The World Bank Tajikistan Emergency COVID-19 Project (P173765) REPORT NO.: RES49212 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF TAJIKISTAN EMERGENCY COVID-19 PROJECT APPROVED ON APRIL 2, 2020 TO REPUBLIC OF TAJIKISTAN HEALTH, NUTRITION & POPULATION EUROPE AND CENTRAL ASIA Regional Vice President: Anna M. Bjerde Country Director: Lilia Burunciuc Regional Director: Fadia M. Saadah Practice Manager/Manager: Tania Dmytraczenko Task Team Leader(s): Jakub Jan Kakietek, Baktybek Zhumadil The World Bank Tajikistan Emergency COVID-19 Project (P173765) ABBREVIATIONS AND ACRONYMS ICU Intensive Care Unit MOHSP Ministry of Health and Social Protection PDO Project Development Objective PIU Project Implementation Unit PPE Personal Protective Equipment UNICEF United Nations Children’s Fund UNOPS United Nations Office for Project Services The World Bank Tajikistan Emergency COVID-19 Project (P173765) BASIC DATA Product Information Project ID Financing Instrument P173765 Investment Project Financing Environmental and Social Risk Classification (ESRC) Substantial Approval Date Current Closing Date 02-Apr-2020 31-Jul-2022 Organizations Borrower Responsible Agency Ministry of Health and Social Protection,State Agency for Republic of Tajikistan Social Protection Multiphase Programmatic Approach (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) Status and Key Decisions (Public Disclosure) 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. The World Bank Tajikistan Emergency COVID-19 Project (P173765) 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 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. 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. 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 November 15, 2021, the Bank has approved 65 operations to support vaccine procurement and rollout in 62 countries amounting to $5.8 billion. The 65 AF-V operations approved, include 4 operations that involved restructuring of parent projects (North Macedonia, Philippines and Pakistan) and in the case of Lebanon, restructuring of the Health Resilience Project. Of the 65 approved operations: (i) 35 are in Africa – 16 in AFE and 19 in AFW; (ii) 7 in East Asia; (iii) 7 in Europe and Central Asia; (iv) 5 in Latin America and the The World Bank Tajikistan Emergency COVID-19 Project (P173765) Caribbean; (v) 5 in Middle East and North Africa; and (vi) 6 in South Asia. Thirty three (33) projects are disbursing. Total disbursements as of November 15, 2021, under these projects amount to US$1,046 million or 18% of overall commitments. As with the MPA operations, streamlined procedures, delegated approval, coupled with flexible project design and intensified efforts across the Bank have contributed to the rapid design and processing of the operations. Sixty-three (63) loan/financing agreements have already been signed. Also, fifty-three (53) loan/financing agreements have become effective; several others are expected to become effective in the coming days/weeks. Implementation of the AF-V operations, as with MPA operations is facing challenges as several countries are still under different levels of lockdown or mobility restrictions and counterparts and Bank teams are operating from home. OPS_TABLE_PDO_CURRENTPDO Project Development Objective (PDO) Original PDO Project Development Objective (PDO) is to prepare and respond to the COVID-19 pandemic in the Republic of Tajikistan. Current PDO Project Development Objective (PDO) is to prevent, prepare and respond to the COVID-19 pandemic in the Republic of Tajikistan. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-D7760 11-Feb-2021 21-May-2021 30-Jun-2021 31-Jul-2022 8.63 7.29 1.17 IDA-D7770 11-Feb-2021 21-May-2021 30-Jun-2021 31-Jul-2022 12.57 8.52 3.92 IDA-D6040 02-Apr-2020 03-Apr-2020 24-Apr-2020 01-Dec-2021 11.30 11.37 .23 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No The World Bank Tajikistan Emergency COVID-19 Project (P173765) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING Background 1. The Project, with an original funding envelope of SDR 8.3 million (US$ 11.3 million equivalent) was approved on April 2, 2020, signed on April 3, 2020 and declared effective on April 24, 2020. Two AF packages were approved on February 11, 2021 and became effective in March 2021. The first, for SDR 6 million (US$ 8.63 million equivalent), supports the access to COVID-19 vaccines. The second, for SDR 8.8 (US$ 12.57 million equivalent), supports strengthening the oxygen supply system, expanding emergency cash transfers, and providing emergency funding for routine child immunization. Project Status 2. Progress towards achieving the project development objective (PDO) is rated Satisfactory and overall implementation progress is rated Moderately Satisfactory. Activities under all components are progressing well and are on schedule. As of November 19, 2021, cumulative disbursements stand at 83.6% (US$ 27.18 million). There are no overdue audit reports. 3. Under Component 1, the small works to prepare the intensive care units (ICUs) in eight of the 10 hospitals selected for the delivery and installation of the equipment have been completed. Through a US$ 5.3 million contract with United Nations Office for Project Services (UNOPS), the Government has procured essential medical equipment and personal protective equipment (PPE) for the ICUs in the 10 selected hospitals. Despite substantial global shortages and market disruptions, the delivery and installation of the equipment have been completed. The Project has also procured 650,400 doses of the Moderna vaccine through COVAX (expected to be delivered in early calendar year 2022) and has provided financing support for vaccine deployment and the production of vaccine registers and certificates for the national campaign. The procurement of oxygen supply stations in 15 major hospitals is expected to be completed before the end of calendar year 2021 and the delivery and installation are expected by June 2022. 