Report and Recommendation of the President to the Board of Directors

Project Number: 54282-001 July 2020

Proposed Loan and Administration of Loan Republic of Uzbekistan: COVID-19 Emergency Response Project Distribution of this document is restricted until it has been approved by the Board of Directors. Following such approval, ADB will disclose the document to the public in accordance with ADB’s Access to Information Policy.

CURRENCY EQUIVALENTS (as of 22 July 2020)

Currency unit – sum (SUM)

SUM1.00 = $0.000098 $1.00 = SUM10,204.06

ABBREVIATIONS

ADB – Asian Development Bank AIIB – Asian Infrastructure Investment Bank ASEW – Agency for Sanitary and Epidemiological Wellbeing CARES – COVID-19 Active Response and Expenditure Support Program COVID-19 – coronavirus disease ICT – information and communication technology MOH – Ministry of Health PAM – project administration manual PCR – polymerase chain reaction PIU – project implementation unit PPE – personal protective equipment WHO – World Health Organization

NOTE

In this report, “$” refers to United States dollars.

Vice-President Shixin Chen, Operations 1 Director General Werner Liepach, Central and West Asia Department (CWRD) Directors Rie Hiraoka, Social Sector Division (CWSS), CWRD

Cindy Malvicini, Uzbekistan Resident Mission (URM), CWRD

Team leaders

Team members

Hiddo A. Huitzing, Health Specialist, CWSS, CWRD Raushanbek Mamatkulov, Senior Portfolio Management Specialist,

URM, CWRD Yorkinjon Alimov, Procurement Officer, URM, CWRD Farida Djumabaeva, Associate Project Analyst, URM, CWRD Shaista Hussain; Senior Results Management Specialist; Portfolio,

Results, Safeguards and Gender Unit (CWOD-PSG); CWRD Feruza Insavalieva, Associate Safeguards Officer, URM, CWRD Jenevieve Javier, Associate Project Analyst, CWSS, CWRD Mekhri Khudayberdiyeva, Senior Social Development Officer

(Gender), URM, CWRD Ursula Lagan, Counsel, Office of the General Counsel Olivier Leonard; Senior Procurement Specialist; Procurement

Division 1 (PFP1); Procurement, Portfolio and Financial Management Department (PPFD)

Akmal Nartayev, Senior Financial Management Specialist, Public Financial Management Division, PPFD

Jose Tiburcio Nicolas, Senior Social Development Specialist (Safeguards), CWOD-PSG, CWRD

Kirthi Ramesh, Social Sector Specialist, CWSS, CWRD Thomas Robinson, Procurement Specialist, PFP1, PPFD Mary Alice Rosero, Social Development Specialist (Gender and

Development), CWOD-PSG, CWRD One ADB Teama

Syed Asim Ali Sabzwari, Environment Specialist, CWOD-PSG, CWRD

Raushania Sibagatulina, Financial Management Officer, URM, CWRD

Laureen Felisienne Tapnio, Operations Assistant, CWSS, CWRD Donneth Walton, Lead Project Management Specialist, CWOD,

CWRD Zehra Abbas, Principal Environment Specialist, Safeguards Division

(SDSS), Sustainable Development and Climate Change Department (SDCC)

Linda Adams, Senior Evaluation Specialist, Thematic and Country Division, Independent Evaluation Department

Cigdem Akin; Senior Public Management Economist; Public Management, Financial Sector, and Trade Division; CWRD

Eduardo Banzon, Principal Health Specialist, Health Sector Group, SDCC

Charlotte Benson, Principal Disaster Risk Management Specialist, Climate Change and Disaster Risk Management Division, SDCC

Haidy Ear-Dupuy, Senior Social Development Specialist (Core Labor Standards), SDSS, SDCC

Carlo Antonio Garcia, Senior Integrity Officer, Prevention and Compliance Division, Office of Anticorruption and Integrity

Januar Laude, Senior Financial Control Specialist, Loan and Grant Disbursement Section, Controller’s Department

Oksana Nazmieva, Principal Financial Management Specialist, CWOD-PSG, CWRD

Irina Novikova, Senior Social Development Specialist (Safeguards), SDSS, SDCC

Susann Roth, Principal Knowledge Sharing and Services Specialist, Knowledge Advisory Services Center, SDCC

Malika Shagazatova, Social Development Specialist (Gender and Development), Gender Equity Thematic Group, SDCC

Agnes Surry; Senior Planning and Policy Specialist; Operations Planning and Coordination Division; Strategy, Policy and Partnerships Department

Takashi Yamano, Senior Economist, Economic Analysis and Operational Support Division, Economic Research and Regional Cooperation Department

a Interdepartmental advisory team.

In preparing any country program or strategy, financing any project, or by making any designation of or reference to a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.

CONTENTS

Page

PROJECT AT A GLANCE

I. THE PROPOSAL 1

II. THE PROJECT 1

A. Rationale 1 B. Project Description 5 C. Value Added by ADB 6 D. Summary Cost Estimates and Financing Plan 6 E. Implementation Arrangements 7

III. DUE DILIGENCE 9

A. Technical 9 B. Economic and Financial Viability 9 C. Sustainability 9 D. Governance 10 E. Poverty, Social, and Gender 10 F. Safeguards 11 G. Summary of Risk Assessment and Risk Management Plan 11

IV. ASSURANCES 12

V. RECOMMENDATION 12

APPENDIXES

1. Design and Monitoring Framework 13

2. List of Linked Documents 16

Project Classification Information Status: Complete

PROJECT AT A GLANCE

Source: Asian Development BankThis document must only be generated in eOps. 23062020111340238853 Generated Date: 22-Jul-2020 11:43:09 AM

1. Basic Data Project Number: 54282-001Project Name COVID-19 Emergency Response Project Department/Division CWRD/CWSSCountry Uzbekistan Executing Agency Ministry of HealthBorrower Ministry of Finance

Country Economic Indicators

https://www.adb.org/Documents/LinkedDocs/?id=54282-001-CEI

Portfolio at a Glance https://www.adb.org/Documents/LinkedDocs/?id=54282-001-PortAtaGlance

2. Sector Subsector(s) ADB Financing ($ million)Health Disease control of communicable disease 50.00

Health sector development and reform 50.00

Total 100.00

3. Operational Priorities Climate Change InformationAddressing remaining poverty and reducing inequalities

Accelerating progress in gender equality

Strengthening governance and institutional capacity

Fostering regional cooperation and integration

GHG reductions (tons per annum) 0Climate Change impact on the Project

Low

ADB Financing

Adaptation ($ million) 0.00

Mitigation ($ million) 0.00

Cofinancing

Adaptation ($ million) 0.00

Mitigation ($ million) 0.00

Sustainable Development Goals Gender Equity and MainstreamingSDG 1.5SDG 3.3, 3.8, 3.dSDG 5.1SDG 10.4SDG 16.8

Effective gender mainstreaming (EGM)

Poverty TargetingGeneral Intervention on Poverty

4. Risk Categorization: Low.

5. Safeguard Categorization Environment: B Involuntary Resettlement: C Indigenous Peoples: C

.

