Document of The World Bank FOR OFFICIAL USE ONLY Report No: PAD4166 INTERNATIONAL DEVELOPMENT ASSOCIATION PROPOSED ADDITIONAL GRANT FROM THE PANDEMIC EMERGENCY FINANCING FACILITY IN THE AMOUNT OF US$942,857 TO THE REPUBLIC OF RWANDA FOR AN ADDITIONAL FINANCE FOR RWANDA COVID-19 EMERGENCY RESPONSE PROJECT November 25, 2020 Health, Nutrition and Population Global Practice Eastern and Southern Africa Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. CURRENCY EQUIVALENTS (Exchange Rate Effective {Nov 25, 2020}) Currency Unit = Rwanda (RWF) 978.83 RWF = US$1 FISCAL YEAR January 1 - December 31 Regional Vice President: Hafez M. H. Ghanem Country Director: Keith E. Hansen Regional Director: Amit Dar Practice Manager: Francisca Ayodeji Akala Task Team Leader(s): Miriam Schneidman, Naoko Ohno ABBREVIATIONS AND ACRONYMS BFP Bank Facilitated Procurement COVID-19 Coronavirus Disease 2019 CDC Center for Disease Control CPF Country Partnership Framework ES Environment and Social ESCP Environmental and Social Commitment Plan ESF Environmental and Social Framework ESMF Environmental and Social Management Framework FM Financial management GBV Gender-based violence GDP Gross Domestic Product GRS Grievance Redress Service IBRD International Bank for Reconstruction and Development ICWMP Infection Control and Waste Management Plan IDA International Development Association IFRs International Financial Reporting Standards ILO International Labor Organization JEE Joint External Evaluation MPA Multiphase Programmatic Approach NEPRCC National Epidemic Preparedness & Response Committee OSH Occupational safety and health OPCS Operations Policy and Country Services PAD Project Appraisal Document PDO Project Development Objective PPSD Project Procurement Strategy for Development PRAMS Procurement Risk Assessment and Management System RBC Rwanda Biomedical Center RCCE Risk Communication and Community Engagement RfQ Request for Quotations SARS Severe Acute Respiratory Syndrome SEA Sexual exploitation and abuse SEP Stakeholders Engagement Plan SOEs Statements of Expenditures SPIU Single Project Implementation Unit SPRP Strategic Preparedness and Response Program SPRP Stunting Prevention and Reduction Project STEP Systematic tracking of Exchanges in Procurement WB World Bank WHO World Health Organization Rwanda Additional Financing for Rwanda COVID-19 Emergency Response Project TABLE OF CONTENTS I. BACKGROUND AND RATIONALE FOR ADDITIONAL FINANCING ........................................ 7 II. DESCRIPTION OF ADDITIONAL FINANCING ...................................................................... 9 III. KEY RISKS ..................................................................................................................... 10 IV. APPRAISAL SUMMARY .................................................................................................. 12 V. WORLD BANK GRIEVANCE REDRESS .............................................................................. 17 VI SUMMARY TABLE OF CHANGES ..................................................................................... 18 VII DETAILED CHANGE(S) .................................................................................................... 18 VIII. RESULTS FRAMEWORK AND MONITORING ................................................................... 21 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) BASIC INFORMATION – PARENT (Rwanda COVID-19 Emergency Response Project - P173855) Country Product Line Team Leader(s) Rwanda IBRD/IDA Miriam Schneidman Project ID Financing Instrument Resp CC Req CC Practice Area (Lead) P173855 Investment Project HAEH2 (10210) AECE2 (6542) Health, Nutrition & Financing Population Implementing Agency: Rwanda Biomedical Center ADD FIN TBL1 Is this a regionally tagged project? No Bank/IFC Collaboration No Expected Approval Date Closing Date Guarantee Environmental and Social Risk Classification Expiration Date 07-Apr-2020 30-Jun-2022 Substantial Financing & Implementation Modalities Parent [✓] Multiphase Programmatic Approach [MPA] [ ] Contingent Emergency Response Component (CERC) [ ] Series of Projects (SOP) [ ] Fragile State(s) [ ] Performance-Based Conditions (PBCs) [ ] Small State(s) [ ] Financial Intermediaries (FI) [ ] Fragile within a Non-fragile Country [ ] Project-Based Guarantee [ ] Conflict [ ] Deferred Drawdown [✓] Responding to Natural or Man-made disaster [ ] Alternate Procurement Arrangements (APA) [✓] Hands-on, Enhanced Implementation Support (HEIS) Development Objective(s) Nov 25, 2020 Page 1 of 24 Official Use The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) MPA Program Development Objective (PrDO) 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 Project Development Objectives (Phase 085) The objective of the Project is to prevent, detect and respond to the threat posed by COVID-19 and strengthen nationa systems for public health preparedness in the Republic of Rwanda. Ratings (from Parent ISR) RATING_DRAFT_NO Latest ISR 13-Jul-2020 Progress towards achievement of PDO S Overall Implementation Progress (IP) S Overall ESS Performance S Overall Risk S Financial Management S Project Management S Procurement S Monitoring and Evaluation S BASIC INFORMATION – ADDITIONAL FINANCING (Additional Financing for Rwanda COVID-19 Emergency Response Project - P175252) ADDFIN_TABLE Urgent Need or Capacity Project ID Project Name Additional Financing Type Constraints P175252 Additional Financing for Restructuring, Scale Up Yes Rwanda COVID-19 Emergency Response Project Financing instrument Product line Approval Date Investment Project Recipient Executed 25-Nov-2020 Financing Activities Projected Date of Full Bank/IFC Collaboration Nov 25, 2020 Page 2 of 24 Official Use The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) Disbursement 30-Jun-2022 No Is this a regionally tagged project? No Financing & Implementation Modalities Child [✓] Multiphase Programmatic Approach [MPA] [ ] Series of Projects (SOP) [ ] Fragile State(s) [ ] Performance-Based Conditions (PBCs) [ ] Small State(s) [ ] Financial Intermediaries (FI) [ ] Fragile within a Non-fragile Country [ ] Project-Based Guarantee [ ] Conflict [✓] Responding to Natural or Man-made disaster [ ] Alternate Procurement Arrangements (APA) [✓] Hands-on, Enhanced Implementation Support (HEIS) [ ] Contingent Emergency Response Component (CERC) Disbursement Summary (from Parent ISR) Net Source of Funds Total Disbursed Remaining Balance Disbursed Commitments IBRD % IDA 14.25 12.77 2.23 85 % Grants % MPA Financing Data (US$, Millions) Financing MPA Program Financing Envelope 18,000,000,000.00 MPA FINANCING DETAILS (US$, Millions) MPA FINA NCI NG DET AILS (US$, Millions) Approve d Board Approved MPA Financing Envelope: 18,000,000,000.00 MPA Program Financing Envelope: 18,000,000,000.00 of which Bank Financing (IBRD): 9,900,000,000.00 of which Bank Financing (IDA): 8,100,000,000.00 Nov 25, 2020 Page 3 of 24 Official Use The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) of which other financing sources: 0.00 PROJECT FINANCING DATA – ADDITIONAL FINANCING (Additional Financing for Rwanda COVID-19 Emergency Response Project - P175252) PROJECT FINANCING DATA (US$, Millions) SUMMARY -NewFi n1 SUMMARY (Total Financing) Proposed Additional Total Proposed Current Financing Financing Financing Total Project Cost 14.25 0.94 15.19 Total Financing 14.25 0.94 15.19 Financing Gap 0.00 0.00 0.00 DETAILS - Additional Financing NewFinEnh1 Non-World Bank Group Financing Trust Funds 0.94 Pandemic Emergency Financing Facility 0.94 COMPLIANCE Policy Does the project depart from the CPF in content or in other significant respects? [ ] Yes [ ✔ ] No Does the project require any other Policy waiver(s)? [ ] Yes [ ✔ ] No Nov 25, 2020 Page 4 of 24 Official Use The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) ESStandards Environmental and Social Standards Relevance Given its Context at the Time of Appraisal E & S Standards Relevance Assessment and Management of Environmental and Social Risks and Impacts Relevant Stakeholder Engagement and Information Disclosure Relevant Labor and Working Conditions Relevant Resource Efficiency and Pollution Prevention and Management Relevant Community Health and Safety Relevant Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Not Currently Relevant Biodiversity Conservation and Sustainable Management of Living Natural Not Currently Relevant Resources Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Not Currently Relevant Local Communities Cultural Heritage Not Currently Relevant Financial Intermediaries Not Currently Relevant ESStandardsNote NOTE: For further information regarding the World Bank’s due diligence assessment of the Project’s potential environmental and social risks and impacts, please refer to the Project’s Appraisal Environmental and Social Review Summary (ESRS). INSTITUTIONAL DATA Practice Area (Lead) Health, Nutrition & Population Contributing Practice Areas PROJECT TEAM Bank Staff Name Role Specialization Unit Team Leader (ADM Miriam Schneidman HAEH1 Responsible) Nov 25, 2020 Page 5 of 24 Official Use The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) Naoko Ohno Team Leader HAEH2 Procurement Specialist (ADM Mulugeta Dinka EAERU Responsible) Financial Management Mkombozi Bosco Karake EAEG1 Specialist (ADM Responsible) Social Specialist (ADM George Bob Nkulanga SAES2 Responsible) Environmental Specialist (ADM Svetlana Khvostova SAEE2 Responsible) Beth Anne Hoffman Counsel LEGKL Blanca Ximena Talero Counsel LEGAS Dimitrie Mukanyiligira Sissi Procurement Team AEMRW Hilari Asasira Counsel LEGAM Jean O Owino Team Member WFACS Nancy Umwiza Team Member AEMRW Patrice Mwitende Team Member HAEH2 Raykhona Atakhodjaeva Team Member HAEH2 Rogers Kayihura Team Member ECRAE Ruxandra Maria Floroiu Team Member SAEE2 Sujani Eli Team Member HAEH2 Tamru Demsis Temam Environmental Specialist SAEE2 Wilson Muyenzi Team Member IDD04 Extended Team Name Title Organization Location Nov 25, 2020 Page 6 of 24 Official Use The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) I. BACKGROUND AND RATIONALE FOR ADDITIONAL FINANCING 1. The Additional Financing (AF) is being made available under the Pandemic Emergency Financing Facility (PEF). The PEF was launched in 2016 in response to the 2014 Ebola crisis in West Africa which highlighted the difficulty in rapidly mobilizing funding from the international community to contain a pandemic outbreak. PEF is housed at the World Bank and provides an additional source of financing to the world’s poorest countries when they face cross-border, large-scale outbreaks. The PEF financing consists of funding provided by Australia, Germany, International Development Association (IDA), and Japan as well as insurance coverage provided in 2017 through catastrophe bonds issued by the World Bank and sold to capital market investors as well as insurance-linked swaps executed by the World Bank with insurance companies. 2. The PEF was activated based on the COVID-19 1 pandemic which was declared by the World Health Organization a Public Health Emergency of International Concern (PHEIC) on January 30, 2020. COVID-19 is one of the viruses covered by the PEF insurance window. As per the PEF committee report of April 17, 2020, all PEF activation criteria including outbreak size, spread and growth were met on March 31, 2020. 3. The PEF Steering Body met on April 27, 2020 and determined the allocation of the PEF funds. The entire amount of US$195.84 million available under PEF for the COVID-19 response being allocated to 64 of the world’s lowest income countries that are members of the World Bank’s International Development Association with reported cases of COVID-19 (as on April 22, 2020). Specific funding allocations were determined by population size and reported cases, with a minimum of US$1 million and maximum of US$15 million going to each country, and a heavier weight given to countries classified as fragile or conflict-affected. 4. An allocation of US$1.0 million is being made available to Rwanda. All countries were informed of these allocations which included a US$1.0 million allocation for Rwanda which results in an Additional Financing of US$942,857 after deducting the World Bank administrative fees. The PEF country payout must be utilized by the country by April 30, 2021. In this context, the World Bank agreed with the Government of Rwanda that AF to the ongoing parent project Rwanda COVID-19 Emergency Response Project (P173855) is the fastest and most efficient way to enable Rwanda to benefit from the available resources. 