Document of The World Bank FOR OFFICIAL USE ONLY Report No: PAD4440
Public Disclosure Authorized INTERNATIONAL DEVELOPMENT ASSOCIATION
PROJECT PAPER ON A PROPOSED GRANT IN THE AMOUNT OF SDR 47.3 MILLION (US$67.0 MILLION EQUIVALENT)
AND
PROPOSED ADDITIONAL CREDIT
Public Disclosure Authorized IN THE AMOUNT OF EUR 57.2 MILLION (US$67.0 MILLION EQUIVALENT)
TO THE REPUBLIC OF SENEGAL
FOR THE SENEGAL COVID-19 RESPONSE PROJECT May 10, 2021
UNDER THE
Public Disclosure Authorized 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 AND
UP TO US$12 BILLION ADDITIONAL FINANCNG APPROVED BY THE BOARD ON OCTOBER 13, 2020
Health, Nutrition and Population Global Practice Western and Central Africa Region
Public Disclosure Authorized This document is being made publicly available prior to Board consideration. This does not imply a presumed outcome. This document may be updated following Board consideration and the updated document will be made publicly available in accordance with the Bank’s Policy: Access to Information.
CURRENCY EQUIVALENTS
(Exchange Rate Effective March 31, 2021)
Currency Unit = CFA Franc (CFAF) US$1.00 = CFAF 559 US$1.00 = EUR 0.8523
FISCAL YEAR January 1 - December 31
Regional Vice President: Ousmane Diagana Country Director: Nathan M. Belete Regional Director: Dena Ringold Practice Manager: Gaston Sorgho Task Team Leaders: Djibrilla Karamoko, Moussa Dieng
ABBREVIATIONS AND ACRONYMS
ACG Anti-Corruption Guideline AEFI Adverse Event Following Immunization AF Additional Financing AMC Advanced Market Commitment ASA Advisory Services and Analytics AVAT African Vaccine Acquisition Task Team AZ AstraZeneca BCG Bacillus Calmette-Guérin BFP World Bank Facilitated Procurement CCE Cold Chain Equipment CCEOP Cold Chain Optimization Platform CCIA National Interagency Coordinating Committee for the EPI (Comité National de Coordination Inter Agence du Programme Elargi de Vaccination CCIA) CNGE Technical Committee for Epidemic Management (Comité National de Gestion des Epidémies) COVAX COVID-19 Vaccines Global Access COVID-19 Coronavirus Disease 2019 CPF Country Partnership Framework CSSDOS Digital Health Unit (Cellule de la Carte sanitaire et sociale, de la Santé digitale et de l'Observatoire de la Santé) DA Designated Account DAGE Directorate of General Administration and Equipment (Direction de l’Administration Générale et de l’Equipement) DFIL Disbursement and Financial Information Letter DHIS2 District Health Information System 2 DIEM Directorate of Infrastructure, Equipment, and Maintenance (Direction des Infrastructures, des Équipements et de la Maintenance) DP Directorate of Prevention (Direction de la Prévention) DPM Directorate of Pharmacy and Medicines (Direction de la Pharmacie et du Médicament) DSME Directorate for Maternal and Child Health (Direction de la Santé de la Mere et de l’Enfant) DSSI Debt Service Suspension Initiative EPI Expanded Program on Immunization ESCP Environmental and Social Commitment Plan ESF Environmental and Social Framework ESMAP Energy Sector Management Assistance Program ESMF Environmental and Social Management Framework ESS Environmental and Social Standard ETC Epidemiological Treatment Center EUL WHO Emergency Use Listing EVD Ebola Virus Disease FCDO United Kingdom Foreign, Commonwealth and Development Office FGM Female Genital Mutilation FM Financial Management FTCF Fast Track COVID-19 Facility FY Fiscal Year GAVI Global Alliance for Vaccines and Immunizations GBV Gender-based Violence GDP Gross Domestic Product GFF Global Financing Facility
DGS General Directorate for Public Health (Direction Générale de la Santé Publique) GHG Greenhouse Gas GRM Grievance Redress Mechanism GRS Grievance Redress Service HEIS Hands-On, Enhanced Implementation Support HR Human Resources IBRD International Bank for Reconstruction and Development ICPBWM Infection Control Plan and Biomedical Waste Management IDA International Development Association IFAC International Federation of Accountants IFC International Finance Corporation IFR Interim Financial Report IMF International Monetary Fund IPF Investment Project Financing ISMEA Investing in Maternal, Child and Adolescent Health ISR Implementation Status and Results Report J&J Johnson & Johnson LMP Labor Management Procedures M&E Monitoring and Evaluation MoHSA Ministry of Health and Social Action MPA Multiphase Programmatic Approach NCC National Coordination Committee NCD Non-communicable Disease NCVS National COVID-19 Vaccination Strategy NGO Nongovernmental Organization NPF New Procurement Framework NDVP National Deployment and Vaccination Plan for COVID-19 vaccines OECD Organisation for Economic Co-operation and Development OHS Occupational Health and Safety PBC Performance-based Condition PCU Project Coordination Unit PDO Project Development Objective PEF Pandemic Emergency Facility PHC Primary Health Care PIM Project Implementation Manual PNA National Pharmacy Supply (Pharmacie Nationale d’Approvisionnement) PP Project Paper PPE Personal Protective Equipment PPSD Project Procurement Strategy for Development PrDO Program Development Objective PRES Economic and Social Resilience Programme (Programme de Resilience Économique Social) PVS Pharmacovigilance System REDISSE I Regional Disease Surveillance Systems Enhancement Project I RMNCHA+N Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition SAGE Strategic Advisory Group of Experts on Immunization SDD Solar Direct Drive SDR Special Drawing Rights SEP Stakeholder Engagement Plan SH Sexual Harassment SG General Secretariat (Secretaire Générale)
SMT Supply Management Tool SNEIPS National Service for Health Education and Information (Service National de L’Education et de l’Information pour la Santé) SOE Statement of Expenditures SPJ Social Protection and Jobs SPRP Strategic Preparedness and Response Program SRA Stringent Regulatory Authority STEP Systematic Tracking of Exchanges in Procurement ToR Terms of Reference TOT Training-of-Trainers TWG Technical Working Group UN United Nations UNICEF United Nations Children’s Fund UNFPA United Nations Population Fund USAID United States Agency for International Development VAC Vaccine Approval Criteria VIRAT Vaccine Introduction Readiness Assessment Tool VRAF Vaccine Readiness Assessment Framework WB World Bank WBG World Bank Group WHO World Health Organization
Senegal
Additional Financing for the Senegal COVID-19 Response Project
TABLE OF CONTENTS
I. BACKGROUND AND RATIONALE FOR ADDITIONAL FINANCING ...... 9 II. DESCRIPTION OF ADDITIONAL FINANCING ...... 27 III. KEY RISKS ...... 35 IV. APPRAISAL SUMMARY ...... 38 V. WORLD BANK GRIEVANCE REDRESS ...... 47 VI SUMMARY TABLE OF CHANGES ...... 48 VII DETAILED CHANGE(S) ...... 48 VIII. RESULTS FRAMEWORK AND MONITORING ...... 53 ANNEX 1: SUMMARY TABLE ON VACCINE DEVELOPMENT AND APPROVAL STATUS ...... 66 ANNEX 2: WBG COUNTRY PROGRAM ADJUSTMENTS IN RESPONSE TO COVID-19 ...... 67 ANNEX 3: LATEST COVID-19 SITUATION IN SENEGAL ...... 69 ANNEX 4: SUMMARY OF THE PARENT PROJECT COMPONENTS ...... 73 ANNEX 5: COLD CHAIN EQUIPMENT INVENTORY ...... 74 ANNEX 6: FINANCIAL MANAGEMENT AND DISBURSEMENT ARRANGEMENTS ...... 75
The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
BASIC INFORMATION – PARENT (Senegal COVID-19 Response Project - P173838)
Country Product Line Team Leader(s) Senegal IBRD/IDA Djibrilla Karamoko
Project ID Financing Instrument Resp CC Req CC Practice Area (Lead) P173838 Investment Project HAWH3 (9542) AWCF1 (6550) Health, Nutrition & Financing Population
Implementing Agency: Ministry of Health and Social Action ADD_FIN_TBL1 Is this a regionally tagged
project?
No
Bank/IFC Collaboration
No Expected Approval Date Closing Date Guarantee Environmental and Social Risk Classification Expiration Date 02-Apr-2020 30-Sep-2021 Substantial
Financing & Implementation Modalities Parent
[✓] Multiphase Programmatic Approach [MPA] [ ] Contingent Emergency Response Component (CERC) [ ] Series of Projects (SOP) [ ] Fragile State(s)
[ ] Performance-Based Conditions (PBCs) [ ] 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) [ ] Hands-on Expanded Implementation Support (HEIS)
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
Development Objective(s)
MPA Program Development Objective (PrDO) 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
Project Development Objectives (Phase 086) To prevent, detect and respond to the COVID-19 disease outbreak in Senegal.
Ratings (from Parent ISR) RATING_DRAFT_NO
Implementation Latest ISR
05-Jun-2020 14-Dec-2020 12-Feb-2021
Progress towards achievement S S S of PDO Overall Implementation S S S Progress (IP)
Overall ESS Performance S U MS
Overall Risk M M M
Financial Management S MS MS
Project Management S S S
Procurement S MS MS
Monitoring and Evaluation S S S
BASIC INFORMATION – ADDITIONAL FINANCING (Additional Financing for the Senegal COVID-19 Response Project - P175992) ADDFIN_TABLE Urgent Need or Capacity Project ID Project Name Additional Financing Type Constraints P175992 Additional Financing for Scale Up No the Senegal COVID-19 Response Project Financing instrument Product line Approval Date Investment Project IBRD/IDA 02-Jun-2021
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
Financing Projected Date of Full Bank/IFC Collaboration Disbursement 31-Dec-2025 No Is this a regionally tagged project? No
Financing & Implementation Modalities Child [✓] Multiphase Programmatic Approach [MPA] [ ] Series of Projects (SOP) [ ] Fragile State(s) [ ] Performance-Based Conditions (PBCs)
[ ] Small State(s) [ ] Financial Intermediaries (FI)
[ ] Fragile within a Non-fragile Country [ ] Project-Based Guarantee
[ ] Conflict [✓] Responding to Natural or Man-made disaster
[✓] Alternate Procurement Arrangements (APA) [✓] Hands-on, Enhanced Implementation Support (HEIS) [ ] Contingent Emergency Response Component (CERC)
Disbursement Summary (from Parent ISR)
Net Source of Funds Total Disbursed Remaining Balance Disbursed Commitments
IBRD %
IDA 20.00 17.76 3.30 84 %
Grants %
MPA Financing Data (US$, Millions) Financing
MPA Program Financing Envelope 18,000,000,000.00
MPA FINANCING DETAILS (US$, Millions)
MPA FINA NCING DETAILS (US$, Millions) Approved Board Approved MPA Financing Envelope: 18,000,000,000.00
MPA Program Financing Envelope: 18,000,000,000.00
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
of which Bank Financing (IBRD): 9,900,000,000.00
of which Bank Financing (IDA): 8,100,000,000.00
of which other financing sources: 0.00
PROJECT FINANCING DATA – ADDITIONAL FINANCING (Additional Financing for the Senegal COVID-19 Response Project - P175992)
PROJECT FINANCING DATA (US$, Millions)
SUMMARY-NewFin1
SUMMARY (Total Financing)
Proposed Additional Total Proposed Current Financing Financing Financing Total Project Cost 20.00 134.00 154.00
Total Financing 20.00 134.00 154.00
of which IBRD/IDA 20.00 134.00 154.00
Financing Gap 0.00 0.00 0.00
DETAILSNewFinEnh1- Additional Financing
World Bank Group Financing
International Development Association (IDA) 134.00
IDA Credit 67.00
IDA Grant 67.00
IDA Resources (in US$, Millions)
Credit Amount Grant Amount Guarantee Amount Total Amount Senegal 67.00 67.00 0.00 134.00
National PBA 67.00 67.00 0.00 134.00
Total 67.00 67.00 0.00 134.00
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
COMPLIANCE
Policy
Does the project depart from the CPF in content or in other significant respects? [ ] Yes [ ✔ ] No
Does the project require any other Policy waiver(s)? [ ✔ ] Yes [ ] No
Explanation
The project is being processed using the following waivers granted through the MPA: a partial waiver relating to the application of Anti-Corruption Guidelines to unsuccessful bidders in the context of retroactive financing and of framework agreements in place between the borrower and suppliers and financed under retroactive financing or advanced procurement. The project also applies the Blanket waiver issued by the OPCS VP on October 27 for projects being under implementation for less than 12 months (the Bank Policy for IPF, Section III, paragraph 28). Has the waiver(s) been endorsed or approved by Bank Management? Approved by Management [ ] Endorsed by Management for Board Approval [✔] No [ ]
Explanation
The MPA-specific waivers have been approved by the Board as part of the Global SPRP MPA approval.
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
ESStandards 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 Not Currently Relevant
Biodiversity Conservation and Sustainable Management of Living Natural Not Currently Relevant Resources Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Not Currently Relevant Local Communities Cultural Heritage Not Currently Relevant
Financial Intermediaries Not Currently Relevant
ESStandardsNote 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). INSTITUTIONAL DATA
Practice Area (Lead) Health, Nutrition & Population
Contributing Practice Areas
Climate Change and Disaster Screening This operation has been screened for short and long-term climate change and disaster risks
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
PROJECT TEAM
Bank Staff Name Role Specialization Unit Team Leader (ADM Djibrilla Karamoko Sr. Health Specialist HAWH3 Responsible) Moussa Dieng Team Leader Sr. Health Economist HAWH2 Procurement Specialist (ADM Mountaga Ndiaye Sr. Procurement Specialist EAWRU Responsible) Laurent Mehdi Brito Procurement Specialist Sr. Procurement Specialist EAWRU Ndeye Fatou Mbacke Procurement Specialist Procurement Specialist EAWRU Financial Management Fatou Fall Samba Sr. FM Specialist EAWG1 Specialist (ADM Responsible) Financial Management Faly Diallo Finance Officer WFACS Specialist Social Specialist (ADM Lucienne M. M'Baipor Senior Social Specialist SAWS4 Responsible) Environmental Specialist (ADM Sophie Lo Diop Environmental Specialist SAWE1 Responsible) Alexandra C. Sperling Counsel Legal Analyst LEGAM Amath Diop Procurement Team Procurement Specialist EAWRU Anta Tall Diallo Procurement Team Program Assistant AWCF1 Begnadehi Claude Bationo Team Member Sr. Operations Officer AWCF1 Fatoumata Binta Maama Team Member Health Specialist HAWH3 Barry Lansong Zhang Team Member Operations Officer HEASP Ndeye Absa Cisse Team Member Program Assistant AWCF1 Rebekka E. Grun Team Member Practice Leader HAWDR Sariette Jene M. C. Jippe Team Member Program Assistant HAWH3 Seynabou Thiaw Seye Team Member Operations Analyst AWCF1 Sophie Martine Olivia Counsel Country Lawyer LEGAM Wernert Sr. Financial Management Tahirou Kalam Team Member EAWG1 Specialist Valerie F. Trouillot-Ligonde Team Member Program Assistant HAWH3
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
Extended Team Name Title Organization Location
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
I. BACKGROUND AND RATIONALE FOR ADDITIONAL FINANCING
A. Introduction
1. This Project Paper (PP) seeks the approval of the World Bank’s Board of Executive Directors to provide an International Development Association (IDA) credit in the amount of Euro 57.2 million (US$67.0 million equivalent) and an IDA grant in the amount of SDR 47.3 million (US$67.0 million equivalent) for a total of US$134 million equivalent for an Additional Financing (AF). The AF will support the costs of expanding the activities of the Senegal COVID-19 Response Project (P173838) under the COVID-19 Strategic Preparedness and Response Program (SPRP) using the Multiphase Programmatic Approach (MPA), approved by the Board on April 2, 2020, and the vaccines AF to the SPRP approved on October 13, 2020.1 The primary objectives of the AF are to enable safe, affordable, and equitable access to Coronavirus Disease 2019 (COVID-19) vaccines, ensure effective vaccine deployment in Senegal through vaccination system strengthening, and further strengthen preparedness and response activities under the parent project. The Senegal COVID-19 Response Project (P173838) with an amount of US$20 million equivalent was approved on April 2, 2020, prepared under the SPRP.
2. The purpose of the proposed AF is to provide upfront financing to help the Government of Senegal purchase and deploy COVID-19 vaccines that meet the World Bank’s Vaccine Approval Criteria (VAC) and strengthen relevant health systems that are necessary for successful deployment and to prepare for the future. The proposed AF will help vaccinate 55 percent of the country’s population.2 The COVID-19 vaccines will be provided free of cost. The COVID-19 Vaccines Global Access (COVAX) Advanced Market Commitment (AMC) Facility is expected to fully subsidize vaccine purchase for 20 percent of the population. The AF will finance the purchase of vaccines for an additional 35 percent of the population through the COVAX Facility, direct from manufacturers and through other mechanisms. The AF will also finance the deployment costs of these vaccines, including those fully subsidized by the COVAX AMC. The Government of Senegal has purchased vaccines from the Chinese pharmaceutical company, Sinopharm, and has received donations from the Government of India and a South Africa telecommunications company through the African Union (AU), and deployment began in February 2021. On April 16, 2021, the Board approved a revised VAC and will accept as a threshold for eligibility of International Bank for Reconstruction and Development (IBRD)/IDA resources in COVID-19 vaccine acquisition and/or deployment under all World Bank-financed projects: (i) the vaccine has received regular or emergency licensure or authorization from at least one of the Stringent Regulatory Authorities (SRAs) identified by the World Health Organization (WHO) for vaccines procured and/or supplied under the COVAX Facility, as may be amended from time to time by WHO; or (ii) the vaccine has received WHO Prequalification (PQ) or WHO Emergency Use Listing (EUL).
1 The World Bank approved a US$12 billion WBG Fast Track COVID-19 Facility (FTCF or “the Facility”) to assist IBRD and IDA countries in addressing the global pandemic and its impacts. Of this amount, US$6 billion came from IBRD/IDA (“the Bank”) and US$6 billion from the International Finance Corporation (IFC). The IFC subsequently increased its contribution to US$8 billion, bringing the FTCF total to US$14 billion. The AF of US$12 billion (IBRD/IDA) was approved on October 13, 2020 to support the purchase and deployment of vaccines as well as strengthening the related immunization and healthcare delivery system. 2 All individuals residing in Senegal regardless of their immigration status have access to COVID-19 vaccines. The groups that are ineligible at this time are children/adolescents and pregnant women until more studies on vaccine safety for these groups are available.
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
3. The need for additional resources to expand the COVID-19 response was formally conveyed by the Government of Senegal in a letter dated February 4, 2021. The proposed AF will form part of an expanded health response to the pandemic, which is being supported by development partners under the coordination of the Government of Senegal. Additional World Bank financing will provide essential resources to enable the expansion of a sustained and comprehensive pandemic response that will appropriately include vaccination in Senegal.
4. Critically, the AF seeks to enable the acquisition of vaccines from a range of sources to support Senegal’s objective to have a portfolio of options to access vaccines under the right conditions (of value- for-money, regulatory standards, and delivery time, among other key features). The COVAX Facility has put in place a framework that will anchor Senegal’s strategy and access to vaccines. In December 2020, Senegal entered into an agreement with the COVAX Facility to access COVID-19 vaccines at no cost for 20 percent of the population. The proposed IDA financing will support the deployment of these vaccines on a priority basis and will also expand Senegal’s access to COVID-19 vaccines through the COVAX Facility and beyond through other mechanisms including direct purchases from manufacturers. In addition to vaccines acquired through COVAX, the African Vaccine Acquisition Task Team (AVAT) convened by the AU is in the process of negotiating, through the United Nations Children’s Fund (UNICEF), additional access to vaccines in countries that request for it. When firm contracts are in place between UNICEF, as the appointed procurement agent, and the manufacturers, UNICEF will conclude contracts with participating countries for the supply of the vaccines. These contracts will be reviewed by the World Bank to ensure that they comply with all operational policies and provide value for money in terms of both price and delivery times before financing from this project can be disbursed toward the member country upon its request. The availability and terms of vaccines remain fluid and prevent the planning of a firm sequence of vaccine deployment, especially as the actual delivery of all vaccines is unlikely to be immediate. Rather, the proposed financing enables a portfolio approach that will be adjusted during implementation in response to developments in the country’s pandemic situation and the global market for vaccines.
5. Latest situation on COVID-19 pandemic. Senegal was the second country in Sub-Saharan Africa to report its first imported case of COVID-19, on March 2, 2020, which led to the Government’s activation of emergency management mechanisms and request for World Bank financing. A second wave emerged in November 2020 and recent estimates (as of April 25, 2021) show a continued surge with the cumulative number of confirmed cases at 40,135 (Figure 1a), including 38,861 recoveries, 171 patients under treatment, 11 severe cases, and 1,102 deaths. Senegal is ranked fourth in the highest number of cases (Figure 1b) and second in the highest number of deaths (Figure 1c) due to COVID-19 in West Africa. Senegal began its COVID-19 vaccination deployment on February 23, 2021 and as of April 25, 2021, 398,941 people have received at least one dose of the vaccine (Figure 1d). With Ebola Virus Disease (EVD) cases re-emerging in the neighboring country of Guinea (Conakry), ramping up climate-sensitive disease surveillance and ensuring effective COVID-19 vaccination deployment will be even more critical. Please refer to Annex 3 for more details.
