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

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The proposed project comes to support preparedness for and deployment of vaccines in South Sudan as well as essential health service delivery in the states of Upper Nile and Jonglei States as well as hard-to-reach areas of South Sudan, while developing Government capacity for health sector stewardship. This project follows on from the South Sudan Provision of Essential Health Services (PEHSP) Project, (P168926).The project has five components. The first component, to be implemented by UNICEF, will support COVID-19 vaccination cold chain, logistics, and delivery. The second component will support delivery of essential health services to Jonglei and Upper Nile States, implemented by UNICEF and the International Committee of the Red Cross (ICRC), and building off service delivery in these areas under PEHSP. The third component will finance development of Government health sector stewardship capacity to allow a gradual transition to a government-led implementation modality in future World Bank projects. The fourth component will support project management and monitoring. The fifth component is a Contingent Emergency Response Component.Component 1 will support 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. Subcomponent 1.1. Climate friendly cold-chain (US$2 million ESMAP). 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 vaccine deployment in light of South Sudan’s annual floods and droughts. The project will support purchasing solar direct drive refrigerators for cold chain as well as cold boxes to support climate friendly transport of vaccines to vulnerable populations. The project will also support investments in solar power for some facilities in Upper Nile and Jonglei based on the assessment. Subcomponent 1.2. Vaccine Deployment and Climate Sensitive Vaccine Planning (US$5 million IDA): This subcomponent will contribute to the government efforts in the deployment of COVID-19 vaccination under Phase I of South Sudan’s NVDP. This subcomponent will finance (i) COVID-19 vaccine storage and transportation to target populations throughout South Sudan; (ii) training of health workers to administer the COVID-19 vaccine; (iii) waste management and disposal; (iv) supervision of vaccine deployment; (v) allowances for health workers to administer vaccination; (vi) vaccination supplies needed for vaccine delivery and distribution including diluents, syringes, and medical supplies; and (vii) routine monitoring of vaccine deployment. Subcomponent 1.3. Community Engagement and Behavior Change (US$ 0.50 million IDA). This subcomponent will support activities 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. Multi-level health promotions interventions will be tailored to the specific needs to vulnerable and hard-to-reach groups and be designed to be understood by all, including women, girls, and other disadvantaged populations who are illiterate or lack access to information sources. Building “vaccine literacy” for the COVID-19 vaccine is also an opportunity to boost overall confidence in vaccinations, thereby leading to greater utilization and retention in the EPI program. The overall communications strategy for COVID-19 vaccinations encompasses advocacy (for social and political commitments to vaccination efforts, and for required resources); social mobilization (civil society and citizen engagement); and behavioral change communication (to increase uptake of vaccines and preventive measures). Influential leaders at national and local levels can also be engaged as vaccine champions to help build confidence and trust from different target groups, as well as to clearly communicate the logic and rationale of the targeting and allocation framework to non-targeted groups to help mitigate perceptions of favoritism and exclusion. The Stakeholder Engagement Plans (SEPs) and communications strategies highlight differentiated methods for reaching targeted and vulnerable groups, including essential workers, the elderly, those with chronic conditions, and the general public, as well as women, IDPs, refugees, and other harder to reach populations. Component 2 will be based on lessons learned from delivery of essential health services through PEHSP and will maintain the delivery of essential health services through PEHSP, with some adjustments to improve service availability. The package of services to be delivered through Component 2 will be similar to the one supported by PEHSP and will include 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 will support 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 will maintain health service delivery arrangements under PEHSP, which have seen notable service delivery achievements and provide core essential services to target populations.Component 2 will channel resources through UNICEF and ICRC, two of the project implementing agencies. The two organizations will 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, maintaining implementation arrangements under PEHSP. Implementation strategies will 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, as with PEHSP, the geographical focus for component 2 will be Upper Nile and Jonglei States. To align with the financing and delivery of basic services by HPF3 in the eight remaining states, UNICEF’s geographical coverage will remain within Upper Nile and Jonglei. 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 (UNICEF; US$42 million, IDA). Under this subcomponent, UNICEF will ensure the delivery of cost-effective, high impact essential health services to the general population living in the states of Upper Nile an