The World Bank Ebola Emergency Response Project (P152359) REPORT NO.: RES34983 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF EBOLA EMERGENCY RESPONSE PROJECT APPROVED ON SEPTEMBER 16, 2014 TO REPUBLIC OF LIBERIA,REPUBLIC OF SIERRA LEONE,REPUBLIC OF GUINEA HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Hafez M. H. Ghanem Country Director: Rachid Benmessaoud Senior Global Practice Director: Timothy Grant Evans Practice Manager/Manager: Gaston Sorgho Task Team Leader: Preeti Kudesia, Ibrahim Magazi, Shiyong Wang The World Bank Ebola Emergency Response Project (P152359) ABBREVIATIONS AND ACRONYMS CRI Corporate Results Indicator CRW Crisis Response Window EERP Ebola Emergency Response Project EVD Ebola Virus Disease GOL Government of Liberia IDA International Development Association IPC Infection Prevention and Control IFC International Finance Corporation ISR Implementation Status Report MOH Ministry of Health PDO Project Development Objective SDR Special Drawing Right US$ US Dollar WHO World Health Organization The World Bank Ebola Emergency Response Project (P152359) Note to Task Teams: The following sections are system generated and can only be edited online in the Portal. BASIC DATA Product Information Project ID Financing Instrument P152359 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 16-Sep-2014 31-Mar-2021 Organizations Borrower Responsible Agency Republic of Liberia,Republic of Sierra Leone,Republic of MINISTRY OF HEALTH,Ministry of Health,Ministry of Guinea Health and Sanitation Project Development Objective (PDO) Original PDO The Project Development Objective is to contribute in the short term to the control of the Ebola Virus Disease (EVD) outbreak and the availability of selected essential health services, and mitigate the socio-economic impact of EVD in Guinea, Liberia, and Sierra Leone. Current PDO To contribute to the control of the Ebola Virus Disease (EVD) outbreaks and the recovery of selected essential health services in Guinea, Liberia, and Sierra Leone. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-D0070 18-Nov-2014 20-Nov-2014 03-Dec-2014 31-Dec-2020 98.00 83.22 10.09 IDA-D0080 18-Nov-2014 24-Nov-2014 02-Dec-2014 31-Mar-2021 115.00 94.15 16.78 The World Bank Ebola Emergency Response Project (P152359) IDA-D0090 18-Nov-2014 20-Nov-2014 26-Nov-2014 31-Dec-2019 72.00 63.95 4.11 IDA-H9900 16-Sep-2014 17-Sep-2014 24-Sep-2014 31-Dec-2019 25.00 24.61 0 IDA-H9910 16-Sep-2014 17-Sep-2014 19-Sep-2014 31-Mar-2021 52.00 51.13 0 IDA-H9920 16-Sep-2014 17-Sep-2014 24-Sep-2014 31-Dec-2020 28.00 27.55 .03 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No Note to Task Teams: End of system generated content, document is editable from here. The World Bank Ebola Emergency Response Project (P152359) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING Project Status: The Ebola Emergency Response Project (EERP) has been under implementation for five years and has a total financing envelope of US$ 390 million. The original IDA grant in the amount of US$ 105 million was approved on September 16, 2014 and became effective on September 19, 2014 to support the Governments of Guinea, Liberia and Sierra Leone to control the spread of the Ebola Virus Disease (EVD) and mitigate the unprecedented health and socio- economic impacts of the epidemic. This original project had a closing date of September 30, 2015. The additional source of financing from the IDA CRW in the amount of US$ 285 million was approved on November 18, 2014 as part of the Additional Financing to respond to a rapidly changing situation and, for the three countries, to scale up community-based care and community engagement for earlier triage of suspected EVD cases, more rapid confirmation of infectious status, strengthened treatment and care, and safe burials to curb the epidemic. While the project’s original and additional financing supported the control of the spread of the Ebola virus in Guinea, Liberia and Sierra Leone, there were possibilities that Ebola might surge back in these countries (with Liberia and Sierra Leone facing recurred outbreaks), and therefore implying the need to maintain presence in these countries to control Ebola in case of its reemergence as well as to provide a smooth transition to a phase when these countries would regain their capacity to deliver essential health services. Therefore, a Level I restructuring of the project, approved on December 8, 2016, provided support during this transition complemented by a number of operations, each in their area of comparative advantage, to gradually regain the health system capabilities in Guinea, Liberia and Sierra Leone. The project restructuring, which inter alia included revision of the PDO, results framework, project components and their allocated amounts, also extended the project closing date