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
Figure 1: COVID-19 Pandemic in Senegal and West Africa
a) Total confirmed cases, Senegal b) Total confirmed cases, West Africa
c) Total confirmed deaths, West Africa d) Total people vaccinated (one dose of the COVID-19 vaccine)
B. Consistency with the Country Partnership Framework (CPF)
6. Neither the parent project nor the proposed AF were included in the CPF (FY20-FY24) for Senegal (Report No. 143333-SN) given the emergency nature of the global COVID-19 pandemic, which emerged just after the CPF was presented to the Board of Executive Directors on March 5, 2020. However, both the parent project and the proposed AF are consistent with the CPF Focus Area I: Build Human Capital to Enhance Productivity and Ignite the Demographic Dividend, with a Focus on the Most Vulnerable. The need to invest in health systems to ensure the productive capabilities of the Senegalese population is recognized, as is the challenge of overcoming limited investment in human capital and social resilience systems. Moreover, the CPF also recognizes that financial access remains a key constraint in access to healthcare and therefore, the parent project and the proposed AF enable the removal of this barrier helping to reduce catastrophic health expenditures during this pandemic. One of the operations mentioned in the CPF, the Regional Disease Surveillance Systems Enhancement Project I (REDISSE I, P154807), was prepared after the West Africa EVD outbreak of 2014–2016 to strengthen national and regional cross-sectoral capacity for collaborative disease surveillance and epidemic preparedness. This
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
operation also enables in the event of an emergency, such as the COVID-19 pandemic, to provide immediate and effective response. The Support to Universal Health Coverage and Pandemic Preparedness (P164017) Advisory Services and Analytics (ASA), which closed on June 30, 2020, was also included in the CPF and this analytical work among other objectives enabled the strengthening of capacities, especially on coordination, for pandemic emergency response. These constituted one of the core elements of World Bank’s strategy to assist the Government in responding to the COVID-19 pandemic. Additional information is provided in Annex 2 on the Country Program Adjustments.
C. Project Design and Scope
7. The Project Development Objective (PDO) of the parent project and this AF is to prevent, detect, and respond to the COVID-19 disease outbreak in Senegal. The parent project is strengthening the capacity of the Senegalese Government, and more specifically, the Ministry of Health and Social Action (MoHSA) to detect and respond to infectious diseases on time. This includes improvements in coordination, surveillance, and response and timely information sharing with the public. The parent project has three components as follows: (a) Emergency COVID-19 Response; (b) Community Engagement and Risk Communication; and (c) Project Management and Monitoring and Evaluation (M&E) (refer to parent project3 for additional details).
8. The MoHSA is the implementing agency for the parent project. The General Secretariat (Secretaire Générale, SG) of the MoHSA is responsible for the overall technical coordination of implementation of the parent project, while the MoHSA’s Directorate of General Administration and Equipment (Direction de l’Administration Générale et de l’Equipement, DAGE) is responsible for the financial management (FM) and procurement functions of the project. The Project Coordination Unit (PCU) of the ongoing REDISSE I (P154807), under the leadership of the DAGE, is responsible for the parent project’s day-to-day management, including fiduciary management (procurement and FM). The PCU has extensive experience in the World Bank’s fiduciary, safeguards, and technical implementation arrangements and will continue to be the implementing agency for this proposed AF. It has been strengthened with additional key staff for FM, procurement, and safeguards. The Directorate of Prevention (Direction de la Prevention, DP), under the General Directorate for Public Health (Direction Générale de la Santé Publique, DGS), will take the lead in the preparation, deployment, and monitoring of COVID-19 vaccines and will be integrated in the overall coordination of the proposed AF. The DP also coordinates Senegal’s Expanded Program on Immunization (EPI), which has achieved strong results in the past, which will be beneficial for the COVID-19 vaccine deployment.
D. Project Performance
9. The progress toward achievement of the PDO and overall implementation progress (IP) was rated Satisfactory in the last Implementation Status and Results Report (ISR) of February 12, 2021, and the project continues to make progress. Fiduciary processes, including procurement and FM, are rated Moderately Satisfactory. As of April 26, 2021, disbursements amount to US$17.76 million equivalent, or 84.34 percent of the net commitment of US$20 million equivalent. The remaining funds will be used for the original scope and activities. As of November 17, 2020, three out of the four PDO indicators already
3 https://projects.worldbank.org/en/projects-operations/project-detail/P173838.
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
surpassed their targets.4 The intermediate outcome indicators are also progressing well and out of the 14 indicators, four have already surpassed their final targets and two have achieved their final targets.
10. The PCU has been effectively coordinating project planning and procurement. As of November 17, 2020, there were several results of the parent project: (a) 1,295 out of 2,000 healthcare workers and 160 point of entry/border officers (originally expected 45 point of entry/border officers) have been trained in COVID-19 prevention, control, and contact tracing; (b) 1,295 community health workers out of 2,000 were trained on community-based disease surveillance; (c) an Epidemiological Treatment Center (ETC) at Fann Hospital is currently being established; (d) 350 healthcare workers5 have been recruited to support the COVID-19 treatment center; (e) 105 district health centers/hospitals (originally expected 90 health centers/hospitals) have received a vast amount of equipment and supplies such as personal protective equipment (PPE) (masks, gloves, face shields, and gowns); (f) seven designated laboratories (originally expected five laboratories) have received COVID-19 diagnostic equipment, test kits, and reagents; (g) audio-visual equipment (monitors, microphones, and subscriptions to online meeting applications) for all regions was procured; and (h) ten equipped ambulances were procured for emergency medical services.
11. In terms of the Environmental and Social Framework (ESF) Directives, the parent project prepared, consulted upon, and disclosed all required plans6 and established a grievance redress mechanism (GRM). The Environmental and Social Standards (ESSs) instruments have been disclosed jointly on the MoHSA website and the World Bank website.7 A Project Implementation Manual (PIM) was shared with the World Bank on May 29, 2020. In the parent project, the performance for the ESS was initially weak due to the resignation of the Safeguards Specialist, which delayed the implementation of the ESF plans and the preparation of the quarterly monitoring reports. However, the PCU recruited a consultant to support this work in November 2020. Plans are being implemented and reports are being submitted on time and in a manner acceptable to the World Bank. The ESS performance was updated in the last ISR in February 2021, with a Moderately Satisfactory rating due to the improvements noted during the period from November 2020 to January 2021. The recruitment of the Occupational Health and Safety (OHS) Specialist was a dated covenant that was not complied with. The recruitment of the OHS Specialist took longer than expected due to the lack of candidates with this expertise in Senegal. The PCU submitted a request for a Non-Objection for this position on April 30, 2021 and therefore, this position will be filled by the dated covenant of the AF (one month after project effectiveness).
4 Number of suspected cases of COVID-19 cases reported and investigated per approved protocol (228,129 suspected cases against a target of 1,000 suspected cases); Number of diagnosed cases per approved protocol (15,835 diagnosed cases against a target of 1,000); Number of District health centers/ hospitals with person protective equipment and infection control products and supplies (105 health centers/hospitals against a target of 90). 5 During the first wave, 291 health workers were trained; 59 health workers have been trained for the second wave that started in November/December 2020. 6 ESF documents that were disclosed: Environmental and Social Commitment Plan (ESCP), a Stakeholder Engagement Plan (SEP), an Environmental and Social Management Framework (ESMF) including an Infection Control Plan and Management of Biomedical Waste (ICPBWM), a Sexual Exploitation and Abuse/ Sexual Harassment (SEA/SH) Action Plan, Labor Management Procedures (LMP), and Grievance Redress Mechanism (GRM) Manual. 7 The ESCP was disclosed on March 25, 2020 and re-disclosed on March 31, 2020. The SEP was disclosed on March 25, 2020 and re-disclosed on June 8, 2020. The ESMF was disclosed on June 8, 2020. The ICPBWM, SEA/SH Action Plan and LMP were disclosed on June 8, 2020. The GRM was disclosed on June 15, 2020.
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
E. Rationale for Additional Financing
12. The proposed AF will provide critical financing for COVID-19 response, with a specific focus on safe, affordable, and equitable access to vaccines in Senegal. COVID-19 vaccination, along with improved diagnostics and therapeutics, is essential to protecting lives and enabling the country to reopen safely. The proposed AF will finance the scale-up of project activities and include new activities to achieve the PDO and to reduce the impact of the COVID-19 pandemic. The scale-up of project activities with a focus on vaccination will be implemented in close coordination with other development partners in Senegal, as elaborated in Box 1. The proposed AF will also support Senegal to effectively rollout its COVID-19 vaccination strategy as defined in the National COVID-19 Vaccination Strategy (NCVS) and the National Deployment and Vaccination Plan for COVID-19 Vaccines (NDVP).8 It is important, however, to note that the uncertainties related to the COVID-19 vaccine market, including testing, approval, availability, and pricing, will require flexibility, close monitoring and strong World Bank supervision during implementation.
Box 1: Potential Supportive Roles for Partner Agencies in Implementation
WHO’s role: Financing amount (if known) Not known. - Providing technical leadership for vaccine introduction and support to the MoHSA and the National Coordination Committee (NCC) in developing the COVID-19 deployment and vaccination plans, including the quantification and forecasting of supply needs (vaccines and immunization-related supplies), and supervision and management of COVID-19 vaccinations - Providing technical support and capacity building/guidance on health systems assessments that provide information on existing and pending resources to prepare for the introduction of COVID-19 vaccines of immunization. - Providing technical support in preparing appropriate regulatory pharmacovigilance authorities for vaccine licensing and emergency authorization for use in the national vaccination program.
UNICEF’s role: Financing amount Not known. - Providing technical assistance to the MoHSA to develop the COVID-19 deployment and vaccination plans, including the quantification and forecasting of supply needs (vaccines and immunization-related supplies) - Providing technical support and capacity building to the MoHSA in the development and implementation of a communication/demand generation and communication strategy (includes advocacy, communications, social mobilization, risk and safety communication, community engagement, and training) to generate confidence, acceptance, and demand for COVID-19 vaccines - Supporting the assessment of cold chain capacity and developing standard operating procedures for collection and disposal of medical waste - Supporting supervision and management, in close collaboration with the WHO - Facilitating access to additional vaccines with the AVAT convened by the AU.
Gavi/COVAX’s role Financing amount
8 Stratégie Nationale de la Vaccination contre la COVID-19 et le Plan National d’introduction du vaccin contre la COVID-19.
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Vaccine provided at no cost for 20 percent of the - Provide COVID-19 vaccines free-of-charge for the first 20 percent of the population population (including freight - Provide technical assistance related to the development of the National COVID-19 costs [US$35.16 million to Vaccine Strategy and Plan (TA COVAX Readiness and Preparation) US$46.88 million]), - Providing catalytic support toward cold-chain equipment (CCE) needs at the national and US$371,993 (COVAX TA regional levels. Ceiling), US$460,000 (CCE Ceiling) Other partners: AVAT/UNICEF Financing amount Approximately 4 million doses - The AVAT convened by the AU is in the process of negotiating, through UNICEF, additional of Johnson & Johnson (J&J) access to vaccines that would contribute to taking the total population covered up to 60 percent can be purchased by the in countries that request for it. Government
13. This AF is proposed at a critical juncture in the Government of Senegal’s response to COVID-19. An important change in the state of science since the early stages of the pandemic has been the emergence of new therapies and the successful development and expanding production of COVID-19 vaccines (see Annex 1 for status). The WHO has five vaccines under EUL/Prequalification (Pfizer/BioNTech, AstraZeneca (AZ) [two versions: AZ-SKBio and the Serum Institute of India], Moderna, J&J, and Sinopharm).9 As of May 10, 2021, the Pfizer/BioNTech, AZ, Moderna, J&J, and Sinopharm COVID-19 vaccines are the only vaccines that have met the World Bank’s VAC. A key rationale for the proposed AF is to provide upfront financing for safe and effective vaccine acquisition and deployment in Senegal, thus enabling the country to procure safe and effective vaccines at the earliest, recognizing that there is currently excess demand for vaccines from both high-income and lower-income countries. Moreover, additional investments will be made in health systems strengthening to ensure an effective and sustainable deployment of COVID-19 vaccines and future vaccines.
14. The proposed AF will form part of an expanded health response to the pandemic. The activities will build on the COVID-19 MPA-Program, the Senegal COVID-19 Response Project (P173838), as well as the World Bank’s existing health portfolio in the country. The World Bank was among the first development partners to offer support to the Government of Senegal in its response to the COVID-19 pandemic, which included technical assistance for the implementation of the National COVID-19 Emergency Response Plan. The total World Bank support to the Senegal COVID-19 health sector response to date is US$25.5 million equivalent. This includes three financing sources: (a) US$20 million of the COVID-19 Response Project (P173838) approved under the SPRP (approved by the Board of Executive Directors on April 2, 2020); (b) US$4 million from the REDISSE 1 (P154807); and c) US$1.5 million from the Pandemic Emergency Facility (PEF). The proposed AF will support vaccine purchase and shipment to Senegal at approximately US$76.13 million, service delivery and cold-chain activities in-country at US$49.87 million, and the remaining US$8.0 million will support disease surveillance and detection, communication activities, project management, and M&E. Other partners such as the WHO, UNICEF, United Kingdom’s Foreign, Commonwealth and Development Office (FCDO), and United States Agency for International Development (USAID) partners have supported Senegal with essential supplies and equipment for COVID-19 pandemic response.
9 Source: WHO (2021), https://extranet.who.int/pqweb/vaccines/covid-19-vaccines
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F. National Capacity and COVID-19 Vaccination Plan
(i) Vaccine Readiness Assessment
15. Senegal has conducted a vaccine readiness assessment to identify gaps and options to address them, as well as to estimate the cost of vaccine deployment, with the support of WHO, UNICEF, Global Alliance for Vaccines and Immunizations (GAVI), and the World Bank.10 This assessment considers the Government’s vaccine deployment strategy described below. Senegal’s EPI to ensure full immunization of children against various preventable diseases has achieved strong results in the past and the COVID-19 vaccination process will benefit from its success.11 The readiness assessment for COVID-19 vaccinations is being led by the MoHSA and it considers the NCVS and NDVP. Table 1 below provides a summary of the initial findings of this assessment with key gaps in readiness and measures to address them identified as of April 2021. Considering the uncertainties related to the COVID-19 vaccine market, the assessment will continue to be an evolving process and will be dynamically revised and updated as necessary to continue to improve project implementation. The assessment has shown that Senegal has many important elements already in place since vaccine deployment began in February 2021. Specifically, the Government has established a technical working group (TWG) within the MoHSA to lead the work on the recently developed NCVS and NDVP. Furthermore, substantial improvements have been made in the broader immunization system in recent years, including significant investments in the vaccine cold chain, including the procurement of cold chain equipment (CCE) from various energy sources12 (Annex 5) with the majority (72 percent) purchased within the last ten years. One of the major priorities is to ensure sufficient demand-generation activities and sensitization of the population as it relates to the safety and efficacy of the vaccine. Moreover, several new protocols and measures are in development to: (a) promote voluntary vaccination and address vaccine hesitancy among the population; (b) adapt existing surveillance and monitoring framework for the sourcing and deployment of COVID-19 vaccines; (c) set up indemnification agreements for vaccines sourced beyond COVAX AMC whose indemnification plan will be developed by the MoHSA by July 2021; and (d) introduce an electronic vaccine stock-management system.
10 The Vaccine Introduction Readiness Assessment Tool (VIRAT) developed by the WHO in collaboration with UNICEF and GAVI is a tool for national authorities to allow the establishment of a roadmap and to monitor progress in the preparation of the activities related to the introduction of the COVID-19 vaccines. The Vaccine Readiness Assessment Framework (VRAF) complements the VIRAF and provides a more operational lens to identify capacity gaps, risks, and options regarding vaccine procurement and deployment. 11 Senegal has been able to maintain immunization coverage for children aged 12–23 months at over 90 percent (in 2019, measles vaccine coverage was estimated at 90 percent (first dose); Bacillus Calmette-Guérin [BCG] was estimated at 99 percent; and Diphtheria, Tetanus Toxoids, and Pertussis- containing vaccine [DTP3] was estimated at 93 percent). 12 According to the Cold Chain Inventory Analysis conducted by UNICEF in 2019, CCEs in Senegal are powered through three main energy sources: (a) 71 percent on-grid, (b) 22 percent gas, and (c) 7 percent solar.
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Table 1: Summary of Vaccination Readiness Findings from the VIRAT-VRAF 2.0 Assessment in Senegal13
Readiness Readiness of Government Key Gaps to Address Before Deployment Domain Planning and • The Government of Senegal, through the MoHSA, established an NCC and national TWG and coordination subcommittees for specific workstreams, namely: (a) service delivery; (b) vaccine cold chain and logistics; (c) demand generation and communication; (d) prioritization, targeting, and COVID-19 surveillance; (e) M&E: determination and proof of eligibility, proof of vaccination, monitoring of coverage in risk groups, and monitoring of the impact of the vaccine; and (f) prevention of injuries and detection of and response to any adverse event following immunization (AEFI). Its creation and the designation of the members were published across various national newspapers and on the MoHSA website. • The NCVS has been finalized. The NDVP was developed in a two phased approach: (i) plan for the priority groups (20 percent) and (ii) plan for the remaining population. Both of these NDVPs have been finalized and adopted. COVID-19 vaccines have been integrated in the EPI as a routine vaccination, and the population is being encouraged to register for the vaccine through a digital registry. The DP is the lead agency for routine vaccinations and will lead the implementation of the NDVP. Budgeting • The procedures for managing the Ministry of Finance appropriations and the MoHSA are already established. The budget for the COVID-19 rollout has been finalized. The budget drawn up for the implementation of the vaccination strategy varies according to the type of vaccine selected in the NCVS. Regulatory • The existing legal framework, namely Decree No.17550 of November 20, 2014, regulates the • The Government is exploring authorization for placing on the market medicines for human use. Therefore, once the vaccines from indemnification, liability, and no-fault COVAX arrive, the Directorate of Pharmacy and Medicines (Direction de la Pharmacie et du Medicament, compensation clauses directly with DPM) will allow the distribution of the vaccines in the country after assessing the documents that will pharmaceutical companies that are be provided by UNICEF. This may take up to one week. Vaccines sourced outside of COVAX will need to outside of COVAX. And it will develop a go through a different process of authorization. specific plan to cover indemnification • The Government does not plan to put in place blanket legislation on COVID-19 vaccine indemnification for the vaccines that will be deployed. and liability. In December 2020, the Government signed a Model Indemnity Agreement with COVAX This plan is expected to be finalized in AMC. Some vaccine manufacturers may also require other protections against product liability claims, July 2021. including legislative limits on liability or a national no-fault compensation scheme. Under COVAX, a
13 Latest readiness information as of April 2021; a multi-partner effort led by the WHO and UNICEF developed the VIRAT to support countries in developing a roadmap to prepare for vaccine introduction and identify gaps to inform areas for potential support. Building upon the VIRAT, the World Bank developed the VRAF to help countries obtain granular information on gaps and associated costs and program financial resources for deployment of vaccines. To minimize burden and duplication, in November 2020, the VIRAT and VRAF tools were consolidated into one comprehensive framework, called VIRAT-VRAF 2.0.
