The World Bank Implementation Status & Results Report Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) SOUTH ASIA | Sri Lanka | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 6 | ARCHIVED on 23-Jun-2022 | ISR51699 | Implementing Agencies: Democratic Socialist Republic of Sri Lanka, Ministry of Finance, Ministry of Health, State Ministry of Samurdhi, Household Economy, Micro Finance, Self-Employment, Business Development, Key Dates Key Project Dates Bank Approval Date: 02-Apr-2020 Effectiveness Date: 03-Apr-2020 Planned Mid Term Review Date: 04-Apr-2022 Actual Mid-Term Review Date: 16-Jun-2022 Original Closing Date: 31-Dec-2023 Revised Closing Date: 31-Dec-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Sri Lanka 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 $349.48 M) Component 2: Strengthening National and Sub-national Institutions for Prevention and Preparedness:(Cost $35.00 M) Component 3: Strengthening Multi-sectoral, National institutions and Platforms for One Health:(Cost $8.60 M) Component 4: Implementation Management and Monitoring and Evaluation:(Cost $5.00 M) Component 5: Contingent Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating High High Implementation Status and Key Decisions The project is progressing well in supporting the national COVID-19 management program and pandemic preparedness capacity. Project activities are progressing at a relatively satisfactory level. All four PDO indicators have been fully achieved as of June 2022. Out of the 18 IR results indicators, 6 have fully achieved their targets while 12 are in progress. Therefore, overall project Implementation Progress (IP) rating remains moderately satisfactory. Overall project disbursements stand at 93.04 percent as of June 16, 2022. 6/23/2022 Page 1 of 11 The World Bank Implementation Status & Results Report Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) 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 June 15, 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 June 15, 2022, amount to US$3.6 billion or 84% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. Sixty-seven (67) country projects or 77% of projects approved have reached 70-100% disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). Out of the 67 operations, 48 operations or 72% have disbursed over 90% of commitments. Of these, 30 operations are fully disbursed. There are thirteen (13) operations with closing dates by the end of FY22. Other 10 operations which had closing dates by the end of the FY have extended their closing dates. There are 12 operations with disbursements under 50%. Out of these 12 operations, one has not disbursed, and four have disbursed 30 percent or less. 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. MNA has the highest percentage of disbursements, followed by SRA, EAP, ECA and LAC, AFE and AFW. Retroactive Financing represents 26% of commitments. 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. 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 significant level of disbursements attests to the strong implementation of the Bank' response thanks to the commitment of counterparts supported by Bank country teams. The Additional Financing (MPA AF-V) to the COVID-19 Strategic Preparedness and Response Program utilizing the Multiphase Programmatic Approach (“Global COVID-19 MPA”) was approved by the Board on October 13, 2021. The AF-V is significantly expanding Bank support to client countries for COVID-19 vaccination, with the aim to support vaccination of 1 billion people globally. The AF-V was approved with an envelope of US$12 billion ($6 billion from IDA and $6 billion from IBRD) in financing. On June 30, 2021, President Malpass announced the expansion of financing available for COVID-19 vaccine financing to $20 billion over the next 18 months, adding $8 billion to the previously announced $12 billion. This financing is critical to expand affordable and equitable financing for vaccine purchase and deployment. The AF-V is expected to enable vaccination for up to 750 million people, with potential surge capacity for an additional 250 million people in the poorest countries (depending on the delivered price of approved vaccines) while scaling support to strengthen immunization delivery, with design flexibility at the country level. The AF-V is a scale-up of planned vaccination activities anticipated and supported under the Global COVID-19 MPA and a key contribution to the WBG’s overall COVID-19 response. 