4. Under Component 2, a Strategic Emergency Response Advisor, a Social and Behavior Change Communication Expert, an Administrative Assistant, and an External Relations Advisor for the Ministry of Health and Social Protection (MOHSP) have been hired to strengthen the capacity to respond to COVID-19. Fifty journalists from the key media outlets in the country and over 490 community volunteers have been trained on communication on key issues related to the pandemic, including prevention and risk reduction and measures to reduce vaccine hesitancy, with further trainings being planned. 5. Under Component 3, the Project has delivered emergency nutrition-sensitive cash to over 164,000 vulnerable households with children under the age of 7 for a total value of about US$ 8.2 million. In addition, in partnership with the United Nations Children’s Fund (UNICEF), the State Agency for Social Protection, and the project implementation unit (PIU), have developed a series of communication materials including posters, brochures, and mobile phone messages (SMS) on optimal child nutrition and stimulation for dissemination to the emergency cash beneficiaries, local government agencies, and the branches of the Amonatbank to help children stay healthy and grow to their full potential, despite the challenges caused by the pandemic. 6. Activities under Component 4 reflect the strong ownership of the Project by the MOHSP. Overall, coordination and roles of key staff responsible for the implementation, including those in the PIU, have been defined and implemented in a satisfactory manner. In addition, the financial management arrangements at the PIU, including planning and budgeting, accounting, financial reporting, funds flow, internal control, external audits, and staffing are satisfactory and continue to be acceptable to the World Bank. Procurement, financial management, project management, counterpart funding, and The World Bank Tajikistan Emergency COVID-19 Project (P173765) monitoring and evaluation are all rated Satisfactory. Applicable environmental and social standard measures are under implementation and have been rated Moderately Satisfactory. Rationale for Restructuring 7. To align the closing dates of all Project grants and to ensure that the funds are disbursed, the Government has requested to restructure the Project to extend the end disbursement date for the original grant. The Government formally requested the restructuring on November 17, 2021. This request is provided as a supporting document to this restructuring paper. 8. The closing date of the original grant (December 1, 2021) is not consistent with the overall Project closing date and the closing dates of the two additional financing grants (July 31, 2022). In addition, as of November 19, 2020, the original grant has an undisbursed balance of US$ 230,000, which cannot be disbursed before the closing date of the original grant (December 1, 2021). The balance is due to a combination of cost savings, including SDR exchange rate savings, lower than expected costs for training community volunteers and media, and to the decision of the Government not to pursue an agreement with UNICEF to carry out communication activities. II. DESCRIPTION OF PROPOSED CHANGES 9. This paper seeks the approval of the Country Director of the Central Asia Country Management Unit to restructure the Project to extend the closing date of the original grant (IDA D6040) from December 1, 2021 to July 31, 2022 in order to align it with the closing dates of the other grants (IDA D7770 and IDA D7760) and to allow the Government to disburse the grant’s remaining balance. No other changes to Project’s scope or scale, PDO, cost, results framework, or other elements are being sought. III. SUMMARY OF CHANGES Changed Not Changed Loan Closing Date(s) ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ MPA Program Development Objective ✔ MPA Expected Results and Indicators ✔ Results Framework ✔ The World Bank Tajikistan Emergency COVID-19 Project (P173765) Components and Cost ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Disbursement Estimates ✔ Overall Risk Rating ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) MPA PROGRAM DEVELOPMENT OBJECTIVE Current 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 EXPECTED MPA PROGRAM RESULTS Current Expected MPA Results and their Indicators for the MPA Program Progress towards the achievement of the PDO would be measured by outcome indicators. Individual country-specific projects (or phases) under the MPA Program will identify relevant indicators, including among others: • Country has activated their public health Emergency Operations Centre or a coordination mechanism for COVID-19; • Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents; The World Bank Tajikistan Emergency COVID-19 Project (P173765) • Number of acute healthcare facilities with isolation capacity; • Number of suspected cases of COVID-19 reported and investigated per approved protocol; • Number of diagnosed cases treated per approved protocol; • Personal and community non-pharmaceutical interventions adopted by the country (e.g., installation of handwashing facilities, provision of supplies and behavior change campaigns, continuity of water and sanitation service provision in public facilities and households, schools closures, telework and remote meetings, reduce/cancel mass gatherings); • Policies, regulations, guidelines, or other relevant government strategic documents incorporating a multi- sectoral health approach developed/or revised and adopted; • Multi-sectoral operational mechanism for coordinated response to outbreaks by human, animal and wildlife sectors in place; • Coordinated surveillance systems in place in the animal health and public health sectors for zoonotic diseases/pathogens identified as joint priorities; and • Mechanisms for responding to infectious and potential zoonotic diseases established and functional; and • Outbreak/pandemic emergency risk communication plan and activities developed and tested OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-D6040 Effective 01-Dec-2021 31-Jul-2022 30-Nov-2022 IDA-D7760 Effective 31-Jul-2022 31-Jul-2022 30-Nov-2022 IDA-D7770 Effective 31-Jul-2022 31-Jul-2022 30-Nov-2022 .