Document of The World Bank FOR OmFCAL USE ONLY Report No, P-6291-BUR MEMORANDUM AND RECOMMENDATION OF THE INTERNATIONAL DEVELOPMENT ASSOCIATION TO TrE EXECUTIVE DIRECTORS ON A PROPOSED CREDIT OF SDR 19.0 MILLION TO THE REPUBLIC OF BURKINA FASO FOR A POPULATION AND AIDS CONTROL PROJECT MAY 31, 1994 This document has a mstricted diWribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be discled without World Bank authorization. CURRENCY EQUIVALENTS Currency Unit = CFA Franc (CFAF) US$1 = CFAF 590 (February 1994) WEIGHTS AND MEASURES I m 1.1 yd 1 km 0 0.6mi 1 m2 = 1.2 sqyards I km2 0 0.38sqmi 1 ha = 2.5 acres ACRONYMS CNLS National AIDS Committee CONAPO Interministerial Population Committee CP Contraceptive Prevalence FP Family Planning MCH Maternal and child Health MS Ministry of Health MSAF Ministry of Social Action and Family STD Sexually transmitted disease UNFPA United Nations Fund for Population Activities WHO World Health Organization FISCAL YEAR January 1 - December 31 FOR OFFICIAL USE ONLY BURKINA FASO POPULATION AND AIDS CONTROL PROJECT CREDIT AND PROJECT SUMMARY Borrower: Burkina Faso Beneficiaries: Ministry of the Economy, Finance and Plan Ministry of Health, and Ministry of Social Action and Family Credit Amount: SDR 19.0 million (US$26.3 million) Financing Plan: IDA 26.3 Government 2.2 Denmark 3.0 Norway 3S Total 34.5 Econonic Rate of Return: Non applicable Staff Appraisal Report: Report No. 12819-BUR Map: IBRD 25394 This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. MEMORANDUM AND RECOMMENDATION OF THE PRESIDENT OF THE IDA TO THE EXECUTIVE DIRECTORS ON A PROPOSED CREDIT TO THE REPUBLIC OF BURKINA FASO FOR A POPULATION AND AIDS CONTROL PROJECT 1. I submit for your approval the following report and recommendation on a proposed development credit to the Republic of Burkina Faso for SDR 19.0 million, the equivalent of US$26.3 million, on standard IDA terms with a maturity of 40 years, to help finance a population and AIDS control project. The Government would contribute US$2.2 million. Cofinancing of a total of US$6.0 million may be provided by the Govermnents of Norway and Denmark. 2. Country Economic Backg. ound. Burkina Faso is a landlocked country with a population of about 10 million. With a gross domestic product per capita of US$304 in 1992, Burkina is among the world's poorest countries. Social and economic conditions are alarming. The Human Development Index of UNDP ranks the country 157th out of 160. Basic social services are underdeveloped. The economy is dominated by agriculture and the public sector. Agriculture and stock rais ng are the main sources of income and provide employment for almost 90% of the active population, and account for about 40% of GDP and 60% of exports. Cultivation of traditional food crops (millet and sorghum) is by far the most important farming activity, while cotton is the major cash crop. The service sector accounts for an additional 40% of GDP, while mining and manufacturing-mainly agroprocessing and textiles-remain under- developed and together contribute only 13 % of GDP. With the other twelve countries of the CFA zone, Burkina Faso devalued its currency by 50% relative to the French Franc in January 1994. The Country Assistance Strategy for Burkina Faso is presented to the Executive Directors in a free-standing document together with this operation. 3. Sector Background. Burkina's commitment to addressingpopulation and AIDS- related issues has increased very considerably in recent years. Burkina's population is growing at about 3% per annum. At this rate, the population will double in 23 years. Bank projections based on recent fertility trends and assumptions about future changes suggest that, in the absence of aggressive measures to enhance fertility decline, the population will reach about 50 million before it stabilizes. Increased public understanding of the negative impacts of such a dramatic increase has led the Government to take a number of actions designed to advance the onset of fertility decline. Family