The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) Ghana COVID-19 Emergency Preparedness and Response Project (P173788) AFRICA WEST | Ghana | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 2 | ARCHIVED on 19-Nov-2020 | ISR43982 | Implementing Agencies: Ghana Health Services, Republic of Ghana, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 02-Apr-2020 Effectiveness Date: 03-Apr-2020 Planned Mid Term Review Date: 29-Mar-2021 Actual Mid-Term Review Date: Original Closing Date: 30-Jun-2022 Revised Closing Date: 30-Jun-2022 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 Ghana Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Emergency COVID-19 Response:(Cost $21.50 M) Strengthening Multi-sector, National Institutions and Platforms for Policy Development and Coordination of Prevention and Preparedness using One Health approach:(Cost $3.40 M) Community Engagement and Risk Communication:(Cost $7.40 M) Implementation management and monitoring and evaluation and project management:(Cost $2.70 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Substantial Moderate Implementation Status and Key Decisions Since approval on April 2, 2020, the Project has been highly effective in supporting the implementation of the country’s emergency response and preparedness plan (EPRP) for COVID-19 response at unprecedented scale and speed. The Project has been carried out as planned and overcoming unprecedented challenges despite the global supply shortages and rapidly changing epidemiological trends. The Project has disbursed US$34.3 million (95 percent) out of US$35 million. The Government has requested for Additional Financing, which amount of US$130 million is currently being processed (November 2020). MPA Program Development Objective 11/19/2020 Page 1 of 8 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) 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[1]. The projects benefit around 3.7 billion people or 48 percent 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 percent of overall commitment. In addition, $286 billion have been committed undersigned contracts with UNICEF and Bank Facilitated Procurement (BFP), bringing to 38 percent 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 73 percent 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 lockdowns 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 teamwork; 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. [1] Commitments do not include: (i) $500m for the India project which was restructure on May 7 to include $500m co-financing from the Asian Infrastructure Investment Bank; (ii) $300m for the China Project; and (iii) $35m AF for the Morocco Project. Risks 11/19/2020 Page 2 of 8 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial Substantial Macroeconomic Substantial Substantial Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate Institutional Capacity for Implementation and Substantial Moderate Moderate Sustainability Fiduciary High Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Low Low Low Other -- -- -- Overall Substantial Substantial Moderate Results PDO Indicators by Objectives / Outcomes Emergency COVID-19 Response IN00909234 ►Diagnosed cases treated in the designated treatment centers per approved protocol (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 68.00 68.00 80.00 Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 This indicator relates to only severe cases admitted requiring ventilation at treatment centers. As of October 23, 2020, the total number of active cases on admission/home care was 488 out of which Nine (9) cases classified as severe and two (2) as critical. One patient is on ventilator support. Three hundred Comments: and sixteen (316) deaths have been recorded. Cumulative number of recoveries stands at 46,971 out of 47,775 total confirmed cases. IN00909235 ►Designated acute healthcare facilities with isolation capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 9.00 15.00 50.00 Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 Redefined the project end target as activities have been scaled up. Comments: IN00909281 11/19/2020 Page 3 of 8 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) ►Confirmed COVID-19 cases that conducted contact tracing (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 100.00 Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 This indicator measures all confirmed individuals triggering contact tracing. All cases arising from arriving passengers at Points of Entry or through routine surveillance triggered contact tracing referred to as enhanced surveillance. After reopening of the Kotoka International Airport (KIA) on September 1, 2020, all the international travelers arriving in the country through the KIA were tested and contract traced. A total Comments: of 19,169 cases were detected from routine surveillance and 28,497 cases were identified through enhanced surveillance. Among these, a total of 109 cases have been detected among international travelers at the KIA. The cumulative test positivity rate was 9.1 percent. IN00909282 ►Country adopted personal and community non-pharmaceutical interventions (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 The Government has successfully instituted both therapeutic and non-therapeutic measures to contain the spread of the COVID-19 diseases. The Government has developed necessary policies and legislative instruments, including the Imposition of Restrictions Act 2020 (Act 1012) and Executive Instruments (EI 61) and (EI 64) on the wearing of face masks and border closures to protect the populations from the Comments: spread of the virus. The inter-agency NTCC and the regional and district PHEMCs have been supported by the Project to take adequate public health and social measures nationwide. The Project enables the Ministry of Information and Ghana Health Service to continue proactive risk communication and community