Document of The World Bank Report No: 21474-GM PROJECT APPRAISAL DOCIJMENT ON A PROPOSED CREDIT IN THE AMOUNT OF SDR 11.8 MILLION (US$15.0 MILLION EQUIVALENT) TO THE REPUBLIC OF THE GAMBIA FOR HIV/AIDS RAPID RESPONSE PROJECT DECEMBER 19, 2000 Human Development II Country Department 14 Africa Region CURRENCY EQUIVALENTS (Exchange Rate Effective November 15, 2000) Currency Unit = Gambian Dalasi GMD 14.25 = US$1 US$1 = GMD 14.25 FISCAL YEAR January Ito December31 ABBREVIATIONS AND ACRONYMS AfDB African Development Bank AIDS Acquired Immuno-Deficiency Syndrome ARI Acute Respiratory Infections AWP Annual Work Programs BBC Behavioral Change Communications BHF Basic Health Facility Bl Bamako Initiative CAC Catchment Area Committees CAS Country Assistance Strategy CBO Community Based Organization CHN Community Health Nurse CMA Contract Management Agency CPAR Country Procurement Assessment Review CSW Commercial Sex Workers CCSI Community and Civil Society Initiatives D Dalasi DAC Divisional HIVIAIDS Committee DALY Disability Adjusted Life Year DCC Divisional Coordination Committee (or municipal equivalent) DCD Department of Community Development DHT Divisional Health Team DPI Directorate of Planning and Information DPT Diphtheria, Pertussis and Tetanus DSE Department of State for Education DSFE Department of State for Finance and Economic Affairs DOSH Department of State for Health and Social Welfare DSLGL Department of State for Local Government and Lands DSS Directorate of Support Services EPI Expanded Program of Immunization EU European Union FAIS Financing and Accounting Information System FLE Family Life Education FMA Financial Management Agent GAFNA The Gambian Food and Nutrition Association GAMBLOOD The Gambia Blood Association Vice President: Callisto E. Madavo Country Manager/Director: John Mclntire Acting Sector Manager/Director: Anwar Bach-Baouab Task Team Leader/Task Manager: Richard M. Seifman GAMWORKS Gambian Agency for the Management of Civil Works GDP Gross Domestic Product HARRP HIV/AIDS Rapid Response Project HIS Health Information System HIV Human Immuno-deficiency Virus HMIS Health Management Information HNP Health, Nutrition, Population HRIS Human Resource Information System IAPSO Inter-Agency Procurement Services Organization IBRD Intemational Bank for Reconstruction and Development IC Individual Consultant ICB International Competitive Bidding ICR Implementation Completion Report IDA Intemational Development Association IDB Islamic Development Bank IEC Information, Education and Communication IMCI Integrated Management of Childhood Illnesses IMF International Monetary Fund IMR Infant Mortality Rate IPAA International Partnership against AIDS in Africa KAP Knowledge, Attitude, Practice LCS Least Cost Selection LIF Local Initiative Fund MAP Multi-country HIV/AIDS Program for the Africa Region M&E Monitoring and Evaluation MMR Matemal Mortality Ratio MRC Medical Research Council NAC National HIV/AIDS Council NAS National HIV/AIDS Secretariat NCB National Competitive Bidding NGO Non-Govemmental Organization PA Project Account PAD Project Appraisal Document PHC Primary Health Care PHPNP Participatory Health, Population and Nutrition Project PIP Project Implementation Plan PIU Project Implementation Unit PLWHA People Living with HIV/AIDS PMR Project Management Report POM Project Operations Manual PPF Project Preparation Facility PTA Parent Teacher Association PTI Program of Targeted Interventions QCBS Quality and Cost Based Selection SA Special Account SOE Statement of Expenses SSS Single Source Selection STI Sexually Tranmitted Infections TA Technical Annex TB Tuberculosis TBA Traditional Birth Attendant TFR Total Fertility Rate ToR Terms of Reference ToT Training of Trainers TWG Tecnhical Working Group UN United Nations UNDP United Nations Development Fund UNFPA United Nations Population Fund UNICEF United Nations Children's Fund UNIPAC United Nations International Packing and Assembly Center VCT Voluntary Counseling and Testing VDC Village Development Committee WDC Ward Development Committee WB World Bank WDR World Development Report WFP World Food Program WHO World Health Organization THE GAMBIA HIV/AHDS RAPID RESPONSE PROJECT CONTENTS A. Project Development Objective Page 1. Project development objective 2 2. Key performance indicators 2 B. Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported by the project 3 2. Main sector issues and Government strategy 3 3. Sector issues to be addressed by the project and strategic choices 7 C. Project Description Summary 1. Project components 9 2. Key policy and institutional reforms supported by the project 13 3. Benefits and target population 13 4. Institutional and implementation arrangements 14 D. Project Rationale 1. Project alternatives considered and reasons for rejection 17 2. Major related projects financed by the Bank and other development agencies 18 3. Lessons learned and reflected in proposed project design 19 4. Indications of borrower commitment and ownership 20 5. Value added of Bank support in this project 20 E. Summary Project Analysis 1. Economic 20 2. Financial 20 3. Technical 21 4. Institutional 22 5. Environmental 22 6. Social 23 7. Safeguard Policies 23 F. Sustainability and Risks 1. Sustainability 24 2. Critical risks 24 3. Possible controversial aspects 25 G. Main Conditions 1. Effectiveness Condition 25 2. Other 25 H. Readiness for Implementation 25 I. Compliance with Bank Policies 26 Annexes Annex 1: Project Design Summary 27 Annex 2: Detailed Project Description 32 Annex 3: Estimated Project Costs 39 Annex 4: Cost Benefit Analysis Summary, or Cost-Effectiveness Analysis Summary 40 Annex 5: Financial Summary for Revenue-Earning Project Entities, or Financial Summary 45 Annex 6: Procurement and Disbursement Arrangements 46 Annex 7: Project Processing Schedule 66 Annex 8: Documents in the Project File 69 Annex 9: Statement of Loans and Credits 70 Annex 10: Country at a Glance 71 Annex I1: Monitoring and Evaluation 73 MAP(S) THE GAMBIA HIV/AIDS Rapid Response Project Project Appraisal Document Africa Regional Office AFTH2 Date: December 19, 2000 Team Leader: Richard M. Seifinan Country Manager/Director: John McIntire Sector Manager/Director: Anwar Bach-Baouab Project ID: P060329 Sector(s): MY - Non-Sector Specific Lending Instrument: Specific Investment Loan (SIL) Theme(s): Health/Nutrition/Population Poverty Targeted Intervention: N Project Financing Data [ 1 Loan [X] Credit [ I Grant [ I Guarantee 1 Other: For Loans/Credits/Others: Amount (US$m): SDR1 1.8 million (US$15.0 million equivalent) Proposed Terms: Standard Credit Grace period (years): 10 Years to maturity: 40 Commitment fee: Up to 0.5% Service charge: 0.75% Financing Plan: Source Local Foreign Total BORROWER 0.60 0.00 0.60 IDA 13.45 1.55 15.00 LOCAL COMMUNITIES 0.60 0.00 0.60 Total: 14.65 1.55 16.20 Borrower: GOV. OF THE GAMBIA Responsible agency: OFFICE OF THE PRESIDENT Address: Office of The President State House Banjul, The Gambia Contact Person: Mr. Anthony Taylor, Secretary to the Cabinet Estimated disbursements ( Bank FY/US$M): FY 2001 2002 2003 2004 2005 Annual 3.20 2.90 3.40 3.80 1.70 Cumulative 3.20 6.10 9.50 13.30 15.00 Project implementation period: 4 years Expected effectiveness date: 03/15/2001 Expected closing date: 12/31/2005 OCS PAD Fo R-v M.AD. 2C A. Project Development Objective 1. Project development objective: (see Annex 1) 1.1. This Project is a country program within the context of the US$500 million Multi-Country HIV/AIDS Program for the Africa Region (MAP) approved by the Board on September 12, 2000. Reference is made to Section A. Program Purpose and Development Objective of the Multi-Country HIV/AIDS Program (MAP) Project Appraisal Document (Report No. 20727-AFR). Only key features are highlighted below which are relevant to the situation of the HIV/AIDS epidemic in The Gambia and the Gambia Multi-sectoral HIV/AIDS Rapid Response Project (HARRP). 1.2. The Gambia fully meets the criteria for MAP eligibility. In line with the goals of the MAP, the overarching purpose of this HIV/AIDS Rapid Response Project (HARRP) is to assist the Government of The Gambia stem a rapid growth of human immuno-deficiency virus (HIV) infection which causes the acquired immuno-deficiency syndrome (AIDS). The project will help organize a preemptive response to the growing lV/AIDS epidemic through a multi-sectoral approach by: (a) maintaining the current low levels of the epidemic; (b) reducing its spread and mitigating its effects; and (c) increasing access to prevention services as well as care and support for those infected and affected by HIV/AIDS. The overall project is premised on the development and expansion of local responses to the epidemic. 1.3. In collaboration with other members of the International Partnership Against AIDS in Africa (IPAA), the project will help step up, organize, and mainstream the response against HIV/AIDS, sexually transmitted infections (STIs) and TB, which are important risk co-factors in the early stages of an lUV/AIDS epidemic. This will be achieved through the provision of HIV/AIDS prevention and care services at all levels (national, regional, and local) as well as in a number of sectors. The emphasis of the project will be placed on the prevention among youth, a group that is particularly vulnerable to WV/AIDS and that represents a large segment of the Gambian population. 2. Key performance indicators: (see Annex 1) 2.1 While a more detailed list of indicators appears in the Logical Framework, the project will contribute to the achievement of three key targets indicating progress against the goal of slowing the transmission of HV in The Gambia: (1) Increasing the percentage of 15 to 24 year olds with access to HIV/AIDS Informnation, Education & Communication (IEC) & services; (2) Stagnant and low rate of prevalence of WV arnong 15 to 24 year olds; and (3) Stagnant and low rate of prevalence of WHV among pregnant women. 2.2. The following constitute the summary indicators for outputs, process, and impact of the program: A. Output Indicators I . At least 50% of population reached through IEC/BCC programs on WV/AIDS. 2. At least 5 key line Departments are implementing agreed action plans. 3. The number of sentinel surveillance sites will have increased by 2 in Project Year I and to a total of 8 by the end of the project. 4. Disbursements for the Community and Civil Society Initiatives (CCSI) will have reached at least 75% of planned levels. -2 - 5. Access to treatment for STIs, TB, and other opportunistic infections available in at least 20% of health facilities by end of the project. B. Process Indicators 6. The National AIDS Council (NAC) fully functioning and formal National HIV/AIDS Strategy and Plan of Action adopted. 7. All seven Divisional HIV/AIDS Committees and Municipality equivalents start implementation of Project activities by the end of Project Year 2 8. Voluntary counseling and testing (VCT) services incorporated into antenatal, TB, and STI services in 50% of Western Division by the end of Year I and in 50% of health facilities in the other divisions by Year 5. C. Impact Indicators 9. At least 90% of the population (aged 15-49) aware of HIV/AIDS transmission modes and means of prevention by end of project 10. Use of condom at last sexual contact among young people (aged 15-24) will have increased by 40% by the end of the project. I11. Prevalence rates of HIV and STI contained to present levels. 2.3. The project will be tracking the epidemiology of HIV/AIDS through the Health Information System currently under development and separately, the monitoring of HARRP activities. B. Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported by the project: (see Annex 1) Document number: The Gambia (Report No. 18361 GM) Date of latest CAS discussion: September 10, 1998 1.1. In the mid-i 990s the HIV/AIDS epidemic was still in its early stages in the Gambia; however the 1998 CAS did mention the need for HIV/AIDS prevention. The CAS also addressed the threat of the sexually transmitted diseases or infections (STI), which are an important co-factor in the early stages of the spread of an HIV/AIDS epidemic. The CAS stressed the importance of addressing major public health concems through preventive rather than curative measures. The instrument that was envisioned in the CAS to tackle the issue of HIV/AIDS prevention (and its linkage to reproductive health outcomes) was a Population Policy LIL. Initial preparatory work for the Population Policy LIL operation has been subsequently subsumed into this larger HIV/AIDS Rapid Response Project. The preemptive nature of this HIV/AIDS project and its objective to both organize and increase the response against the HIV/AIDS epidemic are well in line with the overall social and human capital development strategy that is spelled out in the CAS. Moreover, the proposed operation is fully consistent with the overarching objective of Bank Group assistance, which is to achieve a sustainable reduction in poverty. Both in the context of the Poverty Reduction Strategy and HIPC preparations currently underway, HIVIAIDS and reproductive health are being taken into account (see IDA R2000/221, HIPC Decision Point Document). 2. Main sector issues and Government strategy: Main Epidemiological Issues 2.1 HIV was first diagnosed in The Gambia in 1986. In 1988 the first sero-prevalence survey was undertaken and found a consolidated HIV prevalence of 1.8% among adults (people 15 years old and above), consisting of 1.7% HIV-2 infection and 0.1% HIV-1 infection. This survey was repeated in 1991 at which time survey data showed an increase of HIV-I infection from 0.1% to 0.5%, whereas HIV-2 - 3 - infection was stable at 1.7%. From 1993 to 1995, a study undertaken among antenatal mothers showed similar prevalence rates. Additionally, specific studies of a very high risk group, commercial sex workers (CSW), reflected a similar trend. While HIV-2 remained relatively stable among CSWs at 2.1%, HIV-l infection increased in this group from 2.1% in 1989 to 8.1% in 1993. Unfortunately there are no prevalence data available from 1995 to 1999. However, indirect indicators show a steady increase in the number of HIV cases as well as an increase in HIV prevalence among blood donors (reaching a consolidated level of 3.5% for HIV-I and HIV-2 in one center in 1999). The predominant means of HIV transmission in The Gambia is heterosexual. The extent of mother-to-child transmission, contaminated blood products, needle sharing, and from men having sex with men, is not known. 