The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) Tunisia COVID-19 Response project (P173945) MIDDLE EAST AND NORTH AFRICA | Tunisia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 4 | ARCHIVED on 17-Feb-2022 | ISR50245 | Implementing Agencies: Republic of Tunisia, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 30-Apr-2020 Effectiveness Date: 01-Jun-2020 Planned Mid Term Review Date: 20-Apr-2023 Actual Mid-Term Review Date: Original Closing Date: 30-Jun-2021 Revised Closing Date: 31-Mar-2025 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) To improve COVID-19 detection and infection control in Tunisia through increasing the availability of COVID-19 equipment and supplies. Has the Project Development Objective been changed since Board Approval of the Project Objective? Yes Board Approved Revised Project Development Objective (If project is formally restructured) To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. Components Table Name Emergency COVID-19 Response:(Cost $102.85 M) Implementation Management and Monitoring and Evaluation:(Cost $2.10 M) Support Health Systems Strengthening:(Cost $14.75 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 High Substantial Implementation Status and Key Decisions The Parent project was approved by the World Bank's Executive Board on April 30, 2020 and was declared effective on June 1st, 2020. The project is financed by a US$20 million loan under the Multiphase Programmatic Approach supported by the Fast Track COVID-19 Facility. An additional financing of a US$100 million loan has been approved by the World Bank’s Executive Board on March 26, 2021 and was declared effective on May 26, 2021. A total of US$73.85 million (or 62 percent) of the loan has been disbursed. The project has enabled purchase and deployment of COVID- 19 vaccines to contribute to Tunisia fully immunizing 53 percent of its population as of February 9, 2022. Over a million booster doses have been deployed as of February 9, 2022, focusing on populations above age 60. 2/17/2022 Page 1 of 8 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) 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 January 17, 2022, 87 MPA-projects had been approved with a total commitment of US$4.2 billion. One operation (Guatemala) was canceled in mid-September 2021, at the request of the Government. Therefore, there are 86 MPA active operations. Fifty-eight (58) country projects or 67% of projects approved have reached 70-100% disbursement (reasons for >100% disbursements relate to fluctuations between the Euro and the SDR against the US$). Out of the 58 projects, 35 operations or 60% have disbursed over 90% of commitments. 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 January 17, 2022, amounted to US$3.30 billion or 78% of overall commitments. Streamlined procedures, delegated approvals, coupled with flexible project design and intensified efforts across the Bank have contributed to the progress. Six parent projects have been 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 Omicron variant is spreading rapidly among populations. The variant which was first identified in South Africa and Botswana has been detected in more than 80 nations by mid-December. 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 the 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 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 January 17, 2022, the Bank has approved 83 operations to support vaccine procurement and rollout in 69 countries amounting to $7.6 billion. The 83 AF-V 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 83 approved operations: (i) 45 are in Africa – 21 in AFE and 24 in AFW; (ii) 8 in East Asia; (iii) 9 in Europe and Central Asia; (iv) 6 in Latin America and the Caribbean; (v) 7 in Middle East and North Africa; and (vi) 8 in South Asia. Forty-three (43) projects are disbursing. Thirty new operations are under various stages of processing. Total disbursements as of January 17, 2022, under these projects amount to US$1.8 billion or 24% of overall commitments. As 2/17/2022 Page 2 of 8 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) 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. Seventy (70) loan/financing agreements have been signed. Also, sixty (60) 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 lockdown or mobility restrictions and counterparts and Bank teams are operating from home. Countries are dealing with new waves of infections as the Omicron variant is spreading rapidly among populations. The variant, which was first identified in South Africa and Botswana, has been detected in more than 80 nations by mid- December. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Moderate High High 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 High Substantial Sustainability Fiduciary Substantial High Substantial Environment and Social Moderate Moderate Substantial Stakeholders Moderate Substantial Substantial Other -- -- -- Overall Moderate High Substantial Results PDO Indicators by Objectives / Outcomes To prevent, detect and respond to the threat posed by COVID-19 IN01102531 ►Number of health facilities and laboratories provided with personal protective equipment under the project (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 228.00 228.00 228.00 Date 30-Apr-2020 02-Aug-2021 09-Feb-2022 30-Jun-2021 IN01102532 ►Number of tests conducted for COVID-19 using Polymerase Chain Reaction (PCR) machines (Number, Custom) 2/17/2022 Page 3 of 8 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) Baseline Actual (Previous) Actual (Current) End Target Value 17,558.00 1,820,000.00 3,937,009.00 600,000.00 Date 27-Apr-2020 05-Jul-2021 09-Feb-2022 30-Jun-2021 IN01102533 ►Percentage of priority populations vaccinated based on targets defined in national plan, total (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8.00 52.60 50.00 Date 01-Feb-2021 02-Aug-2021 09-Feb-2022 31-Mar-2025 The definition of priority populations has changed since the project was prepared; as such, this indicator will track the full vaccination rate for the entire population. The target of reaching 50 percent full vaccination nationally remains the same. Comments: There is currently no gender gap in vaccination coverage, with the vaccine rates by gender being identical and 50 percent of all those being vaccinated being women. IN01102534 Percentange of priority populations vaccinated based on targets defined in national plan by gender (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 8.00 52.60 50.00 Date 01-Feb-2021 02-Aug-2021 09-Feb-2022 31-Mar-2025 Intermediate Results Indicators by Components Emergency COVID-19 response IN01102535 ►Percentage of Project supported health facilities and laboratories confirming receipt of equipment within 14 days of in-country delivery of such equipment (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 30-Apr-2020 02-Aug-2021 09-Feb-2022 30-Jun-2021 Supporting Health System Strengthening IN01102537 ►Functional National Coordinating Committee (or the engagement of an existing committee) for COVID-19 vaccine introduction is in place (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target No committee with clear terms of reference, roles, Committee established Committee established Committee established Value responsibilities and and operational and operational and operational regular meetings defined 2/17/2022 Page 4 of 8 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) Date 01-Feb-2021 02-Aug-2021 09-Feb-2022 31-Mar-2025 IN01102538 ►COVID-19 vaccine delivery strategies to reach identified target groups are defined and include women in hard to reach areas and frontline health workers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Operational strategies Operational strategies Operational strategy defined to identify and defined to identify and defined to identify and No specific strategies Value deliver vaccines to deliver vaccines to deliver vaccines to defined targeted groups to targeted groups to targeted groups to ensure high coverage ensure high coverage ensure high coverage Date 01-Feb-2021 02-Aug-2021 09-Feb-2022 31-Mar-2025 IN01102539 ►Percentage of people reached by messages and/or materials to explain the vaccination campaign, total (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 01-Feb-2021 31-Mar-2021 31-Mar-2021 31-Mar-2025 Data for this indicator will be collected through iterative beneficiary monitoring (IBM), which has not been Comments: launched yet and will be launched in the coming months. IN01102540 Percentage of people reached by messages and/or materials to explain the vaccination campaign by gender (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 01-Feb-2021 31-Mar-2021 31-Mar-2021 31-Mar-2025 IN01102541 ►Percentage of beneficiaries reporting that community engagement processes were effective (transparent, inclusive, responsive), total (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 01-Feb-2021 31-Mar-2021 31-Mar-2021 31-Mar-2025 Data for this indicator will be collected through iterative beneficiary monitoring (IBM), which has not been Comments: launched yet and will be launched in the coming months. IN01102542 Percentage of beneficiaries reporting that community engagement processes were effective (transparent, inclusive, responsive), by gender (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 01-Feb-2021 31-Mar-2021 31-Mar-2021 31-Mar-2025 IN01102543 2/17/2022 Page 5 of 8 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) ►Functional health management and information system to deploy the COVID-19 vaccine is in place, including identification, registration and follow up with recipients by gener age and locality (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target No functional health Information system for Information system for Information system for management and COVID-19 vaccine COVID-19 vaccine COVID-19 vaccine Value information system for deployment is in place deployment is in place deployment is in place COVID-19 vaccine in and functional and functional and functional place Date 01-Feb-2021 02-Aug-2021 09-Feb-2022 31-Mar-2025 IN01102544 ►Number of of freezers, fridges, cold boxes, and vaccine carriers procured to upgrade the national cold chain to support delivery of COVID- 19 vaccines and improve national capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 2,939.00 Date 01-Feb-2021 31-Mar-2021 31-Mar-2021 31-Mar-2025 13 -80 freezers, 33 -20 freezers, 300 PQS fridges, 627 vaccine carriers, over 2000 fridge tags, and 26 refrigerated vehicles were either purchased with government funds are donated from FADES, Gavi, Japan, US, EU, or UNICEF. Discussions during the January 2022 mission have confirmed that World Comments: Bank project resources will not be utilized for cold chain procurement at this point, given the fact that all national gaps have been closed by these efforts. IN01102545 ►Percentage of female community workers (as a share of total community workers) providing vaccine information compared to baseline (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 60.00 60.00 60.00 Date 01-Feb-2021 02-Aug-2021 02-Aug-2021 31-Mar-2025 No new data was available on this since August 2021. Comments: IN01102546 ►Share of people agreeing with the importance of the vaccine, total (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 41.00 41.00 85.00 70.00 Date 01-Feb-2021 31-Mar-2021 09-Feb-2022 31-Mar-2025 Data for this indicator will be collected through iterative beneficiary monitoring (IBM), which has not been launched yet and will be launched in the coming months. Current estimate is based on the latest Facebook survey which was implemented in December 2021 - January 2022. The Facebook survey also Comments: demonstrated the 85 percent rate being identical for men and women; ie no gender gap regarding coverage. IN01102547 Share of people agreeing with the importance of the vaccine, by gender (Percentage, Custom Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 41.00 41.00 85.00 70.00 2/17/2022 Page 6 of 8 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) Date 01-Feb-2021 31-Mar-2021 09-Feb-2022 31-Dec-2025 Implementation Management and Monitoring and Evaluation IN01102536 ►Percentage of sampled Project supported health facilities and laboratories that have received equipment verified for installation and functionality (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 100.00 Date 30-Apr-2020 16-Jul-2020 16-Jul-2020 30-Jun-2021 Procurement for the technical audit remains in progress. Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173945 IBRD-91120 Effective USD 20.00 20.00 0.00 20.52 0.00 100% P173945 IBRD-92230 Effective USD 100.00 100.00 0.00 47.85 50.14 49% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173945 IBRD-91120 Effective 30-Apr-2020 11-May-2020 01-Jun-2020 30-Jun-2021 31-Mar-2025 P173945 IBRD-92230 Effective 26-Mar-2021 31-Mar-2021 26-May-2021 31-Mar-2025 31-Mar-2025 Cumulative Disbursements 2/17/2022 Page 7 of 8 The World Bank Implementation Status & Results Report Tunisia COVID-19 Response project (P173945) 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 18-Jun-2021 Related Project(s) P175785-Additional Financing for Tunisia COVID-19 Response Project ,P178540-Second Additional Financing to Tunisia COVID-19 Response Project 2/17/2022 Page 8 of 8