The World Bank Implementation Status & Results Report Nepal: COVID-19 Emergency Response and Health Systems Preparedness Project (P173760) Nepal: COVID-19 Emergency Response and Health Systems Preparedness Project (P173760) SOUTH ASIA | Nepal | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 5 | ARCHIVED on 19-Jun-2022 | ISR51567 | Implementing Agencies: Government of Nepal, Ministry of Health and Population Key Dates Key Project Dates Bank Approval Date: 03-Apr-2020 Effectiveness Date: 07-Apr-2020 Planned Mid Term Review Date: 31-Oct-2022 Actual Mid-Term Review Date: 02-May-2022 Original Closing Date: 16-Jul-2022 Revised Closing Date: 15-Jul-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to prevent, detect and respond to the threat posed by COVID-19 and to strengthen national systems for public health preparedness in Nepal. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name 1. Emergency COVID-19 Response:(Cost $116.50 M) 2. Community Engagement and Risk Communication:(Cost $3.00 M) 3. Implementation Management and Monitoring and Evaluation:(Cost $2.50 M) 4. Contingency Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating High High Implementation Status and Key Decisions Nepal has demonstrated robust progress in prevention, treatment and management of COVID-19 pandemic, particularly with strengthening its health system with necessary equipment, drugs, consumables, hygiene products and complementary skill sets, as well as vaccinating its eligible populations with safe and effective COVID-19 vaccines. This progress has been achieved largely with the in-kind support from the international community (friendly neighbors, bilateral agencies, UN and global alliances), private sector and civil society organizations). This includes, (i) full vaccination of 65 percent of Nepal’s population and at least one dose provided to 74 percent of the total population. Also, 85 percent of eligible population over 12 years of age is fully vaccinated and 96 percent of eligible population over 12 years of age has received at least one dose of COVID-19 vaccine. Approximately 16 percent of population >12 years of age has received an additional dose to boost immunity against COVID-19; (ii) At least 105 public and private laboratories are fully equipped with personnel, test kits, reagents and PPE to test for COVID-19, ensuring test results within World Health Organization (WHO) stipulated standard time of 24 hours for over 93 percent of specimen; (iii) Over 78 acute health care 6/19/2022 Page 1 of 9 The World Bank Implementation Status & Results Report Nepal: COVID-19 Emergency Response and Health Systems Preparedness Project (P173760) facilities have isolation capacity and of these at least 30 have strengthened triage capacity; (iv) Over 4,073 Intensive Care Unit (ICU) beds have been established to address needs of critically ill COVID-19 patients; (v) Cold chain capacity was augmented significantly at central and provincial levels to 280.77m3, with over 155.75m3 storage space dedicated to hold at least 17 million doses of Astrazeneca COVID-19 vaccines; (vi) and deployment of a robust plan for community engagement and risk communication with technical assistance from development partners. In the last eight months, limited use has been made of IDA resources made available to Nepal on emergency basis for its COVID-19 health response. 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$3.6 billion or 83% of overall commitments. This amount does not include disbursements under MPA-V operations which are reported together with AF-V operations. Sixty-seven (67) country projects or 77% of projects approved have reached 70-100% disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). 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 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 6/19/2022 Page 2 of 9 The World Bank Implementation Status & Results Report Nepal: COVID-19 Emergency Response and Health Systems Preparedness Project (P173760) 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. As of May 16, 2022, the Bank has approved 96 operations (including MPA-V operations) to support vaccine procurement and rollout in 73 countries amounting to $8.1 billion. The 96 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 96 approved operations: (i) 54 are in Africa – 24 in AFE and 30 in AFW; (ii) 9 in East Asia and the Pacific; (iii) 10 in Europe and Central Asia; (iv) 8 in Latin America and the Caribbean; (v) 7 in Middle East and North Africa; and (vi) 8 in South Asia. Fifty (50) projects are disbursing. Twenty-two (22) new operations are under various stages of processing. Total disbursements as of May 16, 2022, under these projects amount to US$3.3 billion or 40% 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. Fifteen (15) operations have disbursed over 70% of their commitments. Eighty-five (85) loan/financing agreements have been signed. Also, eighty (80) loan/financing agreements have become effective; several others are expected to become effective in the coming weeks. 