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Readiness Readiness of Government Key Gaps to Address Before Deployment Domain donor-funded and private-insurance-covered no-fault compensation scheme has been established to cover AMC countries. • For vaccines that will be acquired outside COVAX, the Government is prepared to sign indemnity agreements with the manufacturers concerned. For instance, an indemnity agreement was signed with the manufacturer of the Sinopharm vaccines before the arrival of the vaccines in February 2021. The Government will continue to handle these agreements on a case-by-case basis. Prioritization, • Programmatic objectives have already been defined with the participation of the main stakeholders at • Due to the uncertainties surrounding targeting, and central and sub-national levels. In Senegal’s NCVS, it aims to cover 100 percent of its eligible population. the type and quantity of vaccines surveillance It expects that in the first phase, 90 percent of the priority population (20 percent) will be vaccinated by available in 2021, the quantities of the the end of 2021 and in its second phase, 90 percent of the remaining eligible population will be vaccine that will be delivered and the vaccinated in subsequent years. However, due to the uncertainties regarding COVID-19 vaccines for intervals of the delivery are still children/adolescents and pregnant women at this time (approximately 45 percent of the population), provisional. the vaccination coverage for the proposed AF will be approximately 55 percent of its population (16+). There are two phases proposed: (a) Phase 1 (2021)—vaccinate 20 percent of the population (priority) and (b) Phase 2 (2022 and beyond)—vaccinate 35 percent of the population. At-risk population groups were identified, namely: front-line health professionals (0.12 percent of the population), population 60 years old and above (4.8 percent of the population), population with underlying conditions between the ages of 19 and 59 (10.7 percent of the population), and population with other co-morbidities (3.5 percent of the population). Service delivery • Senegal has good vaccination coverage of the population with the existing structures in all municipalities (usual vaccination posts for routine vaccinations: health centers and health posts). The rollout of the COVID-19 vaccines is being done through the country’s EPI. This allows the vaccine to be fully integrated into the essential package of services and accessible at health centers and health posts. Vaccinations will also be done through mobile units and some health centers where priority groups go for follow-ups (geriatric centers, diabetes services, cardiology services). • There are protocols for infection prevention and control measures and the elaboration of distribution strategies for COVID-19 vaccines and awareness strategies, taking advantage of existing platforms. • The guidelines for service delivery have been developed and adopted. Micro-planning to operationalize the vaccination campaign has taken place in each district with support from the central level, regions, nongovernmental organizations (NGOs), and community leaders. Training and • There were two Training-of-Trainers (TOT) sessions in all the regions before the deployment of the • Additional human resources (HR) may supervision COVID-19 vaccines and when the COVID-19 vaccines arrived. The regional TOTs have trained all be needed for vaccinations and will be
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Readiness Readiness of Government Key Gaps to Address Before Deployment Domain necessary personnel at the district level. Additional training of all actors involved in the vaccination assessed during the implementation campaign will continue to be conducted at all levels of the health sector (central, regional, district). of the project. • Training will be conducted during vaccinations by supervisors at the district, regional, and central levels, with the help of a standardized supervisory matrix. • Supervision of the implementation of activities will be monitored on the ground. This will be conducted by technical, logistical, and communication supervisors at each level of the health sector. • Standard adapted training modules and guides for vaccinations have been developed on administration strategies, vaccination schedule, safety of injections, and AEFI. M&E • The country uses the District Health Information System 2 (DHIS2) (adapted for specific COVID-19 • Data quality. The SMT system will vaccine needs) as the main health information system to collect data and monitor the rollout of the need to be developed during project COVID-19 vaccination program. The overall M&E plan was finalized before the rollout of the Sinopharm implementation for the rollout of the vaccines on February 23, 2021. Development partners such as UNICEF, the WHO, and World Bank will COVID-19 vaccine. provide support for specific areas of performance management where possible. • Digital tools are also being developed through the MoHSA’s Digital Health Unit (Cellule de la Carte sanitaire et sociale, de la Santé digitale et de l'Observatoire de la Santé CSSDOS). For instance, with the support of the Tony Blair Institute, cloud-based technology to enable Senegal to create electronic health records for their vaccination programs for yellow fever, human papillomavirus (HPV), polio, measles, and COVID-19 was established and is fully operational as of the end of April 2021. Training of the teams that will be responsible for entering data at the central level has begun and was piloted in one district in April 2021. • A digital registry has been established and is operational to enable people to register for COVID-19 vaccinations and to enable vaccinators to register, which will also enable better monitoring of the COVID-19 vaccine deployment.14 As of March 29, 2021, 209,959 people have registered. This digital registry was optimized to enable AEFI notifications as of April 2021. The form for AEFI notification has been developed and is operational. • Data quality. For the tracking and monitoring system for the deployment of the COVID-19 vaccine, the country will adopt an electronic logistics and supply management tool (SMT) which will appropriately track the activities of the routine immunization program. This tool will be adapted to the anticipated needs for the COVID-19 vaccine and therefore for the tracking and management of the COVID-19 vaccine rollout.
14 https://vaccincovid19.sec.gouv.sn.
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Readiness Readiness of Government Key Gaps to Address Before Deployment Domain Vaccine, cold • Vaccines, PPEs, and other medical and non-medical supplies. Senegal, an AMC 92 eligible country, will • Vaccines, PPEs, and other medical and chain, logistics, make use of the COVAX AMC as the main mechanism for acquiring vaccines. The country is expected non-medical supplies. This proposed infrastructure to receive enough vaccines to vaccinate 20 percent of the population in a fully donor-subsidized AF will allow to cover the gaps in terms manner and World Bank financing will be used to cover the operational costs and costs for additional of purchasing vaccines to reach a vaccines. The COVAX subsidy may also cover costs of some ancillary supplies such as needles and cold vaccination coverage up to 55 percent boxes and transport to the country’s international airport. Procurement and delivery of the vaccine will of the country’s population. The be undertaken by UNICEF’s Supply Division. Vaccines facilitated by the AVAT and UNICEF are expected remaining 45 percent of the to be made available in the third quarter of 2021, which will also allow the Government to procure population is made up of vaccines at a subsidized rate. The Government is also having discussions with manufacturers directly children/adolescents (under 16 years to determine the feasibility of acquiring more vaccines (Sputnik V - Russia and India). Senegal received of age) and pregnant women, who are its first delivery of 200,000 doses from the Chinese pharmaceutical company, Sinopharm, on February not yet eligible to be vaccinated due to 17, 2021, and deployment began on February 23, 2021. The first batch of the COVAX AMC AZ doses the lack of studies on the safety and (324,000) arrived on March 3, 2021, and deployment has begun. The Government of India has also efficacy for these groups. Further, this donated 25,000 doses on March 12, 2021, and a South African telecommunications company through proposed AF will cover the costs of the AU has donated 90,000 doses towards the end of March 2021 that are also being deployed. As of purchasing the PPEs and other medical April 25, 2021, 398,941 people have received at least one dose of the vaccine in Senegal. and non-medical supplies for the • Logistics. There is a functional mechanism for the provision of routine EPI and a system for distributing rollout of the COVID-19 vaccines. vaccines from the central level to the local level (central level and EPI distribute to regional level as well • Logistics. The needs and respective as district level and then distributed to service delivery points (healthcare facilities). The DPM and the budgets for the supply chain to be able National Pharmacy Supply (Pharmacie Nationale d’Approvisionnement, PNA) handles the logistics of to rollout COVID-19 vaccine after vaccine distribution. The MoHSA’s Directorate of Infrastructure, Equipment, and Maintenance phase one was included in the final (Direction de la Prevention and Direction des Infrastructures, des Équipements et de la Maintenance, draft of the NDVP that covered the DIEM) also provides support and deals with requisitions and Letters of Postage for Vaccines' monthly remaining population of Senegal. filling. Shipping will be done by road. Estimates and respective budgets have been defined in case a • Cold Chain. Due to potential energy larger quantity of vaccines will be shipped to the country. supply shortages, off-grid solar • Cold chain. Storage capacities were analyzed using the WHO Logistic Planning Tool, taking into account equipment, and supplies will have to all EPI vaccines, including COVID-19. The central vaccine depot has eight (8) positive cold rooms of 40 be procured. Moreover, additional m3 gross each, for a net capacity of 70 m3. After the storage of routine vaccines, the available capacity CCEs, in particular refrigerators, to store the COVID-19 vaccine is 24 m3. Each regional depot has a cold room of 15 m3 gross each except freezers, and energy-efficient Dakar, Thies, and Diourbel, which each have 30 m3 gross with an average occupancy rate of 50 percent. refrigerated trucks will be procured. A There are refrigerators of 240 liters and 150 liters in sufficient quantity for the required needs at the list of the CCE needs is provided in district level. For vaccine storage at -20°C, at the central level, there are eight freezers (240 liters). There Annex 5. are no licensed freezers at the district and service delivery points. Within the framework of the EPI, the
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
Readiness Readiness of Government Key Gaps to Address Before Deployment Domain country does not have high-performance freezers capable of storing vaccines at -80°C. Within the • Waste Management. Revisions must framework of the GAVI-funded Cold Chain Optimization Platform (CCEOP), the country has acquired be made in the Waste Management 1,117 additional CCE units by the end of 2020 to bring all district warehouses and immunization units Plan to include vaccines. This is in the country up to standard. expected to be finalized one month • Waste management. Each region has at least one large-capacity incinerator to cover the incineration after project effectiveness. It will also needs of the districts. The incinerators of the ETCs, hospitals, and health centers could also be used. be important to determine the There is a Healthcare Waste Management Plan at the national level. The subcommittee on vaccines feasibility of procuring and logistics was created to identify the additional need for strengthening the waste management environmentally friendly, energy- system linked to the COVID-19 vaccination. The plan will include the purchase and installation of efficient waste equipment. incinerators (environmentally friendly) to ensure appropriate COVID-19 waste management. Safety • Decree No. 05036 (April 22, 2009) established the National System for Pharmacovigilance that has the surveillance responsibility to prevent and reduce risks linked to pharmaceutical products, including the COVID-19 vaccines. The DPM is responsible for the pharmacovigilance system (PVS), including surveillance of AEFI, in close collaboration with the DP, which will forward the notifications received from the districts. The data will also be transmitted to the Poison Control Center where a committee of experts will be responsible for the AEFI reporting. • Senegal has an AEFI monitoring system to detect any expected or unexpected adverse events. The introduction of new vaccines was an opportunity to strengthen the AEFI surveillance system. However, even though systematic AEFI reporting has improved, some shortcomings persist, particularly in the reporting. • During the training of health workers, special emphasis will be placed on the reporting, investigation, and management of possible cases of AEFI. Although the safety of the COVID-19 vaccine has been demonstrated, mild cases of AEFI such as pain and swelling/soreness at the injection site have been reported. Training and adaptation of existing instruments for surveillance and monitoring of recommended indicators (vaccine coverage, acceptability, disease surveillance, AEFI) for COVID-19 vaccines was completed in April 2021. • As part of the post-introduction surveillance, tools and case definitions for the AEFI cases related to the administration of the COVID-19 vaccine are integrated into the pharmacovigilance guide. Demand • Communication and community engagement are important parts of the NDVP, including advocacy with • The communication plan is being generation and government officials, decision makers, religious and community leaders; training and sensitization of updated. It will create an enabling communication health personnel; social mobilization of community organizations and civil society; and behavior change environment for the effective communication. deployment of COVID-19 vaccines and will include: (a) advocacy with decision
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Readiness Readiness of Government Key Gaps to Address Before Deployment Domain • COVID-19 vaccine deployment began in Senegal in February 2021 with guidance from the National makers, community and local leaders Service for Health Education and Information (Service National de l’Education et de l’Information pour (including publicizing their own COVID- la Santé SNEIPS). A draft COVID-19 vaccine communication plan has been developed and highlights: (a) 19 vaccination); (b) behavior change the activities that are being implemented and those that need to be urgently implemented to increase communication (messages and the demand of COVID-19 vaccines from the priority groups; (b) the key messages that are being materials for the population); (c) social broadcasted throughout the country to build confidence in the COVID-19 vaccine (that is, secondary mobilization; and (d) production and effects of COVID-19 vaccines, groups that should be prioritized, and so on); and (c) the training and dissemination of information and behavioral change communications activities that will need to be implemented until 2022. The promotional materials. Government has launched a few initiatives since vaccine deployment in line with the communication plan to promote COVID-19 vaccinations: (a) broadcasting vaccinations of high-level government officials and religious and community leaders; (b) mass communications via the newspapers, social media, radio, and television; and (c) information sessions with key population groups, women groups, youth groups, and civil society.
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(ii) National Deployment and Vaccination Plan (NDVP)
16. The Government of Senegal has prepared an NCVS and an NDVP (two phases – priority group [20 percent of the population] and the remaining population), which draw on the findings of the VRAF/VIRAT 2.0 assessment and gap analysis. The NCVS and NDVP include inputs from relevant teams from within the MoHSA (surveillance systems, laboratory network, pharmaceuticals, health promotion) and technical partners (WHO, UNICEF, and GAVI). They also align with the principles of the WHO Fair Allocation Framework which defines priority population as follows: (a) frontline workers in health and social care settings; (b) population over 60 years of age; and (c) people who have underlying conditions that put them at a higher risk of death. The NDVP provides information on the deployment plans to reach the priority population (20 percent of the population) and the Government revised the NDVP for the remaining population. The NCVS and NDVP outline the costs, strategies, and plans for vaccine delivery and distribution; certification process of the vaccines; digital vaccine registration and establishment of cloud-based electronic health records system; community mobilization through advocacy; logistics management; and vaccine safety surveillance (see Table 1 for more information). An NCC, national TWG, and subcommittees will monitor all activities related to COVID-19 vaccination efforts, among other activities. A commission under the DPM certifies all pharmaceutical products for human use (Decree No. 17550 of November 20, 2014) and the DPM is also responsible for the distribution of the certified vaccines. The DPM also coordinates all activities of the National System for Pharmacovigilance (Decree No. 05036 of April 22, 2009).
17. Senegal has an ambitious strategy for COVID-19 vaccination in the country.15 However, it is important to note that due to ongoing clinical trials regarding the safety and efficacy of COVID-19 vaccines on children and pregnant women, who represent almost 42 percent and 3 percent of the Senegalese population, respectively, 55 percent of the population (16+) will be eligible to be vaccinated (see Table 2). This proposed AF will support Phase I and II of vaccine purchase and deployment, which will cover the first 55 percent of the population, which also includes priority groups. Phase 1 vaccine acquisition is mainly through COVAX AMC, with the first 20 percent of doses fully subsidized; deployment costs will be financed by the World Bank. The first batch of AZ doses from the COVAX AMC arrived on March 3, 2021 (324,000 doses), and additional doses are expected by May 2021 and the second half of 2021. The Government purchased additional doses (200,000) for Phase I, which were delivered in Senegal on February 17, 2021, from the Chinese pharmaceutical company, Sinopharm, and deployment began on February 23, 2021. The Sinopharm vaccines will not be retroactively financed by the World Bank. The Government of India has also donated 25,000 AZ doses to the Government of Senegal on March 12, 2021, and a South African telecommunications company through the AU donated 90,000 AZ doses by end of March 2021 which will also be used in Phase I. Discussions are ongoing with Russia regarding the purchasing of the Sputnik V vaccines and no delivery date is available at this time. For Phase 2, vaccines will be purchased through a facilitated process with the AVAT and UNICEF (~4.0 million J&J doses), COVAX Facility (2.0 million doses), and direct contracts with pharmaceutical companies (3 million doses to be confirmed), if appropriate regulatory approvals are obtained. The vaccines procured through the AVAT/UNICEF facilitated process are expected in the third quarter of 2021.
15 The Government is expecting performance thresholds to be between 80 and 90 percent of the target for vaccine administration.
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
Table 2: Overview of Senegal Vaccine Coverage and Purchase Plan
Based on the current available estimates as of May 10, 2021
Source of Population Targeted Vaccines Number Estimated World Bank’s Contract status Vaccines already financing of doses total cost to VAC Status of arrived in the country (IBRD,IDA, needed Government the Vaccine TF, Govt, (US$ millions) other) % Number Source Name(s) Price Shipping16 Name Doses ($/dose) ($/dose)
Stage 1/ Phase I (frontline healthcare workers, population 60 years of age and above, population with underlying health conditions and morbidities) COVAX AMC 20% 3,439,261 COVAX AZ 0.0017 1.67 2 11.49 VAC Official request AZ 324,000 and IDA compliant submitted to COVAX; credit initial confirmation received. First batch arrived on March 3, 2021; additional doses expected by May 2021 and the second half of 2021. Govt 0.5% 90,000 Sinopharm Sinopharm 20.6718 1.67 2 4.02 VAC Direct purchase; vaccines Sinopharm 200,000 direct purchase compliant received in-country on February 17, 2021; these vaccines will not be retroactively financed by the World Bank. Govt 0.9% 150,000 Sputnik V direct Sputnik 10.00 1.67 2 3.50 Not eligible In discussion with the - - purchase at this time; manufacturer to domestic purchase 300,000– regulatory 500,000 doses; these standards vaccines will not be
16 Cost of shipping is included in the cost per dose for all sources of vaccines presented in Table 2. We assume shipping costs are also included. 17 As of January 2021, donor-subsidized doses will cover 20 percent of the population. However, it is not guaranteed that all 20 percent will be available up front due to funding constraints—some doses purchased through co-pay may be available before the final tranche of the 20 percent. 18 The government has purchased 200,000 doses of Sinopharm for US$3.72 million at a cost of US$18.60 per dose; however, a total of 10 percent of these doses have been donated to The Gambia and Guinea-Bissau, leaving 180,000 doses available for deployment in Senegal, with an effective price per dose of US$20.67.
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
World Bank-financed (unless they become VAC compliant). Govt of 0.07% 12,500 Government of AZ 0.00 1.67 2 0.04 VAC India has donated 25,000 AZ 25,000 India India compliant doses of AZ to the Government of Senegal on March 12, 2021.
South Africa 0.26% 45,000 South Africa AZ 0.00 1.67 2 .15 VAC South Africa has donated AZ 90,000 Telecom/AU Telecom compliant 90,000 doses to the Government of Senegal towards the end of March 2021. Stage 1 21.73% 3,736,261 19.20 639,000 Total Stage 2/ Phase II (population 16+ except for pregnant women) IDA credit 23.24% 3,997,153 UNICEF/AVAT19 JJ (1 dose) 10 1.67 1 46.65 VAC Expression of Interest has - - compliant been submitted; Vaccines expected at the end of Q3 2021. IDA credit 6.0% 1,031,778 COVAX TBC 7.00 1.67 2 17.89 Vaccine An official request sent. - - (2 doses) unknown at Doses expected toward this time the end of 2021. IDA credit 9.02% 1,551,173 Direct purchase TBC 10.55 1.67 TBC 37.91 Vaccine NA - - (2 doses) unknown at this time Stage 2 38.26% 6,578,854 102.45 Total National 60%20 11,613,039 121.65 639,000 Total Notes: Supply through COVAX assumed to be 9,000,000 doses in CY21, following COVAX communication from January 19, 2021. Doses to cover 20 percent of the population (not accounting for wastage) are assumed to be provided free of charge, and a US$7 per dose assumption is used for the remaining doses, assumed to be 6.0 percent. 3,997,153 doses are expected to be facilitated through the AVAT/UNICEF from J&J (at a price of US$10 per dose). The cost of further doses, purchased through bilateral agreements, is assumed to be US$10.55, in line with COVAX assumptions for AMC countries. In all cases, transport to country is assumed to be included in the dose price, pending further information. Costs for supply chain and service delivery are based on estimates from the COVAX Unit Cost Working Group and calculations by the Energy Sector Management Assistance Program (ESMAP). A coverage of an additional 5 percent of the population to address potential wastage of doses is included in the calculations.
19 Based on public information; agreements between UNICEF and the manufacturers are not yet finalized and may be subject to change. 20 Wastage of vaccines is expected and therefore this table accounts for an additional 5 percent of coverage of the population. If there is no wastage, the Government will be able to cover 60 percent instead of 55 percent of its population.
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18. In December 2020, the Government signed a Model Indemnity Agreement to which all manufacturers under COVAX have agreed. Some vaccine manufacturers may also require other protections against product liability claims, including legislative limits on liability or a national no-fault compensation scheme. Under COVAX, a donor-funded and private-insurance-covered no-fault compensation scheme has been established to cover AMC countries such as Senegal. The Government is aware that separate liability and indemnification provisions will have to be developed with any manufacturer from which they will purchase vaccines directly (more information on indemnification and liability in Box 2).
Box 2: Liability and Indemnification Issues in Vaccine Acquisition
For all countries: • Rapid development of vaccines increases manufacturers’ potential liability for adverse effects
following immunization. • Manufacturers want to protect themselves from this risk by including immunity from suit and liability clauses, indemnification provisions, and other limitation of liability clauses in their supply contracts. • Contractual provisions and domestic legal frameworks can all operate to allocate that risk among market participants, but no mechanism will eliminate this risk entirely. For COVAX-financed vaccines for AMC countries: • COVAX has negotiated model indemnification provisions with manufacturers for vaccines purchased and supplied under the COVAX AMC. • In providing vaccines through COVAX AMC, COVAX requests COVAX AMC participants to have in place an indemnity agreement directly with manufacturers, and the necessary indemnity and liability frameworks for that purpose—either in the form of the COVAX model indemnification arrangements or prior bilateral arrangements with manufacturers. • The COVAX Facility will have a no-fault compensation scheme for AMC countries as part of its risk mitigation strategy. This will cover vaccines supplied only through COVAX AMC. • Senegal will have to consider what it will take to implement these indemnification provisions (including statutory implementation) and how they can avail of the benefits of the no-fault compensation scheme. For vaccines purchased outside of COVAX: • Senegal will need to enter into direct indemnification arrangements with manufacturers. • Senegal does not currently have legislation in place to provide statutory immunity for manufacturers. Senegal does not have a national no-fault compensation scheme. • Adoption of any such indemnification provisions or compensation scheme would have to be in accordance with Senegal’s own national strategy and framework. Possible World Bank support to Senegal • Information sharing on (a) statutory frameworks in Organisation for Economic Co-operation and Development (OECD) countries and other developing countries and (b) overall experience in other countries • Provide training and workshops for government officials to familiarize them with the issues. • For World Bank-financed contracts, the World Bank can provide Hands-On Enhanced Implementation Support (HEIS).
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
II. DESCRIPTION OF ADDITIONAL FINANCING
A. Proposed Changes
19. The changes proposed for the AF entail expanding the scope of activities in the parent project, Senegal COVID-19 Response Project (P173838), and will provide financing for the procurement and deployment of safe and effective COVID-19 vaccines, adjusting its overall design. Activities under Component 1 (Emergency COVID-19 Response) of the parent project will continue to be supported, except for Subcomponent 1.3 (Social and Financial Support to Households) due to support being provided through an ongoing Senegal Safety Net Operation (P133597). Vaccine purchasing and deployment will be done through Component 1. Component 2 (Community Engagement and Risk Communication) will include additional risk communication and community engagement activities related to COVID-19 vaccines. Component 3 (Project Management and M&E) will include additional support to the PCU and other implementing entities for vaccination efforts. As the new activities to be funded under the proposed AF are aligned with the original PDO, the PDO will remain unchanged.
