The World Bank Implementation Status & Results Report PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) SOUTH ASIA | Pakistan | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 2 | ARCHIVED on 21-Nov-2020 | ISR43818 | Implementing Agencies: Ministry of National Health Services Regulations and Coordination, National Disaster Management Authority, Benazir Income Support Programme, Islamic Republic of Pakistan Key Dates Key Project Dates Bank Approval Date: 02-Apr-2020 Effectiveness Date: 03-Apr-2020 Planned Mid Term Review Date: -- Actual Mid-Term Review Date: Original Closing Date: 30-Jun-2023 Revised Closing Date: 30-Jun-2023 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to prepare and respond to the COVID-19 pandemic in Pakistan and strengthen national systems 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 Preparedness and Response:(Cost $155.00 M) Component 2. Mitigation of Disruptive Impacts:(Cost $42.00 M) Component 3. Implementation Management and Monitoring and Evaluation:(Cost $3.00 M) Component 4. Contingent Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Unsatisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The implementation of the PREP project has been significantly delayed due to the pending PC-I issue. Following Economic Affairs Division’s instruction, Federal and Provincial PC-Is were prepared for the Health component of the project. However, due to a significant delay in their approval process, implementation has been on a pause. A restructuring is planned to amend one of the implementing agencies under the project. MPA Program Development Objective 11/21/2020 Page 1 of 8 The World Bank Implementation Status & Results Report PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) 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 Impressive efforts continue to be made to advance the implementation of the MPA-funded projects. As of August 28, 2020, 80 projects have been approved providing a total commitment of US$3.9 million billion. The projects benefit around 3.7 billion people or 48% of the global population. Of the 80 approved projects: (i) 30 are in Africa –11 in AFE and 19 in AFW; (ii) 12 in East Asia; (iii) 12 in Europe and Central Asia; (iv) 10 in Latin America and the Caribbean; (v) 7 in Middle East and North Africa; and (vi) 8 in South Asia. Sixty (60) projects are disbursing. Total disbursements as of August 28, 2020 under these projects amount to US$1,193 billion or 30% of overall commitment. In addition, $286 billion have been committed under signed contracts with UNICEF and Bank Facilitated Procurement (BFP), bringing to 38% actual disbursements and committed amounts. Streamlined procedures and delegated approval coupled with flexible project design and intensified efforts across the Bank have contributed to the progress. . The implementation faces significant challenges as seventy three percent (73%) of countries with MPA projects were reported still in lockdown at the end of May. This was identified by a survey to TTLs conducted by OPCS and the OEC. The findings of the survey indicated that a fundamental implementation challenge was (and still is) that government officials are not sufficiently equipped to carry out their roles and responsibilities during a lockdown, with most facing severe mobility constrains and relying to operate with cell phones. The constrains posed by the lockdown, along with the limited number of staff to do different jobs simultaneously, and existing government norms that prevent hiring of consultants, further aggravated already weak institutional and operational capacity in some countries. Another fundamental challenge for implementation, apart from lock-downs or partial lockdowns, relates to travel restrictions, as they caused multiple delays and constraints to monitoring and supervision. These problems were exacerbated by limited face-to-face meetings, which made it difficult to communicate and engage with counterparts. Working remotely with variable internet capacity also created difficulties transmitting large procurement files; ensuring team work; and coordinating multiple donors funded activities at the same time. In some countries, knowledge of the pandemic was variable and response plans have to be adjusted frequently. Bank teams had to follow up regularly with counterparts to ensure that procurement plans are adapted to rapidly evolving or changing circumstances. Other specific challenges identified by teams include: (i) several countries have not adopted emergency procedures for signing of financing agreements, processing procurement and payments – bureaucracy in making decisions and approving procurement, contracts, and payments continue to be a bottleneck; (ii) fear of future audits/investigations by national audit agencies and accountability offices is one of the reasons that is holding back the use of BFP; (iii) limited face-to-face meetings makes it difficult to communicate and engage with counterparts; (iv) Retroactive Financing has little or no uptake in some countries, mainly because the reimbursed funds will go to central government (MOF) and not to the ministries of health. Notwithstanding these challenges, the MPA is on track to achieving its PDO – to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. The significant level of disbursement in just over four months attest to the strong implementation of the Bank response thanks to the commitment of country teams. However, the capacity of teams is being stretched to meet delivery demands and provide enhanced implementation support to clients, this may not be sustainable in the long term. Risks Systematic Operations Risk-rating Tool 11/21/2020 Page 2 of 8 The World Bank Implementation Status & Results Report PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders High High High Other Substantial Substantial Substantial Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes District health center/hospital with pandemic preparedness and response plans per MONHSRC guidelines IN00903566 ►Proportion of district health centers/hospitals with pandemic preparedness and response plans per MONHSRC guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Denominator: Number of district health centers/hospitals involved in pandemic preparedness and Comments: response Numerator: Number of district health centers/hospitals with pandemic preparedness and response plans per MONHSRC Guidelines Proportion of laboratory confirmed cases of COVID-19 responded to within 48 hours IN00903567 ►Proportion of laboratory confirmed cases of COVID-19 responded to within 48 hours (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Denominator: Number of laboratory-confirmed cases of COVID-19. Numerator: Number of laboratory- Comments: confirmed cases of COVID-19 where there was deployment of a rapid response team, contract tracing was initiated, and public messaging was disseminated within 48 hours. 