5. The Rwanda COVID-19 Emergency Response Project, valued at US$14.25 million equivalent was approved by the RVP on April 7, 2020 and became effective on April 20, 2020. The parent project is part of the global COVID-19 Multiphase Programmatic Approach (MPA; P173789). The original MPA was approved by the World Bank’s Board of Executive Directors on April 2, 2020 with an overall Program financing envelope of International Development Association (IDA) US$1.3 billion and of International Bank for Reconstruction and Development (IBRD) US$2.7 billion. The original MPA included 87 participating countries. The parent project’s Project Development Objective (PDO) is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Rwanda. Specific objectives are as follows: (i) strengthen case detection and confirmation and conduct contact 1 Coronavirus Disease 2019 (COVID-19) Nov 25, 2020 Page 7 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) tracing; (ii) improve clinical care capacity; (iii) raise public awareness and promote community engagement; and (iv) bolster coordination, planning, logistical support, and reporting. The parent project is supporting roughtly 20 percent of the Government’s COVID-19 National Preparedness and Response Plan issued in March 2020 2, which focuses on: (i) testing high-risk groups; (ii) establishing laboratory capacity at decentralized levels to ensure equitable access; (iii) providing free services, given the public good nature of interventions and ensuring the poor and vulnerable do not face financial barriers; and (iv) raising public awareness to maintain confidence and ensure strict adherence to public health measures. The World Bank is one of the main donors supporting Rwanda’s COVID-19 response. The Government has made a substantial financial commitment (i.e. budget of about US$24.0 million) and many other development partners including UN agencies, the Global Fund, Gavi, bilateral donors (USA, Belgiun, France, China, Korea, EU, UAE, Qatar, Brazil and Egypt), private sector, and faith based organizations (FBOs) and NGOs are providing financial and in kind support. 6. The parent project has been under implementation for seven months, and its implementation status is satisfactory. As of November 24, 2020, 89.6 percent (US$12.76 million) of the total amount of US$14.25 million has been disbursed. This rapid disbursement was partly made possible because of the increase of the threshold for retroactive financing from 40 to 60 percent for emergency operations. Both Project Development Objective (PDO) and overall Implementation Progress (IP) have been rated Satisfactory since the commencement of implementation. The Government of Rwanda is presently in compliance with all applicable key legal covenants under the Financing Agreement with some inevitable delays in safeguards that have now been rectified. 7. The project supports the national response which has been strong with the: (i) swift introduction of lock down policies which were adapted/amended over time through limited lockdowns in hot spot areas to minimize the impact on the poor and vulnerable; (ii) establishment of a COVID-19 Command Post of 400 multi-disciplinary experts tracking and coordinating the pandemic and supporting contact tracing; (iii) roll out of a comprehensive, ambitious and well targeted testing, tracing and treatment strategy with the total number of monthly tests increasing from about 9,000 in March to over 611,600 tests on November 24, 2020; and (iv) designation of quarantine, isolation and treatment centers which are now operational. To date, Rwanda has established 12 functional laboratories for COVID-19 testing, and since August 2020, the Home-Based Care (HBC) strategy is being implemented countrywide for asymptomatic and simple cases. There are currently 8 treatment centers with 770 beds in total, including 26 ICU beds 3. As of November 24, Rwanda has successfully contained transmission with a total of 5,750 cases; only 47 fatalities; and a positivity rate of 1 percent, one of the lowest on the continent and well below the 5 percent WHO recommendation. Beside the swift health response, the Government also promptly mounted an economic and social protection response. On April 30, 2020 the Rwandan Cabinet approved the Economic Recovery Plan, covering the period May 2020-December 2021. The plan makes the case for required key interventions across sectors that would provide support to households and boost employment and growth towards recovery. 8. Despite the swift health sector response, the economic and social repercussions of the COVID- 19 crisis are likely to be severe and are being partly addressed through the government supported social protection program. Since the early-2000s Rwanda’s growth in Gross Domestic Product (GDP) per capita 2 An updated plan for December 2020 to June 2021 is under development. 3 The number and location of treatment centers and beds are dynamic depending on the evolution of cases. Nov 25, 2020 Page 8 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) has averaged 5 percent per year, second on the continent only to Ethiopia. However, the medium-term outlook for Rwanda has worsened considerably due to the impact of COVID-19. Real GDP growth in 2020 is projected at about 2 percent – a 5.5 percentage point decline compared to the pre-COVID projection. The COVID-19 crisis is also likely to lead to a further deterioration in Rwanda’s fiscal position. The budget execution report of FY2019/20 indicates that a 6.1 percent shortfall in domestic revenues in FY2019/20, compared to the revised budget prior-COVID-19. This, coupled with the need to increase expenditures to provide health services and support household incomes, imply that the overall deficit would be 10.5 percent of GDP in 2020, around 2.5 percentage points of GDP higher than in the previous year (International Monetary Fund, 2020). 9. The new Rwanda Country Partnership Framework (CPF) for FY2021-26 (Report No. 148876‐ RW), which was recently completed, continues to prioritize improving human capital as one of five CPF objectives for poverty reduction and inclusive growth. A healthy, well‐educated and skilled labor force is essential to Rwanda’s future prospects, and the contribution of the WB’s ongoing COVID-19 response is well recognized in the CPF for protecting Rwanda’s human capital. II. DESCRIPTION OF ADDITIONAL FINANCING 10. The AF is being processed to take advantage of the PEF resources through the IDA-financed parent project. The modest PEF country payout for Rwanda in the amount of US$942,857 will be prioritized for testing and tracing in order to consolidate achievements and support the Government to further contain the pandemic. In addition, a beneficiary feedback indicator will be added to the Results Framework, to comply with this new corporate requirement. No other changes are being introduced as part of the AF processing. The safeguards instruments that were developed for the parent project, in compliance with the Environmental and Social Framework (ESF), will also apply to the proposed AF. 11. World Bank procedures require that AF is processed for projects that have been under implementation for at least 12 months, while the parent project does not meet this criterion having been under implementation for just over six months. The RVP approval of the exception was received on August 26, 2020. The task team also sought the approval on the use of condensed project preparation procedures under paragraph 12 of Section III of the IPF Policy apply to the proposed AF. The parent project was processed using the condensed procedures under paragraph 12, due to the emergency nature of COVID- 19 response. 