Additional Financing to the COVID-19 Emergency Response Project

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This Additional Financing is being proposed at a crucial juncture in the Government’s response to COVID-19 with the recent surge in cases and the imminent availability of vaccines. The AF will play a critical role in enabling affordable and equitable access to vaccines for Rwanda. There is broad based recognition that economies will not recover fully until people feel they can live, socialize, work, and travel with confidence. Given the importance of limiting the spread of COVID-19 to improve health outcomes and support economic recovery, providing access to COVID-19 vaccines will be critical to accelerate economic recovery and restore growth in Rwanda. COVID-19 has upended Rwanda’s strong economic performance. The government expects that GDP will fall by 0.2 percent for 2020, compared to a projected expansion of 8 percent before the COVID-19 outbreak. Unemployment soared from February to May 2020 from 13 to 22 percent of the labor force, while nearly 60 percent of workers who kept their jobs through the lockdown reported receiving lower salaries.The Additional Financing involves changes that are fully aligned with the original PDO and fall under existing components. Hence, both the PDO and the project components will remain unchanged with new activities incorporated into existing components: (i) Case Detection, Confirmation and Contact Tracing; (ii) Public Health Measures and Clinical Capacity; (iii) Program/Project Implementation and Monitoring and Evaluation; and (iv) Contingency Emergency Response Component. The AF will cover both the procurement and deployment of vaccines and systems strengthening activities required for effective distribution. The AF will also provide an opportunity to increase development effectiveness of the parent project by addressing emerging gaps, such as oxygen therapy. The implementation arrangements would remain unchanged, as these have proven robust and resilient. The government has set a bold target of vaccinating 30 percent of the population during the initial phase (2021) and the remaining 30 percent during a second phase (2022), to reach the African Union target of vaccinating 60 percent of the population, that is considered critical for herd immunity. Rwanda expects to cover the cost of vaccinating the first 20 percent of the population (2.5 million people) through COVAX. Rwanda has also been recently approved to receive additional supplies of vaccines through the African Union sponsored African Vaccine Acquisition Task Team (AVATT) that would reach another 10 percent of the population. Finally, the World Bank will finance up to 1.3 million additional people (additional 10 percent) during the life of the project. Given the Bank’s comparative advantage to provide flexible financing, a sizable proportion of the IDA credit will be used for the procurement and deployment of the vaccines, including operational costs. The AF will enhance the capacity of the country’s routine immunization system through additional investments in cold chains, human resources, transport, and risk communication to ensure a strong uptake of the vaccines. Discussions are underway with the Global Financing Facility (GFF) to secure a grant for Rwanda to protect essential health and nutrition services that would complement the IDA financing. The proposed AF is being prepared under the Additional Financing to the existing COVID-19 Strategic Preparedness and Response Program utilizing the Multiphase Programmatic Approach (“Global COVID-19 MPA AF”), approved by the World Bank’s Board of Executive Directors on October 13, 2020 (R2020-0193/2). New requirements to be tracked for all COVID-19 operations approved in FY21 will apply to this AF, namely: Gender Tag, Citizen Engagement Framework, and Climate and Disaster screening requirement and climate co-benefit commitments. The Results Framework indicators will be modified to reflect the new activities. The closing date will be extended by one year to June 30, 2023, to allow sufficient time for implementation, given continued uncertainties around the global availability of vaccines. The section below provides details on the proposed changes activities. Proposed Changes/Additional Activities The AF is expected to support the following activities and interventions within the existing project components.Component 1. Case Detection, Confirmation and Contact Tracing - This component supports the government to enhance disease surveillance, improve sample collection and ensure rapid laboratory confirmed diagnoses to promptly detect all potential COVID-19 cases and carry out contact tracing to quickly contain COVID-19. • Continuation: The focus will be on: (i) screening travelers at 31 Ports of Entry as well as priority communities and targeted health facilities; (ii) diagnosing cases and referring them for treatment; (iii) carrying out contact tracing to minimize risk of transmission; (vi) conducting risk assessments to identify hot spot areas of transmission; and (v) carrying out multi-sectoral simulation exercises for COVID-19 and other disease outbreaks.Component 2: Public Health Measures and Clinical Care Capacity - This component supports the reinforcement of public health measures and establishment of critical clinical care capacity at a network of public sector district hospitals.• Continuation: The main public health policies to be enforced include social distancing measures; personal hygiene promotion; and risk communication to disseminate messages about the risks associated with COVID-19. Clinical care and isolation capacity is being strengthened at select national and district hospitals responsible for triaging and treating COVID-19 cases to ensure health personnel are well protected and work in a safe environment.• Proposed New Activities: In line with the government’s long standing strategy of using a health systems approach to tackle major public health challenges, the roll out of the COVID-19 vaccines will leverage the immunization infrastructure and play a catalytic role in building capacity of the health care system to immunize adults and the most vulnerable groups across the life cycle and address underlying risk factors. To this end, the AF will support:• Vaccine deployment, including: (i) procurement of COVID-19 vaccines to complement financing under the COVAX facility; (ii) strengthening the supply chain and logistic systems to comply with the cold-chain requirements of different vaccines; (iii) supporting training of health providers, community health workers and other personnel responsible for the delivery, storage, handling, transportation, tracking and safety of vaccines; (iv) conducting assessments to inform the deployment of the vaccines; and (v) strengthening the policy environment through production of guidelines, standard operating procedures and protocols; reinforcing the regulatory capacity of the Rwanda Food and Drugs Authority to expedite the registration and approval processes, in line with WHO prequalification procedures and World Bank requirements for financing of vaccines; supporting planning and coordination of the vaccine deployment leveraging existing coordinating mechanisms under the national immunization program; and health care waste management and occupational health. To this end, the AF would support procurement of vaccines; cold chain equipment; vehicles; medical supplies and consumables (e.g. PPE, syringes and safety boxes, vaccine sharp disposal containers); technical assistance; and operating costs.• Vaccine communication campaign, to ensure acceptance and uptake, and take into account lessons learned from Rwanda’s pioneer work on the HPV and Ebola vaccine, through support to the Rwanda Health Communication Center to: (i) conduct communication campaigns which are well targeted to increase awareness, foster demand, and address hesitancy through mass media, radio, social media and outreach; (ii) track and monitor correct knowledge of COVID-1