FOR OFFICIAL USE ONLY Report No: PAD3845 · report no: pad3845 international development assoiation...

FOR OFFICIAL USE ONLY Report No: PAD3845

INTERNATIONAL DEVELOPMENT ASSOCIATION

PROJECT APPRAISAL DOCUMENT

ON A

PROPOSED INTERNATIONAL ASSOCIATION DEVELOPMENT GRANT/CREDITS IN THE AMOUNT OF SDR 2.80 MILLION GRANT AND US$ 3.75 MILLION CREDIT

(US$ 7.5 MILLION EQUIVALENT) IN CRISIS RESPONSE WINDOW RESOURCES

TO

Republic of Liberia

FOR

LIBERIA COVID-19 EMERGENCY RESPONSE PROJECT

UNDER THE COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PROGRAM (SPRP)

USING THE MULTIPHASE PROGRAMMATIC APPROACH (MPA) WITH A FINANCING ENVELOPE OF

UP TO US$ 6 BILLION

APPROVED BY THE BOARD ON APRIL 2, 2020

Health, Nutrition & Population Global Practice

Africa Region

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CURRENCY EQUIVALENTS

(Exchange Rate Effective February 29, 2020)

Currency Unit =

SDR 0.74087 = US$1

US$ 1.34977 = SDR 1

FISCAL YEAR

January 1 - December 31

Regional Vice President: Hafez M. H. Ghanem

Country Director: Pierre Frank Laporte

Regional Director: Dena Ringold

Practice Manager: Gaston Sorgho

Task Team Leader(s): Noel Chisaka, Opope Oyaka Tshivuila Matala

The World Bank Liberia COVID-19 Preparedness and Response Project (P173812)

ABBREVIATIONS AND ACRONYMS

BSL Biosafety level

COVID-19 Coronavirus Disease

DHIS2 District Health Information System 2

EVD-WA West African Ebola Virus Disease

FM Financial Management

GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria

LRCS Liberia Red Cross Society

GRS Grievance Redress Service

FCV Fragility, Conflict, and Violence

ICT Information and Communication Technology

IDSR Integrated Disease Surveillance Response

IFC International Finance Corporation

IHR International Health Regulations

IMF International Monetary Fund

JEE Joint External Evaluation

LIC Low-income Country

MDBs Multilateral Development Banks

MoH Ministry of Health

MoU Memorandum of Understanding

NDMA National Disaster Management Agency

NHEC National Health Emergency Committee

NGOs Non-governmental Organizations

PCU Program Coordination Unit

NPHIL National Public Health Institute of Liberia

US CDC United states Centre for Disease Control

FAO Food and Agricultural Organization

EOC Emergency Operation Center

PIU Project implementing Unit

CH County Hospital

PPE Personal Protective Equipment

POE Point of Entry

PPSD Project Procurement Strategy for Development

SARS-CoV-2 2019 Novel Coronavirus

SOP Standard Operating Procedure

TA Technical Assistance

UN United Nations

WBG World Bank Group

WHO World Health Organization


TABLE OF CONTENTS

DATASHEET.................................................................................................................................1

I. PROGRAM CONTEXT ...........................................................................................................7

A. MPA Program Context ............................................................................................................. 7

B. Updated MPA Program Framework......................................................................................... 8

C. Learning Agenda .................................................................................................................... 10

II. CONTEXT AND RELEVANCE ................................................................................................10

A. Country Context ..................................................................................................................... 10

B. Sectoral and Institutional Context .............................................................................................. 11

C. Relevance to Higher Level Objectives ......................................................................................... 13

IV. PROJECT DESCRIPTION ......................................................................................................14

A. Project Development Objective ................................................................................................ 14

B. Project Components ................................................................................................................. 15

C. Project Beneficiaries ................................................................................................................. 19

V. IMPLEMENTATION ARRANGEMENTS ................................................................................19

VI. .................................................................................................................................................. 19

VII. A. Institutional and Implementation Arrangements ............................................................ 19

B. Results Monitoring and Evaluation Arrangements ..................................................................... 20

C. Sustainability ............................................................................................................................. 21

VIII. PROJECT APPRAISAL SUMMARY .......................................................................................21

A. Technical, Economic and Financial Analysis (if applicable) .................................................... 21

B. Fiduciary ................................................................................................................................ 22

C. Legal Operational Policies ..................................................................................................... 24

D. Environmental and Social Standards ..................................................................................... 24

IX. GRIEVANCE REDRESS SERVICES .........................................................................................26

X. KEY RISKS ...........................................................................................................................26

XI. RESULTS FRAMEWORK AND MONITORING .......................................................................33

ANNEX 1: Implementation Arrangements and Support Plan ......................................................... 41

.


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DATASHEET

BASIC INFORMATION BASIC_INFO_TABLE

Country(ies) Project Name

Liberia Liberia COVID-19 Emergency Response Project

Project ID Financing Instrument Environmental and Social Risk Classification

P173812 Investment Project Financing

Substantial

Financing & Implementation Modalities

[✓] Multiphase Programmatic Approach (MPA) [ ] Contingent Emergency Response Component (CERC)

[ ] Series of Projects (SOP) [✓] Fragile State(s)

[ ] Disbursement-linked Indicators (DLIs) [ ] Small State(s)

[ ] Financial Intermediaries (FI) [ ] Fragile within a non-fragile Country

[ ] Project-Based Guarantee [ ] Conflict

[ ] Deferred Drawdown [✓] Responding to Natural or Man-made Disaster

[ ] Alternate Procurement Arrangements (APA)

Expected Project Approval Date

Expected Project Closing Date

Expected Program Closing Date

31-Mar-2020 10-Apr-2022 31-Mar-2025

Bank/IFC Collaboration

No

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

MPA Financing Data (US$, Millions) Fi na nci ng

The World Bank Liberia COVID-19 Emergecy Response Project (P173812)

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MPA Program Financing Envelope 4,057.75

with an additional request to IBRD 163.80

with an additional request to IDA 240.45

Proposed Project Development Objective(s) The development objective is to prepare and respond to the COVID-19 pandemic in Liberia

Components

Component Name Cost (US$, millions)

Component 1: Emergency Preparedness Response 1.00

Component 2: Supporting Preparedness through Laboratory System Strengthening 1.00

Component 3: Case Management and Clinical Care 3.00

Component 4: Community Engagement, Risk Communication and Advocacy 1.75

Component 5: Project Management and Coordination, Monitoring and Evaluation 0.75

Organizations

Borrower: Republic of Liberia

Implementing Agency: Ministry of Health

MPA FINANCING DETAILS (US$, Millions)

M PA FINANCING D ETAILS (US$, M illions) App roved

Board Approved MPA Financing Envelope: 3,653.50

MPA Program Financing Envelope: 4,057.75

of which Bank Financing (IBRD): 2,762.80

of which Bank Financing (IDA): 1,294.95

of which other financing sources: 0.00

PROJECT FINANCING DATA (US$, Millions)

FIN_SUMM_NEW


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SUMMARY-NewFin1

Total Project Cost 7.50

Total Financing 7.50

of which IBRD/IDA 7.50

Financing Gap 0.00

DETAILS-NewFinEnh1

World Bank Group Financing

International Development Association (IDA) 7.50

IDA Grant 7.50

IDA Resources (in US$, Millions)

Credit Amount Grant Amount Guarantee Amount Total Amount

Liberia 0.00 7.50 0.00 7.50

National PBA 0.00 7.50 0.00 7.50

Total 0.00 7.50 0.00 7.50

Expected Disbursements (in US$, Millions)

WB Fiscal Year

2020 2021 2022

Annual 4.88 2.25 0.38

Cumulative 4.88 7.13 7.50

INSTITUTIONAL DATA

Practice Area (Lead) Contributing Practice Areas

Health, Nutrition & Population

Climate Change and Disaster Screening

This operation has been screened for short and long-term climate change and disaster risks


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SYSTEMATIC OPERATIONS RISK-RATING TOOL (SORT)

Risk Category Rating

1. Political and Governance ⚫ Substantial

2. Macroeconomic ⚫ Substantial

3. Sector Strategies and Policies ⚫ Moderate

4. Technical Design of Project or Program ⚫ Low

5. Institutional Capacity for Implementation and Sustainability ⚫ Substantial

6. Fiduciary ⚫ Substantial

7. Environment and Social ⚫ Substantial

8. Stakeholders ⚫ Low

9. Other

10. Overall ⚫ Substantial

Overall MPA Program Risk ⚫ High

COMPLIANCE

Policy

Does the project depart from the CPF in content or in other significant respects?

[ ] Yes [✓] No

Does the project require any waivers of Bank policies?

[ ] Yes [✓] No


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Environmental and Social Standards Relevance Given its Context at the Time of Appraisal

E & S Standards Relevance

Assessment and Management of Environmental and Social Risks and Impacts Relevant

Stakeholder Engagement and Information Disclosure Relevant

Labor and Working Conditions Relevant

Resource Efficiency and Pollution Prevention and Management Relevant

Community Health and Safety Relevant

Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Relevant

Biodiversity Conservation and Sustainable Management of Living Natural Resources Not Currently Relevant

Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local

Communities

Not Currently Relevant

Cultural Heritage Not Currently Relevant

Financial Intermediaries Not Currently Relevant

NOTE: For further information regarding the World Bank’s due diligence assessment of the Project’s potential environmental and social risks and impacts, please refer to the Project’s Appraisal Environmental and Social Review Summary (ESRS). Legal Covenants

Sections and Description

1. Project Implementation Manual: The Recipient shall, not later than forty-five (45) days after the Effective Date,

prepare and adopt a Project operations manual containing detailed guidelines and procedures for the

implementation of the Project.

Conditions

Type Description

Disbursement Section III.B.1: Notwithstanding the provisions of Part A above, no withdrawal shall

be made for payments made prior to the Signature Date, except that withdrawals


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up to an aggregate amount not to exceed (i) $ 1,500,000 out of the proceeds of the

Credit, and (ii) SDR 1,120,000 out of the proceeds of the Grant, may be made for

payments made prior to this date but on or after February 12, 2020, for Eligible

Expenditures.

