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have yet to adapt internal procedures. Some banks may still require fixed addresses as part of their due diligence, which recently-arrived refugees often do not have.

When it comes to access to credit provided by microfinance institutions (MFIs), regulatory requirements can be less restrictive. Several MFIs [71] in a number of countries such as Jordan, Lebanon, Uganda, Rwanda, Morocco, Tunisia, and Argentina have started providing loans to refugees by accepting UNHCR ID or the ID issued by governments to refugees, using alternative ways to verify residence and credit scoring. What has proven to be a key enabler to facilitate access to these services was the work done by UNHCR and partners to raise awareness about the financial needs of refugees with FSPs in the country. This advocacy work is fundamental and could be replicated in other countries to ensure greater access to a broader range of financial services by refugees.

_**Access to Mobile Money**_ To what extent does the regulatory environment facilitate or constrain access to mobile money?

As with SIM registration, of the 20 countries examined, none extend consistent legal access to mobile money to asylum seekers, though workarounds are regularly reported.
However, in late 2018 the Afghan Central Bank reportedly authorized certain mobile money operators to accept any letter or other form of certification from UNHCR (including the Voluntary Repatriation Form and asylum seeker and refugee certificates) to facilitate SIM registration for mobile money services as part of a cash-based intervention program.

Access to mobile money is varied for refugees across the countries studied. In Zambia, special approval was received from the Bank of Zambia and ZICTA, the telecommunications regulator, to use the proof of registration, refugee certificate and refugee ID card as valid ID for mobile wallet registration. In Nigeria, the regulatory framework is particularly progressive and accommodating.

Nigeria's mobile money framework based on a three-tier KYC/CDD regulation, the lowest level of which (Level 1) is particularly inclusive and, in theory, can accommodate the displaced (see Table 3).

**Case study: Rwanda**

According to the World Bank's Global Findex database, Rwanda's mobile money penetration (in terms of account ownership for 15+ years old) is 31.11%. The National Bank of Rwanda has enacted Regulation No. 08/2016 Governing the Electronic Money Issuers [72], which reiterates the core ID 71 Pistelli, _5 Things You Should Know About Financial Services for Refugees_ : http://www.findevgateway.org/blog/2018/jun/5-things-you-should-know-about-financial-services-refugees 72 JuriAfrica, _The National Bank Regulates the Activities of Issuers of Electronic Money_ : https://juriafrique.com/ eng/2017/01/27/rwanda-national-bank-the-governor-enacts-new-standards-for-issuers-of-electronic-money/

**Level 1** _**Low Value Accounts**_

i. They are subject to close monitoring by the financial institutions and less scrutiny by Bank Examiners.

ii. The accounts can be opened at branches of financial institutions by the prospective customer or through banking agents.

iii. No amount is required for opening of accounts iv. Such accounts cover Mobile Banking Products (issued in accordance with the CBN Regulatory Framework for Mobile Payments Services in Nigeria).

_**Main Characteristics**_ i. Deposits can be made by account holder and 3rd parties while withdrawal is restricted to account holder only.

ii. Be linked to mobile phone accounts.

iii. Operation is valid only in Nigeria.

iv. Automated Teller Machine transactions are allowed.

v. There is Prohibition on International Funds Transfer.

vi. Accounts are strictly savings.

73 IGC, _The Regulation of Mobile Money in Rwanda_, p.15 requirements for opening a bank account. "[Mobile Network Operators] are required to respect KYC rules prior to opening accounts — in practice a national ID card is required to register for mobile money." [73] As such, refugees continue to face barriers to accessing mobile money.
Mobile money agents from different operators are present in all camps in the country. However, while cash assistance to returnees is still based on mobile money transfers, UNHCR and WFP no longer use mobile money, but rather smart cards, for cash assistance in refugee settings due to challenges with SIM access and meeting KYC/CDD requirements.

_Table 3: Tier 1 of Nigeria’s Three-Tiered KYC Requirements (including Mobile Money)_

**Description and characteristics** **Amount / Threshold** **Customer**
**Limitation** **Identification**
**requirements**

i. Basic customer information required to be provided are:

- Passport photo;

- Name, Place and
Date of Birth;

- Gender, Address,
Telephone number, etc ii. Information may be sent electronically or submitted onsite in bank’s branches or agent’s office iii. Evidence of the Information provided by customer or verification of same is not required.

It is limited to a minimum single deposit amount of N20,000 and maximum cumulative balance of N200,000 at any point in time.

_**Mobile Banking**_ _**Products**_ Level One Mobile Banking Products are Allowed:

- Maximum
transaction limit of N3,000 and daily limit of N30,000.

- Such products
are subject to the CBN Regulatory Framework for Mobile Payments Services in Nigeria.

27 28


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**I.** **Background**
Niger is marked by a humanitarian situation characterized by attacks by non-state armed groups (NSAG) in Liptako Gourma and in the Lake Chad basin, which have caused forced displacement of around 700,000 people [1] including 400,000 internally displaced people (IDP) [2], 251,760 refugees and 50,377 returnees. Despite efforts made by the State and its partners, the security situation remains worrying in certain localities in the regions of Tillabery, Tahoua, Diffa and Maradi. In 2022, approximately 3,821 protection incidents were recorded in these 4 regions and affected 18,408 people. During the first half of 2023, the protection situation did not improve despite a lull observed in some regions. More than 1,800 protection incidents were recorded from January to June 2023 (on average 955 incidents per quarter in 2022 against 934 during 2023). It is deploring to see the continued abuses by the NSAGs including theft and extortion of property, physical assaults, kidnappings, murders, sexual violence but also incidents related to explosive devices (ED). The security situation and military operations in neighboring countries (Mali, Burkina Faso, Nigeria), the continuation of NSAG incursions into Niger, the intensification of operations by the Defense and Security Forces (DFS) are all factors that predict the persistence of ED threats in Niger.

Indeed, since 2022, the threat of ED has continued to rage in the regions of Tillabery and Diffa. The Protection Cluster recorded approximately 55 ED-related incidents in 2022 (a 34% increase compared to 2021). From January to June 2023, 32 ED incidents were reported, representing more than half of the total number of incidents reported in 2022. It is also worth highlighting the problem of food insecurity which affects several departments, including those affected by ED threats. In fact, faced with the effects of food insecurity, communities could resort to negative coping strategies, in particular that of venturing into areas affected by ED in search of means of subsistence or even collecting scrap metal found on explosive remnants of war for resale.
In the face of a growing threat from ED, mine action capacities remain limited in Niger. Considerable challenges exist both in programmatic actions and in the coordination of interventions. No mine action coordination mechanism is functional either at the national level or in the regions affected by ED. This makes it difficult to strategically harmonize, target and prioritize mine action interventions. The objective of this note is to strengthen advocacy with state authorities, the various technical and donor partners in order to support mine action in Niger, protect communities and humanitarian actors against the risks associated with ED and enable them to enjoy their fundamental rights and freedoms.

## **II. Analysis of the evolution of ED incidents and their impact**

From the last quarter of 2022 to the 2nd quarter of 2023, 56 EE incidents [3] were Graph2: Number of ED incidents per quarter reported mainly in the regions of Tillabery 30 24 and Diffa. **Compared to the 1st quarter of** 20
**2023, it can be noted that the number of** 20 12
**ED incidents doubled in the 2nd quarter of** 10
**2023, which indicates a worrying increase**

0

**in the threat of ED in Niger.** This threat

Graph2: Number of ED incidents per quarter 30 20 24 20 12 10 0 Q4_2022 Q1_2023 Q2_2023 1 UNHCR Niger montlhy PoC statistics, Juin 2023 2 Population displacement statistics, Ministry of Humanitarian Action and Disaster Management, july 2023 3 Source : National Commission for the Collection and Control of Illicit Weapons (CNCCAI in french)


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affects civilians more than the military, especially in the 2nd quarter of 2023 **(Ref graph3).** In fact, the reported ED incidents resulted in a total of 132 victims [4] and survivors, most of whom (52%) were civilians (killed or injured). **The percentage**
**of civilians killed is almost double that of military**
**killed,** which puts the threat on civilians more
than militaries and reflects the need to strengthen mine action within affected communities.

50 40 30 20 10 0 Graph3. Profil of ED victims 34 40 44 25 21 23 23 15 8 8 4 6 11 0 0 2 Q4-2022 Q1-2023 Q2-2023 Total Military killed Military injured Civilian killed Civilian injured The affected regions are those of Tillabery (areas of the 3 borders in the Sahel) and Diffa (region of the Lake Chad basin). **The Tillabery region has 7 affected** departments [5] **, and the Diffa region has 4** . A minimal number of ED incidents have also been reported in 3 other regions: Agadez, Dosso and Niamey ( **Ref graph2** ). This situation puts more than 200,000 people at risk of ED incidents in the affected areas.

The prevalence of ED incidents related also leads to restrictions on the mobility of civilian populations on the roads to weekly markets, and the main cities of communities/departments.
About 36% of those interviewed [6] say they encounter mobility constraints due to the activities of the NSAGs and military operations.
This indicator varies from one region to another. In the regions of Diffa and Tillabery, 56% of respondents say they encounter mobility constraints, one of the main reasons being the presence of ED. This considerably limits the periodic supply of households with means of subsistence and necessities in addition to the fear and psychological distress that the unpredictable presence of ED inflicts on communities. It is also important to highlight that of the 11 affected departments in the Diffa and Tillabéry regions, 9 (82%) are also affected by the food insecurity [7] . This could exacerbate 4 CNCCAI: The disaggregation by sex and age of the 2023 data for victims is not yet available. However, according to the Child Protection Sub-cluster, the Child Protection Working Group of the Diffa region recorded 18 child victims of ED in 2022, the majority of whom (74%) are girls who went to look for firewood.
5 Departments of: Torodi, Say,Téra, Tillabéry, Gotheye, Bankilaré et, Ouallam (région de Tillabéry) et Diffa, Bosso, Mainé et N'Guingmi (region de Diffa) 6 According to protection monitoring data (P21) 1st semester 2023.
7 [Food security situation, june 2023](https://drive.google.com/file/d/1FVzLNdVSeHdrZ0iNx0YUf2LNiWuO5gBS/view?usp=sharing)


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the needs of communities to intensify their coping strategies including livelihood-seeking activities that may expose them to ED risks.

