The World Bank Burundi COVID19 Preparedness and Response Project (P173845) REPORT NO.: RES47119 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF BURUNDI COVID-19 PREPAREDNESS AND RESPONSE PROJECT APPROVED ON APRIL 10, 2020 TO REPUBLIC OF BURUNDI HEALTH, NUTRITION & POPULATION AFRICA EAST Regional Vice President: Hafez Ghanem Country Director: Jean-Christophe Carret Regional Director: Amit Dar Practice Manager: Francisca Ayodeji Akala Task Team Leaders: Laurence Elisabeth Marie-Paule Lannes, Moulay Driss Zine Eddine El Idrissi The World Bank Burundi COVID19 Preparedness and Response Project (P173845) ABBREVIATIONS AND ACRONYMS ESCP Environmental and Social Commitment Plan ESMF Environmental and Social Management Framework FM Financial Management FTCF Fast Track COVID-19 Facility GoB Government of Burundi IPC Infection, Prevention and Control MoH Ministry of Health PDO Project Development Objective PIU Project Implementation Unit RSA Regional Safeguards Advisor SEA/SH Sexual Exploitation and Abuse/Sexual Harassment SEP Stakeholder Engagement Plan The World Bank Burundi COVID19 Preparedness and Response Project (P173845) BASIC DATA Product Information Project ID Financing Instrument P173845 Investment Project Financing Environmental and Social Risk Classification (ESRC) Substantial Approval Date Current Closing Date 10-Apr-2020 30-Jun-2021 Organizations Borrower Responsible Agency Ministère de la Santé Publique et de la Lutte contre le Republic of Burundi Sida,Ministère des Finances, du Budget et de la Coopération au Développement Economique Multiphase Programmatic Approach (MPA) Program Development Objective 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 Multiphase Programmatic Approach (MPA) Status (Public Disclosure) Status and Key Decisions (Public Disclosure) 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. Seventy six (76) projects are disbursing. Total disbursements as of June 15, 2021 under these projects amount to US$2.43 billion or 58% of overall commitments. Streamlined procedures, delegated approval coupled with flexible project design and intensified efforts across the Bank have contributed to the progress. Several projects have/are being restructured to include vaccine related procurement. Implementation is being guided by Bank teams working in parallel in other health related The World Bank Burundi COVID19 Preparedness and Response Project (P173845) projects, including Additional Financing operations supporting vaccine and vaccination efforts in countries. Implementation continues to face challenges as some countries are still under different levels of lockdown or mobility restrictions and counterparts and Bank teams are operating from home. Bank teams continue to conduct implementation support missions virtually, which is challenging for both Bank teams and counterparts. This has created connectivity challenges since the internet is not reliable in many countries, especially IDA countries. Notwithstanding challenges, the MPA is on track to achieving its PDO – to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. The significant level of disbursements in just over 13 months attests to the strong implementation efforts of the Bank response thanks to the commitment of counterparts supported by Bank country teams. OPS_TABLE_PDO_CURRENTPDO Project Development Objective (PDO) Original PDO To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Burundi. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-D6160 10-Apr-2020 14-Apr-2020 08-Jul-2020 30-Jun-2021 5.00 5.21 .05 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Project Background 1. The Burundi COVID-19 Preparedness and Response Project was approved by the World Bank Board on April 10, 2020 and became effective on July 8, 2020. The total Project amount is US$ 5 million. The closing date of the Project is June 30, 2021. The Project was prepared under the COVID-19 Strategic Preparedness and Response Program (SPRP) using the Multiphase Programmatic Approach (MPA), approved by the Board on April 2, 2020. 2. The Project Development Objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Burundi. The World Bank Burundi COVID19 Preparedness and Response Project (P173845) 3. Project beneficiaries are the population at large given the nature of the disease, infected people, at-risk populations, particularly the elderly and people with chronic/underlying conditions, medical and emergency personnel, medical and testing facilities, and public health agencies engaged in the response in participating countries. B. Project Status 4. Key achievements/results to date: The Project is rated Satisfactory both for progress towards the Project Development Objective (PDO) and overall implementation progress, with 95 percent of the total project cost having been disbursed. On the progress towards the PDO, under Component 1: Emergency COVID-19 response (US$3.05 million equivalent), almost all the activities have been implemented. These include: (i) finalization of the construction of the Ebola/COVID 19 treatment center; (ii) purchase of drugs, PPE and medical equipment; (iii) support to COVID 19 screening campaign. The ongoing activities are the completion of boreholes for potable water supply as well as the electrification of the Ebola/ COVID-19 treatment center in Mudubugu, the installation of air conditioning equipment and provision of laundry amenities for the same center. The drilling and electrification works were delayed by the prior need to compensate affected populations and the delay in awarding the electrification contract to the selected contractor. Additionally, personal protective equipment (PPE) and hand sanitizers, intended to be delivered by the Chinese company MEHECO, could not be delivered because the Chinese government has classified them as dangerous goods that cannot be delivered by air. As other transport modalities were deemed to be lengthy, the MoH abandoned the procurement of these items and replaced them with the local purchase of rapid tests for COVID-19. MEHECO has refunded the funds. 