12. The full PEF allocation for Rwanda will be added to Component 1 of the IDA-financed parent project. As per the request from the Government of Rwanda, the PEF country payout of US$942,857 will be allocated for the procurement of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) test kits under Component 1. In order to remain vigilant and manage intermittent increases in new COVID-19 cases and continue to flatten the curve, the Government identified the need to continually enhance the country’s laboratory testing capacity. 13. The Table below shows the revised project cost by component/sub-component of the parent project. Nov 25, 2020 Page 9 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) Table: Revised Project Costs by Component and Sub-Component (US$ millions) IDA PEF AF Sub-total % of Total Project Components and Activities Financing (P175252) (P173855) Component 1: Case Detection, Confirmation and 5.9 0.94 6.84 45.0 Contact Tracing -Disease Surveillance, RRTs and case investigation 2.2 0.00 -Laboratory Capacity and Specimen Transport 2.8 0.94 -Points of Entry 0.9 0.00 Component 2: Public Health Measures and Clinical 8.0 0.00 8.00 52.6 Care Capacity -Risk Communication and Community Engagement 0.4 -Case management/specialized units/lab capacity 5.8 -Infection Prevention and Control 1.8 Component 3: Program/Project Management and 0.35 0.00 0.35 2.3 M&E -Country level coordination, planning, and monitoring 0.20 -Project Management 0.15 Total Costs 14.25 0.94 15.19 100.0 Modifying the Results Framework 14. The project results framework has been restructured to include one beneficiary feedback indicator to comply with this new corporate requirement on citizen engagement in the project. The following indicator has been added as one of the project’s intermediate results indicator: Percentage of grievances documented, processed and resolved within 30 days. 15. Furthermore, it is proposed to add one intermediate results indicator to monitor total tests performed by the Government, disaggregated by gender. This indicator will help to track the performance of the program in reaching those most affected by COVID-19. III. KEY RISKS 16. The key risks related to this AF are the same risks identified for the parent project for which mitigation measures have been put in place. Several substantial risks to the project were identified during preparation of the parent project, including (i) adverse effects on the macroeconomic and fiscal situation of the Government of Rwanda stemming from COVID-19; (ii) health sector institutional capacity, which can be overwhelmed if there is a surge in the number of new cases or more widespread local transmission; and (iii) fiduciary concerns, including procurement related problems, stemming from potential difficulties in procuring critical equipment given the disruptions in global supply chains, and (iv) environmental related concerns. The table below identifies the main risks, proposes mitigation measures, and notes the residual Nov 25, 2020 Page 10 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) risks. Based on the assessment of these important risks, which stem in large part from the heavily constrained global supply chain, the overall risk of the proposed AF as well as the parent project remains Substantial. To date, even though there have been several localized surges in COVID-19 cases, the government has skillfully managed these through appropriate measures. Main Risks Mitigation Measures Risk Rating Macroeconomic: -The health sector project would partly Substantial Reduction in fiscal capacity of government due mitigate this risk by supporting critical public to global economic disruption and slowdown, health programs, in addition to the COVID-19 and potential decline in fiscal revenues, given response and mitigation efforts. expected downturn in aviation, tourism and conferences. The resulting fiscal constraints -A budgetary support operation under could negatively impact public health service discussion will partly mitigate the economic delivery with respect to COVID-19 prevention, fallout from the coronavirus outbreak in mitigation, and treatment, in addition to other Rwanda. essential health services. Health sector institutional capacity for -The government put in place a national lock Substantial implementation and sustainability: down policy early in the pandemic’s The severity and unpredictability of the trajectory and adopted stringent, mandatory coronavirus global pandemic poses potential social distancing policies and has continued high risks to Rwanda, both in terms of its to monitor and enforce these measures, ability to respond swiftly to a rapid rise in the including dealing promptly with localized number of reported cases as well as to sustain outbreaks. other critical health services, particularly if there is transmission to high-density rural -The project will support interventions to areas. conduct risk assessments and conduct epidemiological surveillance, to facilitate Lack of predictable financing for COVID-19 and rapid responses. other disease outbreaks -The project will fund operational costs (including recruitment of additional personnel), while the Rwanda: Human Capital for inclusive growth Development Policy Operation(P171554) will include policy measures to strengthen the availability of human resources for health and address chronic understaffing in the health sector. -Further work is needed to mobilize domestic resources for disease outbreak response and preparedness and to mainstream these interventions in the government’s budget. Fiduciary: -World Bank to continue providing Bank Substantial Lack of enough global supply of critical Facilitated Procurement (BFP) to facilitate equipment and supplies given significant the Borrower’s access to available supplies, disruptions in supply chains delineating clearly the roles of all parties to avoid perception of conflict of interest. Nov 25, 2020 Page 11 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) Environmental and Social: - The revised ESMF covers the procedures Substantial Increased medical waste due to testing and for the safe handling, storage, and treatment of COVID-19 cases will generate processing of COVID-19 materials including biological waste and hazardous biproducts. the relevant guidance (e.g. Infection Inadequate adherence to occupational health Control and Waste Management Plan) and and safety standards can lead to