20. The content of the components and the Results Framework of the parent project are adjusted to reflect the expanded scope and new activities proposed under the AF. Implementation arrangements and disbursement categories will also be revised, which will include the DP that will take the lead in the preparation, deployment, and monitoring of COVID-19 vaccines and direct contracting with United Nations (UN) agencies for vaccine deployment and procurement of additional CCEs. The Closing Date will also be extended to December 31, 2025, to provide adequate time for AF implementation.
(i) Proposed New Activities
21. Vaccine purchasing will be done through Component 1 of the Global COVID-19 MPA (SPRP). Emergency COVID-19 Response (Original: US$16.5 million; AF: US$129 million). The support for vaccines when available, which was anticipated in the initial Global COVID-19 MPA, is added as part of the containment and mitigation measures to prevent the spread of COVID-19 and deaths under Component 1: Emergency COVID-19 Response. Two subcomponents (Subcomponents 1.4 and 1.5) are added to address COVID-19 vaccine procurement and deployment and pharmacovigilance, respectively. Senegal will use COVAX AMC, COVAC Facility, AVAT/UNICEF Facilitated Process, and direct purchase with manufacturers for vaccine purchase; the financing mechanisms will be domestic resources as well as World Bank financing. Given the recent emergence of COVID-19, there is no conclusive data available on the duration of immunity that vaccines will provide. While some evidence suggests that an enduring response will occur, this will not be known with certainty until clinical trials follow participants for several years. As such, this AF will allow for re-vaccination efforts if they are warranted by peer-reviewed scientific knowledge at the time. In the case that re-vaccination is required, limited priority populations (such as health workers and the elderly) will need to be targeted for re-vaccination given constraints on vaccine production capacity and equity considerations (that is, tradeoffs between broader population coverage and re-vaccination). As a prudent and contingent measure, budget for funding has been retained for re- vaccination, if needed, of such a subset of the population. Details are provided below on the activities that will continue to be supported through this AF as well as the proposed new activities. This component will also continue to provide immediate support to the country to enhance disease detection capacities through provision of technical expertise, laboratory equipment, and systems to ensure prompt case
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finding and contact tracing, consistent with the WHO’s SPRP for COVID-19. It has enabled countries to mobilize surge response capacity through trained and well-equipped frontline health workers. Most of the original activities will be maintained to ensure that national and sub-national health systems are equipped to continue to prevent, detect, and treat COVID-19 cases in the country.
22. Subcomponent 1.1: Case Detection, Confirmation, Contact Tracing, Recording, Reporting (Original: US$5 million; AF: US$3 Million). This subcomponent will continue to support the Government’s National COVID-19 Emergency and Response Plan by covering costs related to the strengthening of climate-sensitive disease surveillance and epidemiological capacity for early detection and confirmation of cases and active contact tracing.
23. Subcomponent 1.2: Health System Strengthening (Original: US$8 million; AF: US$5 Million). This subcomponent will continue to support efforts to strengthen the public health system’s capacity to provide optimal medical care to patients at risk, measures for contingency planning (surge capacity), as well as maintain essential healthcare services and minimize risks for patients and health personnel. New activities will be financed in this subcomponent to support effective and safe vaccine deployment, including: (a) PPE for vaccinators such as surgical masks and face shields; (b) procurement of vaccination supplies, emergency kits for anaphylactic shock management, and resuscitation equipment; (c) adoption of global tools and adaptation of the supply chain system to best practices, including the rehabilitation of existing cold rooms and the procurement of CCE such as Solar Direct Drive (SDD) Refrigerators, climate- friendly refrigerators, fuel-efficient refrigerated trucks, fuel-efficient regular trucks, deep freezers, and waste management equipment to reduce the impact on the country’s greenhouse gas (GHG) emissions, and sustainable end-of-life options for old or high-polluting equipment using the guidance from the Coordination Centre for Effects; and (d) strengthening remote temperature-monitoring systems including the purchase of freeze-tag/fridge-tags.
24. Subcomponent 1.3: Social and Financial Support to Households (Original: US$3.5 million). The AF will not support this subcomponent since the ongoing Social Protection and Jobs’ (SPJ’s) Senegal Safety Net Operation (P133597), which covers 15–20 percent of households in Senegal (poorest quintile), is supporting the most vulnerable populations through a cash transfer program.
25. Subcomponent 1.4: COVID-19 Vaccine Acquisition, Planning, and Distribution (Original: US$0 Million; AF: US$119 million). This is a new subcomponent which will support the MoHSA in implementing its NCVS and NDVP. As it relates to COVID-19 Vaccine Planning and Management, activities that will be financed are as follows: (a) development of operational/micro-plans and budgets for implementation; (b) contingency measures included in the NDVP to deal with any unexpected disruptions to vaccine supply from climate change and natural disasters (that is, flooding and extreme heat); (c) support the estimation, mapping, and identification of target populations; (d) support for the development of legal regulatory documents (including indemnification and liability protection, statutory indemnification, or national/regional no-fault compensation schemes), and plans for swift importation of the COVID-19 vaccines; (e) establishment of policies to ensure that there is no forced vaccination and that any mandatory vaccination program (such as for entry to schools) is well designed regarding consent and follows due process for those who choose to opt out; (f) operationalization of a robust electronic health
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records system21 that uses cloud-based technology from Oracle; (g) support development of a roadmap for improved integration of COVID-19 vaccine deployment with the EPI and other primary health care (PHC) services; (h) support the development of a HR mobilization and training plan and capacity building for vaccine rollout and how to address vaccine hesitancy and gender-based violence (GBV) concerns; and (i) technical analyses for expanded and sustained vaccine acquisition and overall vaccine manufacturing, including COVID-19 vaccines for the pandemic and subsequent phases.22
26. As it relates to COVID-19 Vaccine Acquisition and Distribution, procurement, importation, storage, and distribution of the COVID-19 vaccines that are supplied through COVAX and others23 will be financed. Vaccines will be purchased for approximately 35 percent of the population and will cost the Government an estimated US$82.85–84.85 million.24 The World Bank is financing a portion of the vaccine costs (US$76.13 million), while the Government has and will purchase other vaccines through domestic resources that will not be retroactively financed by the World Bank (US$6.7–8.7 million). Priority groups for COVID-19 vaccination have been defined in accordance with the WHO and the Strategic Advisory Group of Experts on Immunization (SAGE) values framework for the allocation and prioritization of COVID-19 vaccination for the 20 percent of Senegal’s population.25 Targeting criteria and implementation plans are described below (see Table 3) and include frontline healthcare workers, populations over 60 years, patients with underlying conditions, and patients with co-morbidities. The remaining 35 percent will be vaccinated in subsequent years. Efforts are being made by the Government to ensure equitable access to vaccines for people with disabilities and other vulnerable groups. Vaccinations will take place at health centers, health posts, through mobile units, and specialized health facilities (such as geriatric centers, diabetes services, cardiology services, and so on).
Table 3: Priority Groups for Vaccination in Senegal Ranking of Priority groups Population % of vulnerable groups estimates population First Frontline healthcare workers 20,668 .12 Second Population aged 70+ years 312,000 1.8 Population aged 60–69 years 521,000 3.0 Third Patients with underlying conditions (specifically 1,842,914 10.7 hypertension) aged 19–59 years Patients with other co-morbidities 602,822 3.5 SUB-TOTAL 3,018,604 19.92 Fourth Population aged 16+ years (except pregnant 6,020,000 35.00 women) SUB-TOTAL 6,020,000 35.00 TOTAL 9,038,604 54.92
21 The MoHSA with the support of the Tony Blair Institute is establishing a cloud-based (Oracle) electronic health records system to manage essential vaccination programs, including COVID-19. The Tony Blair Institute is providing a grant for 10 years for the cloud-based system, but operational costs such as computer equipment for health facilities, Internet access, and training will need to be financed. 22The aim of the technical assessment will be to develop a broad and robust strategy to secure a portfolio of vaccines for the pandemic and beyond. The technical assessment will include analyses on the opportunities to leverage COVID-19 vaccine investments for wider health capacity and systems strengthening and to develop a business model for vaccine manufacturing. This activity will only focus on technical analyses and will not translate into financing production of vaccines through this AF. 23 In addition to the modification of the threshold for eligibility of IBRD/IDA resources for vaccine purchase, either vaccines will also need to meet domestic regulatory standards and approvals, which should be assessed for readiness as part of the appraisal of any vaccine project. 24 First 20 percent of the population is covered by COVAX AMC for a total of 55 percent coverage. Wastage of vaccines is expected and therefore, an additional 5 percent of coverage of the population is included in the costs. If there is no wastage, the Government will be able to cover 60 percent instead of 55 percent of its population. 25https://apps.who.int/iris/bitstream/handle/10665/334299/WHO-2019-nCoV-SAGE_Framework-Allocation_and_prioritization-2020.1-eng.pdf?sequence=1&isAllowed=y.
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27. Subcomponent 1.5: Pharmacovigilance and Patient Safety (Original: US$0 Million; AF: US$2 million). This is a new subcomponent that will support the management of AEFIs that are imperative for all national immunization systems. During the COVID-19 vaccination campaign, the MoHSA through the National Commission of Pharmacovigilance under the Directorate of Pharmacies and Laboratories (Direction de la Pharmacie et des Laboratoires), plans to conduct surveillance for AEFI across all health regions over a 12-month period when vaccines are introduced. Several bodies and structures will be involved in monitoring the occurrence of AEFIs, their management, and case management. Moreover, at the peripheral level, notifications will be conducted by focal points at health districts. National regulation specifies that state-funded free medical care will be provided to individuals that experience AEFIs.
28. This subcomponent will finance: (a) training of health personnel on aspects related to AEFI, including planning, communication, vaccine management, M&E, administration strategy, immunization calendar, AEFI notification, and vaccine and injection safety; (b) revision of guidelines and tools for AEFI notification to adapt them to the COVID-19 vaccine context; (c) implementation of an electronic notification system for cases of AEFI; (d) support of health district teams and supervisors at the central level to investigate severe cases of AEFI and clusters of AEFIs; (e) coordination and functionality of the technical and expert structures involved in the management of AEFI; (f) the collection and transport of biological samples from cases of AEFI to designated laboratories, and analysis of samples; and (g) organizing the transport of persons who are victims of severe AEFI to referral facilities and cover costs related to their medical care. This subcomponent will also support the MoHSA in maintaining contact with individuals who are receiving COVID-19 vaccines (one- and two-dose vaccines) to ensure adequate surveillance of AEFIs for each individual. This will include costs related to the purchase of telephone credit and data bundles for site teams and coordination teams to send reminders by phone, text, or email two days before the appointment for the second dose.
29. Component 2: Community Engagement and Risk Communication (Original: US$2 million; AF: US$3 million). Original activities will be maintained to ensure effective risk communication and community/citizen engagement to raise public awareness and knowledge on prevention and control of COVID-19 among the general population, including greater awareness about climate change risks and adaptation measures.
30. Subcomponent 2.1: Community Engagement for Prevention (Original: US$0.75 million) will not be supported since the ongoing REDISSE I (P154807) will continue to support community-based disease surveillance, event-based public health surveillance, and multi-stakeholder engagement.
31. New activities will be financed in Subcomponent 2.2: Comprehensive Behavioral Change and Risk Communication (Original: US$1.25 million; AF: US$3 million). A multi-faceted communications campaign will be developed as part of a broader social engagement and mobilization strategy to address vaccine hesitancy, with tailored content and channels, to target priority groups. Vaccine acceptance is very important to ensure the population is well protected from COVID-19. However, there is a lack of studies on vaccine sentiment in African countries. Although the Senegalese population is well informed about the COVID-19 pandemic and the Government’s efforts in response, anti-vaccine sentiment remains
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high in Senegal (78 percent).26 This may be a result of wide vaccine misinformation online and on social media. Moreover, there is also a lack of confidence in the vaccines (short time frame for vaccine development) and lack of verified, accurate information. Therefore, the country needs a strong sensitization campaign for vaccine acceptance to ensure a return to normalcy. This includes the publicization of high-level government officials and religious and community leaders getting vaccinated. The social engagement strategy to reduce vaccine hesitancy includes active disinformation management through social listening, review, and follow-up with exposed groups. This will be critical for women and adolescent girls since there is misinformation spreading that COVID-19 vaccines may cause infertility, which may lead to more hesitancy to take the vaccine when it becomes available. Mobilizing men to get vaccinated given the heightened COVID-19 burden and general hesitation of men to use health services and prevention interventions will also be important. Building confidence in a new vaccine will boost overall confidence in vaccinations, thereby leading to greater utilization of other vaccines and medicines. Moreover, with the increase of GBV around the world and in Senegal during the pandemic, raising awareness on options and providing psychosocial support to women and adolescent girls will be important.
32. The communication campaign will be implemented in all stages of the national vaccination rollout, and will leverage mass media, social media, religious leaders, community leaders, and healthcare workers. Communication activities will also focus on climate-related diseases to ensure greater awareness of the risks among key population groups, thereby building resilience against infectious diseases. The topics will cover critical prevention measures such as handwashing and mask wearing, which protect against pathogens such as rotavirus in addition to COVID-19. Activities that will be financed include: (a) implementation of national risk communication and outreach campaign, demand creation, and community engagement plans for COVID-19 vaccines; (b) ensuring vaccines reach the target populations; (c) training of healthcare workers on GBV/sexual exploitation and abuse (SEA)/sexual harassment (SH) to ensure proper psychosocial support to victims; and (d) strengthening and adapting the PVS to be sensitive to detect AEFI for the COVID-19 vaccine.
33. Component 3: Project Management and M&E (Original: US$1.5 million; AF: US$2 million). Original activities in Subcomponent 3.1 (Program Management) will be maintained to support the strengthening of public structures for the coordination and management of the project, including central and local (decentralized) arrangements for coordination of activities, FM, and procurement. The existing PCU will continue to be responsible for the overall administration, procurement, environmental and social aspects, FM, and M&E of project activities. The proposed AF will engage partner organizations, particularly the WHO and UNICEF, in various roles such as procurement agents and suppliers and providers of specialized technical assistance. Moreover, original activities in Subcomponent 3.2 (M&E) will also be maintained to support M&E of prevention, preparedness, and response and building capacity for clinical and public health research, including veterinary services.
34. New activities will be financed in Subcomponent 3.1 (Original: US$1 million; AF: US$1.5 million) for project management. Specific emphasis will be placed on building the capacity of MoHSA officials and other stakeholders on the deployment of COVID-19 vaccines.
26 Afrobarometer. 2021. Senegalese Approve the Government’s Response to the COVID-19 Pandemic but are Skeptical of the COVID-19 Vaccines. Report no. 430. Available at: https://afrobarometer.org/sites/default/files/publications/Dispatches/ad430- les_senegalais_sont_sceptiques_envers_les_vaccins_de_covid-19-depeche_afrobarometer-5mars21.pdf.
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35. New activities to be financed under Subcomponent 3.2 (Original: US$0.5 million; AF: US$0.5 million) will support the strengthening of existing data and monitoring systems to accommodate for COVID-19 vaccines. This will improve data collection, analysis, reporting, and use of data for action and decision making. The AF will also cover costs related to the capacity building and adoption of global tools and/or adaption of existing tools and systems (for example, HMIS and so on) for M&E of COVID-19 vaccine distribution, including for adverse drug reactions and to collect data and improve activities implemented (review validation, monitoring, harmonization, and workshops).
(ii) Financing Arrangements
36. The increase in scope as outlined above will be reflected in an increase in indicative component allocations from US$20 million (equivalent) to US$154 million (equivalent), with 94.5 percent of the AF amount under Component 1 mostly for vaccine acquisition, planning, and distribution (see Table 4 below). The allocation to Component 2 has increased from US$2 million to US$5 million to strengthen communication and community engagement activities. Component 3 will increase from US$1 million to US$3.5 million to ensure adequate project management and monitoring of activities being implemented. Table 5 provides a summary of vaccine sourcing and World Bank financing.
Table 4: Project Cost and Financing Parent AF Cost Parent Project + IDA Financing Project Cost (US$, AF Cost (US$, (US$, Project Components (US$, millions) millions) millions) millions) Component 1: Emergency COVID-19 Response 16.50 129.00 145.50 145.5 Subcomponent 1.1: Case Detection, Confirmation, Contact 5.00 3.00 8.00 8.00 Tracing, Recording, Reporting Subcomponent 1.2: Health System Strengthening 8.00 5.00 13.00 13.00 Subcomponent 1.3: Social and Financial Support to 3.50 0 3.50 3.50 Households [US$3.5 million]. Subcomponent 1.4: COVID-19 Vaccine Acquisition, - 119.00 119.00 119.00 Planning and Distribution Subcomponent 1.5: Pharmacovigilance and Patient Safety - 2.00 2.00 2.00 Component 2: Community Engagement and Risk 2.00 3.00 5.00 5.00 Communications Subcomponent 2.1: Community Engagement for 0.75 0 0.75 0.75 Prevention Subcomponent 2.2: Comprehensive Behavioral Change 1.25 3.00 4.25 4.25 and Risk Communication Component 3: Project Management and M&E 1.50 2.00 3.50 3.50 Subcomponent 3.1: Project Management 1.00 1.50 2.50 2.50 Subcomponent 3.2: Monitoring and Evaluation (M&E) 0.50 0.50 1.00 1.00 Total Costs 20.00 134.00 154.00 154.00
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Table 5: Summary of vaccine sourcing and World Bank financing Source of vaccine financing and population National Doses coverage Estimated plan purchased World Bank-financed Other allocation of target Specific vaccines and sourcing plans with World COVAX Through Through World Bank (populatio Bank grant other direct financing n %) finance mechanisms purchase 20% (COVAX AMC); 0.5% Purchase: Stage 1: (Sinopharm - GOV); 0.9% (Sputnik US$76.13 21.73% 20% - - 1.73% 0 V- GOV); 0.07% (AZ - Gov of India); million
0.26% (AZ- SA Telecom and AU) Deployment: US$54.87 23.24% (J&J through UNICEF/AVAT million Facilitated process); 6.0% (COVAX) Other (case Stage 2: - 29.24% 9.02% - and 9.02% (direct purchase from 9,153,055 detection): 38.26% manufacturers -pharmaceutical US$3 million companies TBD).
(iii) Retroactive Financing
37. In accordance with the provisions under the SPRP, Retroactive Financing for up to 20 percent of the total cost of the project (grant and loan amounts) will be available for this AF for disbursing resources quickly in response to the needs such as vaccine purchase that adhere to the World Bank’s VAC and other World Bank procedures and guidelines, vaccine deployment for vaccines that adhere to the World Bank’s VAC, sensitization activities, climate-sensitive CCE, and other agreed-upon interventions. For payments made prior to the Signature Date of the Financing Agreement, except that withdrawals up to an aggregate amount not to exceed EUR 26.8 million may be made for payments made prior to this date but on or after April 14, 2021 for Eligible Expenditures under Category (2) or (3).
(iv) Changes in Institutional Arrangements NDVP Implementation and Oversight
38. The MoHSA will remain the implementing ministry of the proposed AF. The SG of the MoHSA will continue to be responsible for the overall coordination and oversight of the implementation of the project and the MoHSA’s DAGE will continue to be the unit responsible for the FM and procurement functions of the project. The DGS will continue to be responsible for the technical coordination of the project. The DP under the DGS will take the operational lead for the preparation, deployment, and monitoring of COVID-19 vaccines. The National Interagency Coordinating Committee for the EPI (Comité National de Coordination Inter Agence du Programme Elargi de Vaccination, CCIA) ensures the political validation of strategies and plans related to immunization.
39. A Multisectoral Steering Committee will be created to assure the overall governance of the project, including the validation of plans and monitoring of project implementation. The Steering Committee will be chaired by the MoHSA and will include representatives from other ministries such as the Ministry of Livestock and Animal Protection, the Ministry of Agriculture and Rural Equipment, the Ministry of Environment and Sustainable Development, and the Ministry of Water and Sanitation. The NDVP has been prepared and will be submitted to the Steering Committee for validation. The Project’s Multisectoral Steering Committee will be established before project effectiveness. The PCU will continue
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to be responsible for the day-to-day management of the project by: (a) coordinating the project activities; (b) ensuring the proper fiduciary management of project activities in all components under oversight of the MoHSA’s DAGE; (c) preparing consolidated annual work plans, updating the PIM, ESF quarterly reports, budgets, and M&E; and (d) preparing the implementation report of the project to be submitted to the Steering Committee and the World Bank Group (WBG). Additional staff have been recruited within the PCU (environmental specialist and social specialist) and the contract of the current environmental and social specialist that supports all ESF-related matters in the parent project has been extended. An Occupational Health and Safety (OHS) specialist is also being recruited and will be on board no later than one month from the effectiveness date of the AF. The proposed institutional arrangements are based on lessons learned from coordination and implementation of the two ongoing health projects (REDISSE I [P154807] and Investing in Maternal, Child and Adolescent Health [ISMEA, P162042]) and the parent project.