till March 31, 2021. A detailed description of changes in project components is described in Table 2. The current Project Development Objective, approved at the 2016 restructuring, is to contribute to the control of the Ebola Virus Disease (EVD) outbreaks and the recovery of selected essential health services in Guinea, Liberia, and Sierra Leone. Progress toward achievement of the PDO and Implementation Progress rating has been Moderately Satisfactory in the last two Implementation Status Reports (ISRs) dated November 9 and June 12, 2018. Overall, project implementation is on track (with some variations between the three countries). To date, the project has disbursed US$ 341.92 million of US$390 million (incorporating SDR exchange loss), representing 91.06% disbursement rate for the original grant and additional financing combined: Table 1: Project disbursement (as of February 25, 2019) (US$ millions) Project Disbursement US$341.92 (91.06%) Disbursement (Liberia) / Undisbursed balance US$145.28 / US$16.75 Disbursement (Sierra Leone) / Undisbursed balance US$109.8 / US$10.99 Disbursement (Guinea) / Undisbursed balance US$86.84 / US$5.85 Rationale for Restructuring: Following a comprehensive review mission held in Liberia from December 3-14, 2018i; in Sierra Leone between September 23-27, 2018 and Guinea between September 28 - October 2, 2018, the objectives of which were to: (i) assess implementation progress till date; (ii) assess expenditures till date, commitments till project closing, including the likelihood of any savings; and (iii) complete the review of the Results Frameworks (RF), the task team concluded that the overall PDO is achievable. Each of the three countries is likely to complete all planned activities by their respective closing dates: December 31, 2019 for Guinea; December 31, 2020 for Sierra Leone; and March 31, 2021 for Liberia. However, detailed discussion of the Results Framework with each of the three countries revealed that there was a lack of clarity between the three countries on the definition and measurement of several indicators (including those related to the early phase of the EBV outbreak and response), despite a restructuring of the Results Framework in 2016. This proposed restructuring aims to address the reporting issues with the Results Framework because of the lack of a common understanding among the three countries; and hence has revised the Results Framework appropriately - no change in PDO but greater clarity of indicator statements. Specifically, some of the changes include clarifying the indicator formulation and definition, accordingly revising baseline and end-line values, introducing the new corporate results The World Bank Ebola Emergency Response Project (P152359) indicators, and including data sources for PDO-level indicators. The March 2021 end-line targets for most of the intermediate results indicators, as agreed to previously were maintained. The updated results framework with updated progress values is in section IV. The current task team encountered significant difficulties in understanding the rationale and targets for some indicators and obtaining data to validate those which were reported during the Ebola outbreak period. Institutional memory on both the clients’ side (particularly in Sierra Leone and Liberia) and Bank side has been substantially lost; and more importantly the institutional arrangements that were established by the individual countries to lead the EVD response, were later disbanded, resulting in a loss of valuable information and data points. Though disbanded in Guinea, the focal person remained on the client side resulting in consistency of data availability. These are important lessons to be learned for the future. Additionally, this restructuring includes a change in one activity that was planned in Liberia: a potential Public Private Partnership at the John F Kennedy (JFK) Medical Center’s National Diagnostics Center with the IFC arm of the World Bank Group, with the EERP contributing US$ 2 million to the initial set-up costs. This activity has been under planning for more than two years, and unfortunately despite a lot of ground work put in by IFC, the Bank team has been informed that GOL and JFK no longer support this activity. Therefore, the US$ 2 million will now be utilized for equipping the New Redemption Hospital which is being constructed with EERP financing. The availability of this financing is fortunate because as per the original agreement for the new hospital, MOH was to finance the equipment. However, in December 2018, MOH informed the Bank that they would not be able to do it, and therefore it became critical for the Bank to identify financing for this critical activity. Currently, the remaining activities for each country against the available undisbursed funds (which is