The World Bank Implementation Status & Results Report The Gambia COVID-19 Preparedness and Response Project (P173798) The Gambia COVID-19 Preparedness and Response Project (P173798) AFRICA WEST | Gambia, The | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 3 | ARCHIVED on 30-Nov-2021 | ISR48750 | Implementing Agencies: Ministry of Health, The Gambia Key Dates Key Project Dates Bank Approval Date: 02-Apr-2020 Effectiveness Date: 03-Apr-2020 Planned Mid Term Review Date: 12-Nov-2021 Actual Mid-Term Review Date: 10-Nov-2021 Original Closing Date: 31-Mar-2022 Revised Closing Date: 31-Mar-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 system for public health preparedness 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 $4.23 M) Component 2: Strengthening Multi-sector, National Institutions and Platforms for Policy Development and Coordination of Prevention and Preparedness using One Health approach.:(Cost $0.60 M) Component 3: Supporting National and Sub-national, Prevention and Preparedness:(Cost $5.71 M) Component 4: Implementation Management and Monitoring and Evaluation:(Cost $0.40 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating High Substantial Implementation Status and Key Decisions The progress towards the Project Development Objective and overall implementation are rated Satisfactory. All the targets of the PDO-level indicators have been met except for the COVID-19 vaccination rate is currently 9.7 percent against a target of 40 percent by March 31, 2023. The Project is contributing to the implementation of the national COVID-19 plan and the National Deployment and Vaccination Plan for COVID-19 vaccines. As of November 18, 2021, Of the total financing of US$18.91 million, the disbursement is US$14.86. Key issues and actions identified include:  Project vaccine coverage. The 9.7 percent of the total population vaccinated is far below the Project target of 40 percent by March 23, 2023. This is partly due to the vaccine hesitancy. Given that reaching out to people in the communities for vaccination yielded better results than vaccination at the health facilities, the MOH will shortly undertake another massive community engagement to increase vaccine uptake. 11/30/2021 Page 1 of 11 The World Bank Implementation Status & Results Report The Gambia COVID-19 Preparedness and Response Project (P173798)  Project support to COVID-19 supplies. In April 2020, when there was an acute global shortage of COVID-19 medical equipment and supplies, including in the United States and Europe, the WB supported the MOH in procuring critical medical equipment and supplies. These included the following: 10 high-quality, well-equipped ambulances for intensive care; critical lifesaving medical equipment and supplies including 60 intensive care unit (ICU) beds, 600,000 surgical masks, 1.2 million gloves, 5,000 oxygen masks, four ultrasound machines, 20,000 face shields, 25,000 units of personal protective equipment (PPE, coverall), 30,000 respirators (N95), 205 oxygen flowmeters, three digital 4D color ultrasound machines, four ultrasound scanners and 100 non-touch thermometers;  Establishing an environmentally friendly healthcare waste management system in The Gambia: a. The overall system was established but the construction of two clinical waste treatment centers was delayed. Residents in the vicinity of the site at Brusubi that the Ministry of Local Government and Lands located in March 2020 expressed misgivings on the location and a more suitable site at Farato was allocated in November 2020. Subsequently, a second access gate to Farato was locked by the security forces until October 2021 when it was opened to allow the transport of the construction materials to the site. The heavy rains during August-October 2021 also hampered the construction. The mission visited the Farato site on November 15, 2021 and was pleased with the progress made so far. GAP Consultants and Kurubally Construction Company Ltd were competitively selected for the architectural designs and construction respectively. The construction at the two sites are expected to be completed in January 2022. After completion, AMB Ecosteryl engineers from Belgium will do the installations and training of the operators. b. Procurement of seven containerized environmentally friendly and energy efficient dual chamber incinerators (i.e., pre-installed with electrical generator and control panels and other accessories), one for each region, can be moved from one place to another for waste treatment. Five have arrived and are being cleared from the Banjul port and the remaining two are expected in January 2022. c. Procurement of four 10-ton refrigerated waste collection trucks and 90 yellow wheelie bins (660 liters) for Ecosteryl 250 series, and 30 yellow wheelie bins (360 liters) for Ecosteryl 75 plus series will facilitate the collection and transport of healthcare waste from the various health facilities to the waste treatment centers. The wheelie bins arrived in September 2021 and the waste trucks are expected in December 2021.  Project support to health infrastructure construction. The project supported the (i) renovation of the Ndemban Clinic (which was not used in years) and is now functional as a COVID-19 treatment center; the construction of the (a) National Emergency Treatment Centre Intensive Care Unit (20 beds); (b) the National Emergency Observation and Treatment Centre General Ward (84 beds); (c) the National Public Health Laboratory and Training Center; (d) National Blood Transfusion Centre, and (e) a Conference Centre. International (IDOM) and local (GAP Consultants) consulting firms have completed the architectural design, and a contract has been signed with an international construction firm with local presence. The construction will be financed under The Gambia Essential Health Services Strengthening Project.  