The World Bank Liberia COVID-19 Emergency Response Project (P173812)

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I. PROGRAM CONTEXT

1. This Project Appraisal Document (PAD) describes the emergency response to Liberia under the COVID-19 Strategic Preparedness And Response Program (SPRP) using the Multiphase Programmatic Approach (MPA), approved by the World Bank’s Board of Executive Directors on April 2, 2020 with an overall Program financing envelope of International Development Association (IDA) US$1.3 billion and of International Bank for Reconstruction and Development (IBRD) US$2.7 billion.1

A. MPA Program Context

2. An outbreak of the coronavirus disease (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) has been spreading rapidly across the world since December 2019, following the diagnosis of the initial cases in Wuhan, Hubei Province, China. Since the beginning of March 2020, the number of cases outside China has increased thirteenfold and the number of affected countries has tripled. On March 11, 2020, the World Health Organization (WHO) declared a global pandemic as the coronavirus rapidly spreads across the world. Figure 1 provides details about the global spread of COVID-19. As of April 6 , 2020, the outbreak has resulted in an estimated 1,247,182 cases and 69,212 deaths in 211 countries.2

WHO MP as at April6,2020

3. COVID-19 is one of several emerging infectious diseases (EID) outbreaks in recent decades that have emerged from animals in contact with humans, resulting in major outbreaks with significant public health and economic impacts. The last moderately severe influenza pandemics were in 1957 and 1968; each killed more than a million people around the world. Although countries are now far more prepared

1 Report No: PCBASIC0219761 2 Source: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports


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than in the past, the world is also far more interconnected, and many more people today have behavior risk factors such as tobacco use3 and pre-existing chronic health problems that make viral respiratory infections particularly dangerous4. With COVID-19, scientists are still trying to understand the full picture of the disease symptoms and severity. Reported symptoms in patients have varied from mild to severe, and can include fever, cough and shortness of breath. In general, studies of hospitalized patients have found that about 83% to 98% of patients develop a fever, 76% to 82% develop a dry cough and 11% to 44% develop fatigue or muscle aches5. Other symptoms, including headache, sore throat, abdominal pain, and diarrhea, have been reported, but are less common. While 3.7% of the people worldwide confirmed as having been infected have died, WHO has been careful not to describe that as a mortality rate or death rate. This is because in an unfolding epidemic it can be misleading to look simply at the estimate of deaths divided by cases so far. Hence, given that the actual prevalence of COVID-19 infection remains unknown in most countries, it poses unparalleled challenges with respect to global containment and mitigation. These issues reinforce the need to strengthen the response to COVID-19 across all IDA/IBRD countries to minimize the global risk and impact posed by this disease.

4. This project is prepared under the global framework of the World Bank COVID-19 Response financed under the Fast Track COVID-19 Facility (FCTF) and Liberia IDA19 allocation.

B. Updated MPA Program Framework

5. Table 1 provides an overall MPA Program framework. The first two countries, Afghanistan and Ethiopia, were presented with the framework. Projects for other countries, including Burkina Faso will be added as they are processed under the MPA Program.

3 Marquez, PV. 2020. “Does Tobacco Smoking Increases the Risk of Coronavirus Disease (Covid-19) Severity? The Case of China.” http://www.pvmarquez.com/Covid-19 4 Fauci, AS, Lane, C, and Redfield, RR. 2020. “Covid-19 — Navigating the Uncharted.” New Eng J of Medicine, DOI: 10.1056/NEJMe2002387 5 Del Rio, C. and Malani, PN. 2020. “COVID-19—New Insights on a Rapidly Changing Epidemic.” JAMA, doi:10.1001/jama.2020.3072

http://www.pvmarquez.com/Covid-19


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Table 1. MPA Program Framework

No. Project ID Sequential or Simultaneous

Phase’s Proposed DO*

IPF, DPF or PforR

Estimated IBRD Amount ($ million)

Estimated IDA Amount ($ million)

Estimated Other Amount ($ million)

Estimated Approval Date

Estimated Environmental & Social Risk Rating

1 Liberia * Simultaneous IPF 0.0 7.5 0.0 TBC Substantial

Total

Board Approved Financing Envelope

0.0 7,5

*Liberia : US$ 5.0 million allocated from COVID-19 Crisis Response Window and an additional US$2.5 million allocated from IDA19 envelope


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C. Learning Agenda

6. Learning possibilities. The proposed project under the MPA Program will support adaptive learning throughout implementation. It will build on Burkina Faso’s experience responding to multiple zoonotic diseases present in the sub-region, including Ebola, as well as knowledge and lessons provided from other international organizations including the WHO, the Africa Centers for Disease Control (CDC), United States CDC, United Nations Children’s Fund (UNICEF), International Organization of Migration (IOM) and other Liberia may contribute to the MPA learning agenda as follows:

• Technical: Cost and effectiveness assessments of prevention and preparedness activities - the proposed project will support documenting the lessons learned from the current pandemic to improve preparedness for future epidemics as part of the ex-post evaluation under Component 2; research may be financed for the re-purposing of existing anti-viral drugs and development and testing of new antiviral drugs and vaccines;

• Supply chain approaches: Assessments may be financed on options for timely distribution of medicines and other medical supplies;

• Social behaviors: Assessments on the compliance and impact of social distancing and hand washing measures under different contexts; and

• Operational: The project will use surveys to create rapid feedback loops for operational activities (Iterative Beneficiary Monitoring) and COVID-19 impact and communications activities (sample-based phone survey of households).

II. CONTEXT AND RELEVANCE

A. Country Context

7. Liberia’s uneven economic performance over the last four decades has largely been driven by the twin shocks of two civil wars and the 2014 Ebola Virus Disease (EVD) outbreak. For a quarter-century, Liberia’s two civil wars caused widespread loss of life, destroyed vital infrastructure, and suppressed economic growth. Thereafter, Liberia entered a period of sustained economic growth with an average annual growth rate of 7.4 percent between 2004-2013. However, the 2014 EVD outbreak, coupled with a sharp decline in global prices for iron ore and rubber, disrupted Liberia’s economic recovery. The real gross domestic product (GDP) growth rate slowed to 0.7 percent in 2014, zero percent in 2015, and the drawdown of the United Nations mission pushed the economy into recession in 2016. The macro-economic situation has continued to deteriorate. In 2019, both inflation and exchange rate depreciation remained high (30 percent), mostly due to sustained growth in monetary aggregates6, and the economy is estimated to have contracted by a further 1.4 percent driven by falling demand, as indicated by the evolution of taxes and bank credit7. The impacts of the shocks were compounded by the transition to a new political administration in 2018, as the relative inexperience of the incoming administration increased policy uncertainty and weakened economic management.

8. The prevailing resource constraints and persisting fragility have hindered the Government of Liberia (GOL) from improving the living standards of the population. More than half of Liberia’s population of 4.7 million people live in urban areas, and one quarter resides in Monrovia. Adolescents and youth8 (10-24 years old) represent

6 IMF (2019). IMF country report No. 19/381: Liberia – Request for a Four-Year Arrangement Under the Extended Credit Facility-Press Release; Staff report; staff statement; and statement by the executive director for Liberia 7 Liberia DPO series 8 World Health Organization (WHO) defines young people as individuals between ages 10 and 24. Adolescents represent the 10-19


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approximately one-third of the total population. Poverty is widespread and increasing, and in 2016, almost half the population (2.2 million people) were unable to meet their food needs. The headcount poverty rate rose from 54.1 percent in 2014 to 61.2 percent in 20169, and poverty rates are higher in rural (71.6 percent) than urban areas (31.5 percent). In addition to the high levels of poverty, Liberia has amongst the worst human capital and human development outcomes. Liberia ranks 181 of 189 countries tracked on the 2017 Human Development Index10, and 153 of 157 countries tracked on the 2018 Human Capital Index. Moreover, the HCI estimates that a child born in Liberia today is expected to receive only 4.4 years of school and realize, at best, 32 percent of their human capital potential

III.

B. Sectoral and Institutional Context

9. As of March 17, 2020, Liberia has 3 confirmed cases of COVID-19 in Monrovia, the capital city, where more than 45 percent of the population live. Health authorities continue to trace all primary and secondary contacts of index cases, and the National Public Health Institute of Liberia (NPHIL) has activated its preparedness plan. Considering the contextual and health system challenges in Liberia, in the absence of a rapid, effective, and sustained response, a COVID-19 outbreak would have a devastating impact on the health system, health outcomes, and the broader Liberian economy.

10. The EVD outbreak of 2014 decimated a health system already weakened by conflict, and recovery has been slow. Following the end of the second civil war in 2003, Liberia’s health system slowly recovered to the point where health outcomes started improving. Between 2003-2012, life expectancy increased from 54 to 61 years, child deaths declined from 149 to 88 deaths per 1,000 live births, and Liberia became one of the first countries in Sub-Saharan Africa to achieve the child-related Millennium Development Goal11. However, the EVD crisis devastated the healthcare system and severely constrained the GOL’s ability to deliver essential health services, which led to many preventable deaths. By March 2016, an estimated 10,675 people were infected, 5000 people died, and fear and community distrust led to a rapid decline in the utilization of health care services. EVD deaths were disproportionately concentrated among Liberia’s health personnel (doctors, nurses, and midwives), further depleting an already deficient health workforce. By May 2015, 327 health workers were infected, of which 184 died. The loss in health personnel is estimated to have contributed to a 111 percent increase in the maternal mortality ratio between the pre-Ebola era (2013) and May 2015 (from 640 to 1347 deaths per 100,000 live births); a 20 percent increase in infant mortality (from 54 to 64 deaths per 1000 live births) and 28 percent increase in child deaths (from 71 to 91 deaths per 1000 live births)12.

11. Since the EVD crisis, Liberia has made great strides to strengthen its level of epidemic preparedness. The NPHIL was established soon after the EVD crisis and – in line with requirements of the 2005 International Health Regulations (IHR) – is responsible for detecting, preventing, and responding to disease outbreaks and health13. Before Ebola, Liberia’s laboratory system could only test for three diseases. This has increased to more than 10, including yellow fever, Lassa Fever, EVD, cholera, meningitis, and measles14. The World Banks Regional Disease Surveillance Systems Enhancement Program (REDISSE) – Phase 2 (P159040) supports Liberia’s efforts to

years old age group and youth represent the 15-24 years old age group. 9 World Bank (2018). “Country Partnership Framework for the Republic of Liberia, FY2019-FY2024”. Report No. 130753-LR 10 United National Development Program (2017). Human Development Index 11 Between 1990 – 2015, child deaths declined from 255 to 70 per 1000 live births. 12 Idem. 13 Salm-Reifferscheidt.(2019) Liberia post Ebola: ready for another outbreak? Lancet vol 393 pg. 1583-1584 14 Idem.