2.2 Since the beginning of 2000, a sentinel surveillance system has been put in place. The first results show that HIV-2 continues to be stable at 1.7% of adults, but MIV-1 has now overtaken HIV-2, and HIV-1 has increased to a level of 1.8%, resulting in a total consolidated HIV prevalence of 3.5% among adults. Thus on the basis of the most current and reliable data in The Gambia there has been an absolute increase in the IIV prevalence from 1.7% to 3.5%, representing a doubling in the level of HIV-I and HIV-2 infections over the past 5 years. What is even of greater concern is that the HIV-1 rate has gone from 0.5% to 1.8% in the last ten years with indications that the rate of increase has accelerated during the most recent five-year period. An important co-factor of the HIV prevalence, namely the rate of sexually transmitted infections (STIs), is very high in The Gambia. A rapid STI assessment conducted in 1994 showed that one in three pregnant women had signs of an STI, reflecting a high prevalence of these infections not only in women but also among their husbands/partners. This high level of STIs will also undoubtedly accelerate the HIV/AIDS epidemic (Condom use and availability have been erratic, with 1997 survey data estimating that about 5.2 million condoms were available that year, in country, from all sources). Furthermore, the future trends in the number of cases of tuberculosis (TB) is also increasing and will echo the increase in HIV-1 prevalence, as has been the case in other countries in sub-Saharan Africa. In sum, these factors indicate that The Gambia has now entered the stage of an exponential increase of HIV-1 infection, one which is more easily transmissible and damages the immune system faster. The conclusion is that the country is on the verge of transitioning to a high prevalence country unless preventive actions are taken quickly. Government's Initial Response to HIV/AIIDS 2.3. Although aware the HIV/AIDS epidemic had the potential to wipe out hard-won progress made in improving social indicators in past decades, Gambian Governments did not initially aggressively combat the virus because of competing demands, concerns about religious leader attitudes, and concerns about undermining the tourism industry. The Gambia's response to the HIV/AIDS epidemic began modestly in 1986 when the Ministry of Health, Labor, and Social Welfare established the National AIDS Control Program within the ministry. In 1987, the Cabinet approved the establishment of an advisory body, the National AIDS Committee, comprised solely of health professionals. In 1992, the Government launched a limited program to fight the epidemic, prepared a five-year HIV/AIDS prevention, care, and support plan, and also held a resource mobilization meeting to fund the program. Pledges were received from a number of donors, but the military coup in 1994 led to the suspension of aid flows. In 1995, the National AIDS Committee was reconstituted as a multi-sectoral body, continuing under the Department of Health. It has recently been replaced by a multi-sectoral, public and private sector National HIV/AIDS Council, supported by a National HIV/AIDS Secretariat under the Office of the President. 2.4. It must be stressed that initial attitudes toward the HIV/AIDS epidemic has changed significantly. In recent years, efforts to combat the WHV/AIDS epidemic have been conducted in a more open manner and today a number of high government officials are seized with the problem and the dangers stemming from an - 4 - HIV/AIDS epidemic, are more vocal about these dangers, and recognize the risks to Gambia's future development if a major and well-coordinated effort is not launched quickly to stem its spread. In sum, the Government as a whole is conscious of the need to curtail the spread of the virus before it reaches an explosive dimension, as has occurred in a number of SSA countries. Government's Overall Development Strategies 2.5. The Government's long-term development strategy is principally articulated in "Vision 2020 - The Gambia Incorporated" as well as the Strategy for Poverty Alleviation. The Government's goal is to transform the country from its least developed country status into a middle-income one, through the promotion of an economy based on exports of goods and services and the development of human resources. The Government has also adopted a National Youth Policy, a National Education Policy, and a Strategy for Local Government Reforms, each of which bear importantly on long-term development prospects. With respect to the strategy for local government reforms, government line Departments and the funding of activities are to be decentralized to local area councils, over time. 2.6. The Government is now fully aware that the HIV/AIDS epidemic might, if unchecked, jeopardize its long-term development prospects. The basic strategic framework for HIV/AIDS is contained in the National Health Policy: 1994-2000 "Improving Quality and Access" and is a major aspect of reproductive health policy. Over the years, there has been increased multi-sectoral awareness and engagement in HIV/AIDS prevention as evidenced by workshops, surveys on reproductive health behavior, and contacts with youth, women groups, and religious leaders. Many activities have been promoted in conjunction with the Government, principally by UN agencies and NGOs, to prevent and mitigate the spread of HIV/AIDS. These activities have included limited information, education and communication (IEC) campaigns, conferences, condom promotion, dissemination and use of HIV test kits, and sentinel surveillance activities. However, these activities have neither been adequately funded nor coordinated. Government HIV/AIDS Strategy 2.7 HIV/AIDS is referenced in a number of Government strategy documents and most recently in a national consensus workshop on HIV/AIDS policy. The Gambian Development Forum on WIV/AIDS, held November 2000 was a major step in furthering policy debate, discussion and action by Government, civil society, religious leaders and others. In his opening address on November 1, 2000 Gambian President A.J.J. Jammeh called on all Gambians to join him "in declaring war against HIV/AIDS, and to ensure that The Gambia becomes totally free from this number one enemy to development and improved living standards." 2.8 This reflects the recognition by the highest levels of the Gambian Government and civil society that HWV/AIDS is a complex multi-faceted and multi-sectoral problem requiring long-term sustained responses from all sectors of govemment and society. It is also fully consistent with the main program pillars contained in the HARRP. The policy and strategic framework will continue to be developed through a process of planning and program development at both the national and Divisional levels. This process will engage national and regional governmental institutions, the major regional sector NGOs and religious organizations, PLWHAs associations, and other key stakeholders. The goal will be to complete this effort by mid-2001 and in September 2001 have it presented for adoption to the National Assembly (See Annex 7 "Key Implementation Steps, B. National HIV/AIDS Strategy and Action Plan"). The framework will focus on reducing the transmission of HIV and associated morbidity and mortality as well as its impact on individuals, families, and society at large. -5- 2.9. This work will build on existing health, education, agriculture, youth, interior, defense, and tourism plans of action and structures to implement key interventions for HIV/AIDS prevention, care, and support. In the area of prevention, the strategic framework will examine, inter alia, the following areas for action: * Establish effective WHV/AIDS prevention and mitigation activities to curb the spread of the epidemic; * Promote a broad, multi-sectoral response to HIV/AIDS, including more effective coordination and resource mobilization, by government, NGOs, religious associations, the private sector, and communities; * Encourage government sectors, NGOs, the private sector, and communities to take measures to alleviate the social and economic impact of HIV/AIDS; * Encourage a supportive institutional, home, and community-based health care and psychological environment for Persons Living with IHV/AIDS (PLWHAs), orphans, and surviving dependents; * Safeguard the human rights of PLWHAs and avoid discrimination against them; * Empower women, youth, and other vulnerable groups at risk to take action to protect themselves against HIV/AIDS; * Promote and encourage research activities targeted toward preventive, curative, and rehabilitative aspects of HIV/AIDS, provide access to, and quality of, STIs, tuberculosis (TB), and HIV/AIDS prevention, treatment and care (including opportunistic infections), and support services to meet the needs of groups at increased risk of HIV infection; * Increase access to, and use of, voluntary testing and counseling activities; * Increase the provision of comprehensive STI/HIV/TB management in health care facilities; * Increase access to HIVAIDS education and communication; * Encourage delays in the onset of sexual activity among adolescents; o Promote reductions in the number of sexual partners; * Increase accessibility, availability, and use of condoms; a Promote information, education, and communications (IEC) as well as Behavioral Change Communications (BCC) messages that are continuous, appropriate, acceptable, and effective in inducing individual behavioral change; * Empower women and girls to reduce their risk of, and vulnerability to, HIV infection; e Prevent mother-to-child HIV transmission; and * Prevent WV transmission in hospital and health center settings. In the area of care and support, this strategic framework would include, inter alia, the following activities: * Provide home/community-based and clinical care for PLWHAs; * Increase social support for PLWHAs and their families; * Establish an ethical, legal, and human rights framework for PLWHAs; * Expand and accelerate sector-specific interventions to mitigate HIV/AIDS impact; and * Increase HIV/AIDS operations research and surveillance. 2.10 Recognizing that the HIV/AIDS epidemic is an "emergency" and that time is of the essence, the proposed project will focus on a relatively limited number of key priority activities with the maximum potential for slowing the spread of the epidemic, thereby avoiding dispersal of energies and resources over too wide range of actions in the short term. This fast-track project would therefore begin before completion of any new strategy, while being a means to finance the ongoing strategic planning process. The Government expects that if its comprehensive, multi-sectoral five year strategy and plan of action, receives additional technical and financial support from the international community, the people and institutions of - 6 - The Gambia will have the capacity to contain the spread of the epidemic and its enormous burden on society and the economy. Synergies with Existing HIV/AIDS Activities 2.11. HARRP will build on activities already underway at various stages of implementation, including those financed by the IDA-Participatory Health, Population and Nutrition Project (PHPNP), approved in March 1998. Of particular note are the recently approved STI and HIV management manuals developed by the DOSH and a technical advisory group. These manuals use the syndromic management approach and are consistent with UNAIDS guidelines, providing the basic framework for a national approach for prevention, treatment and care. PHPNP also supported revision of the mid-wifery curriculum, blood supply donor mobilization, and improvements in primary and secondary health facilities. Under a complementary health project financed by the African Development Bank (AfDB), a national public laboratory will provide essential testing support for reproductive health activities. 2.12 Another program which is to be expanded with the help of the HARRP is the "Stepping Stones" effort which has been supported by donor and technical assistance agencies both within and outside the UN system. This community level, empowerment and participatory learning and action approach uses infertility prevention as the acceptable pathway to discuss STIs and HIV prevention issues with traditional villages and communities. Several local organizations including Action Aid, The Gambia Family Planning Association, the German Gambia Family Planning Program, the Worldwide Evangelization for Christ, the Medical Research Council and the DOSH have undertaken a collaborative effort, run under a joint management structure, to pilot the approach. They have now developed the methodology and manuals and tested it in several communities. This "Stepping Stones" approach has been partly evaluated and found successful. 2.13 Other relevant ongoing activities include defining priority health indicators and the allocation of resources in the health sector. HARRP is designed to channel government, donor, community, and other partner resources, to a multi-sectoral HIV/AIDS prevention and care strategy and action plan. The emphasis will be on interventions which can be implemented rapidly, targeting high risk and other target groups, working as much or more outside the public sector, with communities and NGOs. 3. Sector issues to be addressed by the project and strategic choices: 3.1 The basic issue is how to prevent the spread of HIVAIDS in a multi-sectoral manner. The Multi-country HIV/AIDS Program for the Africa Region (MAP) provides the framework to do so as well as the concept for the HARRP. The Gamnbia is eligible for MAP funding in that it has satisfied the four MAP eligibility criteria, namely: (a) Satisfactory evidence of a strategic approach to HIV/AIDS. Gambia has a strategic approach in place and intends to improve and strengthen this approach through an intensive participatory process which will culminate in a new medium term strategy and plan of action; (b) A high level HIV/AIDS coordinating body. The Gambia has created the National HIV/AIDS Council under the Office of the President, with broad representation of key stakeholders from all sectors, including people living with WV/AIDS. It has also established a National HIV/AIDS Secretariat under the Office of the President to oversee implementation. (c) Government agreement to use appropriate implementation arrangements. Government has agreed to accelerate project implementation by channeling funds to communities and civil society. In addition, Government has agreed to contract out financial management. -7- (d) Government agreement to use and fund multiple implementation agencies. Government has agreed to expand HIV/AIDS activities to a broad range of Departments, Divisions, Municipalities, as well as to fund activities undertaken by non-government and community-based organizations and the private sector. 3.2. HIV/AIDS is a complex, multifaceted, multisectoral problem requiring long term, sustained and broad-based responses, including a range of activities involving virtually all levels and sectors of government and society. Rapid spread of the HIV/AIDS epidemic would have potentially damaging consequences for several sectors, such as education, rural development/agriculture and the tourism industry, that are key for the future development of The Gambia. However, each of these sectors could in turn provide potential key contributions to the overall fight against HIV/AIDS. These contributions are important and must be mobilized to achieve the overarching goal of the project which is to stem the spread of the WIV/AIDS epidemic. 3.3 This fast-track project will begin with core activities that are ready for implementation. Support to capacity building and policy development will help galvanize the fight against WV/AIDS and STIs, as well as organize prevention and care activities in sectors and communities not yet engaged. Activities within the various sectors will be geared to reaching the personnel and staff involved in these sectors and using them as agents in the fight against the HIV/AIDS epidemic. First, uniforn personnel and other public sector staffs will be trained about HIV/AIDS and STI prevention, and care activities. Second, these staff will be HIV/AIDS and STI prevention agents for the people they interact with. Sector staff will refer their constituencies to HIV/AIDS and STI care services that will be provided by the health sector. Thirdly, these HIV/AIDS and STI prevention agents, as community members, will advocate, contribute to, and participate in community and civil society initiatives. 3.4. Taking the example of the education sector, this approach will work in the following manner: First, teachers will be targeted for information, education and communication (IEC) and behavioral change communications (BCC) programs. Teachers will be enrolled as key agents and role models in the fight against HIV/AIDS and STIs. Second, students, when properly informed and educated about the dangers of HIV/AIDS and STIs, will themselves become potent communicators of WHV-related prevention messages to their age group peers, friends, parents, and the society at large. Teachers will promote behavioral change messages through their interactions with the parents-teachers associations and other in-school and out-of-school groups, constituencies, and organizations. Finally, Family Life Education (FLE) programs will be expanded. While curricula in The Gambia already includes the teaching of FLE and therefore offers a solid base on which to build, FLE is not mandatory at this juncture. As a result of the national HIV/AIDS strategy process, this will be examined and the policy possibly changed. These types of activities are primarily designed to reach adolescents in and out of schools. 