planning (FP) was first introduced into public health facilities in 1985 and integrated into maternal and child health care (MCH). In 1991, the Government approved a national population policy which sets ambitious targets in terms of contraceptive prevalence (CP) and fertility reduction. In December 1993, it approved legislation to give primary responsibility for disseminating and operationalizing this policy to the Interministerial Population Commission (CONAPO) and its Permanent Secretariat. It also adopted a National Family Planning Strategy for the 1993-1998 period, which introduces a number of reforms essential for the expansion of the FP program, such as allowing obstetrical assistants, more numerous in rural areas than midwifes, to prescribe and distribute clinical contraceptives, and authorizing traditional birth attendants to refill prescription contraceptives. The Strategy also acknowledges the need to establish a FP outreach program beyond the public health system, supported by non-governmental (NGO) and other private sector organizations. 4. Efforts to expand FP services have so far mosdy benefitted the country's urban areas, while they remain limited in rural areas. This has resulted in a considerable difference t,Aween the CP in urban areas (17%) and that in rural areas (1.5%). Efforts to expand CP are also constrained by high infant and child mortality, high illiteracy rates, particularly among 2 women, and an inadequate health service delivery system. Under the FP Strategy, the Government aims to increase the CP in rural areas to 9 % and that in urban areas to 32%. Helping the Government make FP service more accessible, particularly in rural areas, while at the same time stimulating the demand for contraceptive services is the main thrust of the population component of the proposed project. Activities under this project complement those supported under the Health and Nutrition Project (approved by the Board on March 31, 1994) which will help the Government to improve significantly the quality, coverage, and utilization of basic health services. 5. AIDS was first reported in Burkira Faso in 1986 and has since been growing rapidly. As of December 31, 1992, a total of 2,886 AIDS cases have been reported. The high prevalence of endemic diseases (malaria, tuberculosis and other pulmonary infections, chronic diarrhea) with symptoms similar to AIDS, the limited skill of health providers, and the limited availability of diagnostic tests and equipment have led to misdiagnosis, hence considerable underreporting of the disease. The Ministry of Health (MS) estimates that about 7% of the adult population is currently infected with HIV, the AIDS-causing virus. Taking into account also infected newborns, it is estimated that about 450,000 persons are currently HIV-positive. This prevalence rate places Burkina Faso third, after the C6te d'Ivoire and Ghana, among the Western African countries most affected by the disease. Heterosexual transmission is predominant (85% of the cases), followed by blood transfusion and perinatal transmission. Women are being increasingly infected, and it is expected that infection rate among women will soon equal that of men. Biological factors and traditional harmful practices, such as excision (still widely practiced) make women more vulnerable to HIV. With more women being infected with HIV, perinatal transmission of the infection will also increase. It is estimated that one in every four children born to an infected mother is also infected. A high prevalence of Sexually Transmitted Diseases (STDs) increases several-fold the susceptibility of acquiring HIV. This has important implication for women, since at their initial stages, STDs are asymptomatic in women and are left undiagnosed and untreated. The above issues underline the importance of mainstreaming HIV/AIDS/STD prevention into MCH/FP programs. 