5. Under Component 2: Supporting national and subnational, prevention and preparedness (US$ 1 million equivalent), all the activities have been implemented (purchase of laboratory equipment for COVID 19 testing, COVID 19 testing kits and reagents, support to coordination activities). Under Component 3: Community engagement and risk communication (US$ 0.7 million equivalent), surveillance strengthening activities at health facility and community level were abandoned due to insufficient funds. There has been: (i) an increase in unit cost for some equipment and PPE purchased through World Bank Facilitated Procurement (BFP); (ii) an increase in cost estimates for the drilling and electrification of Ebola/COVID-19 treatment center; and (iii) inclusion of new priority activities by MoH not foreseen in the initial annual budgeted work plan. However, these activities were carried out by the MoH with funds from other partners. Under Component 4: Implementation management monitoring ad evaluation (US$ 0.25 million equivalent), all the activities planned have been implemented. 6. Project implementation status has been rated Satisfactory. After eleven months of implementation of project activities, the disbursement rate is close to 95%. Despite a national and global context of crisis linked to COVID-19, and difficult access to goods and services at the local and international level, all project components experienced a high completion rate. All five project development indicators have been achieved. Likewise, all intermediate result indicators met or exceeded their end line targets. 7. Financial Management: The financial management of the project is rated Satisfactory and the financial risk is moderate. There is no outstanding audit report. 8. Procurement: The overall procurement performance is rated Moderately Satisfactory and the procurement risk is substantial. 9. Safeguards: There are delays in validation of some safeguards instruments and the three targeted health facilities The World Bank Burundi COVID19 Preparedness and Response Project (P173845) for COVID-19 treatment were not equipped with efficient incinerators (Montfort type) for lack of financial resources. The SEA/SH sensitive GRM (Grievance Redress Mechanism) is annexed to the ESMF document pending RSA’s final clearance (expected by end of June).The environmental and social assessment of the project is rated Moderately Unsatisfactory due to delays in preparing safeguards instruments. C. Rationale for Restructuring 10. On June 9, 2021, the World Bank received a request, from the Government of Burundi, for a no-cost extension of the current closing date of the Project from June 30 to September 30, 2021. The request for extension is justified on the following grounds and the action plan to complete the delayed activities is presented in Annex A: (i) Delays in borehole water supply and electrification of the Ebola/COVID-19 treatment Centre of Mudubugu: the borehole drilling and electrification works were delayed by the prior need to compensate affected populations (completed in June 2021), the delay in awarding the electrification contract to REGIDESO, which initially indicated that it did not have equipment for electrification of the Center. (ii) Need for the contractor (REGIDESO) to import certain equipment for the electrification of the Mudubugu treatment center: although the contractor confirms that technically, the electrification can be carried out in one month, six weeks would be required to import the necessary equipment and comply with national procurement guidelines for the submission and analysis of the bids received. (iii) Delays in producing/updating safeguards documents: the Project’s Environmental and Social Management Framework (ESMF) was updated to reflect unplanned activities which triggered new E&S policies. As a result, the ESMF has been amended, reviewed by the Bank, and is now pending RSA’s final clearance. (iv) Delays in the receipt of COVID-19 rapid screening tests purchased by the project. (v) Need to elaborate the client’s implementation and completion report that integrates the delayed activities. II. DESCRIPTION OF PROPOSED CHANGES A. Grant closing date 11. The three-month extension would result in changing the Grant Closing Date from June 30, 2021 to September 30, 2021. B. Results Framework 12. In the Project’s Results Framework, the end target dates would be updated to reflect the new proposed Project closing date of September 30, 2021. The target values will remain unchanged. C. Implementation schedule 13. As a result of the Project closing date extension, the implementation schedule would be modified to allow completion of the remaining activities by September 30, 2021. III. SUMMARY OF CHANGES Changed Not Changed Results Framework ✔ The World Bank Burundi COVID19 Preparedness and Response Project (P173845) Loan Closing Date(s) ✔ Implementation Schedule ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ MPA Program Development Objective ✔ MPA Expected Results and Indicators ✔ PBCs ✔ Components and Cost ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Disbursement Estimates ✔ Overall Risk Rating ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) MPA PROGRAM DEVELOPMENT OBJECTIVE Current MPA Program Development Objective 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 The World Bank Burundi COVID19 Preparedness and Response Project (P173845) EXPECTED MPA PROGRAM RESULTS Current Expected MPA Results and