The World Bank Implementation Status & Results Report Bhutan: COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) Bhutan: COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) SOUTH ASIA | Bhutan | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 5 | ARCHIVED on 23-Jun-2022 | ISR51105 | Implementing Agencies: Kingdom of Bhutan, Ministry of Health, Royal Government of Bhutan Key Dates Key Project Dates Bank Approval Date: 17-Apr-2020 Effectiveness Date: 27-Apr-2020 Planned Mid Term Review Date: 30-Jun-2022 Actual Mid-Term Review Date: 15-Jun-2022 Original Closing Date: 31-Dec-2022 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 to strengthen national systems for public health preparedness in Bhutan Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Emergency COVID-19 Response:(Cost $14.69 M) Community Engagement and Risk Communication:(Cost $0.01 M) Implementation Management and Monitoring and Evaluation:(Cost $0.30 M) Contingency Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions The Royal Government of Bhutan has demonstrated exemplary 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 and boosting its eligible populations with safe and effective COVID-19 vaccines. This specifically includes financing testing equipment, RT-PCR and Antigen Test Kits, consumables, hygiene products and PPE for over 50 hospitals and 184 primary health centers; strengthening capacities of 5 laboratories (Phuntsholing, Deothang, Central Regional Referral, Jigme Dorji Wangchuk National Referral and Easter Regional Referral Hospitals) for COVID-19 testing; establishing isolation, triage and treatment centers in designated hospitals and public health centers (over 700 isolation beds were established in four COVID hospitals at Thimphu, Chhukha, Mongar and Sarpang); and provision of adult, neonatal and pediatric Intensive Care Units (total of 54 beds), dialysis services and Operation Theatres in these four hospitals to manage COVID-19 patients needing critical care. Additionally, approximately 62,400 population above 12 years old (8.3 percent of the population) received primary series Moderna vaccines (0.5ml per dose) and another 345,570 population above 18 years old (46 percent of the population) received their (0.25ml 6/23/2022 Page 1 of 9 The World Bank Implementation Status & Results Report Bhutan: COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) per dose) booster dose of Moderna vaccine, also financed by IDA. A multi-faceted awareness campaign was launched to closely engage with the community, keep them informed of the risks and trajectory of the pandemic and to support and encourage appropriate public health and health seeking behaviors. Mass-, mid- and print-media were leveraged to create awareness of public health measures to manage COVID-19 as well as demand for testing, treatment and vaccination services. Toll free hotlines (1010 and 112 ) were set up to meet the information requirements and address grievances of the population with respect to the pandemic. Capacities were enhanced of health administrators and workers to technically and operationally manage the pandemic. Technology was appropriately leveraged for evidence-based technical and programmatic decision making, reporting on implementation progress, sharing information with all stakeholders efficiently as well as monitoring performance. As of the Mid-Term Review (July 15-21, 2022), the original Credit of US$5 million is fully disbursed and the Additional Financing of US$10 million is on track to disbursing 44.5 percent before June 30, 2022. 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. MPA AF-V - ISR Write-up – June 15, 2022 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 6/23/2022 Page 2 of 9 The World Bank Implementation Status & Results Report Bhutan: COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) 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. 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 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 Substantial Moderate Moderate Sustainability Fiduciary Moderate Moderate Moderate Environment and Social Substantial Substantial Substantial Stakeholders Substantial Moderate Moderate Other Moderate Moderate Moderate Overall Substantial Moderate Moderate 6/23/2022 Page 3 of 9 The World Bank Implementation Status & Results Report Bhutan: COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) Results PDO Indicators by Objectives / Outcomes Prevent, detect and respond to COVID-19 and strengthen health systems IN01157908 ►Bhutan 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 31-May-2021 15-Jun-2022 31-Dec-2023 Health Emergency Operation Centre or similar coordination mechanism of MoH is activated as a Comments: secretariat for the effective administration of emergency preparedness and response. IN01157937 ►Percentage of suspected cases of COVID-19 cases reported and investigated based on national guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 90.00 Date 10-Jan-2020 31-May-2021 30-Apr-2022 31-Dec-2023 Numerator= number of suspected cases of COVID-19 tested and managed as per the approved protocol Comments: Denominator= number of suspected COVID-19 cases notified IN01157941 ►Number of acute healthcare facilities with isolation capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 4.00 4.00 3.00 Date 10-Jan-2020 31-May-2021 30-Apr-2022 31-Dec-2023 Comments: A healthcare facility should have at least 5 isolation bed facilities IN01157943 ►Country adopted personal and community non-pharmaceutical interventions (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 10-Jan-2020 31-May-2021 15-Jun-2022 31-Dec-2023 Through public channels, the Government has declared schools closures, telework and remote meetings, Comments: reduce/cancel mass gatherings. IN01157945 ►Percentage of population vaccinated, which is included in the priority population targets defined in national plan [by gender] (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/23/2022 Page 4 of 9 The World Bank