Laos COVID-19 ISM Aide Memoire – October 2020 Lao PDR COVID-19 Response Project (Credit No. 6606-LA) The Frist Virtual Implementation Support Mission October 12-19, 2020 Aide Memoire Public Disclosure Authorized I. INTRODUCTION 1. The first virtual implementation support mission (ISM) for the Lao PDR COVID-19 Response Project (Laos COVID-19) from October 12-19, 2020. The mission was led by Ms. Emiko Masaki (Senior Health Economist and Task Team Leader) and Ms. Keiko Saito (co-TTL, Senior Disaster Risk Management Specialist). A list of the officials met, and the team members is provided in Annex 1. The objectives of the mission are to: (i) review the progress made since the Project became Effective (April 7, 2020) which covers Project Components, procurement, financial management, environmental and social framework, and the Results Framework in terms of progress toward achieving the Project Development Objective (PDO); (ii) review implementation progress of the US$1 million grant from the Pandemic Emergency Financing Facility (PEF) implemented by UNICEF and WHO; and (iii) discuss and assess the need for additional financing for the COVID-19 vaccines. Public Disclosure Authorized 2. The team would like to thank Dr. Founkham Rattanavong, Director General of the Department of Planning and Cooperation (DPC), and Dr. Chansaly Phommavong, Deputy Director of DPC and representatives from other departments of the Ministry of Health (MOH) for their close cooperation and support during the virtual ISM and continued commitment in implementing the Laos COVID-19. The team also thanks the development partners for their valuable inputs and contributions to the technical discussions during the mission. The Aide-Memoire was discussed at the wrap-up meeting on October 19, 2020 chaired by Dr. Founkham Rattanavong, Director General of DPC, and this final version incorporates MOH’s comments and was endorsed by the World Bank (WB) management. As part of the WB Access to Information Policy, and with the agreement of the MOH, the Aide-Memoire will be publicly disclosed. II. PROJECT DATA AND RATINGS Public Disclosure Authorized Table 1: Key Project Data and Ratings Project Data US$ (millions) Original Project Amount 18 Total Disbursement 6.36 (35%) Disbursement in FY 0.83 Closing Date December 31, 2022 Project Ratings: Previous Current Project Development Objective Satisfactory Satisfactory Implementation Progress Satisfactory Satisfactory Component 1: Emergency COVID-19 Response Satisfactory Satisfactory Component 2: Strengthening System for Emergency Response Satisfactory Satisfactory Public Disclosure Authorized Component 3: Project Management and Monitoring and Evaluation Satisfactory Satisfactory Project Management Satisfactory Satisfactory Moderately Procurement Satisfactory Satisfactory Financial Management Satisfactory Satisfactory Monitoring and Evaluation Satisfactory Satisfactory Moderately Environmental and Social Compliance Satisfactory Satisfactory 1 Laos COVID-19 ISM Aide Memoire – October 2020 III. IMPLEMENTATION PROGRESS AND KEY FINDINGS 3. Since Project Effectiveness, there has been significant progress in implementing activities for the COVID-19 emergency response under Component 1. Overall progress towards achievement of PDO indicators is progressing well (see Annex 3) and is Satisfactory. Component 1: Emergency COVID-19 Response 4. The mission team noted that significant progress has been made under this Component, which has disbursed US$4.13 million or 32% of the total Component budget mostly for the procurement of laboratory and medical equipment. Key achievements include (a) all procured items have been distributed to health facilities at central and provincial level; (b) training on medical equipment and molecular polymerase chain reaction diagnostics has been provided in 17 Provinces; (c) surveillance training on the use of the District Health Information System version 2.0 (DHIS2) modules (data entry, data processing, use of system to monitor indicators for COVID-19) has been completed at central and provincial levels; (d) training of staff and volunteers on contact tracing, contact monitoring for COVID- 19 in 18 Provinces; (e) supported key activities of National Center Laboratory and Epidemic (NCLE) for surveillance, report, contact tracing and follow-up, sample collection; (f) provided funds for warehouse management and vehicle maintenance; (g) completed the procurement of IT equipment and furniture for the Emergency Operating Center (EOC) to sustain 165-166 hotlines for access by communities; and (h) completed procurement documents for the second round of the procurement of the medical equipment. 