engagement. Overall Comments PDO All the four PDO indicators have made significant progress towards achieving the stated goals, two among which have surpassed the end targets. The end target to measure the isolation capacity of health facilities is modified to increase as activities have been scaled up. Under the Additional Financing, the indicator on the adoption of personal and community non-pharmaceutical interventions is dropped as the original indicator has been achieved and it was found to be no longer useful to measure by yes or no. Intermediate Results Indicators by Components Emergency COVID-19 Response IN00909283 ►Designated laboratories with COVID-19 diagnostic equipment, test kits and reagents (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 9.00 10.00 14.00 Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 Comments: Refined the project end target as the activities have been scaled up. 11/19/2020 Page 4 of 8 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) IN00909287 ►Designated laboratories diagnosed suspected COVID-19 cases within 24 hrs (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 9.00 10.00 10.00 Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 Refined the project end target as the activities have been scaled up. Comments: IN00909290 ►Referral system to care for COVID-19 patients prepared (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 IN00909291 ►COVID-19 Compensation Benefit Framework developed and implemented (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 After the effectiveness of the COVID-19 Project, other sectors of the World Bank have extended their support in the fields of social protection, jobs and education. Given the limited amount of the originally allocated budget for cash transfer under this Project, the Compensation Benefit Package for the Comments: affected and the vulnerable under this Project has been cancelled. Rather, the Project refocuses on the health sector interventions to save lives and protect the vulnerable as an integral part of the World Bank’s support for the country's COVID-19 response. IN00909292 ►Simulation exercises and scenarios conducted in facilities and communities marked as DSS sites and quarantine facilities (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1.00 17.00 17.00 7.00 Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 Strengthening Multi-sector, National Institutions and Platforms IN00909284 ►Designated facilities for COVID-19 received monitoring and supportive supervision in preceding quarter (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 80.00 11/19/2020 Page 5 of 8 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 All designated facilities were visited by the Case Management Team during the quarter and a report was Comments: submitted. Community Engagement and Risk Communication IN00909285 ►COVID-19 sensitization campaigns conducted (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1,611.00 1,611.00 800.00 Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 The Government of Ghana has been proactively reaching communities, local leaders and community- based associations for risk communication. The data count at the district and community level and media content analysis showed that every district and community in the country carried out at least one risk communication and community engagement activity during the period. The awareness survey showed that 100% of those who surveyed was aware of COVID-19; more than Comments: 70% could cite at least one of the symptoms; and 83% perceived that they received enough information about COVID-19. Eighty-nine percent (89%) were satisfied with the government's response to COVID-19. There are numbers of risk communication campaigns conducting. It is difficult to count the number of campaigns as there are so many. IN00909288 ►Individuals reached with tailored information on COVID-19 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 40.00 100.00 100.00 80.00 Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 The awareness survey showed that 97 percent of those who surveyed was aware of COVID-19. Comments: Implementation Management, Monitoring and Evaluation and Project Management IN00909286 ►M&E system established and implemented to monitor project progress (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No Yes Yes Yes Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 IN00909289 ►Complaints resolved within one week of having received them (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 100.00 100.00 70.00 11/19/2020 Page 6 of 8 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) Date 02-Apr-2020 30-Jun-2020 30-Oct-2020 30-Jun-2022 All complaints received were addressed within one week as anticipated. Comments: Overall Comments IR The Project made progress on a majority of the intermediate results indicators. The end targets of the two indicators on laboratories are revised to increase in response to the rapidly changing COVID-19 situations in the country. The indicators on COVID-19 Compensation Benefit framework, the simulation exercises and scenarios and the COVID-19 sensitization campaigns are dropped under the Additional Financing due to the World Bank's additional support with the project for social protection and shifts in emergency phases from acute to recovery. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P173788 IDA-66020 Effective USD 35.00 35.00 0.00 33.86 1.90 95% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173788 IDA-66020 Effective 02-Apr-2020 03-Apr-2020 03-Apr-2020 30-Jun-2022 30-Jun-2022 Cumulative Disbursements 11/19/2020 Page 7 of 8 The World Bank Implementation Status & Results Report Ghana COVID-19 Emergency Preparedness and Response Project (P173788) 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) P174839-GHANA COVID-19 EMERGENCY PREPAREDNESS AND RESPONSE PROJECT ADDITIONAL FINANCING 11/19/2020 Page 8 of 8