The World Bank Ebola Emergency Response Project (P152359) REPORT NO.: RES38909 RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF EBOLA EMERGENCY RESPONSE PROJECT APPROVED ON SEPTEMBER 16, 2014 TO REPUBLIC OF LIBERIA,REPUBLIC OF SIERRA LEONE,REPUBLIC OF GUINEA HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Hafez M. H. Ghanem Country Director: Soukeyna Kane Regional Director: Deborah L. Wetzel Practice Manager/Manager: Gaston Sorgho Task Team Leader: Preeti Kudesia, Ibrahim Magazi, Shiyong Wang The World Bank Ebola Emergency Response Project (P152359) ABBREVIATIONS AND ACRONYMS CRW Crisis Response Window CHW Community Health Worker EERP Ebola Emergency Response Project ETCs Ebola Treatment Centers EVD Ebola Virus Disease IDA International Development Association MOH Ministry of Health PPE Personal Protection Equipment The World Bank Ebola Emergency Response Project (P152359) BASIC DATA Product Information Project ID Financing Instrument P152359 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 16-Sep-2014 31-Mar-2021 Organizations Borrower Responsible Agency Republic of Liberia,Republic of Sierra Leone,Republic of MINISTRY OF HEALTH,Ministry of Health,Ministry of Guinea Health and Sanitation Project Development Objective (PDO) Original PDO The Project Development Objective is to contribute in the short term to the control of the Ebola Virus Disease (EVD) outbreak and the availability of selected essential health services, and mitigate the socio-economic impact of EVD in Guinea, Liberia, and Sierra Leone. Current PDO To contribute to the control of the Ebola Virus Disease (EVD) outbreaks and the recovery of selected essential health services in Guinea, Liberia, and Sierra Leone. OPS_TABLE_PDO_CURRENTPDO Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-D0070 18-Nov-2014 20-Nov-2014 03-Dec-2014 31-Dec-2020 98.00 93.22 .03 IDA-D0080 18-Nov-2014 24-Nov-2014 02-Dec-2014 31-Mar-2021 115.00 100.52 10.24 IDA-D0090 18-Nov-2014 20-Nov-2014 26-Nov-2014 31-Dec-2019 72.00 65.84 2.21 IDA-H9900 16-Sep-2014 17-Sep-2014 24-Sep-2014 31-Dec-2019 25.00 24.61 0 The World Bank Ebola Emergency Response Project (P152359) IDA-H9910 16-Sep-2014 17-Sep-2014 19-Sep-2014 31-Mar-2021 52.00 51.13 0 IDA-H9920 16-Sep-2014 17-Sep-2014 24-Sep-2014 31-Dec-2020 28.00 27.59 0 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No The World Bank Ebola Emergency Response Project (P152359) I. PROJECT STATUS AND RATIONALE FOR RESTRUCTURING A. Background and Context 1. In 2014, The World Bank approved the Ebola Emergency Response Project (EERP) to support the Governments of Guinea, Liberia and Sierra Leone to contribute in the short term to the control of the Ebola Virus Disease (EVD) outbreak, support the availability of selected essential health services, and mitigate the socio-economic impact of EVD in Guinea, Liberia, and Sierra Leone. The project supported the financing of essential supplies and staffing of the Ebola Treatment Centers (ETCs); personal protection equipment (PPE), hazard pay and death benefits for Ebola care givers and other health workers providing essential health services for non-Ebola conditions; safe and dignified burials, and support for contact tracing, social mobilization, and provision of food and other essential services to quarantined and Ebola affected populations. 2. The EERP totaling US$390 million, consists of an original IDA grant (US$105 million) and Additional Financing grant (US$285 million) from the Bank’s Crisis Response Window. The original IDA was approved on September 16, 2014 to support the Governments of Guinea, Liberia and Sierra Leone to control the spread of the deadly EVD and mitigate the unprecedented health and socio-economic impacts of the Ebola epidemic. The Additional Financing approved on November 18, 2014 was designed to respond to a rapidly changing situation and for the three countries to scale up community-based care and community engagement for earlier triage of suspected EVD cases, more rapid confirmation of infectious status, strengthened treatment and care, and safe burials to curb the epidemic. The country allocations of the original and AF amounts were as follows: 1) Original IDA (US$105 million):  Guinea (IDA-H9900): US$25 million;  Liberia (IDA-H9910): US$52 million; and  Sierra Leone (IDA-H9920): US$28 million). 