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

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The AF will support the cost of expanding activities of the Zambia COVID-19 Emergency Response and Health Systems Preparedness Project (P174185) 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 vaccine AF to the SPRP approved on October 13, 2020 . The Zambia COVID-19 Emergency Response and Health Systems Preparedness Project (P174185) in the total amount of US$25 million, of which US$20 million IDA credit is co-financed with a US$5 million grant from the GFF, was approved on October 20, 2020 and prepared under the SPRP. The primary objectives of the AF are to enable affordable and equitable access to COVID-19 vaccines and help ensure effective vaccine deployment in Zambia through vaccination system strengthening, and to further strengthen preparedness and response activities under the parent project. The parent project is also being restructured to reflect the inclusion of vaccination activities, and revision to the components, results framework, institutional and implementation arrangements, and closing dateThe AF will provide upfront financing to help the government 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 a successful deployment and to prepare for future pandemics. The support will include: Procurement of vaccines to vaccinate 5.1 percent of Zambia’s population; Deployment costs of World Bank financed vaccines plus deployment costs associated with vaccinating 20 percent of the population using vaccines from COVAX Advance Market Commitment(AMC) and other COVID-19 vaccines meeting the World Bank VAC that will be made available during the life of the project; Improved diagnostics in genomic sequencing and surveillance; and Expanded activities of the COVID-19 response which are essential to protect lives. The GFF grant co-financing will further leverage the opportunity to strengthen COVID-19 related systems for deployment of vaccines, including strengthening health systems to address disruption of essential reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N) services, but will not support COVID-19 vaccine purchase. The World Bank financing for the COVID-19 vaccines and their deployment will follow the World Bank’s VAC. Vaccines will be provided by the Government of Zambia free of cost.1. The proposed changes include: (a) Components and cost: Sub-component 1.1 has been split into two: Sub-component 1.1(a) COVID-19 Surveillance, Case Investigation and Rapid Response Capacity, and Sub-component 1.1(b) Vaccine Introduction comprising vaccine purchase and strengthening institutional and regulatory frameworks to enable safe and effective deployment of COVID-19 vaccines. 1) The following activities have been dropped under Sub-component 1.1: (a) establishment of operation of the central and provincial Public Health Emergency Operation Centers (PHEOC) (b) support to the PHEOC including strengthening the call response center; (c) disease surveillance activities as part of integrated disease surveillance and response (IDSR) through: (i) the development/updating of surveillance protocols; (ii) establishment of Influenza-Like Illnesses and Severe Acute Respiratory Infections (ILI/SARI) sentinel sites; (iii) capacity building in surveillance, including the training of community volunteers in event-based surveillance in high-risk districts, and training of staff in the IMS, epidemic preparedness and response; and (iv) disease surveillance information systems, including data audit; (d) assessment of the implementation of International Health Regulations including related operational costs for all activities to release US$2.3 million to support scale up of proposed priority case management interventions that have been informed by lessons learned during implementation of Zambia’s COVID-19 response second wave and reallocation of these resources to component 2 under case management. The dropped activities will be funded under the ACDCP (P167916).2) The following activities will continue to be supported under the parent project: (i) coordination of COVID-19 response at national and subnational levels; (ii) COVID-19 risk assessments to identify high-risk areas, events and population groups; (iii) rapid response teams to conduct contact tracing for COVID-19 and emergency response vehicles; and (iv) establishment/rehabilitation of quarantine facilities for suspected COVID-19 cases.• Specific changes under each component include: i) Component 1o Procurement of COVID-19 vaccines.o Strengthening of systems for vaccine deployment, including distribution and administration of the COVID-19 vaccineo Enhanced capacity for genomic sequencing and surveillance.o Enhancing digital health solutions such as the DHIS2 COVID-19 vaccine delivery tool kit including expansion of Logistimo functionality up to the vaccination sites.o Expanded risk communication and community engagement to overcome vaccine/brand hesitancy and maintain demand for essential services.ii) Component 2: o Reallocation of funds from Component 1 to expand oxygen production and strengthen delivery systems for medical oxygen therapy; and expansion of isolation health facilities/wards. o Expansion of IPC including strengthening WASH in healthcare facilities and health care waste management.o Expansion of activities to strengthen capacity to ensure continuity of essential health services. iii) Component 3 o Establishment and operational costs of a sub-PIU in the MOH for implementation of vaccine introduction.o Enhancing platforms for third party monitoring.(b) Results framework: Th e results framework is being revised to add new indicators for the proposed AF and dropping or modifying original indicators to capture new activities.(c) Institutional and implementation arrangements: These will be adjusted to reflect the shift in the Implementing agency from MOH to ZNPHI and changes to the project implementation arrangements and oversight structures. (d) Disbursement Arrangements. Creation of an operational account in MOH to finance operation costs for vaccine deployment and maintenance of essential RMNCAH-N services(e) Closing date: The closing date of the parent project will be extended by one year from December 31, 2022 to December 31, 2023. The extension is necessitated by: (i) consideration of the implementation timeline of the NVDP which proposes to vaccinate 21 percent of the population (18 years and older) under Phase 2, given the uncertainties related to the availability of vaccines globally and their efficacy against new variants of the virus, and (ii) to allow for implementation of activities to be supported by the additional US$10 million GFF grant.Detailed activities by components Component 1: Emergency Public Health Response to COVID-19. US$24.35 million equivalent: US$19.48 million IDA (US$5.98 million parent project; US$13.50 million AF IDA); US$ 4.87 million GFF (US$2.07 million GFF parent project; US$ 2.80 million Additional Grant).a) Sub-component 1.1(a): COVID-19 Surveillance, Case Investigation, and Rapid Response Capacity. US$2.20 million equivalent: US$2.00 million IDA (parent project after reallocation US$1.00 million; AF Allocation; US$1.00 million AF); US$ 0.2 million additional GFF. The AF under this sub-component will finance: Expansion of emergency response activities including: (i) Enhancing COVID-19 hotlines, sensitive to the unique needs of vulnerable and marginalized populations as well as gendered roles and responsibilities, and social norms in a multicultural society; (ii) SMS to provide callers with information about COVID-19 vaccination, referrals, and information about how to access other essential health services during the pandemic and climate hazards, including serving as an additional channel for grievance redress;