their Indicators for the MPA Program Progress towards the achievement of the PDO would be measured by outcome indicators. Individual country-specific projects (or phases) under the MPA Program will identify relevant indicators, including among others: • Country has activated their public health Emergency Operations Centre or a coordination mechanism for COVID-19; • Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents; • Number of acute healthcare facilities with isolation capacity; • Number of suspected cases of COVID-19 reported and investigated per approved protocol; • Number of diagnosed cases treated per approved protocol; • Personal and community non-pharmaceutical interventions adopted by the country (e.g., installation of handwashing facilities, provision of supplies and behavior change campaigns, continuity of water and sanitation service provision in public facilities and households, schools closures, telework and remote meetings, reduce/cancel mass gatherings); • Policies, regulations, guidelines, or other relevant government strategic documents incorporating a multi- sectoral health approach developed/or revised and adopted; • Multi-sectoral operational mechanism for coordinated response to outbreaks by human, animal and wildlife sectors in place; • Coordinated surveillance systems in place in the animal health and public health sectors for zoonotic diseases/pathogens identified as joint priorities; and • Mechanisms for responding to infectious and potential zoonotic diseases established and functional; and • Outbreak/pandemic emergency risk communication plan and activities developed and tested OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-D6160 Effective 30-Jun-2021 30-Sep-2021 30-Jan-2022 . The World Bank Burundi COVID19 Preparedness and Response Project (P173845) . Results framework COUNTRY: Burundi Burundi COVID19 Preparedness and Response Project Project Development Objectives(s) To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Burundi. Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline End Target Strengthen the national public health preparedness capacity to prevent, detect and respond Suspected COVID-19 cases reported and investigated based on 0.00 100.00 national guidelines (Percentage) Action: This indicator has been Revised Designated laboratories with COVID-19 diagnostic equipment, 0.00 12.00 test kits, and reagents (Number) Action: This indicator has been Revised Acute healthcare facilities with isolation capacity (Number) 8.00 36.00 Action: This indicator has been Revised Burundi adopted adopted personal and community non- No Yes pharmaceutical interventions (Yes/No) Action: This indicator has been Revised Burundi has activated its public health Emergency Operations No Yes Center or a coordination mechanism for COVID-19 (Yes/No) The World Bank Burundi COVID19 Preparedness and Response Project (P173845) RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline End Target Action: This indicator has been Revised PDO Table SPACE Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Emergency COVID-19 Response Health staff trained in infection prevention and control per MOH- 0.00 3,600.00 approved protocols (Number) Action: This indicator has been Revised Burundi has prepared a referral system to care for COVID-19 No Yes patients (Yes/No) Action: This indicator has been Revised Supporting National and Sub-national, Prevention and Preparedness Designated laboratories with staff trained to conduct COVID-19 0.00 12.00 diagnosis (Number) Action: This indicator has been Revised For the first 10 suspected cases, percentage of laboratory results 0.00 100.00 available within 72 hours (Percentage) Action: This indicator has been Revised Community Engagement and Risk Communication Burundi has reported to have contextualized their risk No Yes communication and community engagement strategies (Yes/No) The World Bank Burundi COVID19 Preparedness and Response Project (P173845) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Action: This indicator has been Revised Individuals reached with tailored information (Number) 0.00 6,500,000.00 Action: This indicator has been Revised IO Table SPACE . The World Bank Burundi COVID19 Preparedness and Response Project (P173845) ANNEX 1: ACTION PLAN TO COMPLETE DELAYED ACTIVITIES 1. Electrification of the COVID 19 Treatment Center of MUDUBUGU N° Activities Jun-21 Extension period (July to September 2021) W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 1 Compensation of Completed in affected population June 2021 2 Preparatory works Completed in June 2021 3 Equipment acquisition 4 Electrification of the treatment center 5 Provisional reception of electrification works and correction of any imperfection 2. Borehole water supply of the MUDUBUGU COVID 19 treatment center N° Activities Jun-21 Extension period (July to September 2021) W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 1 Compensation of Completed in affected population June 2021 2 Preparatory works Completed in June 2021 3 Water supply works 4 Provisional reception of water supply works and correction of any imperfection The World Bank Burundi COVID19 Preparedness and Response Project (P173845) 3. Client Implementation Completion and Results report (ICR) N° Activities Jun-21 Extension period (July to September 2021) W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 1 Contract negotiation In progress with a consultant 2 ICR Report finalization 3 Provisional reception of the ICR report 4 Final receipt of the ICR Report 4. Procurement of COVID-19 rapid screening tests N° Activities Jun-21 Extension period (July to September 2021) W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 1 Contract In progress 2 Receipt of COVID-19 rapid screening tests