Additional Financing El Salvador COVID-19 Emergency Response
The development objective of the Additional Financing (AF) for El Salvador’s COVID-19 Emergency Response Project is to respond to and mitigate the threat posed by COVID-19 and strengthen the national system for public health preparedness. The Project is financing the purchase and deployment of COVID-19 vaccines as well as financing both the scale-up of initial project activities and the implementation of new activities designed to contribute to successful vaccine deployment. By August 2021, El Salvador became a leader within the larger Central American region as it boasted the highest percentage of people who are fully vaccinated (33.7% of the total population.) By August 2022, according to the World Bank COVID-19 Vaccine Deployment Tracker, El Salvador had fully vaccinated 67% of its total population.
Lack of disaggregated data: Even though rates of COVID-19 vaccination based on the total population of El Salvador are high, it is unclear who has been left behind because there is no publicly available disaggregated data. Without this data, it is very difficult to identify who has been left out of the vaccination effort and which individuals and groups should be targeted moving forward.
Centralization of services during the initial stages of implementation: The “Vaccination Mega Center” in Hospital “El Salvador”, located in the capital, was the only location administering COVID-19 vaccines during the first phase of implementation (February 2021). This made it difficult, if not impossible, for those from outside San Salvador to get vaccinated because of the long and costly commutes to the capital.
Use of military forces in COVID-19 operations: Mobile vaccination hubs were established a few months after the first phase of vaccine distribution (February 2021) to expand access to rural and hard-to-reach communities. Mobile hubs were a common sight in rural areas of El Salvador. Reports from BIC’s partner explain how these hubs were safeguarded by the military. Though improved vaccine accessibility was a step in the right direction, the presence of the military caused some to not use the mobile hubs or even get vaccinated at all due to fear of harassment, sexual abuse and/or reprisals.
Discrimination and harassment toward LGBTQI+ individuals: BIC’s partner reports instances of harassment and discrimination from the military, health workers, and other members of the community in health centers and mobile vaccination hubs. LGBTQI+ individuals were mocked by military personnel and health workers due to their LGBTQI+ identification. These individuals decided to not go back for a second vaccine dose despite showing a prior interest.
Access to information: Communities and organizations in El Salvador are without access to the “COVID-19 National Vaccination Rollout Plan” (NVRP) and procurement processes because, in March 2021, this information was classified as confidential for three years by the Government. In addition to this, the ESRS, ESCP, and the PID of the AF project are not available in Spanish on the World Bank’s website (as of August 2022). Without information accessible to stakeholders either because it is marked as confidential or not available in Spanish, it becomes difficult for project-affected people to provide insight and feedback to the project. Without this vital input from civil society organizations (CSOs) and communities, the project could harm the most marginalized individuals.
The World Bank is financing the total project cost of $50 million.
The Bank and the Borrower need to provide publicly available disaggregated data that improves the current effort to identify the impact of vaccination efforts and to target those who might face significant barriers to getting vaccinated.
The Borrower, with support from the Bank, should have conducted a military assessment to assess how the use of military forces impact access to vaccines for marginalized groups and hard-to-reach communities, such as LGBTQI+ individuals and women in rural and remote areas.
The Bank should work with the Borrower to properly train and sensitize implementing agency and frontline staff on working with and respecting marginalized groups, especially LGBTQI+ individuals. This could help to prevent issues of harassment and discrimination in vaccination efforts.
The Bank should disclose project documents in the official language(s) of the country, in this case Spanish. It is important that the Bank disclose project documents in the official language(s) of the country, especially in countries where there is restricted civic space and limited access to information through the government. When there is limited transparency and accessibility to information within the project, there is a greater risk that benefits will not go to those they are meant to, potentially putting marginalized and hard-to-reach groups even more at risk of not getting vaccinated.