6. Financing

Modality and Sources Amount ($ million)

ADB 100.00

Sovereign Project (Concessional Loan): Ordinary capital resources 100.00

Cofinancing 100.00

Asian Infrastructure Investment Bank - Project loan (Partial ADB Administration)

100.00

Counterpart 57.00

Government 57.00

Total 257.00

Currency of ADB Financing: US Dollar

I. THE PROPOSAL 1. I submit for your approval the following report and recommendation on a proposed loan to the Republic of Uzbekistan for the COVID-19 Emergency Response Project. The report also describes the proposed partial administration of a loan to be provided by the Asian Infrastructure Investment Bank (AIIB) for the COVID-19 Emergency Response Project, and if the Board approves the proposed loan, I, acting under the authority delegated to me by the Board, approve the administration of the AIIB loan. 2. The proposed project is part of an integral package of support to help the immediate and transition efforts of the Government of Uzbekistan to mitigate the significant health, social, and economic impacts of the coronavirus disease (COVID-19) pandemic. The project will help the government to augment resilience to future public health emergencies, including a resurgence of COVID-19, by improving testing, diagnosis, and management of COVID-19 cases.

II. THE PROJECT A. Rationale 3. COVID-19 pandemic. On 30 January 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern. On 11 March 2020, WHO declared the coronavirus outbreak a pandemic.1 By 7 July 2020, nearly 11.5 million people had been diagnosed with COVID-19, with more than 535,000 deaths, globally.2 On 15 March 2020, the government announced the first confirmed COVID-19 case. Only 10,587 COVID-19 cases and 39 deaths had been confirmed by 7 July 2020 because of strict lockdown measures.3 However, the number of confirmed cases is rising because of the relaxation of lockdown measures and the repatriation of thousands of Uzbek migrant workers, so Uzbekistan needs to reinforce its resilience to COVID-19 and other public health emergencies. 4. Socioeconomic impact. Uzbekistan, with a population of 34.1 million and estimated gross domestic product per capita of $1,742 (2019), is centrally located in Central Asia.4 It is particularly vulnerable to the COVID-19 pandemic and related lockdown, as a regional trade and commerce hub, with a large volume of international travelers and a large migrant population working abroad, especially in the Russian Federation and Kazakhstan. Uzbekistan will suffer a significant macroeconomic impact,5 as gross domestic product growth is expected to decline to 1.5% in 2020 from a pre-COVID-19 estimate of 6.0% (footnote 4). Uzbekistan is vulnerable to external shocks, given its heavy reliance on remittances.

5. The pandemic has resulted in widespread job losses, particularly for migrant laborers and workers in industry and services. Of the small businesses, 85% are estimated to have closed temporarily. According to a World Bank study, in the absence of remittances, the poverty rate based on the poverty line for lower middle-income countries ($3.2 per person per day) in

1 WHO. Coronavirus Disease (COVID-19) Pandemic (accessed 6 April 2020). 2 WHO. COVID-19 Dashboard (accessed 7 July 2020). 3 Government of Uzbekistan, Ministry of Health COVID-19 information site (accessed 7 July 2020). 4 State Statistics Committee (accessed 8 June 2020); and International Monetary Fund. 2020. Republic of Uzbekistan:

Requests for Disbursement under the Rapid Credit Facility and Purchase under the Rapid Financing Instrument—Press Release; Staff Report; and Statement by the Executive Director for the Republic of Uzbekistan. IMF Country Report No. 20/171. Washington, DC.

5 Asian Development Bank (ADB). COVID-19 and Poverty: Some Scenarios Based on Grouped Distribution Data on Household Consumption. Unpublished.

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Uzbekistan would have increased from 9.6% to 16.8% in 2018.6 Estimates indicate that the poverty rate based on the same poverty line for lower middle-income countries, would increase from a projection of 7.4% before the crisis, to 8.7%, following the outbreak—equivalent to an additional 448,000 people falling into poverty in 2020.7 Household income, employment, and food security are all expected to decline further unless the pandemic is contained, and the lockdown measures can be further eased. 6. Government response. The government established the Special Republican Commission on 29 January 2020 to (i) monitor the epidemic and raise public awareness, (ii) communicate with international organizations and countries experiencing outbreaks, and (iii) expand health care facilities and procure the necessary antiviral medicines and equipment. 8 The government released the National Health Strategic Preparedness and Response Plan on 19 March 2020.9 The plan aims to (i) address the COVID-19 emergency by identifying, isolating, and providing care for patients with COVID-19 to minimize the disease spread, morbidity, and mortality; (ii) strengthen the short- and long-run capacity of the health system to provide intensive care; (iii) implement effective public awareness campaigns on how to tackle the COVID-19 emergency; (iv) expand unemployment benefits to formal sector workers; (v) provide wage subsidies for companies for furloughed workers; and (vi) expand cash transfers to vulnerable households and individuals. The government established the SUM10.00 trillion Anti-crisis Fund and has undertaken health, economic stabilization, and social protection measures.10 Lockdown measures, including the closing of schools and businesses and a curfew in the most affected locations, came into effect on 16 March 2020. The government requested emergency assistance from the Asian Development Bank (ADB) to upgrade and expand the national laboratory and surveillance system on 26 April 2020. ADB’s Disaster and Emergency Assistance Policy paper (2004) (Emergency Policy) requires that an emergency assistance loan be processed in an expeditious manner (within 12 weeks). Counting from the time the government officially requested ADB to provide the emergency assistance on 26 April 2020, the processing of the proposed emergency assistance loan exceeds the 12-week period, as stipulated in the Emergency Policy, by eleven days. The reason for the short delay was due to the government and ADB exploring different options for support and defining the scope for the proposed project. 7. Damage and needs assessment. The rigorous lockdown measures, including the quarantine of all suspected cases and contacts, helped reduce the 5-day moving average of daily new confirmed COVID-19 cases from more than 100 in mid-April to less than 50 by the end of April 2020. With the gradual lifting of travel restrictions,11 it increased to 300 by the first week of July 2020.12 WHO estimates that the weekly number of confirmed cases could plateau at more than 8,000 by January 2021.13 Health workers, more than 80.0% of whom are women, are disproportionately affected (11.0% of total cases) while representing only 1.3% of the population.