US$10.99 million for Sierra Leone, US$5.85 million for Guinea and US$16.75 million for Liberia) are as follows: Liberia: majority of the remaining financing allocated for the construction of the New Redemption Hospital, and fully equipping it. Guinea: completing the construction and provision of equipment to selected health facilities, and continuation of the other ongoing activities till project closing: strengthening surveillance at the national level; strengthening the coordination of interventions; and strengthening the activities of the emergencies Operation Center (operation cost). Sierra Leone: In the remaining phase, the Project will focus on continuing the implementation of: (a) maintaining the operation of the functional national emergency medical service program; (b) provision of essential health services, in particular, in the hard to reach areas, through ensuring adequate staffing, provision of fit for purpose equipment and supplies, and needed operation cost and incentives; (c) supporting public health interventions for improving sanitation, safe water and environment health, as well as improving medical waste management in the selected health facilities and (d) supporting the integrated supervision and support to the districts. Table 2: Project Components/Sub-Components/Activities – Original and changes at AF/Restructuring While this restructuring is not making any changes in the components or sub-components as agreed in 2016; the description below is provided to better understand the changes since project start, and thereby how the current RF fits into the two components as agreed in 2016. EERP: Project Components/Sub-Components/Activities – Original and changes at AF/Restructuring Original Components Revised/Enhanced Components Revised Components/Sub-Components (2016 Restructuring) September 2014 Additional Financing Nov 2014: Additional/Enhanced activities proposed in the Project Paper (however unclear how each was planned to be implemented in individual countries – possibly through the agreements with UN Agencies). The World Bank Ebola Emergency Response Project (P152359) Component 1: Support to the (i) Ebola community-based Component 1: Support to the EVD Outbreak Response Plans EVD Outbreak Response Plans care and essential health and and Strengthening Essential services Strengthening of Essential Health Services and Disease Health Services (ii) Community engagement Preparedness and community-based Financed intensified Ebola responses In addition to the original activities, new sub-components (as responses, including case (iii) Surveillance and lab below) were added to continue control activities in case management at ETUs and capacity another outbreak occurred, and support to recovery of Community Care Centers, (iv) Storage and distribution essential services: procurement and distribution capacity of PPEs, community (v) Waste management and 1. Service Delivery Recovery engagement, surveillance, water and sanitation Support to health facilities on staffing, drugs and other contact tracing, and safe (vi) M&E of the response essential supplies, and transport and logistics including burials. emergency medical services (EMS) and fleet management 2. Preparedness for potential future Ebola outbreaks Rehabilitation of health facilities with new triage and isolation units to improvement of water, sanitation, and hygiene (WASH), upgrade (new construction) of Redemption Hospital in Liberia 3. Management and Coordination Support the Strengthening of project management and coordination functions at the MoH and counties/provinces, through staffing, office supplies, and logistics. Component 2: Human Additional activities proposed in the Component 2: Human Resources Scale Up for Outbreak Resources Scale Up for Project Paper (however unclear how each Response and Essential Health Services Outbreak Response and was planned to be implemented in Essential Health Services individual countries – possibly through the In addition to the original activities, new sub-components (as agreements with UN Agencies): below) were added to leverage community and community Financed human resources for health workers for urgent health services, disease surveillance, the Ebola response, including (i) Human resource and Infection Prevention and Control (IPC); and to recover lost deployment of Foreign Medical arrangements to operate health workers, Teams and payment of hazard ETUs, ECUs/CCCs, and and strengthen their IPC practices: pay to Ebola response workers community engagement and health workers. activities 1. Community-led recovery and preparedness (ii) Hazard pay and death Support community-led activities including detection, referral, benefit and reporting of suspected diseases of epidemic potential, IPC (iii) Scaling up training and community-led total sanitation, and