6. As the number of AIDS cases mounts dramatically in the country, the Government has moved from a stage of reluctant acceptance to one of more constructive engagement. MS has nou declared the fight against AIDS one of its top priorities. Efforts to slow down the spread of AIDS are constrained by (a) insufficient awareness of risk behavior, thus reluctance to adopt safer health practices, such as the use of condoms; (b) limited information on the development of the HIV/AIDS epidemic, due to poor epidemiological surveillance; (c) low condom distribution; and (d) very weak institutional capacity. Particularly vulnerable is the youth, who becomes sexually active early but lacks the information on how to prevent HIV/STD transmission. The economic impact of AIDS (the sum of the direct cost of treating the disease and production lost to the economy because of AIDS) has been estimated to be between US$8 million and US$16 million (based on the currently reported incidence rate of 0.173 per 1000 population). While already substantial, these figures are expected to increase rapidly as the number of AIDS cases grows. 7. PrjQect Objectives. The overall objectives of the project are to: (a) enhance the onset of fertility decline by increasing the prevalence of modern methods of contraception, and (b) slow the spread of HIV infections by promoting behavioral change and treating STDs. 3 8. Project Description. The project would finance investments designed to: (a) support the implementation of the Government's population policy by: (i) improving quality of, and access to, FP and MCH services nationwide; (ii) promoting information, education and communication (IEC) programs in the areas of population, FP and women's rights, with particular emphasis on issues concerning their reproductive health; and (iii) strengthening institutions in charge of implementing the national population policy and of planning, managing and evaluating FP programs; (b) strengthen the national capacity to contain the spread ot HIV/AIDS/STDs by: (i) strengthening the institution in charge of implementing the national AIDS program and the health system's capacity to deal with AIDS needs; (ii) promoting safer health practices and behavioral change through information, education, and communications campaigns; (iii) promoting the use of condoms; (iv) treating STDs; and (v) strengthening clinical management and community care; and (c) encourage private sector and NGO participation in the areas of population. FP and HIV/AIDS/STD, by establishing a Fund to finance projects in those areas. 9. Project Implementation. The project will be implemented by existing entities in the health system and in the Ministry of the Economy, Finance and Plan (MEFP), NGOs, and private sector agencies. IEC interventions will be implemented through the Ministry of Health, the Ministry of Social Action and Family (MSAF), and the Permanent Secretariat of CONAPO in the MEFP, and through the country's television and radio system, NGOs and other private sector organizations. Overall project coordination would be the responsibility of CONAPO's Permanent Secretariat. The Permanent Secretary would delegate day-to-day coordination of project implementation and monitoring to a Coordinator, under his supervision. The project is expected to be completed over a five-year period, and the IDA Credit disbursed in six years. 10. Project Sustainability. The incremental recurrent costs directly generated by project investments would be small. However, the project contributes essential inputs to two Government programs, the FP and AIDS control programs, which have important recurrent cost implications for the financing of contraceptives, condoms, drugs, and medical and protective supplies. The annual cost at the end of the project of supplying the above material has been estimated at about US$3.4 million. These costs are expected to remain high for a number of years and donor funding will probably be necessary for the foreseeable future. As cost recovery is being gradually introduced in Burkina Faso's health system together with decentralization, chirges will be made for drugs, with the proceeds being r^tained within the district health budget. Contraceptives and condoms are currently being sold by the public health system and through a social marketing program (for condoms) at highly subsidized prices, and will continue to be sold. However, as far as condoms are concerned, given the urgency to dramatically increase the demand for this commodity, free distribution is also envisaged in the context of IEC campaigns and some interventions targeted to high risk groups. 