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

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The Project Development Objective (revised PDO) is to prevent, detect, and respond to the threat posed by COVID-19, increase access to an essential package of health and nutrition services for the target population, develop health sector stewardship and preparedness capacity, and provide an immediate and effective response to an eligible crisis or emergency.The CERHSPP was approved on June 28, 2021, in the total amount of US$63.93 million as follows: (i) IDA grant in the amount of US$51.5 million to UNICEF; (ii) IDA grant in the amount of US$8.0 million to the International Committee of the Red Cross (ICRC); and (iii) IDA grant in the amount of US$500,00 to the World Health Organization (WHO). A restructuring and first AF of US$200 million were approved on March 31, 2022 and declared effective on April 25, 2022. The AF1 was approved to scale up the response to COVID-19 nationwide and expand the provision of essential health services in selected states in the country and has a financing envelop of US$110 million of IDA grants, a US$40 million grant from the IDA Crisis Response Window (CRW) and a US$50 million grant from the IDA-19 Window for Host Communities and Refugees (WHR).The project (parent + AF1) has five components. The first component, implemented by UNICEF, supports COVID-19 vaccination, cold chain, and delivery and community engagement. The second component, implemented by UNICEF and ICRC, supports the provision of essential health and nutrition services in selected states (Upper Nile and Jonglei). The third component, implemented by UNICEF and WHO, supports strengthening the MoH’s institutional capacity and health emergency preparedness. The fourth component, implemented by UNICEF and WHO, supports project management and monitoring. The fifth component is a zero allocation Contingent Emergency Response Component (CERC).Due to the food insecurity and malnutrition crisis in the Greater Upper Nile Region, the project requested to trigger the CERC to allow a reallocation of US$50 million from component 2 (subcomponent 2.1) to component 5 to enable a timely and integrated health and nutrition response to the crisis. Following the review of the package and the fulfillment of IDA conditions, the WB approved the request for activating the CERC on October 10, 2022. The activation of the CERC has allowed the project to provide rapid expansion of provision of an integrated health and nutrition package to a larger number of people in food insecure areas in Jonglei, Upper Nile and Unity. The provision of micronutrients through blanket and supplementary feeding programs (BSFP and TSFP) was rolled out in the Greater Upper Nile region. The systems for delivery of support are well-established and disbursed efficiently through UNICEF under the current project as well as the recently closed Provision of Essential Health Services Project. The proposed second AF (P180277) in the amount of US$70 million to the South Sudan COVID-19 Emergency Response and Health System Preparedness Project (CERHSPP- P176480) will (i) replenish the US$50 million which was reallocated from Component 2 to CERHSPP’s Contingent Emergency Response Component (CERC) which was triggered on October 10, 2022, to respond to the declared food insecurity emergency in the Greater Upper Nile Region; and (ii) support the scale up of the provision of health and nutrition services to refugees and host communities in project supported areas, which will be expanded to include Unity state. This AF would be in the form of an additional International Development Association (IDA) grant in the amount of US$70 million equivalent to the United Nations Children’s Fund (UNICEF) financed through (i) US$50 million from the Crisis Response Window (Emergency Response Fund); and (ii) US$20 million from the Window for Host Communities and Refugees (WHR). Component 1 supports COVID-19 vaccine deployment in South Sudan. Both systems strengthening to support COVID-19 vaccination and delivery of the vaccine to the population will be financed by the project. Systems strengthening will encompass climate friendly cold chain procurement, training, waste management, and monitoring. Vaccine delivery will include health worker allowances and supervision, risk communication, and procurement of vaccination supplies such as syringes and waste management equipment. - No additional funds will be allocated through AF2 and no changes apply.Component 2 is based on lessons learned from delivery of essential health services through PEHSP and maintains the delivery of essential health services through the predecessor project, with some adjustments to improve service availability. Additional funds through AF2 are only provided to subc omponent 2.1 and 2.3.The package of services to be delivered through Component 2 includes maternal and child health services such as vaccinations, prenatal care, skilled birth attendance, neonatal care and preventive and curative health and preventive nutrition services. Priority services also included in the package include mental health and psycho-social support services and services serving victims of sexual and gender-based violence (GBV). Component 2 supports the delivery of these services at primary care facilities and strategically identified secondary hospitals, complemented with community outreach and mobile health services to increase and expand equitable coverage and access, especially for remote or hard to reach communities. The work under this component maintains health service delivery arrangements under the predecessor project, which have seen notable service delivery achievements and provide core essential services to target populations.Component 2 channels resources through UNICEF and ICRC, two of the project implementing agencies. The two organizations coordinate to deliver of the package of essential health services in the two states and other areas in the country acutely affected by the conflict. Implementation strategies include: (i) direct service provision of said agencies using their own staff; and (ii) sub-contracting local and international NGOs to support the coordination and delivery of health services.To align with other donor financing in the country such as the HPF and fill critical resource gaps the geographical focus for component 2 has been Upper Nile and Jonglei States and has expanded to Unity State as part of the CERC, a scope expansion to be stabilized during AF2. To ensure continuity of care at secondary-level in conflict-prone Akobo county, the project will also support hospital level services, implemented by ICRC in Akobo County Hospital. The World Bank will facilitate close coordination with the two partner agencies for best service coverage and to respond to anticipated movement of population given the security situation context.Subcomponent 2.1. Delivery of high impact essential health services in Upper Nile and Jonglei States. Under this subcomponent, UNICEF will ensure the delivery of cost-effective, high impact essential health services to the general population. AF2 will support the replenishment of the project funds for this subcomponent to ensure that some critical originally planned activities are financed and implemented. No changes to the activities or the implementation arrangements are envisaged. Under this subcomponent, the project supports 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 eq