6 W. Seitz. 2019. International Migration and Household Well-Being. Evidence from Uzbekistan. Policy Research

Working Paper. No. 8910. Washington, DC: World Bank. 7 World Bank. 2020. Supplementary Development Policy Financing: Sustaining Market Reforms in Uzbekistan.

Washington, DC. 8 The term “republican” is used to designate the national level (as opposed to the regional or district level). 9 WHO. 2020. National Health Strategic Preparedness and Response Plan. 6 April. Tashkent. Unpublished. 10 Presidential Decrees No. 5969 and No. 5978. 11 Xinhua. 2020. Uzbekistan Extends Lockdown over COVID-19, Lifts Restrictions. 15 May. 12 WHO. 2020. Uzbekistan COVID-19 Situation Report. 6 July. Tashkent. Unpublished. 13 WHO. WHO COVID-19 Essential Supplies Forecasting Tool v2.0. Unpublished.

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8. Testing, contact tracing, risk stratification, surveillance and monitoring, and treatment of COVID-19 patients are crucial in containing the spread of the disease.14 The Agency for Sanitary and Epidemiological Wellbeing (ASEW) is responsible for infectious disease control, and operates a surveillance and response system, laboratories, and infectious disease hospitals. Most of the COVID-19 polymerase chain reaction (PCR) testing is conducted at ASEW laboratories and regional AIDS centers. The turnaround time for testing results is 1 day. ASEW’s laboratory capacity needs to be expanded to be prepared for the COVID-19 surge and other public health emergencies. About 12,000 PCR tests can be performed daily by ASEW laboratories. Inadequate supplies of test kits, reagents, and personal protective equipment (PPE) limit the full use of testing capacity. Laboratory staff receive COVID-19 virtual training through the Tashkent Institute of Postgraduate Medical Education. More training is needed on topics such as (i) laboratory biosafety, (ii) use of equipment, and (iii) use of information and communication technology (ICT) systems. Primary health care workers need further training in identifying potentially infected and high-risk individuals to improve contact tracing for screening, testing, isolation, and referral for the treatment of cases. 9. An additional 30,800 beds are available for quarantine in Tashkent city and Tashkent region. Fourteen regional hospitals and three republican (i.e., national) hospitals in Tashkent have been designated for treating COVID-19 cases. While more than 1,800 medical ventilators have been procured, this might not be sufficient in case of a surge of COVID-19 patients. The hospitals also lack medical equipment to diagnose and treat comorbidities (simultaneous ailments) often seen in COVID-19 patients. These facilities need upgrading to provide safer working conditions and better personal protection to protect health workers. Targeted training on infection prevention and control and COVID-19 management is also needed. 10. The preoccupation with COVID-19 and the diversion of resources such as staff time, facilities, equipment, and supplies, have affected the availability and quality of health services. It has also affected demand for health services because of the lockdown, increased anxiety among the population, and reduced household spending.15 Delays in the vaccination of children may give rise to outbreaks of other communicable diseases. Disruption to the treatment of chronic conditions such as HIV, AIDS, and tuberculosis may exacerbate drug resistance. Women’s access to safe delivery and other maternal and child health services may be jeopardized. Maintaining COVID-19 response and essential health services in parallel is needed.

11. Emergency assistance coordination. A COVID-19 management team was established on 12 March 2020 to plan and coordinate multilateral support for COVID-19 socioeconomic response and recovery.16 The proposed response totals $289 million, including an ADB–AIIB contribution of $200 million and a $38 million health component of the World Bank’s $95 million loan that focuses on the immediate needs of COVID-19 treatment and testing. ADB also mobilized $19.5 million from the Primary Health Care Improvement Project.17 Other support is in kind, including technical assistance, training, equipment, and supplies.18 ADB also provided grants of about $1.6 million under regional technical assistance for the procurement of medical supplies

14 Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health-related data

essential to the planning, implementation, and evaluation of public health practice. Centers for Diseases Control and Prevention. Frequently Asked Questions COVID-19 Data and Surveillance.

15 Global Financing Facility. 2020. Preserve Essential Health Services During the COVID-19 Pandemic: Uzbekistan. 16 United Nations Development Programme. 2020. Consolidated Multilateral COVID-19 Socio-economic Response and

Recovery Offer. Tashkent. Unpublished. 17 ADB. Uzbekistan: Primary Health Care Improvement Project. 18 Including assistance from the European Union, France, Germany, Japan, the People’s Republic of China, the

Republic of Korea, the Russian Federation, Turkey, the United States, the International Committee of the Red Cross and Red Crescent, the Islamic Development Bank, UNICEF, WHO, and local companies and funds.

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such as oxygen respirators.19 Budget support was provided through (i) $375 million from the International Monetary Fund, (ii) two Development Policy Operations totaling $700 million from the World Bank, and (iii) ADB’s $500 million COVID-19 Active Response and Expenditure Support Program (CARES) approved in June 2020.20 A more detailed overview is in the emergency assistance coordination document.21 12. Lessons learned. The COVID-19 pandemic is exceptional in size and nature, with evolving epidemiological and treatment scenarios. The government and development partners are learning from international experience and regular communication and coordination. A holistic government and societal response, together with risk-based community interventions, is essential. Health systems, protocols, and services must be adjusted to meet quality and safety standards. Global supply of medical equipment and supplies constraints require the use of flexible procurement and implementation arrangements. Implementation capacity must be accelerated to respond effectively to the pandemic. ADB’s experience in supporting countries during the severe acute respiratory syndrome (SARS) outbreak shows the importance of partnering with technical agencies such as WHO; and the value of early response, planning, and building up health system resilience. 13. Proposed ADB assistance. The proposed project is part of a comprehensive ADB package that includes budget support through the CARES Program (footnote 20). It will be cofinanced by AIIB to increase Uzbekistan’s resilience to the COVID-19 pandemic and future public health emergencies. The project will support the testing, surveillance, and case management of COVID-19 in Uzbekistan by equipping and refurbishing the national laboratory system, establishing an ICT-based national surveillance and monitoring system, and improving and expanding the COVID-19 treatment capacity. Activities will be coordinated with, and complementary to, assistance from the World Bank and other partners, and fill the remaining gaps in medical equipment and supplies. 14. The proposed project is aligned with four operational priorities of Strategy 2030: (i) addressing poverty and reducing inequalities through improved health access, (ii) accelerating gender equality through occupational safety and training targets for women, (iii) strengthening governance and institutional capacity, and (iv) fostering regional cooperation through reducing risks of cross-border disease transmission.22 Consistent with the country partnership strategy 2019–2023, the project will address rural-urban disparities in the quality of health care provision, increase the health sector’s efficiency, and contribute to the development of an e-health system.23 The project aligns with Uzbekistan’s national development strategy 2017–2021,24 and the government’s strategy for developing the health care system, 2019–2025.25

19 ADB. 2020. Technical Assistance for Regional Support to Address the Outbreak of Coronavirus Disease 2019 and

Potential Outbreaks of Other Communicable Diseases. Manila. 20 ADB. 2020. Report and Recommendation of the President to the Board of Directors: Proposed Countercyclical

Support Facility Loan to the Republic of Uzbekistan for the COVID-19 Active Response and Expenditure Support Program. Manila.

