The World Bank Mongolia PEF support for COVID-19 Project Information Document/ Identification/Concept Stage (PID) Public Disclosure Copy Concept Stage | Date Prepared/Updated: 04-Aug-2020 | Report No: PIDC227353 Aug 04, 2020 Page 1 of 8 The World Bank Mongolia PEF support for COVID-19 BASIC INFORMATION A. Basic Project Data Environmental and Project ID Parent Project ID (if any) Social Risk Project Name Classification Substantial Mongolia PEF support for P174571 COVID-19 Region Country Date PID Prepared Estimated Date of Approval EAST ASIA AND PACIFIC Mongolia 04-Aug-2020 Financing Instrument Borrower(s) Implementing Agency Investment Project Mongolia Ministry of Public Disclosure Copy Mongolia Financing Health PROJECT FINANCING DATA (US$, Millions) SUMMARY -NewFin1 Total Project Cost 1.00 Total Financing 1.00 Financing Gap 0.00 DETAILS -NewFinEnh1 Non-World Bank Group Financing Trust Funds 1.00 Pandemic Emergency Financing Facility 1.00 B. Introduction and Context Country Context Mongolia has made important progress on economic and social development over the past three decades, but key vulnerabilities remain. Fueled by the mining sector, its economy has expanded significantly. With improved living standards, strong results on human development have been achieved. Mongolia’s upcoming graduation from IDA is a sign of confidence in Mongolia’s development trajectory and reaffirms its middle- income country status. To fulfill its potential, Mongolia needs to address unstable economic growth, population well being at risk, and growing environmental stress. Aug 04, 2020 Page 2 of 8 The World Bank Mongolia PEF support for COVID-19 Mongolia’s economy was recovering strongly from the economic crisis started in 2016, but now is expected to be significantly impacted by the COVID-19 outbreak. Faced with the potential public health and economic impact, the population, especially the vulnerable and the poor will need to be protected. Even before the COVID-19 outbreak, at 28.4 percent in 2018, poverty remains high in Mongolia, with stagnating poverty rates in urban areas. While herders and rural workers have benefited from high meat prices, the robust economic performance of mining and manufacturing has not translated into sufficient income opportunities for the majority of the urban population. During previous periods of adverse economic conditions, Mongolia has seen weakened human development growth. For example, between 2014 and 2016, the poverty rate in Mongolia climbed back to 29.6 percent with only 35.3 percent of households found to be food secure and 50.2 percent experiencing moderate or severe food insecurity. Protecting the poor and vulnerability is the face of a potential crisis is therefore critical. Public Disclosure Copy Sectoral and Institutional Context COVID-19 pandemic is the defining global health crisis of our time and possibly the greatest challenge we have faced since World War Two. Since its emergence in Asia late last year, the virus has spread to every continent except Antarctica. On March 11, 2020, the World Health Organization (WHO) declared a global pandemic as the coronavirus rapidly spreads across the world. Cases are rising daily in Africa, the Americas, Asia and Europe. Countries are racing to slow the spread of the virus by testing and treating patients, carrying out contact tracing, limiting travel, quarantining citizens, and cancelling large gatherings such as sporting events, concerts, and schools. As of July 20th, 2020, the outbreak has resulted in an estimated 14.4 million cases and 604,000 deaths in 216 countries. The pandemic is moving like a wave—one that may yet crash on those least able to cope. But COVID-19 is much more than a health crisis. By stressing every one of the countries it touches, it has the potential to create devastating social, economic and political crises that will leave deep scars. Every day, people are losing jobs and income, with no way of knowing when normality will return. Although countries are now far more prepared than in the past, the world is also far more interconnected, and many more people today have behavior risk factors such as tobacco use and pre-existing chronic health problems that make viral respiratory infections particularly dangerous. Reported symptoms in patients have varied from mild to severe, and can include fever, cough and shortness of breath. Mongolia is one of few pioneer countries that has taken aggressive measures from January 2020 in terms of prevention and containment of the COVID-19 outbreak. Mongolia tool several early actions including restricting travel from People’s Republic of China, postponing the start of academic sessions of high schools and universities, cancellation of all types of public gatherings and Tsagaan Sar, Lunar New Year celebrations. Since January 9, 2020, Mongolia has been focusing on the preventive and containment measures, including, detecting, isolating and testing suspected cases and implementing quarantine measures for passengers arriving from the affected countries. Aggressive contact tracing and testing have been carried out ever since. Ministry of Health has been working with WHO, international partners and stakeholders from non-health sectors to enhance preparedness. Rapid risk assessment (RRA) has been conducted five times to inform Aug 04, 2020 Page 3 of 8 The World Bank Mongolia PEF support for COVID-19 decision making, update national COVID-19 response plan, and inform public health interventions at points of entries and assessed the risk of insufficient control capacities for COVID-19 community transmission as “High”. Review of national