Maldives COVID-19 Emergency Response and Health Systems Preparedness Project

closed

As of March 16, 2020, the Maldives has already reported 13 confirmed cases of the novel coronavirus COVID-19, mostly among tourists. Three people are hospitalized with another 20 people quarantined in Villivaru and 12 in isolation at Farukolhu. With a high population density in Male and tourists from all over the world, it is crucial to effectively prevent, control and respond to public health emergencies in a timely manner. The government has been proactive in its COVID-19 response and has increasingly been implementing travel restrictions. Measures have taken by the Government of the Maldives relating to the entry of passengers and crew with a travel history to Mainland China, Iran, the South Korean regions of North Gyeongsang Province and South Gyeongsang Province, Italy, Bangladesh, Spain, Ile-de-France and Grand Est Regions of France, Bavaria, North Rhine Westphalia and Baden-Wuerttemberg regions of Germany, to minimize the risk of spread of COVID-19 in the Maldives. Furthermore, travel between inhabited islands and resorts have been banned, and hotel check-ins are not permitted in Greater Male (Vilingili, Male and Hulhumale). These measures are in place for two weeks and will be subject to review. A national public health emergency was declared on March 12, 2020. Most recently, some measures of social distancing have been put in place, including temporary park, school and cinema closures.Maldives is very vulnerable to a more widespread outbreak with severe economic consequences due to its economic dependence on the tourism sector. Travel restrictions – imposed by outbound countries and Maldives as well—to contain the global outbreak are already having a broad impact on Maldives economy. In 2019, Maldives received 1.7 million tourists. Announced restrictions on tourists flows, as of March 15, account roughly for 40 percent of total arrivals. Real growth for the Maldives has been revised downwards to -4.7 percent for 2020 (from a forecast of 5.5 percent in January 2020). Furthermore, the decline in tourist arrivals is expected to sharply reduce revenue collection since most tax and non-tax revenue originate directly or indirectly from tourism (Airport Service Charge, Airport Development Fee, green tax, rent from resorts, tourism GST, business profit tax, import duties). Additional social distancing measures, while aimed at controlling the outbreak, are expected to further slowdown aggregate demand. The severity of the impact will depend on the speed at which the outbreak is contained across the globe and in Maldives, and the time it takes for tourism flows to return to normalcy.The proposed project development objective is to respond to and mitigate the threat posed by COVID-19 and strengthen national systems for public health preparedness in the Maldives. The project will have 4 components: (1) Emergency Response for COVID-19 Prevention component to prevent the disease taking hold in the country for as long as is reasonably possible and slow the spread in the country; (2) Emergency Health System Capacity Strengthening for COVID-19 Case Management component to provide the best care possible for people who become ill, support hospitals to maintain essential services despite a surge in demand and ensure ongoing support for people ill in the community to minimize the overall impact of the disease on society, public services and on the economy; (3) Implementation Management and Monitoring and Evaluation component to support the strengthening of public structures for the coordination and management of the project as well as the monitoring and evaluation of prevention and preparedness, building capacity for clinical and public health research, and joint-learning across and within countries; and (4) Contingent Emergency Response Component: This zero-dollar component is being added to ensure additional flexibility in response to the current and any potential other emergency that might o ccur during the lifetime of this project. The implementing unit will be the Regional and Atoll Health Service (RAHS) Division within the MOH. RAHS will have overall responsibility for project implementation and oversight of the project activities. The RAHS Division will be responsible for all procurements, trainings and capacity building activities supported by the project. In addition, for certain activities at the community level, the government may partner with Maldivian Red Crescent who have wider local presence to support implementation. A Project Management Unit (PMU) will be established within the Division to ensure effective and efficient implementation of these urgent activities. Composition of the PMU will include a Project Director, Project Coordinator/EOC Liaison, Procurement Specialist, Financial Management Specialist, Environmental Safeguards (biomedical waste management) Specialist, Social Safeguards Specialist and an M&E Specialist. Given that MoH and its RAHS Division have no previous experience in Bank financed projects, an interim arrangement to support project implementation will be put in place. Staff will be seconded from three existing World Bank-financed project PMUs to quickly ensure sufficient capacity and experience implementing World Bank-financed projects: (1) Public Financial Management Systems Strengthening project (P145317) in the Ministry of Finance for procurement and financial management support; (2) Enhancing Employability and Resilience of Youth project (MEERY) (P163818) for social safeguards support; and (3) Maldives Clean Environment project (P160739) for environmental safeguards support. Additional staff will need be recruited to support financial management, procurement, and social and environmental safeguards. The capacity of the PMU will be strengthened particularly to manage fiduciary and safeguards aspects of the project.A Project Steering Committee will be established comprised of members of the Emergency Operations Centre (EOC: MoH/HPA/NDMA). It was specifically established for COVID-19 response on March 3, 2020. The EOC will ensure multi-sectoral coordination and emergency response oversight over the management of the COVID-19 response. As such, it will provide oversight and guidance for the implementation of project activities.Procurement of medical supplies, including PPEs, will be preferably procured using the World Bank-UN procurement framework to mitigate risks of global supply chain shortages for COVID-19 supplies and resulting price gouging in the market. Procurement through the Standard Trading Organization (STO), the national procurement agency, may be considered for some cases that are not hindered by the current stock shortages.The overall risk to achieving the PDO is High. This reflects high macroeconomic, institutional capacity and fiduciary risks combined with substantial technical design and environmental and social risks.