Project support to the data management system. The National Public Health Laboratory electronic data management system was improved through the procurement of five tablets, IT equipment, air conditioner, and expansion of local area network. During the March 2021 mission, it was noted that there were intermittent internet connectivity issues which hampered the timely issuance of test results. This has since been resolved and patients can now access their COVID-19 test results directly in the COVID-19 portal. 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 November 15, 2021, 87 MPA-projects had been approved with a total commitment of US$4.2 billion. One operation (Guatemala) was cancelled in mid-September, at the request of the Government. Therefore, there are 86 MPA active operations. The pace of disbursements during the past month has increased. Fifty-seven (57) country projects or 66% of projects approved have reached 70-100% disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). The projects are benefitting around 3.7 billion people or 50% of the global population. Of the 86 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) 7 in Middle East and North Africa; and (vi) 9 in South Asia. Eighty-five (85) or 99% of projects approved are disbursing. Total disbursements as of November 15, 2021, amounted to US$3.25 billion or 77% of overall commitments. Streamlined procedures, delegated approvals coupled with flexible project design and intensified efforts across the Bank have contributed to the progress. Several projects have/are being restructured to include vaccine-related procurement. 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 lockdown or 11/30/2021 Page 2 of 11 The World Bank Implementation Status & Results Report The Gambia COVID-19 Preparedness and Response Project (P173798) mobility restrictions, and counterparts and Bank teams are operating from home or partially from home. Also, countries are dealing with new waves of infections as the Delta variant spreads rapidly among populations. Many Bank teams continue to conduct implementation support missions virtually, which is challenging for both Bank teams and counterparts. This “virtual” world poses connectivity challenges as internet is not reliable in many countries, especially IDA countries. 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 in just over 19 months 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 High Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Fiduciary Moderate High Moderate Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial High Substantial Results PDO Indicators by Objectives / Outcomes Strengthen the national public health preparedness capacity to prevent, detect and respond IN01054269 ►Suspected cases of COVID-19 cases reported and investigated per approved protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 50.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 IN01054270 ►Isolation and treatment centers with pandemic preparedness and response plans per Ministry of Health Guidelines (Percentage, Custom) 11/30/2021 Page 3 of 11 The World Bank Implementation Status & Results Report The Gambia COVID-19 Preparedness and Response Project (P173798) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 50.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 IN01054281 ►Health staff trained in infection prevention per MOH-approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 807.00 1,307.00 500.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 IN01054282 ►Hospitals with personal protective equipment and infection control products and supplies, without stock-outs on the first day of each quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 50.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 IN01054283 ►Diagnosed cases treated per approved protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 55.00 55.00 50.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 IN01054284 ►Population vaccinated, which is included in the priority population targets defined in national plan (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 9.70 40.00 Date 31-Mar-2021 31-Mar-2021 15-Nov-2021 31-Mar-2023 IN01054285 Population vaccinated, which is included in the priority population targets defined in national plan, female (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 5.20 20.00 Date 26-Feb-2021 31-Dec-2020 15-Nov-2021 31-Mar-2023 Intermediate Results Indicators by Components 11/30/2021 Page 4 of 11 The World Bank Implementation Status & Results Report The Gambia COVID-19 Preparedness and Response Project (P173798) Component 1: Emergency COVID-19 Response IN01054288 ►Public Health Emergency Operation Center (PHEOC) activated and operationalized to support coordination and planning for COVID-19 or other future emergencies (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target PHEOC operational - has dedicated toll-free 1025 number, equipped with PHEOC activated to computers and Value Not operational Operational coordinate response communication equipment and emergency vehicles, and a designated National Focal Point Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 IN01054290 ►Points of Entries equipped and staff trained in SOPs (including for infection prevention and control, screening of passengers (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 9.00 9.00 9.