The World Bank AFR RI-East Africa Public Health Laboratory Networking Project (P111556) REPORT NO.: RES40944 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF AFR RI-EAST AFRICA PUBLIC HEALTH LABORATORY NETWORKING PROJECT APPROVED ON MAY 25, 2010 TO MINISTRY OF FINANCE AND ECONOMIC PLANNING (UGANDA),MINISTRY OF FINANCE, BUDGET AND PRIVATIZATION (BURUNDI),MINISTRY OF FINANCE (TANZANIA),THE NATIONAL TREASURY AND PLANNING (KENYA) HEALTH, NUTRITION & POPULATION AFRICA Regional Vice President: Hafez M. H. Ghanem Country Director: Deborah L. Wetzel Regional Director: Dena Ringold Practice Manager/Manager: Ernest E. Massiah Task Team Leader(s): Miriam Schneidman, Alain-Desire Karibwami, Peter Okwero The World Bank AFR RI-East Africa Public Health Laboratory Networking Project (P111556) I. BASIC DATA Product Information Project ID Financing Instrument P111556 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 25-May-2010 30-Mar-2020 Organizations Borrower Responsible Agency Ministry of Finance and Economic Planning Ministry of Health (Uganda),Ministry of Health, (Uganda),Ministry of Finance, Budget and Privatization Community Development, Gender, Elderly and (Burundi),Ministry of Finance (Tanzania),The National Children,Ministry of Health (Kenya) Treasury and Planning (Kenya) Project Development Objective (PDO) Original PDO To establish a network of efficient, high quality, accessible public health laboratories for the diagnosis and surveillance of tuberculosis and other communicable diseases. Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-56140 07-Jul-2015 25-Sep-2015 12-Jan-2016 30-Mar-2020 15.00 14.89 .01 IDA-56150 07-Jul-2015 11-Feb-2016 31-Mar-2016 30-Mar-2020 15.00 14.70 .15 IDA-56160 07-Jul-2015 21-Oct-2015 16-Feb-2016 30-Mar-2020 10.00 9.95 0 IDA-D0470 07-Jul-2015 01-Apr-2016 18-Jul-2016 30-Mar-2020 10.00 8.25 1.71 IDA-H7740 17-May-2012 28-Jun-2012 25-Sep-2012 29-Mar-2019 14.99 13.74 0 The World Bank AFR RI-East Africa Public Health Laboratory Networking Project (P111556) IDA-47310 25-May-2010 22-Jun-2010 07-Sep-2010 30-Mar-2017 15.05 14.92 0 IDA-47320 25-May-2010 05-Jul-2010 01-Oct-2010 30-Mar-2016 22.99 22.83 0 IDA-47330 25-May-2010 12-Aug-2010 31-Jan-2011 30-Mar-2016 9.84 9.52 0 IDA-H5930 25-May-2010 25-Jun-2010 25-Oct-2010 30-Dec-2016 14.90 14.81 0 Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES The US$ 127.8 million East Africa Public Health Laboratory Networking Project (P-111556) has been supporting four East African Community Member states (Burundi, Kenya, Tanzania, Uganda) to establish a network of efficient, high quality, accessible public health laboratories for the diagnosis and surveillance of tuberculosis and other communicable diseases. To this end, the project has supported member countries to: (i) strengthen diagnostic and surveillance capacities, including joint cross border disease surveillance and disease outbreak preparedness activities, and a unique inter-country peer review mechanism for conducting annual audits; (ii) conduct joint training and research activities; and (iii) document, generate and share good practices and lessons. Significant achievements have been made as summarized below: a) Component 1 – Diagnostic and Surveillance Capacity: Increased diagnostic capacity was a major outcome of the project, with the roll out of new molecular technologies, an expanded menu of tests, and a substantial rise in the number of laboratories making progress on accreditation. In total, roughly 88% of all participating laboratories in the four countries scored three stars and above (Burundi: 89%; Kenya: 80%; Tanzania: 75% and Uganda: 87.5%) during the May 2019 regional audit using the Stepwise Laboratory Improvement Process towards Accreditation (SLIPTA) score card, fourteen have attained international accreditation, and seven have been recommended or undergoing international accreditation, which surpasses the end of project targets and represents a major achievement. All four participating countries have enhanced capacity for monitoring antimicrobial drug resistance (AMR) and enhancing cancer surveillance through on-the-job training at satellite laboratories. Preparedness and response capacity has been enhanced through: (i) cross border disease surveillance activities; (ii) laboratory-confirmed diagnoses during outbreaks; (iii) regular simulation exercises and training activities (i.e. cholera, Marburg, Ebola) have been held and critical equipment and supplies procured to facilitate screening and contact tracing; and (iv) establishment of Events Based Surveillance system, including digital data collections along cross border areas in collaboration with the Connecting Organizations on Regional Disease Surveillance (CORDS) and the Africa CDC. b) Component 2 – Training and Capacity Building: Training and capacity building activities continue to boost human resources capacity with a cumulative total of roughly 17,300 health personnel trained to date. Roll out of new molecular technologies has improved access to TB diagnostic services, strengthened turnaround time, and picked up missing cases. With the introduction of the GeneXpert machines, project-supported facilities conducted about 350,000 tests, accurately diagnosing multi-drug resistant TB within several hours, rather than waiting months for culture results. Personnel recruited under the project have been fully absorbed in Kenya and Burundi, which augurs well for The World Bank AFR RI-East Africa Public Health Laboratory Networking Project (P111556) sustainability of these investments, and a mentorship TOT was conducted in July 2019 to prepare a cohort of laboratory mentors to sustain laboratory improvements beyond the life of the project. c) Component 3: Operational Research, Knowledge Sharing, and Management: The findings from the three multi- country, multi-site operational research studies conducted in Kenya, Rwanda, Tanzania, and Uganda continue to be disseminated through different modalities. In addition to the three original operational research studies, several offshoot OR studies were completed. For example, in Tanzania, over 13 offshoot studies have been completed and have generated valuable information relevant for policy dialogue, and as part of dissemination, five policy briefs have been developed and published to influence policy change. Despite solid progress, the project has experienced some delays in civil work activities and in fund absorption. The proposed 6 month no-cost extension of the closing date, from March 30, 2020 to September 30, 2020 (for Burundi, Kenya and Tanzania) and the 12 month no-cost extension for Uganda (which needs to complete the construction of an isolation center) will: (i) allow for the governments to complete all activities, consolidate achievements, and fully utilize remaining funds; and (ii) enable the clients to prepare their Implementation Completion Reports which will feed into the Bank’s preparation of a learning ICR, to capture the experiences and lessons from this flagship project. II. DETAILED CHANGES LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications 30-Mar-2017, 29- IDA-47310 Closed 30-Mar-2016 Mar-2018 IDA-47320 Closed 30-Mar-2016 28-Feb-2017 IDA-47330 Closed 30-Mar-2016 21-Dec-2016 IDA-56140 30-Mar-2020 30-Sep-2020 30-Jan-2021 IDA-56150 30-Mar-2020 30-Mar-2021 30-Jul-2021 IDA-56160 30-Mar-2020 30-Sep-2020 30-Jan-2021 IDA-D0470 30-Mar-2020 30-Sep-2020 30-Jan-2021 30-Dec-2016, 28-Jun- IDA-H5930 Closed 30-Mar-2016 2017 29-Mar-2019, 30- IDA-H7740 Closed 30-Sep-2017 Aug-2019