2) Additional Financing (US$285 million):  Guinea (IDA-D0090): US$72 million;  Liberia (IDA-D0080): US$115 million; and  Sierra Leone (IDA-D0070): US$98 million). 3. After the three supported countries were declared Ebola free, a Level I restructuring of the project was done in December 2016 to support rebuilding of the health systems in Guinea, Liberia and Sierra Leone. B. Project Status 4. Following 2016 project restructuring, the current Project Development Objective is to contribute to the control of the Ebola Virus Disease (EVD) outbreaks and the recovery of selected essential health services in Guinea, Liberia, and Sierra Leone. Progress toward achievement of the PDO rating has been Satisfactory and Implementation Progress rating has been Moderately Satisfactory in the last Implementation Status Report (ISR) dated June 3, 2019. Overall, project implementation is on track (with some variations between the three countries). To date, the project has disbursed US$362.90 million of US$390 million (incorporating SDR exchange loss), representing 96.65% disbursement rate for the original grant and additional financing combined: Table 1: The World Bank Ebola Emergency Response Project (P152359) Net Commitment (mln) Total Disbursed (mln) Undisbursed (mln) IDA 390.00 362.90 12.46 Liberia 167.00 151.65 10.24 Sierra Leone 126.00 120.81 0.03 Guinea 97.00 90.45 2.19 C. Rationale for Restructuring 5. The project’s overall closing date is March 31, 2021 with the following respective closing dates: March 31, 2021 for Liberia; December 31, 2020 for Sierra Leone; and December 31, 2019 for Guinea. This proposed restructuring aims to extend the grant closing date (IDA-H9900 and IDA-D0090) for Guinea for one year till December 31, 2020 to (a) support the Government of Guinea in implementing the National Measles control plan in eleven districts and (b) complete remaining activities and continue the remaining surveillance activities. There is no change in the project’s PDO and no pending financial audit reports for all three countries. 6. Implementation of activities in Guinea under the project is currently on track, with a number of pending activities now finalized. Activities successfully completed include the construction of 53 out of 54 health centers, procurement of equipment for the health centers, and the support to the epidemic response teams. The efficiencies gained during the course of implementation as well as advanced planning to take into account currency fluctuations have created savings, leaving the project with US$4.5 million in available uncommitted funding: US$2.5 million in Client Connection and US$2 million in the project’s local accounts. A restructuring of the project is therefore being proposed in order to do the following: i.) Extend the closing date for Guinea grants by one more year, from December 31, 2019 to December 31, 2020 in order to reinforce the country’s measles immunization program in 11 districts by controling recurrent measles outbreaks in the country. To do this an implementation support plan has been developped to control future outbreaks in the 11 districts. This will help face the repetitive outbreaks of measles in the country; ii.) Continue to support the epidemic response teams for one more year. 7. The objective of the implementation support plan is to develop a new approach to reach children that routine or national campaign activities cannot reach. This approach has been developped in Forecariah, a village where community health workers going household by household have been trained in identifying all children under five, and checking their immunization status to find out whether or not they have been vaccinated. Following this identification and vaccination checks, the national immunization program provides the required doses of measles vaccine for the community health workers to conduct catch-up intervention. The aim is to have a demonstrated effect showing that it is more efficient to use the community health workers to undertake household surveys in the villages and vaccinate children directly, rather than continuing to finance costly mass campaigns that