health staff 0.00 Apr/2020 1,141 31-May-2024 1,527 11-Nov-2024 1,448.00 Dec/2025 trained in infection prevention and control per MOH-approved protocols (Number) No Jun/2021 No 31-May-2024 No 11-Nov-2024 Yes Dec/2025 Oxygen plant installed and Comments on Procurement contract signed for supply, delivery, installation and commissioning functional (Yes/No) achieving targets Number of health surveillance 0.00 Apr/2020 4,598.00 31-May-2024 4,598.00 11-Nov-2024 4,500.00 Dec/2025 assistants (HSAs) oriented in contact tracing, by gender. (Number) (Number) Number of female 0.00 Jun/2021 2,340.00 31-May-2024 2,340.00 11-Nov-2024 2,025.00 Dec/2025 health surveillance assistants (HSAs) oriented in contact tracing (Number) (Number) Percentage of health worker 0.00 Jun/2021 46.00 31-May-2024 46.00 11-Nov-2024 70.00 Dec/2025 Page 6 of 12 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) COVID-19 related trainings for which the training materials were assessed to identify the extent to which Gender-Based Violence (GBV) is addressed (Percentage) Number of healthcare 0.00 Jun/2021 1,475 31-May-2024 1,475 11-Nov-2024 1,475.00 Dec/2025 professionals (HCPs) and district investigation officers trained on detection and reporting, or investigation of AEFIs, by gender (Number) Number of female 0.00 Jun/2021 603 31-May-2024 603 11-Nov-2024 516.00 Dec/2025 healthcare professionals (HCPs) and district investigation officers trained on detection and reporting, or investigation of AEFIs. (Number) Number of districts 0.00 Mar/2022 28 31-May-2024 28 11-Nov-2024 29.00 Dec/2025 conducting monthly community dialogues on COVID-19 vaccination and prevention measures (Number) Number of districts with the 0.00 Mar/2022 29 31-May-2024 29 11-Nov-2024 29.00 Dec/2025 required climate- Comments on Procurement completed. Fridges distributed to districts sensitive/energy-efficient achieving targets ultra-low temperature freezer to store COVID-19 vaccines Page 7 of 12 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) (Number) Number of central hospitals 0.00 Mar/2022 0.00 31-May-2024 0.00 11-Nov-2024 4.00 Dec/2025 rehabilitated for COVID-19 case management (Number) Number of incinerators that 0.00 Mar/2022 27 31-May-2024 27 11-Nov-2024 15.00 Dec/2025 are functional (Number) Contraceptive utilization rate 62.00 Mar/2022 65 31-May-2024 90.40 11-Nov-2024 70.00 Dec/2025 (Percentage) Percentage of pregnant 24.00 Mar/2022 15.30 31-May-2024 19.30 11-Nov-2024 30.00 Dec/2025 women who made their first ANC visit within the first three months of pregnancy (Percentage) Percentage of surviving 93.00 Mar/2022 85 31-May-2024 100 11-Nov-2024 97.00 Dec/2025 infants receiving the last (i.e., third) recommended dose of Pentavalent vaccine at the national level (Percentage) People who have received 0.00 May/2022 1,362,316 31-May-2024 2,035,168 11-Nov-2024 1,250,867.00 Dec/2025 essential health, nutrition, and population (HNP) services (Number) People who have 0.00 581,985 876,199 560,000.00 received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number) Number of children 0.00 May/2022 780,331 31-May-2024 1,158,969 11-Nov-2024 690,867.00 Dec/2025 Page 8 of 12 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) immunized (Number) Supporting National and Sub-national, Prevention and Preparedness Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Number of health staff 0.00 Apr/2020 250 31-May-2024 250 11-Nov-2024 180.00 Dec/2025 trained in emerging infectious diseases (Number) Number of district where 0.00 Mar/2022 12 31-May-2024 12 11-Nov-2024 10.00 Dec/2025 Event- Based Surveillance system is functional (Number) Implementation Management and Monitoring and Evaluation Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Percentage of grievances 0.00 Apr/2020 80 31-May-2024 72.60 11-Nov-2024 80.00 Dec/2025 addressed within 4 weeks of initial complaint being recorded (Percentage) Percentage of health care 0.00 Mar/2022 30.00 31-May-2024 67 11-Nov-2024 100.00 Dec/2025 facilities supported by the project that are adhering to health care waste management as per the national IPC minimum standards (Percentage) Contingent Emergency Response Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Case Fatality Rate (CPR) 3.27 Feb/2023 3.00 31-May-2024 1.85 11-Nov-2024 3.00 Jul/2023 Page 9 of 12 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) (Percentage) Number of districts reporting 3.00 Feb/2023 28 31-May-2024 27 11-Nov-2024 29.00 Jul/2023 zero cholera cases for the past 14 days (Number) Number of Vibrio Cholera 0.00 Feb/2023 125 31-May-2024 125 11-Nov-2024 100.00 Jul/2023 genomic sequencing tests conducted during active outbreak (Number) Percentage of CTC/CTUs at 0.00 Feb/2023 0.00 31-May-2024 0.00 11-Nov-2024 100.00 Jul/2023 the district level adhering to Comments on CTU supervision not done given no active cholera cholera case management achieving targets guidelines during active outbreak (Percentage) Percentage of CTC/CTUs at 0.00 Feb/2023 0.00 31-May-2024 0.00 11-Nov-2024 100.00 Jul/2023 the district level adhering to Comments on CTU supervision not done. waste management protocols achieving targets during active outbreak (Percentage) Page 10 of 12 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) 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 IDA-D6200 Effective 7.00 6.78 0.00 7.16 0.14 98.12% 7.00 IDA-D8870 Effective 30.00 27.62 0.00 14.20 13.70 50.90% 30.00 IDA-71770 Effective 25.40 25.38 0.00 16.09 8.85 64.51% 25.40 IDA-E0980 Effective 24.50 23.92 0.00 10.97 13.19 45.41% 24.50 TF-B8719 Effective 10.00 10.00 0.00 8.75 1.25 87.48% 10.00 Dec 31, 2024 Page 11 of 12 The World Bank Implementation Status & Results Report Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) 7.3 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing IDA-71770 Effective 21-Jun-2022 01-Aug-2022 13-Sep-2022 31-Dec-2025 31-Dec-2025 IDA-D6200 Effective 14-Apr-2020 17-Apr-2020 30-Apr-2020 31-May-2022 31-Dec-2025 IDA-D8870 Effective 15-Jun-2021 02-Jul-2021 23-Aug-2021 31-Dec-2023 31-Dec-2025 IDA-E0980 Effective 21-Jun-2022 01-Aug-2022 13-Sep-2022 31-Dec-2025 31-Dec-2025 TF-B8719 Effective 28-Jul-2022 01-Aug-2022 13-Sep-2022 30-Jun-2024 30-Jun-2025 8. KEY DATES Key Events Planned Actual Approval 14-Apr-2020 14-Apr-2020 Effectiveness 30-Apr-2020 30-Apr-2020 Mid-Term Review No. 01 30-Jun-2022 24-Jun-2022 Operation Closing/Cancellation 31-Dec-2025 9. RESTRUCTURING HISTORY Restructuring Level 2 Approved on 29-Mar-2024 10. ASSOCIATED OPERATION(S) There are no associated operations Dec 31, 2024 Page 12 of 12