The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) REPORT NO.: RES22186 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF NIGER DISASTER RISK MANAGEMENT AND URBAN DEVELOPMENT PROJECT (P145268) INTERNATIONAL DEVELOPMENT ASSOCIATION CREDIT IN THE AMOUNT OF SDR 65.1 MILLION AND EUR 21.9 MILLION (US$125 MILLION EQUIVALENT) BOARD APPROVAL DATE OF ORIGINAL PROJECT: DEC 11, 2013 TO THE REPUBLIC OF NIGER URBAN, RESILIENCE AND LAND GLOBAL PRACTICE WESTERN AND CENTRAL AFRICA REGION Regional Vice President: Ousmane Diagana Country Director: Soukeyna Kane Regional Director: Simeon K Ehui Practice Manager: Sylvie Debomy Task Team Leaders: Claudia Soto Orozco, Brahim Ould Abdelwedoud The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) ABBREVIATIONS AND ACRONYMS CERC Contingency Emergency Response Component DRM Disaster Risk Management IDA International Development Association IRM Immediate Response Mechanism M&E Monitoring and Evaluation PIU Project Implementation Unit PDO Project Development Objective PGRC-DU Disaster Risk Management and Urban Development Project (Projet de Gestion des Risques de Catastrophes et Développement Urbain) The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) BASIC DATA Product Information Project ID Financing Instrument P145268 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 11-Dec-2013 31-Jul-2021 Organizations Borrower Responsible Agency Republic of Niger Cabinet du Premier Ministre Project Development Objective (PDO) Original PDO The Project Development Objective (PDO) is to improve Niger’s resilience to natural hazards through selected disaster risk management interventions in targeted project sites and strengthening of Government's capacity to respond promptly and effectively to an eligible crisis or an emergency. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing (US$, Millions) Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-64130 17-May-2019 02-Sep-2019 05-Nov-2019 31-Jul-2021 25.00 12.60 13.13 IDA-53400 11-Dec-2013 16-Dec-2013 15-Aug-2014 30-Jun-2021 100.00 90.87 .01 TF-16000 16-Dec-2013 16-Dec-2013 15-Aug-2014 30-Jun-2020 6.64 6.64 0 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Project Status 1. The Niger Disaster Risk Management and Urban Development Project (Projet de Gestion des Risques de Catastrophes et Développement Urbain, PGRC-DU) was approved on December 11, 2013 and declared effective on August 15, 2014, for an equivalent of US$100 million (International Development Association [IDA] Credit No.53400-NE), with an additional US$6.65 million Grant from the Least Developed Countries Fund (TF 16000; P145932). The Project Development Objective (PDO) of the PGRC-DU is to improve Niger’s resilience to natural hazards through selected Disaster Risk Management (DRM) interventions in targeted project sites and strengthening of Government's capacity to respond promptly and effectively to an eligible crisis or an emergency. The project finances primarily (i) Flood Risk Management Investments (including drainage, irrigation and socio-economic priority infrastructure, flood protection infrastructure, and rehabilitation of watersheds); and (ii) Capacity Building for Urban Development and DRM (including for elected officials at local and national levels, municipal services, and civil society) in the geographical areas of Niamey, Dosso, Diffa, Tillaberi, Tahoua, and Agadez. 2. A Level II restructuring was carried out in March 28, 2016 to amend the Financing Agreement reflecting a change in the institutional arrangements for the project coordination to the Cabinet of the Prime Minister. 3. A second Level II restructuring was carried out in March 23, 2017 to reallocate funds for the Contingent Emergency Response Component (CERC) (US$13.5 million) for the activation of the IDA Immediate Response Mechanism (IRM) to address the negative impact of the El Niño-related flooding in 2016. An additional financing (AF) in the amount of US$25 million was also approved on March 17, 2019, with an extension of the initial project closing date from June 30, 2020, to July 31, 2021, to address a US$13.5 million financing gap caused by use of IRM CERC activation, scale up project activities in two additional regions, Agadez and Tahoua, and incorporate new Information and Communication Technology activities. 4. The project’s performance has been consistently rated Satisfactory on the progress towards achieving the PDO and Moderately Satisfactory on Implementation Progress since the start of implementation. Two out of three PDO's indicators have reached their final target: Direct beneficiaries reached amount to 4,302,886 (target is 4,300,000); and 100 percent of targeted flood protection and sustainable land and water management interventions contributing to increased resilience have been implemented (target 100 percent). 