May 27, 2020 Mr. Sameer Kumar Khare Additional Secretary Department of Economic Affairs (DEA) Ministry of Finance Governm ent of India North Block New Delhi Dear Mr. Khare: Re: Loan Number 9086-IN COVID-19 Emergency Response and Health Systems Preparedness Project Amendment to the Loan Agreement We refer to the Loan Agreement between India ("Borrower") and the International Bank for Reconstruction and Development ("World Bank") dated April 3, 2020 (Loan Agreement"), pursuant to which the World Bank has extended the above captioned Loan ("Loan") for the COVID-19 Emergency Response and Health Systems Preparedness Project ("Project"). We also refer to the letter from the Department of Economic Affairs, Ministry of Finance F.No.5/1/2020-FB.V, dated May 11, 2020, requesting a restructuring of the Project to reflect the Asian Infrastructure Investment Bank ("AIIB") co-financing and to include the Ministry of Railways as one of the implementing agencies of the Project. We are pleased to inform you that the World Bank concurs with the above request, and accordingly the Loan Agreement is amended as set forth below: 1. Component 1 (Emergency COVID-19 Response) of Schedule 1 (Project Description) is amended by deleting the word "and" at the end of paragraph (a), deleting the period at the end of paragraph (b) and replacing it with a semicolon, adding the word "and" after the semicolon, and adding a new paragraph ( c) which reads as follows: "(c) (i) creation of isolation wards in railway coaches; (ii) procurement of medicine, consumables, and paramedics for railway trains and premises for COVID-19 activities under the Project; and (iii) sanitizing of railway premises and trains." India Country Office, 70 Lodi Estate, New Delhi 110 003, India P.O. Box 416, Phone: +911141479301 / +911149247601 Mr. Sameer Kumar Khare -2- May 27, 2020 2. Section I.A. I (Institutional Arrangements) of Schedule 2 (Project Execution) is amended to read as follows: 1. The Borrower shall vest responsibility for overall Project management to its MOHFW, in collaboration with the Participating States, through: (a) its National Health Mission ("NHM") and its National Center for Disease Control ("NCDC"), both of which come under MOHFW's Department of Health and Family Welfare; (b) its Indian Council of Medical Research ("ICMR"), which comes under the MOHFW's Department of Health Research; and (c) such other agencies as deemed appropriate during the implementation of the Project to address the evolving needs of the Project, upon consultation and approval by the Bank. 3. Section I.A. (Institutional Arrangements) of Schedule 2 (Project Execution) is amended by adding a new paragraph 8, which reads as follows: "8. Without limitation upon the provisions of Section 3.01 of this Agreement and the provisions of this Section I.A of this Schedule 2 to this Agreement, the Borrower shall vest responsibility for implementation of Project activities under Component l(c) of the Project to the Ministry of Railways ("MOR") under the overall management and coordination of the MOHFW, as set forth in the Project Implementation Manual ("PIM")." 4. The Appendix (Definitions) is amended by adding new paragraphs 49, 50, 51, and 52, which read as follows: "49. "Co-financier" means the Asian Infrastructure Investment Bank ("AIIB"), a multilateral financial institution whose purpose is to foster sustainable economic development, create wealth and improve infrastructure connectivity in Asia by investing in infrastructure and other productive sectors. 50. "Co-financing" means, for purposes of paragraph 16 of the Appendix to the General Conditions, an amount of United States Dollars five hundred million (US$500,000,000) provided by the Co- financier pursuant to the Co- financing Agreement to assist in financing the Project. 51. "Co-financing Agreement" means the agreement entered into between the Borrower and the Co-financier, dated May 8, 2020, providing for the Co-financing." 52. "Ministry of Railways" and "MOR" each means the ministry of railways of the Borrower, or any successor thereto." 5. The Results Framework of the Project is revised as set forth in Annexure I. Except as specifically amended by this Amendment Letter, all other provisions of the Loan Agreement shall remain unchanged and in full force and effect. The World Bank will disclose this Amendment Letter and related information in accordance with the World Bank's Policy on Access to Information. By agreeing to this Amendment Letter, the Borrower consents to disclosure of this Amendment Letter and related information. Mr. Sameer Kumar Khare -3- May 27, 2020 Please confirm your agreement to the foregoing by signing and dating two originals, retaining one original for your records and returning the other original to the World Bank. This Amendment Letter shall become effective as of the date of the last countersignature of this Amendment Letter upon receipt by the World Bank of the duly countersigned original of the Amendment Letter. Yours sincerely, INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT By_M!