participation in planning, implementing, monitoring, and feedback through community health committees. This sub-component was designed to cover the urgent, recovery phase only, and will be taken over by country-specific projects for longer-term implementation and scale-up 2. Health worker recovery and preparedness Strengthen physician and specialist training program and selected midwifery, nursing, and clinical health officers/physician assistants training institutions to recover the loss of health workers Component 3: Provision of Continued as original, except for enhanced Deleted Food and Basic Supplies to targets Quarantined Populations and EVD Affected Households Component 4: Provision of essential public services to affected populations (NEW) Component 5: Pre-investment assessment and planning of new Ebola therapies, diagnostics and vaccines, and The World Bank Ebola Emergency Response Project (P152359) establishment of a Regional Network of Institutes of Public Health II. DESCRIPTION OF PROPOSED CHANGES The Results Framework (RF) has been discussed with all three countries, and all modifications required are being recorded and completed as part of this restructuring. Some of the proposed changes, details of which are described in detail in section IV, are: 1. The original project had three components. The first restructuring with Additional Financing in November 2014 introduced two additional components, taking the total to five components. The 2016 restructuring limited the project and AF to only two components. However, some of the original indicators mapped to Component 3 were retained in the 2016 RF; hence they now are being mapped to one of the two existing components. Though these indicators were reporting only till the EBV outbreak, they are being retained as they measure parts of the PDO, and this restructuring has corrected some errors in the data (as available from the three countries at present). 2. Second PDO indicator statement significantly changed to reflect the correct meaning and definition and measurement. 3. As per the latest OPCS guideline, ‘Births (deliveries) attended by skilled health personnel’ should be a sub- Corporate Results Indicator (CRI) and moved to Intermediate Indicators. However, this indicator is an important indicator to measure the ‘recovery of essential health services’, and hence is also being retained as a PDO indicator; 4. ‘Health facilities that received essential drugs’ – one-time financing, but some supplies not complete yet, therefore, retained as end target of 2021; and 5. The CRI will be constituted by a total of the two sub-indicators (deliveries and immunizations). Note to Task Teams: The following sections are system generated and can only be edited online in the Portal. III. SUMMARY OF CHANGES Changed Not Changed Results Framework ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ Components and Cost ✔ Loan Closing Date(s) ✔ The World Bank Ebola Emergency Response Project (P152359) Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Disbursement Estimates ✔ Overall Risk Rating ✔ Safeguard Policies Triggered ✔ EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) . The World Bank Ebola Emergency Response Project (P152359) . Results framework COUNTRY: Western Africa Ebola Emergency Response Project Project Development Objectives(s) To contribute to the control of the Ebola Virus Disease (EVD) outbreaks and the recovery of selected essential health services in Guinea, Liberia, and Sierra Leone. Project Development Objective Indicators by Objectives/ Outcomes RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target Contribute to control of EVD outbreaks Availability (at any given time) of at least two weeks needs of PPEs and other required IPC supplies in the Ebola 0.00 80.00 TreatmentCenters(ETCs) and referral centers (Percentage) Registered contacts followed up (during the mandated period) to 0.00 100.00 detect new EVD cases (Percentage) Rationale: No further reporting of this indicator since the Ebola outbreak. As per discussions with each of the three countries and WHO, the original indicator statement "New confirmed EVD cases from registered contacts" (and therefore its purpose) is not clear. This indicator was a NEW indicator introduced at the 2016 restructuring, when the peak of the outbreak was declining. Therefore, it is assumed that the indicator was meant to measure the system readiness to measure the follow up of all registered contacts to detect new cases. The reporting in Action: This indicator has been Revised previous ISRs indicates that 100% of all registered contacts were followed up for the mandated period of time for new case detection- thereby indicating the robustness of the system. Hence, the indicator statement is being changed. The country-specific data indicating the proportion