illness and techniques for preventing, minimizing, and death among healthcare workers. The facilities controlling environmental and social to be supported by the project may cause the impacts. potential harm to the laboratory staff and to - The ESMF also includes LMP that identifies the community to cause serious illness risks. key labor risks with respect to COVID-19 with reference to ILO and WHO guidelines for Occupational Health and Safety. IV. APPRAISAL SUMMARY A. Technical, Economic, and Financial Analysis 17. Similar to the parent project, the proposed AF is based on a strong economic rationale for investing in communicable disease control and for public provision of these services, as preventing and controlling disease outbreaks generates large and lasting economic benefits. Disease outbreaks can deter tourists and investors; cause severe economic shocks, including loss of jobs, drops in productivity and economic growth; and inflict lasting damage on stocks of both human and physical capital leading to drops in economic productivity and slowing long-term growth (United Nations Development Programme, 2014). The ongoing COVID-19 global pandemic is a stark reminder of the astronomical human and economic costs associated with pandemics which can throw the global economy into a recession as seen during the past year. The proposed investments under the AF are public goods because of inherent market failures, underscoring the important role of the public sector. 18. The AF contributes to the parent project’s focus on best buy interventions and evidence-based approaches to disease outbreak preparedness and response and incorporates lessons learned from the national, regional and global level. Key lessons learned from the implementation of the East Africa Public Health Laboratory Networking Project (P111556) have been incorporated into the parent project’s design and continue to apply to the AF. The design has been also guided by best practice in terms of the minimum package of interventions that countries should strive to attain for a comprehensive approach in line with the WHO guidelines. Strong and rapidly deployed Rapid Response Teams which are well trained can swiftly detect cases; well-equipped and staffed laboratories can ensure rapid and accurate confirmation of cases; and well trained and adequately protected clinical staff can triage and treat urgent cases. The proposed set of interventions will enable teams to respond quickly and reliably to COVID-19 and other public health threats, reducing the risk of transmission, and assisting health care providers to deal more efficiently with patients, ultimately reducing morbidity and mortality. B. Financial Management 19. The AF will utilize the same Financial Management (FM) arrangements in place for the parent project, which leverages the existing FM and disbursement arrangements of the ongoing Stunting Nov 25, 2020 Page 12 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) Prevention and Reduction Project (SPRP; P164845) for its implementation. The implementing agency of the SPRP and the COVID-19 parent project is the Single Project Implementation Unit (SPIU) of the Rwanda Biomedical Center (RBC), which has a good track record in handling fiduciary matters according to the World Bank guidelines. The AF will continue to rely on the existing fiduciary and disbursement arrangements and capacity at the RBC/SPIU. 20. The project includes several potential FM risks. Key potential risks include confirmation of delivery of the right quality and quantity of medical supplies and equipment; possibility of payments being made for substandard products or outputs or unintended beneficiaries. In addition, potential fund flow delays could impact delivery of key interventions under this emergency operation. There could also be challenges of project supervision as well as delayed Interim Financial Reports (IFRs) and audit reports due to government-implemented measures to contain the spread of COVID-19. To address these risks, the project will rely on the country-level internal control framework established under the ongoing SPRP. This includes confirmation of delivery of the right quantity and quality of medical supplies and equipment and certification of services rendered before payment. Payments will be made to beneficiaries’ bank accounts to mitigate the risk of loss or diversion of funds. The fund flow arrangements include flexibility of direct disbursement to suppliers and contractors to mitigate the risks associated with holding funds in the Designated Account. As much as possible, direct payments will be used to facilitate efficient implementation of the emergency operation and mitigate potential fiduciary risks. The World Bank has continued to closely monitor the project and provide appropriate FM support in response to the evolving COVID-19 crisis. To date, these risks have been well managed and no major financial management issues have arisen. The residual project FM risk is assessed as Moderate. The implementation of the mitigation measures will be reviewed continuously during implementation, and the FM risk will be reassessed as part of the continuous implementation support to the project. C. Procurement 21. The AF will utilize the same procurement arrangements in place for the parent project. Procurement implementation will be undertaken by the SPIU of the RBC. 22. Procurement under the project will be carried out in accordance with the World Bank’s Procurement Regulations for IPF Borrowers for Goods, Works, Non-Consulting and Consulting Services, dated July 1, 2016 (revised in November 2017 and August 2018). The project will be subject to the World Bank’s Anticorruption Guidelines, dated October 15, 2006, revised in January 2011, and as of July 1, 2016. The country will use the Systematic tracking of Exchanges in Procurement (STEP) to plan, record and track procurement transactions. 23. The major planned procurement under the parent project includes: (i) medical/laboratory equipment and consumables, (ii) personal protective equipment, (iii) clinical and waste management equipment, (iv) minor rehabilitation and equipment of health facilities, (v) technical assistance, and (vi) human resources for response. Finalization of the streamlined project procurement strategy for development (PPSD) was deferred to implementation and has now been completed. An initial procurement plan for the first three months was agreed with the borrower and has been continuously updated since project inception. Nov 25, 2020 Page 13 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) 24. Country procurement approaches utilize the flexibility provided by the Bank’s Procurement Framework for fast track emergency procurement by the countries. Key measures to fast track procurement include: (i) use of simple and fast procurement and selection methods fit for an emergency situation including direct contracting, as appropriate, (ii) streamlined competitive procedures with shorter bidding time, (iii) use of framework agreements including existing ones, (iv) procurement from UN Agencies enabled and expedited by Bank procedures and templates, (v) use of procurement agents, (vi) force account, as needed, and (vii) increased thresholds for Requests For Quotations s and national procurement, among others. 