21 Emergency Assistance Coordination (accessible from the list of linked documents in Appendix 2). 22 ADB. 2018. Strategy 2030: Achieving a Prosperous, Inclusive, Resilient, and Sustainable Asia and the Pacific.

Manila. 23 ADB. 2019. Country Partnership Strategy: Uzbekistan, 2019–2023 —Supporting Economic Transformation. Manila. 24 Presidential Decree No. 4947. 25 Presidential Decree No. 5590.

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B. Project Description 15. Impact and outcome. The project is aligned with the following impacts: (i) efficiency, quality, and accessibility of health care increased (footnote 24), and (ii) human-to-human transmission of COVID-19 contained (footnote 25). The project will have the following outcome: resilience to outbreaks of COVID-19 and other public health emergencies reinforced.26 The project will have three outputs. 16. Output 1: National laboratory system strengthened. The project will help increase diagnostic capacity to detect COVID-19 and future epidemics by supporting 38 out of 671 laboratories, to increase testing capacity for COVID-19 and related diseases.27 The output will support the assessment of laboratories, minor refurbishment to ensure safe working conditions and female and male staff convenience such as separate sanitation facilities and changing rooms, as well as procurement of laboratory equipment, PPE, test kits, reagents, and other supplies to increase testing capacity, and a laboratory networking and information system. At least 30 of the selected laboratories will meet safety standards to Biosafety Level 2 according to WHO guidelines.28 Health workers and facility staff who are at high risk of infection will have priority access to diagnostic services. International best practices using autoclave sterilizing and shredding of medical waste will be pioneered in Uzbekistan. 17. Output 2: National surveillance and response system established for COVID-19. The project will help improve the surveillance capacity to identify potentially infected people and improve contact tracing, including screening, testing, isolation, and referral for the treatment of cases, nationwide. The output will assist ASEW to (i) develop and disseminate online protocols and training of primary health care workers and institutional caretakers to identify potential COVID-19 cases and contacts, provide appropriate advice, and use a real-time digital reporting system to report these potential cases and contacts to ASEW; (ii) develop and test this digital real-time monitoring system; and (iii) strengthen screening, and collection and transportation of respiratory samples to a laboratory. The project will support consulting services for designing a real-time monitoring system and associated training, vehicles for surveillance, and other supplies to increase the surveillance capacity of ASEW nationwide. 18. Output 3: COVID-19 treatment capacity expanded. This output aims at providing improved clinical care of COVID-19 patients without disruption to essential services. The project will finance the refurbishment, including sex-segregated facilities for staff and patients, of 16 treatment centers, which consist of 14 regional hospitals for infectious diseases and two national level hospitals, i.e. the Scientific Research Institute of Virology and the Scientific Research Institute of Epidemiology, Microbiology and Infectious Diseases that are the designated COVID-19 treatment centers. The project will support these hospitals to function as specialized COVID-19 treatment centers by providing: (i) medical supplies and equipment, including for the expansion of intensive care units; (ii) training of staff in infection prevention control, safety, and quality of care for COVID-19 patients; and, through technical agencies, clinical and services guidelines; and (iii) ambulances, as required.

26 The design and monitoring framework is in Appendix 1. 27 The 38 laboratories consist of one republican and 14 regional laboratories of ASEW; one republican and

14 laboratories of the AIDS Centers; one republican and three regional laboratories of the Center for the Prevention of Plague, Quarantine and Especially Dangerous Infections; and the Scientific Research Institute of Virology, the Scientific Research Institute of Epidemiology, Microbiology and Infectious Diseases, the Institute of Sanitary and Professional Diseases, and the Institute of Medical Parasitology named L.M. Isaeva.

28 WHO. 2004. Laboratory Biosafety Manual.

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19. Emergency assistance eligibility. The proposed emergency assistance loan meets the eligibility criteria for ADB’s emergency assistance financing as it (i) helps refurbish high-priority physical assets, such as hospitals and medical facilities, and restore economic, social, and governance activities; (ii) is designed to mitigate immediate losses to priority assets, capacity, or productivity (such as health care workers); (iii) provides immediate short-term transitional assistance; (iv) is restricted to the transition phase and is exclusively for priority rehabilitation; and (v) complements efforts by other development partners to ease the transition from relief to development. C. Value Added by ADB 20. ADB is active in Uzbekistan’s health sector through the Primary Health Care Improvement Project (footnote 17). It also provided $500 million in budget support for the CARES Program to (i) strengthen the health system capacity to combat the spread of COVID-19; (ii) support businesses, employment, and job-creating regional public works; and (iii) expand social safety nets. For the health sector, the CARES Program will help the government procure ventilators, testing kits, and PPE. While the CARES Program provides for immediate medical needs, the proposed project will support the remaining urgent needs and help Uzbekistan prepare for a potential resurgence of COVID-19 and future public health emergencies. The existing project implementation unit (PIU) of the Primary Health Care Improvement Project (footnote 17), which is also engaged in COVID-19 related procurement, will help ensure efficient implementation of the project. With macroeconomic support through the CARES Program, an ongoing project, and technical assistance, ADB is providing complementary support to Uzbekistan’s health sector. ADB’s close relationship with the government and key ministries, local presence, and good understanding of local procurement practices have made ADB a trusted partner, allowing development partners such as AIIB to crowd in and trust ADB’s processes. D. Summary Cost Estimates and Financing Plan 21. The project is estimated to cost $257,000,000 (Table 1). Detailed cost estimates by expenditure category and by financier are included in the project administration manual (PAM).29

Table 1: Summary Cost Estimates ($ million)

Item Amounta A. Base Costb 1. Output 1: National laboratory system strengthened 152.5 2. Output 2: National surveillance and response system established for COVID-19 28.6 3. Output 3: COVID-19 treatment capacity expanded 59.6 Subtotal (A) 240.7 B. Contingenciesc 13.9 C. Financial Charges During Implementationd 2.4 Total (A+B+C) 257.0 a Includes taxes and duties of $57 million. Such amount does not represent an excessive share of the project cost.