of new cases diagnosed from all the registered contacts followed up, that was available is for different periods: Guinea - 594 confirmed EVD cases from 34,944 registered contacts – cumulative data for outbreak. Liberia 1,468 confirmed EVD cases from 33,627 registered contacts between March 2014 to February 2015. The World Bank Ebola Emergency Response Project (P152359) RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target Sierra Leone - 373 confirmed EVD cases from 431 registered contacts between January 2015 to October 2015. Contribute to recovery of selected essential health services Births (deliveries) attended by skilled health personnel (number) 0.00 24,000.00 (Number) Rationale: This indicator is being added to intermediate indicators as sub-CRI but it is also being retained as PDO indicator since it captures the second part of the PDO. The basis of the end target has not been determined. The numbers are based on annual calendar year reporting from DHIS2 for each country: Action: This indicator has been Revised Guinea: 55,684 in 2014, 226,900 in 2015, 245,323 in 2016 and 271,303 in 2017. Cumulative number is 799,210 (2014-2017). Liberia: 2014-2017 cumulative number is 324,738. Disaggregated data being ascertained. Sierra Leone: 462,123 during the EBV outbreak period. Ascertaining disaggregated data, but not available till date. Total Actual (Current): 1,586,071 for 31 December 2017. Number of health workers trained on IPC and Ebola (Number) 0.00 30,000.00 Rationale: No methodology or process was developed and agreed with the three countries to measure the knowledge of trained health workers. Therefore, the original indicator statement "Percentage of trained health workers with knowledge of Ebola and IPC" is being changed. End target is being changed to March 2021: 30,000. Actual Total: 32,579 (30 Nov 2018). Action: This indicator has been Revised Guinea: 12,218 (111 doctors, 309 nurses, 39 laboratory assistants, 767 hygienists and 10,992 health workers private – 3,876 and public – 7,116 structures); Liberia: 20,361; Sierra Leone: health workers training on Ebola and IPC was financed by DFID, so no reporting for this indicator under EERP. The World Bank Ebola Emergency Response Project (P152359) RESULT_FRAME_TBL_PDO Indicator Name DLI Baseline End Target Number of health centers rehabilitated according to national IPC 0.00 125.00 standard (Number) Rationale: The original indicator statement "Percentage of health centers rehabilitated according to national IPC standard" is being changed. Current total: 105 (30 November 2018); End Target: 125 Action: This indicator has been Revised Guinea: 41/54; Liberia: 41/48 (included expansion of maternity wings of clinics, health centers, and hospitals, isolation units); Sierra Leone: 23/23 PDO Table SPACE Intermediate Results Indicators by Components RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Component 1: Support to the EVD Outbreak Response Plans and Strengthening Essential Health Services Total food distribution (Metric ton) 0.00 22,900.00 Rationale: No further activity or reporting after the Ebola outbreak. For better and complete reporting, the task team (for the 2019 restructuring of the RF) tried to get the data for different Action: This indicator has been Revised reporting periods during the Ebola outbreak (15 Sep 2014, 15 March 2015, 15 Sep 2015, 15 March 2016, and 15 Sep 2016) but this was not available from any available source in any of the three countries. Despite efforts, the task team could not ascertain the source and basis for the data previously reported. The World Bank Ebola Emergency Response Project (P152359) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target The data available at present is the following, though the end target set in Nov 2014 was 22,900 (Guinea 8100, Liberia 8100, SL 6700). Actual Current (30 Jun 2016): 11,164.73. Guinea: 1,717.13 (1,653.13 metric tons of rice at and 64 metric tons of Super Grain); Liberia : 4,261.90 metric tons Sierra Leone: 5,185.7 metric tons. Number of people in the quarantined areas and other Ebola- affected households who received food and other basic supplies 0.00 544,000.00 (Number) Rationale: No further activity or reporting since Ebola outbreak. For better and complete reporting, the task team (for the 2018 restructuring of the RF) tried to get the data for different reporting periods during the Ebola outbreak (15 Sep 2014, 15 March 2015, 15 Sep 2015, 15 March 2016, and 15 Sep 2016) but this was not available from any available source in any of the three countries. Action: This indicator has been Revised End target of Total 544,000 (Guinea 175,000, Liberia 169,000, SL 200,000) set in Nov 2014. Actual (30 Jun 2016) 1,536,720 Guinea: 973,000 Liberia: 125,400 (source: WFP) Sierra Leone: 438,320 Number of women and children who have