=_ Junaid Kamal Ahm ad Country Director, India AGREED: INDIA By: ± s wa Khare, lA& 'SY, Kf fa /Addi. Secretary 7 >% Authoriz fat pie@,/Ministry of Finance apf@fas 4sf fa4p1/Department of Economic Affair3 Name: t/ Government of India me """""K,"ks» bi» Title: ---------------- Date: 27. 05. 2020 Enclosures Annexure I- Revised Results Framework Mr. Sameer Kumar Khare -4- May 27, 2020 cc: Ms. Apama S., Executive Director (India), the World Bank Mr. Santosh Dattatraya Vaidya, Senior Advisor to Executive Director, the World Bank Mr. Hanish Chhabra, Deputy Secretary, DEA, Ministry of Finance Mr. Navjot Singh, Under Secretary, DEA, Ministry of Finance Mr. Sukhbir Singh, Controller of Aid Accounts and Audit, Department of Economic Affairs, Ministry of Finance, Government of India Mr. Vikas Sheel, Joint Secretary (Policy), Department of Health and Family Welfare, MoHFW, Gol Mr. Kuldeep Singh Sachdeva, Deputy Director General, Department of Health and Family Welfare, MoHFW, Gol Annexure I Attachment to the World Bank's Letter dated May 27, 2020 Loan Number 9086-IN Revised Results Framework Results framework COUNTRY: India India COVID-19 Emergency Response and Health Systems Preparedness Project Project Development Objectives(s) The proposed project development objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national health systems for preparedness in India. Project Development Objective Indicators by Objectives/ Outcomes Indicator Name PBC Baseline End Target Support Gol to prevent, detect and respond & strengthen national HS for pandemic preparedness Percentage of district hospitals with isolation capacity (Percentage) 0.00 70.00 Proportion of specimens submitted for COVID-19 laboratory testing confirmed within WHO-stipulated standard time 0.00 70.00 (Percentage) Proportion of population able to identify three key symptoms of COVID-19 and/or seasonal influenza and three personal prevention measures (as assessed by a representative population 0.00 50.00 survey) (Percentage) The Government has activated their one health coordination mechanism for COVID-19 (Text) No Yes 1 Indicator Name PBC Baseline End Target Percentage of district health centers/district hospitals with personal protective equipment and infection control products and supplies, without stock-outs in preceding two weeks 0.00 70.00 (Percentage) Number of states with at least 80% of districts having dedicated core surveillance staff in the District Surveillance Unit (District Surveillance Officer, Epidemiologist, and Data Manager) in 28.00 65.00 position (Percentage) Action: This indicator is New Intermediate Results Indicators by Components Indicator Name PBC Baseline End Target 1: Emergency COVID-19 Response Proportion of states with sufficient COVID-19 testing capacity within 4 weeks of project implementation (Percentage) 0.00 70.00 Proportion of states using a national health information reporting platform that unifies multiple pre-existing platforms. 0.00 70.00 (Percentage) Proportion of suspected cases who are tested within 2 days of being identified (Percentage) 0.00 70.00 Proportion of district hospitals who have submitted complete monthly data reports (Percentage) 0.00 70.00 Action: This indicator has been Marked for Deletion 2: Strengthening National and State health Systems to support Prevention and Preparedness Proportion of district hospital doctors and nurses who are trained on WHO standards of clinical treatment for COVID-19 0.00 80.00 within 8 weeks of project implementation (Percentage) Proportion of outbreaks where human samples were collected and sent to laboratory for confirmation (Percentage) 19.00 65.00 Indicator Name PBC Baseline End Target Action: This indicator is New •%of Real Time Polymerase Chain Reaction (RT-PCR) designated laboratories meeting external quality control standards (reflects laboratory system quality, using COVID19 testing as a proxy) 100.00 100.00 (Percentage) Action: This indicator is New 3. Strengthening Pandemic Research and Multi-sector,National Institutions & Platforms for One Health Proportion of states with Emerging Infectious Disease Contingency Plans in place with dedicated budget (Percentage) 0.00 70.00 Number of new BSL3 labs with biosafety certification (Number) 0.00 5.00 4: Community Engagement and Risk Communication Proportion of states issuing school closures with state-level distance learning strategies for primary and secondary school 0.00 70.00 students. (Percentage) 5: Implementation Management, Capacity Building, Monitoring and Evaluation Number of peer-reviewed publications produced with support of the project funding (Number) 0.00 40.00