have limited or no effect. This operation will increase measles coverage from 48% (669,830 children under five, U5) to 95% (1,223,700 children U5) in the 11 districts. No additional procurement will be done under the project as any required commodities and equipment will be provided by the immunization program, through GAVI financing. The remaining funds will finance: i) Implementation of measles control program and remaining surveillance activities (logistics, per diems, transportation) for US$3,816,000 and ii) the payment of the remaining civil works US$484,000. The World Bank Ebola Emergency Response Project (P152359) II. DESCRIPTION OF PROPOSED CHANGES 8. While the current Guinea grant is closing on December 31, 2019, the project has undisbursed funds of about US$2.5 million dollars; and an additional US$2 million unspent at the Country-level account. This is with the disbursement reflected in the Portal as of November 18, 2019. However, given the significant recent US$ to SDR fluctuations, the amount of US$ equivalent available may reduce further, which the client and task team will take into account and follow-up during implementation. Therefore, the Government of Guinea has requested the Bank for one year extension to enable support to reinforcing the National Measles immunization program in 11 districts in order to better control measles outbreaks in the country and to continue the ongoing surveillance activities. Therefore, the level 2 restructuring proposes the following changes: 1) Extension of the Grant Closing Date for Guinea (IDA-H9900 and IDA-D0090); and 2) Change in Disbursement Estimates. This restructuring requires RVP approval since cumulative extension of the Guinea grants is more than two years from the original closing dates. The project’s overall current closing date March 31, 2021 will not change with this proposed restructuring. This is because as designed, the closing date of the two respective grants for each country (i.e. the original IDA approved on September 16, 2014 and Additional Financing approved on November 18, 2014) is different: March 31, 2021 for Liberia; December 31, 2020 for Sierra Leone; and December 31, 2019 for Guinea. This restructuring is limited to extending only the closing dates of the two Guinea grants (IDA-H9900 and IDA-D0090) from December 31, 2019 to December 31, 2020. Therefore, while there is no change in the project’s overall closing date (March 31, 2021), the extension of the Guinea grants closing date is more than two years from the original date, hence requires RVP approval. III. SUMMARY OF CHANGES Changed Not Changed Loan Closing Date(s) ✔ Disbursement Estimates ✔ Implementing Agency ✔ DDO Status ✔ Project's Development Objectives ✔ Results Framework ✔ Components and Cost ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Disbursements Arrangements ✔ Overall Risk Rating ✔ Safeguard Policies Triggered ✔ The World Bank Ebola Emergency Response Project (P152359) EA category ✔ Legal Covenants ✔ Institutional Arrangements ✔ Financial Management ✔ Procurement ✔ Implementation Schedule ✔ Other Change(s) ✔ Economic and Financial Analysis ✔ Technical Analysis ✔ Social Analysis ✔ Environmental Analysis ✔ IV. DETAILED CHANGE(S) OPS_DETAILEDCHANGES_LOANCLOSING_TABLE LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications 31-Mar-2016, 30- IDA-D0070 Effective 30-Sep-2015 Sep-2016, 30-Dec- 2016, 31-Dec-2020 31-Mar-2016, 30- IDA-D0080 Effective 30-Sep-2015 Sep-2016, 30-Dec- 2016, 31-Mar-2021 31-Mar-2016, 30- IDA-D0090 Effective 30-Sep-2015 Sep-2016, 30-Dec- 31-Dec-2020 30-Apr-2021 2016, 31-Dec-2019 31-Mar-2016, 30- IDA-H9900 Effective 30-Sep-2015 Sep-2016, 30-Dec- 31-Dec-2020 30-Apr-2021 2016, 31-Dec-2019 31-Mar-2016, 30- IDA-H9910 Effective 30-Sep-2015 Sep-2016, 30-Dec- 2016, 31-Mar-2021 31-Mar-2016, 30- IDA-H9920 Effective 30-Sep-2015 Sep-2016, 30-Dec- 2016, 31-Dec-2020 The World Bank Ebola Emergency Response Project (P152359) OPS_DETAILEDCHANGES_DISBURSEMENT_TABLE DISBURSEMENT ESTIMATES Change in Disbursement Estimates Yes Year Current Proposed 2015 259,867,321.57 0.00 2016 91,337,533.14 0.00 2017 -27,539,020.08 0.00 2018 29,469,696.96 0.00 2019 21,738,556.13 0.00 2020 17,853,185.03 0.00 2021 4,545,454.55 2,900,000.00 .