The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) EASTERN AND SOUTHERN AFRICA | Lesotho | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 5 | ARCHIVED on 28-Jun-2022 | ISR51386 | Implementing Agencies: Kingdom of Lesotho, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 09-May-2020 Effectiveness Date: 27-May-2020 Planned Mid Term Review Date: 31-May-2022 Actual Mid-Term Review Date: 03-May-2022 Original Closing Date: 30-Jun-2022 Revised Closing Date: 30-Jun-2024 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To prevent, detect and respond to the threat posed by COVID-19 to the Kingdom of Lesotho. 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 $29675000.00 M) Component 2: Project Implementation and Monitoring & Evaluation:(Cost $3325000.00 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 High Implementation Status and Key Decisions The Lesotho COVID-19 Emergency Preparedness and Response Project has aimed to support the Government of Lesotho’s (GOL) effort to prevent, detect and respond to the threat posed by SARS-COV-2. The project has supported the procurement of critical equipment and medical supplies such as personal protective equipment for hospitals and health care workers, supported additional human resources and training, both for specialized and for community health workers, and supported the refurbishment of the Mafeteng COVID-19 treatment center, which provides critical medical care for Covid-19 patients in the district of Mafeteng and the country. In response to GOL’s January 21, 2021, request for Additional Financing (AF), the Bank approved on June 1, 2021, US$22 million for the procurement and deployment of coronavirus disease (COVID-19) vaccines and an additional grant of US$3.5 million from the Health Emergency Preparedness and Response Trust Fund (HEPR TF) to support the scale-up of the COVID-19 response under the parent project, vaccine deployment and to further strengthen emergency preparedness. The parent project was also restructured to include the AF, adjust the scope of work and results framework accordingly. The AF became effective on June 30, 2021. The total project envelope now includes US$33 million (US$29.5 million from IDA and US$3.5 million from HEPR TF). This project is aligned to the GOL’s COVID-19 National Integrated Response Plan and complements support from other development partners in providing a comprehensive response to the GOL to manage the COVID-19 pandemic and implement the COVID 19 vaccination program. As of 31st May 2022, 6/28/2022 Page 1 of 7 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) 39 percent of the project financing is disbursed indicating that progress has been made regarding the implementation and rolling out of the country’s national coronavirus disease (COVID-19) emergency response and the National Deployment Vaccination Plan (NDVP). The key achievements to date include (i) Establishing and expanding infrastructure and equipment to support COVID 19 case management, (ii) Refurbishment of Mafeteng (completed), Berea, and Motebang (completed) hospitals to facilitate COVID19 patient management, and (iii) Development of Infection Prevention and Care (IPC) guidelines, (iv) Improvements in laboratory diagnostic capacity for COVID 19 testing, (v) significant progress in the COVID-19 detection and case management process(es). resulting in a low number of COVID-19 cases, (v) Establishment of community-based contact tracing and COVID-19 surveillance, (vi) Sufficient stock of COVID-19 vaccines, (vii) Good progress in COVID 19 vaccination, (ix) completion of digital health assessment and introduction of digitalization with the Citizens App, and (x) overall good progress in the results PDO and intermediate indicators. However, the country needs to address some current challenges which are critical to delivering quality health services in the country. These include (i) the need to develop a National Critical Care strategy. While most of the medical equipment has been distributed and the manufacturer has done training on how to operate the equipment, one of the key challenges remains for case management across the country with a high case fatality rate among hospitalized patients (15-20 percent). This has been linked to a lack of trained health workers, inadequate oxygen supply, and late referrals. The MOH is developing a high care strategy with technical support from WHO and CHAI. The Bank is a part of these efforts and will also support the MOH to recruit an international consultant as a critical care specialist who would train the existing health workers to manage patients needing intensive care; (ii) Limited Oxygen supply. The country working with partners is engaged in the development of a comprehensive oxygen plan. While the procurement of oxygen concentrators for hospitals has been completed; a sufficient and predictable supply of oxygen remains a challenge in hospitals. The current availability of oxygen meets around 65 percent of the total need within the country. Hence there is a need to ensure equitable supply and distribution of oxygen cylinders across the different hospitals. Data highlights that the private hospitals are well stocked and have excess oxygen in comparison to the public hospitals. Currently, the installation of two oxygen plants is supported by the Bank, and the work is ongoing; (iii) Weak COVID-19 related Surveillance system. The surveillance system in Lesotho faces numerous challenges such as health staff shortages, ICT issues, and the high workload of the district rapid response team (DRRT). As a result, the surveillance system is still manual, siloed from other health information systems, and is ineffective in rapidly detecting cases or building complete investigation cases – all necessary for successful pandemic containment. To address these issues, using HEPR TF technical assistance is being provided to the national surveillance system by carrying out a process mining analysis to identify the barriers and challenges; propose suitable digital solutions to strengthen the surveillance processes; and (iv) delayed/ irregular data on COVID-19. 