25. Rwanda may be significantly constrained in purchasing critically needed supplies and materials due to significant disruption in the global supply chain, especially for Personal Protection Equipment. The supply problems that have initially impacted PPE have occasionally emerged for other medical products but on balance the government has managed these potential disruptions well. 26. In addition to the above country procurement approach options available to countries, the World Bank is providing, at borrowers’ request, Bank Facilitated Procurement (BFP) to proactively assist clients to access existing supply chains. The BFP constitutes additional support to Borrowers over and above usual Hands on Expanded Implementation Support which will remain available. If needed, the World Bank could also provide hands-on support in contracting to outsource logistics. To date, the World Bank has made a series of BFP offers available to the government. 27. All the procurement approach options mentioned above remain available depending on Rwanda’s preference in order to provide the most efficient and effective support in securing these goods and services. 28. Procurement Risks. Procurement capacity and risk assessment was originally carried out by the World Bank for the RBC to review the organizational structure and capacity for implementing the project and remains valid. The agency has adequate experience in implementation of similar procurements. In addition, there are adequate number of experienced procurement staff at the SPIU/RBC. The key procurement risk is failed procurement by countries due to lack of enough global supply of essential medical consumables and equipment needed to address the health emergency, given the significant disruptions in the global supply chain, especially for PPE. All these factors could lead to difficulties and delays in meeting tight deadlines but in practice RBC with use of Rwandan embassies in suppler countries and using suppliers lists shared by World Bank from time to time has proven to have overcome the risks. The Procurement Risk Assessment and Management System (PRAMS) at implementation has been done on September 10, 2020 and based on the assessment and taking note of the factors noted above, the procurement risk rating remains Substantial. Nov 25, 2020 Page 14 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) D. Legal Operational Policies . Triggered? Projects on International Waterways OP 7.50 No Projects in Disputed Areas OP 7.60 No . E. Environmental and Social 29. The environmental and social assessment conducted for the parent project applies to the AF. The parent project was prepared under the ESF and benefited from the ESF Guidance for COVID-19 response which allowed the preparation of Environmental and Social (ES) instruments during project implementation, but prior to works and main activities commencement. The ES documents are being finalized. Consultations were completed on October 16, 2020, which will be followed by the World Bank clearance, which is expected shortly, and final public disclosure of the Environmental and Social Management Framework (ESMF)/ Infection Control and Waste Management Plan (ICWMP) in late November 2020. 30. Although this project is expected to have positive outcomes as it could improve COVID-19 surveillance, monitoring and containment, there are also potential environmental and social risks associated with the project financed activities. The main environmental and social risks and impacts of the project may result from Component -1 which will finance among other things medical supplies and equipment (e.g. thermo scanners; test kits; drugs; lab equipment and supplies, personal protective equipment) and Component 2 which will also fund medical and laboratory equipment and supplies as well as minor civil works (rehabilitate/adapt existing structures). Besides, the project will support the establishment of isolation centers (national and district hospitals which would be responsible for triaging and treating COVID-19 cases) which can have potential environmental and social risks if not well managed. 31. The project could have substantial environmental, health and safety risks due to the dangerous nature of the pathogen (COVID-19) and reagents to be used in project-supported facilities. Infections due to inadequate adherence to occupational health and safety standards can lead to illness and death among healthcare workers. The laboratories which will be used for COVID-19 diagnostic testing can generate biological waste, chemical waste, and other hazardous biproducts. As the facilities to be supported by the project will process COVID-19 that can have the potential to cause serious illness or potentially lethal harm to the laboratory staff and to the community, effective administrative and containment controls should be put in place so minimize these risks. There are also occupational health and safety risks associated with the rehabilitation of medical facilities/minor civil works to be financed by the project. Wastes from the rehabilitation of medical centers could cause considerable environmental and social risks if not properly managed. 32. Environmentally and socially sound medical laboratory operations will require adequate provisions for minimization of occupational health and safety risks, proper management and disposal of hazardous waste (including sharps disposal), use of approved disinfectants, proper quarantine procedure for COVID-19, appropriate chemical and infectious substance handling and transportation procedures, Nov 25, 2020 Page 15 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) and appropriate institutional/implementation arrangements for environmental and social risks. Moreover, the ES impacts of rehabilitation should be properly identified and managed. To proactively address potential environmental and social risks and impacts, the Rwanda Ministry of Health prepared an ESMF. The ESMF developed under the original project will apply to the AF activity which is a part of the parent project. The virtual consultations on the ESMF were completed on October 16, 2020. Medical facilities/isolation centers which receive the project financed laboratory supplies and equipment have been prepared site-specific infection control and waste management plans. 