(v) Changes in the disbursement categories
40. The project’s disbursement categories will remain the same. Disbursements will be frontloaded as much as possible; however, delays may be experienced due to unavailability of the vaccines from direct purchase, COVAX, and AVAT/UNICEF Facilitated process. The AVAT/UNICEF Facilitated process is expecting the first shipment of vaccines in the country in quarter (Q)3 of 2021 (July 2021).
(vi) Results Framework
41. To measure the overall progress of the coverage and deployment of the COVID-19 vaccines and the gender gaps the project can address, eight new indicators are being proposed and two indicators from the parent project are being dropped (see Table 6 for more information). Some indicators in the parent project will have revised targets to account for the increased financing (see Section VIII: Results Framework and Monitoring).
Table 6: Summary of changes to the PDO and Intermediate Results Indicators under the AF Indicator Level Status Rationale/ Comments Indicator introduced to measure progress in Percent of population vaccinated PDO New access to COVID-19 vaccines by the general (by gender) population. Also, disaggregated by gender. Percentage of population Indicator introduced to measure progress in vaccinated, which is included in the prioritizing of the most vulnerable for priority population targets defined PDO New COVID-19 vaccines. Also, disaggregated by in the national priority group and gender. plan (by priority group and gender). Indicator introduced to measure capacity to Number of healthcare facilities and Intermediate/ safely handle vaccines and proper disposal. warehouses provided with climate- Subcomponent New Also, provides progress in mitigation and sensitive/energy-efficient CCE to 1.2 adaptation to climate change. store COVID-19 vaccines
Number of national, subnational, Indicator introduced to ensure proper Intermediate/ facility-based, and mobile staff training takes place for proper handling of Subcomponent New trained in COVID-19 vaccine cold COVID-19 vaccines. 1.4 chain, storage, and handling
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Intermediate/ Indicator introduced to ensure proper PVS adapted to detect AEFI for the Subcomponent New follow-up is conducted for patients that COVID-19 vaccine (Yes/No) 1.5 experience unusual side effects. Intermediate/ Indicator introduced to ensure proper Number of AEFI cases reported via Subcomponent New follow-up is conducted for patients that the electronic notification system 1.5 experience unusual side effects. Intermediate/ Indicator introduced to ensure community Number of TV, radio and social Subcomponent New engagement for COVID-19. media spots produced on COVID-19 2.2 Indicator introduced to ensure healthcare Healthcare workers and community- Intermediate/ professionals have adequate training to deal based nurses trained on Subcomponent New with patients that have experienced GBV/SEA/SH 2.2 GBV/SEA/SH Number of eligible households Activities related to this indicator are being Intermediate/ provided with food and other dropped under the AF since it is covered Subcomponent Dropped supplies among affected under an SPJ project. 1.3 populations Intermediate/ Activities related to this indicator are being Number of handwashing kits Subcomponent Dropped dropped under the AF. distributed 2.2
B. Sustainability
42. There is strong political commitment in the Republic of Senegal to mobilize financial resources for COVID-19 response, including for vaccine purchase and deployment. Having the funds through the proposed AF for vaccine purchase and deployment will establish an enabling environment for other donors, multilateral development banks, and UN agencies to also support vaccination efforts (that is, trained staff, improved distribution systems) in the country. Investments under the parent project and the AF are expected to strengthen the health system in the country, ensuring institutional sustainability to deal with infectious diseases.
III. KEY RISKS
43. The overall risk to achieving the PDO with the expanded scope and AF for vaccination will be revised from Moderate in the parent project to High due to the uncertainties with the COVID-19 vaccine acquisition and deployment.
44. The large-scale acquisition and deployment of COVID-19 vaccines entails certain significant risks. First, global demand for vaccines continues to exceed supply, and vaccines that meet the Bank’s VAC may not be available to be acquired in a timely manner. Second, a mass vaccination effort stretches capacity, in particular in low-capacity environments such as Senegal, entailing risks. The proposed World Bank support for Senegal to develop vaccination acquisition strategies and investment in deployment system capacity specifically aim to mitigate these risks. The World Bank will work with Senegal to partner with service providers that can acquire and/or deliver the vaccines. The World Bank will also work with the country to consider trade-offs and to determine the appropriate approach and risk balance. The remaining risk must be considered against the risk of resulting in the country having less timely and
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effective deployment of vaccines, potentially exacerbating development gaps, and eroding past development gains.
45. Political and governance risks have been raised to Substantial. Political pressures may create pressure on Senegal to purchase vaccines before they have been appropriately certified. In the case of Senegal, the Global COVID-19 MPA AF mitigates this risk as financing will only be used for vaccines that adhere to the World Bank’s VAC. The other risk relates to the commitment and ability of the authorities to ensure appropriate targeting of the vaccines to priority populations, based on objective public health criteria, and to avoid elite capture. This risk will be mitigated through the assurance mechanisms that this AF will support such as the establishment of an acceptable policy and plan for prioritized intra-country allocation. For instance, the Government of Senegal equitably distributed the Sinopharm vaccines purchased among all the regions of Senegal to ensure equitable access.
46. In addition, there are risks associated with fraudulent attempts to gain access to vaccines to be administered not following approved protocols of priority populations or for personal gain and to use sensitive data from the electronic registry to restrict certain individuals/groups from accessing the vaccines. This will be mitigated through a rigorous inspection regime and Anti-Corruption Guidelines (ACGs) for vaccine purchase and deployment. This includes traceability of supply. To guard against abuse of that data and to ensure data protection, the proposed AF will incorporate best international practices for dealing with such data in such circumstances similarly to the parent project. There are also risks related to indemnification. Senegal plans to have specific indemnification and liability clauses when purchasing vaccines directly from manufacturers. As an AMC country, Senegal also has access to the regional no-fault compensation scheme for vaccines acquired through COVAX. The Government will develop an indemnification plan during project implementation to ensure clear arrangements are included as it relates to indemnification and liability issues.
47. Macroeconomic risk remains Moderate as Senegal is experiencing some fiscal pressures and faces the risk of not having enough additional fiscal space for the purchase of vaccines at scale and other COVID-19-related response interventions. The proposed AF specifically aims to mitigate this risk by providing financing for vaccine purchase and promoting prioritized deployment to vulnerable groups. Residual macroeconomic risk will remain as the country aims to scale vaccine access to higher coverage levels. COVID-19 vaccination is a key priority within the government’s economic recovery plan as it will help create the conditions for reopening the country to tourism, which in its turn will alleviate the economic and fiscal crisis given the importance of tourism to the country’s economy.
48. The AF is designed to address key institutional capacity risks related to vaccine deployment and distribution, but the residual risks remain Substantial. Notwithstanding the high performance of the immunization program in Senegal, vaccine deployment cold-chain and distribution capacity are currently inadequate and need to be strengthened given the anticipated scale and population group coverage for COVID-19 vaccination. This risk will be mitigated by this AF and technical support for immunization system strengthening, including capacity assessments in coordination with the WHO, GAVI, UNICEF, and other partners, and coordinating with other partners in their provision of systems strengthening support.
49. Stakeholder risks have been raised to Substantial. Senegal must be prepared to address hesitancy and build vaccine literacy so that the public will accept immunization when appropriate. The
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accelerated pace of vaccine development has further heightened public anxieties and could compromise acceptance. Therefore, there are risks related to the continuation of the COVID-19 pandemic and the rollout of the NDVP. These include: (a) the set of challenges related to the implementation of preventive responses and control measures and (b) pressure from groups being unable to access vaccines in the initial phases due to limited availability of vaccines and/or limited deployment capacity. The Government’s policy will be to promote voluntary COVID-19 vaccinations. In Senegal, the population strongly believes in the positive effects of vaccination as shown by the high uptake and high coverage rates through the EPI. Clear and consistent communication by government officials and specifically by religious leaders will ensure that we build public confidence in the COVID-19 vaccination program, and this will include explaining how vaccines work, their level of effectiveness, and the importance of population-wide coverage to achieve community immunity in an adequate and health literacy appropriate fashion. This will also include publicization of higher-level government officials being administered the vaccine. Credible and culturally appropriate health and risk communication will be vital in influencing positive health behaviors among the priority vaccination groups.
50. Fiduciary risks associated with the parent project remain Substantial. The procurement and FM risks initially assessed for the parent project cover risks associated with the procurement and distribution of vaccines, including fraud and corruption risks. Risks specific to the vaccines include:
• Procurement: The key procurement risk associated with vaccines relates to: (a) the complexity of the vaccines market given the significant market power enjoyed by vaccine manufacturers; (b) inability of the market to supply adequate quantities of vaccines to meet the demand, (c) limited market access due to advance orders by developed countries; and (d) weak bargaining power of individual countries; and (e) delays in triggering emergency procurement procedures which could delay procurement and contract implementation including payments. The risks under this AF will be mitigated by providing options to support the country’s needs for direct or advance purchase, including technical assistance.
• Fiduciary Management (FM): The key FM risk relates to lack of adequate controls over the transparent, prioritized distribution and application of vaccines, particularly for the most vulnerable population groups. This AF will use the same options as in the parent project to assess and strengthen control systems, facilitate the timely flow of funds, and ensure adequate liquidity to finance project activities.
51. Technical design remains Substantial. These risks arise from the uncertainties around the timing when COVID-19 vaccines will be available and the supply chain capacity to implement such a large vaccination effort, which may compromise the achievement of the project’s objectives. Additionally, there are risks related to the limited supply of medical equipment, COVID-19 tests, PPEs, and other medical inputs necessary to control the pandemic and address the health needs of the general population during a pandemic. The World Bank will work closely with government officials (MoHSA), as well as UN agencies involved in the pandemic response (for example, WHO, UNICEF), to support the process of acquiring and delivering the COVID-19 vaccines as well as other necessary supply of medical equipment, tests, and PPEs.
52. The anticipated overall environmental and social risks remain Substantial. Key social and environmental risks are those related to: (a) medical waste management and disposal; (b) the spread of
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the virus among healthcare workers and the population at large; (c) occupational and community health and safety issues related to testing, handling, transporting, disposing of supplies and medical samples, and upgrading of designated health facilities/laboratories; (d) marginalized and vulnerable social groups being unable to access vaccines provision, facilities, and services designed to combat the disease; (e) social conflict, and risks to human security resulting from diagnostics testing, limited availability of vaccines, and social tensions related to the difficulties of a pandemic situation; (f) SEA/SH risks among patients and healthcare providers, especially in relation to distribution of lifesaving vaccines; (g) labor influx, related to the rehabilitation of existing health facilities; (h) inappropriate data protection measures and insufficient/ineffective stakeholder communication on the vaccine rollout strategy; and (i) risks associated with AEFI. The Government does not intend to use military or security personnel for the deployment of the vaccines due to the experiences and capacities gained so far with the use of the EPI which is well implemented through the health centers.
53. Possible risks and impacts are considered mostly temporary, predictable, and/or reversible, but they could become widespread given the highly infective nature of the COVID-19 virus. These risks are covered by ESS 1, ESS 2, ESS 3, ESS 4, and ESS 10. To mitigate these risks the MoHSA has updated the Environmental and Social Commitment Plan (ESCP) and Stakeholder Engagement Plan (SEP), which was publicly disclosed on the World Bank website on May 3, 2021 and by MoHSA on May 10, 2021 and is currently updating the ESMF, Labor Management Procedures (LMP), Infection Control Plan and Biomedical Waste Management (ICPBWM), SEA/SH Action Plan, and the GRM Manual, which will be consulted upon, finalized, and disclosed no later than one month from project effectiveness. The ESMF will contain provisions for storing, transporting, and disposing of contaminated medical waste and will outline guidance (in line with international good practice and WHO standards on COVID-19 response) on limiting viral contagion in healthcare facilities. In addition to the ESMF, the Borrower will implement and supervise the activities listed in the ESCP.
54. These risks will be mitigated through several measures to ensure vaccine delivery targets the most vulnerable populations, particularly women, the elderly, poor, refugees, and minorities in accordance with criteria specified in this AF. First, the World Bank will support Senegal in developing and adapting explicit, contextually appropriate, and well-communicated targeting criteria and implementation plan (for example, the national vaccination program and any subsidiary programs) including criteria for access to vaccines. The Borrower should ensure that this plan is subject to timely and meaningful consultations in accordance with ESS 10. There should be consensus to first target health workers, other essential workers, and the most vulnerable populations, which will include a mix of the elderly, people with co-morbidities, and people in high population density locations such as slums. The World Bank will also continue to provide technical and implementation support to mitigate this risk.
55. The Other category references the general vaccine-related risks, which is rated as High due to the uncertainties of vaccine acquisition and deployment. There is high demand of vaccines globally and low supply. The COVAX Facility and other mechanisms such as the AVAT will help to mitigate the low supply through AMCs, but the delivery of these doses in-country may take longer than expected.
IV. APPRAISAL SUMMARY
A. Technical, Economic and Financial Analysis
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56. Although there are very significant gaps in knowledge of the scope and features of the COVID- 19 pandemic, it is apparent that economic disruptions will derive from increased sickness and death among humans and the impact this will have on the potential output of global and regional economies. In the Spanish Influenza pandemic (1918–19), 50 million people died—about 2.5 percent 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’s 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. The SARS outbreak of 2003 led to an estimated 800 deaths, and it resulted in economic losses of about 0.5 percent of annual gross domestic product (GDP) for the entire East Asia region, concentrated in the second quarter. The West Africa EVD epidemic in 2014–2016 reiterated the importance of strengthening national disease surveillance systems and inter-country collaboration for more effective response. Senegal was able to successfully contain this disease outbreak with timely identification and response. The measures that people took resulted in a severe demand shock for services sectors such as tourism, 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.
57. The economic rationale for investment in a COVID-19 vaccine is strong, considering the massive and continuing health and economic losses due to the pandemic. As of April 25, 2021, more than 147.19 million people have been infected by the virus and over 3.11 million have died worldwide. Global output is projected to decline by 4.9 percent in 2020, with cumulative losses across 2020 and 2021 exceeding US$12 trillion. Likewise, the real GDP growth in Senegal is estimated at 0.9 percent in 2020 compared to 4.4 percent in 2019, reflecting larger-than-anticipated disruptions in the economic activity stemming from the pandemic and strict containment measures. Important sectors of the Senegalese economy have been impacted such as tourism, transport, and hospitality. Agriculture was the most dynamic, growing at 4.5 percent year-over-year, followed by the secondary sector (that is, industry) at 1.8 percent, while services contracted by 0.7 percent. The services contraction is explained by the weak performance of transport (- 12.4 percent) and hospitality (-10 percent). The young, economically active population (20–44 years old) proves to be the most vulnerable to the economic impact of the disease, which may pose an additional risk for economic recovery without adopting an adequate, safe, and effective vaccination strategy. However, stronger health systems that can respond to the pandemic and deployment of COVID-19 vaccines, which is being proposed in the AF, have the potential to contribute substantially to economic growth and reverse these trends.
58. The successful development, production, and delivery of a vaccine however has the best potential to reverse these trends, generating benefits that will far exceed vaccine-related costs. Indeed, a rapid and well-targeted deployment of a COVID-19 vaccine can help reduce the increases in poverty and accelerate economic recovery. Even at levels of imperfect effectiveness, a COVID-19 vaccine that is introduced and deployed effectively to priority populations can assist in significantly reducing mortality and the spread of the coronavirus and accelerating a safe reopening of key sectors that are affected. It can also reverse human capital losses by ensuring schools are reopened. The effective administration of a COVID-19 vaccine will also help avoid the associated healthcare costs for potentially millions of additional cases of infection and associated health-related impoverishment. Global experience with immunization against diseases shows that by avoiding these and other health costs, vaccines are one of
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the best buys in public health. For the most vulnerable population groups, especially in countries without effective universal health coverage, the potential health-related costs of millions of additional cases of COVID-19 infection in the absence of a vaccine represent a significant or even catastrophic financial impact and risk of impoverishment. The pandemic is also having dire effects on other non-COVID-19 health outcomes. Increased morbidity and mortality due to interruption of essential services associated with COVID-19 containment measures hinder access to care for other health needs of the population, including maternal and childcare services; routine immunization services have been affected, threatening polio eradication and potentially leading to new outbreaks of preventable diseases, with their own related deaths, illnesses, and long-term costs. In Senegal, simultaneous epidemics are overwhelming public health systems that had few resources to begin with, and services needed to address the needs of people with chronic health conditions and mental and substance use disorders have also been disrupted.
59. While the uncertainty around COVID-19 vaccines make it difficult to calculate its cost- effectiveness, the effective launch of a COVID-19 vaccine will have direct benefits in terms of averted costs of treatment and disability, as well as strengthened health systems. Estimated COVID-19 treatment costs from low- and middle-income countries is at US$50 for a non-severe case and US$300 for a severe case. This excludes costs of testing of negative cases as well as the medical costs associated with delayed or forgone care-seeking, which usually results in higher costs. Further, investments in vaccine delivery systems generate health and economic benefits beyond just delivering the COVID-19 vaccine. First, investments in last-mile delivery systems to administer the COVID-19 vaccine to remote communities will require strengthening community health systems, which can have spillover effects to effective delivery of other services, helping close the significant urban-rural gap. Second, as the COVID-19 vaccine is introduced and lockdowns and movement restrictions are eased, patients can continue to access care for other conditions. Third, the economic benefits of slowing down the economic downturn are likely to significantly exceed the costs needed to vaccinate 55 percent of the population, leaving aside the immediate health benefits. Given both the economic and health system benefits, an effectively deployed COVID-19 vaccine presents significant benefits.
B. Financial Management
60. In line with the guidelines as stated in the Financial Management Practices Manual issued by the Financial Management Sector Board on March 1, 2010, the FM assessment was conducted for the parent project.
61. The FM arrangements established for the parent project will be replicated for the proposed AF under the MoHSA’s DAGE responsibility. The FM team in place is fully dedicated to the ISMEA, REDISSE I, and ongoing parent project and is familiar with World Bank procedures and regions-based interventions. This FM team comprising an administrative and financial officer and two accountants remains and is being reinforced by a chief accountant. The multi-project accounting software is easily integrated in the proposed project’s accounts and the administrative and FM manual in place is adequate.
62. The overall FM performance of the parent project was rated as Moderately Satisfactory further to the supervision undertaken in November 2020, and the FM risk was assessed as Moderate.
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63. The following measures should be put in place within two months from effectiveness of the AF Financing Agreement: (a) customize the accounting software to include this AF component and (b) update the terms of reference (ToR) of the external auditor. The following measures should be put in place no later than four months after Project Effectiveness: an update of the work plan of the internal auditor. The conclusion of the FM assessment is that the FM arrangements meet the World Bank’s minimum requirements under World Bank Investment Project Financing (IPF) Policy and Directive, and the residual risk remains Moderate due to the mitigation measure proposed in the action plan.
64. The inherent risk of Senegal’s public FM system is rated as Substantial. However, it will not materially impact the project as the project is not executed through the country public FM system.
C. Procurement
65. Procurement under the AF 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 November 2020. As with the parent project, the AF 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 transactions.
66. The Borrower has prepared a Project Procurement Strategy for Development (PPSD) and a 18- month Procurement Plan that was approved by the World Bank. All COVID-19 vaccines being purchased will come from the international market, countries with additional doses, and several global mechanisms supporting low- and middle-income countries. There is a preference of using the national market to procure various other items such as PPE and CCE. The Procurement Plan specifies for each contract: (a) a description of the activities/contracts; (b) the selection methods to be applied; (c) the estimated cost; (d) time schedules; (e) the World Bank’s review requirements; and (f) any other relevant procurement information. The Borrower shall submit to the World Bank, for its review and approval, any updates of the Procurement Plan.
67. The major planned procurement under this project will include: (a) vaccine purchase; (b) CCE (refrigerators, freezers, vehicles including refrigerator vehicles and vaccinator personnel transport); (c) technical assistance for demand creation, including mass media and communication campaigns; (d) other technical assistance to support in-country implementation, including assessments of effective vaccine management capacity and training of frontline delivery workers; (e) advisory and legal services for vaccine certification, indemnification, and liability; and (f) vaccine logistics and information management systems and information systems to monitor adverse effects from immunization. Contracts for vaccines purchase financed by the World Bank will be subject to the World Bank’s prior review irrespective of value and procurement approach.
68. The current demand for COVID-19 vaccines exceeds the supply in the market which makes it more difficult for client countries to negotiate terms and conditions. Procurement of vaccines will therefore follow Direct Selection. Senegal, an AMC 92 eligible country, will make use of the COVAX AMC as one of the main mechanisms for purchasing vaccines. The country will use direct purchasing from vaccines manufacturers and purchase of stocks from other countries that reserve excess doses. All freight costs
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for vaccines delivered to the country from COVAX AMC are fully subsidized. The project will support the country to cover the operational costs, including freight costs, and costs for additional vaccines.
69. For other proposed procurement, the PCU will use: (a) streamlined competitive procedures with shorter bidding time; (b) framework agreements including existing ones; (c) procurement from UN agencies enabled and expedited by World Bank procedures and standard agreements; and (d) increased thresholds for Requests for Quotations and national procurement, among others. These will be based on the country’s risk-based thresholds given the market easing and end of emergency period.