The application of the [sanctions in progress following the coup in Niger could increase the cost of living](https://ecowas.int/wp-content/uploads/2023/07/COMMUNIQUE-FINAL-CINQUANTE-ET-UNIEME-SOMMET-EXTRAORDINAIRE-DE-LA-CONFERENCE-DES-CHEFS-DETAT-ET-DE-GOUVERNEMENT-DE-LA-CEDEAO-SUR-LA-SITUATION-POLITIQUE-AU-NIGER.pdf) and increase the vital needs of already vulnerable populations. This new situation would expose them to the risk of enrolment in NSAG for a salary and therefore increase the capacity of NSAG in the installation of ED. In addition, the population could intensify their survival strategies by engaging in several types of activities to adapt to the high cost of living, including the search for subsistence in areas potentially affected by ED. Consequently, an upsurge in ED incidents is very likely.

## **III. Major challenges in mine action interventions (MA)**

Graph4. Mapping of MA activities, 30 juin 2023 In January 2023, the Protection Cluster launched a joint initiative of mapping protection interventions including mine action. The analysis of the data resulting from this mapping combined with the analysis of the protection response monitoring data brought out the observation below:

- Only two protection
actors have interventions in MA which cover only a few localities of the 7 out of 11 departments affected by ED **(Ref Graph4 & Gaph2).** 4 out of 11 departments most affected by EE remain without any LAM intervention.

- There is a **major gap in Explosive Device Risk Education** (EDRE) interventions in several regions
affected by ED (Diffa, Tillabery, Dosso, Agadez and Niamey).

- A critical lack of victim assistance is observed in all 11 affected departments ( **Ref Graph5)** .

- Existing capacities have only made it possible to reach about 3,000 people [8] with EDRE
[activities, representing only 2% of target set in the Humanitarian Response Plan (HRP).](https://reliefweb.int/report/niger/niger-plan-de-reponse-humanitaire-mars-2023)

- 98% of the HRP LAM target is therefore not reached. In addition, 77% of the funding
requirement MA interventions is not met.

- There is also a **lack of human resources dedicated to coordination at national and regional**
**level, prevention, and assistance to victims** . The MA Sub-Cluster has not been functional since
the withdrawal of UNMAS in early November 2022, despite joint coordination efforts between CNCCAI and MA actors including Mines Advisory Group (MAG) and Humanity and Inclusion (HI) 8 Dashboard des réalisations de protection, cluster Protection, Avril 2023


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- **A** **considerable** **need** **for**
**capacity building in MA** for
the various actors including frontline humanitarian actors, MA committees is urgently needed.

## **IV. Key recommandations**

With the growing threat of ED, low geographic coverage, and low diversity of MA interventions, more than 200,000 people living in ED affected areas remain unassisted and at increased risk of becoming victims of ED. It is crucial to invest more in mine action to ensure communities receive gender and ageappropriate ED risk education. It would also enable communities to adopt safe behavior and access inclusive care services for victims and survivors of ED. Therefore, it is essential to strengthen the following aspects:

1. Advocacy: Strengthen advocacy with the various decision-makers (state authorities, technical

and donor partners) for the return of UNMAS to Niger 2. Coordination: Identify additional technical partners who can support MA coordination at national and regional level (particularly in Tillabery and Diffa regions) 3. Resource mobilization: In 2023 approximately 77% of MA funding requirement is not met. It is essential to mobilize an amount of USD [9] 2,000,000 to scale up MA coordination, data collection by the CNCCAI, ED risks education (EDRE), assistance to victims, demining and MA capacity building.

4. Collaboration: Strengthen collaboration with the various actors to have a map of the areas affected by ED in order to intensify training sessions, awareness-raising with both communities and frontline humanitarian actors 9 [plan de reponse humanitaire/HRP 2023-2025, Niger](https://reliefweb.int/report/niger/niger-plan-de-reponse-humanitaire-mars-2023)


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**I. Introduction: securing the rights of urban refugees**

1. The world is undergoing a process of rapid urbanization. In 1950, less than 30
per cent of the world’s population lived in cities and towns. That figure has now increased to over 50 per cent and is expected to reach 60 per cent by 2030.

2. In terms of population numbers, the statistics are equally striking. While some 730 million people lived in urban areas in 1950, that figure has more than quadrupled in the past 60 years and now stands at over 3.3 billion.

3. In view of these developments, it is no surprise to find that a growing number and proportion of the world’s refugees are also to be found in urban areas. [1] According to UNHCR’s most recent statistics, almost half of the world’s 10.5 million refugees now reside in cities and towns, compared to one third who live in camps.

4. As well as increasing in size, the world’s urban refugee population is also changing in composition. In the past, a significant proportion of the urban refugees registered with UNHCR in developing and middle-income countries were young men who possessed the capacity and determination needed to survive in the city.

5. Today, however, large numbers of refugee women, children and older people are also to be found in urban areas, particularly in those countries where there are no camps. They are often confronted with a range of protection risks: the threat of arrest and detention, _refoulement_, harassment, exploitation, discrimination, inadequate and overcrowded shelter, as well as vulnerability to sexual and gender-based violence (SGBV), HIV-AIDS, human smuggling and trafficking.

6. Until recently, the Office continued to give primary attention to those refugees who are accommodated in camps. This approach was encouraged by the organization’s 1997 policy statement on refugees in urban areas, a document that was based on the assumption that such refugees were more the exception and less the norm, as is now increasingly the case.

7. Experience with the 1997 policy statement revealed a number of other difficulties. It was preoccupied with the growing cost of providing assistance to refugees in urban areas, which limited its scope of application. So too did its focus on the issue of refugees who take up residence in an urban area after moving in an irregular manner from their country of first asylum. In addition, the 1997 paper did not establish a sufficient balance between UNHCR’s security concerns in urban settings and the need to deal with the underlying causes of the refugees’ frustration.

8. Recognizing the need to address the issue of urban refugees in a more comprehensive manner, UNHCR is now replacing the 1997 policy statement with the current document.

1 It is very difficult to establish a global definiton of the ‘urban area’ concept. For the purposes of this paper, it will be taken to mean a built-up area that accommodates large numbers of people living in close proximity to each other, and where the majority of people sustain themselves by means of formal and informal employment and the provision of goods and services. While refugee camps share some of the characteristics of an urban area, they are excluded from this definition.

2


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- the establishment of local community centres, where refugees and other
members of the urban population can socialize and gain access to information, services, counselling and recreational facilities;

- an active programme of community communications (replacing the former
UNHCR notion of ‘mass information’) that enables UNHCR to keep in touch with refugees by means of activities such as cultural events, neighbourhood meetings, and, when it is technologically viable, through SMS messages, telephone hotlines and interactive websites;

- professionally designed surveys and opinion polls, undertaken or
commissioned by UNHCR with the intention of gaining a better knowledge of the living conditions, attitudes, intentions and aspirations of urban refugees; and,

- the establishment of Field Units and Field Offices in cities and countries with
particularly large and dispersed urban refugee populations.

80. In addition to such activities, UNHCR staff will make periodic visits to the neighbourhoods where refugees have congregated and to facilities used by refugees, such as schools and health centres. Opportunities for visits to local police stations, immigration detention centres and prisons, as well as human rights and civil society organizations will also be pursued with the authorities. .

81. UNHCR will make particular efforts to reach out and respond to the needs of refugee women and girls, especially those who are destitute and who may resort to survival sex and other negative coping mechanisms. Programmes that are designed to offer women and girls constructive and productive alternatives to such mechanisms will be formulated, drawing on effective practices in past and current operations.

82. The Office will also take steps to prevent and respond to gender-based violence and human trafficking. Action will be taken to ensure that victims and potential victims of such crimes can report on them in full confidentiality and safeguard their identity. Those people will be protected from reprisals and receive appropriate clinical and counselling support.

83. In the urban context, special efforts are also required to identify unaccompanied and separated minors, who run the risk of becoming ‘street children’ and subjected to exploitation and abuse. In order to locate and protect these children, UNHCR will work closely with national child protection agencies, as well as UN agencies, NGOs and civil society organizations that work in the area of child protection. All of UNHCR’s work in this area will be guided by the principle of the ‘best interest’ of the child.

**f) Fostering constructive relations with urban refugees**

84. UNHCR’s relationship with refugees in urban areas has on occasions been a tense one, characterized by a degree of mutual suspicion. This has been to some extent inevitable, given the unrealistic expectations that urban refugees sometimes 14


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- pending a durable solution, stay is permitted under conditions which protect
against arbitrary expulsion and deprivation of liberty and which provide for adequate and dignified means of subsistence; and,

- the unity and integrity of the family is ensured, and the specific protection
needs of the affected persons, including those deriving from age and gender, are identified and respected.

155. A refugee who is unable to live in decent and dignified conditions and who has no real prospect of finding a durable solution in or from their country of asylum within a reasonable timeframe cannot be considered to have found effective protection. When a refugee moves to seek reunification with immediate family members who are not in a position to reunite in that person’s country of first asylum, and when a refugee moves as a result of other strong linkages with the country of destination, the onward movement may also be justified.

156. UNHCR offices will be encouraged to collect and analyze data on secondary movements so as to understand and respond effectively to their causes. UNHCR and its partners will also formulate and implement information strategies to advise refugees about the protection risks associated with secondary movements. In order to avert secondary movements, UNHCR will also endeavour to harmonize the protection, solutions and assistance available to refugees within each region where it operates.

**V. Conclusion: pursuing a positive and proactive approach**

157. Rapid urbanization is one the most significant ‘mega-trends’ confronting our planet today. It is also an issue that interacts with and reinforces many other global developments, including climate change, environmental degradation, volatile commodity prices, financial and economic instability, and the absence of decent work for growing numbers of young people.