received basic 0.00 312,270.00 nutrition services (Number) The World Bank Ebola Emergency Response Project (P152359) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Rationale: Action: This indicator has been Marked for Deletion This indicator is being deleted as part 2019 restructuring as disaggregated data was never collected. Community health and social mobilization staff deployed for door-to-door communication and case identification in target 0.00 7,800.00 chiefdoms/sub-districts/counties (Number) Rationale: No active communication and case identification after the Ebola outbreak, so end target date is being changed to 30 Sep 2016. For better and complete reporting, the task team (for the 2019 restructuring of the RF) tried to get the data for different reporting periods during the Ebola outbreak (15 Sep 2014, 15 March 2015, 15 Sep 2015, 15 March 2016, and 15 Sep 2016) but this was not available from any available source in any of the three countries. Despite efforts, the task team could not ascertain the source and basis for the data previously reported. Action: This indicator has been Revised The data available at present is the following, however the end target set in Nov 2014 was 7,800 (Guinea 3,800, Liberia 2,000, and Sierra Leone 2,000). Actual Current (30 Sep 2017): 55,136 Guinea: 12,538 Liberia: 10,434 Sierra Leone: 32,164 Proportion of beneficiary households who received cash 0.00 100.00 transfers by 15th of every payment quarter (Percentage) Rationale: No further activity or reporting since Ebola outbreak. For better and complete reporting, the task team (for the 2019 restructuring of the RF) tried to get the data for different Action: This indicator has been Revised reporting periods during the Ebola outbreak (15 Sep 2014, 15 March 2015, 15 Sep 2015, 15 March 2016, and 15 Sep 2016) but this was not available from any available source in any of the three countries. The World Bank Ebola Emergency Response Project (P152359) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Component 2: Human Resources Scale up for Outbreak Response and Essential Health Services Expatriate health workers deployed to provide medical care to 0.00 725.00 EVD patients and for other essential health needs (Number) Rationale: For better and complete reporting, the task team (for the 2019 restructuring of the RF) tried to get the data for different reporting periods during the Ebola outbreak (15 Sep 2014, 15 March 2015, 15 Sep 2015, 15 March 2016, and 15 Sep 2016) but this was not available from any available source in any of the three countries. No further activity or reporting after the Ebola outbreak. The numbers reported for each country are as below. It is unclear what the basis for reporting the previous data and end Action: This indicator has been Revised target was. Actual Current (31 June 2016): 479. Guinea: 124 (104 from the African Union and 20 from the WHO) Liberia: 214 Sierra Leone: 141 Redemption Hospital Phase 1 (Maternity and Pediatric hospital) No Yes constructed (Yes/No) Health facilities that received essential drugs (Number) 0.00 804.00 Rationale: This was a one-time supply financed by the EERP, however supplies not complete yet in all countries so end target of Mar 2021 retained. Guinea: 54 health facilities (for 41 facilities procured and delivered; for 13 facilities procured and in UNICEF warehouse, will Action: This indicator has been Revised be delivered after completion of the construction); Liberia: 539 health facilities in 15 counties received essential drugs in five rounds. (691 facilities were planned for); Sierra Leone: supplied to 59 facilities through UNICEF. Total actual: 652; Total End Target: 804 The World Bank Ebola Emergency Response Project (P152359) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Number of health workers who received financial incentives 0.00 18,000.00 (hazard/indemnity pay and death benefits) (Number) Rationale: No further activity or reporting since Ebola outbreak. For better and complete reporting, the task team (for the 2019 restructuring of the RF) tried to get the data for different reporting periods during the Ebola outbreak (15 Sep 2014, 15 March 2015, 15 Sep 2015, 15 March 2016, and 15 Sep 2016) but this was not available from any available source in any of the three countries. End target set in Nov 2014: Guinea 5,000, Liberia 8,000, Sierra Leone 5,000. Action: This indicator has been Revised Actual Total (30 June 2016) 37,097. Guinea: 7,785 Liberia: 6,958 Sierra Leone: 23,197 (23,040 Health workers were paid during the outbreak. The death benefits are still being paid (but no longer through EERP) once beneficiaries are verified by the legal firm. So far 157 death beneficiaries have been paid). Female beneficiaries (Number) 0.00 10,800.00 Rationale: This indicator is being deleted as part of 2019 