Page 1 PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No.: AB3719 Project Name Health Sector Support and AIDS project - Additional Financing Region AFRICA Sector Health (70%);Other social services (30%) Project ID P110815 Borrower(s) THE GOVERNMENT OF BURKINA FASO Government of Burkina Faso Burkina Faso Implementing Agency MINISTERE DE LA SANTE MINISTER DE LA SANTE Burkina Faso Environment Category [ ] A [ ] B [X] C [ ] FI [ ] TBD (to be determined) Date PID Prepared March 7, 2008 Estimated Date of Appraisal Authorization March 24, 2008 Estimated Date of Board Approval June 3, 2008 1. Key development issues and rationale for Bank involvement National surveys show that underweight prevalence has increased by 0.6 percentage points per year since the early nineties and if the trend continues, the prevalence could reach 45% in 2015 (from 33% in 1992/93). Acute under-nutrition, which was 18% in 2003, has now reached 23% according to the latest national survey (2006). The World Health Organization (WHO) distinguishes four categories of severity based on the prevalence of acute under-nutrition. Between 1998 and 2003, Burkina Faso moved from category III (high) to category IV (very high). Since then, the prevalence has increased even further to 23% in 2006 and is now on a par with South Sudan (24%) and above any other country in the world, including India (20%), Sudan (North and South; 16%), Laos (15%), Chad (14%) and Eritrea (13%), while it is double the rate in the neighboring countries such as Mali (11%) and Niger (10%). Burkina Faso is not on target to reach MDG 1b (halving the non-income side of poverty as measured by the prevalence of undernutrition). Through the multiplier effect of undernutrition on morbidity and mortality, Burkina Faso is also unable to make progress on the other MDGs, notably 4 and 5, which concern child survival and maternal health respectively. Over the past 15-20 years, under-five mortality has virtually remained unchanged. DHS data estimated under- five mortality at 184 per 1,000 life births for the period 1999-2003, down only very minimally from 187 per 1,000 in 1989-1993. Moreover, the latest data from the MICS survey (2006) estimated under-five mortality at 188 per 1,000 life births. In absolute numbers, this translates to Page 2 131 thousand children who die each year before reaching their fifth birthday; 71,000 of them due to the effects of malnutrition. Malnutrition has continued to increase despite years of economic growth and surplus food production. The government therefore recognizes this as a structural rather than cyclical problem. Notwithstanding, the country is currently experiencing a double negative shock including a poor harvest combined with global price rises and a meningitis outbreak, which may cause the problem to become even worse, unless consolidated efforts are made to turn the tide. The Recipient and the implementing Agency (Ministry of Health) are fully committed to the project and have complied with all covenants specified in the Financing Agreement. The performance of the Ministry of Health has been satisfactory. It has established an acceptable accounting and reporting system for the pooled funds, which will continue for the additional financing. At present, the Government is unable to provide sufficient funding to finance the scaling up of proposed activities. The original HSSMAP also provides insufficient scope to expand and accelerate direct nutrition action at family and community level. The development partners, including UNICEF, WHO, WFP and NGOs, are unable to bring in the kind of resources necessary to accelerate the scaling up of the broad range of direct nutrition action aimed at behavior change but are contributing notably through increased support for the case management of severe acute malnutrition (see aide memoire of the October/November 2007 mission). The total cost of the additional financing, based on actualized unit costs, is estimated at US$10.0 million, all of which will be allocated to this new component. The additional financing will be subject to 100 percent IDA financing according to the Country Financing Parameters for social sectors. The costs and financing plan for the original operation and for the additional financing are presented below. Activity Original PAD Proposed New Project Health Action Plans 20.7 - International Procurement 6.0 - Community Nutrition Plans - 10.0 HIV/AIDS Pooled Fund 21.0 - Details of activities to be financed with the additional funding were identified during the technical mission in October/November 2007. Apart from some technical preparations, the financial, procurement and implementation arrangements are ready for implementation. The activities proposed have very favorable cost-effectiveness ratios documented by the Bank, most recently in the “Repositioning nutrition as central to development” report. Activities to be financed under the additional financing are expected to be completed by July 31, 2012 which will also coincide with the closing of the project. Page 3 2. Proposed objective(s) The original project development objective, which remains unchanged, is to support implementation of the Borrower’s health sector and multi-sectoral HIV/AIDS strategies, in order to accelerate progress toward the Millennium Development Goals. The original project has two components. Component (A) provides support for the national health strategy for: (i) improved quality and utilization of maternal and child health services; (ii) malaria prevention and treatment; and (iii) treatment for HIV/AIDS and sexually transmissible infections. Component (B) supports the National HIV/AIDS Strategy through a pooled fund at the National AIDS Council to: (i) improve knowledge of HIV prevention and encourage adoption of lower risk behaviors, among high-risk groups as well as the general population; and (ii) mitigate the socio- economic consequences o f the AIDS epidemic through improved coverage of social safety nets. The additional financing will support achievement of the Project Development Objectives through: (i) coordinating multisectoral nutrition action, (ii) scaling up essential health and nutrition actions at all levels, (iii) implementing effective community mobilization strategies through the dense network of local associations, and (iv) strengthening of the nutrition surveillance system. 3. Preliminary description The proposed additional financing will support a new component comprised of essential health and nutrition actions at family and community level. This component will support (i) the implementation of direct nutrition action at community level, 1 and (ii) policy and program coordination, and monitoring and evaluation of direct nutrition action. The community-based activities will be implemented in five out of the 13 regions over a period of four years, reaching between 15-20% of the total population of rural children under two (40-50% in the five selected regions). This will be achieved by contracting out implementation to NGOs and CBOs. This component will: (i) harmonize and scale up activities for health and nutrition at community level; (ii) build on the current political momentum to engage in community health and nutrition strategies by generating results towards the improvement of health and nutritional conditions and indicators; and (iii) enhance the impact of the PDO. 4. Safeguard policies that might apply The environmental category is C. No safeguard policies will apply to the activities of the new component. 1 Direct nutrition action at community level includes community-based child growth promotion with emphasis on behavior change communication, including care of pregnant women, and adequate case management of severe acute malnutrition using community-based management of severe acute malnutrition (CMAM) for non-complicated cases to complement in-patient therapeutic care for cases with complications. Page 4 5. Tentative financing Source: ($m.) BORROWER/RECIPIENT 0 International Development Association (IDA) 10 Total 10 6. Contact point Contact: Tshiya Subayi-Cuppen Title: Operations Analyst Tel: 226- -5049-6319 Email: Tsubayi@worldbank.org Location: Cotonou, Benin (IBRD)