70. In view of the significant disruptions in the usual supply chains for medical consumables and equipment and vaccines, the World Bank will provide technical assistance upon request through World Bank’s HEIS and Bank Facilitated Procurement (BFP) to help them access the existing supply chain.
71. As under the parent project, the procurement risk is estimated as Substantial. Procurement of COVID-19 vaccines and ancillary supplies are subject to high level of uncertainties in terms of prices and quantities that will be made available through different purchasing options. Other items being procured through the project such as climate sensitive CCE will have to be procured internationally. The Substantial risk will be mitigated by arranging practical trainings on the World Bank’s New Procurement Framework (NPF) for PCU staff, support throughout procurement processes, and other needs as they arise. The parent project also provided ample experience as it relates to the procurement of some of the supplies and equipment for COVID-19 response.
D. Legal Operational Policies . Triggered?
Projects on International Waterways OP 7.50 No Projects in Disputed Areas OP 7.60 No .
E. Environmental and Social
72. Activities under the AF will fill a critical gap in the scope of the parent project, providing financing for the procurement and deployment of safe and effective COVID-19 vaccines, including vaccine-related communication activity, planning and management, supply and distribution, and digital health information and other supporting systems. However, it could also pose risks to the environment, health, and safety due to the dangerous nature of the pathogen (COVID-19) and the reagents and equipment used in vaccination activities. As the activities under the AF will also broaden the scope of the activities of the parent project, facilities treating patients may also generate biological, chemical waste, and other hazardous by-products that could be detrimental to human health. These risks will be mitigated with OHS standards and specific infectious-control strategies, guidelines, and requirements as recommended by the WHO.
73. In accordance with the recommendations of the WHO Interim Guidance (February 12, 2020) on Laboratory Biosafety Guidance related to the novel coronavirus (2019-nCoV), and other guidelines, the
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parent project developed an ICPBWM and an ESMF for the project by adding to it WHO standards on COVID-19 response. The plan includes training of staff to be aware of all hazards they might encounter. This provides for the application of international best practices in COVID-19 diagnostic testing and handling the medical supplies and disposing of the generated waste.
74. The last environmental and social performance rating of the parent project was Moderately Satisfactory. The environmental and social instruments for the parent project have been developed and publicly disclosed on the World Bank's website and at the country level. These instruments are being updated for the proposed AF. The project implementation will ensure appropriate stakeholder engagement, proper awareness raising, and timely information dissemination. This will help: (a) avoid conflicts resulting from false rumors; (b) ensure equitable access to services for all who need it; (c) address the unavailability of vaccines at the right time for people at risk; (d) cases of uprisings related to restrictions put in place by the authorities because of the lack of vaccines; (e) the risk of poor communication about the vaccine to the population; and (f) SEA/SH risks to patients and healthcare from the distribution of life-saving vaccines. These will be guided by standards set out by the WHO as well as other international good practices including social inclusion and prevention of SEA and SH. The SEP and ESCP have been updated and publicly disclosed on the World Bank’s website as of May 3, 2021 and by the MoHSA on May 10, 2021. The updated ESMF, LMP, ICPBWM, SEA/SH Action Plan, and the GRM Manual will have to be consulted upon, finalized, and disclosed on the MoHSA’s website no later than one month from project effectiveness, prior to the implementation of relevant project activities, and implemented thereafter throughout project implementation. The PCU has extended the contract of the current Environment and Social Consultant and has recruited two full-time Environmental and Social Specialists to manage and supervise the overall proposed AF’s ESS. An OHS specialist is being recruited to support the project on a part-time basis and will be on board no later than one month from project effectiveness.
F. Gender gap analysis
75. Senegal ranked 168th out of 189 countries in the latest Gender Inequality Index,27 which reflects gender-based inequalities in three dimensions—reproductive health, empowerment, and economic activity. Gender relations in Senegal are shaped by sociocultural norms and customs that establish hierarchical relationships in which males are dominant. Senegalese girls and women continue to experience unequal rights such as discriminatory family code (laws and institutional practices governing marriage, divorce, and inheritance) and many forms of GBV including female genital mutilation (FGM).
76. Some progress has been noted, but more must be done to strengthen gender equality and women’s empowerment. The adoption of the National Strategy for Equity and Gender Equality (2016– 2026),28 which ensures that women and men benefit equally from development and the establishment of an environment conducive to achieving gender equality, was a very important step for the country. Although there have been improvements in the inclusion of women in government in recent years with 41.8 percent of women holding parliamentary seats, only 10.3 percent of adult women have reached at least a secondary level of education compared to 26.5 percent of their male counterparts.29 The maternal
27 UNDP (United Nations Development Programme). 2020. Gender Inequality Index. Available at: http://hdr.undp.org/en/composite/GII. 28 Stratégie Nationale Equité et Egalité de Genre (SNEEG) 2016–2026. 29 UNDP (United Nations Development Programme). 2020. “The Next Frontier: Human Development and the Anthropocene.” Briefing note for countries on the 2020 Human Development Report, Senegal. Available at: http://hdr.undp.org/sites/all/themes/hdr_theme/country- notes/SEN.pdf.
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mortality ratio has improved since 2000, but 315 women die from pregnancy-related cases for every 100,000 live births. Moreover, the adolescent fertility rate as of 2018 remains high with 70.71 births per 1,000 women aged 15–19 years. The labor force participation rate is also lower for women than men; 35 percent of women compared to 57.5 percent of men.
77. The COVID-19 pandemic may impact the progress made on gender equality and women’s empowerment. Lockdown measures, quarantines, and travel restrictions adopted to respond to the COVID-19 pandemic have affected businesses where women are overrepresented such as tourism and restaurant/catering in urban areas; and agricultural, fishing, and livestock activities in rural areas. An increased risk of GBV in Senegal has also been observed in 2020 due to financial uncertainty and other stresses exacerbated by lockdown measures. A study conducted in Senegal found that 193 out of 201 women interviewed suffered from physical and mental violence during lockdowns due to COVID-19;30 a 15-percent increase of reported GBV compared to the period before the pandemic. Therefore, this project will continue to build awareness as it relates to women‘s and adolescent girls’ rights, GBV, and other relevant issues such as vaccine hesitancy for this population group due to fears of impact on fertility.
78. Other consequences of the COVID-19 pandemic include: (a) lack of access to basic social services, public and community structures such as safe spaces, listening centers, and women's houses; (b) an increase in demand for healthcare for COVID-19 patients has created a reduction, modification, discontinuity, or even interruption in the supply of specialized health services for GBV and SEA/HS survivors; (c) unfavorable social norms that increase the vulnerability of people with disabilities, the elderly, young people, pregnant women, people living with HIV/AIDs to exposure to COVID-19, and several forms of GBV, including domestic violence; and (d) restriction of movement with the state of emergency forces many women/girls to stay at home in a context of low protection, promiscuity, which increases the risk of GBV, including SEA/SH. The vaccine distribution phase may also increase the risks of SEA, especially for female healthcare workers as patients visit vaccination points.
79. In this regard, ensuring gender mainstreaming in response strategies, such as immunization, will require, among other measures: (a) sensitization of healthcare providers to the risks of increased SEA/SH during the pandemic; (b) preparation of an inclusive communication plan that also specifically targets vulnerable people and is adapted to sociocultural realities; and (c) carrying out vaccination considering the gender targeting of beneficiaries.
80. To ensure effective project implementation in line with ESSs, the MoHSA has mobilized two specialists: (a) an environmental specialist to oversee all environmental aspects to ensure that the project is carried out in accordance with environmental standards; and (b) a social specialist with a background in communications on SEA/SH aspects (study ways to involve and engage the media and communities, especially key community actors). The contract of the environmental and social consultant has been extended to continue to support all ESF-related matters. An OHS Specialist is being recruited and will begin no later than one month from project effectiveness. In addition to the ESMF, the Borrower will implement the activities set out in the ESCP. The SEP and ESCP have been publicly disclosed on the
30 JDWS (Justice and Dignity for the Women of the Sahel). 2020. Impact de la COVID-19 sur les violences faites aux femmes et aux filles au sahel. Available at: https://www.jdwsahel.org/2020/08/02/impact-de-la-covid-19-sur-les-violences-faites-aux-femmes-et-aux-filles-au-sahel-de-40- 63-avant-la-pandemie-a-52-18-soit-12-daugmentation/.
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World Bank’s website as of May 3, 2021 and by the MoHSA on May 10, 2021. All remaining E&S instruments, the ESMF, LMP, ICPBWM, SEA/SH Action Plan, and the GRM Manual, will be updated and disclosed no later than one month from project effectiveness. No relevant project activities should be implemented prior to the update and disclosure of the E&S instruments. All activities that will be retroactively financed will be validated to ensure they adhere to World Bank procedures and guidelines. The project implementation will ensure appropriate stakeholder engagement, proper awareness raising, and timely information dissemination. This will help: (a) avoid conflicts resulting from false rumors; (b) ensure equitable access to services for all who need it; and (c) address issues resulting from people being kept in quarantine. These will be guided by standards set out by the WHO as well as other international good practices including social inclusion and prevention of SEA and SH.
G. Climate Co-benefits
81. Climate change risks and vulnerabilities. Senegal has been assessed for climate change and disaster risks and is highly exposed to extreme temperature, extreme precipitation and flooding, drought, and sea level rise. This exposure risk is assessed at this level for both the current and future timescales. Senegal is particularly vulnerable to changes in the sea level since 70 percent of its population lives along the coast. Heat waves have also increased in the region, affecting the health of the elderly and other vulnerable groups. However, the risk to project activities and outcomes is categorized as ‘moderate’ due to a number of adaptation measures. Some mitigation measures have also been integrated and will reduce the impact of the project’s activities on the environment and reduce the impact on the country’s GHGs.
82. Senegal is vulnerable to climate change with more intense rainfall in shorter periods leading to frequent flooding and drier seasons leading to food insecurity. Moreover, temperatures will continue to increase, which will impact the interior regions more than the coastal regions. These climatic events have grave consequences for health outcomes such as nutrition-related effects and waterborne illnesses. In particular, it is projected that risks will increase for vector-borne diseases such as malaria, waterborne diseases such as cholera due to the lack of quality/viability of water resources, parasitic diseases such as schistosomiasis and soil-transmitted helminths, and mental health issues due to the potential financial stress from lowered agricultural output. In 2009 alone, the floods that affected the coastal regions and Saint Louis resulted in over US$100 million of overall damage and loss, including health centers, and it was reported that there were approximately 2,000 cases of diarrhea and 3,300 cases of malaria following the flood.31
83. The AF intends to address climate change vulnerabilities, enhance climate resilience and adaptation, and mitigate GHG emissions through the following activities. In terms of climate adaptation measures, under Subcomponent 1.1: Case Detection, Confirmation, Contact Tracing, Recording, Reporting (AF: US$3 Million), the strengthened case management capabilities and disease surveillance system will enhance the ability of the health services to better respond to future climate-related health impacts from extreme weather events. This will include the integration of weather surveillance to improve the use of information for detecting, investigating, and responding to public health threats. Under Subcomponent 1.2: Health System Strengthening (AF: US$5 million), special attention will be given to healthcare facilities that have unstable electricity supply and weak health infrastructure that may be
31 USAID (United States Agency for International Development). 2018. Technical Report - Climate Change and Health Risks in Senegal.
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
affected by climate change and climate variability (that is, heat waves, flooding). The widespread loss of power may seriously threaten the COVID-19 vaccine cold chain as vaccine conservation standards will be affected. Therefore, as an adaptation measure, some of the CCEs purchased will be off-grid solar equipment/supplies such as solar-powered fridges and freezers that will provide reliable 24/7 power and efficient cooling and battery-powered coolers (provide up to seven days of cooling during emergencies). Low-carbon, energy-efficient waste management equipment will be procured to enhance climate resilience to flooding threats faced by the country. This will include properly and safely disposing of supplies/products such as syringes, partially used COVID-19 vaccines, unrefrigerated vaccines that are rendered ineffective, expired vaccines, PPE, and other vaccine-related waste in compliant containers.
84. Under Subcomponent 1.4: COVID-19 Vaccine Acquisition, Planning, and Distribution (AF: US$119 million), purchase of the COVID-19 vaccines will consume US$76.13 million of the budget. This includes the costs of the vaccines, supplies, safety boxes for disposal of syringes, syringes, international freight, procurement fees to UNICEF, and other in-country deployment-related costs. While no direct climate financing is expected to be assigned at this time to any of these investments, it is expected that some suppliers are taking active steps to ensure climate-resilient considerations are taken into account during the manufacturing, shipment, and distribution stages of the vaccines. The World Bank team, together with UNICEF, the WHO, and GAVI will continue to explore these areas to provide latest information on any specific climate adaptation and mitigation actions taken with regard to the vaccines. The NDVP will include measures to deal with any unexpected disruptions to the vaccine supply chain, distribution, and storage from climate change impacts and other unexpected disasters (that is, power outages from flooding and extreme heat). Under Subcomponent 2.2: Comprehensive Behavioral Change and Risk Communication (AF: US$3 million), this subcomponent will finance community outreach, sensitization, and raise awareness of COVID-19 vaccinations. Important health information on climate change-related health risks linked to the COVID-19 crisis such as the increased risks associated with quarantine in extreme heat events and the promotion of healthy behaviors will be provided. This will include sensitization of the population on the risks of co-morbidities such as being infected with COVID- 19 and climate-related diseases such as malaria, EVD, or other communicable diseases and non- communicable diseases (NCDs) as these can lead to more severe complications or death.
85. In terms of climate mitigation activities, under Subcomponent 1.2: Health System Strengthening (AF: US$5 million), the procurement of solar and off-the-grid fridges/freezers and low-carbon, energy- efficient waste management equipment will reduce the impact of the project on the country’s GHG emissions. Additionally, the installation of temperature controls and monitoring system on the refrigerators and freezers will monitor any fluctuations and will cut down on excessive use of energy and reduce the project’s contribution to the country’s GHG emissions. Climate-smart civil works will also be financed such as rehabilitation of health facilities and cold rooms to ensure they are well-insulated against extreme heat from climate change. This will include procurement of improved thermal insulation and solar reflective roofs. Fuel-efficient refrigerated vehicles and non-refrigerated vehicles will also be procured, and route optimization will be taken into account for vaccine transportation by adjusting routes for vehicles depending on weather and road conditions. This will improve fuel mileage and fuel efficiency of the vehicles. The project will also finance the operationalization of the digital vaccine registry to manage COVID-19 vaccine deployment and a cloud-based electronic health records system. This will help reduce the use of paper and the incidence of record loss. Moreover, the use of mobile phone technologies will also enable vaccinations to take place outside of fixed health facilities, which will allow vaccinators to get
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in closer proximity to beneficiaries. This will reduce the use of transportation by beneficiaries, leading to lower GHG emissions from cars, trucks, buses, and other modes of transportation.
H. Citizen Engagement and Outreach
86. The involvement of the local population is essential to the success of the project to ensure smooth collaboration between project staff and local communities, and to minimize and mitigate environmental and social risks related to the proposed project activities. In the context of infectious diseases, broad, culturally appropriate, and adapted awareness-raising activities are particularly important to properly sensitize the communities to the risks related to infectious diseases. As such, the project developed an SEP with the overall objective of defining a program for stakeholder engagement, including public information disclosure and consultation, throughout the entire project cycle. The SEP outlines the ways in which the project team will communicate with stakeholders. It ensures that the Borrower engages in continuous, meaningful, and safe consultations on policies and procedures (including grievances) with all stakeholders, providing them with timely, understandable, and accessible information throughout the project life cycle. Moreover, as it relates to COVID-19 vaccine administration, the Government has built their targeting strategy on the WHO’s Fair Allocation Framework, which not only prioritizes populations that are older and populations at risk of being more exposed to COVID-19 such as frontline healthcare workers, but populations with underlying health conditions including those living with disabilities.
87. GRM. The parent project incorporates a comprehensive GRM which aims to provide individuals and communities who feel aggrieved by project activities with accessible, timely, effective, and culturally appropriate opportunities to raise their project-related complaints and concerns. The project is working on the SNEIPS to use the established number (numero vert) within the MoHSA for complaints. The GRM will be adapted to take into account possible grievances for the COVID-19 vaccine for the proposed AF project. Other mechanisms will also be used to engage citizens, and target beneficiaries more specifically in: (a) providing ideas and feedback on program delivery; (b) identifying gaps at the point of service delivery (information availability, access to testing and vaccination, access to relevant care, equal treatment, and so on); (c) building community knowledge and confidence, establishing trust; and (d) ensuring governments respond to community needs (including vulnerable groups).
V. WORLD BANK GRIEVANCE REDRESS
88. Communities and individuals who believe that they are adversely affected by a World Bank (WB)-supported project may submit complaints to existing project-level grievance redress mechanisms or the WB’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 WB’s independent Inspection Panel which determines whether harm occurred, or could occur, as a result of WB 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 World Bank Management has been given an opportunity to respond. For information on how to submit complaints to the World 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.
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
VI SUMMARY TABLE OF CHANGES
Changed Not Changed
Results Framework ✔ Components and Cost ✔ Loan Closing Date(s) ✔ Disbursements Arrangements ✔ Procurement ✔ Implementing Agency ✔ Project's Development Objectives ✔ Cancellations Proposed ✔ Reallocation between Disbursement Categories ✔ Legal Covenants ✔ Financial Management ✔ APA Reliance ✔
VII DETAILED CHANGE(S)
MPA PROGRAM DEVELOPMENT OBJECTIVE
Current 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
Proposed New MPA Program Development Objective
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EXPECTED MPA PROGRAM RESULTS
Current Expected MPA Results and their Indicators for the MPA Program Progress towards the achievement of the PDO would be measured by outcome indicators. Individual country- specific projects (or phases) under the MPA Program will identify relevant indicators, including among others: • Country has activated their public health Emergency Operations Centre or a coordination mechanism for COVID-19; • Number of designated laboratories with COVID-19 diagnostic equipment, test kits, and reagents; • Number of acute healthcare facilities with isolation capacity; • Number of suspected cases of COVID-19 reported and investigated per approved protocol; • Number of diagnosed cases treated per approved protocol; • Personal and community non-pharmaceutical interventions adopted by the country (e.g., installation of handwashing facilities, provision of supplies and behavior change campaigns, continuity of water and sanitation service provision in public facilities and households, schools closures, telework and remote meetings, reduce/cancel mass gatherings); • Policies, regulations, guidelines, or other relevant government strategic documents incorporating a multi- sectoral health approach developed/or revised and adopted; • Multi-sectoral operationalmechanism for coordinated response to outbreaks by human, animal and wildlife sectors in place; • Coordinated surveillance systemsin place in the animal health and public health sectors for zoonotic diseases/pathogens identified as joint priorities; and • Mechanisms for responding to infectious and potential zoonotic diseases established and functional; and • Outbreak/pandemic emergency risk communication plan and activities developed and tested
Proposed Expected MPA Results and their Indicators for the MPA Program
COMPONENTS Current Component Name Current Cost Action Proposed Component Proposed Cost (US$, (US$, millions) Name millions) Component 1. Emergency 16.50 Revised Component 1. 145.50 COVID-19 Response Emergency COVID-19 Response
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Component 2. Community 2.00 Revised Component 2. 5.00 Engagement and Risk Community Engagement Communication and Risk Communication Component 3. Project 1.50 Revised Component 3. Project 3.50 Management and Management and Monitoring Monitoring TOTAL 20.00 154.00
LOAN CLOSING DATE(S) Ln/Cr/Tf Status Original Closing Current Proposed Proposed Deadline Closing(s) Closing for Withdrawal Applications IDA-65990 Effective 31-Mar-2021 30-Sep-2021 31-Dec-2025 30-Apr-2026
DISBURSEMENT ARRANGEMENTS Change in Disbursement Arrangements Yes
Expected Disbursements (in US$) DISBURSTBL Fiscal Year Annual Cumulative
2020 7,959,549.94 7,959,549.94
2021 12,000,000.00 19,959,549.94
2022 50,000,000.00 69,959,549.94
2023 40,000,000.00 109,959,549.94
2024 20,000,000.00 129,959,549.94
2025 15,000,000.00 144,959,549.94
2026 9,040,450.06 154,000,000.00
SYSTEMATIC OPERATIONS RISK-RATING TOOL (SORT) Risk Category Latest ISR Rating Current Rating
⚫ Moderate ⚫ Substantial Political and Governance ⚫ Moderate ⚫ Moderate Macroeconomic
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⚫ Moderate ⚫ Moderate Sector Strategies and Policies ⚫ Moderate ⚫ Substantial Technical Design of Project or Program Institutional Capacity for Implementation and ⚫ Moderate ⚫ Substantial Sustainability ⚫ Moderate ⚫ Substantial Fiduciary ⚫ Substantial ⚫ Substantial Environment and Social ⚫ Moderate ⚫ Substantial Stakeholders ⚫ High Other Overall ⚫ Moderate ⚫ High
LEGAL COVENANTS2
LEGAL COVENANTS – Additional Financing for the Senegal COVID-19 Response Project (P175992) Sections and Description Schedule 2, Section 1, B1: The Recipient shall by no later than one (1) month after the Effective Date or at any later date agreed upon in writing with the Association, reflect additional activities under the Project in form and substance satisfactory to the Association, by updating the Project Implementation Manual. Schedule 2, Section 1, C2: the Recipient shall: (a) by no later than one (1) month after the Effective Date, draft an update to the current Work Plan and Budget under the Original Project to reflect additional activities, in accordance with paragraph 1. Schedule 2, Section 4.1: No later than two (2) months after the Effective Date, or any later date agreed upon in writing with the Association, the Recipient shall: (i) customize the accounting software under specifications agreed upon with the Association; and (ii) revise the external auditor’s terms of reference; all to accordingly reflect the additional activities under the Project, and under terms and conditions satisfactory to the Association. Schedule 2, Section 4.2: No later than four (4) months after the Effective Date, or any later date agreed upon in writing with the Association, the Recipient shall update the internal auditor’s terms of reference, to reflect the additional activities under the Project, with terms and conditions satisfactory to the Association. As agreed in ESCP, the ESMF is to be updated, disclosed, consulted upon, and adopted no later than one month from the Effective Date and prior to the implementation of relevant Project activities and implemented thereafter throughout Project implementation. As agreed in ESCP, ICPBWM is to be updated, disclosed, consulted upon, and adopted no later than one month after the Effective Date and prior to the implementation of relevant Project activities. As agreed in ESCP, prepare, disclose, consult, adopt and implement all environmental and social management plans or other instruments necessary for the respective Project activities on the basis of the assessment process, in accordance with the ESSs, ESMF including the ICPBWM and SEA/SH Action Plan annexed to the ESMF. As agreed in ESCP, the LMP is to be updated, disclosed, consulted upon, and adopted no later than one month after the Effective Date and prior to the implementation of relevant Project activities.