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enhance its disease surveillance and response systems15, thereby also contributing to the regions ability to respond to epidemics and emergencies. REDISSE II was approved on March 2, 2017; became effective in July 27, 2017, and the anticipated closing date is August 31, 2023. The project development objectives (PDO) are: (i) to strengthen national and regional cross-sectoral capacity for collaborative disease surveillance and epidemic preparedness in West Africa; and (ii) in the event of an eligible crisis or emergency, to provide immediate and effective response to said eligible crisis or emergency. In Liberia, REDISSE is implemented within the One Health approach to ensure that the human-animal-environment interface is addressed in strengthening Liberia’s disease surveillance systems. This has seen Liberia lead on innovations to enhance the modalities of implementation of the One Health approach by working across sectors and establishing an active, functional regional One Health platform. Liberia has also developed a National Action Plan for Health Security (NAPHS) and conducted a partner mapping exercise to support an integrated approach to financing One health activities. The new project is being designed to complement the ongoing REDISSE project. The proposed project focuses primarily on the GOL’s efforts to respond to the current COVID-19 pandemic, while REDISSE II continues to address issues related to sustainability, and One health. 12. Despite these efforts, serious weaknesses remain, and Liberia is not prepared to respond to COVID-19. Respiratory diseases, like SARs, MERS, and COVID-19, are not part of Liberia’s active surveillance. Therefore, early identification in communities and health facilities, compliance with infection prevention and control measures, contact tracing, and good hygiene practices remain major challenges. Liberia’s overall state of preparedness has been assessed as moderate (67 percent) across nine technical domains (Table 2). Moreover, Liberia continues to have one of the weakest health systems in the world. This is evident from the severe shortage of human and financial resources (2016 per capita health spending: US$68.3)16, limited institutional capacity and infrastructure, weak health information systems, and critical gaps in the availability of essential inputs including drugs, equipment and medical supplies. A COVID-19 is likely to further strain the already fragile health system and reverse gains made in the health sector specifically, and Liberia more generally.

Table 2: Liberia COVID-19 Readiness Status

Category Average National Score (percent) Last National Score Category

Coordination 90.00 Adequate

Logistics 85.00 Adequate

Points of Entry 80.00 Moderate

Laboratory capacity 73.33 Moderate

Risk communication and community engagement

70.00 Moderate

Overall 66.82 Moderate

Case management 66.67 Moderate

Rapid Response Teams (RRT) 65.00 Moderate

Surveillance 53.33 Moderate

Infection Prevention and Control 36.67 Moderate

15 The World Banks Regional Disease Surveillance Systems Enhancement Program (REDISSE) – Phase 2 (P159040) supports efforts to

enhance regional disease surveillance and response systems in West Africa, notably Liberia, Nigeria, Guinea-Bissau and Togo. 16 Much lower than the US$86 per capita needed to provide a comprehensive primary healthcare package needed to move the country towards UHC.


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13. Lessons learned from past epidemics are insufficient but have informed the design of the proposed project. In the past, Liberia has suffered deeply of various epidemics of variable magnitude (e.g., Lassa fever, meningitis, measles, yellow fever). The country also experienced the one of the worst in crises during Ebola Virus Disease (EVD) epidemic. In accordance with the requirements of the International Health Regulations (IHR), due to the Ebola context, high level entry points have been identified in Liberia. These entry points are characterized by the lack of suitable infrastructure and equipment (e.g., thermal cameras, thermo flash), lack of human resources, poorly qualified and poorly motivated personnel, all within the specific framework of COVID-19. Regarding the establishment of International Health Regulations (IHR) within the framework of COVID-19, Liberia benefited from the existing framework in the context of the outbreak of the Ebola virus disease (EVD) epidemic in West Africa in 2014. Liberia has also benefited from the REDISSE II project which is designed to strengthen disease surveillance, preparedness and response. These experiences will greatly enhance Liberia capacity to respond to COVID-19 pandemic and hopefully mitigate the high cost on human life.

C. Relevance to Higher Level Objectives 14. The project is aligned with World Bank Group’s (WBG) strategic priorities, particularly the WBG’s mission to end extreme poverty and boost shared prosperity. The project’s focus on preparedness is critical to countries achieving Universal Health Coverage. It is aligned with the WBG’s support for national plans and global commitments to strengthen pandemic preparedness through three key actions under preparedness: (i) improving national preparedness plans including organizational structures of the government; (ii) promoting adherence to the IHR; and (iii) utilizing international frameworks for monitoring and evaluation of IHR. The economic rationale for investing in the MPA interventions is strong, given that success can reduce the economic burden suffered both by individuals and countries. The project complements both WBG and development partner investments in health systems strengthening, disease control and surveillance, attention to changing individual and institutional behavior, and citizen engagement. Further, as part of the proposed IDA19 commitments, the WBG is committed to “support at least 25 IDA countries to implement pandemic preparedness plans through interventions (including strengthening institutional capacity, technical assistance, lending, and investment).” The project contributes to the implementation of IHR (2005), Integrated Disease Surveillance and Response (IDSR), and the OIE international standards, the Global Health Security Agenda, the Paris Climate Agreement, the attainment of UHC and the Sustainable Development Goals (SDG), and the promotion of a One Health approach. The project will also be sure to address risks related to gender-based violence (GBV) and preventing sexual exploitation and abuse (SEA) during project design and implementation. 15. The WBG remains committed to providing a fast and flexible response to the COVID-19 epidemic, utilizing all WBG operational and policy instruments, and working in close partnership with government and other agencies. Grounded in One-Health, which provides for an integrated approach across sectors and disciplines, the proposed WBG response to COVID-19 will include emergency financing, policy advice, and technical assistance, building on existing instruments to support IDA/IBRD-eligible countries in addressing the health sector and broader development impacts of COVID-19. The WBG COVID-19 response will be anchored in the WHO’s COVID-19 global Strategic Preparedness and Response Plan (SPRP) outlining the public health measures for all countries to prepare for and respond to COVID-19 and sustain their efforts to prevent future outbreaks of emerging infectious diseases.


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IV. PROJECT DESCRIPTION

16. The Project objectives are aligned to the results chain of the COVID-19 Strategic Preparedness and Response Program (SPRP). 17. The proposed project intends to fill critical gaps in implementing the GOL’s COVID-19 master Plan, including strengthening prevention activities, rapid detection, preparedness, and response to the COVID-19 outbreak. The budget will be utilized within 24 months to enhance response activities for COVID-19 and provide residence to the health system both at the national and county level. The project’s objectives and design are in line with the request from the Ministry of Finance and Development Planning for Liberia for the COVID-19 project. In addition, climate change adaptation and mitigation measures will be incorporated throughout the sub-components, as applicable, and gender issues will be addressed as necessary.

A. Project Development Objective

18. The PDO statement: To prepare and respond to the COVID-19 pandemic in Liberia.

19. The specific objectives that the project will support include: To (i) mitigate and contain the transmission of COVID-19; (ii) ensure adequate management of severe COVID-19 disease; (iii) strengthen the laboratory network systems for COVID-19 detection; (iv) provide humanitarian and social support to healthcare workers and families affected by COVID-19; (v) strengthen project management and coordination, including partnerships for COVID-19 Response. 20. These objectives fully align with the overall goal of the GOL’s COVID-19 Master Plan, which is to mitigate and contain the spread of COVID-19 in Liberia. 21. PDO level indicators: The PDO will be monitored through the following PDO level indicators:

• Country has activated its public health Emergency Operations Center or a coordination mechanism for COVID-19;

• Number of cases of COVID-19 reported and investigated based on national guidelines, disaggregated by gender;

• Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents;

• Percentage of acute health care facilities with isolation capacities.

• Percentage of counties with pandemic preparedness and response plans per MOH guidelines;

• Percentage of facilities with healthcare works trained in COVID-19 emergency preparedness and other emergency response;

• Country has developed and operationalized a referral system to care for COVID-19 patients (Yes/No)


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22. Theory of change

B. Project Components

23. The Liberia COVID-19 response project falls within the MPA Fast-Track Facility. The proposed project will support the implementation of the ten thematic pillars of the GOL’s COVID-19 Plan17, as presented on March 20, 2020. This plan has seen several additions from the first iteration on February 2020 to date and is complementary to areas supported by the REDISSE II project and the contingency emergency response component of the REDISSE II (Table 3).

Table 3: World Bank Financing of the Government of Liberia Response, expressed in Million US$ Activity Financing projects

CERC component of REDISSE II

REDISSE II COVID-19 Emergency Response project

Total Percentage of contribution

Thematic pillar of the GOL’s plan addressed by financing

Surveillance and strengthening of information systems

0.5 0.42 0.8 1.7 10.11 Pillars I, III, IV, VIII

Strengthening laboratory capacity

1.0 0.16 1.0 2.1 12.40 Pillar VI

Preparedness and 1.7 0.24 1.0 2.9 17.28 Pillar I,III, X

17 Ten thematic pillars of GOL’s COVID-19 Plan: (I) Coordination (command and control and continuity of operations, EOC, official communication, Finance, HR); (II) Case management (including isolation, referral); (III) Point of Entry (including cross border surveillance); (IV) epidemiology/surveillance; (V) Health promotion and communication (community engagement, risk communication, social mobilization; (VI) Laboratories; (VII) WASH/Dead body management; (VIII) Infection Prevention & Control; (IX) Supply Chain and logistics; (X) Rapid Response Team.


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emergency response

Human resource management for effective disease surveillance and epidemic

2.0 0.00 1.0 3.0 17.34 Pillar I

Institutional capacity building, project management, coordination, and advocacy

2.9 0.11 0.8 3.8 22.10 Pillar V

Case management 0.0 0.37 2.0 2.4 13.93 Pillar II, VII, IX

Risk communication and advocacy

0.0 0.21 1.0 1.2 6.82 Pillar V

Total 8.0 1.51 7.5 17.0 100.00

24. The proposed project has five main components: Component 1: Emergency Preparedness Response (US$1.0 Million) 25. This component would provide immediate support to Liberia to prepare and respond to COVID-19 importation and local transmission of cases through containment strategies and provision. 26. Subcomponent 1.1: Support to National and Sub-national, Preparedness and Response ($0.3M). This subcomponent will contribute to financing of: (i) activities needed to support relevant sectors jointly develop standard operating procedures (SOPs), coordinate and implement the Liberian COVID-19 preparedness and response plan such as stakeholder coordination meetings, development of counties contingency plans, development of Points of Entry (PoE) contingency plans and activities, conduct simulation exercise and training of rapid response teams; (ii) activities that enhance country health system capacities for the management of disaster recovery priorities such as support for county cross boarder actions plans, and support for both operations and after action reviews. The capacity for the integration of community-center emergency care into the broader healthcare system will be increased through support of community emergency care. 27. Sub-component 1.2: Support for case detection, confirmation, contact tracing, recording and reporting ($0.6M). This subcomponent will support costs related to: (i) the training and equipping point of entry (PoE) staff, contact tracers, Community Health Assistants/hygiene promoters and Community Animal Health Workers to support cross border surveillance, community surveillance/case detection and reporting at PoE; (ii) training and equipping of frontline health care workers in infection prevention, and control (IPC) (iii) strengthening of disease detection capacities through the provision of technical expertise to ensure prompt case finding and contact tracing, consistent with WHO guidelines in the Strategic Response Plan; (iv) strengthening of emergency operations centers (EOCs) and support for (v) epidemiological investigations, cross border information sharing and coordination, and strengthening of risk assessments. 28. Subcomponent 1.3 Support to the surveillance system to facilitate recording and on-time virtual sharing of information ($0.1M). This subcomponent will contribute to financing of: (i) the roll out of the electronic data management system activities; (ii) training of data monitors; (iii) supervision of data collection at different levels of the response. This will complement the ongoing activities being rolled out through REDISSE