158. In this context, UNHCR has considered it essential to reconsider the organization’s position on the issue of refugees in urban areas and to adopt an approach to this matter that is more positive, constructive and proactive than has been the case in the past.

159. UNHCR wishes to thank the many people who have contributed to the formulation of this policy statement, especially staff members in the field and the NGO community. Their contribution has been invaluable.

160. The implementation and impact of the new UNHCR policy will be reviewed and revised as appropriate, in close collaboration with other actors who have a substantive role to play in expanding the protection space available to refugees in urban areas.

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**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) ABBREVIATIONS AND ACRONYMS AEFI Adverse Events Following Immunization AF Additional Financing ACG Anti-Corruption Guidelines BFP Bank Facilitated Procurement CERC Contingent Emergency Response Component COVAX Facility COVID-19 Vaccines Global Access Facility COVID-19 Coronavirus Disease 2019 CT Computed Tomography DA Designated Account DO Development Objective EHS Environment, Health and Safety EOC Emergency Operations Center EODP Emergency Operation for Development Project EPI Expanded Program for Immunization EPRP Emergency Preparedness and Response Plan ESCP Environmental and Social Commitment Plan ESF Environmental and Social Framework ESMF Environmental and Social Management Framework EUA Emergency Use Authorization EUL Emergency Use Listing FM Financial Management FTCF Fast Track COVID-19 Facility GAVI Global Alliance for Vaccines and Immunization GDP Gross Domestic Product GOI Government of Iraq GHG Greenhouse Gas GRM Grievance Redress Mechanism GRS Grievance Redress Service HEIS Hands-on Enhanced Implementation Support HNP Health, Nutrition, and Population I3RF Iraq Reform, Recovery and Reconstruction Fund IBM Iterative Beneficiary Monitoring IBRD International Bank for Reconstruction and Development ICU Intensive Care Unit IDA International Development Association IDP Internally Displaced Persons IFC International Finance Corporation IHR International Health Regulation IPF Investment Project Financing ISR Implementation Status and Results Report LMIS Logistics Management Information System

LMIS Logistics Management Information System


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**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) TABLE OF CONTENTS

**DATASHEET ........................................................................................................................... 1**

**I.** **PROGRAM CONTEXT ....................................................................................................... 6**

A. Introduction .................................................................................................................................. 6 B. MPA Program Context .................................................................................................................. 7 C. Updated MPA Program Framework .............................................................................................. 8 D. Learning Agenda ........................................................................................................................... 9

**II.** **CONTEXT AND RELEVANCE ............................................................................................. 9**

A. Country Context ............................................................................................................................ 9 B. Sectoral and Institutional Context ................................................................................................ 9 C. Relevance to Higher Level Objectives ......................................................................................... 18

**III.** **PROJECT DESCRIPTION .................................................................................................. 19**

A. Development Objectives ............................................................................................................. 19 B. Project Components ................................................................................................................... 19 C. Project Beneficiaries ................................................................................................................... 23

**IV.** **IMPLEMENTATION ARRANGEMENTS ............................................................................ 24**

A. Institutional and Implementation Arrangements ....................................................................... 24 B. Results Monitoring and Evaluation Arrangements ..................................................................... 25 C. Sustainability ............................................................................................................................... 25

**V.** **PROJECT APPRAISAL SUMMARY ................................................................................... 25**

A. Technical, Economic and Financial Analysis................................................................................ 25 B. Financial Management................................................................................................................ 26 C. Procurement ............................................................................................................................... 27 D. Legal Operational Policies ........................................................................................................... 29 E. Environmental and Social Standards .......................................................................................... 29 F. Climate Co-Benefits..................................................................................................................... 31 G. Citizen Engagement .................................................................................................................... 32 H. Gender ........................................................................................................................................ 33 I. Grievance redress mechanisms .................................................................................................. 35

**VI.** **GRIEVANCE REDRESS SERVICES ..................................................................................... 35**

**VII.** **KEY RISKS ..................................................................................................................... 35**

**VIII.** **RESULTS FRAMEWORK AND MONITORING ................................................................... 39**

**ANNEX 1: Status of Vaccines as of 09/15/2021 .......................................................................... 47**


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**The World Bank**
Iraq COVID-19 Vaccination Project (P177038)

**ANNEX 2: Financial Management Assessment Report ................................................................ 48**

**ANNEX 3: Implementation Arrangements and Support Plan ....................................................... 53**

.


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**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) DATASHEET

**BASIC INFORMATION**
~~BASIC~~ ~~INFO~~ ~~TABLE~~ Country(ies) Project Name Iraq Iraq COVID-19 Vaccination Project Project ID Financing Instrument Environmental and Social Risk Classification Investment Project P177038 Substantial Financing

**Financing & Implementation Modalities**

[✓] Multiphase Programmatic Approach (MPA) [ ] Contingent Emergency Response Component (CERC)

[ ] Series of Projects (SOP) [✓] Fragile State(s)

[ ] Performance-Based Conditions (PBCs) [ ] Small State(s)

[ ] Financial Intermediaries (FI) [ ] Fragile within a non-fragile Country

[ ] Project-Based Guarantee [✓] Conflict

[ ] Deferred Drawdown [ ] Responding to Natural or Man-made Disaster

[ ] Alternate Procurement Arrangements (APA) [ ] Hands-on Enhanced Implementation Support (HEIS) Expected Project Approval Date Expected Project Closing Date Expected Program Closing Date 24-Sep-2021 30-Jun-2023 31-Mar-2025 Bank/IFC Collaboration No

**MPA Program Development Objective**

The Program Development Objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness

**MPA Financing Data (US$, Millions)** **Financing**

Page 1 of 54


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**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) MPA Program Financing Envelope 18,000.00

**Proposed Project Development Objective(s)**
The development objective is to support the Government of Iraq in the acquisition and deployment of COVID-19 vaccines.

**Components**

**Component Name** **Cost (US$, millions)**

COVID-19 Vaccines and Deployment 97.00 Project Management and Monitoring and Evaluation 3.00

**Organizations**

Borrower: Republic of Iraq Implementing Agency: Ministry of Health and Environment

**MPA FINANCING DETAILS (US$, Millions)**

**MPA FINANCING DETAILS (US$, Millions)** Approved

**Board Approved MPA Financing Envelope:** 18,000.00

**MPA Program Financing Envelope:** 18,000.00

**of which Bank Financing (IBRD):** 9,900.00

**of which Bank Financing (IDA):** 8,100.00

**of which other financing sources:** 0.00

**PROJECT FINANCING DATA (US$, Millions)**

FIN_SUMM_NEW
**SUMMARY-NewFin1**

**Total Project Cost** 100.00

**Total Financing** 100.00

**of which IBRD/IDA** 98.00

**Financing Gap** 0.00

Page 2 of 54


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**The World Bank**
Iraq COVID-19 Vaccination Project (P177038)

**DETAILS-NewFinEnh1**

**World Bank Group Financing**

International Bank for Reconstruction and Development (IBRD) 98.00

**Non-World Bank Group Financing**

Trust Funds 2.00 Reform and Reconstruction in Iraq MDTF 2.00

**Expected Disbursements (in US$, Millions)**

**WB Fiscal**
2022 2023 2024
**Year**

**Annual** 75.00 22.00 1.00

**Cumulative** 75.00 97.00 98.00

**INSTITUTIONAL DATA**

**Practice Area (Lead)** **Contributing Practice Areas**

Health, Nutrition & Population

**Climate Change and Disaster Screening**

This operation has been screened for short and long-term climate change and disaster risks

**SYSTEMATIC OPERATIONS RISK-RATING TOOL (SORT)**

**Risk Category** **Rating**

1. Political and Governance ⚫ High

2. Macroeconomic ⚫ High 3. Sector Strategies and Policies ⚫ Substantial 4. Technical Design of Project or Program ⚫ Substantial 5. Institutional Capacity for Implementation and Sustainability ⚫ High Page 3 of 54


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**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) 6. Fiduciary ⚫ High 7. Environment and Social ⚫ Substantial 8. Stakeholders ⚫ Substantial 9. Other ⚫ Substantial 10. Overall ⚫ High

**Overall MPA Program Risk** ⚫ High

**COMPLIANCE**

**Policy**
Does the project depart from the CPF in content or in other significant respects?

[ ] Yes [✓] No Does the project require any waivers of Bank policies?

[ ] Yes [✓] No Page 4 of 54


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**The World Bank**
Iraq COVID-19 Vaccination Project (P177038)

**Environmental and Social Standards Relevance Given its Context at the Time of Appraisal**

**E & S Standards** **Relevance**

Assessment and Management of Environmental and Social Risks and Impacts Relevant Stakeholder Engagement and Information Disclosure Relevant Labor and Working Conditions Relevant Resource Efficiency and Pollution Prevention and Management Relevant Community Health and Safety Relevant Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Not Currently Relevant Biodiversity Conservation and Sustainable Management of Living Natural Resources Not Currently Relevant Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities Not Currently Relevant Cultural Heritage Not Currently Relevant Financial Intermediaries Not Currently Relevant

**NOTE** : For further information regarding the World Bank’s due diligence assessment of the Project’s potential
environmental and social risks and impacts, please refer to the Project’s Appraisal Environmental and Social Review Summary (ESRS).

**Legal Covenants**

**Conditions**

Type Financing source Description Effectiveness Trust Funds The Borrower, through MOHE, appoints TPMA for purposes of carrying out a technical audit.