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
Conditions
Type Financing source Description Effectiveness IBRD/IDA Article IV, 4.01: the Recipient shall have established the Project’s Multisectoral Steering Committee, with terms of reference, mandate and resources satisfactory to the Association, in accordance with Section I.A.2 of Schedule 2 to this Agreement Type Financing source Description Disbursement IBRD/IDA Schedule C, Section III, B, 1(b), under Category (1), until and unless the proceeds of the Financing under the Original Financing Agreement have been fully committed and documented, or disbursed.
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The World Bank Additional Financing to the Senegal COVID-19 Response Project (P175992)
VIII. RESULTS FRAMEWORK AND MONITORING
Results Framework COUNTRY: Senegal RESULT_NO_PDO Additional Financing for the Senegal COVID-19 Response Project Project Development Objective(s)
To prevent, detect and respond to the COVID-19 disease outbreak in Senegal.
Project Development Objective Indicators by Objectives/ Outcomes
RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4
To prevent, detect and response to the COVID-19 outbreak and other disease outbreaks.
Suspected cases of COVID-19 cases reported and 0.00 500,000.00 540,000.00 565,000.00 585,000.00 600,000.00 investigated per approved protocol (Number) Rationale: Action: This indicator has been Revised Increased from 1,000 to 600,000.
Suspected cases that test positive (Number) 0.00 42,000.00 46,000.00 48,000.00 49,000.00 50,000.00 Rationale: Action: This indicator has been Revised Indicator revised for clarity and target revised from 1,000 to 50,000.
Health staff trained in COVID- 19 prevention, testing and care 1,518.00 2,000.00 2,200.00 2,300.00 2,400.00 2,500.00 per MoHSA-approved protocols (Number)
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The World Bank Additional Financing to the Senegal COVID-19 Response Project (P175992)
RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 Rationale: Action: This indicator has been End target increased (2,000 to 2,500) to account for additional personnel trained for COVID-19 prevention, testing and care. Change in end target date to Revised stay consistent with the AF closing date.
District health centers/hospitals with personal protective equipment and 0.00 88.00 88.00 89.00 89.00 90.00 infection control products and supplies (Percentage) Rationale: Action: This indicator has been Revised Change in end target date to stay consistent with the AF closing date.
Percentage of population 0.00 20.00 30.00 45.00 50.00 55.00 vaccinated (Percentage) Rationale: Indicator introduced to measure progress in access to COVID-19 vaccines by the general population. Also, disaggregated by gender. Action: This indicator is New
Females (Percentage) 0.00 50.00
Rationale: Action: This indicator is Indicator introduced to measure progress in access to COVID-19 vaccines by women. New
Percentage of population vaccinated, which is included in the priority population targets 0.00 20.00 defined in national plan (Percentage)
Action: This indicator is New Rationale:
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The World Bank Additional Financing to the Senegal COVID-19 Response Project (P175992)
RESULT_FRAME_TBL_PDO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 Introduced to ensure equity of access to vaccines by most vulnerable. Add sub-indicator to disaggregate by % female
Females vaccinated 0.00 40.00 (Percentage) Rationale: Action: This indicator is In order to track the percentage of females vaccinated as part of the priority group. New
Female healthcare workers 0.00 60.00 vaccinated (Percentage) Rationale: Action: This indicator is Indicator introduced to measure progress in prioritizing healthcare workers, particularly women, for COVID-19 vaccines. New
Females with co-morbidities vaccinated (Percentage) 0.00 30.00 Rationale: Action: This indicator is Indicator introduced to measure progress in prioritizing people with co-morbidities, particularly women, for COVID-19 vaccines. New
PDO Table SPACE
Intermediate Results Indicators by Components
RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4
Component 1: Emergency COVID-19 Response
Point of entry/ border officers trained on COVID-19 0.00 160.00 prevention, control and
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The World Bank Additional Financing to the Senegal COVID-19 Response Project (P175992)
RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 contact tracing (Number)
Rationale: Action: This indicator has been Revised Target revised from 45 to 160.
Healthcare workers and community-based nurses trained on COVID-19 0.00 1,500.00 1,700.00 1,800.00 1,900.00 2,000.00 prevention, control and contact tracing (Number) Rationale: Action: This indicator has been Change in end target date to ensure consistency with AF closing date. Revised
Healthcare facilities that received protective equipment 0.00 105.00 110.00 115.00 119.00 119.00 and hygiene materials (Number) Rationale: Action: This indicator has been Revised Target revised from 85 to 119.
Designated laboratories with COVID-19 diagnostic equipment, test kits, and 0.00 7.00 7.00 7.00 7.00 7.00 reagents per MOHSA guidelines (Number) Rationale: Action: This indicator has been Target revised from 5 to 7. Revised
Number of eligible households 0.00 1,000.00 provided with food and other
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The World Bank Additional Financing to the Senegal COVID-19 Response Project (P175992)
RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 supplies among affected populations (Number) Rationale: Action: This indicator has been Marked for Deletion Activities related to this indicator are being dropped under the AF since it is covered under an SPJ project.
Patients that are satisfied with the treatment of COVID-19 0.00 65.00 70.00 70.00 70.00 70.00 received (Percentage) Rationale: Action: This indicator has been The target indicator was revised from 90% to 70%. Slight change in the numerator to solely focus on health services. Change in end target date to ensure Revised consistency with AF closing date.
Number of healthcare facilities and warehouses provided with climate-sensitive/energy- 0.00 10.00 25.00 40.00 45.00 50.00 efficient cold chain equipment to store COVID-19 vaccines (Number) Rationale: Indicator introduced to measure capacity to safely handle vaccines and proper disposal. Also, provides progress in mitigation and adaptation to climate Action: This indicator is New change.
Number of national, sub- national, facility-based and mobile staff trained in COVID- 0.00 50.00 150.00 250.00 275.00 300.00 19 vaccine cold chain, storage and handling (Number) Rationale: Action: This indicator is New Indicator introduced to ensure proper training takes place for proper handling of COVID-19 vaccines.
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The World Bank Additional Financing to the Senegal COVID-19 Response Project (P175992)
RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 Pharmacovigilance System (PVS) adapted to detect Adverse Events Following No Yes Vaccination (AEFI) for the COVID-19 vaccine (Yes/No) Rationale: Action: This indicator is New Indicator introduced to ensure proper follow-up is conducted for patients that experience unusual side effects.
Number of AEFI cases reported 0.00 50.00 65.00 80.00 90.00 100.00 (Number) Rationale: Action: This indicator is New Indicator introduced to ensure proper follow-up is conducted for patients that experience unusual side effects.
Component 2: Community Engagement and Risk Communication
Social Distancing communication strategy No Yes developed (Yes/No) Assessment conducted to identify behavioral and socio- cultural risk factors for COVID- No Yes 19 covering all the regions (Yes/No) Handwashing kits distributed 0.00 1,000.00 (Number) Action: This indicator has been Marked for Deletion People reached through hygiene promotion activities 0.00 250.00 600.00 800.00 900.00 1,000.00 (Number)
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The World Bank Additional Financing to the Senegal COVID-19 Response Project (P175992)
RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 Rationale: Action: This indicator has been Change in end target date to ensure consistency with AF closing date. Revised
Community health workers trained on community-based 0.00 2,000.00 disease surveillance (Number) Number of TV, radio and social media spots produced on 0.00 75.00 200.00 250.00 275.00 300.00 COVID-19 (Number) Rationale: Action: This indicator is New Indicator introduced to ensure community engagement for COVID-19.
Healthcare workers and community-based nurses trained on GBV/SEA/SH 0.00 40.00 100.00 200.00 250.00 300.00 (Number) Rationale: Action: This indicator is New Indicator introduced to ensure healthcare professionals have adequate training to deal with patients that have experienced GBV/SEA/SH
Component 3: Program Management and Monitoring and Evaluation
Health centers/hospitals received supervision for 0.00 70.00 75.00 80.00 80.00 80.00 COVID-19 (Percentage) Rationale: Action: This indicator has been Change in target from 100-80%. Change in end target date to ensure consistency with AF closing date. Revised
Establishment of joint M&E systems supporting the One No Yes Health approach and epidemic
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The World Bank Additional Financing to the Senegal COVID-19 Response Project (P175992)
RESULT_FRAME_TBL_IO Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 preparedness and response (Yes/No) Number of meetings held by 0.00 91.00 143.00 156.00 the platform (Number) Rationale: Action: This indicator has been The indicator title was changed for clarity since the CNGE meets on a weekly basis. The indicator's target was revised from 12 months to 156 weeks Revised (expected to meet until at least March 2023).
IO Table SPACE
Monitoring & Evaluation Plan: PDO Indicators Mapped Methodology for Data Responsibility for Data Indicator Name Definition/Description Frequency Datasource Collection Collection Suspected cases of COVID-19 cases Cumulative number of Weekly Report Routine monitoring MoHSA reported and investigated per approved cases tested in laboratory protocol Cumulative number of Weekly Report Routine monitoring MoHSA Suspected cases that test positive suspected cases that are
positive Cumulative number of Health staff trained in COVID-19 health staff trained at Quarterly Report Routine monitoring MoHSA prevention, testing and care per MoHSA- different level in the approved protocols system Cumulative number of District health centers/hospitals with district health and Hospital Quarterly Report Routine monitoring MoHSA personal protective equipment and with adequate supply of infection control products and supplies PPE without stockout in preceding two weeks.
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Numerator: Number of people that received a full Directorate of Weekly Report Routine monitoring Percentage of population vaccinated series of a COVID-19 Prevention/PCU
vaccine; Denominator: Total population of Senegal Numerator: Number of Directorate of women that received a full Directorate of Monthly Prevention EPI Routine monitoring Females series of a COVID-19 Prevention/ PCU data vaccine; Denominator:
Total population of Senegal Numerator: Number of Percentage of population vaccinated, people in the priority Routine monitoring by which is included in the priority population that received a Monthly PEV Data MoHSA PEV population targets defined in national full series of a COVID-19 plan vaccine; Denominator: Total population of Senegal Numerator: Number of females vaccinated as part of the priority groups defined in national plan; Directorate of Weekly Report Routine monitoring Females vaccinated Denominator: Total Prevention/ PCU
number of people vaccinated as part of the priority groups defined in the national plan Numerator: Number of female healthcare workers Directorate of vaccinated as part of the Directorate of Female healthcare workers Monthly Prevention's Routing monitoring priority groups defined in Prevention/ PCU vaccinated EPI Data national plan;
Denominator: Total number of healthcare
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The World Bank Additional Financing to the Senegal COVID-19 Response Project (P175992)
workers vaccinated as part of the priority groups defined in the national plan Numerator: Number of females with co- morbidities vaccinated as part of the priority groups Directorate of Directorate of Females with co-morbidities defined in national plan; Monthly Prevention's Routine monitoring Prevention/ PCU vaccinated Denominator: Total EPI data
number of people with co- morbidities vaccinated as part of the priority groups defined in the national plan ME PDO Table SPACE
Monitoring & Evaluation Plan: Intermediate Results Indicators Mapped Methodology for Data Responsibility for Data Indicator Name Definition/Description Frequency Datasource Collection Collection Cumulative number of Point of entry/ border officers trained on border officers trained on Monthly Report Routine monitoring MoHSA COVID-19 prevention, control and contact COVID-19 (45 districts tracing identified by the sector) Cumulative number of Healthcare workers and community- healthcare workers and Monthly Report Routine monitoring MoHSA based nurses trained on COVID-19 community based nurses prevention, control and contact tracing trained on COVID-19 Number of health care Report - Healthcare facilities that received facilities (Districts health Quarterly Administratio Routine monitoring MoHSA protective equipment and hygiene Centers and Hospital) who n data materials received the PPE and
hygiene materials
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The World Bank Additional Financing to the Senegal COVID-19 Response Project (P175992)
Cumulative number of Report - Designated laboratories with COVID-19 Laboratories with COVID- Weekly administrative Routine monitoring MoHSA diagnostic equipment, test kits, and 19 diagnostic equipment, data reagents per MOHSA guidelines test kits and reagents Report - Number of eligible households provided Monthly administrative Routine monitoring MoHSA with food and other supplies among data affected populations
Numerator: Number of patients that test positive for COVID-19 that are Patients that are satisfied with the quarterly Report Routine monitoring MoHSA satisfied with the treatment of COVID-19 received treatment Denominator: Patients that test positive for COVID-19 Number of healthcare facilities and warehouses that have received climate Number of healthcare facilities and sensitive or energy- warehouses provided with climate- Monthly EPI data Routine monitoring DP/ PCU efficient refrigerators, sensitive/energy-efficient cold chain freezers, refrigerated equipment to store COVID-19 vaccines trucks, waste management equipment and other equipment Number of staff at national Number of national, sub-national, facility- and sub-national facilities, based and mobile staff trained in COVID- including mobile staff, that Monthly DP's EPI Data Routine monitoring DP/PCU 19 vaccine cold chain, storage and receive training in COVID- handling 19 vaccine cold chain, storage and handling
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Pharmacovigilance System (PVS) adapted Pharmacovigilance System to detect Adverse Events Following (PVS) adapted to detect Monthly DP's EPI data Routine monitoring DP/ PCU Vaccination (AEFI) for the COVID-19 AEFIs for the COVID-19 vaccine vaccine Number of AEFI cases reported by focal points Monthly DP's EPI data Routine monitoring DP/ PCU Number of AEFI cases reported and through the electronic notification system Social Distancing communication strategy year Report Routine monitoring MoHSA developed Assessment conducted to identify Year Report Survey MoHSA behavioral and socio-cultural risk factors for COVID-19 covering all the regions Report - Quarterly administrative Routine monitoring MoHSA Handwashing kits distributed data
Cumulative number of People reached through hygiene individuals reached Year Report Survey MoHSA promotion activities through hygiene promotion activities Community health workers trained on Quarterly Report Routine monitoring MoHSA community-based disease surveillance Community engagement plan to increase demand Number of TV, radio and social media Yearly Report Survey MoHSA/ SNEIPS/PCU for the COVID-19 vaccine spots produced on COVID-19 by the population developed Number of healthcare MOHSA/Direction of Healthcare workers and community- workers and community- Quarterly Report Routine monitoring Prevention/PCU based nurses trained on GBV/SEA/SH based nurses trained on
GBV/SEA/SH
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The World Bank Additional Financing to the Senegal COVID-19 Response Project (P175992)
Numerator : Number of health centers/hospitals Report - Health centers/hospitals received who received quarterly Quarterly administrative Routine Supervision MoHSA supervision for COVID-19 supervision; Denominator : data Total number of health centers/hospitals Establishment of joint M&E systems Year Report Routine monitoring MoHSA supporting the One Health approach and epidemic preparedness and response Number of meetings of the Report Comité national de gestion Weekly (Minutes of Routine monitoring MoHSA Number of meetings held by the platform des épidémies (CNGE) for the meeting) the duration of project
implementation ME IO Table SPACE
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
ANNEX 1: SUMMARY TABLE ON VACCINE DEVELOPMENT AND APPROVAL STATUS
As of May 10, 2021
Vaccine SRA Emergency Use Approval WHO PQ/EUL BNT162b2/COMIRNATY Tozina United Kingdom: December 2, 2020 WHO EUL: December 31, meran (INN) - Pfizer BioNTech Canada: December 9, 2020 2020 United States of America: December 11, 2020 European Union: December 21, 2020 Switzerland: December 19, 2020 Australia: January 25, 2021
mRNA-1273 - Moderna USA: December 18, 2020 WHO EUL: April 30, 2021 Canada: December 23, 2020 EU: January 6, 2021 Switzerland: January 12, 2021 UK: January 8, 2021 AZD1222 (also known UK: December 30, 2020 WHO EUL: February 15, as ChAdOx1_nCoV19/ EU: January 29, 2021 2021 for vaccines commercialized Australia: February 16th, manufactured by SK as COVISHIELD in 2021 (overseas manufacturing); March Bio and Serum India) - AstraZeneca/Oxford 21st, 2021 (for local manufacturing Institute of India by CSL – Seqirus) Canada: February 26, 2021
Ad26.COV2.S - Johnson & USA: February 27, 2021 WHO EUL: March Johnson Canada: March 5, 2021 12, 2021 EU: March 11, 2021 Switzerland: March 22, 2021 BBIBP-CorV - Sinopharm WHO EUL: May 7, 2021
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
ANNEX 2: WBG COUNTRY PROGRAM ADJUSTMENTS IN RESPONSE TO COVID-19 SENEGAL April 2021
I.IMPACT OF THE COVID-19 PANDEMIC ON SENEGAL AND GOVERNMENT RESPONSE
1. The COVID-19 pandemic has resulted in significant economic, fiscal and social repercussions for Senegal, which are threatening to reverse half of the last decade’s poverty reduction. The COVID-19 outbreak halted years of strong economic performance, with growth slowing from 4.4 percent in 2019 to an estimated 0.9 percent in 2020. Private consumption and investment were severely cut in the wake of the pandemic. Fiscal pressures have been aggravated, while services and export growth have slowed. The estimated fiscal deficit of 6.4 percent of GDP in 2020 reflects the attempt to accommodate the shock. International supply chain disruptions and weak global demand have weakened exports. Lower remittances and labor income losses have subdued private consumption. The current account deficit is estimated to have widened to around 11 percent of GDP in 2020. Public debt is estimated to have increased from 64.8 percent of GDP in 2019 to 68.9 percent in 2020.1 However, Senegal’s participation in the Debt Service Suspension Initiative (DSSI) provided short-term liquidity of 0.2 percent of GDP in 2020. Extension of DSSI through June 2021 could provide an additional 0.4 percent of GDP in debt service savings and up to 0.8 percent of GDP if extended to end 2021.
2. COVID-19 impacts household welfare significantly. A second stronger wave of COVID-19 cases is underway since late November 2020. As of April 25, 2021, there is a continued surge with the cumulative number of confirmed cases at 40,135 with 38,861 recoveries, 171 patients under treatment, 11 severe cases and 1,102 deaths. Senegal is ranked second in the highest number of cases and first in highest number of deaths due to COVID-19 in West Africa. All health districts have registered at least one case of COVID-19. COVID-19 vaccinations in Senegal began on February 23, 2021, and as of April 25, 2021, 398,941 doses have been administered.
3. 2020 GDP per capita is expected to have contracted by 3.3 percent. Instead of falling by an additional 1.4 percentage points (pre-COVID-19 estimate), poverty incidence is likely to have increased to circa 39 percent in 2020, reversing half of the progress in poverty reduction since 2011. Similarly, extreme poverty is expected to have increased to 7.3 percent, up from 6.8 percent, equal to an additional 75,000 extreme poor. Food insecurity is also an issue. According to the September/October 2020 phone survey, seven out of ten households worry about not having enough to eat due to lack of resources or money. In addition, 19,525 children aged 4-11 and 9,293 youth aged 12-17 are likely to drop out of school in Senegal as a result of COVID-19.
4. The Government of Senegal has taken decisive measures to mitigate the socio-economic impact of the pandemic. On top of temporary, stringent containment measures, the Government is implementing a comprehensive support and recovery plan, the Economic and Social Resilience Program (Programme de Resilience Économique Social - PRES). The main vehicle is a dedicated solidarity fund at Central Bank of Western African States (BCEAO), FORCE-COVID-19. The objectives are to upgrade the health system and contain the economic fallout while providing targeted support to vulnerable households and firms.
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5. In addition, in response to the COVID crisis, the Government of Senegal issued a new version of the Priority Action Plan 2 - Adjusted and Accelerated (PAP2-AA) in September 2020. This 2021-23 action plan aims to implement the Senegal Emergent Plan (“Plan Senegal Emergent – PSE”) initiated in 2012. This program aims to improve infrastructure, achieve economic reforms, increase investment in strategic sectors, and strengthen the competitiveness of the private sector.
