Third Additional Financing for the Ethiopia COVID-19 Emergency Response Project

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The third AF will support investments to bring immunization systems and service delivery capacity to the level required to successfully deliver COVID-19 vaccines at scale, through all the 5 Components of the parent project. Component 1: Medical Supplies and Equipment [proposed AF3 allocation US$41.0 million equivalent] Under this component, AF3 will finance: (i) the procurement of COVID-19 vaccine doses to cover an additional 10 percent of the population; (ii) procurement of vaccination supplies needed to vaccinate the additional 10 percent of the population such as diluents, syringes, and all medical supplies associated with the vaccination response; (iii) infection prevention and waste management; (iv) vaccine storage and transportation through EPSA, including purchase of spare parts for climate friendly cold chain equipment and; (v) procurement and distribution of COVID-19 ICU supplies; and (vi) laboratory equipment and consumables. These frontline health workers will be expected to conduct house-to-house visits hence the project will procure additional PPEs in adequate supply designed specifically for female health workers and volunteers. Component 2: Preparedness, Capacity Building and Training [proposed AF3 allocation US$142.0 million equivalent] finances (i) coordination at the national, subnational and regional/cross-country levels, which will require substantial strengthening to prepare for and effectively manage the roll out of vaccines; (ii) Emergency Operations Center (EOC) functionalization (including sub-national coordination and support for preparedness, training, and supervision) (iii) deployment of health workers and other personnel required for COVID-19 preparedness and response, human resources for supportive supervision and subnational support, including logistics management, delivery and supervision and monitoring; (iv) operating costs for Public Health Emergency Management (PHEM) and Incident Management functions; (v) screening at designated points of entry; (vi) strengthening call/hotline centers; (vii) strengthening PHEM and community- and event-based surveillance for COVID-19; and (viii) building diagnostic capacity for COVID-19 at the subnational (regional/state) level, including preparation of guidelines and standard operating procedures (SOPs).Component 3: Community Discussions and Information Outreach [proposed AF3 allocation US$5.0 million equivalent] include: (i) risk communication and community engagement; (ii) behavioral and sociocultural risk factors assessments; (iii) production of a Risk Communication and Community Engagement strategy to address the key gaps for the expected behavioral change for COVID-19 response; (iv) production of communication materials; (v) establishing a production center for information and communication tools to support media and community engagement; and (vi) monitoring and evidence generation; and (vii) human resources for risk communication.Component 4: Quarantine, Isolation and Treatment Centers[proposed AF3 allocation US$57.0 million equivalent]: through the rehabilitation of existing facilities and setting up temporary structures, establishes and equips quarantine, isolation, and treatment centers; provision of nutrition and dignity kits.Component 5: Project Implementation and Monitoring [proposed AF3 allocation US$5.0 million equivalent]includes: (i) support for procurement, financial management, environmental and social safeguards, monitoring and evaluation, and reporting; (ii) recruitment and training of Grant Management Unit (GMU) and Ethiopia Public Health Institute (EPHI) staff and technical consultants; and (iii) operating costs specifically for the project staff under the GMU and COVID-19 hazard pay /risk allowance for staffs who will be involved in COVID-19 response at different levels. Vaccine purchasing will be done through Component 1 of Ethiopia COVID-19 Emergency Response and Preparedness project. The support for vaccines when available, which was anticipated in the initial Global COVID-19 MPA, will be added as part of the containment and mitigation measures to prevent the spread of COVID-19 and deaths under Component 1: Emergency COVID-19 Response. Ethiopia will use options the AVAT platform and/or direct procurement through UNICEF for vaccine purchase and financing mechanisms. Given the recent emergence of COVID-19, there is no conclusive data available on the duration of immunity that vaccines will provide. While some evidence suggests that an enduring response will occur, this will not be known with certainty until clinical trials follow participants for several years. As such, this additional financing will allow for re-vaccination 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). As a prudent and contingent measure, budget for funding has been retained for re-vaccination, if needed, of such a subset of the population.To support the Government of Ethiopia’s vaccination planning, the AF will finance upfront technical assistance to support Ethiopia to establish institutional frameworks for the safe and effective deployment of vaccines. These will include: i) establishment of policies related to ensuring that there is no forced vaccination and that any mandatory vaccination program (such as for entry to schools) is well designed including regarding consent and follows due process for those who choose to opt out; ii) acceptable approved policy for prioritized intra-country vaccine allocation; iii) regulatory standards at the national level, including pharmacovigilance; iv) appropriate minimum standards for vaccine management including cold chain infrastructure (with financing as well for the investment to meet those standards as described below); and v) the creation of accountability, grievances, and citizen and community engagement mechanisms. The policies for prioritizing intra-country vaccine allocations will follow principles established in the WHO Allocation Framework, including targeting an initial coverage of 20 percent of a country’s population; focusing first on workers in health and social care settings; and then focusing on the elderly and younger people with an underlying condition which places them at higher risk.