3.5. Rural development is another area that has an important role to play in the concerted effort to inform and motivate populations to prevent the spread of the virus. A rural development strategy is being developed and it is planned that this strategy will take into account ways in which rural development programs and rural development staff can incorporate and cooperate in the effort to prevent the spread of HIV/AIDS. Currently there exists a wide array of agriculture and livestock services which can be brought to bear in addressing HIWV/AIDS problems during their frequent interaction with rural communities. 3.6 The health sector in The Gambia has unique responsibilities and expertise. First, the health sector is responsible for specific aspects of the campaign such as epidemiological oversight, testing, management of the blood supply system and quality assurance, provision drugs for STI, TB, and other opportunistic infections, and application of the STI syndromic management approach. The health sector must be the - 8 - supplier of, and assure that such services and/or products are available (no stock-outs), of good quality, and affordable. Health personnel will be further trained in how to provide these services, counseling related to these services, and/or products. Second, in The Gambia the health sector is organized at Divisional levels with health centers that could serve as referral units to support HIV/AIDS activities carried out by other sectors, non-governmental organizations, and communities. Third, health personnel must become key allies in the fight against HV/AIDS, in its prevention and care dimensions. Overall, it is envisioned that health services will not only play its customary service supply function, but also welcome and help patients referred to it either by efforts in other sectors and/or by NGOs and communities. The DOSH is already engaged in a variety of relevant communicable disease and reproductive health activities. These include the provision of contraceptives, a tuberculosis program, as well as STIs testing and treatment. Such ongoing efforts will be taken into account in the new undertakings. 3.7. Community involvement is of a crucial importance for this project (roughly half of the funds will support community and civil society initiated activities through the "Community and Civil Society Initiatives" component). Community activities are needed to support prevention (principally at this stage), as well as care of those infected and affected. Such efforts will help empower communities at different levels to heighten the level of awareness of their general population, fight discrimination against individuals infected and/or affected by the WHV virus, and be an incentive for individuals to seek prevention and care services when needed. Strong emphasis will be placed on counseling of both patients and families. C. Project Description Summary 1. Project components (see Annex 2 for a detailed description and Annex 3 for a detailed cost breakdown): 1.1. The proposed project will have four components: 1) capacity building and policy development; 2) multi-sectoral responses to prevention and care; 3) health sector responses to STIs and HIV/AIDS management, including prevention and care; and 4) Community and Civil Society Initiatives. While described in greater detail in subsequent sections, HARRP institutional arrangements are straightforward and briefly described here: The National HIV/AIDS Council (NAC) and National HIV/AIDS Secretariat (NAS) will be under the Office of the President. The NAC is the oversight body, the NAS is the administrative, coordinating, and monitoring mechanism for the entire project. Using the existing decentralization structures, namely the Divisional Coordinating Committees, sub-bodies called "Divisional HIV/AIDS Committees" (DACs) will be established at Divisional (or Municipality equivalent) level. Line Departments will receive funds to carry out sectoral H1IV/AIDS programs which will be supervised by their designated focal points. Component 1. Capacity Building and Policy Development (US$3.50 million) 1.2 This component would aim at strengthening Gambia's capacity to cope with the spread of HIV/AIDS by supporting: (i) the work of the multi-sectoral National HWV/AIDS Council (NAC) and the Secretariat (NAS), the Divisional/Municipal AIDS Committees (DACs), and small entities requesting proposal preparation assistance; and (ii) the development of the national HWV/AIDS Strategy and Action Plan. Four sub-components address the following areas: (a) National Strategy and Action Plan; (b) HARRP Coordination and Administration, (c) Advocacy, Training, and Technical Support Activities, and (d) Assessment, Monitoring and Evaluation (i.e. surveillance and mapping, operational research and pilot testing, and other monitoring and evaluation activities). These sub-components are further detailed in Annex 2, Project Description. Component 2. Multi-sectoral Responses for HIV/AIDS Prevention and Care (US$2.65 million) -9- 1.3 This component will improve the capacity of non-health sector line Departments to respond to the HIV/AIDS epidemic, emphasizing prevention and care. As part of their ongoing Departmental operations, this will be achieved through development of Departmental policies, coupled with a two-prong action approach, namely: (i) the provision to the line Department staff and their dependents of HIV/AIDS and STIs education, training, condoms, and other support, to encourage HIV/AIDS and STIs avoidance behavior; and (ii) the enhancement of the capacity of these staffs to provide their partners and audiences (e.g. parents-teachers associations, farmers associations, village health committees) with means to provide effective HIV/AIDS and STI prevention, and ways to access health care facilities and care. Interested line Departments either have or will appoint HIV/AIDS focal persons to refine and carry out Departmental policies and action plans, with support from HARRP in terms of facilities, equipment, and incremental operating costs. 1.4 Currently the Departments of Education, Agriculture, Defense, Interior (Police, Prisons and Religious Affairs), Youth, and Tourism, have such action plans in process and will be HARRP participants. Other Departments may join after project effectiveness, subject to availability of Government, HARRP, or other donor funds (The health sector is separately treated under Component-3 "Health Sector Responses to STI/HIV Management"). 1.5 Line Departments would have wide discretion in how they seek to achieve the two goals of: i) Departmental staff HIV/AIDS and STI avoidance behavior, and ii) their staff reaching their constituencies on HIV/AIDS and STI issues. Eligible line Department activities would depend on the content of interim Departmental action plans for the first project year, some of which have already been developed. These plans include appointment of Departmental focal points, provision for training, technical advisory services, HIV/AIDS and STI IEC/BCC materials, VCT and condom distribution, and support for facilities and equipment, including incremental operating costs to effectively carry out this effort. As mentioned, such plans address both intemal groups (Departmental staff) and their external target groups on a phased basis. Subsequently, the final National HIV/AIDS Strategy and Action Plan will refine the activities/instruments of Departmental plans, and provide the basis for longer-term engagement. (.omponent 3. Health Sector Responses to STI/HIV Management (US$1.85 million) 1.6 The Department of State for Health and Social Welfare (DOSH) and more broadly the health community, have special responsibilities for STI and HIV/AIDS prevention and management. This sector therefore warrants a separate component, making provision for prevention and care from a health sector perspective, whether public or private. This component provides the resources to the health sector to build on the framework of the HIV/AIDS and STI management manuals recently adopted by the DOSH, as well as other reproductive health and communicable disease activities currently performed by the DOSH and its health sector partners. Under this component, the DOSH will be able to do the activities described above for other line Departments (WV/AIDS and STI avoidance behavior by its staff and dependents, and reaching constituencies and external target groups). In addition DOSH can enhance its reproductive health and opportunistic infection efforts with funds provided herein (especially those tested for HIV), recognizing it will not be able to undertake all health sector specific tasks at once, nor do it without assistance from other non-public health care providers. It will prioritize which aspects, where, when, and how quickly it can implement and scale up its HIV/AIDS and STI management services. Using the experience and capacity of the PHPNP, the procurement of condoms, opportunistic infection drugs, gloves and other medical supplies, testing kits, and limited laboratory equipment is envisioned. Further, based on the model already in place in one health facility (Brikama), reproductive health clinics will be installed in each of the Divisions, with trained staff. A draft of the DOSH HIV/AIDS and STIs Action Plan is being refined. The basic features - 10- which differentiate the health sector from other sectors are those related to its medical functions such as diagnosis and treatment of opportunistic infections such as STIs and TB, care at health posts, health centers, and hospitals, and laboratory test assaying. 1.7 Two other aspects need highlighting with respect to the health sector: First, blood supply is important and the enhancement of the blood supply system is being partly addressed under the PHPNP. In this regard, the stated policy goal of The Gambia is that national blood supplies be controlled and assured as safe. Blood donor mobilization is being financed under the PHPNP along with a readiness to cover preparation costs of a plan for a national blood transfusion services, identify the necessary equipment to complement what is being done under existing AfDB and IDA financing, what would be needed in terms of blood bags and reagents, and training of laboratory technicians. The objective would be to ensure that blood for transfusion and blood products do not transmit HIV and other infections. Second, there is need for specialized training in HIV/AIDS and STI hazardous materials handling and provision of medical supplies to health workers so as to prevent STI and HIV transmission. Health workers represent a particularly vulnerable group because of their routine contact with hazardous materials, they are on the front line, and need to be confident that their personal safety and well-being are taken into account so that they actively promote testing of patients and care for PLWHAs. Further, inclusion of norms and standards for hazardous waste disposal, appropriate to The Gambia, will be taken into account at all health facilities, along with training of facility personnel in this regard. 1.8 The Bank has also been working closely with its UNAIDS partners, drug companies, and developing-country governments on access to antiretroviral (ARV) therapy. As the situation evolves, individual Departments or Ministries of Health may explore ways of introducing ARV therapy. In The Gambia, should the Government so decide, the HARRP will be able to support the development of guidelines and the strengthening of health infrastructure to make the use of these drugs safe, effective and sustainable. IDA will also actively follow up the trend in affordability and efficacy and remain open, on a case-by-case basis, to supporting ARV drugs and the necessary infrastructure where resources may be required. Component 4. Community and Civil Society Initiatives (US$8.20 million) 1.9 "Community and Civil Society Initiatives" will be a financing mechanism to provide grant resources to support community, civil society, worker associations, and "establishment or primary unit" initiatives ("establishments or primary units" are businesses, military camps, prisons, refugee camps, religious groups, trade associations, sports clubs and the like). This component will therefore support both "community-based" and "community-involved" activities. A Community and Civil Society Initiative mechanism will be established by, and report to, the NAC, through the NAS. A nominal initial allocation will be made to the five Divisions (and two municipalities) on a population density basis, so that there is proportionate sharing and an indicative planning amount from which to begin work. (See also Annex 2 "Project Description" for more details). These allocated ceilings will be adjusted based on experience and performance. 1.10 Eligible Applicants. Applications to the Community and Civil Society Initiatives (CCSI) can be submitted to the DACs directly by the community or community association, a private entity, or by collaborators (NGOs, consortiums) on their behalf. An NGO or other organization can consolidate a number of smaller proposals to create a medium sized proposal, and submit it to the DAC. In addition, a national, multi-Divisional, or divisional concept/program benefiting communities which are a priori not identifiable, may be approved for funding under this component, provided the concept/program meets CCSI's pre-established eligibility criteria. Basically there will be three types of proposals submitted by - 11 - eligible organizations (ranging from NGOs, CBOs, VDCs, PLWHAs, associations, the private sector and the like) for approval: (i) large scale "Category A" activities with National, Multi-Divisional, or Divisional coverage which will require substantial experience, and institutional capacity, and for which entities will be pre-qualified; (ii) medium-small scale "Category B" activities which will require considerably lesser standards of capacity; and (iii) "Category C" activities proposed by communities (CBOs and VDCs inclusive) on their own behalf. Qualified Category B and C applicants will be able to obtain modest grant assistance from the HARRP for local consultant support to help in preparing proposals and organizational training, if need be. I. I I Activities Eligible for Funding. Project proposals will be considered based on an HIV/AIDS Activity Positive List which will be further defined in an IDA approved, Community and Civil Society Initiatives Operations Manual. Assuming a qualified applicant puts forward a proposal consistent with the menu/positive list, it would be presumed to be eligible for financing. Community and Civil Society Initiatives' activities would inter alia address the following areas: (i) information education and communication/behavioral change communications (IEC/BCC) campaigns; (ii) support to high-risk groups; (iii) youth-related activities; (iv) condom supply and dissemination. (This "illustrative" list is not intended to limit the scope of activities that may become eligible for funding under this component.). CCSI would therefore use various ongoing means to mobilize and attract target groups to discuss and decide how to prevent HIV/AIDS. Examples of such common interest social activities could include gardening, literacy and local crafts. 