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 The number of staff at the points of entry (POEs) has increased. For instance, there were 20 personnel from MOH assigned to POEs prior to COVID-19 but it has since increased to 43. A total of 105 POE staff (including police, immigration and 43 MOH POE staff) have been trained on a comprehensive POE standard operating procedures that cover infection prevention and control, International Health Comments: Regulations, contact tracing, surveillance, quarantine, border issues, and transportation of suspected cases. Additionally, 30 MOH POEs have been trained on COVID-19 Rapid Diagnostic Testing and the DHIS2 platform. The staff at the POEs are now conducting test on incoming travelers and entering data in the DHIS2. Though some MOH staff had initial difficulty in accessing DHIS2 but this has improved. IN01054292 ►Rapid-response teams members trained and equipped to investigate cases and conduct contact tracing (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 35.00 36.70 80.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 36.7 (55/150*100) Comments: IN01054294 ►Table-top simulation exercises and findings documented to inform future preparedness and response activities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Report on table-top 1 table-top simulation 1 table-top simulation simulation exercises Value None exercise conducted exercise conducted with recommendations or lessons learned Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 IN01054295 11/30/2021 Page 5 of 11 The World Bank Implementation Status & Results Report The Gambia COVID-19 Preparedness and Response Project (P173798) ►Supervisory visits undertaken to nine Points of Entry (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 3.00 3.00 27.00 Date 02-Mar-2020 30-Jun-2020 30-Jun-2020 31-Mar-2022 Comments: Cumulative number of supervisory visits undertaken to all nine Points of Entry IN01054296 ►Border officers trained on COVID-19 prevention and control and contact tracing (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 105.00 135.00 50.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2020 IN01054297 ►Community-based nurses and PHO trained on COVID-19 prevention and control and contact tracing (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 243.00 500.00 100.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 382 PHOs and 218 Community Health Nurses Comments: IN01054298 ►Emergency Ambulance Services operational (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8.00 18.00 9.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 Currenrly, there are 18 ambulances Comments: IN01054299 ►MoU signed with Republic of Senegal PHES (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target No formal MoU signed No formal MoU signed but there has been but there is Value None knowledge exchange signed communication between visits between the two the two countries countries Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 IN01054300 ►Table-top simulation exercises conducted (Number, Custom) 11/30/2021 Page 6 of 11 The World Bank Implementation Status & Results Report The Gambia COVID-19 Preparedness and Response Project (P173798) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 1.00 10.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 IN01054301 ►Sites for treatment of healthcare waste established (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 7.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 Five containerized environmentally friendly and energy efficient dual chamber incinerators have arrived Comments: and are being cleared from the Banjul port IN01054302 ►COVID-19 sensitization campaigns conducted in all regions (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 7,380.00 14.00 7.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 12,726 COVID-19 sensitization campaigns were conducted in the 7 health regions using a mega phone system. 13,121 house to house COVID-19 sensitization campaigns were conducted in the 7 Health Regions. Comments: However, to ensure consistency in reporting, the sensitization campaign during March-June 2021 in each region is counted as one campaign for each region (making a total of 7) and the campaign undertaken during July-August 2021 in each region is counted as one campaign for each region (making a total of 7). IN01054303 ►Grievances responded to within stipulated service standards for response (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 20.00 50.00 40.00 Date 31-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 A total of 27,456 calls to the 1025 toll-free line were logged. Calls received pertained to people sharing their concerns and asking questions on available support services such as how to get their sample Comments: collected for testing, seeking clarifications on quarantine, isolation and testing protocol and seeking information on vaccination services. IN01054304 ►Population vaccinated, which is included in the priority population targets defined in national plan (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 236,470.00 960,000.00 Date 26-Feb-2021 26-Feb-2021 15-Nov-2021 31-Mar-2023 IN01054305 Population vaccinated, which is included in the priority population targets defined in national plan, female (Number, Custom Breakdown) 11/30/2021 Page 7 of 11 The World Bank Implementation Status & Results Report The Gambia COVID-19 Preparedness and Response Project (P173798) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 145,865.00 480,000.00 Date 26-Feb-2021 26-Feb-2021 29-Oct-2021 31-Mar-2023 IN01054306 ►Health personnel (such as nurses and Public Health Officers) trained in capacity and skills to administer the COVID-19 vaccine (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 200.00 200.00 Date 26-Feb-2021 26-Feb-2021 29-Oct-2021 31-Mar-2023 IN01054307 Health personnel (such as nurses and Public Health Officers) trained in capacity