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II related to the strengthening the electronic Infectious Diseases Reporting System (IDSR). This will also support reporting mechanisms. Component 2: Supporting Preparedness through Laboratory System Strengthening (US$ 1.0 Million):

29. This component would support activities to strengthen disease surveillance systems in public health laboratories and epidemiological capacity for early detection and confirmation of cases. This components will finance the: (i) strengthening of the sample transfer system at a national and county level; (ii) establishment of two satellite laboratories in prioritized counties to support the National Reference Laboratory (NRL), and ensure that the links between NRL and satellite laboratories are strengthened; (iii) training of laboratory staff and support laboratory surge capacity; (iv) procurement of laboratory equipment, consumables and laboratory tests (including COVID-19 testing kits). Component 3: Case Management and Clinical Care (US$ 3.0 Million). 30. As COVID-19 would place a substantial burden on inpatient and outpatient health care services, this component would finance the strengthening of public health services to increase the capacity of the public health system for the response to COVID-19. 31. Subcomponent 3.1: Strengthening of health facilities and service delivery ($1.2M): This subcomponent will support financing of rehabilitation and equipping of prioritized primary health care facilities and hospitals in high transmission areas for the delivery of critical medical services. Moreover, it will increase the availability of isolation rooms, ambulatory areas for screening and address the immediate health system needs for medical supplies and medical equipment to treat severe cases of COVID-19. It will support promoting the use of climate smart technologies including the use of solar power where possible. The subcomponent will support the development of increased hospital bed availability through the repurposing of available bed capacity and ward space. This sub-component will also contribute financing to: (i) the development of intra-hospital infection control measures, (ii) as part of clinical care, it will support necessary improvements for water and oxygen management at selected health facilities to ensure safe water and basic sanitation. The subcomponent will also finance procurement of electric generators and WASH in health facilities and (iv) strengthening of medical waste management and disposal systems. Considerations will always be given to the procurement and mobilization of energy efficient equipment. Moreover, it will support the strengthening of clinical care capacity through the financing of plans for establishing specialized units in selected hospitals, treatment guidelines, clinical training of health workers, and hospital infection control guidelines. The project will also support more stringent triage for admission, and earlier discharge with follow-up by home health care personnel. 32. Subcomponent 3.2: Strengthening of the human resource surge ($1.0.M). This subcomponent will support costs related to the mobilization of additional health personal to support the surge response, training, and provision of hazard/indemnity payments and standardized health and life insurance for those directly involved in surveillance and case management, consistent with the government’s applicable policies. This subcomponent will also support activities aimed at minimizing risks for patients and health personnel, including training of health facilities staff and front-line workers on risk mitigation measures, and providing them with the appropriate protective equipment and hygiene materials, including personal protective equipment (PPE) kits. This component will also support for psycho-social activities as part of comprehensive response to care for COVID-19 affected patients and their families.


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33.. Subcomponent 3.3: Logistics and emergency ambulance services ($0.8M): This sub-component will cover costs related to logistics for COVID-19 management, and the procurement of ambulance services or ambulances as the case maybe for transportation of COVID-19 patients. This will also support dead body management. Component 4: Community Engagement, Risk Communication, and Advocacy (US$ 1.75 Million): 34. Subcomponent 4.1 Community engagement ($0.8M): This component remains one of the key pillars for both mitigation and containment of the COVID-19 epidemic. Support will be provided to develop systems for community-based disease surveillance and multi-stakeholder engagement. This component would support rebuilding community and citizen trust that can be eroded during crises, through engagement with local traditional leaders, political and religious leaders. The project would support training for animal health workers, extension professionals, and paraprofessionals who would receive hands-on training in the detection of clinical signs of COVID-19. The project would also provide basic biosecurity equipment such as sprayers and protective equipment. This component will also support the procurement of IPC materials and kits.

35. Subcomponent 4.2: Risk communication and advocacy (US$ 0.475 Million): This subcomponent will finance activities including, but not limited to: developing and testing messages and materials to be used in the COVID-19 disease outbreak, and further enhancing infrastructures to disseminate information from national to counties and local levels, and between the public and private sectors. Communication activities would include support for cost-effective and sustainable methods such as marketing of “handwashing” through various communication channels via mass media, counseling, schools, and workplaces. Risk engagement for awareness of social distancing measures, seen as an effective way to prevent contracting the COVID-19, as well as risk communication training of county education officers and superintendents, will be supported for implementation to impact on immediate term responses. Support will also be provided for information and communication activities to increase the attention and commitment of government, private sector, and civil society, and to raise awareness, knowledge, and understanding among the general population about the risk and potential impact of the COVID-19 pandemic and to develop multi-sectoral strategies to address it. 36. Subcomponent 4. 3: Social and community support ($0.475M): While understanding that this would be a challenging area to support effectively, this project will support activities that relieve the impact of COVID-19 on communities. This subcomponent will provide social support activities, including mechanisms to eliminate financial barriers for families who seek and utilize needed health services. Moreover, under this component, the provision of food and basic supplies to quarantined populations in isolation, treatment, and precautionary observation centers will be supported. Given the nature of COVID-19 disease, all suspected and patients undertreatment are regarded high risk. Given the negative impact of the disease on families and the economy, the onus is on government to ensue those that are in isolation centers, quarantine and treatments centers are supported adequately in terms of food and psychosocial counselling. The component as case maybe support the provision of a discharge package for patients from COVID-19 treatment centers. The project seeks an authorization for food expenditures from IDA financing to support vulnerable people that are affected by COVID-19 be provided with food package and or as case may be provided with resources to purchase food.


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Component 5: Project Management and Coordination, Monitoring and Evaluation (US$ 0.75 Million) 37. Subcomponent 5.1. Project Management ($0.375M). The project will provide support for the strengthening of public structures for the coordination and management of the GOL’s project coordination efforts. Existing coordination structures operating through the REDISSE II Project will be utilized to ensure the project is ready at effectiveness. The current REDISSE II project implementing unit (PIU) structure will be strengthened through the recruitment of additional staff/consultants responsible for overall administration, procurement, and financial management. To this end, this subcomponent will finance the activities that support project coordination. The project will support the following activities under this project management strengthen the capacities of national institutions to efficiently perform core project management functions including operational planning, financial management, procurement arrangements, and environmental and social safeguards policies, in accordance with the WGB guidelines and procedures 38. Subcomponent 5.2. Monitoring and Evaluation (M&E) ($0.375M). The project will work to strengthen the existing M&E arrangements under the REDISSE II Project. The project will support the monitoring and evaluation of prevention and preparedness. Specific activities will include, but not limited to; building capacity for clinical and public health research, including veterinary, and joint-learning across and within countries, training in participatory monitoring and evaluation at all administrative levels, evaluation workshops, and development of an action plan for M&E and replication of successful models

C. Project Beneficiaries

39. The Governments Strategic Pandemic Preparedness and Response Plan is expected to benefit the entire 4.5 million population of Liberia by directing efforts towards the prevention, control and slowing down of the spread of the outbreak, and by providing critical health care services needed by the infected populations. The project is especially expected to benefit COVID-19 infected people, specific at-risk populations (e.g. the elderly and people with chronic conditions), medical and emergency personnel, medical and testing facilities, and public health agencies engaged in the response in participating counties. This project also strengthens the public health care network for future health emergencies and care provision, which is expected to benefit the poor and vulnerable populations who rely solely on the Ministry of Health (MOH) services for their healthcare.

V. IMPLEMENTATION ARRANGEMENTS

VI.

VII. A. Institutional and Implementation Arrangements 40. The MOH, working through the NPHIL will be the responsible implementing agency for the project. The institutional arrangements will the same as for the ongoing Regional Disease Surveillance Systems Enhancement Project Phase II (P159040) (REDISSE II Project. The REDISSE II project is technically implemented by the NPHIL, under the oversight of the MOH. The Minister of Health chairs the national steering committee of REDISSE II. The PIU – established within the MOH – manages the entire Bank health sector portfolio in Liberia, including the REDISSE II project. The PIU includes designated Technical Coordinators under different Bank health projects including for REDISSE II. The REDISSE II project coordinator manages PIU specifically for REDISSE II. The REDISSE II PIU will also manage the proposed project on COVID-19; however, the project will have a provision to strengthen all areas of the PIU in line with the increased need arising from inclusion of COVID--19


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implementation (expanded mandate). These include specific domains, such as procurement, financial management, environmental and social safeguard officers, monitoring & evaluation, and other technical advisors/consultants as required. The additional consultants/advisors will be used for strengthening the MOH/PCU procurement unit functions and not specifically for the project activities. As part of the enhanced implementation in view of the government limited capacities stretched by the COVID-9 pandemic it may enter into cooperating agreements with UN agencies, bilateral and local civic authorities to perform specific functions in line with their comparative advantages.

41. The guiding document for the project will be a Project Implementation Manual (PIM). A PIM will be developed and approved within 30 days, including standard project fiduciary, safeguard, implementation, and M&E requirements environmental and social safeguards. A reviewed detailed project implementation plan in line with Government approved action plan will be approved by the Bank for project implementation.

42 Funds flow and accountabilities for financial reporting. The current structure operating under the REDISSE II project will be utilized after making a few changes to accommodate the COVID-19 emergency, for flexibility the Designated Account (DA) will be moved to a commercial bank (GT Bank). The current DA in Central Bank of Liberia (CBL) will be closed. However, the PIU and PFMU is responsible for submitting a quarterly interim unaudited financial reports (IFR), starting from the first quarter following the project’s first disbursement to the WBG no later than 45 days after first quarter.

B. Results Monitoring and Evaluation Arrangements 43. The existing PIU at MOH, working through the NPHIL, and the Ministry of Finance and Development Planning will be responsible for implementing the project and its functions, which will include but is not limited to: (i) collecting and compiling all data relating to their specific suite of indicators; (ii) evaluating results; (iii) interacting with partners and other stakeholders in ensuring coordination in the implementation of COVID-19; and (iv) strengthening the link between current COVID-19 actions with the REDISSE II project for program sustainability. The current functional structure for REDISSE II will be retained to ensure project readiness and complementarity of actions. 44. Large volumes of personal data, personally identifiable information and sensitive data are likely to be collected and used in connection with the management of the COVID-19 outbreak under circumstances where measures to ensure the legitimate, appropriate and proportionate use and processing of that data may not feature in national law or data governance regulations, or be routinely collected and managed in health information systems. In order to guard against abuse of that data, the Project will incorporate best international practices for dealing with such data in such circumstances. Such measures may include, by way of example, data minimization (collecting only data that is necessary for the purpose); data accuracy (correct or erase data that are not necessary or are inaccurate), use limitations (data are only used for legitimate and related purposes), data retention (retain data only for as long as they are necessary), informing data subjects of use and processing of data, and allowing data subjects the opportunity to correct information about them, etc. In practical terms, operations will ensure that these principles apply through assessments of existing or development of new data governance mechanisms and data standards for emergency and routine healthcare, data sharing protocols, rules or regulations, revision of relevant regulations, training, sharing of global experience, unique identifiers for health system clients, strengthening of health information systems, etc


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C. Sustainability 45. The sustainability of the project is embedded within the country REDISEE II project. The project has both medium, and medium-to-long-term outcomes, which will see Liberia strengthen its capacity in emergency preparedness and response. In addition, most of the core actions on facility renovation and procurement of equipment will ensure that the system remains resilient and functional post-COVID-19. 46. The focus of some of the project activities on training and capacity building will further enhance the sustainability of the project. It will leverage and further strengthen REDISSE II investments in transitioning key accountabilities and systems to ensure the NPHIL capacity as a national institution for emergency preparedness, and response is strengthened.