1.12. CCSI Subproject approval process. CCSI subproject proposal applications can be submitted to the DACs directly by the community or community association, a private entity, or, by collaborators (NGOs, consortiums), on their behalf. An NGO or other organization can consolidate a number of smaller projects, or a medium size project, and submit it to the DAC. All large projects will be submitted to the NAS for rapid appraisal and approval. Projects approved at the Divisional/municipal level will not go through any re-approval process at the NAS level. However, the NAS will have oversight responsibility as to the quality and compliance of such projects in responding to HARRP objectives. With respect to activities of national scope, whether proposed by civil society, NGOs, associations, research institutions, or a consortium of these groups, these would be reviewed and approved by the NAS and NAC. The details of the proposal approval process, the financial approval thresholds, and the timelines to notify applicants and their options if the proposal is not accepted will be described in the CCSI Operations Manual. I.13. Institutional Arrangements. Various institutional options were considered, including contracting the Gambia Social Development Fund financed by the African Development Bank, channeling all resources to the decentralized rural development structures supported by the European Development Fund (Support to Decentralized Rural Development) and which use multi-disciplinary facilitation teams, or utilizing the Local Initiative Fund (LIF) approved in 1998 under the PHPNP. After due consideration the Gambian Govemment determined its preference would be to use multiple channels for developing and presenting proposals, and to rely on Divisional/municipal AIDS Committees and the NAS to process applications for approval and monitoring activities. The existing mechanisms were found not to be the "right fit", either because they were principally micro-financing credit operations in an early testing mode having limited geographic coverage and more infrastructure-oriented, had other priorities, had long appraisal or developmental timelines, or already had much to do with their current plans and programs. The Community and Civil Society Initiatives system will be demand driven, will complement existing mechanisms in many cases, and will allow the full gamut of potential users to access resources. It is also expected that regular working meetings will be held with the different funding entities such as the Social Development Fund, SDRD, and LIF, to share experience, work to complement each other rather than compete for clients, and consider how these entities might serve as delegated CCSI agents to expand HARRP outreach. - 12 - 1. 14. The selected approach will require supplemental staff for the NAS and DACs as described in Component I sub-component "(b) HARRP Program Coordination and Administration". With the further clarification of the Community and Civil Society Initiatives Operations Manual before operations begin, the full extent of supplemental staff needs will be known. At this juncture at the DAC level, only a HARRP Facilitator is contemplated. Indicate B Sank- % of Componet Sector . Costs % of financing Bank- ________________________ _ . . l )S Total US$M ) financing 1. Capacity Building and Policy Multi Sector 3.50 21.6 3.25 21.7 Development 2. Multi-sectoral Responses for Multi Sector 2.65 16.4 2.50 16.7 Prevention, and Care 3. Health Sector Responses to HIV/STI Health 1.85 11.4 1.75 11.7 Management, including Prevention and Care 4. HIV/AIDS Community and Civil Multi Sector 8.20 50.6 7.50 50.0 Society Initiatives I Total Project Costs 16.20 100.0 15.00 100.0 Total Financing Required 16.20 100.0 15.00 100.0 Explanatory note: (i) The "Indicative Costs" column shows the total project cost including the Government, IDA and CommunitiesiNGOs. (ii) The "% of total" column reflects percentage allocation of the total project cost (US 316.20rn) to the four components, (iii) The "Bank Financing" column indicate the amounts allocated to the four components from total IDA financing (USS15m), and (iv) The "% of Bank financing" indicates the percentage allocation of IDA credit amount to the four components. 2. Key policy and institutional reforms supported by the project: 2.1 The Project will assist in carrying out a comprehensive national HIV/AIDS Strategy and Plan of Action. By supporting the National HIV/AIDS Council and Secretariat in the Office of the President it represents recognition that this is a multi-sectoral issue, and that the Government has taken leadership in engaging public and private institutions to do common cause against this threat. 3. Benefits and target population: 3.1 The project will: * Improve individual and household ability to prevent HIV/AIDS and/or mitigate the effects of the epidemic; * Reduce HIV and STIs incidence through emphasis on safe sex practices, better diagnosis and treatment of opportunistic infections for PLWHAs; and * Improve community responses and local empowerment to mitigate and/or respond to the potential impact of the spread of HIV/AIDS. 3.2 The project would directly benefit three groups, namely those with high-risk behavior, a priority target - 13 - group, and the general population. The high-risk group is comprised of commercial sex workers and their clients, truck drivers or long distance transport personnel, and migrant workers, and those already infected. The priority target group is comprised of women, youths aged 15-24, orphans, and line Department personnel such as educators, health workers, the tourist industry and personnel in uniform (military, police, customs, immigration, firemen). This priority target group was chosen because either they constitute the more vulnerable, with coping mechanisms for households stretched to the limit, or represent a crucial human resource and/or delivery channel of information and attitudes, which have particular impact on the success of an HIV/AIDS prevention program. Although the general population or community is at lower risk of HIV/AIDS infection, it will greatly benefit in its own right from the information campaigns, and better access to HIV and STI prevention services and supplies such as condoms. All Gambians will benefit indirectly from the project's efforts to combat the spread of WHV/AIDS and to strengthen the country's ability to respond to the epidemic, thereby mitigating the social and economic impact of the disease. 4. Institutional and implementation arrangements: 4.1. Implementing agencies and Coordination. Project coordination responsibilities will be carried out by the various implementing agencies at the administrative levels: (i) At the national level, the National HWV/AIDS Council (NAC) and National HWV/AIDS Secretariat (NAS) will be under the Office of the President. The NAC is the policy formulation and the oversight body (national WHV/AIDS Strategy and Plan of Action) with equal participation of the government and the civil society and will be the overall accountable entity for the Project. The NAS will be the coordinating and administrative body reporting to NAC, and will be responsible for (a) operational coordination ( line Departments of State, divisional/municipality authorities, NGOs, associations, the private sector, donors/UN agencies and the like), (b) overall implementation monitoring and evaluation, (c) financial management through a private sector financial management firm/agent, and (d) procurement management. NAS will also coordinate major national level sensitization and mobilization workshops and seminars. It will also constitute any needed technical committee, as directed by the NAC for technical evaluations and/or planning. Line Departments of State will receive funds to carry out sectoral WHV/AIDS programs which will be supervised by their designated focal points. These participating line Departments will prepare and submit annual work plans (AWP) to the NAS as well as monthly progress reports (including financial). (ii) At the Divisional or Municipality levels, the project will use the existing decentralized structures, namely the Divisional Coordinating Committees (DCC). Under the project, divisional (or municipality equivalent) committees on WHV/AIDS will be established as a sub-committee of the DCC and each will be designated as a "Divisional HIV/AIDS Committee" (DAC). Committee members will select the chairperson of the DAC for a one-year period on a rotational basis. The DACs will have roughly equal membership from Government (line Departments and local government) and civil society (NGOs, women, youth, the private sector, PLWHAs. PLWHAs must be represented). DACs will convene monthly to focus on the proposals submitted under the CCSI for project appraisal and implementation coordination. DACs will prepare and submit monthly progress reports to NAS on project implementation progress. They will also be expected to visit Community and Civil Society Initiative sites. DACs will be responsible to mobilize its 'member' frontline staffs to coordinate activities at the community level in accordance with the CCSI Operations Manual. The project will finance HARRP Facilitators at each Division (or municipality equivalent) who would (a) promote the CCSI, (b) advise the DAC on the project cycle, (c) help in screening and presenting proposals, and (d) assist in monitoring CCSI approved activities. (iii) At the Community level, the participating community organizations will be responsible for CCSI -14 - activities implementation with support from CBOs, NGOs, private sector and various groups from the civil society. Community groups will be responsible for implementing community subprojects that qualify for funding in accordance with HARRP principles of transparency, participation and supervision/ monitoring. 4.2. Project Management/Administration. NAS will develop and implement a Project Operations Manual, which will cover components 1-3, and a separate manual for CCSI (component-4). A preliminary draft of the CSCI Operations Manual has been prepared. These manuals will clearly highlight the procedures, rules/regulations, processes, formats, responsibilities and timelines for the administration of the project at the national, divisional and the community levels. 4.3. Financial management, reporting and auditing arrangements (see Annex 6): A financial management capacity assessment was performed during project preparation and appraisal. The report can be found in project files. It covers the project's overall financial management arrangements at all levels including NAS, line Departments, DAC and CCSI grants beneficiaries. The findings of the assessment are taken into account in the design of the project financial management system to ensure that it meets both the project's needs and World Bank requirements. 4.4. Financial Management: The design of the financial management arrangements will aim at ensuring both timely and reliable flow of funds to the implementing entities at all levels. For this purpose, the financial management of the project at the central level will be contracted out to a private Financial Management Agent (FMA). This contract will be initially for two years, at which time it will be jointly reviewed by the Government and IDA to determine if it is necessary to continue financial management outsourcing. The FMA will be responsible for carrying out all matters related to the financial management of the project under the supervision of NAS. Terms of reference for the selection of the FMA specify that the selected firm will set up the project's financial management system (including development of the Project Operations Manual and the installation of financial management software) and provide technical support including training and posting an adequate number and mix of staff at NAS on a permanent basis to facilitate the collation of financial statements received from the various implementing entities. As instructed by NAS, FMA will manage the principal HARRP accounts, disbursements of funds from them, such as advances, replenishments of advances, payments to NAS goods and service providers. In collaboration with the NAS, FMA will also assist the accounting units of participating line Departments and the DACs (or Municipality equivalent) in properly maintaining the project accounts. 4.5. The financial management arrangements for this project will build on existing accounting units within line Departments, municipal councils and the geographic Divisions, under the responsibility of NAS which will be assisted by the financial management agent (FMA). The Project's Operations Manual will describe financial management, reporting and internal control procedures applicable within the line Departments and DACs. It should be noted that with respect to the Community and Civil Society Initiatives, the approval of proposals would be the responsibility of the NAS and DACs (or Municipality equivalent), while disbursement will be separate and overseen by the relevant accounting units and the FMA. To address financial management capacity weaknesses within the line Departments and DAC, training will be provided to accountants involved in the financial management of the Project as part of the FMA terms of reference. In addition, funds will be disbursed by NAS/FMA for line Departments expenses based on approved annual budgets and payment requests sent to NAS by the line Departments; payment requests will be approved only after appropriate controls by NAS/FMA. 4.6. Reporting: Each of the line Departments, DAC secretariats and the NAS will prepare Annual Work Programs (AWP), including disbursement forecasts. All Annual Work Programs will be consolidated by the NAS into the project's overall Annual Work Program. Based on AWPs, each line Department and DAC Secretariat will prepare quarterly reports. The Financial Management Agent will prepare NAS quarterly - 15 - reports and consolidate all individual reports in the project's overall quarterly reports, including financial, procurement and physical progress. Beneficiaries of Community and Civil Society Initiatives will be expected to report on their expenses before their advances are replenished. The Project Operations Manual will further elaborate on reporting requirements, including format and timing. 4.7. Audit requirements: The financial statements of the project will be audited for each fiscal year by an independent auditor acceptable to IDA in accordance with standards on auditing also acceptable to IDA. Audit reports of reasonable scope and detail would be submitted to IDA within six months from the end of the audited period. The auditor will provide an opinion on i) the project financial statements (statement of Source and Application of Funds and Balance sheet); ii) the statement of expenditures (SOE); and iii) the Special Account (SA). The auditor will also issue a separate management report on Intemal Controls and operational procedures outlining any recommendations for improving intemal accounting controls and operational procedures identified as a result of the financial statement audit. The audit will also cover controls on the monthly expenditure reports submitted by line Departments and DACs. Audits of the community and other local implementing entities will be performed on a random sample basis. In addition, all sub-projects financed for an amount greater than the equivalent of US$50,000 (this amount will be subject to review and change, depending on project performance), will be systematically audited and reported on by the auditors. The auditor's report should be submitted to IDA no later than six months after the end of a fiscal year. 4.8. Procurement arrangements: Major procurement such as vehicles, office and medical equipment/supplies will be handled by the NAS. Procurement of items costing less than US$20,000 related to IEC/BCC materials, workshops, training, and operations will be handled by the line Departments and DACs (or Municipality equivalent) using the specified procurement methods identified for the project. This limit may be revised according to experience and performance. Ownership of the signed contracts will be with respective line Departments including contract management. 