Kyrgyz Republic - Emergency COVID-19 Project

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COMPONENT 1: Emergency COVID-19 Response (US$ 11.98 million) 1. This component will provide immediate support to prevent additional arrivals of COVID-19 cases and to limit local transmission through containment strategies. It supports the enhancement of disease detection capacities through the provision of technical expertise, laboratory equipment, and systems to ensure prompt case finding and contact tracing. It will enable the Kyrgyz Republic to mobilize surge response capacity through trained and well-equipped frontline health workers. Supported activities include:>>> Case Detection, Case Confirmation, Contact Tracing, Case Recording, Case Reporting.2. The Project will help to (a) strengthen disease surveillance systems, public health laboratories, and epidemiological capacity for early detection and confirmation of cases; (b) combine detection of new cases with active contact tracing; (c) support epidemiological investigation; (d) strengthen risk assessment; and (e) provide on-time data and information for guiding decision-making and response and mitigation activities. 3. PoE are viewed as the main entry point for the disease into the Kyrgyz Republic. All 22 PoEs have temporary medical points, staffed with public health medical staff. These medical points will be upgraded, and staff will be provided with the necessary training and PPE. PoEs that lack adequate handwashing facilities, restrooms or other basic health and hygiene conditions will be updated to a basic level. The Project will also supply PPE to PoE staff as well as means of transportation and fuel for the transfer of suspected cases. Training will be designed and mostly financed by other development partners (including WHO) but may be financed by the Project as needed.4. Fully operational rapid response teams (RRT) and adequate laboratory testing capacities are key to early response and control of infection. The Project will support RRTs in Bishkek and 7 regions by procuring vehicles, essential equipment and supplies. Testing capacities in designated laboratories will be strengthened through centralized procurement of essential testing supplies and equipment. 5. Maintaining adequate surge capacity in the public health functions is a must as the COVID-19 outbreak continues to evolve in the country. The Department of State Sanitary and Epidemiology Control (DSSEC) and its branches manage the public virology laboratories and public health units that conform RRTs when needed. The Project will advance funds to the DSSEC through the MOH to finance surge capacity in designated laboratories (up to 4) and public health functions (including RRTs) where justified by preparedness needs and/or increased caseloads. The funds earmarked for surge capacities will be disbursed by the Bank after the adoption by the MoH of the instructions specifying the spending regulations and norms for the advanced funds, which should be acceptable to the Bank. The adoption of the instructions will need to be completed within 30 days of the Project's effectiveness. The eligible expenditures for this activity will include surge payments for the existing or additional medical and non-medical laboratory and public health staff. >>> Health System Strengthening.6. The Project aims to contribute to the strengthening of health system preparedness, quality of medical care provided to COVID-19 patients and minimizing the risks for health personnel and patients. These objectives will be achieved through procurement of essential medical goods, rapid conditioning of designated health facilities, and financing of surge staffing needs.7. The Project will finance essential medical goods such as medicines, medical supplies, and equipment through centralized procurement. Clinical care capacity will be strengthened through the financing of equipment and supplies for Intensive Care Units (ICU) in selected hospitals, and the provision of PPE and infection control materials in hospitals and primary care facilities. ICU equipment and supplies will be procured to establish or renew 10 8-bed ICUs in designated hospitals and include mechanical ventilators, cardiac defibrillators, mobile x-rays, oxygen concentrators, and other equipment essential to the provision of critical care to patients with a severe acute respiratory infection. A preliminary list of ICU equipment is provided in Annex 2. The Project will finance the procurement of some medicines for case management of COVID-19 patients, however, it is envisaged that a large share of the medicines and PPE procured would be financed from the CERC of the ERIK project. Support will also be provided to strengthen medical waste management and disposal systems. While incinerators will be procured using financing from the CERC of the ERIK project, the Project support can come in the form of minor works, repairs, and training. Finally, the Pro ject may finance the requisition of facilities for temporary housing of health care workers involved in care for COVID-19 patients.8. The Project will support rapid conditioning and surge capacity in designated hospitals through earmarked funds transfers. Given the deficient conditions in many hospitals, they will require additional investment to maintain basic infection and control measures and accommodate the use of essential medical equipment. Up to 30 ICUs and 100 isolation rooms in 24 designated hospitals will undergo conditioning including the provision and/or repair of handwashing and hygiene facilities, upgrading electrical work to safely operate medical equipment, maintenance, and cleaning of COVID wards, carrying out other emergency repairs to ensure patient and staff safety and infection prevention and control. The funds may support the temporary expansion of physical hospital space to existing buildings or temporary structures such as hospital tents or containers. The funds will also support surge staffing needs and temporary housing and associated communal expenses for health care workers involved in the care for COVID-19 patients, where justified by preparedness needs and/or increased patient loads. These funds will be advanced to hospitals through the MHIF. The funds earmarked for hospitals will be disbursed by the Bank after the adoption by the MoH of the instructions specifying the spending regulations and norms for the advanced funds, which should be acceptable to the Bank. This will need to be completed within 30 days of the Project's effectiveness. The list of designated hospitals and observation facilities to be included in this component will be informed by the recently completed Hospital Master Plan commissioned by the GoK. (Annex 1)COMPONENT 2: Implementation Management and Monitoring and Evaluation (US$ 0.16 million)9. Project Management. This Component will support the capacity of the Project Implementation Unit (PIU), located at the Ministry of Emergency Situations (MOES) to coordinate activities with MoH, RHPC, Mandatory Health Insurance Fund (MHIF) and other entities, and manage the financial management and procurement functions of the Project. The PIU will be strengthened by the recruitment of additional staff/consultants responsible for the overall administration, procurement, environmental and social safeguards, and financial management. 10. M&E. This component will support the M&E of Project implementation. To this end, the following would be supported: (a) Training in participatory M&E at all administrative levels, evaluation workshops, and development of an action plan for M&E and replication of successful models; (b. () Monitoring of project implementation, which would be a function of the PIU, which will be responsible for collecting relevant data from line ministries and other implementation agencies and then compiling them into progress reports focusing on the status of physical implementation by component, use of project funds and monitoring indicators. Facility audits will be conducted to verify indicators. Annual