The World Bank Implementation Status & Results Report North Macedonia Emergency COVID-19 Response Project (P173916) North Macedonia Emergency COVID-19 Response Project (P173916) EUROPE AND CENTRAL ASIA | North Macedonia | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 3 | ARCHIVED on 29-Jun-2021 | ISR47394 | Implementing Agencies: Ministry of Labor and Social Policy, Ministry of Health, Republic of North Macedonia Key Dates Key Project Dates Bank Approval Date: 30-Apr-2020 Effectiveness Date: 29-Oct-2020 Planned Mid Term Review Date: -- 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 North Macedonia. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Emergency COVID-19 Response:(Cost $37.26 M) Household Support to Enable Social Distancing:(Cost $60.01 M) Project Implementation, Communications, Community Engagement, and Monitoring:(Cost $0.99 M) Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status and Key Decisions Since the ratification of the loan by Parliament on October 13, 2020, significant progress has been made, with the Project being declared effective on October 29, 2020, and the first disbursement of EUR 10.0 million (US$12.0 million) on November 5, 2020. As of June 2021, 51% (US$50.44million) of the loan has been disbursed. All three components are progressing well. For component one, the first phase of procurement to support the establishment of 17 Regional COVID-19 Centers with outpatient and inpatient units has been completed. The delivery of more equipment for these centers is expected in July and August 2021. In addition, bidding documents for approximately US$4.0 million for the second phase of procurement involving more essential medicines and SARS-CoV-2 Rapid antigen detection tests have been submitted. For component two, as of May 2021, 24,294 households have applied to the Guaranteed Minimum Income (GMI) program based on the revised targeting criteria; 9,659 have been approved, 95 rejected (did not submit the correct or complete documents to apply), and 3,408 refused (were not eligible according to the criteria), while 9,576 applications are in process. While the assessment of eligibility is within the stipulated period of 60 6/29/2021 Page 1 of 7 The World Bank Implementation Status & Results Report North Macedonia Emergency COVID-19 Response Project (P173916) days, there is a need to ensure that applicants receive a response as soon as possible given the crisis context in North Macedonia. Additionally, the MoLSP has contracted the Red Cross to deliver hygienic packages which are expected to be delivered in the coming weeks. Lastly, the number of people applying for unemployment benefits is lower than expected. As a result, the Government has been able to fully fund unemployment benefits since March 2020. Therefore, few funds, if any, will be required from the Project for this purpose and will be re-programmed in the upcoming Restructuring. On March 23, 2021, the government of North Macedonia sent a formal request to restructure the Project to support further and adapt the COVID-19 response with a focus on vaccine purchasing, financial bonuses to frontline health workers, and medical equipment. The restructuring process is currently ongoing, with the approval of the restructuring is expected in July 2021. 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 The implementation of the MPA-funded projects continues to progress well. As of June 15, 2021, 86 MPA-projects have been approved providing a total commitment of US$4.20 billion. Disbursements during the past month have increased at a rapid pace. Forty two (42) country projects or 49% of projects approved have reached 70-100% disbursements. The projects benefit around 3.7 billion people or 50% of the global population. Of the 86 approved projects: (i) 33 are in Africa – 12 in AFE and 21 in AFW; (ii) 12 in East Asia; (iii) 13 in Europe and Central Asia; (iv) 12 in Latin America and the Caribbean; (v) 7 in Middle East and North Africa; and (vi) 9 in South Asia. 76 projects are disbursing. Total disbursements as of June 15, 2021 under these projects amount to US$2.43 billion or 58% of overall commitments. Streamlined procedures, delegated approval 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 in other health related projects, including Additional Financing operations supporting vaccine and vaccination efforts in countries. Implementation continues to face challenges as some countries are still under different levels of lockdown or mobility restrictions and counterparts and Bank teams are operating from home. Bank teams continue to conduct implementation support missions virtually, which is challenging for both Bank teams and counterparts. This has created connectivity challenges since the internet is not reliable in many countries, especially IDA countries. Notwithstanding 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 disbursements in just over 13 months attests to the strong implementation efforts of the Bank response thanks to the commitment of counterparts supported by Bank country teams. 