5. Progress under Component 1 “Flood risk management investments” includes: i. Most flood protection and sustainable land and water management interventions contributing to increased resilience have been completed, including the recovery of 1,627 ha of irrigable land out of the planned 1,700 ha, the completion of 6,000 ha of dune fixations for sediment management (end target 5,500 ha), and the restoration of 11,020 ha of degraded land. However, the rehabilitation of the Babaye and Maboya flood control ponds, the rehabilitation of the Loube and Bado Koris drainage infrastructure, and the reconstruction of a hydraulic sill at Tamboul have been postponed to the “Niger Integrated Urban The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) Development and Multi-sector Resilience Project” (P175857) currently under preparation, as they would not be completed by the closing date. ii. Water supply and sanitation infrastructure works have progressed well, with the rehabilitation/development of 454 drinking water points, exceeding the end target of 450, the construction of latrines and water wells, the acquisition of sanitation equipment, and the construction of water collectors. iii. Urban infrastructure works have also progressed, with the construction of health, and education infrastructure, as well as urban drainage and roads. Some ongoing works related to urban infrastructure, including the acquisition and installation of traffic lights in Niamey and some drainage infrastructure works are facing challenges due to shortage and delays in the shipment of certain materials and equipment from abroad and the mobilization of foreign firms in the context of the COVID-19 pandemic. 6. As it relates to Component 2, “Capacity building for Urban Development and DRM”, ten municipalities have received technical assistance support from the project to update their municipal development plans. The project also supported the development of the national policy for hygiene and sanitation. Training and institutional strengthening activities in DRM targeted to national and local entities has been completed. Thirteen fire stations have been completed. The activities related to New Technologies of Information and Communication, including drone acquisition, high resolution imagery for key cities, and capacity development for digital skills have been delayed but have recently been launched. 7. The overall disbursement rate is 87.17 percent as of June 7, 2021 (initial IDA 99.99 percent, Least Developed Countries Trust Fund Grant 100 percent and AF IDA 43.64 percent). There are no outstanding audit reports and the project continues to comply with all the environmental and social safeguards and fiduciary requirements. The fiduciary and safeguards performance have been rated Moderately Satisfactory or better in the last ISR despite some shortcomings on procurement, supervision, inspection, and quality control of some ongoing works (dikes, road pavement, etc.), which have gradually been addressed. The performance on Monitoring and Evaluation (M&E) has also improved thanks to an amended M&E methodology. Rationale for restructuring 8. On September 29, 2020, following the devastating floods that occurred during the rainy season (July-October 2020), the Government of Niger requested the activation of the IRM in the amount of US$39.54 million to finance emergency and recovery activities, including: (i) support for the affected people; (ii) support for recovery; and (iii) studies and rehabilitation/protection works for infrastructure affected by the floods. The IRM was activated on October 7, 2020 through the Agriculture and Livestock Transformation Project (P176418), and the PGRC-DU Project Implementation Unit (PIU) is responsible for the implementation of activities. 9. A restructuring is being sought to extend the closing date of the original credit and AF credit1 by 16 months and 15 months, respectively, which entails an extension of the original credit by two years and four months to allow the PGRC-DU PIU to finalize the IRM activities, certain urban infrastructure works (installation of traffic lights in Niamey and some drainage infrastructure works), and activities related to New Technologies of Information and Communication, including drone acquisition, high resolution imagery for key cities, and capacity development for digital skills, which have experienced some delays in their implementation. The 1 TF-16000 closed on June 30, 2020 The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) extension will also allow the Government to continue supporting the preparation of the “Niger Integrated Urban Development and Multi-sector Resilience Project” (P175857), by financing key technical studies, and include Zinder and Maradi in the scope of the high resolution imagery acquisition activity, since these two regions were not initially covered by the PGRC-DU but were very much affected by the recent floods. The “Niger Integrated Urban Development and Multi-sector Resilience Project” is due for Board approval in FY22, and aims to reduce compounded risks related to fragility and climate hazards by improving integrated urban management, service delivery, access to jobs, and resilient infrastructure in targeted municipalities. This project will also provide resources for post-floods reconstruction of damaged critical infrastructure. 