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 MPA Program Development Objective: 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 Multiphase Programmatic Approach (MPA) Status (Public Disclosure): 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 the 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. This financing is critical to expanding 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 already 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 6/28/2022 Page 2 of 7 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) 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 the 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 Substantial Substantial Macroeconomic Substantial Moderate Substantial Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Substantial Low Low Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial High High Environment and Social Substantial Substantial Substantial Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial High High Results PDO Indicators by Objectives / Outcomes Emergency COVID-19 Response IN01139881 ►Diagnosed cases treated per approved protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 99.60 94.00 90.00 6/28/2022 Page 3 of 7 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) Date 27-Apr-2020 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139882 ►Total population vaccinated (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 23.00 42.00 50.00 Date 16-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139883 Total female population vaccinated (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 27.00 48.00 50.00 IN01139884 Total male population vaccinated (Percentage, Custom Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 18.00 36.00 50.00 IN01139885 ►COVID-19 PCR tests processed within two days (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 15.00 100.00 100.00 70.00 Date 16-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 Intermediate Results Indicators by Components Emergency COVID-19 Response IN01139886 ►Grievances addressed on time (as specified in the Stakeholder Engagement Plan) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 96.00 100.00 Date 01-Dec-2020 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139887 ►Doses of eligible COVID-19 vaccines procured (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 892,800.00 151,000.00 302,400.00 800,000.00 Date 31-May-2022 19-Apr-2021 19-Apr-2021 30-Jun-2024 6/28/2022 Page 4 of 7 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) IN01139888 ►Health staff trained in COVID-19 vaccination deployment per MOH-approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 270.00 270.00 400.00 Date 19-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139889 Female health staff trained in COVID-19 vaccination deployment per MOH-approved protocols (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 211.00 211.00 300.00 Date 19-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139890 Male health staff trained in COVID-19 vaccination deployment per MOH-approved protocols (Number, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 59.00 59.00 100.00 Date 19-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139891 ►A patient feedback mechanism for COVID-19 vaccinations is in place and functional (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No Yes Yes Date 19-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139892 ►COVID-19 related information and education sessions targeting women (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 53.00 83.00 500.00 Date 19-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139893 ►Serious AEFI after COVID-19 vaccination investigated (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 92.00 100.00 95.00 Date 19-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139894 ►Intensive Care Units refurbished (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/28/2022 Page 5 of 7 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) Value 1.00 1.00 1.00 3.00 Date 19-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139895 ►National Reference Laboratory is expanded, equipped and functional (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 19-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139896 ►Health staff trained in COVID-19 case management per MOH-approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 85.00 Date 19-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 IN01139897 ►Oxygen plants established (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2.00 Date 19-Apr-2021 16-Nov-2021 31-May-2022 30-Jun-2024 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173939 IDA-66770 Effective USD 7.50 7.50 0.00 6.86 0.64 91% P173939 IDA-69300 Effective USD 22.00 22.00 0.00 8.68 12.48 41% P173939 TF-B5779 Effective USD 3.50 3.50 0.00 0.92 2.58 26% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173939 IDA-66770 Effective 09-May-2020 12-May-2020 27-May-2020 30-Jun-2022 30-Jun-2022 6/28/2022 Page 6 of 7 The World Bank Implementation Status & Results Report Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) P173939 IDA-69300 Effective 01-Jun-2021 11-Jun-2021 30-Jun-2021 30-Jun-2024 30-Jun-2024 P173939 TF-B5779 Effective 02-Jun-2021 11-Jun-2021 30-Jun-2021 30-Jun-2024 30-Jun-2024 Cumulative Disbursements Restructuring History There has been no restructuring to date. Related Project(s) P176307-AF Lesotho COVID-19 Emergency Preparedness and Response Project 6/28/2022 Page 7 of 7