11. The recurrent costs generated by the project are small compared with the long- term cost of not launching an aggressive FP and AIDS prevention program. Without the inputs provided by the project a much more serious sustainability problem would arise in terms of factors such as: (a) costs for increases in social services to cater to a rapidly growing population; (b) costs for caring for AIDS and STD patients if the HIV infection and the STD were left unchecked; and (c) costs of caring for the children of AIDS victims. A rapid assessment of the economic impact of AIDS carried out during project appraisal estimated the average lifetime treatment cost for an AIDS case to be about US$416 (pre-devaluation cost). The total indirect cost of one case of AIDS has been estimated 18 times greater (US$ 7,488). The direct cost of one-year supply of condom. for one sexually active male was estimated at appraisal to be about US$2. 4 12. Drugs for STDs and AIDS-related opportunistic infections and protective supplies for health workers would help restore health or prevent illnesses. Every STD or TB patient treated, or every HIV-infection averted reduces the number of future potential patients seeking health care. The drugs and other medical supplies provided by the project would help ensure the sustainability of existing and forthcoming large investments in health care infrastructure. 13. Lessons Learned from Previous IDA Involvement. The project benefits from the experience gained under the Bank's two previous operations in health, the regional Onchocerciasis Control Program, started in 1974, and the First Health Project (Cr. 1607-BUR). Lessons from the latter operation suggest that greater attention needs to be paid to: (i) ensuring that the necessary policy reforms are in place prior to start-up of project investments; (ii) decentralization of activities, coupled with training and supervision through district management teams; (iii) improving the quality of existing health care facilities; and (iv) active demand creation and government support for FP activities are essential to increasing acceptance rates. The result of the Operations Evaluation Department's evaluation of population projects, as well as the experience gained under AIDS and STDs control projects in developing and developed countries have also been taken into account in the design and preparation of this project. The main lessons learned from these experiences are: (i) need to strengthen and maintain a commitment to population and FP on the part of all officials responsible for implementation of the program; (ii) need to integrate efforts in FP with efforts to directly reduce the demand for children, such as female education, and programs aimed at increasing women's income,-earning capacity and reduce child mortality; (iii) interventions in the early stages of the AIDS epidemic have a greater impact and a higher benefit-cost ratio than interventions at a later stage; (iv) large-scale condom promotion has resulted in large observed changes in sexual behavior and significant increases in condom use; and (v) need to involve NGOs to reach high-risk groups. 