VIII. PROJECT APPRAISAL SUMMARY

A. Technical, Economic and Financial Analysis (if applicable)

47. Technical analysis: The GOL’s COVID-19 strategic preparedness and response plan is aligned with the technical recommendations of the WHO’s COVID-19 Plan (developed in February 2020) and the World Bank’s COVID-19 SPRP, developed in March 2020. As determined by WHO, there are five important stages for successfully addressing epidemics: first is the anticipation of new and re-emerging diseases to facilitate faster

detection and response, followed by their early detection of emergency in the second stage.18 The third stage is the containment of the disease at its early stages of transmission, followed by the control and mitigation of the epidemic during its amplification (the fourth stage), and fifth is the elimination of the outbreak risk or eradication. The first two stages have passed for COVID-19, but for countries like Liberia where the epidemic is still in its early stages, it is critical to focus intensively on the third stage of containment, as well as the fourth stage of control and mitigation. The GOL’s Plan focuses on critical activities that are relevant for these third and fourth stages of epidemic control.

48. Economic and Financial: The project supports of a one health approach for preparedness, and response to public health threats is highly cost-effective. For instance, according to a World Bank estimation, annual investments of US$ 1.9-3.4 billion in low- and middle-income countries for effective disease control via one health approach would yield as much as $37 billion in savings from reduced epidemics and pandemics – a net win of about $34 billion annually. By applying a one health approach, risk-based surveillance can be dramatically improved and EIDs more effectively controlled early on.

49. Although there are very significant gaps in knowledge of the scope and features of the COVID-19 pandemic. It is apparent that one main set of economic effects will derive from increased sickness and death among humans and the impact this will have on the potential output of the global economy. In the Spanish Influenza pandemic (1918-l 9), 50 million people died -about 2.5% of the then global population of 1.8 billion. The most direct impact would be through the impact of increased illness and mortality on the size and productivity of the world labor force. The loss of productivity as a result of illness, which, even in normal influenza episodes, is estimated to be ten times as large as all other costs combined will be quite significant. 50. Another significant set of economic impacts will result from the uncoordinated efforts of private

18 See “Managing Epidemics: Key Facts About Major Deadly Diseases.” WHO, 2018.


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individuals to avoid becoming infected or to survive the results of infection. The SARS outbreak of 2003 provides a good example. The number of deaths due to SARS was estimated at “only” 800 deaths, and it resulted in economic losses of about 0.5 percent of annual GDP for the entire East Asia region, concentrated in the second quarter. The measures that people took resulted in a severe demand shock for services sectors such as tourism, mass transportation, retail sales, and increased business costs due to workplace absenteeism, disruption of production processes and shifts to more costly procedures. Prompt and transparent public information policy can reduce economic losses. 51. A last set of economic impacts are those associated with governments’ policy efforts to prevent the epidemic, contain it, and mitigate its harmful effects on the population. These policy actions can be oriented to the short, medium or long-term or, in spatial terms to the national, regional or global levels.

B. Fiduciary

(i) Financial Management

52. The FM arrangements will be based on the existing arrangements under the PFMU, which is implementing 90 percent of the World Bank and other donor-financed projects in Liberia. The PFMU is comprised of 24 staff headed by the director who is a Chartered Accountant, and all PFMU staff are familiar with Bank procedures. A restricted FM assessment of the Project Financial Management Unit (PFMU) concluded that the control risk is assessed as ‘Moderate’ and the overall residual FM risk for the project is assessed ‘High’ but reduced to ‘Substantial’ due to the articulated risk mitigating measures. A detailed overview of the assessment findings and proposed risk mitigation measures, including among others: an external auditing by an independent qualified auditor. The new project will need to be accommodated within the existing FM system. To do this, the PFMU will need to: (a) update the current accounting manual, (b) customize the existing accounting software to include the account of the new project in order to generate the IFRs and financial statement, (C) Engaging General Auditing Commissions (GAC), this should be completed within six months of the project becoming effective. These arrangements were deemed adequate to ensure: (a) timely reporting of project activities, (b) the safeguarding of project assets, and (c) the strength of internal controls despite considering them to be high with reasonable mitigation measures.

The project will have a retroactive financing on activities that are agreed to by The Bank for equivalent of up to 40 percent value of the project funds. The retroactive date is February 12, 2020. All expenditure for retroactive finance will go through all the fiduciary arrangements. A full FM is in annex 1 of the PAD

(ii) Procurement

53. Procurement. Procurement under the project will be carried out in accordance with the World Bank’s Procurement Regulations for IPF Borrowers for Goods, Works, Non-Consulting, and Consulting Services, dated July 1, 2016 (revised in November 2017 and August 2018). The Project will be subject to the World Bank’s Anticorruption Guidelines, dated October 15, 2006, revised in January 2011, and as of July 1, 2016. The Project will use the Systematic Tracking of Exchanges in Procurement (STEP) to plan, record, and track procurement


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transactions.

54. The major procurement activities will involve the purchase of medical supplies, drugs, and equipment, capacity building and training, community outreach, establishment of quarantine centers and refurbishment of medical facilities, establishment of call centers and support to the project implementation and monitoring. A procurement plan for the first three months will be developed with the Borrower and will be updated during implementation as required to reflect actual project implementation needs and improvements in institutional capacity. Finalization of a streamlined Project Procurement Strategy for Development (PPSD) has been deferred to the implementation phase. Streamlined procedures for approval of emergency procurement and decision making by the Borrower have been agreed and these will be monitored during Implementation Support Missions and during Procurement Post Review exercises, which will cover 20% of the contracts. No Prior Review contracts are envisaged under the project.

55. A fast-track emergency procurement approach will be adopted for the required goods, works, and consulting services. Key measures to fast track procurement include use of simplified procurement and selection methods; procurement of off-the-shelf standard goods where applicable; use of existing framework agreements and new framework agreements, UN Agencies, procurement agents, force account; increased thresholds for RFQ, etc. The Bank will provide Hands-on Expanded Implementation Support, on request, to assist the Borrower to expedite procurement implement.

56. Bid Securing Declaration may be used instead of the bid security. Performance Security may not be required for small contracts. Advance payment may be increased to 40% while secured with the advance payment guarantee. The time for submission of bids/proposal can be shortened to 15 days in competitive national and international procedures, and to 3-5 days for the Request for Quotations depending on the value and complexity of the requested scope of bid. 57. Procurement implementation will be undertaken by MOH. The Procurement Unit of MOH will be responsible for the procurement processes. The Health Infrastructure Directorate of NPHIL and MOH will provide technical input and support for diagnostics and procurement of laboratory and medical supplies and equipment. The MOH Infrastructure Unit and NPHIL will also provide technical inputs for the procurement of equipment and works and manage contract implementation. 58. If the GoL/NPHIL so requests, the Bank may consider supporting the MoH and/or NPHIL in the procurement of the initial needs of the medical equipment and supplies through HEIS (Hands-on Expanded Support). 59. The major risks to procurement are: (a) slow procurement processing and decision making with potential implementation delays; and (b) poor contract management system with potential time and cost overrun and poor-quality deliverable; and (c) lack of familiarity in dealing with such a novel epidemic. To mitigate these risks the following actions are recommended: (a) maintaining accountability for following the expedited approval processes for emergency; and (b) assigning staff with responsibility of managing each contract. To strengthen the procurement capacity of MoH, the agency will recruit additional procurement officers to strengthen the capacity of the procurement unit. To prevent delays and disruption in payments, disbursement of Bank financing shall be made through the Direct Payment disbursement method, unless a Special Commitment disbursement method has been selected.


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60. These risks are elevated by the global nature of the COVID-19 outbreak, which creates shortages of supplies and necessary services. This may result in increased prices and cost. The Bank’ Team will monitor and support implementation to agree with implementing agencies on reasonableness of the procurement approaches and obtained outcomes considering the available market response and needs. 61. Various industries are feeling the impact of COVID-19, especially the construction industry that subsequently impacts the procurement process and implementation of the contracts. To deal with potential procurement delays because of the spreading of COVID-19, the Bank will support the implementing agencies in applying any procedural flexibilities (e.g. bids submitted by an authorized third party, exertion bid submission dates, advising the borrower on the applicability of force majeure, etc.). The procurement risk is High. 62. The Bank’s oversight of procurement will be done through increased implementation support, and increased procurement post review based on a 20% sample while the Bank’s prior review will not apply .

C. Legal Operational Policies

. . . Triggered?

Projects on International Waterways OP 7.50 No

Projects in Disputed Areas OP 7.60 No .

D. Environmental and Social Standards

63. This appraisal ESRS has been prepared for the emergency COVID project hence the exact

locations and specific implementation of the separate components are not known currently. However, there

are potential environmental and social risks that may occur due to the project activities. Environmental risks of

the project include (i) occupational health and safety (OHS) issues related to testing and handling of supplies

and the possibility that they are not safely used by laboratory technicians and medical crews; and (ii) medical

waste (biological and chemical) management and community health and safety issues related to the handling,

transportation and disposal of healthcare waste. The main OHS risk is that health care workers and other staff

testing and treating COVID19 patients will become infected themselves because the project cannot contain its

spread, they have insufficient PPE, lack adequate training, are too overwhelmed to take the necessary protective

measures, etc. Since the project also includes construction and rehabilitation of facilities such as laboratories

and quarantine centers, construction phase impacts in terms of use of raw materials, workers and community

OHS, environmental impacts from labor camp are also relevant. To mitigate these risks the MOH will update

the existing Environmental and Social Management Framework (ESMF) prepared for the ongoing WB–funded

Regional Disease Surveillance Systems Enhancement Project (P159040), and the Medical Waste Management

Plan (MWMP) prepared under the Ebola Emergency Response Project (162359). In addition to the ESMF and

MWMP, the MOH will implement all activities agreed in the Environmental and Social Commitment Plan (ESCP).