6/23/2022 Page 2 of 11 The World Bank Implementation Status & Results Report Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) As of June 15, 2022, the Bank has approved 105 operations (including MPA-V operations) to support vaccine procurement and rollout in 77 countries amounting to $9.6 billion. The 105 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. Of the 105 approved operations: (i) 56 are in Africa – 26 in AFE and 30 in AFW; (ii) 9 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. Fifty-three (53) projects are disbursing. Total disbursements as of June 15, 2022, under these projects amount to US$3.4 billion or 35% of overall commitments. Disbursements under MPA-V operations are included in this total while disbursements under the six restructured projects are counted under parent projects. Sixteen (16) operations have disbursed over 70% of their commitments. Out of the 16, seven have disbursed 90%. Retroactive Financing represents 44% of overall commitments. Thirteen (13) new operations are under various stages of processing. As with the MPA operations, streamlined procedures, delegated approval, coupled with flexible project design, and intensified efforts across the Bank have contributed to the rapid design and processing of the operations. Eighty-eight (88) loan/financing agreements have been signed. Also, eighty-six (86) loan/financing agreements have become effective; several others are expected to become effective in the coming weeks. Implementation of the AF-V operations, as with MPA operations is facing challenges as several countries are still under different levels of mobility restrictions and counterparts and Bank teams are operating in a hybrid environment with some days at the office and some at home. Countries are dealing with new waves of infections, as the Omicron variant continues to spread rapidly among populations. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial High High Results PDO Indicators by Objectives / Outcomes 6/23/2022 Page 3 of 11 The World Bank Implementation Status & Results Report Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) To prevent, detect and respond to the threat posed by COVID-19 IN01149075 ►Emergency Operations Centre for COVID-19 and pandemic responses established (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Apr-2020 30-Sep-2020 30-Apr-2022 31-Mar-2023 Emergency Operations Centre for coordination of pandemic response established and functional. The Epidemiology Division, MoH is being strengthened as the National Emergency Center for Epidemics and Pandemics. Comments: End target achieved. IN01149077 ►Percentage of health districts with a tertiary or secondary care hospital with isolation capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 8.00 61.00 100.00 100.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Dec-2023 Indicator Definition - Numerator: Number of districts with at least one tertiary or secondary care hospital with isolation capacity Denominator: Number of districts (26 districts) Status: The MoH has is proposing the development of 9 provincial case management centers and 25 suspected case management centers. Initial work to identify facilities to be converted into case Comments: management centres and site assessments has started. End target of 100% achieved. IN01149078 ►Percentage of population vaccinated, which is included in the priority population targets defined in the NDVP, disaggregated by gender (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.01 83.00 98.00 56.80 Date 18-Feb-2021 26-Dec-2021 30-Apr-2022 29-Dec-2023 End target of 56.8% has been surpassed. 98% of population has been vaccinated with the first dose. As of May 2022, registration for the 4th dose vaccination has started. Comments: To strengthen national health systems for preparedness in Sri Lanka IN01149076 ►Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 5.00 17.00 17.00 17.00 6/23/2022 Page 4 of 11 The World Bank Implementation Status & Results Report Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Dec-2020 Indicator Definition: Number of designated laboratories with COVID-19 essential diagnostic equipment, test kits, and reagents (identified as essential for COVID-19 response as per WHO guidelines) Status: The PMU is coordinating with the Laboratory Unit to determine the current status and finalize Comments: plans for strengthening under the project. Discussions are at a nascent stage. End target of 17 laboratories 100% achieved, and all functional. Intermediate Results Indicators by Components Emergency COVID-19 Response IN01149079 ►Number of ICU beds in tertiary and secondary hospitals against planned (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 560.00 650.00 650.00 750.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Dec-2023 Owing to the nature of the epidemic it has been decided not to limit the suport to strengthen ALSO for ICU Comments: but to strengthen the HDU facilities with wall oxygen. IN01149083 ►Number of health staff trained in infection prevention and control per MoH approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 100.00 3,000.00 30,000.00 1,000.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Jul-2020 Fully Achieved An online training module was developed and run by all institutions. 30,000 health staff have been trained, surpassin Comments: IN01149085 ►Number of secondary and tertiary care hospitals with environmental protection license (EPL) and Scheduled waste license (SWL) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 20.00 28.00 20.00 81.