capacities for COVID-19 health facility preparedness (surge capacity, personal protective equipment, and emergency medical equipment) has identified major gaps which shall be fully be addressed by the Mongolia COVID-19 Project. Mongolia is still under high risk of the COVID-19 outbreak despite no community transmission having been reported. On March 10, 2020, the country reported its first imported case of the COVID-19. As of July 20th, 2020, a total number of confirmed imported cases reached 227 with no reported deaths. The mandatory quarantine has been extended from 14 to 21 days due to recent occurrences of the COVID-19 virus in patients beyond the original 14-day quarantine. Consequently, treatments have been providing to the patients according to the interim national guideline on the Clinical Management of COVID-19 which was developed in accordance with the WHO interim Guide on the subject matter. Public Disclosure Copy Investment worth of 4.2 billion MNT approved by the Government Resolution No. 30 of 2020 was utilized for the procurement of medical equipment’s including ventilators, patient monitors, oxygen concentrators, medical injection pumps, infusion pumps, aerosol therapy devices, pulse oximeters, infrared thermometers, portable digital x-ray machines for province, district general hospitals and referral centers for the treatment of patients with COVID-19. Moreover, the E-Health Project (Credit No. 5489-MN) supplemented the provision of digital stationery and mobile x-rays, mobile ultrasound machines worth of 2.1 million USD to the selected sites of Mongolia with the most urgent needs of emergency care services. In April 2020, the World Bank’s approved $26.9 million for the Mongolia COVID-19 Emergency Response and Health System Preparedness Project to meet emergency needs in the face of the pandemic and to better prepare for future health crises. The project addresses the immediate needs in response to COVID-19 such as training for emergency care doctors, nurses and paramedical staff; purchase of medical and laboratory equipment and supplies as well as build COVID-19 diagnostic capacity in Ulaanbaatar and all provinces. It will also rehabilitate health facilities; institute infection control measures and training across health facilities; and support public health information and communication campaigns for disease prevention and management. The project funding comprises a US$13.1 million credit from the International Development Association (IDA) and a $13.8 million credit from the International Bank for Reconstruction and Development (IBRD), allocated as part of the World Bank Group’s $14 billion fast-track financing package to strengthen the COVID-19 response in developing countries and shorten the time to recovery. Despite the above-mentioned capital investment funding gaps remain. Due to the negative impact of the COVID-19 on the country economic situation, the funding gap for short term supplies and consumables, such as PPE, medicines, medical supplies for the frontline public personnel directly involved in the COVID-19 pandemic, remains. The need for PPE for health personnel is estimated based on an assumption that every suspected case shall be examined once by a team of 5 persons comprised of a physician, epidemiologist, laboratory staff and nurses. Once the diagnosis is confirmed every case shall be provided with treatment and services 4 times a day for an average of 5 days. It results in the average cost of PPE for one person being 50,000 MNT. Aside from the personnel in health facilities, public officers of Mongolia Customs General Aug 04, 2020 Page 4 of 8 The World Bank Mongolia PEF support for COVID-19 Administration and General Department of Taxation are working at the points of entry into country as well as various other screening points, increasing more need for supplies. A US $1 million has now been made available to the Government of Mongolia to further enhance its response to COVID-19. The Insurance Window of the Pandemic Emergency Financing Facility (PEF), which provides financial support to IDA-eligible countries in case of major multi-country disease outbreaks, has triggered for COVID-19 and has made available a total of US$195.84 million. The PEF Steering Body has approved allocations for 64 PEF eligible countries. As part of this the Government of Mongolia has been allocated a Grant of US$1million. The Government of Mongolia intends the PEF grant to be delivered as a Recipient Executed Trust Fund (RETF) to enhance Mongolia’s COVID-19 response; through investments in critical commodities especially personal protective equipment thus contributing to addressing the above-mentioned funding Public Disclosure Copy shortages. The rationale for support of the Government decision to use the US$ 1 million payouts from the PEF Insurance Window facility include : (i) the Government request is in line with activities of the National Preparedness Plans and the Mongolia COVID-19 Emergency Response and Health Preparedness Project (ii) the financing addresses occupational health and safety of the public personnel dealing with COVID-19 pandemic and (iii) PPE supplies specified in the Government request fall under the BFP category and can be supplied easily in short period of time, yielding immediate impact and disbursement. The RETF Grant request under PEF facility shall. Relationship to CPF The Mongolia PEF Support for COVID-19 (MPEF) will strengthen Government of Mongolia’s COVID-19 response, and is well aligned with the Country Partnership Strategy. The project was not specifically envisioned in the latest Performance and Learning Review (December 2019) which extended the current Country Partnership Strategy (CPS) (Report No. 67567-MN) to December 2020. The emergency nature of the COVID-19 outbreak and its potential negative impacts call for swift support by the Bank to enhance the health sector response in Mongolia and protect the vulnerable and high-risk population. The COVID-19 outbreak has further highlighted the critical importance of improved access and better delivery of basic services in the health sector—Pillar 3 under the CPS. C. Project Development Objective(s) Proposed Development Objective(s) The proposed project development objective is to strengthen Mongolia’s capacity to prevent and to respond to the COVID-19 outbreak. Aug 04, 2020 Page 5 of 8 The World Bank Mongolia PEF support for COVID-19 Key Results 1. No of confirmed COVID -19 cases among health professionals and key front-line staff (number) 2.Central medical stores having adequate stocks of with personal protective equipment and infection control products and supplies, in preceding two weeks (Yes/No) D. Preliminary Description Activities/Components The aim of this project is to strengthen Government of Mongolia’s to prevent and to respond to the COVID- 19 outbreak. Assistance will be provided to the health care system for preparedness planning to provide optimal medical care, maintain essential lifesaving services, ensuring hospital infection control interventions Public Disclosure Copy and minimize risks for patients and health personnel. In doing this it will support the health system with supplies including Personal Protective Equipment like N95 respirators, medical masks, goggles, gloves, gowns; laboratory equipment and supplies for improved diagnostic capabilities etc. To care for the COVID- 19 cases and other influenza like illnesses it will also support medical counter measures and medical supplies for case management and infection prevention, as well as procurement of drugs such as antivirals, antibiotics and essential medicines for patients with co-morbidity and complications such as CVDs and diabetes. Through these measures the project will enhance preparedness and strengthen essential health care service delivery to be able to provide the best care possible in the event of a surge in demand. Environmental and Social Standards Relevance E. Relevant Standards ESS Standards Relevance Assessment and Management of Environmental and Social ESS 1 Relevant Risks and Impacts ESS 10 Stakeholder Engagement and Information Disclosure Relevant ESS 2 Labor and Working Conditions Relevant Resource Efficiency and Pollution Prevention and ESS 3 Relevant Management ESS 4 Community Health and Safety Relevant Land Acquisition, Restrictions on Land Use and Involuntary ESS 5 Not Currently Relevant Resettlement Biodiversity Conservation and Sustainable Management of ESS 6 Not Currently Relevant Living Natural Resources Indigenous Peoples/Sub-Saharan African Historically ESS 7 Relevant Underserved Traditional Local Communities Aug 04, 2020 Page 6 of 8 The World Bank Mongolia PEF support for COVID-19 ESS 8 Cultural Heritage Not Currently Relevant ESS 9 Financial Intermediaries Not Currently Relevant Legal Operational Policies Safeguard Policies Triggered Explanation (Optional) Projects on International Waterways OP No The Project will not affect international waterways 7.50 Projects in Disputed Areas OP 7.60 No The project will not be in or near disputed areas. Summary of Screening of Environmental and Social Risks and Impacts The aim of this project is to strengthen Government of Mongolia?s to prevent and to respond to the COVID- 19 outbreak. Assistance will be provided to the health care system for preparedness planning to provide optimal medical care, maintain essential lifesaving services, ensuring hospital infection control interventions Public Disclosure Copy and minimize risks for patients and health personnel. In doing this it will support the health system with supplies including Personal Protective Equipment like N95 respirators, medical masks, goggles, gloves, gowns; laboratory equipment and supplies for improved diagnostic capabilities etc. It is proposed that the E&S risks for this project be managed using the E&S instruments being prepared for the Emergency Response Project. The first ISR for the Emergency Response Project has just been completed. The ESMF is under preparation and is expected to be completed by end of September 2020. Similarly, recruitment of E&S specialists in the PIU is in progress and these people are expected to be onboard by end of September 2020. Although the goods to be procured under the PEF can be purchased, the client will commit (via the ESCP) to not dispensing/using the goods until the ESMF and requisite staff are in place CONTACT POINT World Bank Contact : Dinesh M. Nair Title : Senior Health Specialist Telephone No : 5788+7786 / Email : Contact : Anna L Wielogorska Title : Lead Procurement Specialist Telephone No : 5777+7320 / Email : Contact : Pagma Genden Title : Operations Officer Telephone No : 5725+8243 / Email : Borrower/Client/Recipient Borrower : Mongolia ODA Policy Division Development Financing Contact : Amarjargal D Title : Department Aug 04, 2020 Page 7 of 8 The World Bank Mongolia PEF support for COVID-19 Telephone No : 97651260347 Email : amarjargal_d@mof.gov.mn Implementing Agencies Implementing Mongolia Ministry of Health Agency : Contact : Gerelt -Od N Title : Project Director Telephone No : 99073313 Email : gerelt-od@moh.gov.mn FOR MORE INFORMATION CONTACT The World Bank Public Disclosure Copy 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects Aug 04, 2020 Page 8 of 8