33. The ESMF covers the procedures for the safe handling, storage, and processing of COVID-19 materials including the techniques for preventing, minimizing, and controlling environmental and social impacts during the operation of project supported laboratories. The ESMF includes Labor Management Procedures (LMP) that identifies key labor risks with respect to COVID-19 by labor category and respective mitigation measures in reference to ILO and WHO guidelines for Occupational Health and Safety. The ESMF also provides as Grievance Redress Mechanism (GRM) that is based on the country’s home-grown legal provisions for crime prevention with special attention to gender-based violence (GBV), sexual exploitation and abuse (SEA) as well as conflict resolution and management. The ESMF also includes procedures to be followed in managing ES risks of health facility rehabilitation as well as the implementation arrangements for environmental and social risk management; training programs focused on COVID-19 laboratory biosafety, operation of isolation centers and screening posts, as well as compliance monitoring and reporting requirements. WHO COVID-19 biosafety guidelines were reviewed while preparing the ESMF so that all relevant risks and mitigation measures will be covered. In addition to the ESMF, the client prepared an Environmental and Social Commitment Plan (ESCP) and Stakeholders Engagement Plan (SEP), which were disclosed on November 9, 2020 on the World Bank external site and on the RBC website and allocated the resources necessary for implementation of the ESCP and the SEP in the parent project. 34. As a result of lack of resources to prepare and protect against COVID-19, the poor face a higher risk of contracting and subsequently spreading the virus. Informal sector workers, like street vendors, construction workers, and those in low-income jobs or in jobs that cannot be performed remotely, are most vulnerable, as these people often have no savings to weather the storm, and even stocking up on food can represent an impossible financial hurdle. The harm inflicted on especially urban poor and many women heads of households, is likely to be devastating. In informal urban settlements, families occupy cramped informal dwellings, and just barely survive by peddling goods in the city, work that is now banished to stop contagion. Men tend to work as day laborers, pulling trolleys of goods to the bazaar, and are now out of work, as trade is curtailed. 35. Amidst all these turbulent times, the Government will engage all stakeholders in an efficient and effective way. The client has prepared a SEP that will be followed with including the AF, that outlines the stakeholder’s engagement strategies for this project. To ensure effective communication WHO has developed the Risk Communication and Community Engagement (RCCE) readiness and response to the COVID-19 to guide governments. To support these efforts, the project has included Component 2 on RCCE, encompassing behavioral and sociocultural risk factor assessments, production of communication materials, media and community engagement, and documentation in line with WHO “Pillar 2: Risk communication and community engagement.” The approaches taken will thereby ensure that information Nov 25, 2020 Page 16 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) is meaningful, timely, and accessible to all affected stakeholders, including use of materials in the local language, addressing cultural sensitivities, as well as challenges deriving from illiteracy or disabilities. 36. The overall project SEP outlines a structured approach to engagement with stakeholders that is based upon meaningful consultation and disclosure of appropriate information, considering the specific challenges associated with COVID-19. In cases of the most vulnerable – the elderly and those with compromised immune systems due to pre-existing conditions, stakeholder engagement will minimize close contact and follow the recommended hygiene procedures as outlined in the Center for Disease Control (CDC) Interim Infection Prevention and Control Recommendations for patients with confirmed COVID-19 or persons under investigation for COVID-19 in healthcare settings. People affected by project activities, including construction workers at health facilities, will be provided with accessible and inclusive means to raise concerns and grievances. The project SEP includes a GRM to assist to resolve complaints and grievances that may emerge in a timely, effective and efficient manner and that satisfies all parties involved in the project. Grievances will continue to be handled at Health Care Facilities (HCFs) by established and operational Health and Safety Committees under the supervision of the MoH Health Facility Specialist at national level. The Health and Safety Committees implement the GRM with the facilitation of the project’s Social Specialist. The Social Specialist ensures that Contractors maintain a grievance register (Incident Reporting Form)” at the project activity sites. Contractors are required to record any grievance in the grievance register/incident form and forward the information to the Health and Safety Committee at the HCF where there are parent project activities. In case of incidents of GBV, the GRM provides that complaints are directed to the country’s Isange One Stop Center (IOSC), a specialized free-of-charge referral center where survivors of GBV can find comprehensive services such as: medical care; psychosocial support; police and legal support, and collection of legal evidence. IOSC works closely with police stations and local governance structures at sector, cell and village levels, hospitals and health centers. V. WORLD BANK GRIEVANCE REDRESS 37. Communities and individuals who believe that they are adversely affected by a World Bank (WB) supported project may submit complaints to existing project-level grievance redress mechanisms or the WB’s Grievance Redress Service (GRS). The GRS ensures that complaints received are promptly reviewed in order to address project-related concerns. Project affected communities and individuals may submit their complaint to the WB’s independent Inspection Panel which determines whether harm occurred, or could occur, as a result of WB non-compliance with its policies and procedures. Complaints may be submitted at any time after concerns have been brought