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Dec-2023 Work is in progress. (EPL) and Scheduled waste licenses (SWL) are to be newly completed in project- Comments: supported IDHH, up to the required standard. IN01149087 ►Guidelines to engage private health facilities in supporting pandemic response (Yes/No, Custom) 6/23/2022 Page 5 of 11 The World Bank Implementation Status & Results Report Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Dec-2023 Indicator Definition: (a) Guidelines to engage private health facilities in supporting pandemic response developed; (b) are available on the Ministry’s website; and (c) include a list of private health facilities empaneled to provide support Status: Laboratory guidelines, and guidelines in establishing quarantine centers and intermediate Comments: treatment centers in private health facilities have been issued. Achieved Laboratory guidelines and guidelines in establishing quarantine centers and intermediate treatment centers in private health facilities have been issued. IN01149089 ►Number of secondary and tertiary hospitals with solar energy backup to overcome electricity outages (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 6.00 20.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Dec-2020 Solar energy backup is planned for identified infectious disease case management centers (both provincial and district). Assessments for some facilities have been completed, however, unless the final Comments: list of facilities is approved, the next steps for the same will get delayed. Works in progress at the estimation level for 6 IDHH IN01149091 ►Number of field staff engaged in elder care, homes for the people with special needs and orphanages trained and equipped for prevention and care measures (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 100.00 510.00 0.00 1,000.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Dec-2023 Indicator Definition: Number of field staff engaged in elder care, homes for the people with special needs and orphanages trained and equipped for prevention and care measures as per MOH-approved protocols. Field staff include public health nursing officers, elderly right promotion officer and care givers, social welfare workers. Approximate 850 homes and centres and at least 2 staff in each = 1700 workers Status: 20 in Shanthi elders care, 80 PHNOs providing community care for elders have been trained. Comments: The training programs conducted at Nation Secretariat for Elders covered 17 out of 25 districts and have been trained 210 officers (64 percent females). IN01149092 ►Number of beneficiaries provided with cash transfers in response to COVID-19 (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3,100,000.00 3,150,429.00 600,000.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Aug-2020 Comments: In total, the cash transfer program has supported 629,303 elderly persons, 52,940 people with special needs, 18,972 patients with chronic kidney disease, and 2,229,214 people who lost livelihoods. The in- kind transfer program has supported 417,427 beneficiaries sent on home quarantine with food packs for 6/23/2022 Page 6 of 11 The World Bank Implementation Status & Results Report Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) two weeks. In total, this subcomponent has provided benefits to 3.5 million people (cash transfer benefits to 3.1 million beneficiaries and in-kind benefits to 417,427). The subcomponent 1.2 in total supported approximately 3.5m (3,150,429 cash transfer and 417,427 in- kind transfer) beneficiaries. Achieved IN01149093 ►Risk communication plan implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Mar-2021 Status: An MoU has been signed between UNICEF and GoSL, activities are in progress An MoU has been signed between UNICEF and GoSL, activities are in progress. It is being implemented at different levels. Continuously being updated to match the pattern of the Comments: epidemic. Achieved. IN01149094 ►Number of individuals utilizing GBV services through the Mithuru Piyasas (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 9,000.00 10,000.00 10,000.00 12,000.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 29-Dec-2023 Promotional activities to create awareness about the centers among the general public are in progress. Comments: IN01149095 Number of women utilizing gender-based violence services through the Mithuru Piyasas (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 8,500.00 10,000.00 9,400.00 11,000.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 29-Dec-2023 IN01149096 Number of children and men utilizing gender-based violence services through the Mithuru Piyasas (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 500.00 550.00 550.00 1,000.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 29-Dec-2023 IN01149097 ►National Deployment and Vaccination Plan for COVID-19 vaccines with input from relevant bodies is updated by the government, as needed (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 18-Feb-2021 26-Dec-2021 30-Apr-2022 29-Dec-2023 Comments: Revision is in progress 6/23/2022 Page 7 of 11 The World Bank Implementation Status & Results Report Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) In progress IN01149098 ►Number of districts with functional vaccination tracking system/HMIS collecting sex and age disaggregated data on COVID-19 vaccines at district level (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 3.00 25.00 25.00 25.00 Date 18-Feb-2021 26-Dec-2021 30-Apr-2022 29-Dec-2023 Achieved Comments: Strengthening National and Sub-national Institutions for Prevention and Preparedness IN01149080 ►Number of individual isolation rooms established within the National Institute of Infectious Diseases established (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 16.00 16.00 27.