4.9. With respect to CCSI activities, the project will encourage contracting technical advisory and capacity building services to private entities including NGOs and similar institutions that have experience working with rural communities. The detailed planning, design, and execution of subprojects will also be contracted out to similar entities. NAS will establish the process for identifying and contracting service providers, based on needs. A large part of the project's training programs will also be contracted out, as well as impact and performance studies, surveys, operations research and beneficiary assessments. 4. 10. Disbursement arrangements: Specific disbursement procedures will be developed for the HARRP to address the need for rapid response. The key considerations defined for the Multi-country HIV/AIDS Program will apply to the HARRP. These considerations are: a) a link between physical progress and project expenditure, b) the need for a sufficient balance in the Special Account to cover decentralized and emergency activities, and c) an efficient and effective flow of funds to meet the needs of the project during a relatively short implementation period. Funds will be disbursed from the IDA to a single Special Account administered by the Financial Management Agent at the central level on behalf of the NAS. The initial deposit to the Special Account will cover IDA estimated financing for the first six months of project implementation. An advance account will be opened for each line Department and each DAC in which an advance will be made from the Special Account, and subsequently replenished. Disbursement of funds to the individual communities will be done from the Divisional/municipal accounts following the approval of the sub-projects. For larger sub-projects, disbursement can be done directly from the Special Account to the beneficiaries account given the large amounts involved. - 16 - FLOW OF FUNDS, INFORMATION AND ORGANIZATION CHART Office of the President National World Bank/IDA HIV/AIDS Credit Account Line Departments - Council 4 National lo f nfrato Divisional HIV/AIDS L _ H.VNAIDSo Committec I Secretariat Bank account in I Financial commercial bank m Management lSpecial Account NGOs, CBOs, VDCs, Private sector (applicants) Bank account in __ commercial bank m s d g a + p| ~~~~~Suppliers of goods| |and services I Flo. of Information ~>Flow of funds 4.1 1. Use of PMR-based disbursement method: The overall project financial management system will include Project Management Reporting (PMR) capability from the beginning of project implementation. It will, however, follow traditional disbursement methods during an 18-month interim period while PMR capacity is being developed, and this includes strengthening of financial management capacity at all levels. In any case, it is difficult to make accurate cash forecasts, particularly for the first year, given the nature of the project. Quarterly PMR reports, including financial, procurement and physical progress reports, will be prepared as soon as the Project starts. Within the interim period of 18 months, PMR capacity will be reviewed and a determination made as to Project readiness to shift fully PMR-based disbursement. In sum, the Project is expected to operate under PMR-based disbursement at the end of the 18-month interim period, while will following traditional disbursement methods in the interim period. D. Project Rationale 1. Project alternatives considered and reasons for rejection: 1. I See Multi-Country HIV/AIDS Program for the Africa Region Project Appraisal Document (Report No. 20727 AFR), paragraphs 67-69 as to the reasons for selecting the MAP approach. With respect to The Gambia specifically, one option considered was to simply supplement the work being done under the Participatory Health, Population and Nutrition Project in reproductive health. However, it was not felt this would be the most effective solution, given the multi-dimensional nature of the HIV/AIDS problem, the need to move flexibly and rapidly at community level, and taking into account the demands already placed on the Department of State for Health. - 17 - 2. Major related projects financed by the Bank and/or other development agencies (completed, ongoing and planned). Latest Supervision Sector Issue Project lPSR) Ratings I__ ___ __ ___ __ ___ __ ___ __ |__ -(Bank-financed projects only) Implementation Development ! Bank-financed Progress (IP) Objective (DO) HNP, HIV/AIDS and Reproductive Cr. 3054-GM: Participatory S S Health Health, Population and Nutrition Project (Closes June 30, 2003) Education, Family Life Education Cr. 3128-GM Third Education S S Project (Closes April 30, 2003) Gender Cr. 2141-GM Women in S S Development Project (Closes 1998) Other development agencies AfDB Social Development, Health infrastructure EU EDF Support to Decentralized Rural Development GTZ Program support (Stepping Stones Approach) WHO Program support (US$500,000) UNAIDS/UNDP Program support (US$500,000) UNICEF Program, support (HIVAIDS Sub-projects: US$1.0 Million) UNFPA Program support Catholic Relief Service Program support (HIV/AIDS home care pilot project US$300,000) - 18 - Action AID Stepping Stones approach and community based programs Australia Consultant Trust Funds (Program Support) IP/DO Ratings: HS (Highly Satisfactory), S (Satisfactory), U (Unsatisfactory), HU (Highly Unsatisfactory) 3. Lessons learned and reflected in the project design: 3.1 Stakeholder Consultation; Key stakeholders, particularly those with an important role in implementation, should be involved from project identification, through preparation and appraisal, and throughout implementation. The project has been prepared in consultation with both implementers and donor agencies, working within the framework of the preparatory process for the HIV/AIDS National Strategy and Plan of Action. The Joint Statements of the UNAIDS Agencies of August 2, 2000 and on November 28, 2000 by representatives of WHO, UNICEF, UNFPA, UNDP, the World Bank and UNAIDS Secretariat reflects the high level of cooperation and collaboration. 3.2 Procurement capacity is often a weak point in achieving rapid project implementation. Therefore provision has been made to finance a Procurement Specialist and procurement consultancy support under the project (a procurement agency would not be appropriate for this project in view of the limited procurement under International Competitive Bidding (ICB) procedures). 3.3 Financial Management: Particularly given the new structures, it is important to have both sound financial management and clear accountability for both the Government and external financing. Stress has been put on this during preparation and it is reflected in agreement to employ a financial management agent. 3.4 Implementing across Departments: Past experience has demonstrated difficulties in implementing projects across multiple Departments. Obviously a multi-sectoral HIV/AIDS project must engage a number of line Departments and local government mechanisms. The risks inherent in this arrangement will be mitigated by the fact that the project will be "coordinated" in the Office of the President. Such high level coordination will give the HARRP sufficient authority to facilitate timely resolution of bureaucratic difficulties which might arise. 3.5 Coordinating Body vs. Managing or Implementing Agency: Experience in other situations has shown the danger of a "so-called" coordinating body overstepping its role and attempting to undertake implementation. This results in numerous implementation problems, and turf conflict. Both the Government of The Gambia and IDA have kept this issue at the forefront of discussions on the establishment of the National HIV/AIDS Secretariat; it will have coordinating, administration and monitoring and evaluation functions, but it will not implement programs. 3.6 Additional lessons learned from IDA financed projects in The Gambia and Bank activities elsewhere, and which guided HARRP development include: (i) where there are limited resources and HIV/AIDS prevalence is low, a focused approach is more likely to be successful; (ii) high level official--and continuing--commitment to the fight against HIV/AIDS, is essential; (iii) large scale condom promotion and marketing should result in large increases in condom use; (iv) WHV/AIDS is not a "health sector" problem alone, but requires a multi-sector effort ; (v) NGOs, CBOs and the private sector should play significant roles in HIV prevention and care. - 19 - 4. Indications of borrower commitment and ownership: The Government has formally advised the Bank of its commitment to undertake an extraordinary effort to contain the spread of the virus. This is fully articulated in the President of the Gambia's address of November 1, 2000 at the National Development Forum in which he specifically commits the country to a war against HV/AIDS. Also, The Gambia has held a series of workshops and planning meetings to sensitize policy and decision makers, civil society, geographic regions, donors, community representatives, and PLWHAs, and to seek guidance, build ownership, and encourage local initiatives. (Senior Policy Makers in Government, the Private Sector and NGO Workshop (2 days)-June 2000; Youth AIDS Forum-September 2000; Line Department Focal Point Workshop (2 days)-September, 2000; NGO Sensitization Meeting-October 2000; National Development Forum on WIV/AIDS-November 2000). The Government intends to formulate and adopt a more comprehensive National WHV/AIDS Strategy, and a National AIDS Council (NAC) is being established under the Office of the President. Further, there is agreement to staff a secretariat under the NAC to support the HARRP. The Government has firmly indicated it is prepared to provide the necessary counterpart for the WHV/AIDS Rapid Response Project despite severe budgetary constraints, and, to include it in the CY2001 Budget. It has agreed to the annual program review approach, inviting other partners and/or potential partners to contribute to its final National HIV/AIDS Strategy and Action Plan. 5. Value added of Bank support in this project: The Multi-country HIV/AIDS Program for the Africa Region places HIV/AIDS at the center of the development agenda for work in the region. For the individual country, but also for neighboring countries and communities, the curtailment of the spread of HIV is pivotal if human development and overall development goals are to be achieved. WHV/AIDS prevention is cross-sectoral and the Bank has experience in financing selected sectors in The Gambia, each of which has a key role to play in carrying forward an HIV/AIDS prevention program (agriculture, education, health, the private sector). Further, the Bank has embarked with the Government and the IMF on a Poverty Reduction Strategy exercise, and this effort will take HIV/AIDS concerns into account. With its IPAA partners, the Bank has experience in the design of HIV/AIDS rapid response programs in other countries, and in supporting successful programs in West Africa. Of significance for The Gambia, because its land is in the midst of Senegal, are Senegal's active HIV/AID prevention programs, where the HIV prevalence rate is, and has been kept, at 2.2%. IDA is one of the few UJNAIDS partners in a position to make a multi-year commitment to the long-term Gambian effort to avert an WHV/AIDS disaster. The HARRP will be relied upon as an important platform and resource in carrying out the broader National HIV/AIDS Plan of Action and Strategy. E. Summary Project Analysis (Detailed assessments are in the project file, see Annex 8) 1. Economic (see Annex 4): O Cost benefit NPV=US$ million; ERR = % (see Annex 4) o Cost effectiveness * Other (specify) NPV and ERR not applicable. See paragraphs 76-78 and "Economic Analysis of WHV/AIDS" (Annex 5) of the Project Appraisal Document for the Multi-Country HIV/AIDS Program for the Africa Region (Report no. 20727 AFR). Also see Annex 4 of this document for ongoing work in this area. 2. Financial (see Annex 4 and Annex 5): NPV=US$ million; FRR= % (see Annex 4) - 20 - Not Applicable Fiscal Impact: See paragraph 79 of the Project Appraisal Document for the Multi-country HIV/AIDS Program for the Africa Region (Report No. 20727 AFR). Furthermore, with the large amount of resources directed at community interventions, reliance on NGOs, CBOs, the outsourcing of financial management and some aspects of monitoring, small additional staff for the NAS/DACs, the recurrent cost impact of the program should be manageable. 3. Technical: a) Project Implementation: 3.1 This project has incorporated the best internationally accepted practices for HIV/AIDS responses as defined in the MAP and by UNAIDS partners. HARRP has tailored these general principles to the Garnbia-specific context and will follow the currently best accepted practices in technical standards for health infrastructure, including the handling of medical supplies and medical waste to minimize any environmental impact. Line Departments will be involved in the preparation of components to ensure their consistency with national technical standards. Further, HARRP will draw on Gambian experience and approaches with other IDA projects as to any civil works. b) Project supervision 3.2 In view of the project risks and the number of implementing and coordinating partners, from the central to Divisional to constituency level, World Bank implementation support and supervision activities are envisaged to be more intensive than customary. On a regular basis, support and supervision activities will be the responsibility of the World Bank Senegal Bank Office involving a task team leader, senior health specialist, financial management specialist, rural development specialist, and procurement specialist. 3.3 Back-up support in Washington would involve a team comprised of senior operations specialist and an HIV/AIDS specialist. HARRP reporting and the annual review process, including work plans and budgets, will allow for mid-course corrections. During supervision the Task Team will pay special attention to, and act upon, any need to formally restructure or "re-work" the Project to reflect "learning by doing". Given the nature of HARRP and its preparation, there is need for intensive supervision during the first two years of operation, and thus resources will be made available to support Bank-based supervision at a level substantially higher than for conventional projects. 3.4 In addition to the regular implementation support and supervision of the project, annual reviews will be organized involving all those involved in the HIIV/AIDS partnership in The Gambia, conceivably organized by the UNAIDS Theme Group. These reviews will focus on the achievements made and constraints faced in the development of the National HIV/AIDS Strategy and Action Plan, and in preparation of the work-program and budget for the subsequent year. c) Procurement Procedures 3.5 IDA will finance goods, civil works, consultancy, training, and other local activities necessary to implement the project. Procurement for all IDA-financed activities will be carried out in accordance with the Bank's Guidelines for Procurement under IBRD Loans and IDA Credits (January 1995 and revised in -21 - January and August 1996, September 1997, and January 1999), in particular, Section 3.15, Community Participation in Procurement. Consulting services by firms or individuals financed by IDA will be awarded in accordance with the Bank's Guidelines: Selection and Employment of Consultants by World Bank Borrowers (January 1997, revised in September 1997 and January 1999). 3.6 Procurement performance (including sub-project procurement activities) will be assessed on an annual basis (in the form of random procurement/physical audits by an external agency). In addition to the formal annual audits, ad-hoc procurement reviews will be conducted periodically. 