The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) SOUTH ASIA | India | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 5 | ARCHIVED on 24-May-2022 | ISR50192 | Implementing Agencies: Ministry of Health and Family Welfare, Republic of India, Ministry of Finance Key Dates Key Project Dates Bank Approval Date: 02-Apr-2020 Effectiveness Date: 06-Apr-2020 Planned Mid Term Review Date: 15-Mar-2022 Actual Mid-Term Review Date: 22-Feb-2022 Original Closing Date: 31-Dec-2024 Revised Closing Date: 31-Dec-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed project development objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national health systems for preparedness in India. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Emergency COVID-19 Response:(Cost $1258.00 M) Component 2: Strengthening National and State health Systems to support Prevention and Preparedness:(Cost $117.00 M) Component 3: Strengthening Pandemic Research and Multi-sector, National Institutions and Platforms for One Health:(Cost $3.00 M) Component 4: Community Engagement and Risk Communication:(Cost $102.00 M) Component 5: Implementation Management, Capacity Building, Monitoring and Evaluation:(Cost $20.00 M) Component 6: Contingent Emergency Response Component (CERC) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The India COVID-19 Emergency Response and Health System Preparedness Project established in the very early days of the pandemic contributed significantly to critical healthcare infrastructure development for COVID response through the National Health Mission rapidly scaling up isolation, oxygen and Intensive Care Unit beds and expansion of COVID facilities. Human resources was augmented by about 326,920 personnel for the emergency COVID response while incentives were provided to existing staff to undertake COVID duties. The project also enabled Indian 5/24/2022 Page 1 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Council of Medical Research to ramp-up RT PCR testing infrastructure with a strong Quality Assurance system in place. As of February 2022, 675 out of the 734 districts in India have at least one RT-PCR testing facility available and duration of testing time now stands at 15 and half hours. A genomic consortium with a network of 28 laboratories has been established to provide early alerts regarding Virus of Concern and Interest. The Ministry of Railways converted 5,601 railway coaches as COVID care centers and optimized its network of hospitals for provision of COVID care. To date, the Ministry of Health and Family Welfare is implementing the project successfully. The MOHFW has put in place a strong team that is managing the four results areas of the project. The task team is working closely with the MOHFW to implement the operation. In addition, the MOHFW consistently follows up on key actions agreed with the Bank during missions and in virtual meetings. The third wave of the COVID-19 pandemic has incurred significant challenges to India’s health care system. India reported over 42 million COVID19 cases and about 511,000 deaths due to COVID-19 as of February 24, 2022. However, the better health system preparedness and response was clearly far more robust than previous waves leading to a much more modest negative impact on people. The mission has agreed that considering the sustained efforts that have been required to bolster the Component 1 of Emergency Response, a restructuring request for reallocating funds to Category 1 would be appropriate and needs to be initiated shortly. MPA Program Development Objective MPA PDO Table The Program Development Objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness MPA Table Multiphase Programmatic Approach (MPA) Status MPA Table Body As of May 16, 2022, 88 MPA-projects had been approved with a total commitment of US$4.3 billion. One operation (Guatemala) was cancelled in mid-September 2021, at the request of the Government. Six parent projects have been restructured to include vaccine-related procurement. Total disbursements as of May 16, 2022, amount to US$3.56 billion or 83% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. Sixty-seven (67) country projects or 77% of projects approved have reached 70-100% disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). Out of the 67 operations, 48 operations or 72% have disbursed over 90% of commitments. Of these, 30 operations are fully disbursed. There are twelve (12) operations with disbursements under 50%. The projects are benefitting around 3.7 billion people or 50% of the global population. Of the 87 active projects: (i) 33 are in Africa – 12 in AFE and 21 in AFW; (ii) 12 in East Asia; (iii) 14 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. Eighty-six (86) or 99% of projects approved are disbursing. Two operations closed last CY. Closing dates for several operations have been extended beyond the end of the FY; twelve (12) operations have closing dates by the end of FY22. Country teams for operations, which have been under implementation for twelve months or more by June 30, 2022, are preparing Mid-Term Review (MTR) ISRs to inform the Global MPA MTR, which will be prepared early next FY. Streamlined procedures, delegated approvals, coupled with flexible project design and intensified efforts across