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. 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. Also, 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 Substantial High Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate High High Institutional Capacity for Implementation and High Substantial High Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other Moderate Substantial Substantial Overall Substantial High High Results PDO Indicators by Objectives / Outcomes 6/19/2022 Page 3 of 9 The World Bank Implementation Status & Results Report Nepal: COVID-19 Emergency Response and Health Systems Preparedness Project (P173760) Prevent, detect and respond and strengthen MoHP systems for public health prepredness IN01145386 ►Proportion of prioritized population fully vaccinated, as per protocol, disaggregated by gender (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.20 78.64 50.00 Date 01-Jan-2021 15-Jul-2021 15-Mar-2022 15-Jul-2024 81.9% ≥ 18 years (16,108,725/19,922,164) Comments: 78.64% ≥12 years (18,343,550/23,327,6190 IN01145387 Proportion of prioritized female population fully vaccinated, as per protocol (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 55.08 50.00 Date 01-Jan-2021 15-Jul-2021 15-Mar-2022 15-Jul-2024 IN01145388 Proportion of prioritized male population fully vaccinated, as per protocol (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 44.92 50.00 Date 01-Jan-2021 15-Jul-2021 15-Mar-2022 15-Jul-2024 IN01145389 ►Proportion of cold chain capacity gaps filled. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 33.00 587.00 60.00 Date 01-Jan-2021 10-Sep-2021 15-Mar-2022 15-Jul-2024 Available cold chain for COVID-19 vaccination: 20.8 m3 Cold chain gap for cold, ultra-cold and super cold chain: 47.8 m3 Comments: The cold chain capacity on March 15, 2022 was 280.77 m3 IN01145390 ►Proportion of female community health volunteers fully vaccinated, as per protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 42.00 93.00 60.00 Date 01-Jan-2021 15-Jul-2021 15-Mar-2022 15-Jul-2024 IN01145391 ►Proportion of vaccination sites/outreach with at least one female health care provider/volunteer (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/19/2022 Page 4 of 9 The World Bank Implementation Status & Results Report Nepal: COVID-19 Emergency Response and Health Systems Preparedness Project (P173760) Value 0.00 100.00 78.80 80.00 Date 01-Jan-2021 01-Jan-2021 15-Mar-2022 15-Jul-2024 Intermediate Results Indicators by Components Emergency COVID-19 Response IN01145393 ►Number of health staff trained in infection prevention and control per MoHP approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8,705.00 11,189.00 1,000.00 Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 8705 as of FY 21 + 2484 till second quadrimester of FY 22. Comments: (Source: NHTC) IN01145395 ►Percentage of specimens submitted for SARS-COV2 laboratory testing and confirmed within WHO stipulated standard time (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 97.21 93.60 90.00 Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 24hrs: 93.6% 48hrs: 94.1% Comments: 72hrs: 96% (Source: NPHL) IN01145399 ►Number of acute healthcare facilities with triage capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 30.00 30.00 10.00 Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 Comments: The designated hospitals for COVID response needs to have triage facility IN01145401 ►New/rehabilitated ICU beds established in the public hospitals for managing public health emergencies (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,276.00 4,073.00 135.00 Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 6/19/2022 Page 5 of 9 The World Bank Implementation Status & Results Report Nepal: COVID-19 Emergency Response and Health Systems Preparedness Project (P173760) New/ rehabilitated functioning ICU Beds established at Federal and Provincial level hospitals Comments: IN01145402 ►Number of designated laboratories with staff