10. All requirements of Bank Policy and Bank Directive on Investment Project Financing for closing date extension have been met: (i) the PDO remains achievable; (ii) the performance of the Borrower remains satisfactory; (iii) the World Bank and the Borrower agree on actions that will be undertaken to complete the project on time; (iv) the project is not subject to suspension of disbursements; and (v) there are no outstanding audit reports and the audit reports are satisfactory to the World Bank. B. Description of proposed changes 11. Closing Date Extension. The closing date of the original IDA credit (IDA 54300) is proposed to be extended by 16 months from June 30, 2021 to October 31, 2022, and the closing date of the AF IDA credit (IDA 64130) is proposed to be extended by 15 months from July 31, 2021 to October 31, 2022. This is the second extension for the original IDA credit, entailing a cumulative extension of two years and four months from the original closing date of June 30, 2020, and the first extension for the AF IDA credit. The implementation schedule has also been revised in accordance with the proposed closing date extension. Disbursement estimates have been updated accordingly as in “IV. Detailed Changes” section2. 12. Change in Activities. The following changes are proposed for the activities under Component 1 and 2: (i) the reduction of the scope of certain flood protection infrastructure and watershed rehabilitation activities3 under Component 1 “flood risk management investments”, to avail budget (about US$1 million or 500,000,000 FCFA) for technical, social and environmental studies in support of the Niger Integrated Urban Development and Multi-sector Resilience Project (P175857) which is under preparation. These activities under Component 1, which will not be completed because of this reduction in scope, are planned to be executed as part of the “Niger Integrated Urban Development and Multi-sector Resilience Project” (P175857). The activities that are planned to be transferred to the project under preparation have been selected by the Government as they have been delayed and not yet been initiated or procured under the current project, and would not be completed by the project closing date. These activities have been delayed as the 2020 floods and the activation of the IRM have mobilized time and resources from the project; and (ii) the addition of two regions, Maradi and Zinder to the high resolution imagery acquisition activity under Component 2 “Capacity Building for Urban Development and DRM” There are no changes to project management component (Component 3), and additional project management resources have been mobilized for the IRM implementation, through the IRM activation. 2Disbursements actuals and projections reflect IDA financing only. 3Rehabilitation of the Babaye and Maboya flood control ponds, rehabilitation of the Loube and Bado Koris drainage infrastructure, and reconstruction of a hydraulic sill at Tamboul. The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) 13. Change in Results Framework. To reflect the change to Component 1 explained above, the Results Framework is proposed to be revised. Proposed adjustments to the indicators include modification of two sub-indicators of the intermediate outcome indicator Drainage infrastructure rehabilitation (Kilometers, Custom) as follows: o Cancellation of the sub-indicator “Pond control infrastructure (Hectare)”as the rehabilitation has been postponed and will not be completed as part of the project. o Decreased target for the Koris drainage infrastructure rehabilitation from 21.5 km to 5 km, as some infrastructure rehabilitation in Tahoua have been postponed, and will not be completed as part of the project4. Also, end target date for all indicators have been revised to October 31, 2022 in accordance with the proposed extension of the closing date. Annex 1 provides more details on changes as well as current figures. 