AF Lesotho COVID-19 Emergency Preparedness and Response Project

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Lesotho remains vulnerable to COVID-19 and has just emerged from an important second wave of infections. While Lesotho launched a timely national response since the first cases of COVID-19 were identified in May 2020, Lesotho, like neighboring countries, experienced a large resurgence of infections in the latter part of 2020, which accelerated from the end of December 2020 and surpassed previous levels in the country. As of April 5, 2021, there have been 10,707 confirmed cases and 315 deaths due to COVID-19. Lesotho, as an enclave of South Africa, is much affected by the evolution of the pandemic in South Africa, one of the worst affected in the African continent. As a result, the Government of Lesotho requested additional resources in the amount of US$25.5 million for the expansion of the support provided under the parent project, the "Lesotho COVID-19 Emergency Preparedness and Response Project" (P173939), to fight the pandemic. The parent project in the amount of US$7.5 million was approved on May 9, 2020 and was prepared as part of the COVID-19 Strategic Preparedness and Response Plan (SPRP) using the Multiphase Programmatic Approach (MPA), which was approved by the Board on April 2, 2020. On October 13, 2020, the Board of Executive Directors approved an additional financing (P175450) to the Global COVID-19 MPA in the amount of US$12 billion. The primary objectives of the AF are to (i) enable affordable and equitable access to COVID-19 vaccines and help ensure effective vaccine deployment in the Kingdom of Lesotho through vaccination system strengthening and (ii) to further strengthen preparedness and response activities under the parent project. The PDO of the parent project and of this AF is to prevent, detect and respond to the threat posed by COVID-19 in the Kingdom of Lesotho. The parent project includes two components:(1) Emergency COVID-19 Response (US$6.675 million); and (2) Project Implementation and Monitoring and Evaluation (US$0.825 million). Component 1 of the parent project comprises three focus areas: (a) COVID-19 case detection, confirmation, contact tracing, recording and reporting; (b) Containment, isolation and treatment through enhanced clinical care capacity; and (c) Community engagement, prevention and risk communication. Component 2 of the parent project supports program coordination, management and monitoring, operational support and logistics, and project management. The AF involves adding three sub-components under Component 1: Emergency COVID-19 Response: Sub-component 1.1: vaccine procurement (US$14 million IDA AF), Sub-component 1.2: Strengthen systems for vaccine deployment (US$ 5.5 million IDA AF), and Sub-component 1.3: Strengthen systems for the COVID-19 response (Total of US$10.175 million IDA including US$6.675 million IDA under the parent project and US$3.5 million HEPR TF AF). Component 2: Project Implementation and Monitoring and Evaluation (Total US$3.325 million including US$ 0.825 million IDA under the parent project and US$2.5 million IDA AF) will continue to support the activities defined under the parent project; the PIU will be strengthened to manage the increased workload and provided with the required technical expertise to implement a large scale immunization program.New activities Sub-component 1.1: vaccine procurement (US$14 million IDA AF):Support for vaccines will be added as part of the containment and mitigation measures to prevent the spread of SARS-CoV-2 and COVID-19 deaths under Component 1. This sub-component will also cover associated costs (freight and insurance, clearing and transportation, handling charges) as well as medical supplies needed for administration (e.g. needles, syringes, alcohol prep pads). Sub-component 1.2: Strengthen systems for vaccine deployment (US$ 5.5 million IDA AF):Envisioned support includes distribution and administration of vaccines and strengthening the immunization supply chain system, including; (a) procurement and distribution of ancillary supply kits that may include COVID-19 vaccination record cards for each vaccine recipient and PPE for vaccinators; (b) supporting the administration of vaccines including training health workers in vaccine distribution, administration, and climate disaster response, micro-planning activities for rollout, development of contingency plans to maintain vaccination campaigns during climate shocks, and outreach sessions to reach specific target groups as well as people living in remote areas (e.g. operating costs, vehicles); (c) strengthening the supply chain and logistics systems including financing climate friendly cold-chain equipment to comply with the cold-chain requirements of different vaccines and the construction of the Maseru district vaccine store; (d) undertaking relevant traceability activities to ensure capabilities for the system to track and trace from production to the target population; (e) strengthening post-vaccination vigilance and monitoring system(s) to identify any adverse reactions on people and undertake corrective measures immediately; (f) conducting focused group discussions at community level targeting different stakeholders to gather information and adapt immunization rollout; (g) developing and distribute risk communication products for COVID-19 vaccination, including communication on the risks and response to climate shocks; and (h) ensuring adequate medical waste management.Sub-component 1.3: Strengthen systems for the COVID-19 response (US$3.5 HEPR TF). The AF will cover new activities to (i) increase capacity for case management such as through refurbishment of two regional/district ICU with minor civil works, supervision and mentoring visits, training of ICU staff and HCW, increased availability of oxygen through procurement of equipment and supplies as needed and establishment of two mini-plants, procurement of medical supplies including PPE; (ii) increase testing capacity such as through expansion of the national laboratory; enhanced and decentralized testing capacity using multiple modalities (such as using the existing polymerase chain reaction (PCR) instrument used for HIV/TB testing (GeneXpert) as well as procuring WHO-approved antigen test kits that can be scaled up rapidly in the community through mobile testing centers at low cost); (iii) strengthening of surveillance capacity; and (iv) strengthening COVID-19 data reporting and management across the board, including support for COVID-19 vaccination specific M&E and surveillance strengthening, which will apply to COVID-19 as well as other climate-induced, vaccine preventable diseases. Component 2: Project Implementation and Monitoring and Evaluation (Total US$2.5 IDA AF). As under the parent project, Component 2 will continue supporting the coordination and management of project activities, including procurement of goods and their distribution across health facilities, technical assistance, rapid surveys as part of the project M&E, and operating costs. The capacity of the PIU is further being enhanced. Moreover, this component will support a client feedback survey through digital health solutions to gather iterative feedback on project implementation, especially of immunization activities.