Output: Capacity of vaccine storage and transport system increased Indicator: By 2027, a new central vaccine storage building with GESI-responsive and climate resilient features and additional 30 cubic meters of storage capacity constructed. Progress/Status: The contract with Design Link Associates Pvt Ltd was signed on 23 September 2024. The inception mission happened in the last week of October 2024. The detailed design is complete and approved. The draft bidding documents were sent for ADB approval on 24 July 2025. The latest loan review mission took place from 15 to 19 June 2025, during which the procurement plan and CAD projections were reviewed and updated with new timelines. The loan was extended until 30 June 2028. IFB was issued on 7 October and Bids will be opened on 6 November. Data Source: PMU records and EPI reports Actual value:

Output: Capacity of vaccine storage and transport system increased Indicator: By 2025, at least 7 sea vehicles made operational for 6 atolls and the Greater Malé region. Progress/Status: Contract with ‘Unit Export Limited' signed on 19 September 2024. Design has been finalized and shared with the supplier. A variation to the contract was approved and the target is to complete the deliveries by end of December 2025. Data Source: PMU records and EPI reports Actual value:

Output: Capacity of vaccine storage and transport system increased Indicator: By 2027, at least 1 refrigerated trucks and 1 van operational in the Greater Malé region. Progress/Status: For the supply of 1 van, a contract was signed with the supplier on 30 May 2024. However, due to a delay in making the advance payment, a contract amendment was made stipulating that the delivery date shall be counted from the date of advance payment date. Similarly, due to the delay in advance payment date the proposed model of the van was not available and change in model of the van was requested from the supplier. As per the PFR policy direction was required along with the bid committee approval which was received on 19th December. Informed the supplier to proceed with the revised recent model of the van without any price change. Awaiting for the delivery. The recent mission found that the supplier did not deliver or extend the performance bond, and the contract has expired. The mission instructed to get ADB approval for rebidding. As a result, the procurement plan was revised. During the mission, it was agreed to limit procurement to one refrigerated truck, as the Ministry of Health confirmed they can use the vehicle even before the building is finished. Based on this, it was decided to start procurement as soon as possible, and the procurement plan was updated. Data Source: PMU records and EPI reports Actual value:

Output: Human resource capacity of the Expanded Program on Immunization enhanced. Indicator: By 2024, at least 50% of hired contract staff (supporting central EPI program, national health data center, and MOH's biomedical services unit) are women Achievement: 50 Progress/Status: Out of 8 target positions, 8 has been filled which is 100% of the target staffs (50% women and 50% men). Data Source: Participant's feedback survey

Output: Information management of the Expanded Program on Immunization strengthened for COVID-19 vaccination and routine immunization Indicator: By 2025, at least 75% of the EPI delivery staff (70% of them women) with increased skills in key vaccination-related technical areas Progress/Status: “Introductory Training on Cold Chain Equipment (CCE) Repair & Maintenance." training was held at Maldives Polytechnic from 22nd September 2024 to 25th September 2024. Total 14 participants participated in the training. PMU plans to hold capacity-building program focused on cold chain equipment repair and maintenance in Q2 2025. Request to provide the details below has been sent to HPA 1. Training Center: Recommended venues where this training can be conducted. 2. Estimated Training Dates: Proposed start and end dates within the specified timeframe. 3. Course Details: A detailed curriculum overview, including specific topics covered and the delivery mode (in-person, online, or hybrid). 4. Course Fee: Total fee for the course per participant. As of 30th September 2024, the Ministry of Higher Education (MOHE) has completed four rounds of advertisement for the long-term training scholarships, resulting in the selection of six candidates. Three of these candidates have commenced their training programs, while two others withdrew their applications as their proposed courses did not meet the requirements of both the MOH and the PMU. Following the fourth round of advertisement, MOHE shared the compiled results for the long-term training scholarships on 29th September 2024. PMU plans to meet with the selected candidate to brief her on the scholarship process, discuss relevant details, and present the offer letter and agreement during early Q4 2024. PMU also plans to arrange a meeting with MOH HR on early Q4 2024 to address the unfilled slot allocated for Biomedical Engineering, as no candidates applied for this position despite four rounds of advertisement. During this meeting, PMU plans to propose revising the slot to a Master's degree, if feasible, as funds are available to support this change in program level. Additionally, PMU intends to formally discuss and inform ADB of this adjustment and will request MOHE to proceed with filling the remaining slots. Data Source: PMU records Actual value:

Output: Indicator Indicator: By 2027, a health data center and a back-up data center established Progress/Status: The items needed to establish a health data center and a backup data center have been awarded and delivered to the Ministry of Health. According to the relevant department/ division within the MoH, the installation has been completed. Data Source: Health IT department data and EPI reports Baseline year: 2022 Baseline value: Not applicable Baseline year: 2022 Baseline value: Not applicable Target year: 2027 Target value: Y

Output: Indicator Indicator: By 2025, at least 257 tablets for vaccination data entry deployed to all public health units and government hospitals across the country Achievement: 257 Progress/Status: All the tablets have been distributed to public health units in atolls for EPI data entry purpose as per the relevant department of MOH. Data Source: EPI reports and PMU records

Output: Indicator Indicator: Vaccination data disaggregated by sex, age, location, comorbidity conditions, and nationality compiled and made available in the systems. Progress/Status: As per HPA immunization program, DHIS2 the Electronic Immunization Register (EIR) dashboard, have 23,399 children registered in the system, including 6,250 children born in 2023. As of Q4 2024, Total % of Routine immunization coverage was at 96.88%, out of which 44.66% male and 52.22% female. As of Q4 2024, the COVID-19 situation in the Maldives remained under control, and the government opt not to mandate COVID-19 vaccinations. During Q4 2024, a total of 18 individuals were vaccinated, comprising 12 males and 6 females, Making the immunization coverage 66.67% for males and 33.33% for females. Further details can be found in the attached annex. Data Source: EPI reports Baseline year: 2022 Baseline value: Not applicable Baseline year: 2022 Baseline value: Not applicable Target year: 2025 Target value: Y

By 2027, routine immunization coverage by age and sex are maintained at more than 95% of eligible populations. Progress/Status: The Routine Immunization Coverage report is done as an annual compilation, and the data compilation process is still ongoing. Consequently, the sex and age disaggregated data for routine immunization coverage is currently unavailable. As per the relevant department MOH plans to generate the data through DHIS2 system once all health facilities update their records by Q4 2024. Immunization coverage by age and sex can be obtained once the records are fully updated from all health facilities. Data Source: EPI reports Actual value:

By 2027, the average transport cost to MOH per dose of COVID-19 and routine immunization vaccines from Malé to atolls reduced by 25%. Progress/Status: PMU (with ADB consultant) finalized the revised methodology to calculate the vaccine transportation cost. • PMU gathered information for the year 2019 (the year before COVID-19), • Estimated total cost for sending vaccines to the Atolls: USD 65479 • Total number of vaccine doses sent to each Atoll: 262,030 doses distributed in 2019 • PMU utilized this information to calculate the existing cost incurred for vaccine transportation • According to the forecast, with the introduction of speed boats to deliver the vaccines to atolls, there will be a cost reduction of 60% to the government Data Source: EPI reports Actual value:

By 2027, routine immunization and COVID-19 sex-disaggregated vaccination data reported annually. Progress/Status: The coverage for COVID-19 vaccination by sex ratio for Q4 2023 were maintained by the Health Protection Agency. % of COVID-19 Vaccination coverage for Q4 2023 was: *Female 47.37% *Male 52.63% Total % of Routine immunization coverage was at 99% as of Q3 2023 (Calculated from the annual routine immunization coverage report by Health Protection Agency) As per Health Protection Agency, currently the Routine immunization coverage reports are being prepared on an annual basis. MOH plans to generate the data through DHIS2 system once all health facilities update their records by Q4 2024. Data Source: electronic Joint Reporting Form Base year: 2022 Baseline value: n/a