4 This represents about US$306,000 The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) II. SUMMARY OF CHANGES Changed Not Changed Results Framework ✔ Loan Closing Date(s) ✔ Disbursement Estimates ✔ Implementation Schedule ✔ Other Change(s) ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ PBCs ✔ Components and Cost ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_LOANCLOSING_TABLE The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-53400 Effective 30-Jun-2020 30-Jun-2021 31-Oct-2022 28-Feb-2023 IDA-64130 Effective 31-Jul-2021 31-Oct-2022 28-Feb-2023 TF-16000 Closed 30-Jun-2020 25-Mar-2021 OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Year Current Proposed 0000 0.00 0.00 2014 0.00 0.00 2015 5,625,000.00 5,624,607.31 2016 15,000,000.00 16,658,729.72 2017 25,000,000.00 32,916,093.19 2018 25,000,000.00 15,845,895.20 2019 25,000,000.00 13,048,192.49 2020 4,375,000.00 11,423,965.19 2021 0.00 7,948,474.68 2022 0.00 12,440,000.00 2023 0.00 700,000.00 The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) . Results framework COUNTRY: Niger Niger Disaster Risk Management and Urban Development Project Project Development Objectives(s) The Project Development Objective (PDO) is to improve Niger’s resilience to natural hazards through selected disaster risk management interventions in targeted project sites and strengthening of Government's capacity to respond promptly and effectively to an eligible crisis or an emergency. Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline End Target To improve Niger’s resilience to natural hazards Direct project beneficiaries (Number) 0.00 4,300,000.00 Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Female beneficiaries (Percentage) 50.00 50.00 Targeted flood protection and sustainable land and water management interventions contributing to increased resilience 0.00 100.00 (% of targeted interventions implemented) (Percentage) Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline End Target Performance of the early warning and response system for natural rapid onset hazards (e.g. floods, strong winds, wild 0.00 5.00 landfires) (Number) Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 PDO Table SPACE Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Comp. 1: Flood Risk Management Investments Sources of drinking water rehabilitated or developed (Number) 0.00 450.00 Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Targeted irrigable land rehabilitated (Hectare(Ha)) 0.00 1,700.00 Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Watershed protection and land restoration interventions 0.00 6,500.00 measured by sub-indicators below (Hectare(Ha)) Action: This indicator has been Revised Rationale: The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Indicator revised to reflect new closing date of October 31, 2022 Sand dune fixation (Hectare(Ha)) 0.00 5,500.00 Action: This indicator has been Revised Restoration of degraded land (Hectare(Ha)) 0.00 6,500.00 Action: This indicator has been Revised Stonewalls (Kilometers) 0.00 10.00 Action: This indicator has been Revised Dike protection (Kilometers) 0.00 50.00 Action: This indicator has been Revised Drainage infrastructure rehabilitation (Kilometers) 0.00 23.50 Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Drainage (Kilometers) 0.00 10.00 Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Drainage pavement (Kilometers) 0.00 20.00 The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Koris (Kilometers) 0.00 5.00 Rationale: Indicator revised to reflect new closing date of October 31, 2022 and the final target was adjusted to reflect infrastructure Action: This indicator has been Revised rehabilitation in Tahoua that have been postponed Pond control infrastructure (Hectare(Ha)) 0.00 4.00 Action: This indicator has been Marked for Deletion Comp. 2: Capacity Building for Urban Development and Disaster Risk Management Development and/or updating of urban master plans and local 0.00 25.00 development plans (Number) Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Percentage of female participation in decision committees for development and/or updating urban master plans and municipal 0.00 25.00 development plans (Percentage) Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Percentage of municipal budget allocated to solid waste 0.00 4.00 collection and processing/transformation (Percentage) The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Support preparedness and emergency response (measured by No Yes sub-indicators below) (Yes/No) Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Fully functional database of risk in Niger (Yes/No) No Yes Action: This indicator has been Revised Support to Civil Protection to strengthening response capacity No Yes (facilities, equipment, training) (Yes/No) Action: This indicator has been Revised Support to National DRM agencies (Equipment, training) 0.00 10.00 (Number) Action: This indicator has been Revised Support urban development (measured by sub-indicators below) No Yes (Yes/No) Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Area with detailed maps in digital and paper formats (Square 0.00 400.00 kilometer(km2)) The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Action: This indicator has been Revised Trained people on digital cartography (Number) 0.00 200.00 Action: This indicator has been Revised Number of local innovation projects supported (Number) 0.00 8.00 Action: This indicator has been Revised Comp. 3: Project Management Quality and timely submission of Procurement and financial Yes Yes management reporting (Yes/No) Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Quality and timely submission of procurement