The World Bank Implementation Status & Results Report Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803) Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803) WESTERN AND CENTRAL AFRICA | Sierra Leone | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 5 | ARCHIVED on 28-Jun-2022 | ISR51330 | Implementing Agencies: Ministry of Finance, Ministry of Health and Sanitation Key Dates Key Project Dates Bank Approval Date: 02-Apr-2020 Effectiveness Date: 03-Apr-2020 Planned Mid Term Review Date: 15-Jul-2021 Actual Mid-Term Review Date: 14-Jul-2021 Original Closing Date: 31-Mar-2022 Revised Closing Date: 30-Jun-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 systems for public health preparedness in Sierra Leone. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Supporting National and Sub-national Public Health Institutions for Prevention and Preparedness:(Cost $4.80 M) Strengthening Multi-sector, National Institutions and Platforms for Policy Development and Coordination of Prevention and Preparedness using One Health approach:(Cost $1.20 M) Emergency COVID-19 Response:(Cost $27.60 M) Implementation Management and Monitoring and Evaluation:(Cost $0.50 M) 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 The Sierra Leone COVID-19 Emergency Preparedness and Response Project has been supporting the Government's efforts to prevent, detect, and respond to the threat posed by COVID-19. The project significantly contributes to containing the pandemic in Sierra Leone by expanding case detection and diagnostic capacity and risk communication and community engagement, and the COVID-19 vaccination. As of June 8, 22.2 percent of the total population was fully vaccinated, 30.8 percent of the total population had received at least one dose of COVID-19 vaccine, and 10,941 people had received a booster shot. Of the 5,123,880 doses the country received, 3,483,872 doses were administered (68 percent 6/28/2022 Page 1 of 9 The World Bank Implementation Status & Results Report Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803) absorption rate). Among those received, 463,200 doses (or 9 percent) were from the Africa Vaccine Acquisition Trust (AVAT) under the World Bank financing. The project will further support and monitor the deployment of vaccines in particular among vulnerable groups, including the elderly and people with disabilities, and continue to strengthen the country's immunization system. 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. The 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 6/28/2022 Page 2 of 9 The World Bank Implementation Status & Results Report Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803) 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 Substantial Moderate Moderate Macroeconomic Substantial Moderate Moderate Sector Strategies and Policies Moderate Low Low Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Moderate Low Low Other -- -- -- Overall Substantial High High Results 6/28/2022 Page 3 of 9 The World Bank Implementation Status & Results Report Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803) PDO Indicators by Objectives / Outcomes Prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems IN01138413 ►Country has activated their public health Emergency Operations Center for COVID-19 (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 20-Mar-2020 31-Jul-2021 31-Mar-2022 30-Jun-2023 Country has administered their public health Emergency Operations Center (EOC) for COVID-19 since Comments: January 30, 2020 at Level 2 and remains active. IN01138414 ►Suspected 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 20-Mar-2020 31-Jul-2021 31-Mar-2022 30-Jun-2023 All suspected COVID-19 cases reported are investigated bases on the national guidelines. Comments: IN01138415 ►Designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents without stock-out in preceding two weeks (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 5.00 3.00 Date 20-Mar-2020 31-Jul-2021 31-Mar-2022 30-Jun-2023 There has been no stock-out of COVID-19 diagnostic equipment, test kits, and reagents in all 5 Comments: designated laboratories in the preceding two weeks. IN01138431 ►Designated acute healthcare facilities with isolation capacity (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 90.00 Date 20-Mar-2020 31-Jul-2021 31-Mar-2022 30-Jun-2023 All designated COVID-19 Healthcare facilities have Isolation capacity, which were constructed after the Comments: Ebola outbreak. IN01138432 ►Population vaccinated, which is included in the target population groups defined in national vaccine deployment plan (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 6/28/2022 Page 4 of 9 The World Bank Implementation Status & Results Report Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803) Value 0.00 1.00 22.20 51.60 Date 14-Mar-2021 30-Sep-2021 08-Jun-2022 30-Jun-2023 As of May 22, 2022, 1,659,093 people had been fully vaccinated or 19.5 % of total population (or 29.6% of target population >12 years) and 2,383,636 people or 28.1% of total population had been vaccinated with Comments: at least 1st dose of COVID-19 vaccine. IN01138433 Proportion of females among those vaccinated (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 40.00 51.00 50.00 Date 14-Mar-2021 30-Sep-2021 10-Mar-2022 30-Jun-2023 Intermediate Results Indicators by Components Supporting National and Sub-national, Prevention and Preparedness IN01138434 ►Designated health facilities for COVID-19 treatment, laboratories and veterinary laboratories, regional and district hospitals reported, using eIDSR in preceding month (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 90.00 90.00 90.00 Date 20-Mar-2020 31-Jul-2021 31-Mar-2022 30-Jun-2023 IN01138439 ►Country has established a sample referral system to care for COVID-19 patients (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 20-Mar-2020 31-Jul-2021 31-Mar-2022 30-Jun-2023 The Directorate of Laboratory, MoHS has established a sample referral system for COVID-19 Sample Comments: transportation. IN01138443 ►Laboratory results available within 72 hours (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 Date 20-Mar-2020 31-Jul-2021 31-Mar-2022 30-Jun-2023 Turn-around-time for all samples received are analyzed and result are releases with 24-48 hours. Comments: 6/28/2022 Page 5 of 9 The World Bank Implementation Status & Results Report Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803) Strengthening Multi-sector, National Institutions and Platforms for One Health IN01138435 ►At least one multi- sectoral simulation exercise conducted with results incorporated into national COVID-19 preparedness and response plans (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 20-Mar-2020 31-Jul-2021 31-Mar-2022 30-Jun-2023 One multi- sectoral simulation exercise conducted by the MoHS in partnership with USCDC, MAF, Red Comments: Cross, World Vision, CARE International, ONS, EPA, WHO, NACOVERC etc.) IN01138440 ►Districts received monitoring and supportive supervision from the MoHS and/or the PBSL for COVID-19 vaccination in the preceding quarter (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 16.00 16.00 Date 14-Mar-2021 31-Jul-2021 31-Mar-2022 30-Jun-2023 Emergency COVID-19 Response IN01138436 ►Designated laboratories with staff trained to conduct COVID-19 diagnosis per EOC protocol (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 5.00 5.00 3.00 Date 20-Mar-2020 31-Jul-2021 31-Mar-2022 30-Jun-2023 All five designated laboratories have trained staff to conduct COVID-19 diagnosis. Comments: 3 molecular scientists trained and deployed to support and strengthen the molecular lab staff strength. IN01138441 ►Health workers and front line staff at the designated POEs and health and quarantine facilities for COVID-19 treatment trained in infection prevention and control per MOH-approved protocols (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 150.00 150.00 90.00 Date 20-Mar-2020 31-Jul-2021 31-Jul-2021 30-Jun-2023 A training of 150 (118 male & 32 female) health care workers at designated PoE’s and COVID-19 Comments: Facilities on COVID-19 related infection prevention and control measures and protocols. IN01138444 ►Complaints at 117 and ACC received and addressed within one week through the project GRM (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 85.40 100.00 80.00 6/28/2022 Page 6 of 9 The World Bank Implementation Status & Results Report Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803) Date 