The government will finance the taxes and duties by cash contributions. b In May 2020 prices. The project management costs are included in outputs. c Physical and price contingencies, and a provision for exchange rate fluctuation, are included. d Includes interest during implementation period, but no commitment or other charges on any sources of financing, in

the case of an Asian Development Bank loan; and interest, commitment charges, and front-end fee in the case of an Asian Infrastructure Investment Bank loan.

Sources: Asian Development Bank, Asian Infrastructure Investment Bank, and Government of Uzbekistan.

29 Project Administration Manual (accessible from the list of linked documents in Appendix 2).

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22. The government has requested a concessional loan of $100 million from ADB’s ordinary capital resources to help finance the project. The loan will have an interest rate of 1.0% per year; a term of 40 years, including a grace period of 10 years; repayment of principal at 2% per year for the first 10 years after the grace period and 4% per year thereafter; and such other terms and conditions set forth in the draft loan agreement. 23. The government has also requested a loan not exceeding $100 million from AIIB to help finance the project. The AIIB loan offers a 6-month London interbank offered rate plus a variable spread (up to 1.00%), a commitment fee of 0.25% per year, a front-end fee of 0.25%, a nominal tenor of up to 35 years, and average maturity of up to 20 years.30 The ADB and AIIB loans will jointly finance the expenditures in relation to goods, civil works, and consulting and non-consulting services, at a 50:50 ratio. The government’s counterpart funding will include financing of taxes and duties, for an estimated $57 million, and other in-kind contributions such as project management support. ADB will partially administer the AIIB loan for environment and social services, financial management services, procurement services, investigative services and disbursement services in accordance with ADB policies and procedures. The summary financing plan is in Table 2.

Table 2: Summary Financing Plan

Source Amounta ($ million)

Share of Total (%)

Asian Development Bank Ordinary capital resources (concessional loan) 100.0 38.9

Asian Infrastructure Investment Bank (loan)b 100.0 38.9 Government 57.0 22.2

Total 257.0 100.0 a Physical and price contingencies, and a provision for exchange rate fluctuation, are included. b Joint cofinancing, partially administered by the Asian Development Bank. The Asian Infrastructure Investment Bank

financing is exclusive of ADB administration fees. Sources: Asian Development Bank, Asian Infrastructure Investment Bank, and Government of Uzbekistan.

E. Implementation Arrangements 24. The project will be implemented over 24 months from August 2020 to July 2022. The loan is expected to be financially closed by 31 January 2023. The implementation arrangements are summarized in Table 3 and described in detail in the PAM. The Ministry of Health (MOH) will be the executing agency and ASEW will be the implementing agency. The MOH will appoint a senior staff as project director to be responsible for overall project implementation. The PIU will be expanded with additional staff and will be responsible for the day-to-day management of project implementation. Individual consultants and consulting firms will be recruited, as needed, to support the monitoring and evaluation, procurement, bioengineering, laboratory services, civil works monitoring, procurement, and other implementation activities. Consulting firms will include the following expertise: (i) building design and construction supervision, and (ii) ICT software design. 25. Among financiers, ADB will (i) partially administer the AIIB financing portion, (ii) lead the supervision and monitoring of the project, and (iii) provide the services identified in the corresponding co-lenders’ agreement to be signed between ADB and AIIB, following ADB’s

30 The Government of Uzbekistan will confirm the loan conditions, including the loan maturity, amortization schedule,

and the choice between a fixed lending spread and variable lending spread during loan negotiations in July 2020.

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applicable policies and procedures. AIIB will approve withdrawal applications reviewed by ADB and may join in review missions. 26. Procurement. The response to the COVID-19 pandemic requires quick procurement actions in a disrupted market characterized by production and supply shortages, price fluctuations, logistics constraints, and a limited number of potential bidders. These impact directly on the timely availability and quality of goods and call for more flexible procurement arrangements while maintaining the necessary due diligence. The procurement of goods, works, and consulting and non-consulting services financed by ADB and AIIB will follow the ADB Procurement Policy (2017, as amended from time to time) and Procurement Regulations for ADB Borrowers (2017, as amended from time to time), as well as the additional exemptions endorsed following ADB’s Comprehensive Response to the COVID-19 Pandemic, which among others, allow for universal procurement.31 Limited tendering or direct contracting with United Nations agencies or government framework contracts will be used when deemed appropriate. Details on procurement arrangements are in the PAM.

Table 3: Implementation Arrangements Aspects Arrangements Implementation period August 2020–July 2022 Estimated completion date 31 July 2022 Estimated loan closing date 31 January 2023

Management (i) Oversight body The Steering Committee (to be formed by September 2020) will be chaired by the

Minister of Health. It will comprise the Project Director; representatives from the Ministry of Health, Ministry of Investments and Foreign Trade, and Ministry of Finance; and the Director of Uzinfocom.

(ii) Executing agency Ministry of Health (iii) Key implementing

agency Agency for Sanitary and Epidemiological Wellbeing

(iv) Implementation unit PIU of Primary Health Care Improvement Projecta Procurementb

OCB, Works (internationally advertised)

Multiple contracts $53.20 million

OCB, Goods (internationally advertised)

multiple contracts $48.40 million

RFQ multiple contracts $0.50 million DC multiple contracts $67.00 million LCB 2 contracts $3.00 million

Consulting services ICS (international and national)

21 person-months, international 120 person-months, national

$0.40 million

QCBS TBD person-months $2.00 million DC TBD person-months $0.40 million LCS Lump sum $0.05 million Non-consulting services, RFQ Lump sum $6.50 million

Retroactive financing and advance contracting

Retroactive financing is allowed for up to 30% of the loan amount for expenditures incurred not earlier than 19 March 2020.c Advance contracting will be used to prepare the tender process and direct negotiations to be contract ready for approval by the Boards of Directors of both ADB and AIIB. All advance contracting will follow ADB Procurement Policy (2017, as amended from time to time), ADB Procurement Regulations for ADB Borrowers (2017, as amended from time to time), as well as additional exemptions endorsed following ADB’s Comprehensive Response to the COVID-19 Pandemic. The issuance of invitations to bids and consulting services recruitment notices under advance contracting will be subject to ADB’s prior approval. The government and executing agency have been advised that approval of advanced contracting and retroactive financing does not commit ADB to finance the project.

