Additional Financing for Malawi COVID-19 Emergency Response and Health Systems Preparedness Project

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The proposed additional financing would support the costs of expanding activities of the Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P173806) 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. The primary objectives of the proposed AF is to enable affordable and equitable access to COVID-19 vaccines and help ensure effective vaccine deployment in Malawi through vaccination system strengthening and to further strengthen preparedness and response activities under the parent project. The scope and the components of this project are fully aligned with the COVID-19 Fast Track Facility. The changes proposed for the AF entail expanding the scope of activities in the parent project Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (P176402), and the procurement and deployment of vaccines, adjusting its overall design. The proposed AF will also provide an opportunity to address health system and case management gaps such as oxygen therapy with broader potential health system benefits. The project components will remain unchanged with new or scaled up activities incorporated into existing components. It will address critical activities and fill financing gaps that have been identified and are not financed by other partners. Component 1: Emergency COVID-19 ResponseThis component would provide immediate support to Malawi to prevent COVID-19 from arriving or limiting local transmission through surveillance and containment strategies. It would support enhancement of disease detection capacities through provision of technical expertise, laboratory equipment and systems to ensure prompt case finding and contact tracing, consistent with WHO guidelines; strengthening of case management capabilities; and provision of care for respiratory illnesses including essential medical supplies, oxygen therapy and assisted ventilation. Vaccine procurement and deployment is added as a new subcomponent.(i) Subcomponent 1.1: case detection, confirmation, contact tracing, recording, and reporting. Although diagnostic testing is part of Malawi’s comprehensive strategy to control COVID-19, limited laboratory capacity (e.g. shortage of test kits, reagents, suboptimal testing performance) poses a challenge in the diagnosis of cases. COVID-19 testing in Malawi is being conducted in 16 molecular testing sites using reverse transcription-polymerase chain reaction (RT-PCR) and GeneXpert platforms as well as 206 sites using antigen rapid diagnostic tests. The AF will scale up and support: (i) optimization of existing RT-PCR platforms including service contracts and calibration of Abbott platforms to accommodate multiple COVID-19 test kits (e.g. Daangen); (ii) procurement of reagents for RT-PCR test; and (iii) procurement of genomic sequencing equipment and reagents. (ii) Subcomponent 1.2: health system strengthening. A January 2021 biomedical equipment survey conducted in health facilities across Malawi found a significant scarcity of oxygen production and delivery equipment and supplies, limited health facility capacity and infrastructure to treat patients, and inequitable distribution of resources for respiratory care in the country. This necessitates immediate scale up of oxygen production capacity, equipment and supplies across health facilities particularly in health zones that do not have PSA plants. The proposed AF will support: (i) procurement and installation of a PSA plant and oxygen supply system at a central hospital as well as supply of oxygen cylinders to an estimated five neighboring district hospitals; (ii) procurement of oxygen therapy equipment that will use climate smart technologies; (iii) operations and management including maintenance of the PSA plant; (iv) development of training materials; and (v) training of biomedical technicians/engineers on production and management of the PSA plant and health workers on the proper provision of oxygen therapy. (iii) Subcomponent 1.3: vaccination procurement and deployment (new). The AF will support investments to bring immunization systems and service delivery capacity to the level required to successfully deliver COVID-19 vaccines at scale. To this end, the proposed AF is geared to assist the GoM, working with the World Bank Group (WBG), WHO, UNICEF and other development partners, to overcome bottlenecks as identified in the COVID-19 vaccine readiness assessment in the country. While the majority of support under this subcomponent 1.3 is allocated towards vaccine procurement (71.0 percent); 16.0 percent will provide complimentary support to deployment priorities identified in the NVDP. These include support to: (i) logistics along the supply chain; (ii) the rollout/strengthening of digital platforms linked to OHSP and the HMIS including the e-Vaccination platform and open LMIS; (iii) monitoring and investigation of AEFI; and (iv) enhancing waste management capacity including (a) support to operation and maintenances costs of existing incinerators; (b) training of health care workers with modules on health care waste management in flood prone areas to address potential climate emergencies; and (c) support development/finalization of guidelines and policies. Demand creation and RCCE interventions are critical to the success of the COVID-19 vaccination efforts. The proposed AF will also support: (i) well targeted communication campaigns through mass media, social media and community outreach to improve knowledge and correct myths and misconceptions that cause vaccine hesitancy, particular attention will be placed on the hesitancy among women and young girls which may be based on potential concerns around perceived effect of vaccines in general on fertility as well as sensitivity towards their concerns around increasing anecdotal evidence on what seem to be female-specific side effects of COIVD-19 vaccines; (ii) tracking and monitoring of correct knowledge of COVID-19 vaccination, and identify views, perceptions, norms and attitudes in order to design correct messaging and effective community outreach strategies (e.g. educating the public on the respect to female health care workers or vaccinators, being sensitive to views and perceptions among women on potential side effects of the COVID-19 vaccines); and (iii) facilitation of civil society and citizen engagement mechanisms for feedback, accountability and grievance redressal. In addition, the risk communication campaigns will integrate prevention and management messages of the emerging and endemic climate-induced disease outbreaks to reduce the Malawi’s disease burden.Component 2: Supporting National and Sub-national, Prevention and Preparedness This component will support strengthening the capacity of the public health system for preparedness and respond to COVID-19 pandemic and to future pandemics and other threats to health security. The financing of this component will target existing institutions such as the EOC within the PHIM as well as new institutions through support for growth of health worker cadres with capacity to respond to EIDs. Component 3: Implementation Management and Monitoring and EvaluationProject Management and Monitoring and Evaluation (M&E). The existing Project Implementation Unit (PIU) of the ongoing Southern African Tuberculosis and Health System Strengthening Project (SATHSSP) will lead coordination of Project activities, as well as fiduciary tasks of procurement and financial management, M&E and environmental and social safeguards. If needed, the PIU will be strengthened by the appointment of additional staff/consultants responsible for specific responsibilities under the Project. To this end, this component will support costs associated with Project management and coordination, monitoring and evaluation, operationa