14. Rationale for IDA Involvement. IDA's country strategy for Burkina Faso is presented to the Board in a free-standing document together with this operation. The strategy rests on the following thiee elements: (i) assisting the Government in creating a policy and regulatory environment more supportive of the private sector; (ii) helping the Government manage public resources more efficiently: and (iii) supporting critical actions needed to alleviate long-term constraints on economic growth and social development, with a focus on population, health and education. The proposed project is a central part of this assistance strategy. The programs required to implement this strategy demand considerable external financial support and a strong Government commitment. IDA has played a catalytic role in a number of important policy reforms recently adopted by the Government in the health and population sectors and is in a good position to mobilize the needed assistance from the donor community and to influence the Government's strategies. The project would provide a framework for enhanced donor coordination in the areas of population and HIV/AIDS prevention. 15. Agreed Actions. The following would be conditions of credit effectiveness: (a) approval of a training program for the project period acceptable to IDA; (b) signing of technical assistance arrangements widh WHO for the procurement of condoms, and with UNFPA for the procurement of contraceptives. Such arrangements would be reviewed after two years to determine the need for further extension; (c) establishment of (i) the project coordination team within CONAPO's Permanent Secretariat in numbers and qualifications satisfactory to IDA, and (ii) an accounting system satisfactory to IDA; (d) (i) establishment of an independent project selection committee, satisfactory to IDA, to review and approve financing proposals prepared by NGOs benefitting from financing under the Fund, and (ii) approval of the procedural manual regulating the management of the Fund and of the standard contract, satisfactory to IDA, between 5 the Government and the NGOs; (e) reorganization of the Permanent Secretariat of the CNLS and its staffing with adequate full-time personnel in numbers and qualifications satisfactory to IDA, and enact a new ministerial decree clarifying the roles and functions of the Permanent Secretary and those of the technical sub-committees; (f) appointment of an independent auditor under a multi-year contract acceptable to IDA to carry out yearly review of the project accounts; and (g) the establishment of a monitoring and evaluation system satisfactory to IDA. The effectiveness of grant agreements between the Government and the Governments of Norway and Denmark to assist in the financing of the project would be an additional condition of effectiveness. 16. Environmental Aspects. The project is rated C. There are no likely direct negative environmental effects. However, the likely medium to long-term impact of the project on fertility reduction and subsequent decline in the rate of population growth would have positive implications for the environment. 17. Project Objective Categories. The project responds directly to the human resources developinent and anti-poverty objectives of the Government. Improving population analysis, planning and management, extending FP services, strengthening MCH services, addressing the important issue of women's reproductive health, and controlling the spread of HIV/AIDS/STDs will contribute significantly to the achievement of the long-term development objectives of the country. 18. Project Benefits. The project's interventions would help increase by 1999 the prevalence of modern methods of contraception in rural areas from 1.5% to 9% and in urban areas from 17% to 32%. The number of FP users would grow from an estimated 80,000 to about 350,000 in 1999. The wider practice of PP would have a particularly beneficial impact on the health of women and children. The project would help slow the spread of the HIV infection and alleviate the burden of HIV/AIDS on individuals, families and the nation. The project would have significant returns in terms of years of healthy life saved and would hold down the indirect economic cost of AIDS, i.e., losses in production and human capital, which threaten the long- term economic development of Burkina Faso. Most impor antly, the cost of dealing with the disease now would be small in comparison