4. Institutional: See paragraph 81-82 of Project Appraisal Document for the Multi-Country HIV/AIDS Program for the Africa Region (Report no. 20727 AFR) and institutional treatment in the Project Description Summary in this document, Section C, Components 1-4. 4.1 Executing agencies: See Detailed Project Description (Annex 2) 4.2 Project management: See Detailed Project Description (Annex 2) and Procurement and Disbursement Arrangements (Annex 6) 4.3 Procurement issues: See Procurement and Disbursement Arrangements, including procurement capacity assessment (Annex 6) 4.4 Financial management issues: See Procurement and Disbursement Arrangements, including the financial management capacity strengthening action plan (Annex 6) 5. Environmental: Environmental Category: C (Not Required) 5.1 Summarize the steps undertaken for environmental assessment and EMP preparation (including consultation and disclosure) and the significant issues and their treatment emerging from this analysis. Steps undertaken for environmental assessment and EMP preparation. See paragraph 84 of the Multi-Country HIV/AIDS Program for the Africa Region (Report No. 20727 AFR). This is an Environmental Category C project which will not generate any adverse environmental effects. 5.2 What are the main features of the EMP and are they adequate? Not Applicable 5.3 For Category A and B projects, timeline and status of EA: Date of receipt of final draft: Not Applicable 5.4 How have stakeholders been consulted at the stage of (a) environmental screening and (b) draft EA report on the environmental impacts and proposed environment management plan? Describe mechanisms of consultation that were used and which groups were consulted? Not Applicable 5.5 What mechanisms have been established to monitor and evaluate the impact of the project on the environment? Do the indicators reflect the objectives and results of the EMP? Not Applicable - 22 - 6. Social: 6.1 Summarize key social issues relevant to the project objectives, and specify the project's social development outcomes. See paragraph 83 of the Multi-Country HIV/AIDS Program for the Africa Region (Report No. 20727 AFR) and treatment in other sections of this PAD. The project will have major effect in destigmatizing those people who are infected or affected by HlV/AIDS. 6.2 Participatory Approach: How are key stakeholders participating in the project? The project concept was developed in a highly participatory manner. Key stakeholders have been integral participants in the HARRP design preparation and will have key roles to play in its implementation, and will be part of the National HlV/AIDS Council. 6.3 How does the project involve consultations or collaboration with NGOs or other civil society organizations? NGOs and other civil society organizations are and will be engaged in both the formulation of the National HIV/AIDS strategy as well as among the principal applicants for activities to be financed under Community and Civil Society Initiatives. CCSI comprises roughly 50 percent of the IDA credit, and is based on the premise of community involvement. 6.4 What institutional arrangements have been provided to ensure the project achieves its social development outcomes? Annual meetings, as well as stakeholder workshops are envisioned to review progress in meeting key indicators, among which are that 90% of the population aged 15-49 are aware of HIV/AIDS transmission modes and the means of prevention by the end of the project period. 6.5 How will the project monitor performance in terms of social development outcomes? Component I "Capacity Building and Policy Development", sub-component "(d) Assessment, Monitoring and Evaluation" describes the monitoring approach as does Annex-Il on "Monitoring and Evaluation" contained in this document. 7. Safeguard Policies: 7.1 Do any of the following safeguard policies apply to the project? Po._cy Applicabitity Environmental Assessment (OP 4.01, BP 4.01, GP 4.01) 0 Yes 0 No Natural habitats (OP 4.04, BP 4.04, GP 4.04) 0 Yes 0 No Forestry (OP 4.36, GP 4.36) 0 Yes 0 No Pest Management (OP 4.09) 0 Yes 0 No Cultural Property (OPN 11.03) 0 Yes 0 No Indigenous Peoples (OD 4.20) 0 Yes 0 No Involuntary Resettlement (OD 4.30) 0 Yes 0 No Safety of Dams (OP 4.37, BP 4.37) 0 Yes 0 No Projects in International Waters (OP 7.50, BP 7.50, GP 7.50) 0 Yes * No Projects in Disputed Areas (OP 7.60, BP 7.60, GP 7.60) 0 Yes 0 No 7.2 Describe provisions made by the project to ensure compliance with applicable safeguard policies. The highest levels of The Gambian Government and civil society recognize that HIV/AIDS is a complex -23 - multi-faceted and multi-sectoral problem that requires a long-term sustained response from all sectors of Government and society if they are to safeguard the nation, and its future. Sensitivity to cultural differences will be taken into account as the National HIV/AIDS Strategy is refined, and as HIV/AIDS prevention measures are brought on stream. F. Sustainability and Risks 1. Sustainability: HARRP sustainability will depend on the degree to which the National HIV/AIDS strategy and HARRP activities become fully owned and appreciated by the various partners at national, divisional, and local levels; their implementation capacity, including their ability to organize for sub-project activities and carry them out; their ability to access funds and use them in accordance with agreed plans. Because most activities involve communities in some way, the prospects for sustained interest will be enhanced if HARRP is able to respond to beneficiary targeted priorities, and do so without extensive delay or bureaucratic requirements. Training is a focus in virtually all aspects of the HARRP, from line Departments to NGOs, from financial administration to IEC/BCC, and this will further enhance prospects of sustainable performance, interest, and support. 2. Critical Risks (reflecting the failure of critical assumptions found in the fourth column of Annex 1): L- _Risk Risk Rating Risk Mnigation Measure _ - IFrom Outputs to Objective 1. Insufficient absorptive capacity to S Annual reviews will permit shifting between spend funds. components should there be a need. 12. Inadequate involvement and/or social M Extensive and targeted IEC/BCC efforts as well exclusion of "outgroups" (e.g., CSWs, as inclusion of "outgroups" on decision-making PLWHAs, etc.) bodies. From Components to Outputs 3. Lack of cooperation among M NAS will hold inter-Departnental meetings on a Departments of State (i.e. line regular basis. Departments) with regard to the multi-sectoral approach. 4. Funds will be misused by implementing S NAS/FMA will provide diligent oversight. entities and advances might not be recovered. 5. Implementing agencies might not report H Line Department replenishments will depend on on a timely basis. timely reporting. Importance of responsive reporting also stressed to DACs and contractors. Where lacking, technical support provided by NAS. 6. Divisional AIDS Committees (DACs) M HARRP promotion and project launch not formed in time to facilitate timely workshop will generate sufficient interest. disbursement. 7. Poor implementation and financial S NGOs and CBOs are recruited according to management capacity of NGOs and their prior track-record in providing similar CBOs. services. Resources made available to strengthen capacity of smaller NGOs/CBOs. -24 - 8. Supervision by IDA weak, S Supervision team comprised of Senegal Bank mono-sectoral, or poorly funded. Office and HQ staff with different backgrounds and skills mix. During initial two years of project operation Bank supervision budget will be substantial. Overall Risk Rating S Risk Rating - H (High Risk), S (Substantial Risk), M (Modest Risk), N(Negligible or Low Risk) 3. Possible Controversial Aspects: As indicated in the Multi-country HIV/AIDS Program for the Africa Region (Report No. 27027 AFR) no aspects of the MAP approach are likely to spark external controversy. In The Gambia, the commitment to undertake this multi-sectoral intensive effort means that, if successful, it will require ongoing support, and this implies a long-term commitment from the Bank and the international community. The willingness to provide grants in future by other donors would help to assuage such concerns. Further, the degree to which sensitive and personal issues are to be addressed could create concern with some religious groups and cultures. By involving stakeholders experienced in dealing with these sensitivities it is expected that such cultural barriers will be overcome in locally appropriate ways. G. Main Credit Conditions 1. Effectiveness Conditions Conditions of Effectiveness are intended to be minimal in order to ensure a swift progression from Board presentation to effectiveness. Many outstanding issues were addressed as conditions for appraisal. Conditions of Effectiveness are: (a) Opening the Project Account and deposit of the initial amount; (b) Appointment of the NAS Director with terms of reference and qualifications acceptable to IDA; (c) Appointrnent of a Financial Management Agent and establishment of an accounting and financial management system satisfactory to IDA; and (d) Finalization of the Project Implementation Plan, a draft Procurement Plan for the first year and the Project Operations Manual in form and substance satisfactory to IDA. 2. Other [classify according to covenant types used in the Legal Agreements.] A Condition of Disbursement of Credit proceeds under Component 4, is that an Operations Manual for activities to be financed under the Community and Civil Society Initiatives has been adopted, satisfactory to IDA. H. Readiness for Implementation El 1. a) The engineering design documents for the first year's activities are complete and ready for the start of project implementation. 0 1. b) Not applicable. CI 2. The procurement documents for the first year's activities are complete and ready for the start of project implementation. - 25 - L 3. The Project Implementation Plan has been appraised and found to be realistic and of satisfactory quality. 1] 4. The following items are lacking and are discussed under loan conditions (Section G): Given the urgent nature of objectives of the HARRP and the need to be innovative with institutional arrangements and flow-of-funds procedures, project activities-are programmed for early implementation so that the process of "learning-by-doing" begins at once. In addition to more intensive supervision in the initial six months than customary, there will be annual reviews of prior year experience, presentation of the following year's work plan and budget, and meetings with existing and potential partners to brief them on progress and to revise the financing of activities to include new contributions. Annex 7 provides key implementation steps in two regards: a) Through Project Launch. Project Implementation Plan, first year Procurement Plan, Project Operations Manual; opening of the Project Bank account and initial deposit; and Project Launch. These are expected to be completed in March 2001; b) Preparation of National HIV/AIDS Strategv and Action Plan: Review of existing policies; preparation of thematic papers; consensus building process; adoption by the National Assembly, engagement of existing and potential partners. These are expected to be completed in September 2001. 1. Compliance with Bank Policies ,Z 1. This project complies with all applicable Bank policies. E 2. The following exceptions to Bank policies are recommended for approval. The project complies with all other applicable Bank policies. Richard M. Seifman r ouaJ cIntire Team Leader Acting Sector Manager Country Manager - 26 - Annex 1: Project Design Summary THE GAMBIA: HIVIAIDS Rapid Response Project Key Performance Hierrchy of Objecties Indicators Monitoring & Evaluation Critical Assumptions Sector-related CAS Goal: Sector Indicators: Sectorl country reports: (from Goal to Bank Mission) Prevent the negative impact of (1) Increase in the percentage Surveillance system and Sustained Government the spread of the HIV of 15 to 24 year olds with surveys. commitment at highest levels epidemic on development and access to HIV/AIDS IEC & to enable a multi-sectoral on the level of poverty in The services. public and non-public Gambia. response to HIV/AIDS (2) Stabilize and reduce prevalence of HIV among 15 to 24 year olds. (3) Stabilize and reduce prevalence of HIV among pregnant women. - 27 - Project Development Outcome / Impact Project reports: (from Objective to Goal) Objective: Indicators: To slow the spread of At least 90% of population National HIV/AIDS Council Political stability and HIV/AIDS epidemic in The aged 15-49 is aware of STIs, (NAC ) Reports sustained socio-economic Gambia, through provision of HIV/AIDS transmission growth. HIV/AIDS and STIs modes and means of prevention, treatment, and prevention by the end of the care services with a focus on project. youth. Use of condoms at last sexual Monitoring system and survey Relevant public sector entities contact among young people (or equivalent) will adopt and implement (15-24) increased by 40% by policies and action plans to the end of the project. prevent further HIV/AIDS transmission. Prevalence rates of STIs and HIV/AIDS sentinel Implementation capacity of HIV contained to present surveillance reports. governmental and levels. non-govermnental organizations improves. Regular National HIV/AIDS Continuous support by Secretariat (NAS) monitoring Government including line and reporting on condom and Departments, to work in drug distribution, as well as partnership with NGOs, line Department and CBOs and the private sector. Community and Civil Society I Initiatives activities. Independent evaluation of community level, divisional, municipal, and national HIV/AIDS prevention and control programs. -28- -HIerachy *1 Objcives IndjbbtorS Mooring 8 Evaluation Criftcal Assumptions Output from each Output Indicators: Project reports: (from Outputs to Objective) Component: 1. Institutional capacity in The National HIV/AIDS * Field supervision and The four MAP criteria for planning, delivery and Council (NAC) fully project reports, work eligibility which were monitoring of HIV/AIDS functioning and a formal plans, training reports, satisfied, are continuously response interventions National HIV/AIDS Strategy monitoring data, actively pursued, namely: (i) through line Departments, and Plan of Action adopted, baseline surveys and a strategic approach to NGOs, CBOs, private sector and being implemented. end-tern evaluation. HIV/AIDS; (ii) a functioning and the civil society, Scoplnadrert.high level coordinating body; developed. Divisional HIV/AIDS * Sector plans and reports. (iii) Government use of Committees and municipal * Regular divisional and financial and procurement equivalents started municipality reporting. implementation arrangements implementation of Project which will accelerate activities by Project Year 2. activities; and (iv) * IEC campaign reports;. Government relying on and 40% of 15-24 years old fimding multiple . ^ ~~~~* KAP and other surveys.. engage in safe sex. implementation agencies. * MIS data. NAC and the (NAS) are fully Use of condom at last sexual R d ck engaged, and the Community contact among commercial * eports on rug sto and Civil Society Initiatives sex workers, truck/taxi functioning successfully. drivers, STI carriers, and * Mid-term and end-term uniformed personnel service utilization data. increased by 50% by the end of the project. 