Page 5 of 54


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**The World Bank**
Iraq COVID-19 Vaccination Project (P177038)

**B.** **MPA Program Context**

4. **The Additional Financing (AF) to the SPRP approved by the World Bank’s Board of Executive Directors on**
**October 13, 2020 to the existing COVID-19 SPRP utilizing the MPA (“Global COVID-19 MPA”) will significantly expand**
**the World Bank support to client countries for COVID-19 vaccination, with the aim to support vaccination of one**
**billion people globally.** An effective and safe COVID-19 vaccine is the most promising path forward for the world to
reopen safely, building on global efforts to develop treatments and to expand testing capacity. The timing of potential vaccine development was not known when the Global COVID-19 MPA was approved, but global vaccine development efforts have progressed rapidly. Production is underway of several vaccines that have been approved for use since the end of 2020. Many high-income countries have made large-scale advance purchases to reserve supply for their populations and have the systems in place to get people vaccinated efficiently. The approval of an envelope of US$12 billion (US$6 billion from IDA and US$6 billion from IBRD) in financing was critical to expand affordable and equitable financing for vaccine purchase and deployment. It also sent a signal to potential suppliers that World Bank financing is available for the demand of vaccines from low- and middle-income countries (LMICs), providing an incentive for production capacity at levels that can also supply developing economies at affordable prices, not only high-income countries. The World Bank’s Global COVID-19 MPA AF is expected to enable vaccination for up to 750 million people, with potential surge capacity for an additional 250 million people in the poorest countries (depending on the delivered price of approved vaccines) while scaling up support to strengthen immunization delivery, with design flexibility at the country level. The Iraq COVID-19 Vaccination Project will enable support to the GOI’s COVID-19 vaccination efforts and will be a key contribution to the World Bank Group’s (WBG) overall COVID-19 response.

5. **The COVID-19 pandemic has had massive global impact and continues to spread** . Since December 2019, following the diagnosis of the initial cases in Wuhan, Hubei Province, China, the number of COVID-19 cases has increased rapidly. On March 11, 2020, the WHO declared a global pandemic. As of September 20, 2021, more than 228 million people have been infected with COVID-19 and 4.7 million have died. The pandemic has caused the largest global economic contraction since the Great Depression in 1929, driving millions of people into poverty. The economic recovery is expected to be slow. Furthermore, many countries are seeing a ‘third wave’ with the spread of the Delta variant.

6. **The World Bank’s response to the pandemic was quick.** On March 3, 2020, the World Bank’s Board of Executive Directors endorsed urgent actions supporting client countries’ response to the COVID-19 pandemic. Subsequently, the Board approved the establishment of a US$12 billion WBG Fast Track COVID-19 Facility (FTCF or “the Facility”) to assist IBRD and International Development Association (IDA) countries in addressing the global pandemic and its impacts. Of this amount, US$6 billion came from IBRD/IDA (“the Bank”) and US$6 billion from the International Finance Corporation (IFC). The IFC subsequently increased its contribution to US$8 billion, bringing the FTCF total to US$14 billion. On March 17, 2020, the World Bank’s Board granted approval of specific waivers and exceptions required to enable the rapid preparation and implementation of country operations under the FTCF. On April 2, 2020, the World Bank’s Board approved the SPRP with a US$6 billion financing envelope of which up to US$4 billion for health financing (up to US$1.3 billion IDA and up to US$2.7 billion under IBRD). The SPRP utilizes MPA, to be supported by the FTCF. On April 2, 2020, the World Bank’s Board also approved the first 25 country projects.

7. **Since the initial FTCF response, the WBG has significantly expanded its support for countries as they respond to**
**the COVID-19 pandemic and its overall impacts** . In March 2020, the WBG announced that the institution has the
capacity to provide up to US$160 billion in total financial support through June 2021 to help countries address the social Page 7 of 54


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**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) and economic impacts of the pandemic. On June 16, 2020, the World Bank’s Board endorsed the COVID-19 Crisis Response Approach Paper, outlining priorities for supporting countries in the longer term, including: a continued focus on saving lives; protecting the poor and vulnerable; ensuring sustainable business growth and job creation; and strengthening policies, institutions, and investments for rebuilding better. By September 30, 2020, the World Bank had committed nearly US$22 billion in new financing for the overall COVID-19 response, of which more than 50 percent has disbursed. In addition to new financing, the World Bank restructured funds in existing projects in at least 68 countries to focus on COVID-19 response, many of these using the contingent emergency response component (CERC). By September 30, 2020, the IFC had committed nearly US$6 billion in new financing, reflecting new investments in more than 300 companies as well as extending trade finance and working capital lines to clients. As of September 17, 2021, 87 MPA operations have been approved with a total commitment of US$4.2 billion, and the Bank has approved 56 operations to support vaccine procurement and rollout in 54 countries amounting to $4.6 billion.

8. **The Global COVID-19 MPA provides a critical and highly effective operational programmatic framework for the**
**World Bank’s emergency health response to COVID-19 with FTCF resources** . The Program development objective of
the Global MPA is “to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness.” At the time of the approval of the Global MPA, and in the absence of a safe and effective COVID-19 vaccine, immediate needs were focused on early detection, diagnosis, confirmation, and treatment of patients (including those afflicted with other chronic conditions that increase the risk of COVID-19 severity and mortality). The Global MPA provided a common operational framework to support individual countries’ specific needs in preventing the spread of the disease and limiting immediate socioeconomic losses, as well as strengthening public health and essential medical care structures and operations to build resilience and reduce the risk from emerging and re-emerging pathogens.

**C.** **Updated MPA Program Framework**

**Table 1. MPA Program Framework**

**Estimated**
**IDA**
**Amount**
**($ million)**

**Estimated**
**Other**
**Amount**
**($**
**million)**

**Estimated**
**Environme**
**ntal &**
**Social Risk**
**Rating**

**Sequential or**
**Phase #** **Project ID**
**Simultaneous**

2 P177038 Simultaneous

**Phase’s**
**Proposed DO***

To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness.

**IPF, DPF**
**or PforR**

September
**IPF** $98 million -- $2 million Substantial

24, 2021

**Estimated**
**IBRD**
**Amount**
**($ million)**

**Estimated**
**Approval**
**Date**

9. All projects under SPRP are assessed for Environmental and Social Framework (ESF) risk classification following the World Bank procedures and the flexibility provided for COVID-19 operations.

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Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038)

**D.** **Learning Agenda**

10. The country project under the MPA Program will support adaptive learning throughout implementation, as well as from international organizations including the WHO, International Monetary Fund (IMF), Centers for Disease Control (CDC), United Nations Children's Fund (UNICEF), and others. It will adjust to emerging technical, social, and economic evidence, as applicable, and incorporate lessons learned from the ongoing global vaccine rollout and COVID-19-related service delivery. In Iraq, this learning agenda involves a continuation of on-going work supported through the World Bank technical assistance (TA) under the I3RF and the ongoing COVID-19 response supported through interventions outside of the MPA, including:

- **Technical:** Vaccine deployment readiness assessments; rapid assessment of infection prevention and control
measures and patient flow; and application of digital tools for contact tracing.

- **Social behaviors** : Studies to assess vaccine hesitancy and A/B message testing to improve uptake of COVID19 vaccines.

**II.** **CONTEXT AND RELEVANCE**

**A.** **Country Context**

11. **Iraq is a large upper-middle income country with a gross national income (GNI) per capita of US$4,660 and a**
**population of 40.15 million in 2020.** Almost two decades after the Iraq war began, the country remains caught in a
fragility trap and faces increasing political instability and fragmentation, geopolitical risks, growing social unrest, and a deepening divide between the state and its citizens. Oil price volatility and COVID-19 have amplified Iraq’s economic woes, reversing two years of steady recovery. These twin shocks have deepened existing economic and social fragilities, adding further to public grievances that existed pre-COVID-19. The absence of fiscal space has limited the ability of the GOI to provide a stimulus to an economy highly dependent on oil exports for growth and fiscal revenues. As a result, the country experienced the largest contraction of its economy since 2003, with gross domestic product (GDP) contracting by 15 percent in 2020. Budget rigidities have constrained the GOI’s ability to respond to COVID-19 and offer a stimulus package to restart the economy.

12. **The economic downturn has worsened the welfare of Iraqis, especially informal workers and the self-employed.** Unemployment is more than 10 percentage points higher than the pre-pandemic level. Unemployment and underemployment are likely to rise, particularly among youth and internally displaced persons (IDPs). The loss of household income and social assistance has increased vulnerability to food insecurity. COVID-19 has also severely limited child learning as evidenced by the small proportion of students engaged in learning activities during school closure. These impacts coupled with reduced access to market and health care services undermined human capital accumulation and economic mobility.

13. **An additional 2.7 to 5.5 million Iraqis could become poor due to the COVID-19 crisis.** This is in addition to the 6.9 million Iraqis already living in poverty. A large vaccination campaign is a key element for future recovery from the health and economic impact of the COVID-19 pandemic.

**B.** **Sectoral and Institutional Context**

**14.** **While Iraq has made progress with some health outcomes, the significant negative impact of conflicts and**

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Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038)

**political instability is apparent in the poor performance of the health system** . Iraq’s life expectancy has increased by
2.3 years over the past decade, rising from 68.3 years in 2009 to 70.6 in 2019. There has been progress in child health and nutrition indicators; with under-5 mortality decreasing by more than 40 percent over the past two decades, falling from 44.9 deaths per 1,000 live births in 1999 to 25.9 deaths in 2019. Despite such progress, Iraq still has some of the worst health outcomes among its peers, mostly driven by the continued conflict. The under-5 mortality rate is 1.4 times higher than the average for upper-middle income countries of 18.5 deaths per 1,000 live births. While Iraq is undergoing a demographic transition, with an increase in the working age share of the population, it still has one of the highest total fertility rates in the MENA region at 3.7. Maternal mortality ratio has been persistently high over the past two decades (75 in 2009, 92 in 2014, and 79 in 2019, deaths per 10,000 live births respectively). There are also regional and socioeconomic inequities in terms of fertility, early childbirth, and family planning outcomes. Utilization of health services has decreased over the years, particularly at the primary care level, and inequities remain. For example, women in the poorest quintile are only 66 percent as likely to receive four or more antenatal care visits during their last pregnancy compared to those in the richest quintile. Child immunization rates in Iraq have not improved over the past decade and have remained significantly lower than those of peer countries. Due to conflict and instability, Iraq faces a significant challenge of delivering care to a large number of refugees and IDPs. In summary, Iraq performs poorly across most universal health coverage (UHC) index indicators, and the UHC effective coverage index stands at only 57.7. [2] Iraq’s Human Capital Index is one of the lowest in the MENA region at 0.41 in 2020. [3] 15. **Non-communicable diseases (NCDs) have become the most significant cause of mortality and morbidity**, representing 77.1 percent of deaths and 65.8 percent of disability-adjusted life years (DALYs) in 2019. In 2019, ischemic heart disease, stroke, diabetes, and chronic kidney disease were the top four causes of mortality in the country. The prevalence of the main NCD risks remains high: 21 percent of the population uses tobacco, 14 percent of the population has diabetes, 35.6 percent of the population has high blood pressure, 65 percent are overweight or obese, and 39.6 percent have elevated cholesterol.