to the cost if the disease were allowed to become more widespread. The pr3ject would help combat STDs, which is one of the most effective strategies to inhibiting the spread of HIV. By 1999, reliable supplies of condoms would provide protection from HIV/AIDS/STD, to at least 20% of Burkina's sexually active adult males and their partners (about 570,000 couples), who are expected to be persuaded by the public information campaigns to use condoms, to do so. Distribution of condoms to high-risk populations, supported by an intensive IEC effort, is expected to cover a much higher percentage of these populations. Protective supplies would safeguard an estimated 4,500 health personnel. By integrating HIV/AIDS/STD prevention in FP/MCH activities, the project would contribute to alleviating the number of infections transmitted to women. Neonatal infection would be reduced. 19. Project Risks. The project faces two major risks. First, attainment of project goals may be hampered by the fact that changing reproductive and health behavior is a difficult and time-consuming undertaking. To mitigate this risk, the project would provide heavy support to IEC activities and use NGOs and other private-sector organizations to reach those at risk. To mobilize continued, strong support for FP as well as for HIV/AIDS/STD prevention and control among political, traditional and religious leaders, the project would support (i) actions to increase these leaders' awareness to the urgency of addressing these issues, and (ii) extensive information campaigns to which nasional leaders are expected to contribute actively. Second, iovernment's weak capacity may result in poor project implementation. This risk would be addressed through 6 (i) the strengthening of the institutions involved in the implementation of the project, and (ii) heavy reliance on the private sector and NGOs. Activities in this area would complement those undertaken under other Bank Group operations to strengthen the health services delivery system. 20. Recommendation. I am satisfied that the proposed credit would comply with the Articles of Agreement and recommend that the Executive Directors approve it. Lewis T. P:eston President Washington, D.C. May 31, 1994 Attachments 7 Schedule A Page 1 of 1 BURKINA FASO POPULATION AND AIDS CONTROL PROJECT Estimated Project Costs and Financing Plan (Net of taxes and Duties) kocl Foreign QI /a -ULSS million)- A. Support the Implementation of the Government's 6.2 10.8 13.0 Population Policy 1. Improving the quality of, and access to, MCH/FP services 0.5 4.6 5.1 2. Promoting information, education, and communications programs 1.5 1.7 3.2 3. Institutional strengthening 2.2 2.5 4.7 4. Fund for population and HIV activities 2.0 2.0 4.0 B. Strengthen the National Capacity to Contain the 2.1 10.6 12.7 Spread of IUV/A1DS/SITDs 1. Institutional strengthenizg and capacity-building 0.6 3.1 3.7 2. Promoting safer health practices and behavorial changes 1.5 0.6 2.1 3. Promoting condom use - 3.0 3.0 4. The STDs program - 3.1 3.1 5. Strengthening clinical management and community care 0.0 0.8 0.8 C. Encourage NGOs and Private Sector Participation 1. Establishing a Fund 2.0 2.0 4.0 Total BASE COSTS 8.3 21.4 29.7 Physical contingencies 0.1 0.8 0.9 Price contingencies 1.9 2.0 3.9 Total PROJECT COSTS 10.3 24.2 34.5 Financing Plan /a (in US$ million) IDA 26.3 Norway 3.0 Denmark 3.0 Govemrnment = TOTAL 34.5 /a Totals may not add up due to rounding. 