According to bank documents, the project objective is to support the Government of Madagascar to acquire and deploy COVID-19 vaccines, and to strengthen its immunization services.

The proposed additional financing (AF) of a US$41 million equivalent International Development Association (IDA) grant will support the costs of expanding activities of the Madagascar Support to COVID-19 Vaccine Purchase and Health System Strengthening (P176841) with a primary objective to enable affordable and equitable access to COVID19 vaccines and help ensure effective vaccine deployment in Madagascar through vaccination system strengthening, and to further strengthen preparedness and response activities under the parent project. The increase in scale will be reflected in an increase in the overall project financing from US$100 million to US$141 million with the amount of the AF being distributed under the two components included in the parent project.

Component 1: Acquisition of Vaccines and Medical Supplies [originally US$71 million; with proposed AF, US$80 million]. The implementation of the activities under the parent project will continue without any changes. The project will continue to finance: (i) acquisition of vaccines for priority groups defined in NVDP; and (ii) acquisition of vaccination supplies needed for activities outlined in the Vaccine Delivery and Distribution Manual, including diluents, syringes, and medical supplies associated with the vaccination response.

Changes: Under this component, the parent project will be able to procure more doses with the allocated budget than initially planned under the parent project as the country opted for single dose Johnson and Johnson/Janssen vaccine which costs less. That will represent 8 million vaccines to cover 27% of the population. The AF will finance: (i) acquisition of COVID-19 vaccine doses to cover an additional 3 percent of the population, thusthe total of 9 million doses purchased by the project will contribute to the government’s plan to reach 50.5 percent COVID-19 vaccination coverage by June 2023; and (ii) acquisition of vaccination supplies needed to vaccinate the additional proportion of the population such as diluents, syringes, and all medical supplies associated with vaccination. The country is considering vaccine purchase via COVAX, as the Janssen vaccine is now available through the cost-sharing mechanism. The cost-sharing framework agreement was signed on November 26, 2021. World Bank procurement arrangements for vaccines through COVAX are still being finalized.

Component 2: Strengthening Health System for the Effective Deployment of Vaccines [originally US$29 million; with proposed AF, US$61 million]. The implementation of the activities under the parent project will continue without any changes. The project will continue to finance: (i) strengthening of vaccine logistics system, cold chain and vaccination sites (storage and transportation); (ii) strengthening surveillance and information systems including vaccine safety and AEFI monitoring; (iii) strengthening planning and coordination capacity including training of health workers/vaccinators
and waste management; (iv) communication campaign to address vaccine hesitancy; and (v) operating costs.

Changes: Under this component, the AF will finance activities to scale up: (i) deployment of health professionals to deliver the additional doses procured through this AF; (ii) purchase of additional equipment for vaccines distribution (cold chain equipment, vehicles and motorbikes) and data reporting (tablets and computers); (iii) additional technical assistance for the deployment of vaccines, including for communication and demand creation based on a geographic mapping of pockets of hesitancy and for the utilization of drones for vaccines transportation in remote areas (this
will be contracted with private operators specialized in drones utilization); and (iv) incentives for community health workers and mobilizers (incentives to be received by community health workers would be linked to the number of people referred to vaccination sites. An independent organization will be contracted for payments which will be based on properly validated statements).

World Bank:
Maud Juquois
Senior Economist, Health

Borrower:
Government of Madagascar

Implementing Agency:
Ministry of Public Health
Zely Arivelo Randriamanantany
Minister of Public Health
zrandriamanantany@yahoo.fr 

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