31 ADB. 2020. ADB’s Comprehensive Response to the COVID-19 Pandemic. Manila.

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Aspects Arrangements Disbursement The loan proceeds will be disbursed following ADB’s Loan Disbursement Handbook

(2017, as amended from time to time), except the commitment procedure, which is not allowed under this project for AIIB funds, and other detailed arrangements agreed between the government, ADB, and AIIB. The project will use advance account and statement of expenditure procedures. The client portal will be used for disbursements.

ADB = Asian Development Bank, AIIB = Asian Infrastructure Investment Bank, DC = direct contracting, ICS = individual consultant selection, ICT = information and communication technology, OCB = open competitive bidding, PCR = polymerase chain reaction, PIU = project implementation unit, QCBS = quality- and cost-based selection, RFQ = request for quotation. a ADB. Uzbekistan: Primary Health Care Improvement Project. b The final distribution of costs will be determined during implementation. The total project loan amount will not exceed

$200 million. c The government issued the National Health Strategic Preparedness and Response Plan on 19 March 2020. Source: Asian Development Bank.

III. DUE DILIGENCE

A. Technical 27. Project activities are considered technically viable, based on the needs assessment conducted by ADB, ASEW, the MOH, and WHO. The project has a low climate risk category, as project sites will be in urban and/or semi-urban areas with limited to no direct risks from climatic conditions. The equipment and infrastructure financed by the project will be standardized with equipment provided by other development partners to ensure compatibility and minimize training requirements. ICT systems solutions will be assessed for compatibility, easy integration and interoperability with other ICT platforms, and legal ICT application requirements within the country. B. Economic and Financial Viability 28. The project outputs are expected to prevent loss of human capital and address short- and medium-term gaps in the health system. Because of the short processing time available for the emergency response, due diligence following ADB guidelines on economic and financial analysis will be conducted during project implementation within 3 months of project effectiveness.32 The financial viability assessment will be limited to the post-COVID-19 period since project outputs are public service goods with no cost recovery, as the testing and treatment of COVID-19 are sponsored by the government. The project administration budget will include resources to undertake the necessary project economic and financial analysis, in compliance with ADB requirements. ASEW will coordinate data collection to ensure that ADB and AIIB are provided with the necessary information to undertake the project economic and financial analysis, in compliance with ADB and AIIB requirements. C. Sustainability 29. Strong government ownership will ensure that the developed surveillance and response system of ASEW and other project components will be sustained. The government budget will fund the operation and maintenance costs of the project assets after the project period. While the contracts for the procurement of equipment under the project will ensure supplier-provided preventive and correct maintenance in the short term, the government’s commitment to ensure

32 ADB. 2000. Handbook for the Economic Analysis of Health Sector Projects. Manila; and ADB. 2017. Guidelines for

the Economic Analysis of Projects. Manila.

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adequate budget allocations for operation and maintenance during and after the project will be covenanted in the financing agreement and monitored during project implementation. D. Governance 30. In 2019, ADB completed a governance risk assessment according to the implementation guidelines of ADB’s Second Governance and Anticorruption Action Plan.33 Uzbekistan needs to improve its performance in governance—e.g., effectiveness, rule of law, and accountability. Its public financial management is deemed reliable in budget credibility, debt management, and treasury functions, but has weaknesses in transparency, public participation, off-budget funding, internal audit, and external audit. The new public financial management reforms aim to improve the tax administration, introduce a medium-term budget framework, establish international public sector accounting and audit standards, and strengthen external audit.34 31. The assessed pre-mitigation financial management risk is substantial mainly because of (i) the emergency nature of the project; (ii) the need for hiring and training new PIU financial management staff on ADB project guidelines for the financial management and loan disbursement process; (iii) the required migration of project financial reporting from Microsoft Excel spreadsheet to the 1C accounting information system; and (iv) the potential risk of loan funds being used for other purposes. Key risk mitigating strategies are set out in the financial management assessment’s action plan and are due by project effectiveness. ADB’s Anticorruption Policy (1998, as amended to date) was explained to and discussed with MOH and ASEW. The specific requirements and supplementary measures are described in the PAM. 32. ADB’s project procurement risk assessment concluded that the procurement risk is moderate mainly because of the scale of procurement to be carried out under difficult conditions, while it recognizes the executing agency and the PIU are familiar with ADB procurement procedures. Accordingly, capacity of the current PIU for the Primary Health Care Improvement Project will be enhanced with additional consultants. The government is also planning to strengthen procurement rules to enhance transparency, including subjecting all procurement of emergency supplies to an ex-post audit by the Audit Chamber with results published on the Ministry of Investments and Foreign Trade website. E. Poverty, Social, and Gender 33. In 2018, 11.4% of the population lived below the national poverty line (footnote 23). About 1.3% of the population is estimated to have already slipped below the poverty line for lower middle-income countries ($3.2 per person per day in purchasing power parity terms) following the outbreak (footnote 7). However, this underestimates a larger impact, especially on households dependent on remittances from migrant workers. The COVID-19 pandemic will have a much higher impact on the poor and near-poor as a result of lower access to information and services, the lockdown resulting in the loss of jobs during and after the pandemic, and the increasing cost of food and medical and other services. Therefore, by containing COVID-19 and other public health emergencies, the project is expected to reduce the poor’s hardship, while benefiting all citizens of Uzbekistan.

33 ADB. 2006. Second Governance and Anticorruption Action Plan (GACAP II). Manila. 34 ADB. 2019. Country Partnership Strategy: Uzbekistan, 2019–2023—Supporting Economic Transformation. Manila;

World Bank. 2019. Uzbekistan Public Expenditure Review. Washington, DC; and World Bank and European Union Delegation to Uzbekistan. 2019. 2018 Public Expenditure and Financial Accountability (PEFA) Performance Assessment Report. Tashkent.

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34. The proposed project’s gender categorization is effective gender mainstreaming. In Uzbekistan, about 80% of health workers are female, and more than 80% of the infected health workers were women as of 26 May 2020. The government has developed standardized testing protocols that would increase access to testing for female health workers, and prioritize testing based on risk level. It has also approved a resolution that outlines additional remuneration for health workers involved in COVID-19 treatment and control. The following gender designs and targets have been agreed with the MOH: (i) all frontline staff in 16 project hospitals will be trained in infection prevention control and, where applicable, patient management to treat COVID-19 cases and other infectious respiratory diseases; (ii) access to testing for health workers and pregnant women will be prioritized; (iii) a COVID-19 monitoring system will be established and operational with sex- and age-disaggregated data; (iv) sex-segregated facilities will be provided for health workers and separate female and male wards for patients; (v) well-fitting PPE and sanitary supplies will be provided; and (vi) sex-disaggregated data on rates of infection among medical and support staff will be regularly collected, monitored, and reported.