8 Burkina Faso Schedule B Population and Aids Control Project Page 1 of 2 Table 4: Summary of Proposed Procurement Arrangements (US$ million, Including contingencles) Procurement Methods Not Bank- ICS LCB Ott* Financed Total 1. Civil works 1.1. Construction 0.5 - 0.5 (0.5) (0.5) 1.2. Rehabilitation 0.03 0.1 0.1 (0.03) (0.1) (0.1) 2. Goods 2.1. Equipment 0.1 0.5 0.02 0.6 (0.1) (0.5) (0.02) (0.6) 2.2. Material 1.7 0.01 0.6 2.2 (1.7) (0.01) (0.6) (2.2) 23. Fumiture 0.2 - 0.2 (0.2) (0.2) 2.4. Vehicles 0.8 0.1 - 0.8 (0.6) (0.1) (0.8) 2.5. Lab. Materials & Supplies - 0.1 0.1 (rI (0.1) 2.6. Medical materal and supplies 2.2 - 22 (2.2) (2.2) 3. Drugs M 4.6 - 4.6 (2.6) (2.6) 4. Contraceptives 4.3 - - 4.3 (4.3) (4.3) 6 Condoms 3.3 3.3 (3.3) (3.3) 6. Specialist Services 6.1. National 6.1.1. Studles, Surveys and Research 0.9 0.9 (0.9) (0.9) 6.12. Pilot Projects - 0.2 02 (02) (02) 6.1.3. Capacity-BuIlding - 0.6 0.6 (0.6) (0.6) 62. Intemational 1.3 1.3 (1.3) (1.3) 7. Training 7.1. Abroad 0.8 - 0.8 (0.8) (0.8) 7.2. Local 1.7 1.7 (1.7) (1.7) 8. Fund for Population & lIV Activities 12 4.0 4.0 8 IEC 9.1. Mass Media 2.5 - 2.5 (2.5) (2.5) 92. CRESAS - 0.1 0.1 (0.1) (0.1) 10. Recurrent costs 10.1. O&M of Equipment and Vehicles 0.7 0.4 /3 1.1 (0.7) (0.7) 102. OMce and audio-visual supplies - 02 0.2 (0.2) (0.2) 10.3. Personnel 10.3.i. SuperAision missions - - 0.03 - 0.03 (0.03) (0.03) 10 32. Salares of contractual staff 0.3 0.3 of the CoordinabngTeam (0.3) (0.3) 10.3.3. Salaries of Ministry staff /4 - 1.8 1.8 Total 16.8 IA 14.2 2.2 34.6 (14.8) (1.4) (10.2) -(26.3) Notes: Totals may not add up due to rounding. Figures In parentheses are amounts financed by the IDA Credit /1 Cofinanced by Norway and Denmark, In the amount of US$1 million equvalent each. /2 Financed by Norway and Denmark but managed by the Bank. /3 Govamments contributon to the finaning of recurent costs. schedbads /4 Salares of ciM servants paricipating In prolect execution, financed 100% by the Govemment as part of is conbibuton to project costa. 9 Svnedule B Page 2 of 2 BURKINA FASO POPULATION ANPT AIDS CONTROL PROJECT Allocation and Disbursement of the IDA Credit % of Expenditures Category of ExRenditures Proposed IDA Allocation Financed by IDA (US$ million) 1. Civil works 0.5 100 2. Equipment, Materials, Furniture, 5.5 100 Vehic!es, Medical and Lab. Materials & Supplies 3. Drugs, Contraceptives, Condoms 9.1 100 4. Specialist Services 2.9 100 5. Trining and fellowships 2.1 100 6. IEC 2.2 100 7. Incremental Operating Costs: (a) Salaries 0.5 100 (b) Other 0.7 * 8. Unallocated 2.8 TOTAL 26.3 * 100 % through December 31, 1995; 65% through December 31, 1997; 35% thereafter. Estimated Credit Disbursements (in US$ million) --------------IDA Fiscal Year 1995 1996 1997 1998 .1990 Annual 1.0 3.0 5.5 8.0 7.2 1.6 Cumulative 1.0 4.0 9.5 17.5 24.7 26.3 10 Schedule C Page 1 of 1 BURKINA FASO POPULATION AND AIDS CONTROL PROJECT Mmetable of Key Project Processing Events (a) Time taken to prepare: 15 months (b) Prepared by: Government with IDA assistance* (c) First IDA mission: October-Nover-ber 1992 (d) Appraisal mission departure: November 23, 1993 (e) Negotiations: March 1994 (t) Planned date of effectiveness: December 1994 (g) List of relevant PCRs and PPARs n.a. *This report is based on the findings of an appraisal mission which visited Burkina Faso in November-December 1993, comprising Ms. B. Vitagliano (Mission Leader) and Messrs./Mmes. A. Kenney, J-G. Dehasse, L. Brenzel, C. Kamenga, A. Drabo, Ms. P. Ciardi, and G. Rooz. Mr. C. Bado of the Burkina Paso Resident Mission participated in seveml aspects of the preparation of this project. Mr. S. Ben-Halima was the pocumement reviewer. Mr. T. Merrick was the Lead Advisor. Dr. S. Habayeb and Ms. M. Mac Donald were the peer reviewers. Mr. B. Predriksen and Ms. K. Marshall are the managing Division Chief and Depattment Diroctor, rtsctively. 11 Page 1 of 2 POPULATION AND AIDS CONTROL PROJECT Status of Bank Group Operations In Burkdna Faso Summary Statement of Loans and IDA Credits (LOA data as of 3/30/94 ) Amount in US$ million (lees cancellations) Loan or Fiscal Undis- Closing Credit No. Year Purpose IDA bursed Credits 29 Credits Closed 227.8 15980-OUR 1886 Education III 21.60 3.09 03/31/94 (R) 16070-BUR 1985 Health 1 26.60 6.02 07/31/94 (R) 18960-BUR 1988 Agric. Research 17.90 7.17 03/31/95 (R) 19790-BUR 1989 Agric. Services 42.00 21.86 12/31/94 20670-BUR 1990 Urban Development 22.20 11.16 06/30/95 22290-BUR 1991 Environmental Management 16.50 13.34 12/31/98 22440-BUR 1991 Education IV 24.00 24.07 06/30/98 22810-BUR (S) 1991 SAL I 80.00 42.37 06/30/94 (R) 22820-BUR 1991 