II.WBG SUPPORT FOR RESPONDING TO THE CRISIS
6. The WBG responded swiftly to support Senegal’s response to COVID-19, reflecting continued relevance of the program agreed in 2020 with the Government under the CPF.2 The Government’s strategy remains intact, but with keen interest to accelerate progress and address weaknesses highlighted by COVID-19, particularly inclusion, resilience and support for sectors with high economic potential. Operationally, WBG support has aligned well with the pillars of the COVID-19 Approach Paper: • Saving Lives: An immediate health response combining a US$20-million operation (Senegal COVID-19 Response Project) as well as the on-going regional project (Renforcement des Systèmes de Surveillance des Maladies en Afrique de l'Ouest « REDISSE »). A request for AF for the Senegal COVID-19 Response Project (US$134 million) to ensure safe and equitable access to COVID-19 vaccines and to strengthen vaccine deployment is in preparation and expected to be approved by the Board in May 2021; • Protecting Livelihoods: The pipeline under discussion includes a possible AF to the social protection program. The existing portfolio has also been used to provide cash transfers and support to the education sector. The restructuring of several operations has helped provide: (i) emergency support to 7,000 workshops, (ii) exceptional food support to daaras (Quranic schools), (iii) water and sanitation services in peri-urban areas (restructuring under way), and (iv) support to start-ups; • Ensuring private sector growth and job creation: The pipeline under discussion includes operations that aim to stimulate private sector-led growth through (i) Jobs, Economic Transformation & Recovery Project, and (ii) an affordable housing program; and • Building back better: An emergency supplemental financing to the US$100-million Third Multi- Sectoral Structural Reforms Development Policy Operation, approved by the Board in June 2020, supports the (PRES) and helps finance the immediate financing gap. In addition, the pipeline envisions an expansion of the successful Stormwater Management and Climate Change Adaptation program to boost resilience to the increased frequency of intense rain events.
III.SELECTIVITY, COMPLEMENTARITY, PARTNERSHIPS
7. The WBG has worked closely with development partners to support Senegal’s response to COVID- 19. Financing needs have largely been met by external (concessional) financing including 1.9 percent of GDP through the International Monetary Fund (IMF) Rapid Credit Facility, 0.3 percent through the WB Supplemental Financing DPF (P173918) approved by the Board in June 2020, 1.8 percent of GDP through other donor support, 0.2 percent of GDP via the DSSI, and 1.4 percent from West African Economic and Monetary Union (WAEMU) bonds. Senegal is benefiting from a three-year IMF Policy Coordination Instrument (2020-2022), for which performance has been solid. The World Bank and IMF teams are coordinating closely.
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ANNEX 3: LATEST COVID-19 SITUATION IN SENEGAL
1. Senegal was the second country in Sub-Saharan Africa to report its first imported case of COVID-19 on March 2, 2020, which led to the Government’s activation of the emergency management mechanisms and request for World Bank financing. Although Senegal had successfully contained disease outbreaks such as the West Africa EVD in 2014–2016, similar to other countries, COVID-19 cases have spread rapidly across the country. By March 22, 2020, the Government had already reported 67 confirmed cases, with a first peak incidence occurring around August 2020 (Figure 1a).32 However, starting in November 2020, a second wave emerged, and recent estimates (as of April 25, 2021) show a continued surge with the cumulative number of confirmed cases at 40,135 including 8,861 recoveries, 171 patients under treatment, 11 severe cases and 1,102 deaths. Senegal is ranked fourth in the highest number of cases (Figure 1b) and second in the highest number of deaths (Figure 1c) due to COVID-19 in West Africa. With EVD cases re-emerging in the neighboring country of Guinea (Conakry), 33 ramping up climate-sensitive disease surveillance and ensuring effective COVID-19 vaccination deployment will be even more critical. As a complement to the proposed AF, the ongoing REDISSE I (P154807) will continue to support the strengthening of community-level disease surveillance and health systems to contain any suspected EVD cases.
Figure 1: COVID-19 Pandemic in Senegal and West Africa a) Total confirmed cases, Senegal b) Total confirmed cases, West Africa
32 Centre des Operations d’Urgence Sanitaire. Presentation from the Coordination Meeting on the Response to COVID-19, December 2, 2020. 33 WHO (World Health Organization). 2021. “New Ebola Outbreak Declared in Guinea.” Available at: https://www.afro.who.int/news/new- ebola-outbreak-declared-guinea.
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c) Total confirmed deaths, West Africa
2. The Senegalese economy has been significantly affected by the COVID-19 crisis, and certain population groups have been more impacted. Real GDP growth is estimated at 0.9 percent in 2020 compared to 4.4 percent in 2019. Services and export growth have slowed as tourism and transport have suffered a standstill and key markets have shut down. The services contraction is explained by the weak performance of transport (-12.4 percent) and hospitality (-10 percent). Growth rate is expected to continue to be negative given lockdown measures and the adverse effects of COVID-19. To deal with the impact of the economic slowdown, the Government issued a decree to establish a response and solidarity fund against the impact of COVID-19 pandemic called FORCE-COVID-19 to provide support to local businesses and households.34 Although the young, economically active population (16–39 years old), is the group with the highest number of cases, posing an additional risk for economic recovery without adopting an adequate, safe, and effective vaccination strategy, the 60+ age group experiences the most deaths similar to what is observed in other countries. In Senegal, men in the 60+ age group are dying at two times the rate of women and populations with underlying health conditions, particularly with hypertension and diabetes, are dying at higher rates.
3. Although women and girls are less likely to die from COVID-19 in Senegal compared to their male counterparts, they are bearing a heavy burden of the pandemic in other ways. For instance, women account for 65 percent of nurses in Africa35 and the majority of the healthcare workforce in Senegal, which puts this group at greater risk of infection. In Senegal, as in many countries around the world, women are also the main caregivers, having to care for ill family members, taking care of children that are home due to school closures, and carrying out other domestic care such as cooking and cleaning. Lockdown measures, quarantines, and travel restrictions adopted to respond to the COVID-19 pandemic have also affected businesses where women
34 The FORCE COVID-19 Fund provides support to businesses and households. An Economic Watch Committee was established that includes representatives from the National Assembly, civil society, and opposition parties to monitor the implementation of activities related to COVID- 19. The FORCE-COVID-19 Fund’s resources, estimated at CFAF 1 trillion (US$1.645 billion) include donor contributions (58.6 percent), national budget reallocations (40 percent), contributions from citizens, private sector, and civil society and other resources authorized by laws and regulations. Eligible expenditures include: (a) purchase of fuel, equipment, supplies, and services for the pandemic; (b) procurement of pharmaceuticals and sanitation/hygiene products; (c) hazard pay for those involved in the response process (mainly health workers); (d) financial support to sectors affected by the pandemic; and (e) miscellaneous grants, operational expenditures for the management of the Fund, and other expenses related to the fight against COVID-19. 35 Boniol M., M. McIsaac, L. Xu T. Wuliji, K. Diallo, J. Campbell J. “Gender Equity in the Health Workforce: Analysis of 104 Countries.” Working paper 1. Geneva: World Health Organization.
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are overrepresented such as in tourism, restaurant/catering, and hairstyling. In rural areas, a sharp decline has been observed since the beginning of the pandemic in agricultural, fishing, and livestock activities, which women are heavily involved in. An increased risk of GBV in Senegal has also been observed in 2020 due to financial uncertainty and other stresses exacerbated by lockdown measures. A study conducted found that 193 out of 201 women interviewed suffered from physical and mental violence during the COVID-1936 lockdowns, a 15 percent increase of reported GBV compared to the period before the pandemic. The proposed AF will continue to address gender disparities that make women and adolescent girls more vulnerable during this pandemic.
4. The COVID-19 pandemic has also created significant disruptions in essential health services, particularly affecting women, adolescent girls, and children. Both supply-side (for example, declining government revenues and health budgets, disruptions in global markets for essential medications and supplies, health work force challenges due to large numbers of providers becoming ill37) and demand-side (for example, unwillingness to seek care out of fear of becoming infected with COVID-19; lack of resource to pay for healthcare due to declining incomes; mobility restrictions) challenges have been observed. An analysis conducted by the Global Financing Facility (GFF) early in the pandemic has shown that in Senegal, disruptions in essential services could lead to an increase of child mortality by 20 percent and maternal mortality by 26 percent.38 The Directorate for Maternal and Child Health (Direction de la Santé de la Mere et de l’Enfant, DSME) conducted supervision missions during the first few months of the COVID-19 pandemic and found: (a) challenges with ability to mobilize healthcare workers to ensure continuity of health services; (b) stockout of several essential medicines, supplies, and equipment; and (c) the utilization of several essential health services had dropped. The MoHSA validated a Contingency Plan in mid-May 2020 which is being financed by several donors and partners, including the World Bank, GFF, UNICEF, United Nations Population Fund (UNFPA), WHO, and USAID to implement activities that will ensure the availability and utilization of essential Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCHA+N) services during the pandemic.39 As part of this Contingency Plan, the proposed AF will provide additional resources that will address the urgent COVID-19 needs, enabling the World Bank-financed ISMEA Project (P162042) to focus on continuity of care to reverse the trends of reduced utilization of essential RMNCHA+N services.
5. COVID-19 vaccinations began in Senegal as of February 23, 2021, which will enable the country to return to some sense of normalcy. As of April 25, 2021, there are 398,941 people that have received at least one dose of the vaccine (Figure 2). The Government of Senegal was able to purchase 200,000 doses of the Sinopharm vaccine (US$3.7 million) to begin vaccination of the priority group, in particular, frontline healthcare workers. To show confidence in the COVID-19 vaccines, several high-level officials, including the President and the Minister of Health, were vaccinated. The Sinopharm COVID-19 vaccines have been equitably distributed across all the regions. Moreover, as a gesture of solidarity, Senegal shared 10 percent of the Sinopharm doses with neighboring The Gambia and Guinea-Bissau. Senegal has also received its first allocation of the vaccines through the COVAX AMC (324,000 doses of the AZ vaccine) on March 3, 2021 and has begun deployment. Another 780,000 doses from the COVAX AMC are expected before the end of May 2021. The Government
36 JDWS (Justice and Dignity for the Women of the Sahel). 2020. Impact de la COVID-19 sur les violences faites aux femmes et aux filles au sahel. Available at : https://www.jdwsahel.org/2020/08/02/impact-de-la-covid-19-sur-les-violences-faites-aux-femmes-et-aux-filles-au-sahel-de-40- 63-avant-la-pandemie-a-52-18-soit-12-daugmentation/. 37 Cumulative of 443 health workers were infected as of February 14, 2021 – Senegal - Centre des Operations d’Urgence. 38 GFF (Global Financing Facility). 2020. Maintaining Essential Health Services during the COVID-19 Pandemic – Senegal. 39 There are six fundamental areas that were included in the Contingency Plan: (a) governance and coordination; (b) essential package of RMNCHA+N services; (c) availability of RMNCHA+N; (d) efficient and effective screening, triage, and referral at health facilities; (e) HR redistribution/reassignment; and (f) availability of medicines and other essential supplies and equipment.
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continues to have discussions directly with manufacturers such as Russia for the Sputnik V vaccine to purchase 300–500,000 doses, but there are no official agreements at this time. Additional doses will also be procured through COVAX (to cover 6 percent of the population) and through the AVAT convened by the AU and through UNICEF (approximately 4.0 million J&J doses). On March 12, 2021, the Government received 25,000 AZ doses from the Government of India and 90,000 AZ doses were donated by a South African telecommunications company through the AU towards the end of March 2021.
Figure 2: Total people vaccinated (one dose of the COVID-19 vaccine)
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
ANNEX 4: SUMMARY OF THE PARENT PROJECT COMPONENTS
1. The parent project, Senegal COVID-19 Response Project (P173838), was developed under the COVID-19 SPRP using the MPA approved by the Board on April 2, 2020, to support the Government’s comprehensive National COVID-19 Response Plan. The World Bank approved a US$12 billion WBG FTCF or “the Facility” to assist IBRD and IDA countries in addressing the global pandemic and its impacts. Of this amount, US$6 billion came from IBRD/IDA (“the World Bank”) and US$6 billion from the IFC. The IFC subsequently increased its contribution to US$8 billion, bringing the FTCF total to US$14 billion.
2. The PDO is to prevent, detect, and respond to the COVID-19 disease outbreak in Senegal. The implementation of parent project is strengthening the capacity of the Senegalese Government, and more specifically, the MoHSA to detect and respond to infectious diseases on time. This includes improvements in coordination, surveillance, and response and timely information sharing with the public. The parent project includes three components:
3. Component 1: Emergency COVID-19 Response (US$16.5 million) provides immediate support to enhance disease detection capacities and mobilize surge capacity through well-trained and well-equipped frontline healthcare workers. The component financed the procurement of equipment and supplies for health facilities and laboratories such as diagnostic equipment, test kits, reagents, and PPE and capacity building of port of entry officers, healthcare workers, community-based nurses, and community health workers involved in the COVID-19 response.
4. Component 2: Community Engagement and Risk Communication (US$2 million) supports activities that ensure effective risk communication and community engagement to raise public awareness and knowledge on prevention and control of COVID-19 among the general population. The component financed community- based disease surveillance, the development of public health communication strategies for COVID-19, and risk communication.
5. Component 3: Project Management and M&E (US$1.5 million) supports the strengthening of public structures for the coordination and management of the project, including central and local (decentralized) arrangements for coordination of activities, FM, and procurement. It also supports M&E of prevention, preparedness, response, and building capacity for clinical and public health research, including veterinary, and joint learning within Senegal. The component financed project management and monitoring, including support for the PCU.
6. The AF for the MPA of US$12 billion (IBRD/IDA) was approved on October 13, 2020 to support the purchase and deployment of vaccines as well as strengthening the related immunization and healthcare delivery system. The proposed AF will enable affordable and equitable access to COVID-19 vaccines and to help ensure effective vaccine deployment in Senegal through vaccination system strengthening. With several COVID-19 vaccines approved for emergency use by the WHO and deployment ongoing, additional World Bank resources will be critical to the country’s overall effort in the fight against this pandemic. Therefore, continuing World Bank engagement is essential to enable a sustained and comprehensive pandemic response in Senegal, so that the country can reopen its economy as safely as possible.
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ANNEX 5: COLD CHAIN EQUIPMENT INVENTORY
1. An assessment was conducted in June 2019 by UNICEF regarding the state of CCE, which found that over 84 percent of CCEs function properly with approximately 8 percent of the CCEs needing repairs.40 The Government also recently received 1,117 WHO-certified refrigerators41 that will allow vaccines to be stored at 2°C and 8°C for health posts in the districts. Moreover, recent evaluations have found that with the current state of the cold chain in Senegal, it will be difficult to store COVID-19 vaccines at ultra-low temperatures. The proposed AF will allow the country to expand the storage, cold chain, and distribution needs to scale up immunization as per the NCVS and NDVP and manufacturer production capacity. It will also ensure procurement of CCEs and other equipment such as off-grid solar refrigerators/freezers and waste equipment that will be low carbon and environmentally friendly and ensure a reduced impact on the climate and environment. The AF will finance the needs of CCEs for the eight (8) regions which are not covered by the ISMEA Project’s (P162042) procurement plan.42
Table 7: State and Additional Needs of CCE in Senegal43 Available CCEs Additional CCEs Needed At the national level - Eight cold rooms (40m3) where vaccines such as the yellow - Two cold rooms (25m3) that can be maintained at - fever and hepatitis B vaccines are being stored between 2°C and 20°C 8°C (approximately 24m3 available for COVID-19 vaccines) - 11 freezers that can maintain -80°C - One cold room (20m3) that is colder (minus) - Two refrigerated trucks; two non-refrigerated trucks - Eight freezers (240 liters) that can be maintained at -20°C At the regional level - One cold room (15m3) in each region (except for Dakar, - Three cold rooms that can maintain -20°C Thies, and Diourbel, where the capacity is 30m3), where - 11 freezers that can be maintained at -20°C vaccines can be stored between 2°C and 8°C (approximately - 17 freezers that can be maintained at -80°C 50 percent full due to routine vaccine storage) - One freezer (240 liters) in each region that can be maintained at -20°C (Dakar, Thies, and Diourbel has two of these freezers) At the district level Refrigerators of 240 liters and 150 liters in sufficient quantity for • 79 freezers that can maintain -20 degrees Celsius the required needs (1,117 refrigerators just received on • 79 freezers that can maintain -80°C February 5, 2021, to store vaccines between 2°C and 8°C) At the service delivery points More than 97 percent of units have approved CCEs for vaccine - Not available storage between 2°C and 8°C
40 UNICEF (United Nations Children’s Fund). 2019. Cold Chain Inventories Analysis– Senegal. 41 These refrigerators were financed by the Government with co-financing from GAVI Alliance (estimated costs: US$6.4 million); they arrived in Senegal on February 5, 2021. 42 The eight regions are Dakar, Diourbel, Saint-Louis, Kaolack, Thies, Louga, Fatick, and Matam. The ISMEA Project (P162042) covers six regions: Kédougou, Kolda, Kaffrine, Tambacounda, Sédhiou, and Ziguinchor. 43 MoHSA (Ministry of Health and Social Action). 2021. COVID-19 Vaccinations – Status in Senegal.
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ANNEX 6: FINANCIAL MANAGEMENT AND DISBURSEMENT ARRANGEMENTS
1. The FM arrangements for the AF will be based on the existing arrangements in place under the ongoing Senegal COVID-19 Response and under the MoHSA’s DAGE responsibility. The overall FM performance of the parent project was rated as Moderately Satisfactory further to the supervision undertaken on November 2020 and the FM risk was assessed as Moderate.
2. The following measures should be taken within two months of effectiveness: (a) Customize the accounting software to include this AF component (b) Update the ToR of the external auditor
3. The following measures should be taken within four months of effectiveness: (a) An update of the work plan of the internal auditor
4. The conclusion of the assessment is that the FM arrangements meet the World Bank’s minimum requirements under World Bank IPF Policy and Directive, and the risk was rated at Substantial but should be updated to Moderate residual risk due to the mitigation measure proposed in the action plan.
FINANCIAL MANAGEMENT AND DISBURSEMENTS ARRANGEMENTS
5. The following are the FM arrangements for the project
1- External audit
6. The ToRs of the parent project will be expanded to include the AF activities. Consolidated Audited Financial Statements (original projects and AF) will be submitted to IDA within six months after year end. The auditor will issue an opinion on the audited project consolidated financial statements in compliance with International Federation of Accountants (IFAC) and a specific opinion on additional activities will be required.
7. The external auditors will also prepare a Management Letter giving observations and comments, and providing recommendations for improvements in accounting records, systems, controls, and compliance with financial covenants in the Financial Agreement. UN agency operations financed under the project will not be subject to external audit.
2- Internal control arrangements
8. The existing manual of administrative financial and accounting procedures is being updated. It will include AF activities and clearly define FM procedures, operations documentation, and controls process. The internal auditor will include the AF project in his annual work program.
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3- Accounting arrangements
9. The SYSCOHADA is the current accounting standards used in Senegal; it is applicable for the ongoing project. The DAGE has a multi-projects computerized accounting system to take into account these AF activities. The FM team under the parent project will manage this AF.
4-Reporting and Monitoring
10. The unaudited Interim Financial Report (IFR) format of the parent project was updated to include the AF. This consolidated IFR should comprise a separate table of sources and uses of funds according to AF expenditures classification, for the quarter. The PCU will submit the financial reports to the World Bank within 45 days following the end of each calendar quarter.
11. The DAGE will produce the project’s consolidated annual financial statements, which will include the AF and will comply with SYSCOHADA and World Bank requirements.
5- Budgeting arrangements
12. The budgeting process and monitoring will be defined in the updated Administrative and Accounting Manual of Procedures. Periodic reports of budget monitoring variance analysis and recommendations should be prepared by the DAGE FM team on a quarterly basis.
6-Disbursement arrangements and flow of funds
a) Disbursement for the project will follow the existing disbursement arrangements for the parent project. Disbursements under the parent project are Statement of Expenditures (SOE) based. Direct Payment method will apply as appropriate. A separate Designated Account (DA) will be opened at an acceptable commercial bank to facilitate payment for eligible expenditures.
b) Disbursement arrangements Disbursements will be transactions-based whereby withdrawal applications will be supported with SOE. The following disbursement methods may be used under the project: reimbursement, advance, direct payment, and special commitment as specified in the Disbursement and Financial Information Letter (DFIL) and in accordance with the Disbursement Guidelines for IPF, dated February 2017. Documentation will be retained at the MoHSA’s DAGE FM team for review by World Bank staff and auditors. The DFIL provides details of the disbursement methods, required documentation, DAs ceiling, and minimum application size. These were discussed and agreed during negotiations of the Financing Agreement.
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The World Bank Additional Financing for the Senegal COVID-19 Response Project (P175992)
Figure 3. Funds Flow Chart
Flow of Funds Arrangements: Flow of funds arrangements for the project is as follows:
Credit Account at the World (Funds) DP
Bank
DA
(MoHSA)
Government • Implementing entities, MoF Suppliers, Consultants, Contractor,
Direct payments Transfer of funds Transmission of documents (report invoice, Withdrawal application audit report IFR, and so on ),
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