F. Safeguards 35. In compliance with ADB’s Safeguard Policy Statement (2009), the project’s safeguard categories are as follows.35 36. Environment (category B). Small-scale refurbishment works will be carried out to prepare health facilities for ensuring staff and patient safety and installing medical equipment. The infectious medical waste produced during the operation of laboratories and treatment centers will require proper management and disposal. An environmental assessment and review framework has been prepared and disclosed on the ADB website. An initial environmental examination study will be undertaken during implementation before the start of any rehabilitation works. 37. Involuntary resettlement (category C). The project will not result in any new land acquisition, as civil works are limited to the minor refurbishment and repair of 54 laboratories and other medical facilities. This will be reconfirmed following the detailed design. An involuntary resettlement screening checklist has been included in the environmental assessment and review framework to screen subprojects for any involuntary resettlement related impacts before the award of civil works contracts. 38. Indigenous peoples (category C). No communities or groups within the project area may be considered indigenous peoples, as defined under ADB’s Safeguard Policy Statement (2009). Hence, no indigenous peoples communities are expected to be affected by the project. G. Summary of Risk Assessment and Risk Management Plan 39. Significant risks and mitigating measures are summarized in Table 4 and described in detail in the risk assessment and risk management plan.36

Table 4: Summary of Risks and Mitigating Measures Risks Mitigation Measures

The government counterpart financing will need to be provided in cash to pre-finance taxes and duties. Timely availability of counterpart contribution for pre-financing might be a challenge.

The PIU will estimate the tax and duty requirements upon contract award on a quarterly basis and submit them to the MOF for cash allocation projection. It will also closely monitor the tax and duty reimbursements.

35 ADB. Safeguard Categories. 36 Risk Assessment and Risk Management Plan (accessible from the list of linked documents in Appendix 2).

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Risks Mitigation Measures

Potential delay in recruiting contractor will delay project civil works and commissioning of the laboratory and medical equipment.

ASEW will recruit additional PIU staff, including the civil engineer and contract management specialist. Advance actions include (i) a rapid assessment of the project sites, and (ii) preparation of contracts with the MOH institute charged with monitoring and with firms for architectural design and technical specifications of infrastructural works and biomedical and nonmedical equipment.

Lack of the allocated financial resources for adequate O&M in the post-warranty period may lead to premature deterioration of equipment and deterioration of the laboratory test and medical treatment quality.

The MOF and MOH will assure, through a loan covenant, that sufficient financial and human resources will be allocated in the budgets to ensure adequate O&M quality. The MOH and ASEW will sign a 2-year (or longer) preventive and corrective maintenance contracts with the suppliers or their designated equipment maintenance companies to ensure regular high-quality O&M. Supplier contracts will include user training.

Failure to ensure adequate project financial reporting and audit may entail the misuse of loan funds and failure to achieve the project outcome. Government accountability for emergency fund expenditures is less robust, with a risk of mismanagement.

The PIU will recruit a well-qualified and experienced financial management specialist. The PIU will install and regularly update “Accounting 1C.” The MOH will recruit a well-qualified audit firm to audit the project financial reports. ADB will ensure that two annual financial audits and two special audits at the midterm review and post-project completion are carried out.

ADB = Asian Development Bank, ASEW = Agency for Sanitary and Epidemiological Wellbeing, MOF = Ministry of Finance, MOH = Ministry of Health, O&M = operations and maintenance, PIU = project implementation unit. Source: Asian Development Bank.

IV. ASSURANCES

40. The government has assured ADB that implementation of the project shall conform to all applicable ADB requirements, including those concerning anticorruption measures, safeguards, gender, procurement, consulting services, financial management, and disbursement as described in detail in the PAM and loan documents. The government has agreed with ADB on certain covenants for the project, which are set forth in the draft loan agreement. The loan agreement will not become effective until, among others, the AIIB loan agreement has been executed and becomes effective in accordance with the terms thereof.

V. RECOMMENDATION 41. I am satisfied that the proposed loan would comply with the Articles of Agreement of the Asian Development Bank (ADB) and recommend that the Board approve:

(i) the loan of $100,000,000 to the Republic of Uzbekistan for the COVID-19 Emergency Response Project, from ADB’s ordinary capital resources, in concessional terms, with an interest charge at the rate of 1% per year; for a term of 40 years, including a grace period of 10 years; with repayment of principal at 2% per year for the first 10 years after the grace period and 4% per year thereafter; and such other terms and conditions as are substantially in accordance with those set forth in the draft loan agreement presented to the Board; and

(ii) waiver of the requirement for a 12-week processing period under the Disaster and Emergency Assistance Policy (2004) and as discussed more fully in paragraph 6 of this report.

Masatsugu Asakawa President

22 July 2020

Appendix 1 13

DESIGN AND MONITORING FRAMEWORK

Impacts the Emergency Assistance Project is aligned with:

Efficiency, quality, and accessibility of health care increased (Presidential Decree No. UP-5590)a

Human-to-human transmission of COVID-19 contained (National Health Strategic Preparedness and Response Plan)b

Results Chain Performance Indicators

with Targets and Baselines Data Sources and

Reporting Mechanisms Risks Outcome Resilience to outbreaks of COVID-19 and other public health emergencies reinforced

By June 2022 a. Testing surge capacity increased to 25,000 PCR tests per day by trained lab technicians, with turnaround time of less than 24 hours for testing for COVID-19 (2020 baseline: 15,000 with turnaround time of 24 hours) b. Treatment surge capacity for critical care increased to more than 3,500 functional intensive care units attended by trained medical staff (2020 baseline: 1,000)

a. MOH report, PIU assessment of facilities, midterm review special audit, and post-project special audit reports b. MOH report, PIU assessment of facilities, midterm review special audit, and post-project special audit reports

Delays in procuring supplies because of global shortages

Outputs By January 2022

1a. At least 30 project-supported laboratories compliant with Biosafety Level 2 requirements and Good Laboratory Practice or equivalent standards, including sex-segregated sanitation facilities (2020 baseline: 0)c

Global supply constraints lead to price inflation beyond what is included in contingencies.