40% of 15-24 years old group and 50% of high risk groups (see above) have participated in VCT. 2. Mechanisms and processes At least 5 key line 1. Choice of project activities of multi-sectoral response of Departments are (e.g., diverse and independent the Government developed, implementing agreed action activities) and design expanded and operational. plans. flexibility allow fine-tuning and/or reallocation of project resources as required. - 29- 3. Provision of: (i) voluntary * Increase in number of 2. Continuous support by counseling and testing, (ii) condoms available for Government including line condoms, (iii) basic outpatient distribution nation-wide. Departments, to work in care at primary level, (iv) * At least 80% of partnership with NGOs and outpatient care for HIV population reached the private sector. positive individuals at through targeted 3. Implementation capacity of primary level, (v) care for IEC/BCC programs on governmental and terminally ill patients, and STIs and HiV/AIDS. non-governmental (vi) care for bereaved e Voluntary counseling organizations improve. families. Training for health and testing (VCT) 4. Relevant public sector workers in the handling services are agencies will adopt and HIV/AIDS hazardous incorporated into implement strategies, policies materials. antenatal, TB, and STIs and action plans to prevent services by the end of further HIV/AIDS the project. transmission. * The number of sentinel 5. Interest and commitment surveillance sites from local governments, increased by 2 in Project communities and Year 1, and to a total of beneficiaries. at least 8 by the end of 6. Administrative expenses the project. maintained at expected levels. * Access to treatment for STIs, TB, and other opportunistic infections offered in 50% of health facilities by the end of project. * 80% of the health workers utilize training and facilities to handle hazardous waste 4. Community and Civil * Community and Civil 7. Special Account Society Initiatives program Society Initiatives replenished in a timely financing community based disbursements reach at manner. Withdrawal sub-projects developed and least 75% of planned applications satisfactorily operational at all levels. levels. prepared. * Number of communities and establishments 8. Free access to public media implementing strategies is available. to cope with HIV/AIDS impact. - 30 - Key Performance Hierarchy of Obectives Indicators Monitoring & Evaluation Critical Assumptions Project Components / Inputs: (budget for each Project reports: (from Components to Sub-components: component) Outputs) I. Capacity Building & US$3.50 million l. Intensive World Bank Policy Development Project supervision and implementation support, as A. National Strategy & . . well as regular monitoring Action Plan aciv1ty repos. and supervision activities B. HARRP Coordination & carried out by the World Bank Administration Senegal Office and World C. Advocacy, Training & Bank Headquarters staff. Technical Support 2. Financial management D. Assessment, Monitoring agent (firm) assists NAS in & Evaluation transferring funds to accounts. in a timely manner in order to prevent funding delays . 3. DACs and line Departments provide timely reporting. II. Multi-sectoral Response US$2.65 million 4. To ensure adequate for Prevention and Care Project supervision and cooperation between line Line Departments activity reports. Departments, the NAC will invite line Departments to discuss Project implementation, refine policies and adopt strategies based on mutual agreement. III. Health Sector US$1.85 million Health information reporting, 5. Payment requests will be Responses to HIV/STI project supervision and based on adequate Management activity reports. demonstration of use of funds. A. Voluntary Counseling & 6. The NAS will regularly Testing contact Focal Points (Health B. Patient Care Services and other line Departments) C. Care for Bereaved to keep them on track, and Families prevent implementation delays. IV. Community and Civil US$8.20 million Project supervision and 7. PHPNP bridges resource Society Initiatives activity (NAS/DAC) reports gaps prior to effectiveness. A. Large Scale Activities 8. DACs are established on B. Medium-to-Small Scale time to facilitate Activities disbursements. C. Community-Driven 9. The Community and Civil Activities Society Initiatives Operations Manual is user friendly and highlights processes for managing local procurement. -31- Annex 2: Detailed Project Description THE GAMBIA: HIV/AIDS Rapid Response Project The HARRP will have four components, namely: 1) capacity building and policy development; 2) multi-sectoral responses to prevention and care; 3) health-sector responses to HI V/AIDS and STI management, including prevention and care; and 4) Community and Civil Society Initiatives. HARRP institutional arrangements are straightforward and briefly described here: The National HIV/AIDS Council (NAC) and National HIV/AIDS Secretariat (NAS) will be under the Office of the President. The NAC is the oversight body, the NAS is the administrative, coordinating, and monitoring mechanism for the entire project. Using the existing decentralization structures, namely the Divisional Coordinating Committees (DCC), sub-bodies called "Divisional HlV/AIDS Committees" (DACs) will be established at the Divisional level. Line Departments will receive funds to carry out sectoral WHV/AIDS programs which will be supervised by their designated focal points. By Component: Project Component I - US$3.50 million Capacity Building and Policy Development 1.1. This component will aim at strengthening Gambia's capacity to cope with the spread of WIV/AIDS by supporting: (i) the work of the multisectoral National WIV/AIDS Council (NAC) and the Secretariat (NAS), the Divisional/Municipal AIDS Committees (DACs), and small entities requesting proposal preparation assistance; and (ii) the development of the National HIV/AIDS Strategy and Action Plan. Four sub-components address the following areas: (a) National Strategy and Action Plan; (b) HARRP Coordination and Administration; (c) Advocacy Training, and Technical Support Activities; and (d) Assessment, Monitoring and Evaluation (i.e., surveillance and mapping, operational research and pilot testing, and other monitoring and evaluation activities). (a) National Strategy and Action Plan. A process to prepare and adopt first an interim followed by a medium-term comprehensive National WIV/AIDS Strategy and Action Plan by September 2001, is contemplated. Preparation of the National Strategy and Action Plan will entail a review of existing relevant national policies and programs, development of papers on specific themes, and a consensus building exercise. It will cover both specific technical aspects (the responsibility of the appropriate entity such as the DOSH in the case of health) and multi-sectoral areas of policy, such as education, rural development, youth, tourism, defense, rights protection of those infected with, and/or affected by, WV/AIDS, and proposals to strengthen or amend appropriate legislation and administrative rules. The Action Plan will be developed concurrently with the preparation of the Strategy, engaging many stakeholders and donors, and then circulated to appropriate partners for financial and technical support. The Strategy and Action Plan would be vetted at Divisional workshops, comprised of both Government and civil society, for comment and revision (As part of the Key Implementation Steps for Project Year I, a processing schedule is contained in Annex 7 B.). (b) HARRP Program Coordination and Administration. Because of the developmental and multi-sectoral nature of the HARRP, the national coordinating/administering secretariat will be under the Office of the President. At Divisional and municipal level HARRP will be administered by Divisional (or equivalent) AIDS Committees with limited HARRP-financed staff appointed to carry out the additional duties created by HARRP. NAS/DAC will rely on line Departments, decentralized government mechanisms at Divisional and Municipality level, and NGOs, CBOs and the private sector ("establishments") to implement WIV/AIDS prevention and care programs. A financial management agent (firm) will be contracted to accelerate and assure efficient resource transfers, financial reporting and monitoring. - 32 - Broadly speaking NAS/DAC tasks will be program promotion and coordination (including national strategy development, Community and Civil Society Initiatives activities, training and IEC), organizing and arranging workshops and meetings, contracting for studies and surveys, providing technical advice and training support to others implementing the HARRP such as NGOs, as well as in monitoring, procurement, and financial management. Sub-components a), c) and d) will be coordinated or administered in varying degrees by the NAS, which reports to the NAC. HARRP will provide the necessary institutional financial support for the NAS including key professional staff, office space, office equipment, transportation, logistical support, maintenance and operating costs. For each of the five Divisions and two Municipalities, HARRP/DAC support will include strengthening existing capacity, and as required, an appropriate HIARRP facilitator and equipment, office supplies, transportation and incremental operating costs similar to that to be provided to the NAS. The strengthening of the DACs will support and encourage the Gambian Government's decentralization initiatives. (c) Advocacy, Training, and Technical Support Activities. This sub-component would be geared to conveying, to the highest levels of Gambian leadership (e.g., religious and traditional leaders, unions, the business community, military and police, educators, the tourism industry, the private sector), the need to be aware of, and to scale up, program activities to stem the expansion of the virus. Various media channels, whether rural radio, theatre groups, traditional singers, TV or newspapers will be involved in the advocacy efforts. The objective would be to have them actively promote HIV/AIDS prevention, destigmatization and care. It would similarly promote HARRP awareness at Divisional and Municipality levels, and in reaching the general public. Efforts would include multi-media campaigns, ongoing fora for youth, workshops, peer education, short-term training, study tours, and conference participation in meetings related to HlV/AIDS prevention and care. Various HARRP constituencies, such as line Departments, unions, NGOs and NGO associations, CBOs, and private establishments would receive training and technical advice/assistance. NAS would have both a coordinating function to assure basic consistency across components, and also under certain circumstances, a more direct role with respect to provision of training and advocacy. (d) Assessment, Monitoring and Evaluation. This sub-component includes surveillance and mapping, operational research and pilot testing, as well as project monitoring and evaluation activities. Surveillance and mapping activities include the design and execution of: (i) an expanded STI/HIV sentinel surveillance system (to at least eight sentinel sites); (ii) behavioral surveys on specific topics such as adolescent sex behavior, on different groups such as religious communities, refugees, as well as regular Knowledge, Attitude and Practice (KAP) surveys; (iii) mapping of high risk groups and identification of hot/cool spots; (iv) investigation of different strains of the HIV virus present in The Gambia in collaboration with research institutes; (v) support for a national epidemiological survey of HIV/STIs, if needed; and (vi) using available Geographic Information System (GIS) capacity to monitor trends. Operational research and pilot testing activities of this sub-component would fund applied research geared at the improvement, expansion, evaluation and/or fine-tuning of prograrnmatic interventions. IIARRP would support operational research aimed at the validation and/or implementation of multi-sectoral approaches to combat the epidemic, and the development of methodologies for The Gambia to analyze relative costs and benefits of different HIV/AIDS interventions. In addition, pilot testing of innovative approaches such as those related to behavioral change communication resulting in safe sex behavior, the impact in delay of the onset of sexual activity among the youth, the linkage between HIV sero-status notification and subsequent behavior, links between productive employment and sexual behavior, would be eligible for financing. The project could also pilot and follow focus groups to assess behavioral changes in target groups, the sustainability of behavioral changes, and the effectiveness in the use of available HIV/STI related services. The NAS would be responsible for coordinating such activities. Monitoring and Evaluation is a key aspect of the HARRP, and in particular with regard to the project's community - 33 - activities. HARRP M&E would be coordinated and consolidated by the NAS. However, much of the information would be collected, and/or generated by line Departments, DACs, NGOs, and other participating partners, and/or contracted entities. Monitoring of CCSI activities (See Component 4, below) will be either contracted out on a national basis by the NAS to cover all Divisions and municipalities, or divided into smaller packages with a defined geographic focus. This aspect of monitoring will concentrate on assuring that: activities are implemented in accordance with the approved proposals; and that qualitative stakeholder progress is taken into account through utilization of tools such as the mapping of behaviors ("risk mapping"), in order to track CCSI input and output indicators. A simple reporting format will be developed for all activities regardless of their size. Similarly, line Departments will report on inputs and outputs related to their activities. These monitoring efforts will provide the data for the Govemment to assess progress in meeting "Key Performance Indicators". The monitoring approach will be developed in light of the UNAIDS National AIDS Programmes "A Guide to Monitoring and Evaluation" (see Annex 11 for additional information). Project Component 2 - US$2.65 million Multi-sectoral Responses for HIV/AIDS Prevention and Care 2.1. This component will improve the capacity of non-health Government Departments to respond to the HIV/AIDS epidemic, emphasizing prevention and care. As part of their ongoing Departmental operations, this will be achieved through a two-pronged approach, namely: (i) the provision to line Department staff of HIV/AIDS and STI education, training, condoms, and other support, to encourage HIV/AIDS and STI avoidance behavior; and (ii) the enhancement of the capacity of their staff to provide their partners and audiences (e.g., parents-teachers associations, farmers associations, village health committees), the means to provide effective HIV/AIDS prevention and care. Interested line Departments either have or will appoint r IIV/AIDS focal persons to carry out Departmental action plans for these two purposes, with support from HARRP in terms of facilities, equipment, and incremental costs. 2.2. Currently the Departments of State for Education, Agriculture, Defense, Interior (Police, Prisons and Religious Affairs), Youth, and Tourism are working on such action plans and will be HARRP participants. Other Departments may join after project effectiveness, subject to availability of funds from the Government, the HARRP, or other donors. The health sector is separately treated under Component 3 "Health Sector Responses to STI/HIV Management". 