16. **Health infrastructure was severely damaged by conflicts.** With the exception of Tal Afar, Al-Muqdadya (Ibid) and Al-Ramadi, all cities for which data were available have at least half of their facilities either partially or fully damaged.
Service delivery is also affected by the functionality of facilities. Data show high rates of nonfunctional health facilities in cities with high levels of damages. According to the Damage and Needs Assessment conducted by the World Bank in 2018, [4] the estimated damages to Iraq’s health system in the seven governorates directly affected by the prolonged conflict total US$2.3 billion. Out of this amount, damages to hospitals in the 16 assessed cities are approximately US$1 billion, while damages to health centers and health offices are around US$12.6 million.

17. **The Iraqi health system is primarily financed by general government revenues and direct payments by**
**households, and fiscal space has remained constrained.** Over the past decade, per capita health spending in Iraq has
fluctuated from a low of US$150.5 in 2010 to a high of US$239.4 in 2018. Despite recent increases, Iraq spends considerably less than peer countries per capita. Compared to its peers, Iraq also spends the lowest share of total 2 Collaborators, G. 2. (2020, October 17). Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1250-1284. Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30750-9/fulltext#%20 3 World Bank (2020).. Iraq Human Capital Index 2020 Brief. The World Bank Group: Washington, D.C.
https://databank.worldbank.org/data/download/hci/HCI_2pager_IRQ.pdf?cid=GGH_e_hcpexternal_en_ext 4 World Bank (2018). Iraq Reconstruction and Investment: Damage and Needs Assessment of Affected Governorates. World Bank, Washington, DC. https://openknowledge.worldbank.org/handle/10986/29438 Page 10 of 54

Iraq Human Capital Index
UHC effective coverage index
universal health coverage (UHC) index

index of effective coverage of health services


Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) government budget on health (about 4.3 percent in 2019), a figure that has not changed considerably over the past decade. This results in an overreliance on out-of-pocket (OOP) expenditures (representing 51.4 percent of current health spending in 2018) and limited financial protection for the population. In 2017, about a third of the population incurred catastrophic health expenditures (i.e., spending more than 10 percent of their household expenditure on health), and 15 percent of households were pushed into poverty due to OOP health spending. [5] 18. **Against this backdrop, Iraq is one of the most significantly impacted countries by COVID-19 in the MENA region.** Iraq remains susceptible to a high risk of morbidity and mortality due to COVID-19, not only through its direct effects but also through the indirect effects on the burden to be imposed on the health system. This risk is attributable to a high and growing burden of NCDs, a diverse range of vulnerable and at-risk populations due to poverty, inequality and displacement, as well as a weak health system with low and inequitable levels of financing, fragmented and inflexible service delivery, limited human and physical resources, and weak surveillance and health information systems.

19. **The GOI launched the national COVID-19 response in March 2020.** This included non-pharmaceutical interventions such as bans on gatherings, closure of businesses, and use of work shifts in public administration buildings.
The measures were successful in limiting the first wave of the pandemic, but their subsequent premature easing contributed to a large second wave of COVID-19 cases. As a result, movement restrictions and a curfew were reinstated from January 14 until March 7, 2021. The GOI reduced spending in non-essential areas and safeguarded budgetary allocations to the Ministry of Health and Environment (MOHE). The GOI also invested in expanding testing and case management capacity. From May 1, 2020 through March 31, 2021, the daily number of reverse transcription and polymerase chain reaction (RT-PCR) tests increased 13-fold (from 3,338 to 44,649 RT-PCR tests per day). Although the number of RT-PCR tests has increased, the number of tests performed per one new confirmed case has declined (below 10 tests per confirmed case).

20. **The World Bank has been providing both financial and technical support for the GOI’s COVID-19 response.** In April 2020, US$7.8 million in uncommitted funds under the Health Component of the ongoing Emergency Operation for Development Project (EODP) was mobilized to purchase essential medical equipment for the COVID-19 response, including 136 intensive care beds, 100 ventilators, 17 mobile x-ray machines, and 17 defibrillators. The project was restructured in May 2020 to reallocate US$25.825 million for the procurement of fixed and mobile computed tomography scanners for COVID-19 case management. The World Bank has also been providing TA for COVID-19 response to the MOHE under the I3RF. This includes support to the MOHE in the: (i) assessment of COVID-19 testing, contact tracing, surveillance, infection prevention and control and patient flow; (ii) development of the National Deployment and Vaccination Plan (NDVP) for COVID-19; (iii) design and implementation of a Facebook survey on COVID19 vaccine hesitancy - a first study of its kind in Iraq; and (iv) development of a COVID-19 Vaccination Communication Action Plan, incorporating the results from the survey. Per MOHE’s request, I3RF is also funding additional TA for a social media-based communication campaign to address vaccine hesitancy.

21. **The project will play a critical role in enabling affordable and equitable access to COVID-19 vaccines in Iraq.** Improved access to vaccination is needed to limit the spread of the disease and lessen the burden on the already weak health system. COVID-19 vaccination, along with improved diagnostics and therapeutics, is essential to protect lives and enable the country to reopen safely. The global economy will not recover fully until people feel they can live, socialize, 5 World Bank (2021). Addressing the Human Capital Crisis: A Public Expenditure Review for Human Development Sectors in Iraq. The World Bank: Washington, D.C. http://documents.worldbank.org/curated/en/568141622306648034/Iraq-HD-PER-Final Page 11 of 54

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**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) work, and travel with confidence. Given the importance of limiting the spread of COVID-19 for both health and economic recovery, providing access to COVID-19 vaccines will be critical to accelerate economic and social recovery. The project activities will build on the ongoing World Bank’s COVID-19 response and health sector support, as well as the support of other development partners (Box 1). Under I3RF, the World Bank has coordinated closely with the WHO and UNICEF on supporting the GOI’s COVID-19 vaccination efforts. WHO and UNICEF have provided technical support for vaccine introduction and deployment, including support for training of health workers for vaccination, communication activities, and monitoring and evaluation (e.g., establishing dashboards to track COVID-19 transmission and vaccination). UNICEF is also the procurement agent for COVID-19 vaccines through the COVAX Facility and has provided support for the procurement of some cold chain equipment. The World Bank’s financing will build on the activities conducted by other development partners, filling the critical gaps to ensure successful deployment of the vaccines. Most importantly, it will provide the needed financing to expand COVID-19 vaccination coverage.

**Box 1: Roles of Partner Agencies in COVID-19 Vaccination in Iraq**

**WHO** **Financing amount (if known)**

- Providing technical support for vaccine introduction and deployment, including
strategies, vaccine safety issues, development guidelines, conducting of training on Adverse Events Following Immunization (AEFI) surveillance for COVID-19 vaccine related issues and other issues of vaccine pharmacovigilance N/A

**UNICEF** **Financing amount (US$)**

- Supporting the development of a roadmap for integration of COVID-19 vaccine
deployment with Expanded Program on Immunization (EPI) and other primary health care (PHC) services; quantification and forecasting of supply needs; cold chain assessment, procurement and maintenance

- Acting as the procurement agent for the COVID 19 vaccine through the COVAX
facility and facilitating the procurement and delivery of vaccines

- Supporting the communication strategy and community engagement

- Supporting the establishment of a robust information system for data
management, monitoring and reporting, etc.

US$1,000,000 (for procurement and to fund various PHC services and supplies; cold chain; training of personnel etc.) US$150,000 (communications) US$100,000 (Management Information System (MIS)) 22. **The project is being introduced at a crucial juncture in the GOI’s response to COVID-19.** A critically important change in the state of science since the early stages of the pandemic has been the emergence of new therapies, as well as the successful development and expanding production of COVID-19 vaccines (see Annex 1). A key rationale for the project is to provide upfront financing for safe and effective vaccine acquisition and deployment in Iraq thus enabling the country to acquire the vaccine at the earliest, recognizing that there are currently supply constraints and excess demand for vaccines from both high-income and lower-income countries.

23. **The GOI, with the support of the World Bank, WHO, and UNICEF, has conducted the COVID-19 vaccine readiness**
**assessment using the integrated Vaccine Introduction Readiness Assessment Tool (VIRAT)/Vaccine Readiness**
**Assessment Framework (VRAF 2.0) instrument and prepared a comprehensive NDVP (dated February 2021 and**
**amended on August 8, 2021)** . Key findings of the VIRAT/VRAF 2.0 Assessment are summarized in Table 2.

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integrated Vaccine Introduction Readiness Assessment Tool


Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038)

**Table 2: Summary of Vaccination Readiness Findings of the VIRAT/VRAF 2.0 Assessment** **[6]**

**Readiness** **Readiness of government** **Key gaps to address during**
**domain** **deployment**

- Establishment of a
mechanism for subnational level coordination.

- The costing is expected to
be updated periodically to reflect subsequent developments in additional vaccine purchase(s) and deployment.

**Planning,**
**coordination,**
**and regulation**

**Costing,**
**budgeting, and**
**financial**
**sustainability**

- A National Coordinating Committee (NCC) and a
National Technical Working Group (NTWG) have been established. The NCC is chaired by the Deputy Minister of Health for Technical Affairs.

- The National Authority for Drug Selection issued
Emergency Use Authorization (EUA) for the Pfizer vaccine on December 27, 2020, for AstraZeneca and Sinopharm vaccines on January 19, 2021, and for Sputnik vaccine on March 8, 2021.

- The Council of Ministers issued a decree on
February 20, 2021 authorizing the MOHE to sign contracts with vaccine manufacturers waiving liability.