and skills to administer the COVID-19 vaccine, female (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 100.00 100.00 Date 26-Feb-2021 26-Feb-2021 29-Oct-2021 31-Mar-2023 IN01054308 ►Electronic COVID-19 vaccination registration system linked to electronic civil registration and vital statistics system established (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target COVID-19 vaccination database, with birth No COVID-19 No COVID-19 Electronic COVID-19 registration Value vaccination database in vaccination database in vaccination system biographical place place established information, established Date 26-Feb-2021 26-Feb-2021 29-Oct-2021 31-Mar-2023 MOH has created a portal to allow linkage of COVID-19 vaccination registration with electronic civil registration and vital statistics (eCRVS) system. However, some of the vaccination teams mainly use tally sheets to capture the number of people vaccinated and do not record the full vaccination information. As a result, not all the vaccinations are captured in the database: as of November 14, 2021, 183118 in the Comments: electronic database as against 236,470 recorded using the tally sheets. The use of tally sheets allows computations of the total numbers vaccinated but do not provide accurate disaggregated data. The November 2021 mission advised that the data in the database could be considered as a large representative sample and the proportions used to produce disaggregated data. IN01054309 ►Implementation of a civil society-based mechanism to monitor, report and facilitate responses to problems in the COVID-19 response (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value Civil society-based Civil society-based A comprehensive Civil society-based monitoring mechanism mechanism in place Gender-based monitoring mechanism not in place Violence, Sexual in place Exploitation and Abuse, and Sexual Harassment (GBV/SEA/SH) Action Plan has been developed with active 11/30/2021 Page 8 of 11 The World Bank Implementation Status & Results Report The Gambia COVID-19 Preparedness and Response Project (P173798) participation of civil society and is under implementation. Date 02-Mar-2020 26-Feb-2021 29-Oct-2021 31-Mar-2023 Component 2: Strengthening Multi-sector, National Institutions and Platforms for Policy Development IN01054287 ►Electronic Integrated Disease Surveillance Response (IDSR) using DHIS2 platform interfaced with laboratory management information system established (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Electronic Integrated Disease Surveillance Response has been integrated into District Health Information System 2 (DHIS2) Value None Ongoing Established produces weekly aggregated data on human diseases but does not include indicators on animal health. Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 Component 3: Supporting National and Sub-national, Prevention and Preparedness IN01054286 ►Health centers reporting stock-out of tracer Infection prevention and control materials on the first day of each month (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 Data not systematically collected for accurate reporting. MOH to keep accurate records for monitoring. Comments: IN01054289 ►Costed plan to collect, package and transport samples to the WHO recommended laboratories for COVID-19 and future emergencies developed and implemented (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Testing is currently being Testing is currently done at the National being done at the Value No plan Public Health Laboratory National Public Health Plan in place so the plan is no longer Laboratory so a plan is necessary. no longer necessary. Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2022 IN01054291 ►Standard Operating Procedures (SOPs) on sample collection, packaging, transportation and testing of samples (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target 11/30/2021 Page 9 of 11 The World Bank Implementation Status & Results Report The Gambia COVID-19 Preparedness and Response Project (P173798) SOPs on sample SOPs on sample collection, packaging, collection, packaging, transportation and transportation and testing testing are available are available and in and in place. All place. All laboratory Value None laboratory personnel SOP in place personnel involved in involved in COVID-19 COVID-19 response response have been have been trained. This trained. This was done was done with the with the support of support of AFENET. AFENET. Date 02-Mar-2020 30-Jun-2020 29-Oct-2021 31-Mar-2021 IN01054293 ►Treatment centres renovated/constructed and/or equipped (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 2.00 2.00 Date 02-Mar-2020 26-Feb-2021 29-Oct-2021 31-Mar-2023 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173798 IDA-D5970 Effective USD 10.00 10.00 0.00 9.75 0.37 96% P173798 IDA-D8020 Effective USD 8.00 8.00 0.00 4.20 3.74 53% P173798 TF-B4724 Closed USD 0.94 0.91 0.03 0.91 0.00 100% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173798 IDA-D5970 Effective 02-Apr-2020 03-Apr-2020 03-Apr-2020 31-Mar-2022 31-Mar-2022 P173798 IDA-D8020 Effective 16-Apr-2021 28-Apr-2021 06-May-2021 31-Mar-2023 31-Mar-2023 P173798 TF-B4724 Closed 22-Dec-2020 22-Dec-2020 22-Dec-2020 31-Jan-2021 31-Jan-2021 Cumulative Disbursements 11/30/2021 Page 10 of 11 The World Bank Implementation Status & Results Report The Gambia COVID-19 Preparedness and Response Project (P173798) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History Level 2 Approved on 17-Jun-2021 ,Level 2 Approved on 14-Sep-2021 Related Project(s) P175740-AF to The Gambia COVID-19 Preparedness and Response Project ,P176125-Second AF to The Gambia COVID-19 Vaccine Preparedness and Response Project 11/30/2021 Page 11 of 11