Implementation Status & Results Report Bhutan: COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) Value 0.00 0.00 8.30 5.60 Date 29-Sep-2021 29-Sep-2021 30-Apr-2022 31-Dec-2023 Numerator: 62,394 persons were provided 0.5ml dose of Moderna vaccine as primary series. Denominator: 756,129 total population Comments: (Source: Vaccine Preventable Disease Program, DoPH/Health Management Information System, PPD) IN01157949 Percentage of males vaccinated (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 48.60 50.00 Date 15-Dec-2021 -- 30-Apr-2022 31-Dec-2023 IN01157950 Percentage of females vaccinated (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 51.40 50.00 Date 15-Dec-2021 -- 30-Apr-2022 31-Dec-2023 IN01157948 ►Percentage of population boosted with a single vaccine dose, in line with WHO/SAGE guidance (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 45.80 28.00 Date 01-May-2022 -- 30-Apr-2022 31-Dec-2023 Numerator: 346,571 persons >18 years received 0.25 ml per dose of Moderna vaccine as booster Denominator: 756,129 as total population Comments: (Source: Vaccine Preventable Disease Program, DoPH/Health Management Information System, PPD) IN01157951 Percentage of males boosted with a single vaccine dose, in line with WHO/SAGE guidance (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 50.50 50.00 Date 01-May-2022 -- 30-Apr-2022 31-Dec-2023 IN01157952 Percentage of females boosted with a single vaccine dose, in line with WHO/SAGE guidance (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 49.50 50.00 Date 01-May-2022 -- 30-Apr-2022 31-Dec-2023 6/23/2022 Page 5 of 9 The World Bank Implementation Status & Results Report Bhutan: COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) Overall Comments PDO 1. End line target dates for all PDO indicators extended to co-terminate with revised project closing date of December 31, 2023 2. End line target for vaccine coverage indicator enhanced (gender disaggregated) 3. New PDO indicator to track booster coverage introduced (gender disaggregated) Intermediate Results Indicators by Components Emergency COVID-19 Response IN01157909 ►Number of health staff trained in infection prevention and control per MoH protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 113.00 356.00 100.00 Date 10-Jan-2020 31-May-2021 30-Apr-2022 31-Dec-2023 The health staff in the designated health care facilities are to be trained on infection, prevention and Comments: control measures. It is a cumulative figure IN01157938 ►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 97.50 100.00 95.00 Date 10-Jan-2020 31-May-2021 30-Apr-2022 31-Dec-2023 Numerator= all test results of specimens for SARS-COV2 testing brought to designated laboratory within Comments: WHO stipulated standard time Denominator= all specimens for SARS-COV2 testing brought to the designated laboratory IN01157942 ►Number of acute healthcare facilities with triage capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 49.00 4.00 10.00 Date 10-Jan-2020 31-May-2021 30-Apr-2022 31-Dec-2023 Comments: The hospitals in the country which have triage facility IN01157944 ►A National Vaccination and Deployment Plan (NVDP) with input from relevant bodies (NITAG, DRA, National Immunization Program, National Regulatory Authority, AEFI committee), in line with WHO guidance (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes 6/23/2022 Page 6 of 9 The World Bank Implementation Status & Results Report Bhutan: COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) Date 31-Dec-2020 04-Jan-2021 30-Apr-2022 31-Dec-2023 IN01157946 ►Potential numbers of target populations estimated who will be prioritized for access to vaccines stratified by target group and geographic location (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Dec-2020 08-Oct-2021 30-Apr-2022 31-Dec-2023 IN01157947 ►Guidelines, documented procedures and tools for planning and conducting vaccine pharmacovigilance activities established (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 31-Dec-2020 08-Oct-2021 30-Apr-2022 31-Dec-2023 Community Engagement and Risk Communication IN01157910 ►Bhutan 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 31-May-2021 30-Apr-2022 31-Dec-2023 Bhutan 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. IN01157939 ►Percentage of received grievances that are addressed (within specified time/protocol) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 100.00 80.00 Date 10-Jan-2020 31-May-2021 30-Apr-2022 31-Dec-2023 Implementation Management and Monitoring and Evaluation IN01157936 ►M&E system established to monitor COVID-19 preparedness and response plan (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 10-Jan-2020 31-May-2021 15-Jun-2022 31-Dec-2023 6/23/2022 Page 7 of 9 The World Bank Implementation Status & Results Report Bhutan: COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) Comments: A monitoring, recording and reporting mechanism for COVID-19 is in place-either digital or manual. IN01157940 ►Joint supervision and monitoring visits conducted (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 2.00 3.00 6.00 Date 10-Jan-2020 31-May-2021 30-Apr-2022 31-Dec-2023 Comments: Government and World Bank team conduct joint supervision and monitoring visits to field Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173787 IDA-66270 Effective USD 5.00 5.00 0.00 5.15 0.00 100% P173787 IDA-70980 Effective USD 10.00 10.00 0.00 0.00 9.84 0% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173787 IDA-66270 Effective 17-Apr-2020 27-Apr-2020 27-Apr-2020 31-Dec-2022 31-Dec-2022 P173787 IDA-70980 Effective 18-Apr-2022 09-May-2022 09-May-2022 31-Dec-2023 31-Dec-2023 Cumulative Disbursements 6/23/2022 Page 8 of 9 The World Bank Implementation Status & Results Report Bhutan: COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) Restructuring History Level 2 Approved on 15-Dec-2021 Related Project(s) P178656-Additional Financing to Bhutan COVID-19 Emergency Response and Health Systems Preparedness Project 6/23/2022 Page 9 of 9