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 Substantial Moderate Moderate Technical Design of Project or Program Moderate Moderate Moderate 6/29/2021 Page 2 of 7 The World Bank Implementation Status & Results Report North Macedonia Emergency COVID-19 Response Project (P173916) Institutional Capacity for Implementation and Moderate Moderate Moderate Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Substantial Substantial Substantial Stakeholders Low Low Low Other -- -- -- Overall Substantial Moderate Moderate Results PDO Indicators by Objectives / Outcomes To prevent, detect and respond to the COVID-19 pandemic in North Macedonia IN01012392 ►Number of people tested for COVID-19 identification per MoH approved protocol (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 11,556.00 0.00 0.00 50,000.00 Date 18-May-2020 18-Aug-2020 22-Jun-2021 30-Jun-2022 Cumulative number of people tested for COVID-19 using project funds. The procurement of rapid antigen Comments: test kits has been finalized and awaits distribution to site laboratories based on national testing needs. IN01012393 ►Recovery rate from COVID-19 (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 77.00 77.00 96.50 90.00 Date 18-May-2020 18-Aug-2020 22-Jun-2021 30-Jun-2022 Numerator: Cumulative number of confirmed cases who recovered from COVID-19. Denominator: Comments: Cumulative number of closed COVID-19 cases. IN01012394 ►Number of new beneficiaries receiving financial support to enable social distancing (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 98,886.00 89,647.00 100,000.00 Date 18-May-2020 20-Nov-2020 22-Jun-2021 30-Jun-2022 The current indicator is lower than the number reported previously because the Government initially reported the number of people enrolled into the Unemployment Insurance (UI) and GMI, even though the Comments: UI was paid fully by Government. In this reporting cycle, the UI beneficiaries have been omitted. Intermediate Results Indicators by Components 6/29/2021 Page 3 of 7 The World Bank Implementation Status & Results Report North Macedonia Emergency COVID-19 Response Project (P173916) Emergency COVID-19 Response IN01012396 ►Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents per MoH guidelines (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 2.00 0.00 60.00 10.00 Date 18-May-2020 18-Aug-2020 22-Jun-2021 30-Jun-2022 At the beginning of the project, targets were set based on the number of laboratories (10) that are part of the Centers for Public Health. Due to the evolving nature of the pandemic and a need to increase testing Comments: capacity nationally, all laboratories (60) in public health facilities were equipped using project funds. IN01012398 ►Number of acute healthcare facilities with isolation capacity (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 17.00 11.00 Date 18-May-2020 18-Aug-2020 22-Jun-2021 30-Jun-2022 The project utilized an innovative approach to create additional isolation capacity through prefabricated containers, which allowed to take on more than originally planned with regular remodeling of existing Comments: facilities. IN01012400 ►Number of ventilators purchased (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 18-May-2020 18-Aug-2020 22-Jun-2021 30-Jun-2022 This indicator will be removed as part of the restructuring process. Sufficient donations have offset the Comments: need to procure more ventilators using funds from the Project. IN01012402 ►Number of personal protective equipment (PPE) purchased (Number (Thousand), Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 1,900.00 Date 18-May-2020 18-Aug-2020 22-Jun-2021 30-Jun-2022 This indicator will be removed as part of the restructuring process. Sufficient donations have offset the need to procure more PPE using the Project's funds. Comments: IN01012404 ►Number of additional fully equipped ICU beds for treatment of COVID-19 cases (Number, Custom) 6/29/2021 Page 4 of 7 The World Bank Implementation Status & Results Report North Macedonia Emergency COVID-19 Response Project (P173916) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 583.00 50.00 Date 18-May-2020 18-Aug-2020 22-Jun-2021 30-Jun-2022 The project utilized an innovative solution to create additional critical care capacity through prefabricated containers, which allowed to take on more bed capacity than originally planned with equipping existing Comments: facilities. IN01012405 ►Number of health care workers trained in infection prevention and control per MoH approved protocol. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 11,400.00 Date 18-May-2020 18-Aug-2020 22-Jun-2021 30-Jun-2022 This indicator will be removed as part of the restructuring process. Remote training for health care workers was supported by WHO, and the Project does not envision financing additional training activities. Comments: IN01012406 ►Number of doctors and nurses trained to treat patients with COVID-19 per approved MoH protocol (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 126.00 0.00 0.00 600.00 Date 18-May-2020 18-Aug-2020 22-Jun-2021 30-Jun-2022 This indicator will be removed as part of the restructuring process. Remote training of doctors and Comments: nurses was supported by WHO, and the Project does not envision financing additional training activities. Household Support to Enable Social Distancing IN01012395 ►Number of GMI beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 27,000.00 31,736.00 33,605.00 42,500.00 Date 18-May-2020 20-Nov-2020 22-Jun-2021 30-Jun-2022 Refers to old (27,000) and new (15,500) GMI beneficiaries (households). The number of beneficiaries may Comments: oscillate and eventually drop to its "regular" level once the old eligibility criteria are back in place and the project financing ceases. IN01012397 ►Number of unemployment insurance beneficiaries (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 4,700.00 12,469.00 0.00 45,000.00 6/29/2021 Page 5 of 7 The World Bank Implementation Status & Results Report North Macedonia Emergency COVID-19 Response Project (P173916) Date 18-May-2020 18-Aug-2020 22-Jun-2021 30-Jun-2022 Demand for unemployment benefits was less than anticipated during project preparation and, as a result, no project funds have been used to date for these benefits. In response, funds for unemployment benefits are being reallocated in the forthcoming restructuring. The acutal number reported in this ISR is zero to Comments: reflect the fact that no project funds were used to pay for unemployment benefits. The figure that was reported in the previous ISR reflects the number of unemployment insurance beneficiaries paid by the Government and, for this reason, is not retained in th cumulative reporting on this indicator. IN01012399 ►Number of households (recipients of means-tested programs) provided with food and hygienic packages (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 40,000.00 Date 18-May-2020 18-Aug-2020 22-Jun-2021 30-Jun-2022 Packages will be delivered to the existing GMI beneficiaries and beneficiaries of other means-tested social assistance programs (child allowances, education allowances, and the elderly assistance). The Comments: contracting process with the Red Cross has been finalized and delivery of hygienic packages is expected to be rolled in the coming weeks. IN01012401 ►Implementation of new application procedures for COVID-19 pandemic related social protection measures (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Working on improvement System functional but implemented and Value not implemented on the test version not yet in use functioning Date 18-May-2020 20-Nov-2020 22-Jun-2021 30-Jun-2022 Refers to new application procedures (including an online and phone application) for social assistance Comments: and unemployment benefits. IN01012403 ►Percentage of beneficiaries reporting satisfaction with the community engagement processes (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 70.00 Date 01-Dec-2020 01-Dec-2020 22-Jun-2021 04-Feb-2022 The plans to conduct a survey assessing the satisfaction of beneficiaries with the community engagement Comments: process are in the final stages. Data are expected in the next reporting period. Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed 6/29/2021 Page 6 of 7 The World Bank Implementation Status & Results Report North Macedonia Emergency COVID-19 Response Project (P173916) P173916 IBRD-91090 Effective USD 98.50 98.50 0.00 52.83 50.44 51% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P173916 IBRD-91090 Effective 30-Apr-2020 19-Oct-2020 29-Oct-2020 30-Jun-2022 30-Jun-2022 Cumulative Disbursements 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) There are no related projects. 6/29/2021 Page 7 of 7