11/21/2020 Page 3 of 8 The World Bank Implementation Status & Results Report PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) Diagnosed cases treated per approved protocol IN00903569 ►Proportion of diagnosed cases treated per approved protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Denominator: Number of diagnosed cases Numerator: Number of diagnosed cases treated per approved Comments: protocol BISP beneficiaries receiving support in cash or kind IN00903568 ►Number of beneficiaries or persons receiving support in cash or kind (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,553,950.00 4,553,950.00 4,010,000.00 Date 18-Mar-2020 18-Jun-2020 18-Jun-2020 30-Jun-2023 Comments: Number of beneficiaries receiving support in cash or kind Intermediate Results Indicators by Components 1. Emergency COVID-19 Preparedness and Response IN00903570 ►Proportion of target hospitals (district health centers/hospitals) with personal protective equipment and infection control products and supplies without stock-outs in preceding two weeks (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Denominator: Number of target hospitals Numerator: Number of target hospitals with personal protective Comments: equipment and infection control products and supplies without stock-outs in preceding two weeks (Percent) IN00903573 ►Proportion of target hospitals (district health centers/hospitals) with triage and isolation capacity (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 16-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Denominator: Number of target hospitals Numerator: Number of target hospitals with triage (the process Comments: of determining the priority of patients' treatments based on the severity of their condition) and isolation capacity 11/21/2020 Page 4 of 8 The World Bank Implementation Status & Results Report PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) IN00903575 ►Proportion of population able to identify three key symptoms of COVID-19 and three personal prevention measures (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Denominator: Number of respondents to representative survey. Numerator: Number of respondents to Comments: representative survey who can accurately identify three key symptoms of COVID-19 and three personal prevention measures. IN00903577 ►Proportion of suspected cases of COVID-19 reported and investigated as per approved national protocols (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Denominator: Number of suspected cases of COVID-19. Numerator: Number of suspected cases of Comments: COVID-19 who are tested as per the national protocol. IN00903578 ►Proportion of designated laboratories with COVID-19 diagnostic equipment, test kits and reagents per national guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Denominator: Number of designated laboratories Numerator: Number of designated laboratories with Comments: COVID-19 diagnostic equipment, test kits, and reagent per national guidelines IN00903579 ►Proportion of target health care workers who are trained on WHO standards of clinical treatment for COVID-19 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Denominator: Number of target health care workers Numerator: Number of target health care workers who Comments: are trained on national standards of clinical treatment for COVID-19 IN00903580 ►Contextualized risk communication and community engagement strategy developed (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value None N/A N/A One Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Comments: Risk Communication and Community Engagement (RCCE) strategy 11/21/2020 Page 5 of 8 The World Bank Implementation Status & Results Report PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) 2. Mitigation of Disruptive Impacts IN00903571 ►Number of BISP beneficiaries receiving emergency cash transfers (Number, Custom, PBC) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 4,553,950.00 4,553,950.00 4,000,000.00 Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Comments: Number of BISP beneficiaries who have received the emergency cash support IN00903574 ►Percentage of crisis affected persons receiving basic food rations (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 20.00 Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Denominator: Number of beneficiaries severely affected by pandemic or with restrictions on movement Comments: Numerator: Number of beneficiaries severely affected by the pandemic or with restrictions on movement that have received the basic food rations for 6 months IN00903576 ►Number of grade - subject programs broadcasted through television, radio, and all other platforms (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40.00 Date 18-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Comments: Number of grade - subject programs broadcasted through television, radio, and all other platforms 3. Implementation Management and Monitoring and Evaluation IN00903572 ►Proportion of target hospitals who have submitted complete monthly reports on COVID-19 as per the national protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 80.00 Date 16-Mar-2020 18-Jun-2020 08-Nov-2020 30-Jun-2023 Denominator: Number of target hospitals Numerator: Number of target hospitals who have submitted Comments: complete monthly reports as per the national protocol Performance-Based Conditions IN00903581 11/21/2020 Page 6 of 8 The World Bank Implementation Status & Results Report PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) ►PBC 1 Number of BISP beneficiaries receiving emergency cash transfers (Number, Outcome, 25,000,000.00, 0.00%) Baseline Actual (Previous) Actual (Current) FY2021 Value 0.00 4,553,950.00 4,553,950.00 -- Date -- 18-Jun-2020 08-Nov-2020 -- Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173796 IDA-65900 Effective USD 200.00 200.00 0.00 79.40 121.20 40% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173796 IDA-65900 Effective 02-Apr-2020 03-Apr-2020 03-Apr-2020 30-Jun-2023 30-Jun-2023 Cumulative Disbursements 11/21/2020 Page 7 of 8 The World Bank Implementation Status & Results Report PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History There has been no restructuring to date. Related Project(s) P174642-AF: PANDEMIC RESPONSE EFFECTIVENESS IN PAKISTAN (P173796) 11/21/2020 Page 8 of 8