5. While most of the activities under sub-components are progressing well, some activities under sub-components: 1.6. Quarantines; 1.8. Essential Health Service Delivery; and 1.9. Contingencies require immediate adjustment and further clarifications on activity scope, roles and responsibilities across implementing Departments, and close monitoring from the Project Coordination Office (PCO) to ensure activities are fully aligned with the National COVID-19 Preparedness and Response Plan and implemented in a timely manner. Key findings and recommendations are summarized below: • Sub-component 1.6. Quarantines. Some activities under this sub-component were not clearly defined in terms of the roles and responsibilities of Departments and Provinces to implement activities for quarantine facilities, including quarantine at boarder check points, government designated facilities (establishment of quarantine facilities, providing food and other necessary supplies to the quarantined population as well as health workers). No clear mechanism is in place for Departments and Provinces to submit their activity plans and funding requests. There is a large financing gap for quarantine activities, especially at sub-national level. The mission team suggested that DPC, through PCO and Department of Communicable Disease Control (DCDC), summarize implementation procedures to clarify the approval process and required documentation, including evidence needed to prove that payments have been made. Once these processes are clearly defined, the PCO should then communicate them to Departments and Provinces and provide training on the processes. • Sub-component 1.8. Essential Health Service Delivery. Procurement of laboratory equipment is currently included under this sub-component; however, this does not correspond to the priority activities included under the Essential Health Services Pillar of the National COVID-19 Preparedness and Response Plan. The mission recommends MOH to revise and update the activities under this sub-component to ensure that funds are prioritized for activities with the largest funding gaps under the Essential Health Service Pillar (7.10-7.12) of the National COVID-19 Preparedness and Response Plan to support the continuation of the maternal and child health services delivery in the COVID-19 era. 2 Laos COVID-19 ISM Aide Memoire – October 2020 • Sub-component 1.9. Contingencies. While it was agreed to allocate contingency funds to pay for healthcare workers' overtime, there has been no progress under this sub-component. The mission recommends that MOH/PCO develop and approve a template and regulation for overtime payment for healthcare workers engaged in COVID-19 response activities, referring to the Ministry of Finance (MOF) instruction of COVID-19 Financial Management no. 0991/MOF. The mission also recommends changing the Department responsible for this activity from the Department of Healthcare and Rehabilitation (DHR) to the Department of Finance (DOF) (or it can be joint) since DOF is directly involved in the overtime payment activity using Government funds. Component 2: Strengthening System for Emergency Response 6. This Component aims to strengthen capacity and provide support for emergency response including training and development of guidelines. A total amount of US$78,543 (2.1%) of the budget has been disbursed as of October 15, 2020. Continued consultative meetings on guidelines development and delivery of medical equipment to health facilities are in progress. The priority activity for Fiscal Year 2020 is the construction of treatment and isolation facilities in the existing hospitals in Champasak, Sekong and Attapue Provinces. The National Procurement Committee for COVID 19 has authorized MOH to procure consultant services for the design and supervision of the planned civil work, and to construct a laboratory at Phonthong District in Champasak Province. The mission discussed and agreed that the construction at the existing hospitals would include intensive care unit, isolation and laboratory rooms. To expedite the procurement process, concerned technical departments are requested to work closely with PCO to review the plan for the new civil works to ensure necessary preparatory activities are completed without delay. 7. The mission discussed the capacity of the current warehouse and acknowledged the immediate need for improving/expanding warehouse capacity and strengthening the logistic and supply chain system. The mission agreed that the PCO and concerned departments such as the Department of Food and Drug (FDD) and Medical Project and Supplies Center should identify the gaps and needs which could be considered by additional financing or restructuring. Component 3: Project Management and Monitoring and Evaluation (M&E) 8. The Project is managed by the PCO under the DPC of MOH. Currently, the Project has three