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64. The main social risks are: (i) exclusion of vulnerable people from the treatment or referral service; (ii)

potential GBV incident in quarantine facilities; ( iii) health workers exposure to COVID-19; (iv) COVID-19

transmission due to negligence and poor hospital and quarantine facilities; (vi) lack of basic food provision to

patient and people who are quarantined; (vii) social trauma, stigmatization and potential for making affected

groups outcast; (viii) communication breakdown and potential for social tension; and (ix) potential risk of forced

land acquisition and property for construction of facilities

65. Climate and Disaster Risk Screening and Climate Co-Benefits. This project has been screened for climate

risk and assessed as being at ‘medium’ risk, based on the exposure and vulnerability risks assessed to be moderate.

66. Exposure: This project has been assessed for climate and disaster risk and assessed as being ‘moderate’

due to exposure of the project location and target beneficiaries to the climate, and geophysical hazards of extreme

precipitation and flooding has been. While being highest along the coast, the southern areas of Liberia receive rain

year-round, whilst the rest of the country experiences two rainy seasons. The average annual rainfall exceeds 2,500

mm. Annually, the heavy rainfall significantly affects the poor infrastructure, including roads in the country. As a

result of which, the access to health services to the population becomes limited, often severely, during the wet

months. Liberia’s infrastructure is highly vulnerable to climate change, and annual damage to the road network

from rainfall and flooding alone could equal as much as 40 percent of GDP by 2030.19 Liberia’s pervasive poverty

and dependence on environmentally sensitive sectors exacerbate its vulnerability to climate change. An increase

in the frequency and severity of extreme weather events would inflict a heavy toll on human lives and welfare

while damaging the country’s scarce and valuable capital, and the poorest households and communities will be hit

hardest, as income and health shocks will drive them deeper into poverty.

67. Vulnerability: The identified exposures to climate and disaster risks described above could affect the

project’s target population, and the vulnerability of this impacting project activities has hence been assessed to

be ‘moderate.’ While the entire population of the country is climate-vulnerable, women and children, whom this

project targets have been identified as a particularly climate-vulnerable group since they are both very dependent

on utilizing health services as well as vulnerable to many climate-related health outcomes in particular water-borne

diseases such as diarrhea, nutritional vulnerabilities and also being less able to travel quickly in times of extreme

weather impacts such as flooding. During the heavy monsoon and flooding seasons, access to health services and

facilities becomes difficult and restricted, disproportionately affecting some of the most climate-vulnerable groups

such as women and children. The flooding and heavy rains also contribute to the increased incidence of water-

borne and vector-borne diseases, including Lassa Fever. Any significant disruptions in transportation and

agriculture due to flooding, and extreme heat, could potentially threaten food security and nutrition available to

the remote communities, particularly the vulnerable under-five children and pregnant and lactating mothers. The

whole population of Liberia is very climate-vulnerable due to chronically poor access to healthcare services

compounded by poverty and poor infrastructure.

68. This project includes climate-smart adaptation and mitigation activities, which is described under the

project components section of the pad.

19 Koi’s et al. (2019) “A Global Multi-Hazard Risk Analysis of Road and Railway Infrastructure Assets.” Nature Communications.


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69. Citizen engagement: The Project will emphasize citizen engagement aspects, building on mechanisms

supported by other WB Projects in the health sector.18 Measures will include: (i) a grievance redress mechanism,

including a toll-free number to provide feedback and register complaints, with stipulated service standards for

response times; and (ii) a live chat under the webpage of the Plan, contact details for information, as well as online

assistance for early diagnosis and quarantining advice.

70. Gender. As mentioned above, the implementation of the Project’s activities will take gender

considerations into account as needed. These include: (i) tailored mass media messaging incorporating gender

considerations; and (ii) female participation in training activities as well as female representation in emergency

management groups and decision-making committees. In addition, project indicators will be disaggregated by

gender, when feasible.

IX. GRIEVANCE REDRESS SERVICES

71. Communities and individuals who believe that they are adversely affected by a World Bank supported

project may submit complaints to existing project-level grievance redress mechanisms or the Bank’s Grievance

Redress Service (GRS). The GRS ensures that complaints received are promptly reviewed in order to address

project-related concerns. Project affected communities and individuals may submit their complaint to the Bank’s

independent Inspection Panel which determines whether harm occurred, or could occur, as a result of Bank non-

compliance with its policies and procedures. Complaints may be submitted at any time after concerns have been

brought directly to the World Bank's attention, and Bank Management has been given an opportunity to

respond. For information on how to submit complaints to the Bank’s corporate Grievance Redress Service (GRS),

please visit: http://www.worldbank.org/en/projects-operations/products-and-services/grievance-redress-service.

For information on how to submit complaints to the World Bank Inspection Panel, please visit

www.inspectionpanel.org.

X. KEY RISKS

The table below highlights the key risk assessment and possible mitigation actions.

INHERENT RISK Assessment of Mitigation measures (indicative)

Relative Risk level

Rias after Mitigation

Political & Governance Inadequate accountability measures to ensure that resources supporting COVID-19 activities reach intended health care facilities and beneficiaries.

Commitment and state of processes to disclose/document funding to support COVID-19 response (e.g., the publication of audit results and achievements, transparency in decision and resource allocation, the extent of stakeholder consultations) Availability of feedback mechanisms to

Substantial

Moderate

http://www.worldbank.org/en/projects-operations/products-and-services/grievance-redress-service

http://www.inspectionpanel.org/


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Low priority given to public accountability and transparency in program management The difficulty of containing the populations of quarantined areas, particularly in food insecure or fragile contexts. Governance challenges in the health and other sectors involved in country responses. Weaknesses in accountability measures to ensure that resources supporting COVID-19 activities reach intended health care facilities and beneficiaries.

confirm that financing has reached intended health care facilities, beneficiaries. The extent to which provision of food supplies and safety equipment, as needed, to the affected populations will be supported. The program would support the implementation of anti-corruption strategies and activities that have been adopted to guide the implementation of the World Bank Group-funded portfolio of projects in participating countries. The program will include incorporating best practice measures for the treatment of such data in operational documents.

Substantial Substantial Substantial Substantial

Moderate Moderate Moderate Moderate

Macroeconomic Reduction in the fiscal capacity of governments due to global economic disruption and slowdown, and potential unavailability of fiscal resources. This would negatively impact public health service delivery with respect to COVID-19 prevention, mitigation, and treatment, in addition to other essential health service delivery.

The extent of government commitment to provide fiscal resources to core COVID-19 and essential health service delivery activities. The program would minimize this risk by supporting critical public health programs, in addition to the COVID-19 response and mitigation effort.

High

Moderate


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Sector policies/strategies National health policies do not provide an adequate enabling environment for COVID-19 emergency response and supported activities (e.g., case detection & reporting, social distancing measures, health system strengthening, communications, multi-sector policy for prevention and preparedness, infrastructure, etc.)

Commitment to supplementary or emergency measures to support COVID-19 emergency response and supported activities, including for prevention, mitigation, treatment, surveillance, and health system strengthening.

High

Moderate

Technical design Intervention activities may not effective in containing the spread of COVID-19, as well as other infectious diseases of animal origin. Lack of timely and predictable access to expert advice and technical support

The COVID-19 Emergency Response project will complement the already existing REDISSE project to further sustain and stretching the already one health platform being supported. This risk would also be mitigated by selecting evidence-based interventions, with robust monitoring and evaluation systems, allowing for modifications and redesign as needed. Supporting project activities that are designed and implemented in partnership with leading multilateral agencies, such as WHO and FAO, regional/sub-regional entities; and bilateral and other donor organizations. The extent of government capacity and commitment to coordinate project activities with efforts undertaken by other international organizations such as WHO, to facilitate access to laboratory and medical care supplies

Moderate

Low


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Inadequate quantity of drugs and other medical inputs needed to address the health needs of the general population during a pandemic Inadequate national M&E to track progress and emerging issues

Will use existing REDISSE procurement mechanism to procure essential inputs. Will utilize already existing systems being used by the REDISSE project and hope to strengthen and sustain the M&E mechanisms.

Moderate Moderate

Low Low

Institutional capacity PIU do not have enough authority, leadership, and capacity to take leading roles in COVID-19 prevention and control. Inadequate institutional capacity to manage the project and perform effectively in Liberia to contain and mitigate the impact of COVID-19 Inadequate capacity for planned surveillance, surveys and monitoring, and evaluation Low-level commitment and engagement at local and community levels means that strong central commitment does not translate into action on the ground

The PIU will be strengthened with increased human resources and leverage on the capacities contained in the MoH technical unit. The project will also ensure adequate training is provided. The project will work within the existing arrangements of the REDISSE project. The implementation arrangements are adequately defined; including the availability of monitoring of leadership. Adequacy of planned capacity building and institutional development for the short and medium terms to help build system resilience. Broader engagement and partnerships to be fostered to support effort Extent of arrangements for technical assistance and partnership between local organizations and international institutions will be provided. M&E plan will include information on instruments for data collection, agencies responsible, and a detailed timetable.

Substantial Substantial Substantial Substantial

Moderate Moderate Moderate Moderate


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Inadequate or lack of multi-sectoral participation

Partners working within the established EOC. Liberia high level of political commitments helping to provide one Government response strategy

Substantial Moderate

Fiduciary Fiduciary: Fiduciary risks are high. The continued engagement of development partners in the PFM area has resulted in an enhanced fiduciary environment in Liberia including improved capacity. However, despite the progress made in improving the fiduciary system, weaknesses remain, including at the CBL and MFDP, that pose risks to the management of public funds. For example, due to weaknesses in the Government’s cash management system and amid a cash flow crunch, some funds from donor project accounts were temporarily used to meet other salary obligations in mid-2019. The GoL has since paid back the funds and, with support from the IMF, cash management and expenditure controls are being strengthened. Furthermore, the capacity of key fiduciary institutions (GAC, LACC, PPCC, FIA) has been weakened over the past twenty months, due to the staff turnover and underfinancing of fiduciary institutions in the context of dwindling fiscal space. This

This risk will be mitigated by using the PFMU and procurement specialist in the PIU, with experience in implementing WB projects, Additionally, the World Bank will provide intensive fiduciary support through staff based in Monrovia. A separate implementation support plan will be developed, before the project is declared effective, to guide the team and will be updated bi-annually. This will be prefaced by a preliminary induction training of the PIU and PFMU staff on how best they can detect project related red flags to be conducted by the INT prevention team. The Project Operational Manual will have a separate chapter focusing on enhanced accountability framework for per diems and allowances, and approval responsibilities will also be developed. The GOL internal audit in MoH in conjunction with the internal auditors in PFMU will be called upon to assist with frequent review of core project activities to ensure controls are working as planned. A project-launch workshop will be undertaken to kick-start proper understanding of roles and responsibilities, and the workshop will be supplemented by continuous training on topical areas to help build capacity. An additional mitigation measure will be that the PIU coordinator will hold monthly meetings with component heads monthly to determine status of implementation of agreed project activities and provide solutions where bottlenecks have been identified to ensure course corrections are designed and implemented as needed to ensure smooth project implementation.