reporting No Yes (Yes/No) Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Quality and timely submission of Financial Management No Yes reporting (Yes/No) Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Planned project activities implemented (Percentage) 0.00 100.00 Action: This indicator has been Revised Rationale: The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) RESULT_FRAME_TBL_IO Indicator Name PBC Baseline End Target Indicator revised to reflect new closing date of October 31, 2022 Grievances registered related to delivery of project benefits that 0.00 80.00 are actually addressed (Percentage) Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 Comp. 4: Contingency Component Time taken the preparation/submission of the activation package by the Client for an eligible crisis or emergency triggering an 0.00 4.00 Immediate Response Mechanism (IRM) (Weeks) Rationale: Action: This indicator has been Revised Indicator revised to reflect new closing date of October 31, 2022 IO Table SPACE . The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) Annex 1: Summary of proposed changes to indicators Current Value Indicator Name Baseline End Target Proposed changes of Indicator Direct project beneficiaries (Number) 0 4,300,000.00 4,302,886.00 No change Female beneficiaries (Percentage) 50 50 49.17 No change Targeted flood protection and sustainable PDO Indicators by land and water management interventions Objectives/ contributing to increased resilience (% of 0 100 100 No change Outcomes targeted interventions implemented) (Percentage) Performance of the early warning and response system for natural rapid onset 0 5 3 No change hazards (e.g. floods, strong winds, wild landfires) (Number) Current Value Indicator Name Baseline End Target Proposed changes of Indicator Comp. 1: Flood Risk Management Investments Sources of drinking water rehabilitated or 0 450 454 No change developed (Number) Targeted irrigable land rehabilitated 0 1,700.00 1,627.27 No change (Hectare(Ha)) Intermediate Watershed protection and land restoration Results Indicators interventions measured by sub-indicators 0 6,500.00 17,020.00 No change by Components below (Hectare(Ha)) Sand dune fixation (Hectare(Ha)) 0 5,500.00 6,000.00 No change Restoration of degraded land (Hectare(Ha)) 0 6,500.00 11,020.00 No change Stonewalls (Kilometers) 0 10 72.7 No change Dike protection (Kilometers) 0 50 40.5 No change The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) Drainage infrastructure rehabilitation 0 23.5 120.95 No change (Kilometers) Drainage (Kilometers) 0 10 1.11 No change Drainage pavement (Kilometers) 0 20 4.07 No change Indicator’s target has been 2.75 reduced from 21.5 to 5 to (previously reflect that some Koris (Kilometers) 0 21.5 misreported as infrastructure rehabilitation in 20 in the last Tahoua that have been ISR) postponed This indicator has been Pond control infrastructure marked for deletion as this 0 4 0 (Hectare(Ha)) rehabilitation has been postponed. Comp. 2: Capacity Building for Urban Development and DRM Development and/or updating of urban master plans and local development plans 0 25 26 No change (Number) Percentage of female participation in decision committees for development 0 25 0 No change and/or updating urban master plans and municipal development plans (Percentage) Percentage of municipal budget allocated to solid waste collection and 0 4 0 No change processing/transformation (Percentage) Support preparedness and emergency response (measured by sub-indicators No Yes Yes No change below) (Yes/No) Fully functional database of risk in No Yes Yes No change Niger (Yes/No) Support to Civil Protection to strengthening response capacity (facilities, No Yes Yes No change equipment, training) (Yes/No) The World Bank Niger Disaster Risk Management and Urban Development Project (P145268) Support to National DRM agencies 0 10 8 No change (Equipment, training) (Number) Support urban development (measured by No Yes Yes No change sub-indicators below) (Yes/No) Area with detailed maps in digital and 0 400 0 No change paper formats (Square kilometer(km2)) Trained people on digital cartography 0 200 0 No change (Number) Number of local innovation projects 0 8 0 No change supported (Number) Comp. 3: Project Management Quality and timely submission of Procurement and financial management Yes Yes Yes No change reporting (Yes/No) Quality and timely submission of No Yes Yes No change procurement reporting (Yes/No) Quality and timely submission of No Yes Yes No change Financial Management reporting (Yes/No) Planned project activities implemented 0 100 84 No change (Percentage) Grievances registered related to delivery of project benefits that are actually addressed 0 80 80 No change (Percentage) Comp. 4: Contingency Component Time taken the preparation/submission of the activation package by the Client for an eligible crisis or emergency triggering an 0 4 8 No change Immediate Response Mechanism (IRM) (Weeks)