- The Parliament adopted the Law on the Response
to the COVID-19 Pandemic on March 8, 2021. The Law includes provisions for indemnity.

- High level costing of NDVP has been completed for
four different scenarios based on population coverage targets.

- The GOI is exploring other funding sources to secure
required doses to increase coverage (including World Bank support).

6 A multi-partner effort led by WHO and UNICEF developed the Vaccine Introduction Readiness Assessment Tool (VIRAT) to support countries in developing a roadmap to prepare for vaccine introduction and identify gaps to inform areas for potential support. Building upon the VIRAT, the World Bank developed the Vaccine Readiness Assessment Framework (VRAF) to help countries obtain granular information on gaps and associated costs and program financial resources for deployment of vaccines. To minimize burden and duplication, in November 2020, the VIRAT and VRAF tools were consolidated into one comprehensive framework, called VIRAT-VRAF 2.0.

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Vaccine Introduction Readiness Assessment Tool


Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038)

**Prioritization,**
**targeting, and**
**surveillance**

- Priority groups have been identified to ensure just,
efficient, and timely vaccination of all eligible populations willing to be immunized based on the following principles adapted for the Iraq situation: `o` The WHO Strategic Advisory Group of Experts on Immunization (SAGE) values framework; `o` The WHO SAGE prioritization roadmap; `o` The fair allocation mechanism for COVID-19 vaccines through the COVAX Facility.

- Displaced individuals residing in camps are included.

- The MOHE has developed a digital registry for
vaccination.

- Vaccine access was expanded to the entire adult
population due to the short shelf-life of some received vaccines and vaccine hesitancy.

**Service delivery** - Fifty vaccination sites in hospitals (often teaching
hospitals), which meet ultra-cold chain requirements, were initially identified for the Pfizer vaccine.

- As of September 9, 2021, there were 1,301
vaccination sites. With the revised guidance for safe storage temperatures for Pfizer vaccine (up to 30 days from +2 to +8 degrees C), the Pfizer vaccine is now delivered at most vaccination sites. The number of sites can be expanded.

- Plans for site readiness assessments are outlined.

- Prioritization of
beneficiaries will be a dynamic process based on multiple factors specific to context in Iraq (feasibility, expiration of available vaccine doses, groups at risk, and vaccine hesitancy among eligible groups).

- Microplanning for
vaccination rollout is underway.

- The GOI is considering the
use of large public venues (e.g., sports halls) as vaccination sites.

- The preliminary estimates
of vaccinators required may need to be updated.

- A well-defined plan to
mobilize human resources to ensure adequate numbers of health care workers at vaccination sites, including through task shifting, adoption of multiple shifts, volunteers, needs to be developed.

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**Training and**
**supervision**

- Descriptions, roles, and broad estimates of staff and
health workers for the campaign are outlined (including vaccination, supervision, communications and community engagement, supply chain, logistics, monitoring, pharmacovigilance, and disease surveillance).

- A training manual has been developed. The MOHE
has conducted training for managers in all health departments, cold chain officials, and health workers at the designated vaccination sites with support from the WHO and UNICEF.

- Mix of different staff and health workers that is
required by each site for deployment specified.


Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038)

- As part of the M&E
framework, an information system including a vaccine registry and dashboard will be enhanced to monitor vaccine coverage, facilitate follow-up, issue vaccine certificates, and ensure data privacy.

- The existing hotline for
receiving grievances and addressing queries of beneficiaries will be enhanced further for the vaccination campaign.

- Detailed distribution plans
are currently being developed.

- AEFI plan is currently being
finalized with preparations for training and implementation activities underway.

- Adoption of the
communication by the high-level government bodies is instrumental in ensuring its successful implementation.

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**Monitoring and**
**evaluation** **and**
**grievance**
**redressal**

**Vaccine, cold**
**chain, logistics,**
**infrastructure**

**Safety**
**surveillance**

**Demand**
**generation and**
**communication**

- Data collection systems and tools to collect COVID19 immunization data are outlined.

- A vaccination record card has been developed and
will include a hotline number for reporting adverse events.

- The GOI has secured and distributed the required
Ultra Low Temperature (ULT) freezers to the initial 50 designated sites for the Pfizer vaccine.

- The estimated needs for ancillary supplies and
Personal Protective Equipment (PPEs) are outlined and covered by KIMADIA. KIMADIA has contracted for 18 million syringes for the Pfizer vaccine (of which 6 million syringes have already been delivered).

- High level vaccine distribution and transportation
networks are outlined in the NDVP.

- Vaccine safety surveillance approach is aligned with
WHO recommendations to detect serious AEFIs to provide timely data that can be shared with relevant stakeholders for rapid action.

- A demand generation and community engagement
plan for optimizing the uptake of the COVID-19 vaccine has been developed in collaboration with the World Bank, UNICEF, and WHO and is included as an annex in the NDVP.

- The communication and demand generation plan
incorporates social and behavioral data from a national Facebook survey, which gathered data on vaccine hesitancy in the population, and is aimed at


Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) generating demand and improving acceptance of COVID-19 vaccines.

24. **The NDVP has all the key elements recommended by the World Health Organization and represents the**
**blueprint for Iraq’s vaccination efforts.** According to the NDVP, Iraq seeks to vaccinate 40 percent of the total
population by the end of 2021 and 70 percent coverage by the end of 2022. The NDVP identifies seven categories of prioritized population groups, regardless of their citizenship status. The WHO SAGE Allocation Framework was used for the prioritization process, with modifications based on Iraq’s context (i.e., significantly younger population and FCV status).

25. **The GOI signed a Committed Purchase Agreement with the COVAX Facility to procure 16 million doses of COVID-**
**19 vaccines for 8 million individuals (with a two-dose regimen), covering almost 20 percent of the total population.**
The total amount due to the COVAX Facility was paid in full by the MOHE. As of August 16, 2021, the MOHE received 1,085,000 doses of the AstraZeneca vaccine, with the next shipment expected by the end of September 2021. Amid the global shortage, Iraq has received the vaccines from the COVAX Facility with delays. The first shipment of the AstraZeneca vaccine also arrived with an impending expiration date, causing the government to expand vaccination eligibility to the entire adult population to ensure that the vaccines would not be wasted.

26. **The GOI also signed a Manufacturing and Supply Agreement with Pfizer on March 21, 2021 to purchase**
**1,500,525 doses for 750,000 individuals.** The agreement was subsequently amended to include additional doses and
modify the delivery schedule. In total, as of June 17, 2021, the GOI has contracted 12 million doses from Pfizer to be delivered by the end of 2021, of which 6 million doses are expected to be financed by the project under retroactive financing. [7] The Manufacturing and Supply Agreement was reviewed and cleared, retroactively, by the World Bank on June 21, 2021.

27. The GOI will finance vaccines for: (i) 20 percent of the population through the COVAX self-financing arm (Committed Purchase Agreement); and (ii) 10 percent through direct procurement. The World Bank financing will cover an additional 7 percent of the population with 6 million doses of the Pfizer-BioNTech vaccine. Table 3 describes the number of secured and received doses of COVID-19 vaccines by financing source.

7 The retroactive financing of up to US$72 million will be available for the eligible expenditures paid by the GOI during a period of 12 months before the signing of the Loan Agreement for COVID-19 vaccines meeting the World Bank’s VAC that have been purchased but have not been deployed prior to the disclosure of the Environmental and Social Management Framework.

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Input:
**The World Bank**
The Iraq COVID-19 Vaccination Project (P177038)

**Table 3: Overview of Iraq’s Vaccine Coverage and Purchase Plan**
_Based on the current available estimates as of September 20, 2021_

**Contract status** **Vaccines already arrived in the**

**Source of**
**financing**

**Population**

**Targeted** **VAC Status of** **country**

**%** **Number** **Source** **Name(s)** **the Vaccine** **Name**

**Targeted**

**Vaccines** **[a]** **Number of doses World Bank’s**

**VAC Status of**

**Name** **Doses**

**Source** **Name(s)**

**the Vaccine**

GOI 20.0% 8 million Other 0.1% 0.05 million GOI 2.4% 1 million Other 0.8% 0.325 million GOI 7.0% 3 million Direct procurement Direct procurement COVAX AstraZeneca 16 million Eligible Signed AstraZeneca 1,085,000 Donation AstraZeneca 0.1 million Eligible Received in full AstraZeneca 100,800 Direct procurement Sinopharm 2.0 million Eligible Received in full Sinopharm 2,000,000 Donation Sinopharm 0.75 million Eligible Received in full Sinopharm 750,000 GOI 7.0% 3 Direct Pfizer 6 million Eligible Signed Pfizer million procurement 5,625,360 IBRD 7.0% 3 Direct Pfizer 6 million Eligible Signed Pfizer 0 million procurement Pfizer 6 million Eligible Signed Pfizer 0 Other 0.6% 0.25 million

**National**
**Total**

**37.9%** **15.625**
**million**

Donation Pfizer 0.5 million Eligible Received in full Pfizer 503,100

**31.35 million** **10,064,260**

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Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038)

**C.** **Relevance to Higher Level Objectives**

28. **The project is aligned with WBG’s strategic priorities, particularly the WBG’s twin goals to end extreme**
**poverty and boost shared prosperity in a sustainable manner.** The project is focused on pandemic preparedness
which is also critical to achieving Universal Health Coverage. It is also aligned with the World Bank’s support for national plans and global commitments to strengthen pandemic preparedness through three key actions under preparedness: (i) improving national preparedness plans including organizational structure of the government; (ii) promoting adherence to the International Health Regulations (IHR); and (iii) utilizing international framework for monitoring and evaluation of IHR. The economic rationale for investing in the MPA interventions is strong, given that success can reduce the economic burden suffered both by individuals and countries. The project contributes to the implementation of the WBG MENA Strategy by providing support to building human capital and strengthening resilience. The project complements both WBG and development partner investments in health systems strengthening, disease control and surveillance, attention to changing individual and institutional behavior, and citizen engagement. The project contributes to the implementation of IHR (2005), Integrated Disease Surveillance and Response (IDSR), and the Office International des Epizooties (OIE) international standards, the Global Health Security Agenda, the Paris Climate Agreement, the attainment of Universal Health Coverage and of the Sustainable Development Goals (SDGs), and the promotion of a One Health approach.