Substantial

Moderate


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has negatively impacted the financial independence of some of these core accountability institutions.

During implementation, enhanced implementation support will be provided by the Bank team to implementing agencies to help them expedite procurement processes.

Environment and Social There is a high/substantial likelihood that exogenous environmental or social risks could adversely affect the achievement of the operation’s objectives or the sustainability of results. The operation is also likely to have significant or potential adverse social impacts on the poor, and/or other vulnerable groups (such as displaced persons and/or refugees) and have the potential to contribute directly to increased social fragility or conflict. These emergency operations will take specific measures to address environmental issues (including explicitly supporting established COVID-19 infection prevention and control guidelines and guidelines for medical waste management)

To mitigate these risks the MOH will update the existing Environmental and Social Management Framework (ESMF) prepared for the ongoing WBG–funded Regional Disease Surveillance Systems Enhancement Project (P159040), and the Medical Waste Management Plan (MWMP) prepared under the Ebola Emergency Response Project (152359). In addition to the ESMF and MWMP, the MOH will implement all activities agreed in the Environmental and Social Commitment Plan (ESCP). To further mitigate the risks and impacts identified, the emergency operation will incorporate specific measures to address environmental and social issues (including explicitly supporting established guidelines for COVID-19 infection prevention and control and for medical waste management in line with established WHO guidelines).

Substantial

Moderate


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. . .

Stakeholders The existence of denial and misinformation associated with COVID-19, in addition to mistrust among the population, which could lead to the rejection of public health interventions and information in some country contexts, contributing to the continued spread of the disease. Controlling the spread of COVID-19 spread may expose the government to criticism for the curtailment of civil rights due to the adoption of quarantines and other related measures

The extent of government and civil society outreach, advocacy, and coalition building to sensitize key groups, including policymakers, the media, and ensure consistent communication. The extent to which the project will support advocacy and coalition building to sensitize key groups, including policymakers, the media, and religious leaders. This will be complemented by carefully designed mass communication campaigns to build support for response and mitigation measures among the wider population.

Moderate Substantial

Low Moderate


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XI. RESULTS FRAMEWORK AND MONITORING

Results Framework COUNTRY: Liberia

Liberia COVID-19 Emergency Response Project Project Development Objective(s)

The development objective is to prepare and respond to the COVID-19 pandemic in Liberia

Project Development Objective Indicators

RESULT_FRAM E_TBL_PD O

Indicator Name DLI Baseline End Target

To prepare and respond to the COVID-19 pandemic in Liberia

Country has activated its Public Health Emergency Operations Center or a coordination mechanism for COVID-19 (Yes/No)

No Yes

Number of suspected cases of COVID-19 reported and investigated based on national guidelines, diagregated by gender (Number)

3.00 50.00

Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents (Number)

1.00 3.00

Number of acute health care facilities with isolation capacities (Number)

2.00 5.00

Percentage of counties with pandemic preparedness and response plans per MOH guidelines (Percentage)

0.00 5.00

Percentage of facilities with healthcare workers trained in 0.00 80.00


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RESULT_FRAM E_TBL_PD O


COVID-19 emergency preparedness and other emergency response (Percentage)

Country has developed and operationalized a referral system to care for COVID-19 patients (Yes/No)

No Yes

PDO Table SPACE

Intermediate Results Indicators by Components

RESULT_FRAM E_TBL_IO


Component 1: Emergency Preparedness Response

Proportion of counties that have activated EOC inline with the national EOC activation as part of COVID-19 response (Percentage)

0.00 80.00

Atleast one multisectoral simulation exercise conducted with results incorporated into national COVID-19 preparedness and response plans (Number)

1.00 3.00

Proportion of counties with EOCs functioning according to standard operating procedures (Percentage) 0.00 80.00

Component 2: Supporting Preparedness through Laboratory System Strengthening

Number of laboratory staff trained to conduct COVID-19 diagnosis (Number) 2.00 10.00

Laboratories established/upgraded to support diagnosis of COVID-19 and other major infectious diseases (Number)

1.00 3.00

Sample transfer system for COVID-19 samples to WHO recommended laboratories developed and operationalized (Yes/No)

No Yes

Component 3: Case Management and Clinical Care


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RESULT_FRAM E_TBL_IO


Treatment and isolation centers renovated and/or developed (Number) 0.00 5.00

Proportion of health centers reporting no stock-out of tracer IPC materials on the first day of each month (Percentage) 0.00 50.00

Incinerators established (Number) 1.00 5.00

Number of health staff trained in case management of COVID-19 and other infectious diseases per MOH-approved protocols (Number)

0.00 200.00

Component 4: Community Engagement, Risk communication and Advocacy

Number of healthcare workers working with COVID-19 patients, who contract the disease (Number) 0.00 10.00

Number of health staff trained in IPC per MOH-approved protocols (Number) 0.00 200.00

Country has reported to have contextualized their risk communication and community engagement strategies (Yes/No) No Yes

COVID-19 sensitization campaigns conducted in all counties (Yes/No) No Yes

Proportion of health centers reporting no stock-out of PPE on the first day of each month (Percentage) 0.00 80.00

Component 5: Project Management and Coordination, Monitoring & Evaluation

Proportion of point of entry that report having received a supervisory visit during the preceding month (Percentage)

0.00 80.00

Number of prioritized facilities reporting supervisory visits on the first day of each month (Number) 0.00 5.00

Number of EOC organized as part of COVID-19 response (Number) 0.00 20.00

IO Table SPACE


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UL Table SPACE

Monitoring & Evaluation Plan: PDO Indicators

Indicator Name Definition/Description Frequency Datasource Methodology for Data Collection

Responsibility for Data Collection

Country has activated its Public Health Emergency Operations Center or a coordination mechanism for COVID-19

This indicators assesses whether the country has activated its Public Health Emergency Operations Center or a coordination mechanism for COVID-19

6-monthly

NPHIL administrative data

Routine monitoring by NPHIL

NPHIL/PIU/MOH

Number of suspected cases of COVID-19 reported and investigated based on national guidelines, diagregated by gender

Cumulative number of suspected COVID-19 suspected cases that are reported and investigated based on national guidelines, disaggregated by gender

Monthly


Routine monitoring by NPHIL

NPHIL/PIU/MOH

Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents

Cumulative number of designated laboratories with diagnostic equipment, test kits and reagents according to WHO guidelines

Quarterly

NPHil administrative data

Routine data collected by NPHIL

NPHIL/PIU/MOH

Number of acute health care facilities with isolation capacities

Cumulative number of designated treatment centers with isolation unit within the facility, trained personnel and equipment

Monthly



NPHIL/PIU/MOH

Percentage of counties with pandemic preparedness and response plans per

Numerator: Number of counties who have

Quarterly

NPHIL administrative


NPHIL/PIU/MOH


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MOH guidelines developed a pandemic preparedness and response plan per MOH guideline ; Denominator: Total number of counties (15)

data

Percentage of facilities with healthcare workers trained in COVID-19 emergency preparedness and other emergency response

Cumulative percentage of facilities with healthcare workers trained in COVID-19 emergency preparedness and other emergency response

Quarterly



NPHIL/PIU/MOH

Country has developed and operationalized a referral system to care for COVID-19 patients

This indicator assesses whether a referral system for the management of COVID-19 cases has been developed and operationalized

Quarterly



NPHIL/PIU/MOH

ME PDO Table SPACE

Monitoring & Evaluation Plan: Intermediate Results Indicators

Indicator Name Definition/Description Frequency Datasource Methodology for Data Collection

Responsibility for Data Collection

Proportion of counties that have activated EOC inline with the national EOC activation as part of COVID-19 response

This indicators assesses the proportion of counties in Liberia who have activated their EOC, inline with the country EOC. The numerator will be the number of counties with activated EOCs and the denominator will be the

Monthly



NPHIL/PIU/MOH


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total number of counties (15)

Atleast one multisectoral simulation exercise conducted with results incorporated into national COVID-19 preparedness and response plans

Table-to simulation exercises are carried out and the findings documented to inform future preparedness and response activities

Quarterly



NPHIL/PUI/MOH

Proportion of counties with EOCs functioning according to standard operating procedures

Numerator: Number of counties with EOCs functioning according to SOP/ Denominator: Total number of EOC

Quarterly



NPHIL/PIU/MOH

Number of laboratory staff trained to conduct COVID-19 diagnosis

Cumulative number of laboratory staff trained to conduct COVID-19 diagnosis

Quarterly



NPHIL/PIU/MOH

Laboratories established/upgraded to support diagnosis of COVID-19 and other major infectious diseases

Cumulative number of laboratories established/upgraded to support diagnosis of COVID-19 and other major infectious diseases

Quarterly

NPHIL Administrative data


NPHIL

Sample transfer system for COVID-19 samples to WHO recommended laboratories developed and operationalized

Development and operationalisation of a sample transfer system for COVID-19 samples to WHO recommended laboratories

Quarterly



NPHIL/PIU/MOH

Treatment and isolation centers renovated and/or developed

Cumulative number of treatment and isolation centers renovated and/or equipped

Quarterly



NPHIL/PIU/MOH


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Proportion of health centers reporting no stock-out of tracer IPC materials on the first day of each month

Numerator: Number of health centers reporting stock-out of tracer infection prevention and control materials (such as detergents and disinfectants, gloves, surgical face masks/shields and safety/sharp boxes) on the first day of each month; / Denominator: total number of health centers nationally

Quarterly



NPHIL/PIU/MOH

Incinerators established Cumulative number of incinerators established

Quarterly



NPHIL/PIU/MOH

Number of health staff trained in case management of COVID-19 and other infectious diseases per MOH-approved protocols

Cumulative number of staff trained in case management of COVID-19 and other infectious diseases

Quarterly



NPHIL/PIU/MOH

Number of healthcare workers working with COVID-19 patients, who contract the disease

Cumulative number of health care workers managing COVID-19 patients contract the virus

Quarterly



NPHIL/PIU/MOH

Number of health staff trained in IPC per MOH-approved protocols

Cumulative number of health staff trained in IPC

Quarterly


Routine data collection by NPHIL

NPHIL/PIU/MOH

Country has reported to have contextualized their risk communication

Context specific risk communication and

Six-monthly

NPHIL administrative


NPHIL/PIU/MOH


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and community engagement strategies community engagement strategies developed

data

COVID-19 sensitization campaigns conducted in all counties

COVID-19 sensitization campaigns conducted in all 15 regions

Quarterly



NPHIL/PIU/MOH

Proportion of health centers reporting no stock-out of PPE on the first day of each month

Numerator : designated health facilities with PPE/ Denominator: All COVID-19 designated health facilities

Quarterly



NPHIL/PIU/MOH

Proportion of point of entry that report having received a supervisory visit during the preceding month

Numerator: Number of point of entry that report having received a supervisory visit during the previous month/ Denominator: Total number of points of entry

Monthly



NPHIL/PIU/MOH

Number of prioritized facilities reporting supervisory visits on the first day of each month

Cumulative number of facilities reporting a supervisory visit on the first day of each month

Monthly



NPHIL/PIU/MOH

Number of EOC organized as part of COVID-19 response

Cumulative number of EOCs organized to discuss COVID-19 response

Quarterly



NPHIL/PIU/MOH

ME IO Table SPACE

.


