South Sudan COVID-19 Emergency Response and Health Systems Preparedness Additional Financing

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The proposed Additional Financing (AF) will support the Government of South Sudan to strengthen health system resilience for and response to COVID-19 and to the historic level flooding among both the general population and refugees. The project will finance: (i) procurement and deployment of COVID-19 vaccines and related supplies under the African Vaccine Acquisition Trust (AVAT) initiative; (ii) response and resilience to climate-change induced flooding to strengthen public health systems in affected areas including the delivery of a tailored package of health and nutrition services to reach affected populations; (iii) health service delivery in Jonglei and Upper Nile States; and (iv) provision of an essential health and integrated nutrition services package to the main refugee populations and host communities in South Sudan. The purpose of the AF is to strengthen South Sudan’s response to the dual crises of COVID-19 and record-level flooding, while strengthening health service delivery for the general population in Upper Nile and Jonglei states and expanding service delivery to refugee and host communities. In 2020 and 2021 South Sudan’s annual floods reached record levels, displacing populations, destroying health facilities, and limiting access to health services. More than 850,000 populations have been displaced due to the flooding, of which almost 60 percent are in the states of Upper Nile and Jonglei. At the same time, the country has been struggling with the ongoing impact of the COVID-19 pandemic. CERHSPP is supporting COVID-19 vaccine deployment nationwide, health service delivery in Upper Nile and Jonglei states, and to improve health system pandemic preparedness. The project has five components:Component 1: COVID-19 Vaccine Acquisition, Deployment, Cold Chain Equipment, and Community Engagement (US$66.5 million equivalent: Parent Project: US$5.5 million from IDA and US$2 million from ESMAP Grant; Proposed AF allocation of US$59 million: US$8 million IDA WHR, US$7 million IDA CRW, US$44 million IDA) 1. Subcomponent 1.1. Climate friendly cold chain (US$3.5 million of which US$2 million ESMAP from the parent project and a proposed AF allocation of US$1.5 million). This subcomponent will support investments to strengthen energy-efficient, climate friendly cold chain in South Sudan’s climate vulnerable context and will support planning and preparations for climate friendly cold chain deployment in light of South Sudan’s annual floods and droughts. The AF will finance solar direct drive refrigerators for cold chain.2. Subcomponent 1.2: Vaccine Deployment and Climate Sensitive Vaccine Planning (US$26.5 million; of which US$5 million IDA from the parent project and proposed AF allocation of US$21.5 million). This subcomponent will build on the progress and achievements of the parent project and would focus on accelerating the MoH’s vaccination efforts of the procured AVAT vaccine doses along with some COVAX delivered vaccines nationwide. This subcomponent will cover the same categories of expenditures under the parent project, including climate-sensitive vaccine planning and deployment. This will include concentrating vaccine distribution during dry season and pre-positioning vaccine supplies for rainy season. Deployment of vaccines to populations impacted by the flooding will also be financed in this subcomponent.3. Subcomponent 1.3. Community Engagement and Behavior Change (US$1.5 million: 0.50 million parent project IDA and proposed AF allocation of US$1 million). This subcomponent will continue to accelerate efforts to increase community awareness on: (i) information on COVID-19 vaccination and its importance, with particular attention to increasing vaccine acceptance; (ii) the risks of COVID-19 disease with the aim of addressing perceptions that COVID-19 is not a health risk; (iii) awareness of signs, symptoms, and control measures for COVID-19; and (iv) messages on preparedness for climate shocks and awareness and containment measures for climate-induced, outbreak-prone diseases; and (v) evidence generation to inform ongoing vaccine deployment. 4. Subcomponent 1.4: Acquisition of COVID-19 vaccines (proposed AF allocation of US$35 million). This subcomponent will finance COVID-19 vaccine acquisition through the AVAT mechanism to expand the coverage of COVID-19 vaccines by around 30 percent. This leads to upward the project target for the COVID-19 vaccination coverage from 20 percent to 50 percent, including the contributions from the COVAX Facility of 20 percent. The support for vaccine acquisition under the AF is part of the containment and mitigation measures to prevent the spread of COVID-19 and deaths under Component 1. South Sudan will use the option for vaccine purchase and financing mechanisms through the AVAT. This additional financing will allow for re-vaccinat ion efforts if they are warranted by peer-reviewed scientific knowledge at the time. In the case that re-vaccination is required, limited priority populations (such as health workers and the elderly) will need to be targeted for re-vaccination given constraints on vaccine production capacity and equity considerations (i.e., tradeoffs between broader population coverage and re-vaccination).Component 2: Provision of Essential Health and Nutrition Services in Selected States (Parent Project: US$51 million equivalent, IDA; proposed AF allocation US$132 million: US$42 million, IDA WHR; US$33 million, IDA CRW; and US$57 million IDA grant)5. Subcomponent 2.1. Delivery of high impact essential health services in Upper Nile and Jonglei States (UNICEF; Parent Project: US$43 million IDA; proposed AF Allocation: US$76.5 million: US$43.5 million IDA, and US$33, IDA-CRW). Under this subcomponent, the parent project financed the delivery of cost-effective, high impact essential health services to the general population living in the states of Upper Nile and Jonglei implemented by UNICEF. This package of services includes, but not limited to: (i) maternal, neonatal, and child health services; (ii) basic and comprehensive emergency obstetric and newborn care; (iii) sexual and gender-based violence (GBV) services; (iv) climate emergency preparedness and response activities; (v) disease surveillance and outbreak response; (vi) quality improvement and supervision; and (vii) procurement and distribution of essential drugs, medical equipment and supplies for essential health services. 6. The AF will expand the parent projects piloting of strengthened supervision and management of health service delivery by financing: (i) basing at least one high level supervisor with management and coaching expertise within each project county to help support improvements in health service delivery coverage and quality with a focus on support for planning and implementation. The activity will also finance additional senior level staff at the State level to conduct field visits to the project sites. This intensified supervision mechanism at the county level aims to provide additional oversight and support to the health service delivery in the country; and (ii) expansion of the Boma Health Initiative (BHI) workers within the current coverage areas to ensure the target communities have adequate population coverage of the BHI services. 7. In addition, this subcomponent will support strengthening the health system resilience and ensure the delivery of essential health and nutrition services to the populations affected by the flooding. Specifically, the subcomponent will finance: (i) expanding the scope of services provided to include an enhanced nutrition package of services and for climate-sensitive diseases with customized modes of delivery to the affected population in the states of Upper Nile and Jonglei; and (ii) sustaining the service provision to the affected population through setup of health tents next to the communities displaced by the floods and rehabilitation of flood-affected health facilities in th