trained to conduct COVID-19 diagnosis (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 96.00 105.00 45.00 Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 Comments: The designated lab to test SARS-CoV2 should have at least one trained staff. IN01145403 ►Nepal has activated its public Health Emergency Operations Centre or a coordination mechanism for COVID-19 (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 IN01145404 ►Nepal adopted personal and community non-pharmaceutical interventions (schools closures, telework and remote meetings, reduce/cancel mass gatherings (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 IN01145405 ►Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 96.00 105.00 45.00 Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 IN01145406 ►Number of acute healthcare facilities with isolation capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 78.00 78.00 50.00 Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 IN01145407 ►A National Deployment and Vaccination Plan (NDVP) is approved and adopted (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes 6/19/2022 Page 6 of 9 The World Bank Implementation Status & Results Report Nepal: COVID-19 Emergency Response and Health Systems Preparedness Project (P173760) Date 01-Jan-2021 15-Jul-2021 15-Mar-2022 15-Jul-2024 Community Engagement and Risk Communication IN01145394 ►Symposium on surveillance, treatment and prophylaxis conducted (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4.00 Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 Conference and workshops at national level for advocacy, and information on surveillance, treatment and Comments: prophylaxis. The targets are the cumulative figure. IN01145396 ►Nepal has contextualized its risk communication and community engagement strategies (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 Nepal has adopted risk communication and community engagement strategies which include Comments: development of different communication materials and dissemination through various media channels including community engagement. IN01145398 ►Proportion of callers to COVID-19 helplines satisfied with support/services provided (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 99.06 60.00 Date 01-Jan-2021 15-Jul-2021 15-Mar-2022 15-Jul-2024 4,803/5,000 rated 4 out of 5 in feedback rating Comments: (Source: Unified COVID-19 hospital for call center 1133) IN01145400 ►Proportion of SEA/SH calls received by COVID-19 helplines referred to OCMC or Women’s Commission for appropriate support (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 100.00 80.00 Date 01-Jan-2021 15-Jul-2021 15-Mar-2022 15-Jul-2024 Two cases referred to NWC and Police Cell respectively Comments: Implementation Management and Monitoring and Evaluation IN01145392 ►M&E system established to monitor COVID-19 preparedness and response plan (Text, Custom) 6/19/2022 Page 7 of 9 The World Bank Implementation Status & Results Report Nepal: COVID-19 Emergency Response and Health Systems Preparedness Project (P173760) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 Comments: A monitoring, recording and reporting mechanism for COVID-19 is in place-either digital or manual. IN01145397 ►Joint supervision and monitoring visits conducted (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7.00 7.00 4.00 Date 10-Jan-2020 15-Jul-2021 15-Mar-2022 15-Jul-2024 Joint supervision and monitoring visits to each province in July 2021 Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173760 IDA-66040 Effective USD 29.00 29.00 0.00 27.14 2.35 92% P173760 IDA-68470 Effective USD 75.00 75.00 0.00 43.61 28.22 61% P173760 IDA-70280 Effective USD 18.00 18.00 0.00 0.00 17.35 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173760 IDA-66040 Effective 03-Apr-2020 07-Apr-2020 07-Apr-2020 16-Jul-2022 15-Jul-2024 P173760 IDA-68470 Effective 18-Mar-2021 02-Apr-2021 06-Apr-2021 15-Jul-2024 15-Jul-2024 P173760 IDA-70280 Effective 12-Jan-2022 25-Feb-2022 25-Feb-2022 15-Jul-2024 15-Jul-2024 Cumulative Disbursements 6/19/2022 Page 8 of 9 The World Bank Implementation Status & Results Report Nepal: COVID-19 Emergency Response and Health Systems Preparedness Project (P173760) Restructuring History Level 2 Approved on 11-May-2021 Related Project(s) P175848-Additional Financing: Nepal COVID-19 Emergency Response and Health Systems Preparedness Project ,P178205-Second Additional Financing to Nepal COVID-19 Emergency Response and Health Systems Preparedness Project 6/19/2022 Page 9 of 9