14-Mar-2021 31-Jul-2021 31-Mar-2022 30-Jun-2023 MoHS stakeholders and IHPAU staff are yet to be granted access to the GRM platform. At present only Comments: corruption related grievances are being investigated by the ACC. IN01138446 ►Districts meeting their COVID-19 vaccination coverage targets for fully vaccinated persons (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 16.00 Date 14-Mar-2021 31-Jul-2021 31-Mar-2022 30-Jun-2023 IN01138448 ►Districts reporting SMT on COVID-19 vaccines in the preceding month (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 16.00 16.00 16.00 Date 14-Mar-2021 31-Jul-2021 31-Mar-2022 30-Jun-2023 ESMT data is only reported at national. Through support from UNICEF, training will be conducted in June Comments: 2022 and equipment provided to all 16 districts to be able to report ESMT effective July 2022. Community Engagement and Risk Communication IN01138437 ►Country has reported to have contextualized risk communication and community engagement strategies (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 20-Mar-2020 31-Jul-2021 31-Mar-2022 30-Jun-2023 The Risk Communication and Social Mobilization pillar of the COVID-19 has developed contextualized risk communication and community engagement strategies which are shared with all stakeholders Comments: involved in the fight against the COVID-19 in the country. IN01138442 ►People having adequate knowledge on preventive measures from COVID-19 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 81.00 81.00 80.00 95.00 Date 14-Mar-2021 14-Mar-2021 31-Mar-2022 30-Jun-2023 80% of People having adequate knowledge on Infection Prevention and Control (IPC) measures and vaccine efficacy based on feedback from mobilization and sensitization training conducted by Risk Comments: Communication and IPC trainings. IN01138445 Females having adequate knowledge on preventive measures from COVID-19 (Number, Custom Breakdown) 6/28/2022 Page 7 of 9 The World Bank Implementation Status & Results Report Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 90.00 95.00 Date 14-Mar-2021 14-Mar-2021 31-Mar-2022 30-Jun-2023 IN01138447 ►People are willing to take COVID-19 vaccines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 72.00 89.00 85.00 90.00 Date 14-Mar-2021 31-Jul-2021 31-Mar-2022 30-Jun-2023 Vaccine acceptancy data is extracted from the periodic survey, conducted by the International Growth Comments: Center (IGC) Sierra Leone. IN01138449 Females are willing to take COVID-19 vaccines (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 89.00 84.00 90.00 Date 14-Mar-2021 31-Jul-2021 31-Mar-2022 30-Jun-2023 Implementation Management and Monitoring and Evaluation IN01138438 ►Quarterly reports with IDSR data submitted in a timely manner (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 16.00 16.00 16.00 Date 14-Mar-2021 31-Jul-2021 31-Mar-2022 30-Jun-2023 Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173803 IDA-D6030 Effective USD 7.50 7.50 0.00 7.64 0.00 100% P173803 IDA-D8530 Effective USD 5.00 5.00 0.00 4.81 0.12 98% P173803 IDA-D9600 Effective USD 18.10 18.10 0.00 0.00 17.85 0% 6/28/2022 Page 8 of 9 The World Bank Implementation Status & Results Report Sierra Leone COVID-19 Emergency Preparedness and Response Project (P173803) P173803 TF-B5745 Effective USD 3.50 3.50 0.00 2.52 0.98 72% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173803 IDA-D6030 Effective 02-Apr-2020 03-Apr-2020 03-Apr-2020 31-Mar-2022 30-Jun-2023 P173803 IDA-D8530 Effective 28-May-2021 03-Jun-2021 28-Jun-2021 30-Jun-2023 30-Jun-2023 P173803 IDA-D9600 Effective 13-Dec-2021 20-Dec-2021 23-Feb-2022 30-Jun-2023 30-Jun-2023 P173803 TF-B5745 Effective 28-May-2021 03-Jun-2021 28-Jun-2021 30-Jun-2023 30-Jun-2023 Cumulative Disbursements Restructuring History Level 2 Approved on 04-Mar-2021 Related Project(s) P176243-Sierra Leone COVID-19 Emergency Preparedness and Response Project Additional Financing ,P176275-Sierra Leone COVID-19 Emergency Preparedness and Response Project Additional Financing ,P176441-Sierra Leone COVID-19 Emergency Preparedness and Response Project Additional Financing ,P177850-Sierra Leone COVID-19 Emergency Preparedness and Response Project Second Additional Financing 6/28/2022 Page 9 of 9