Public Works and Employment 20.00 3.68 06/30/86 23320-BUR 1992 Transport SECAL 66.00 62.06 12/31/96 23780-BUR 1992 Public Institutional 16.00 13.64 03/31/97 23810-BUR (S) 1992 Agric. SECAL 28.00 20.82 12/31/94 24140-OUR 1993 Food Security 7.60 6.95 06/30/99 24720-OUR 1993 Private Sector Assistance 7.00 7.01 12/31/97 26190-BUR 1993 Engineering Credit 4.25 4.24 06/30/96 25900-BUR 1994 Economic Recovery Credit 25.00 26.42 06/30/95 26960-BUR 1994 Health/Nutrition 29.20 29.94 12/31/99 Total number Credits = 17 462.76 292.74 TOTAL /1 680.61 of which repaid 14.21 TOTAL held by IDA 666.30 TOTAL undisbursed 292.74 /1 Total Approved, Repayments, and Outstanding balance represent both active and Inactive Loans and Credits. (R) Indicates formally revised Closing Date. (S) Indicates SAL/SECAL Loand and Credits. The Net Approved and Bank Repayments are historical value, all other are market values. The Signing, Effective, and Closing dates are based upon the Loan Department official data and are not taken from the Task Budget File. ACTION PLAN FOR IMPROVING DISBURSEMENT PERFORMANCE Credit No. Name Disb. * Problem/Reeson for delay Proposed Action 2281 SAL I 47% First tranche fully disbursed. A joint IMF/Bank SAL tranche release was Second tranche, delayed 6 months completed In midJanuary 1994. due to legislative elections, Govt change and subsequent restructuring, will now be released. 1550 Fertilizer 57% Cumbersome procurernent procedures Credit closed on 03/31/94, remained funds have delayed training pro:ams and cancelled. Inst. Develop. Project Is phosphate production workshop and addressing Issues. study. 1896 Ag. Research 60% Preparation of procurement technical Mid-term revlew in Apfil 1993 addressed documents. specific Issues. Computerized financial management system has been installed to remedy the problem. 1979 Ag. Services 48% Weak financial management. Same as above, with significant improvement resulting. 2067 Urban Dev. ll 50% Entitles had little knowledge of procuremet Since October 1992, an action plan under disbursement procedures. No technical implementation has provided a consultant expertise to prepare bidding documents. to strengthen the Projet Management Unit Local ICB procedures cumbersone and and standard bidding documents In French numerous signatures required from Govt on computer. Disbursement rate should officials. Increase as CFAF 2 b of works have now been launched as a result of November 1992 and February 1993 folow-up missions. 1598 Education Ill 86% Management problem resolved. Credit closed on 03131/94; remaining funds cancelled. 1607 Health 1 77% Large residual due to (a) appreciation of SDR; Credit closing date was extended by one year (b immunization comp. reduced; (c} construction to 07/30/94 to allow Govt to take action slow Ino community participation); (e) Go vt on essentiai drug policy. took grant funds when avallable and did not use IDA funds. 2332 Transport SECAL 21% Effective In February 1993. First tranche Is now In process. 2381 Ag. SECAL 26% Effective August 30. 1993. This projet, and the two foRlowing. were delayed as a result of 0 Uz lgislativo elections and changes of Govt Q0 officials. (D D 2378 Instit. Development 9% Effective April 1993. OrI 2414 Food Security 7% Effective AprIl 1993. _ MIS as of March 1994, disbursement as % of total credit. _ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~~~~~~~ML - NI;GHI) ER BURK INA FASO R -t 59 ->t OUD~~~~~ALAN l% NATIONAL CAPITALr CAPITALE D'ETAT Goom - Gorom IGERE PROVINCE CAPITALS SOUM GHANA CHEF- ULEU DE PROVINCES Dr PROViNCE BOUNDARIES Diibo J LIMITES DE PROVINCES INTERNATIONAL BOUNDARIES LiMbUES D'ETATS 1 OucJhigouyo (_ SENO > <_ \7 ~~~~~~~~~~~~~~YATENGA \ iono 3SAN ATENG AV < G) KoGHANAN Nouna PASSORE Bogand deomnatonsandan UBe World Bank Group. \ w KOstatus 1f an terr( _ Boulso r 4 X / ~~~~~~~~~ ~~~MOUHOU 101 /1 Fodo N'Go=ma 0o D'PY p )| Y ( u g>_ ~~~~~~~~~~~~~~~~~~~~~~~~~~BZEGA7\efk oo < GOURJv5A TAPOA ngo Tenkodogo~oran edoseen N ) oob % ZO~~~~~~~~~~ZUNDWEOGO J .pxt°° {-) r J SISSILI {