29. **The WBG remains committed to providing a fast and flexible response to the COVID-19 epidemic,**
**utilizing all WBG operational and policy instruments and working in close partnership with government and other**
**agencies.** Grounded in One-Health, which provides for an integrated approach across sectors and disciplines, the
proposed WBG response to COVID-19 will include emergency financing, policy advice, and technical assistance, building on existing instruments to support IDA/IBRD-eligible countries in addressing the health sector and broader development impacts of COVID-19. The WBG COVID-19 response will be anchored in the WHO’s COVID-19 global SPRP outlining the public health measures for all countries to prepare for and respond to COVID-19 and sustain their efforts to prevent future outbreaks of emerging infectious diseases.

30. **The project is consistent with the Iraq Country Partnership Framework (CPF) for FY22-26, discussed on August**
**3, 2021 (Report #153633-IQ) and contributes directly to CPF Objective 2.1. (Effective and Efficient Deployment of**
**COVID-19 Vaccines and Health Systems Strengthening).** Similarly, the Strategic Country Diagnostic dated February 8,
2017 (Report #112333-IQ) identified “Rebuilding the Social Contract and State Legitimacy” as a priority through, _inter_ _alia_, improving the delivery of public services to fortify trust and legitimacy between citizens and the state. The need to invest in health systems to ensure the productive capabilities of the population is recognized, as is the challenge of overcoming a legacy of limited investment in human capital and social resilience systems. The project will be an important step towards building the strength of the health system and its resilience to shocks. The project is also aligned with both global health priorities and World Bank priorities in pandemic preparedness. In addition, the project complements activities being implemented through other existing World Bank-financed projects in the country.

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Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038)

**III.** **PROJECT DESCRIPTION**

**A.** **Development Objectives**

31. The project development objective (PDO) is to support the GOI in the acquisition and deployment of COVID-19 vaccines.

32. _**PDO level indicators**_ :

**i.** Percentage of specific priority [8] populations fully vaccinated (total and disaggregated by sex).
**ii.** Number of project-supported COVID-19 vaccinations sites with adequate healthcare waste management

for vaccination.
**iii.** Number of COVID-19 vaccine doses acquired through project financing.

33. _**Intermediate results indicators**_ :
**i.** Percentage of administered COVID-19 vaccine doses captured in the national vaccination digital registry;
**ii.** Percentage of vaccination sites which publicized detailed performance data on a regular basis in the last

quarter;
**iii.** Percentage of vaccination sites with functional cold chain;
**iv.** Percentage of reported serious AEFI cases for which investigations were initiated within 48 hours;
**v.** Number of health workers who received training in vaccination with gender-based violence (GBV) related

content;
**vi.** Percentage of feedback cases registered in the project's grievance redress mechanism (GRM) in the last

quarter addressed within a timeframe specified by the project;
**vii.** Number of communication initiatives supported by the project to address vaccine hesitancy;
**viii.** Percentage of vaccination sites visited by the project third-party monitoring agency (TPMA) in the last

quarter;
**ix.** Number of public discussion meetings conducted on the results of the TPMA.

**B.** **Project Components**

**34.** The project comprises two components.

35. **Component 1: COVID-19 Vaccines and Deployment (US$97 million IBRD)** . The component will support the purchase of COVID-19 vaccines and related deployment activities.

36. _**Sub-component 1.1: COVID-19 Vaccine Support**_ **(US$72 million IBRD).** This sub-component will support COVID19 vaccine acquisition. Specifically, this will include the purchase of approximately 6 million doses of the COVID-19 vaccines that meet the World Bank’s VAC. This is expected to cover 3 million individuals or approximately 7 percent of the population in Iraq. The vaccines financed under the project will be prioritized for groups most at risk as defined in the NDVP. This will be supported by awareness raising campaigns targeting the priority groups and encouraging 8 As listed in Table 4, priority groups include health care workers, elderly, social care workers, people with chronic disease and displaced populations.

Page 19 of 54


Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) 41. **The WHO SAGE Allocation Framework was used to determine the priority groups for COVID-19 vaccination of**
**populations in the early phases, and the prioritization was modified based on Iraq’s context (i.e., significantly**
**younger population and fragility, conflict, and violence).** Table 4 presents the priority groups outlined in the NDVP.
Targeting criteria and implementation plans are described below. Efforts are being made by the government to ensure equitable access to vaccines for people with disabilities and other vulnerable groups. Vaccinations take place at fixed health points and through mobile units. Displaced individuals and refugees living in camps are explicitly prioritized for vaccination under phase 2. According to the NDVP, they will be vaccinated by vaccination teams within the nearest health district or the nearest health center after providing proof that they are displaced or have refugee status. The central committees in the health district can also use fixed or mobile MOHE medical clinics located within the camps, or health institutions or the sites of supporting organizations and non-governmental organizations (NGOs) located inside the camps provided that all the logistical requirements for vaccination are available according to the type of vaccine. Vaccination for this population group will be conducted under direct supervision of the health district or the health directorate and in coordination with camp directors.

**Table 4. Priority Groups for Vaccination in Iraq**

**Population** **Percentage** **of**
**Phase** **Category/population group** **Risk category**
**number** **population**

**Phase 1 A**

**Phase 1 B**

**Phase 2**

**Phase 3**

**Phase 4**

Health workers [1] 100,000 High risk 0.2% Elderly 450,000 ≥70 years old 1.1% People with chronic disease 750,000 >2 chronic diseases 1.7% Cancer and immune-deficiency 30,000 0.07% patients Health workers 300,000 Moderate risk 0.7% Elderly 1,350,000 ≥60 and < 70 years old 3.2% People with chronic disease 1,250,000 2 chronic diseases 3.0% Patients with hereditary blood 20,000 0.03% diseases Health workers 100,000 Low risk 0.2% Elderly 2,700,000 ≥50 and < 60 years old 6.5% People with chronic disease 2,000,000 1 chronic disease 4.8% Security personnel [2] at high risk of 100,000 High risk 0.2% exposure to cases Displaced populations/refugees 500,000 Moderate risk 1.2% living in camps Social care staff and residents, 200,000 0.5% prisons staff and prisoners Security personnel at moderate risk 900,000 Moderate risk 2.2% of exposure to cases People working in professions at risk 300,000 ≥40 and <50 years old 0.7% of exposure Security personnel at low risk of 500,000 Low risk 1.2% exposure People working in professions at low 1,000,000 < 40 years old 2.4% risk of exposure [3] 12,550,000 **TOTAL** **30%** Page 21 of 54


Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) 1 MOHE will categorize its staff into these three categories and that high risk will come in phase 1A, moderate in phase 1B, and low in phase 2.
2 Security personnel are classified into three categories: i) high risk are those in direct contact with people (e.g., security of governmental facilities, at check points, traffic police); ii) intermediate risk (e.g., in barracks, working in groups); and iii) low risk, including administrative staff.
3 Including employees of border points and train stations, educational staff, butchers, barbers, restaurants and bakeries workers, prisoners and State bodies staff).
Note: Total population in 2021 is estimated at 41,190,700 (Iraq Central Statistics Agency).

42. **The government initially faced low uptake of COVID-19 vaccines.** In addition, the first shipment of the AstraZeneca vaccine through COVAX arrived with a short shelf life. To overcome vaccine hesitancy and avoid wastage of vaccines, the GOI expanded the vaccination eligibility to the entire adult population, while continuing to prioritize health workers and those above the age of 60 years. Having started this policy, the GOI is not able to reverse it, and, as such, the vaccination is currently open to all individuals ages 18 or older residing in Iraq. While eligibility is open to all individuals in Iraq 18 years or older, the MOHE continues to prioritize groups pre-defined in the NDVP, including through the use of mobile vaccination sites.

43. **The MOHE developed a digital registry for COVID-19 vaccination**, which includes four components: (i) preregistration; (ii) appointment scheduling; (iii) vaccination; and (iv) tracking AEFI. Online preregistration is encouraged for vaccination. All residents of Iraq are eligible to pre-register. [9] To ensure universal access, staff at vaccination centers will also be able to register on behalf of the recipient, and individuals can also register directly at the vaccination sites.

**Box 2: Liability and Indemnification Issues in Vaccine Acquisition**

The rapid development of vaccines increases manufacturers’ potential liability for AEFI. Manufacturers want to protect themselves from this risk by including immunity from suit and liability clauses, indemnification provisions, and other limitation of liability clauses in their supply contracts. Contractual provisions and domestic legal frameworks can all operate to allocate that risk among market participants, but no mechanism will eliminate this risk entirely. Iraq has signed indemnity agreements that were satisfactory to providers (e.g., Pfizer) and has introduced corresponding legislation. On February 20, 2021 the Council of Ministers issued a decree authorizing the MOHE to sign contracts with vaccine manufacturers waiving liability. The Parliament subsequently adopted the Law on the Response to the COVID-19 Pandemic (Law No. 9) on March 8, 2021. The Law includes provisions to provide statutory immunity for manufacturers and calls for an establishment of a national no fault compensation scheme. The GOI, however, has not taken any actions yet to establish the no fault compensation scheme system. Possible World Bank support to Iraq, depending on needs, may include information sharing on lessons from other countries in implementing a national no fault compensation scheme and Hand-on Expanded Implementation Support. The project operation documents (for example, POM) will clarify that the country’s regulatory authority is responsible for its own assessment of the project COVID-19 vaccines’ safety and efficacy and is solely responsible for the authorization and deployment of vaccines in the country.

9 https://cov19reg.phd.iq/ Page 22 of 54

digital registry for COVID-19 vaccination


Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) successful vaccination will be avoiding further human health costs from death and sickness. Global deployment of a COVID-19 vaccine will also generate economic benefits by enabling economic recovery and an increase in productive activity. Ensuring vaccine purchase and delivery in developing economies will also achieve significant distributive benefits and contribute to poverty reduction.