restructuring, as during discussions with the three countries it was concluded Action: This indicator has been Marked for Deletion that the indicator lacks clarity (does it refer to female beneficiaries of male health workers; or families of female health workers), and gender specific data was not collected. Number of health personnel who have completed selected 0.00 1,000.00 training programs (Number) Rationale: The original indicator statement "Staff who completed physician, nursing, midwiferyis being revised. End target is Action: This indicator has been Revised being revised to 1,000. Actual (Current): 925 (Dec 31, 2018) Guinea: training programs not financed by EERP; The World Bank Ebola Emergency Response Project (P152359) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Liberia: 306 (GMRP=28; CHSSs=24 and CHAs= 278); Sierra Leone: 619 paramedics; 10 physicians currently under-going post-graduate training; and 99 midwives and technicians will be graduating in early 2019. People who have received essential health, nutrition and 0.00 2,500,000.00 population (HNP) services (Number) Rationale: This is a CRI. The system does not allow to convert Custom Indicator into a CRI, hence it is being deleted and re-created as a Action: This indicator has been Marked for Deletion CRI. Female beneficiaries (Number) 0.00 1,250,000.00 Rationale: Action: This indicator has been Marked for Deletion This indicator is being deleted as CRI does not require disaggregated data on female beneficiaries. Number of children immunized (Number) 0.00 1,500,000.00 Rationale: This indicator is a sub-set of CRI. The system does not allow conversion from a custom indicator into sub-set of indicator, Action: This indicator has been Marked for Deletion hence it is being marked for deletion and re-created. People who have received essential health, nutrition, and 0.00 2,500,000.00 population (HNP) services (CRI, Number) Rationale: This is a CRI. Action: This indicator is New This indicator reflects the total of the earlier indicators of births attended by SBA (1,605,678) and immunizations (2,205,048), which is 3,810,726. Nutrition services not provided in any of the 3 countries through EERP. The World Bank Ebola Emergency Response Project (P152359) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Number of children immunized (CRI, Number) 0.00 1,500,000.00 Rationale: This is a sub-set of CRI. It was agreed with all 3 countries that they would provide 2 sets of data: for the measles immunization campaign during the outbreak specifically financed by EERP; and country wide immunization data by reporting periods (not necessarily financed by EERP). The actual and end target date will change according to data set finally selected for reporting. However, the task team continues to face serious constraints in getting the data, including DHIS breakdown in Sierra Leone, Action: This indicator is New so is still trying to ascertain the full data set. Guinea: 355,141 (year 2015), 386,879 (year 2016), 396,564 (year 2017). Total 1,138,584. Liberia: 73,848 (year 2014), 88,417 (year 2015), 112,294 (year 2016), 130,822 (year 2017), 108,733 (year 2018). Total 514,114. Sierra Leone: 552,350 – data from DHIS 2 for all facilities reporting during the outbreak (till 2016). Actual (Current): 2,205,048. Number of deliveries attended by skilled health personnel 0.00 24,000.00 (CRI, Number) The World Bank Ebola Emergency Response Project (P152359) RESULT_FRAME_TBL_IO Indicator Name DLI Baseline End Target Rationale: This indicator has been moved to appear as a sub-CRI intermediate indicator. However, given that this indicator captures the second part of the PDO, task team considered keeping as a PDO indicator but also include in the tally of for the CRI HNP services which is an intermediate results indicator. The basis of the end target has not been determined. Total: 1,605,678 for Dec 2018. Action: This indicator is New Guinea: 55,684 (year 2014), 226,900 (year 2015), 245,323 (year 2016), 271,303 (2017). Total 799,210. Liberia: 57,437 (year 2014), 61,392 (year 2015), 78,241 (year 2016), 62,774 (year 2017), 84,501 (year 2018). Total (2014- 2018) is 344,345. Sierra Leone: 462,123 during the EBV outbreak period (till 2016). Ascertaining disaggregated data, but not available till date. December 2018 data for Guinea and Sierra Leone is still awaited. Component 3: Provision of Food and Basic Supplies to Quarantined Populations and EVD Affected Households (Action: This Component has been Marked for Deletion) Component 4: Provision of Essential Public Services (Action: This Component has been Marked for Deletion) Component 5: Pre-Investment Assessment of New Ebola Therapies, Diagnostics and Vaccines (Action: This Component has been Marked for Deletion) IO Table SPACE The World Bank Ebola Emergency Response Project (P152359)