1. National laboratory system strengthened

1a. MOH compliance checks based on WHO guidelines, midterm review special audit, and post-project special audit reports

1b. At least 500,000 additional regular PCR tests to detect COVID-19 conducted by June 2021, prioritizing frontline health workers (80% of whom are women) and pregnant patients (10 June 2020 baseline: 830,000)d

1b. Laboratory records and MOH

2. National surveillance and response system established for COVID-19

2a. All project-supported national and regional laboratories provide real-time sex- and age-disaggregated COVID-19 test results to SMIMS by June 2021 for data analysis, decision-making, and data visualization (2020 baseline: 0)

2a. MOH report, midterm review special audit, and post-project special audit reports, screenshots

14 Appendix 1

Results Chain Performance Indicators

with Targets and Baselines Data Sources and

Reporting Mechanisms Risks 3. COVID-19 treatment capacity expanded

3a. All 16 project-supported COVID-19 treatment facilities refurbished with improved sex-segregated facilitiese and upgraded according to WHO standards (2020 baseline: 0) 3b. All frontlinef staff (at least 80% of whom are women) in 16 project hospitals have improved skills in infection prevention control and patient management to treat COVID-19 cases and other infectious respiratory diseases by June 2021 (baseline: 0%)

3a. MOH compliance checks based on WHO guidelines, midterm review special audit, and post-project special audit reports 3b. Training firm report, midterm review special audit, and post-project special audit reports

Key Activities with Milestones

1. National laboratory system strengthened 1.1. Undertake rapid assessment of current laboratories (July–August 2020) 1.2. Finalize budgets for upgrading infrastructure of laboratories at Biosafety Level 2 (August 2020) 1.3. Finalize budgets for equipping laboratories (August 2020) 1.4. Prepare contract monitoring contract with MOH institute charged with monitoring (August 2020) 1.5. Prepare contracting (multiple lots) for architectural design and technical specifications infrastructure

works, and biomedical and nonmedical equipment for laboratories at Biosafety Level 2 (August 2020) 1.6. Award monitoring contract to MOH institute charged with monitoring (September 2020) 1.7. Award contract for architectural design and technical specifications for infrastructure works, and

biomedical and nonmedical equipment for laboratories at Biosafety Level 2 (September 2020) 1.8. Finalize architectural designs and technical specifications for civil works for laboratories at

Biosafety Level 2 (December 2020) 1.9. Tender for construction companies (multiple lots) for upgrading infrastructure of laboratories to

Biosafety Level 2 (January 2021) 1.10. Award contract to construction companies for upgrading infrastructure of laboratories to

Biosafety Level 2 (March 2021) 1.11. Publish tender for biomedical and nonmedical equipment (multiple lots) (March 2021) 1.12. Award contract for biomedical and nonmedical equipment (June 2021) 1.13. Installation and commissioning of upgraded laboratories (December 2022) 1.14. Installation and commissioning of equipment at upgraded laboratories (January 2022) 1.15. Training on new equipment at upgraded laboratories (February 2022) 2. National surveillance and monitoring system established for COVID-19 2.1. Prepare contracting for the design of the SMIMS and for the development of health apps (multiple

lots) (July–August 2020) 2.2. Award contracts for the design and implementation of the SMIMS and for the development of health

apps (September 2020) 2.3. Finalize the design of the SMIMS (December 2020) 2.4. Finalize the design of the health apps (December 2020) 2.5. Launch the health apps (January 2021) 2.6. Publish tender for ICT equipment for SMIMS (multiple lots) (January 2021) 2.7. Award contract for ICT equipment for SMIMS (March 2021) 2.8. Installation and commissioning of ICT equipment for SMIMS (September 2021) 2.9. Launch of SMIMS (November 2021)

Appendix 1 15

3. COVID-19 treatment capacity expanded 3.1. Undertake rapid assessment of current treatment facilities (July–August 2020) 3.2. Finalize budgets for upgrading of infrastructure of treatment facilities (August 2020) 3.3. Finalize budgets for equipping of treatment facilities (August 2020) 3.4. Prepare contract monitoring contract with the MOH institute charged with monitoring (August 2020) 3.5. Prepare contracting (multiple lots) for architectural design and technical specifications for

infrastructure works, and biomedical and nonmedical equipment for treatment facilities (August 2020) 3.6. Award monitoring contract to MOH institute charged with monitoring (September 2020) 3.7. Award contract for architectural design and technical specifications for infrastructure works, and

biomedical and nonmedical equipment for treatment facilities (September 2020) 3.8. Finalize architectural designs and technical specifications civil works for treatment facilities

(December 2020) 3.9. Publish tender for construction companies (multiple lots) for upgrading infrastructure of treatment

facilities (January 2021) 3.10. Award contract to construction companies for upgrading infrastructure of treatment facilities

(March 2021) 3.11. Tender for biomedical and nonmedical equipment (multiple lots) (March 2021) 3.12. Contract award for biomedical and nonmedical equipment (June 2021) 3.13. Installation and commissioning of upgraded treatment facilities (December 2021) 3.14. Installation and commissioning of equipment at upgraded treatment facilities (January 2022) 3.15. Provide training on new equipment at upgraded treatment facilities (February 2022) Project Management Activities Recruit additional PIU staff Recruit individual consultants to support PIU Purchase and install 1C accounting information system Recruit consultancy firms to develop ICT system for SMIMS Financial and economic analysis conducted by Q3 2020 with assistance of PIU staff (September 2020) Establish monitoring and evaluation system (Q3 2020) Inputs ADB: $100 million (emergency assistance loan) AIIB: $100 million (loan) Government of Uzbekistan: $57 million (counterpart funding) Assumptions for Partner Financing

Not applicable ADB = Asian Development Bank, AIIB = Asian Infrastructure Investment Bank, COVID-19 = coronavirus disease, ICT = information and communication technology, MOH = Ministry of Health, PCR = polymerase chain reaction, PIU = project implementation unit, Q = quarter, SMIMS = surveillance and monitoring information management system, WHO = World Health Organization. a Presidential Decree No. UP-5590 dated 7 December 2018. b WHO. 2020. National Health Strategic Preparedness and Response Plan. 6 April. Tashkent. Unpublished c Sex-segregated facilities will include separate changing rooms and water and sanitation facilities for staff. d According to government protocols, including for pregnant women who visit health facilities. e Sex-segregated facilities will include separate changing rooms and water and sanitation facilities for medical staff as

well as separate female and male wards for patients. f Medical, paramedical, technical, and cleaning staff who come directly or indirectly into contact with suspected or

confirmed COVID-19 patients. Sources: Asian Development Bank.

16 Appendix 2

LIST OF LINKED DOCUMENTS http://www.adb.org/Documents/RRPs/?id=54282-001-3

1. Loan Agreement

2. Summary Assessment of Damage and Needs

3. Project Administration Manual

4. Contribution to the ADB Results Framework

5. Emergency Assistance Coordination

6. Summary Poverty Reduction and Social Strategy

7. Risk Assessment and Risk Management Plan

8. Gender Action Plan

9. Environmental Assessment and Review Framework