55. **The successful development, production, and delivery of a vaccine has the best potential to reverse these**
**trends, generating benefits that will far exceed vaccine-related costs.** Indeed, a rapid and well-targeted deployment
of a COVID-19 vaccine would help reduce the increases in poverty and accelerate economic recovery. Even at levels of imperfect effectiveness, a COVID-19 vaccine that is introduced and deployed effectively to priority populations would assist in significantly reducing mortality and the spread of the coronavirus and accelerating a safe reopening of key sectors that are impacted. It would also reverse human capital losses by ensuring schools are reopened. The effective administration of a COVID-19 vaccine will also help avoid the associated health care costs for potentially millions of additional cases of infection and associated health-related impoverishment. Global experience with immunization against diseases shows that by avoiding these and other health costs, vaccines are one of the best buys in public health. For the most vulnerable population groups, especially in countries without effective universal health coverage, the potential health-related costs of millions of additional cases of COVID-19 infection in the absence of a vaccine represent a significant or even catastrophic financial impact and risk of impoverishment. The pandemic is also having dire effects on other non-COVID health outcomes. Increased morbidity and mortality due to interruption of essential services associated with COVID-19 containment measures hinder access to care for other health needs of the population, including maternal and childcare services, routine immunization services have been affected, threatening polio eradication and potentially leading to new outbreaks of preventable diseases, with associated deaths, illnesses, and long-term costs. Simultaneous epidemics are overwhelming public health systems in different countries that had few resources to begin with, and services needed to address the needs of people with chronic health conditions, and mental and substance use disorders have also been disrupted.

56. **While the uncertainty around the costs and effectiveness of a COVID-19 vaccine makes it difficult to calculate**
**its cost-effectiveness, the effective launch of a COVID-19 vaccine will have direct benefits in terms of averted costs**
**of treatment and disability, as well as strengthened health systems.** Estimated COVID-19 treatment costs from lowand middle-income countries is at US$50 for a non-severe case and US$300 for a severe case. This excludes costs of
testing of negative cases, as well as the medical costs associated with delayed or forgone care-seeking, which usually results in higher costs. Even if the vaccine averts 2 million non-severe cases and no other benefits are considered, the investment will break even. Further, investments in vaccine delivery systems generate health and economic benefits beyond just delivering the COVID-19 vaccine. First, investments in last-mile delivery systems to administer the COVID19 vaccine to remote communities will require strengthening community health systems, which would have spillover effects to effective delivery of other services, helping close the significant urban-rural gap. Second, as the COVID-19 vaccine is introduced and lockdowns and movement restrictions are eased, patients would continue to access care for other conditions. Third, the economic benefits of slowing down the economic downturn are likely to significantly exceed the US$100 million needed to vaccinate 7 percent of the population, leaving aside the immediate health benefits. Given both the economic and health system benefits, an effectively deployed COVID-19 vaccine presents significant benefits.

**B.** **Financial Management**

57. The World Bank undertook an assessment of the financial management (FM) system within the MOHE, during the preparation of the ongoing Iraq EODP (P155732). The FM assessment was updated for the purpose of the project Page 26 of 54


Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) procurement for required emergency goods and services. Key measures to fast track procurement include among others: (i) direct contracting of United Nations (UN) Agencies to supply goods and services as specified in Section VI (Para 6.47 and 6.48) and Section VII (Para 7.27 and 7.28) of the applicable Procurement Regulations, respectively; (ii) limited bidding where justified; (iii) Request for Quotations (RFQ) as appropriate; (iv) streamlined competitive procedures with shorter bidding time; and (v) use of framework agreements including existing ones procured in a satisfactory manner to the Bank.

**65.** **Assessment of MOHE‘s procurement capacity.** The assessment of the procurement system within the MOHE
was carried out during the preparation of the ongoing Iraq EODP (P155732) and recorded in the Procurement Risk Assessment and Management System (PRAM). It was noted that MOHE through the PMU has limited experience in World Bank Procurement Regulations and limited experience in procurement planning, monitoring, and contract management. In addition, procurement of COVID-19 vaccines is subject to high level of uncertainties in terms of prices and quantities. The major issue facing Iraq public procurement is the current uncertainty of public procurement law and regulations and their enforcement, including outdated practices. Additionally, Iraq’s ability to manage public resources is undermined by poor security. Iraq ranks among the lowest in the region on Transparency International’s Corruption Perception Index. This is further compounded by limited human capital for procurement and contract management, as commonly evidenced by delays in decision making. In addition, there is a general lack of emphasis on procurement, including principles in areas such as transparency, conflict of interest, independent complaint mechanism, value for money, fit for purpose, among others. Based on the above, **the residual procurement risk for**
**this project is High.**

66. **Hands-on Expanded Implementation Support (HEIS)** . At the Borrower’s request, the Bank may provide Hands on Expanded Implementation Support (HEIS) to support and build the capacity of staff directly involved in the project in drafting procurement documents and agreements with UN agencies/NGOs to speed up implementation. However, the MOHE will remain fully responsible for signing and entering into contracts and implementation, including assuring relevant logistics with suppliers (e.g., arranging the necessary freight/shipment of the goods to their destination, receiving and inspecting goods).

67. **Project Procurement Strategy for Development (PPSD)** defines how the identified procurement arrangements will enable delivery of value-for-money in achieving the PDO by supporting a fit-for-purpose reconstruction and enhancement of services, where bidding will be done with no substantial delays and no rebidding, and cost and time overruns will be prevented. The preparation of the PPSD is deferred to the project implementation phase.

68. **Systematic Tracking of Exchanges in Procurement (STEP).** The PMU at MOHE will use the World Bank online procurement planning and tracking tool to prepare, clear and update its procurement plans and conduct procurement transactions as referred to in the Procurement Regulations Section V, article 5.9. Any contract not uploaded in STEP, with award notification not being uploaded prior to signing of contracts, will not be eligible for financing **.** The World Bank will organize training on STEP before project effectiveness to register the PMU users and familiarize them with the STEP system. An initial procurement plan for the first six months has been agreed on with the MOHE and will be updated during implementation using STEP.

69. **Complaint mechanism** . The complaint handling mechanism specified in the World Bank’s Procurement Regulations and included in the World Bank’s Standard Procurement Documents (SPDs) will be followed when Bank SPDs are used irrespective of the situation within the country. For the national procedures, Regulation No. 2 of 2014 of “Executing Public Contracting” in Iraq, establishes the right of bidder to raise a complaint to a centralized committee Page 28 of 54

Procurement Risk Assessment and Management System

Transparency International’s Corruption Perception Index

World Bank online procurement planning and tracking tool


Input:
**The World Bank**
Iraq COVID-19 Vaccination Project (P177038) 77. **Rapid Environmental and Social Assessment.** A baseline assessment is currently being undertaken by the Bank to measure the environmental and social impacts of the vaccination program at the national and local levels to: (i) assess the environmental and social (E&S) systems, guidelines and institutional capacity put in place by GOI for COVID-19 vaccine procurement and deployment against the requirements of the E&S Standards, World Bank Group (WBG) EHS General Guidelines, WBG EHS Health Guidelines for Health Care Facilities and relevant WHO guidelines; and (ii) assess the E&S aspects of ongoing vaccine deployment activities implemented by the GOI. The findings of the assessment will be used to further enhance the project’s environmental and social risk management. The project’s environmental and social instruments will be updated following completion of the assessment, as appropriate.

**F.** **Climate Co-Benefits**

**78.** **The effects of climate change are large and exacerbate the already significant environmental, security, political**
**and economic challenges in Iraq.** It is thus critical to increase Iraq’s resilience capacity for current and future crises.
Over 40 percent of the country is desert and is sparsely populated due to harsh weather conditions. In many parts of the country, good quality water is sparse due to salinity. Desertification and water scarcity due to river flow fluctuations render Iraq vulnerable to the adverse effects of climate change. Forecasts suggest that the average annual temperature will increase by 2 degrees Celsius by 2050, with a higher frequency of heat waves. Among others, this will negatively impact agricultural productivity, increase water scarcity, and intensify epidemics. Increase in temperatures is also known to be a direct cause of death, especially among the elderly who may suffer from strokes or heart attacks in extreme heat environments and who are also highly vulnerable to COVID-19.

**79.** **The project has been screened for climate change and disaster risks and is highly exposed to extreme**
**temperature and drought** . The most at-risk groups from climate-related exposures coincide with those vulnerable to
COVID-19. These include women, who form a large proportion of frontline workers in Iraq including health workers, caregivers, and teachers; the elderly; individuals who are ill, including with chronic diseases; the poor, displaced and marginalized who mostly reside in crowded locations with poor access to water and sanitation. However, the risk to project activities and outcomes is categorized as moderate due to several adaptation measures. Relevant mitigation measures have also been integrated in project design and will reduce the impact of the project’s activities on the environment and reduce greenhouse gases (GHG) emissions. Dust storms which are common in Iraq and correlate with dry/arid climatic conditions contribute to vulnerability of population to climate change and to COVID-19 vulnerability.
The project will help improve survival rates in patients who are vulnerable to climate change and dust storms.
Therefore, vaccination could be viewed as a climate change adaptation measure.

**80.** **The project intends to address climate change, address vulnerabilities, enhance climate resilience and**
**adaptation, and mitigate GHG emissions through several activities** . The nationwide vaccination efforts supported by
this project considerably reduce the need for energy-intensive treatment in hospital critical care units, that would have otherwise been required, thus preventing adverse climate change consequences. Deployment of COVID-19 vaccines is key to climate resilience for several reasons. Firstly, the population group to first receive the vaccines are those vital to supporting the health care system (medical professions and support staff) and ensuring the continuity of essential public services, including to populations affected by climate change. Secondly, the project ensures that those most at risk from both the virus as well as from the health impacts of climate change are effectively targeted for COVID-19 vaccination. The GOI aims to cover almost two thirds of its population to achieve herd immunity thereby reducing the health risks of these climate vulnerable groups. Further, the communications strategy will inform the general population on the GOI vaccine deployment strategy during extraordinary events including natural disasters. This will Page 31 of 54