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Dec-2023 In progress. Comments: Preparation of estimates is in progress. 16 have already been completed. IN01149086 ►Number of secondary and tertiary care hospitals with networked laboratory information system in place (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Dec-2021 No progress, discussion is ongoing Comments: IN01149088 ►Number of sub-national emergency operational centers with an established quarantine mechanism (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 8.00 28.00 28.00 26.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Dec-2023 Status: Subnational centers are identified and strengthened . Achieved. Two national centers are strengthened (Epidemiological Unit and Disaster and Emergency Management Center at MOH) The provincial and regional centers are working well under provincial administration. A quarantine mechanism was established. Comments: The need is to have two centers at Epi. Unit and Disaster Management Center, as the provincial and regional centers, are working well under provincial administration. A quarantine mechanism was established. IN01149090 6/23/2022 Page 8 of 11 The World Bank Implementation Status & Results Report Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) ►Number of secondary and tertiary care hospitals with classified accredited labs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 29-Dec-2023 The accreditation process is being developed will implement the process soon . Comments: Strengthening Multi-sectoral, National institutions and Platforms for One Health IN01149082 ►National protocols for detection, surveillance, and response systems for animal and human health infections (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 31-Dec-2021 Status: The Process has initiated under the leadership of the Additional Secretary of public health services in MOH A preliminary discussion was held with the Epidemiology Unit. The consultative meeting had to be Comments: postponed due to the current pandemic surge. Expect to initiate the process last quarter in 2022. The human protocol has been done. May need around LKR 200,000.00. Implementation Management and Monitoring and Evaluation IN01149081 ►Number of peer-reviewed publications from Research Institutions supported to undertake research and monitor progress and capacity of the health system for pandemic preparedness (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 5.00 Date 01-Apr-2020 26-Dec-2021 30-Apr-2022 29-Dec-2023 Status: Two research activities are in progress and Due in 2023 Comments: IN01149084 ►Percentage of received grievances that are addressed within 30 days (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 40.00 68.00 80.00 Date 28-Nov-2021 26-Dec-2021 30-Apr-2022 29-Dec-2023 In progress Comments: Performance-Based Conditions 6/23/2022 Page 9 of 11 The World Bank Implementation Status & Results Report Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173867 IBRD-90850 Effective USD 35.00 35.00 0.00 27.39 7.61 78% P173867 IBRD-92370 Effective USD 54.00 54.00 0.00 53.97 0.03 100% P173867 IBRD-92960 Effective USD 100.00 100.00 0.00 86.76 13.24 87% P173867 IDA-65950 Effective USD 93.60 93.60 0.00 90.00 3.60 96% P173867 IDA-67270 Effective USD 41.90 41.90 0.00 38.53 3.37 92% P173867 IDA-67280 Effective USD 45.34 45.34 0.00 47.02 0.00 100% P173867 IDA-68750 Effective USD 26.52 26.52 0.00 26.60 0.00 100% P173867 TF-B3017 Closed USD 1.72 1.72 0.00 1.72 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173867 IBRD-90850 Effective 02-Apr-2020 03-Apr-2020 03-Apr-2020 31-Dec-2023 31-Dec-2023 P173867 IBRD-92370 Effective 27-Apr-2021 13-May-2021 17-May-2021 31-Dec-2023 31-Dec-2023 P173867 IBRD-92960 Effective 24-Sep-2021 27-Sep-2021 28-Sep-2021 31-Dec-2023 31-Dec-2023 P173867 IDA-65950 Effective 02-Apr-2020 03-Apr-2020 03-Apr-2020 31-Dec-2023 31-Dec-2023 P173867 IDA-67270 Effective 22-Jun-2020 23-Jul-2020 24-Jul-2020 31-Dec-2023 31-Dec-2023 P173867 IDA-67280 Effective 22-Jun-2020 23-Jul-2020 24-Jul-2020 31-Dec-2023 31-Dec-2023 P173867 IDA-68750 Effective 27-Apr-2021 13-May-2021 17-May-2021 31-Dec-2023 31-Dec-2023 P173867 TF-B3017 Closed 22-Jun-2020 23-Jul-2020 24-Jul-2020 31-Jan-2021 31-Jan-2021 Cumulative Disbursements 6/23/2022 Page 10 of 11 The World Bank Implementation Status & Results Report Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project (P173867) Restructuring History Level 2 Approved on 18-Jan-2021 Related Project(s) P174291-Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project AF ,P176422-Second Additional Financing for Sri Lanka COVID-19 Emergency Response and Health Systems Preparedness Project ,P177714-Third Additional Financing for Sri Lanka COVID-19 Emergency Response and Health System Preparedness Project 6/23/2022 Page 11 of 11