directly to the World Bank's attention, and Bank Management has been given an opportunity to respond. For information on how to submit complaints to the World Bank’s corporate Grievance Redress Service (GRS), please visit http://www.worldbank.org/en/projects-operations/products-and-services/grievance-redress-service. For information on how to submit complaints to the World Bank Inspection Panel, please visit www.inspectionpanel.org Nov 25, 2020 Page 17 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) VI SUMMARY TABLE OF CHANGES Changed Not Changed Results Framework ✔ Components and Cost ✔ Implementing Agency ✔ Project's Development Objectives ✔ Loan Closing Date(s) ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ VII DETAILED CHANGE(S) MPA PROGRAM DEVELOPMENT OBJECTIVE Current MPA Program Development Objective Proposed New MPA Program Development Objective Nov 25, 2020 Page 18 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) EXPECTED MPA PROGRAM RESULTS Current Expected MPA Results and their Indicators for the MPA Program Proposed Expected MPA Results and their Indicators for the MPA Program COMPONENTS Current Component Name Current Cost Action Proposed Component Proposed Cost (US$, (US$, millions) Name millions) Component 1. Case 5,900,000.00 Revised Component 1. Case 6,840,000.00 Detection, Confirmation and Detection, Confirmation Contact Tracing and Contact Tracing Component 2: Public Health 8,000,000.00 No Change Component 2: Public 8,000,000.00 Measures and Clinical Care Health Measures and Capacity Clinical Care Capacity Component 3. 350,000.00 No Change Component 3. 350,000.00 Implementation Implementation Management and Management and Monitoring and Evaluation Monitoring and Evaluation Component 4. Contingency 0.00 No Change Component 4. 0.00 Emergency Response Contingency Emergency Component (CERC) Response Component (CERC) TOTAL 14,250,000.00 15,190,000.00 Expected Disbursements (in US$) DISBURSTBL Fiscal Year Annual Cumulative 2020 7,998,119.00 7,998,119.00 2021 6,942,857.00 14,940,976.00 2022 249,024.00 15,190,000.00 SYSTEMATIC OPERATIONS RISK-RATING TOOL (SORT) Risk Category Latest ISR Rating Current Rating Political and Governance  Low  Low Nov 25, 2020 Page 19 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) Macroeconomic  Substantial  Substantial Sector Strategies and Policies  Moderate  Moderate Technical Design of Project or Program  Moderate  Moderate Institutional Capacity for Implementation and  Substantial  Substantial Sustainability Fiduciary  Substantial  Substantial Environment and Social  Substantial  Substantial Stakeholders  Moderate  Moderate Other Overall  Substantial  Substantial LEGAL COVENANTS2 LEGAL COVENANTS – Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) Sections and Description Schedule 2., Section 1., B. 1. (a) (i) No later than ninety (90) days after the Effective Date, the Recipient shall update the project implementation manual containing detailed arrangements and procedures for implementation of the Project. Schedule 2., Section 1., B. 2. (a) The Recipient shall no later than ninety (90) days after the Effective Date: (i) prepare and furnish to the Bank a proposed work plan and budget for Project implementation, (ii) taking into account the Bank’s comments, finalize the plan and furnish it to Bank for its approval; and (iii) adopt the plan as shall have been approved by the Bank. Conditions Nov 25, 2020 Page 20 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) VIII. RESULTS FRAMEWORK AND MONITORING Results Framework COUNTRY: Rwanda RESULT NO PDO Additional Financing for Rwanda COVID-19 Emergency Response Project Project Development Objective(s) The objective of the Project is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in the Republic of Rwanda. Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_ PD O Indicator Name PBC Baseline End Target Prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems Proportion of suspected cases of COVID-19 reported and 80.00 100.00 investigated based on national guidelines (Percentage) Number of designated laboratories with COVID-19 diagnostic capacity (Number) 1.00 4.00 Proportion of designated healthcare facilities with isolation 20.00 100.00 capacity (Percentage) PDO Table SPACE Intermediate Results Indicators by Components RESULT_FRAME_TBL_ IO Indicator Name PBC Baseline End Target Component 1: Case Detection, Confirmation and Contact Tracing Nov 25, 2020 Page 21 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) RESULT_FRAME_TBL_ IO Indicator Name PBC Baseline End Target Number of laboratory staff trained to conduct COVID-19 0.00 50.00 diagnosis (Number) Percentage of grievances documented, processed and resolved 0.00 100.00 within 30 days (Percentage) Rationale: Action: This indicator is New Beneficiary feedback indicator as part of the corporate requirement on citizens engagement Total tests performed by the Government facilities, 0.00 0.00 disaggregated by gender (Number) Rationale: It is to monitor total tests performed by the Government, disaggregated by gender. This indicator will help to track the Action: This indicator is New performance of the program in reaching those most affected by COVID-19. Time response to COVID-19 Proportion of targeted healthcare facilities with clinical capacity 20.00 100.00 for COVID-19 patients (Percentage) Number of health staff trained in infection prevention and control (Number) 20.00 145.00 IO Table SPACE Monitoring & Evaluation Plan: PDO Indicators Mapped Methodology for Data Responsibility for Data Indicator Name Definition/Description Frequency Datasource Collection Collection Proportion of suspected cases of COVID- 19 reported and investigated based on national guidelines Nov 25, 2020 Page 22 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) Number of designated laboratories with COVID-19 diagnostic capacity Proportion of designated healthcare facilities with isolation capacity ME PDO Table SPACE Monitoring & Evaluation Plan: Intermediate Results Indicators Mapped Methodology for Data Responsibility for Data Indicator Name Definition/Description Frequency Datasource Collection Collection Number of laboratory staff trained to conduct COVID-19 diagnosis Percentage of grievances documented, processed and resolved within 30 days Total tests performed by the Government facilities, disaggregated by gender Proportion of targeted healthcare facilities with clinical capacity for COVID- 19 patients Number of health staff trained in infection prevention and control ME IO Table SPACE Nov 25, 2020 Page 23 of 24 The World Bank Additional Financing for Rwanda COVID-19 Emergency Response Project (P175252) Nov 25, 2020 Page 24 of 24