the Bank have contributed to the progress. Implementation is being guided by Bank teams working in parallel with other health related projects, including Additional Financing operations supporting vaccine procurement and deployment efforts. Implementation continues to face challenges as several countries are still under different levels of mobility restrictions, and counterparts and Bank teams are operating from home or partially from home. Some Bank teams continue to conduct implementation support missions virtually, which is challenging for both Bank teams and counterparts. Bank staff are operating in a hybrid environment with some days at the office and others at home. Notwithstanding the challenges, the MPA is on track to achieve its PrDO, which is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. The 5/24/2022 Page 2 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) significant level of disbursements attests to the strong implementation of the Bank' response thanks to the commitment of counterparts supported by Bank country teams. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Moderate Moderate Macroeconomic Moderate Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary Substantial Substantial Moderate Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes Support GoI to prevent, detect and respond & strengthen national HS for pandemic preparedness IN01100869 ►Percentage of district hospitals with isolation capacity (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 70.00 Date 20-Mar-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 Target achieved. Denominator: Number of districts Numerator: Number of districts having at least one hospital with isolation Comments: capacity, defined as a separate room with negative pressure. IN01100870 ►Proportion of specimens submitted for COVID-19 laboratory testing confirmed within WHO-stipulated standard time (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 89.00 100.00 70.00 5/24/2022 Page 3 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Date 20-Mar-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 Target achieved. Denominator: Number of specimens submitted for COVID-19 laboratory testing Numerator: Number of Comments: specimens submitted for COVID-19 laboratory testing confirmed within WHO stipulated standard time IN01100891 ►Proportion of population able to identify three key symptoms of COVID-19 and/or seasonal influenza and three personal prevention measures (as assessed by a representative population survey) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 79.00 79.00 50.00 Date 20-Mar-2020 31-Mar-2021 31-Mar-2021 31-Dec-2024 Target achieved Denominator: Number of respondents to representative population survey. Numerator: Number of Comments: respondents to representative population survey who can accurately identify three key symptoms of COVID-19 and three personal prevention measures. IN01100892 ►The Government has activated their one health coordination mechanism for COVID-19 (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No nil Yes Yes Date 20-Mar-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 To be measured once at end of project Comments: One health coordination mechanism to be developed by end of project as defined per the PAD IN01100893 ►Percentage of district health centers/district hospitals with personal protective equipment and infection control products and supplies, without stock-outs in preceding two weeks (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 99.85 100.00 70.00 Date 20-Mar-2020 31-Mar-2021 30-Sep-2021 31-Dec-2024 Target achieved. Denominator: Number of designated district hospitals Numerator: Number of designated district hospitals Comments: with adequate key personal protective equipment* and IPC supplies without stock-outs in preceding two weeks. (* Key PPE will include total number of PPE and N95 masks available at DCH IN01100894 ►Number of states with at least 80% of districts having dedicated core surveillance staff in the District Surveillance Unit (District Surveillance Officer, Epidemiologist, and Data Manager) in position (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 28.00 61.00 61.00 65.00 Date 21-May-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 61 (14 States) Comments: Overall Comments PDO 5/24/2022 Page 4 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Out of 6 PDO indicators and 10 IR indicators, 4 PDO indicators (namely PDO1, PDO2, PDO3 and PDO5) and 8 IRs have been achieved. Progress on PDO 6 on HR capacity at district needs to be accelerated to ensure achievement of the endline target.. As activities related to establishment of BSL-3 laboratories are now proposed to be covered under PM-ABHIM, IR8 will not be achieved. Intermediate Results Indicators by Components 1: Emergency COVID-19 Response IN01100895 ►Proportion of states with sufficient COVID-19 testing capacity within 4 weeks of project implementation (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 70.00 Date 20-Mar-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 Target achieved. Denominator: Number of states and union territories. Numerator: Number of states or union territories with sufficient COVID-19 testing capacity defined as: 1000 tests per day in states/UTs with a population ≥100 Comments: million, 500 tests per day in states/UTs with a population of 30-99 million, and 200 tests per day in all other states. IN01100900 ►Proportion of states using a national health information reporting platform that unifies multiple pre-existing platforms. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 97.00 70.00 Date 20-Mar-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 To be measured at the end of project period Denominator: Number of states/UTs. Numerator: Number of states/UTs using a national health Comments: information reporting platform that unifies multiple pre-existing platforms. IN01100904 ►No. of tests per million per day (in concordance with WHO stipulated standard of 140 tests per million per day) (%) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 593.00 873.00 140.00 Date 20-Mar-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 Target achieved. Numerator: Average number of COVID-19 diagnostic tests conducted in a day over a one-month period. Comments: Denominator: Total population in million 2: Strengthening National and State health Systems to support Prevention and Preparedness IN01100898 ►Number of district hospital doctors and nurses who are trained on WHO standards of clinical treatment for COVID-19 by March 2021 (Number, Custom) 5/24/2022 Page 5 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 142,350.00 142,350.00 110,000.00 Date 20-Mar-2020 31-Mar-2021 31-Mar-2021 31-Dec-2024 Target achieved. Number of doctors and nurses working at designated district hospitals who are trained on WHO standards of clinical treatment for COVID-19. Comments: IN01100902 ►Proportion of outbreaks where human samples were collected and sent to laboratory for confirmation (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 19.00 65.00 85.00 65.00 Date 21-May-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 Target achieved Comments: IN01100905 ►% of Real Time Polymerase Chain Reaction (RT-PCR) designated laboratories meeting external quality control standards (reflects laboratory system quality, using COVID19 testing as a proxy) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 100.00 96.00 91.00 100.00 Date 20-Mar-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 Target largely achieved Comments: 3. Strengthening Pandemic Research and Multi-sector,National Institutions & Platforms for One Health IN01100899 ►Proportion of states with Emerging Infectious Disease Contingency Plans in place with dedicated budget (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 91.67 70.00 Date 20-Mar-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 To be measured at the end of project Comments: Denominator: Number of states/UTs. Numerator: Number of states/UTs with Emerging Infectious Disease Contingency Plans in place with dedicated budget. IN01100903 ►Number of new BSL3 labs with biosafety certification (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 5.00 5/24/2022 Page 6 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Date 20-Mar-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 To be measured .at the end of project Comments: Count of BSL3 labs with biosafety certification. 4: Community Engagement and Risk Communication IN01100896 ►Proportion of states issuing school closures with state-level distance learning strategies for primary and secondary school students. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 70.00 Date 20-Mar-2020 31-Mar-2021 31-Mar-2021 31-Dec-2024 Target achieved Denominator: Number of states/UTs issuing school closures due to COVID-19 pandemic. Numerator: Comments: Number of states/UTs issuing school closures due to COVID-19 pandemic issuing school closures with state-level distance learning strategies for primary and secondary school students. 5: Implementation Management, Capacity Building, Monitoring and Evaluation IN01100897 ►Number of peer-reviewed publications produced with support of the project funding (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 326.00 40.00 Date 20-Mar-2020 31-Mar-2021 31-Dec-2021 31-Dec-2024 To be measured at end of project. Comments: (Count of publications in peer-reviewed journals produced with support of the project funding) IN01100901 ►Proportion of COVID-19 grievances received and redressed within government’s stipulated timeline (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 88.50 99.00 80.00 Date 31-Mar-2020 31-Aug-2021 31-Dec-2021 31-Dec-2024 Target achieved. Numerator: COVID-19 grievances redressed by MOHFW through CPGRAMS portal. Comments: Denominator: Total COVID-19 grievances received in CPGRAMS portal by MOHFW Performance-Based Conditions Data on Financial Performance 5/24/2022 Page 7 of 8 The World Bank Implementation Status & Results Report India COVID-19 Emergency Response and Health Systems Preparedness Project (P173836) Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173836 IBRD-90860 Effective USD 1,000.00 1,000.00 0.00 939.89 60.11 94% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173836 IBRD-90860 Effective 02-Apr-2020 03-Apr-2020 06-Apr-2020 31-Dec-2024 31-Dec-2024 Cumulative Disbursements Restructuring History Level 2 Approved on 01-Jun-2020 ,Level 2 Approved on 16-Mar-2021 Related Project(s) There are no related projects. 5/24/2022 Page 8 of 8