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COUNTRY: Liberia

Liberia COVID-19 Emergency Response Project

ANNEX 1: Implementation Arrangements and Support Plan

Financial Management

1. The PFMU will continue to be responsible for the day-to-day management of funds and accounting for the World Bank and others in the donor portfolio in Liberia. The project shall use the project’s Financial Procedures Manual already developed for ongoing projects, and it will be brought into the IFMIS system. The PFMU shall be responsible for the project’s financial reporting, using already agreed unaudited IFR formats in use for other projects. The PFMU is adequately staffed with competent finance professionals who have garnered the requisite experience and have qualifications acceptable to the World Bank.

2. The Annual Work Plan and Budget (AWP&B) will be derived from the procurement plan and disbursement plans. It will be updated to reflect implementation progress. The PIU, in consultation with the PFMU, will prepare the AWP&B. The PIU will submit the approved AWP&B to the World Bank for no objection before the end of the financial year.

Accounting and Reporting 3. Project accounts will be maintained on a cash basis, supported with appropriate records and procedures to track commitments and to safeguard assets. The use of the project funds will be reported through the rendition of quarterly IFRs acceptable to the World Bank. The PFMU is responsible for preparing the quarterly IFRs using the existing agreed template. The IFRs are to be submitted to the World Bank 45 days after the end of each fiscal calendar quarter. The IFRs comprise, at a minimum: (a) sources and uses of funds, (b) uses of funds within components, (c) fund disbursement status, (c) a schedule of fixed assets, (d) a schedule of withdrawal applications, and (e) bank account reconciliation statements.

Internal Controls and Audit

4. The PFMU will establish internal control procedures and processes that ensure appropriate personnel approve transactions. Adequate segregation of duties between approval, execution, accounting, and reporting functions should be in place. The Internal Audit Unit that is currently in use will continue to be used for the internal audit of the project. Internal auditors are supposed to submit internal audit reports to the World Bank 45 days after the end of every six months (that is, in September and March).

External Audit Arrangements 5. The General Auditing Commission (GAC) of Liberia is by law responsible for the audit of all government finances and projects. However, GAC could outsource such service to a private firm of auditors with qualifications and experience acceptable to the IDA. It should also be based on terms of reference acceptable to the World Bank. The project financial statements, including movements in the Designated Accounts (DAs), will be audited in accordance with the International Standards of Supreme Audit Institutions (ISSAI), GAC will be responsible for forming and expressing opinion on the financial statements in accordance with the World Bank’s audit policy. The auditors’ report and opinion with respect to the financial statements and activities of the DA,


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including the Management Letter will be furnished to the World Bank within six months after the end of each governmental fiscal year.

Funds Flow Arrangements 6. The project will also use the report-based disbursement method will also be used for accessing funds into the designated account for project implementation. Credit proceeds will flow from the IDA to a Designated US Dollar account to be opened at United Bank for Africa (UBA) which is acceptable by the World Bank and managed by the PFMU. Payments will be made for eligible project expenses from the Designated US Dollar account. The report-based disbursement method (Interim Financial Reports) will be used as a basis for the withdrawal of all credit and grant proceeds. An initial advance will be provided for the implementing entity, based on a forecast of eligible expenditures against each component, linked to the appropriate disbursement category. These forecasts will be premised on the annual work-plans that will be provided to the IDA and cleared by the World Bank task team leader. Replenishments, through fresh withdrawal applications to the World Bank into the designated accounts will be made subsequently, at quarterly intervals, but such withdrawals will equally be based on the net cash requirements that are linked to approved work-plans and percentage contribution to the pooled fund. Supporting documentation will be retained by the implementing agencies for review by the IDA missions and external auditors. For a period of four months after the closing date, disbursement for expenses incurred prior to the closing date will be allowed.

FM Covenants

a) Quarterly progress reports on financial progress will be prepared and sent to the Bank no later than 45 days from the end of the quarter.

b) Annual audit reports will be prepared and submitted to the Bank within six months of the end of the year audited.

c) AWP&B shall be prepared and submitted to the bank by end of each FY year. 7. The IFRs (including the ‘procurements subject to prior reviews’ and ‘DA reconciliation statement’) will serve as the basis for requesting for advances and also for documentation. The initial disbursement will be based on the consolidated expenditure forecast for six months, subject to the World Bank’s approval of the estimates. Subsequent replenishments of the DA would be done quarterly based on the forecast of the net expenditures for the subsequent half-year period. Supporting documentation will be retained by the implementing agencies for review by the IDA missions and external auditors. 8. If ineligible expenditures are found to have been made from the DA, the Borrower will be obligated to refund the same, and IDA will have the right to suspend disbursement of the funds if reporting requirements are not complied with as provided for in the Financing Agreement. The World Bank will periodically assess the adequacy of FM systems and this will form the basis of any change in disbursement methods. 9. For all subcomponents, the request for funds will be done based on Withdrawal Applications duly signed by the authorized signatories and supported by unaudited IFRs using the report-based modalities. Applications and necessary supporting documents will be submitted to the World Bank electronically, in a manner and on terms and conditions specified by the World Bank, through Client Connection. The World Bank establishes


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a minimum value for applications for Reimbursement, Direct Payment, and Special Commitment. The World Bank reserves the right to not accept applications that are below such minimum value. 10. Management of exchange losses. The PFMU is required to take steps to ensure that disbursements for activities occur timely to be able to draw down funds quicker and minimize the impact of exchange differences. One of the key focus areas will be to ensure that all payment requests from the implementing agencies are processed in a timely manner. Delays in PV processing will impact the FM performance rating. Staffing 11. The PFMU will continue to be responsible for the day-to-day management of funds and accounting for World Bank and other donor funds in the Liberia Portfolio. The PFMU is adequately staffed with professionals who have relevant experience and qualifications acceptable to the World Bank. The PFMU is also supported by a PIU, which will be responsible for the day-to-day operations. The PIU will have one Finance assistant (FA) to receive all payment requests from the implementing agencies and submit to the PFMU for review, processing and payment. The PIU (including the FA), will work closely with the relevant stakeholders (project coordinators, managers, procurement specialists/officers, finance officers and project accountants) to provide systemic reasons for variances between actual and budgeted expenditure to make the IFRs more meaningful. 12. The Head of the PFMU will be responsible for overall fiduciary aspects of the project during implementation. The primary responsibility of the Head is to ensure that throughout implementation there are adequate FM systems in place which can report adequately on the use of project funds. The Head of the PFMU will be supported by a qualified Deputy Head of PFMU, Head of Internal Audit and four (4) part qualified Accountants. The part qualified Accountants are responsible for day-to-day accounting and reporting of financial transactions, with oversight from the Deputy and Head of the PFMU. Systems 13. The PFMU will initially use the existing sunsystems software (version 4) to process AF transactions and the vision software to generate reports. Given that Sunsystems is outdated with no annual maintenance arrangements it will be costly to upgrade the system to a new version to benefit from improved patches and an automated bank reconciliation. Based on the ongoing initiative by GoL to improve and effectively roll-out IFMIS, the PFMU is required to engage with the IFMIS team to configure the software, migrate and use IFMIS to process and report on transactions by mid-term of the project. Disbursements 14. The project subcomponents will be implemented under the principles of traditional IPF arrangements using the report-based disbursement arrangements. Under this approach, the allocated resources will be advanced to the PFMU’s U.S. dollar DA based on a six-monthly forecast of expenditures approved in the AWP&B and replenished quarterly using IFRs generated from PFMUs accounting software.


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Disbursement Categories 15. Based on the project design, there will be two disbursement categories, namely Category 1 for– ‘goods, works, consulting services, non-consulting services, training, research, and operating expenses. Table 2: Disbursement Categories

Category Amount of the Credit Allocated

(expressed in USD)

Amount of the Grant Allocated

(expressed in USD)

Percentage of Expenditures to be

Financed (inclusive of Taxes)

(1) Goods (including Food Expenditures), works, non-consulting services, consulting services, Training and Operating Costs under the Project

3,750,000 3,750,000 50% grant and 50%

credit

TOTAL AMOUNT 3,750,000 3,750,000

Retroactive financing on activities that are agreed to by the World Bank for equivalent of up to 40% value of the project funds. The retroactive date is February 12, 2020. 16. Disbursements of funds to the project will follow any of the following methods: (a) reimbursement, where IDA may reimburse the borrower for expenditures eligible for financing, pursuant to the Financing Agreement (eligible expenditures), that the Borrower has pre-financed from its own resources; (b) advances, where IDA will advance funds from the Financing Account into a DA of the borrower to finance eligible expenditures as they are incurred and for which supporting documents will be provided; (c) direct payment, where IDA will make payments, at the Borrower’s request, directly to a third party (for example, supplier, contractor, or consultant) for eligible expenditures; and (d) special commitment, where IDA will pay amounts to a third party for eligible expenditures under special commitments entered into, in writing, at the Borrower’s request and on terms and conditions agreed between the Borrower and the World Bank. Retroactive financing 17. PFMU using the reimbursement will pay GoL the expenses pertaining to allowances that are paid to health works upon GoL submitting the evidence of the payments made for the allowances, the evidence will include schedule of (a) transfers to the health workers. The schedule shall include (1) Full name of the recipient, (2) account number were the funds were transferred and (b) copy of the Identification Document of the recipient (c) copy of the signed contract (d) Review of the payroll by Internal Audit Agency (IAA) Supervision Plan 18. Based on the risk rating of the project and the current FM arrangements, it is expected that following


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project effectiveness, in the first year of implementation, there will be at a minimum of two onsite visits to ascertain adequacy of systems and how effective the country systems are being used to support implementation. The FM implementation support missions will include ensuring that strong FM systems are maintained throughout the life of the project. In adopting a risk-based approach to FM supervision, the key areas of focus will include assessing the accuracy and reasonableness of budgets, their predictability and budget execution, compliance with payment and fund disbursement arrangements, and the ability of the systems to generate reliable project-specific financial reports. Conclusion 19. A description of the project’s FM arrangements as documented in the preceding paragraphs indicates that they satisfy the World Bank’s minimum requirements per World Bank policy on Investment Financing. Overall, the FM risk for the AF is assessed to be Moderate given PFMU’s experience with past World Bank IPF

projects and given proposed risk mitigation measures.

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