2.3. Line Departments would have wide discretion in how they seek to achieve the two goals of: i) Departmental staff HIV/AIDS and STI avoidance behavior, and ii) their staff reaching their constituencies on HIV/AIDS and STI issues. Eligible line Department activities would depend on the content of interim Departmental action plans for the first project year, some of which have already been developed. These plans include appointment of Departmental focal points, provision for training, technical advisory services, HIV/AIDS and STI IEC materials, VCT and condom distribution, and support for facilities and equipment, including incremental operating costs to effectively carry out this effort. As mentioned, such plans address both internal groups (Departmental staff) and their external target groups on a phased basis. Subsequently, the final National HIV/AIDS Strategy and Action Plan will refine the activities/instruments of Departmental plans, and provide the basis for longer-term engagement. Departmental action plans for external target groups, for illustrative purposes, could include approved IEC/behavioral change communications messaging, actions, and referrals related to medical prevention as well as care. Project Component 3 - US$ 1.85 million Health Sector Responses to STI/HIV Management - 34 - 3.1. The Department of State for Health and Social Welfare (DOSH) and more broadly the health community, have special responsibilities for STIs and HIV/AIDS prevention and management. This sector therefore warrants a separate component, making provision for prevention and care from a health sector perspective, whether public or private. This component provides the resources to the health sector to build on the framework of the HIV/AIDS and STIs management manuals recently adopted by the DOSH, as well as other reproductive and communicable disease activities currently performed by the DOSH and its health sector partners. DOSH can enhance its reproductive health and opportunistic infection efforts with fuinds provided herein, recognizing it will not be able to undertake all of the health sector specific tasks at once, nor do it without assistance from other non-public health care providers. It will prioritize which aspects, where, when and how quickly it can implement and scale up its HIV/AIDS and STIs management services. '[he procurement of condoms, opportunistic infection drugs, gloves and other medical supplies, testing kits and limited laboratory equipment is envisioned. Further, based on the model already in place in one health facility (Brikama), Reproductive Health Clinics will be installed in each Division and Municipality, with trained staff. A preliminary draft of the DOSH HIV/AIDS and STI Action Plan will be refined. The basic features which differentiate the health sector from other sectors are those related to its medical functions such as diagnosis and treatment of opportunistic infections such as STI and TB, care at health posts, health centers, and hospitals, and laboratory assaying. 3.2. Two other aspects need highlighting with respect to the health sector: First, blood supply is important and the enhancement of the blood supply system is being partly addressed under the PHPNP. In this regard, the stated policy goal of The Gambia is that national blood supplies be controlled and assured as safe. Donor mobilization is being financed under the PHPNP along with a readiness to cover preparation costs of a plan for a national blood transfusion services, identify the necessary equipment to complement what is being done under existing AfDB and IDA financing, what would be needed in terms of blood hags and reagents, and training of laboratory technicians. The objective would be to ensure that blood for transfusion and blood products do not transmit STI and HIV. Second, there is need for specialized training in HIV/AIDS and STI hazardous materials handling and provision of medical supplies to health workers so as to prevent STI and H1V transmission. Health workers represent a particularly vulnerable group because of their routine contact with hazardous materials, they are on the front line, and need to be confident their personal safety and well-being are taken into account so that they actively promote testing of patients and care for PLWHAs. Inclusion of norms and standards for hazardous waste disposal, appropriate to The Gambia, will be taken into account at all health facilities, along with training of facility personnel in this regard. 3.3. The Bank has also been working closely with its UNAIDS partners, drug companies, and developing-country govemments on access to antiretroviral (ARV) therapy. As the situation evolves, Departments of Health may explore ways of introducing ARV therapy. In The Gambia, should the G ovemment so decide, the HARRP will be able to support the development of guidelines and the strengthening of health infrastructure to make the use of these drugs safe, effective and sustainable. IDA will also actively follow up the trend in affordability and efficacy and remain open, on a case-by-case basis, to supporting ARV drugs and the necessary infrastructure where resources may be required. Project Component 4 - US$8.20 million Community and Civil Society Initiatives 4.1. This component will be a financing mechanism to provide grant resources to support initiatives from a community, civil society, worker association, "establishment or primary unit", or the like. ("establishments - 35 - or primary units" would include businesses, military camps, prisons, refugee camps, religious groups, trade associations, sports clubs, etc.). It will therefore support both "community-based" and "community-involved" activities. A Community and Civil Society Initiatives mechanism will be established by, and report to, the NAC, through the NAS. A nominal initial allocation will be made to the five Divisions (and two municipalities) on a population density basis, so that there is proportionate sharing and an indicative planning amount from which to begin work. 4.2. Eligible Applicants. Applications can be submitted to the DACs directly by the community or community association, a private entity, or by collaborators (NGOs, consortiums), on their behalf. An NGO or other organization can consolidate a number of smaller proposals to create a medium sized proposal, and submit it to the DAC. In addition, a national, multi-Divisional, or divisional conceptlprogram benefiting communities which are a priori not identifiable, may be approved for funding under this component, provided the concept/program meets CCSI eligibility criteria. Basically there will be three types of proposals put forward by eligible applicants for approval: (i) large scale "Category A" activities with National, multi-Division or Division coverage and which will require substantial experience, and institutional capacity, and for which entities will be pre-qualified; (ii) medium-small scale "Category B" activities which will require considerably lesser standards of capacity, with such organizations ranging from NGOs, CBOs, PLWHAs, associations, other groups and establishments; and (iii) "Category C" activities proposed by communities on their own behalf. Category B entities and communities will be able to obtain modest grant assistance from the HARRP for local consultant support to help in mobilizing communities to proposals and organizational training, if need be. 4.3. Activities Eligible for Funding. Project proposals will be considered based on an HIV/AIDS Activity Positive List which will be further defined in an IDA approved, Community and Civil Society Initiatives Operations Manual. Category B and C activities would usually require approximately a 10% contribution, in cash or in kind. Category A activities will generally be require approximately a 20 percent contribution, of which a significant portion is in cash. Assuming a qualified applicant puts forward a proposal consistent with the menu/positive list, it would be presumed to be eligible for financing. As an "illustrative" list, Community and Civil Society Initiatives activities would be directed at the following broad areas: (i) information education and communication/behavioral change communications (IEC/BCC) campaigns; (ii) support to high-risk groups; (iii) youth-related activities; (iv) condom supply and dissemination, each of which are further described below. (These descriptions should not limit what may be finally included under these activities): (a) IEC/BCC campaigns. Activities would be geared at the general community and/or small groups, and encompass public awareness and information campaign/programs. This would include TV and radio, videos and cassettes to reach villagers, songs, plays, road signs, tee-shirts to convey simple messages, and indigenous channels for message delivery. The draft 1999 IEC Communications Strategy prepared by the Department of State for Health can provide a basis for the IEC/BCC menu until a separate HARRP menu is finalized. (b) Support to high-risk groups (and priority target groups). Possible Community and Civil Society Initiatives activities for high risk groups would include IEC/BCC, promotion of condom use and condom availability, provision for STI diagnosis, STI and TB treatment and care. High risk groups include commercial sex workers and their clients, long distance transport workers, migrant workers, hustlers in tourist areas known as "bumsters", refugees and displaced people, prisoners and those already infected. For a particular subset of this group, namely PLWHAs, sub-activities could include financing support groups, NGOs and community organizations to reach families and individuals with coping mechanisms that provide a package of home-based care supplies (for example, gloves, plastic sheets, etc.) and essential drugs (ex. - 36 - aspirin, calamine lotion) for symptomatic and terminally ill patients and their dependents, as well as medical support, shelter, food supplementation, and care to HIV/AIDS parents, students, and orphans, and income generating activities for PLWHAs. (c) Youth-related activities. Activities would target the youth, defined as aged 15-24, and empower them to better tackle the threat of HIV/AIDS and STI. Activities would focus on: (i) youth-specific information, education and communication as well as behavioral change communication (IEC/BCC) programs; (ii) Family Life Education (FLE) programs for in-school and out-of-school adolescents. Community and Civil Society Initiatives financing would cover innovative approaches such as peer-education programs, youth clubs, youth-specific meeting places, and other means. FLE programs in schools would encourage referral of adolescents to services supported by the Community and Civil Society Initiatives in the areas of voluntary counseling and testing (VCT), STI treatment, and condom access. Parent and teacher associations could be financed to play active roles in fostering a "culture of care" in. schools and the school as one of the main community based organizations countering HV/AIDS; and (iii) financing of "youth friendly" reproductive health services. (d) Condom distribution. IEC/BCC messages without means to carry out actions would not produce the desired results. Therefore availability, accessibility, and a steady supply of low-cost, or even cost-free condoms would be essential, and facilitated under Community and Civil Society Initiatives, in conjunction with, or separate from, other activities supported by the Community and Civil Society Initiatives and the public health sector. 4.4. Institutional Arrangements. Various institutional options were considered, including contracting the Gambia Social Development Fund financed by the African Development Bank, channeling all resources to the decentralized rural development structures supported by the European Development Fund (Support to Decentralized Rural Development) and which use multi-disciplinary facilitation teams, or utilizing the Local Initiative Fund (LIF) approved in 1998 under the PHPNP. After due consideration the Gambian Government determined its preference would be to use multiple channels for developing and presenting proposals, and rely on Divisional/municipal AIDS Committees and the NAS to process applications for approval and monitoring activities. The existing mechanisms were found not to be the "right fit", either because they were principally financing micro-credit operations, in an early testing mode, had limited geographic coverage, were more infrastructure-oriented, had other priorities, had long appraisal or developmental timelines, or already had much to do with their current plans and programs. The Community and Civil Society Initiatives system will be demand driven, will complement existing mechanisms in many cases, and allow for the full gamut of potential users to access resources. It is also expected that regular working meetings be held with the different funding entities such as the Social Development Fund, SDRD and LIF, to share experience, work to complement each other rather than compete for clients, and consider how these entities might serve as delegated CCSI agents to expand HARRP outreach. 4.5. The selected approach will require supplemental staff for the NAS and DACs as described in Component 1 sub-component (ii) "HARRP Program Coordination and Administration". With the further clarification of the Community and Civil Society Operations Manual before operations begin, the full extent of supplemental staff needs will be known (at this juncture only a HARRP Facilitatoris contemplated). A CCSI coordinator will be located at NAS, and, for each DAC (or Municipality equivalent) a HARRP facilitator will be assigned. 4.6. Divisional AIDS Committees (DACs) will be constituted by the existing Division Coordination Committees (DCCs or Municipality equivalent) which were formed as part of the Government's decentralization process. The DACs will have roughly equal membership from a) Government (the line - 37 - Departments and local governments), and b) NGOs, women, the private sector and PLWHAs (PLWHAs must be represented). DACs will convene monthly to focus on the proposals submitted under the Comnmunitv and Civil Society Initiatives as well as discuss the status of HIV/AIDS prevention, and care in the area. They will also be expected to visit Community and Civil Society Initiative sites from time to time. 4.7. At the national level, the NAS (Secretariat) will report directly to the NAC (Council) on national proposals or those proposals that exceed threshold amounts and require higher authorization. For finance management arrangements, see Annex 6. - 38 - Annex 3: Estimated Project Costs THE GAMBIA: HIVIAIDS Rapid Response Project P Local I Foreign - Total Project Cost BY Component 1 S $milion U $million US $million Capacity Building and Policy Development 2.12 1.08 3.20 Multi-sectoral Responses for Prevention, Care and Treatment 2.15 0.25 2.40 Support I Health Sector Responses to HIV/STI Management 1 .35 0.25 1.60 Community and Civil Society Initiatives 8.20 0.00 8.20 Total Baseline Cost 13.82 1.58 15.40 Physical Contingencies 0.40 0.00 0.40 Price Contingencies __ _ 0.40 0.00 0.40 Total Project Costs 14.62 1.58 16.20 Total Financing Required 14.62 1.58 16.20 These are very broad estimates of the allocation of local/foreign costs. They will be refined during the course of the first Project Year, as required. Identifiable taxes and duties are O (USSm) and the total project cost, net oftaxes, is 16 2 (tJSSrn). Therefbre, the project cost sharing ratio is 92.59% of total project cost net of taxes. - 39 - Annex 4 THE GAMBIA: HIV/AIDS Rapid Response Project BACKGROUND 1. The "Economic Analysis of HIV/AIDS" of the Project Appraisal Document for the Multi-Country HIV/AIDS Program (MAP) for the Africa Region (Report No. 20727 AFR, Annex 5), provides the overall economic justification for the HARRP project. Furthermore, a preliminary analysis of the anticipated impact of inaction in stemming the course of the HIV/AIDS epidemic in The Gambia has been prepared by Dr. Warren Stevens, Health Economist, MRC Laboratories in Fajara and Mr. Pa Lamin Beyai, Health Economist, WHO Gambia. It is the intention of the HIV/AIDS team at MRC in conjunction with the Health Economist at WHO Gambia, working with the Government of The Gambia, to look in more detail at these issues during the implementation of the HARRP, therefore reflecting Gambian-specific needs and approaches. The assumptions and methodology for the preliminary analytical work are set forth in this Annex. MAJOR ASSUMPTIONS OF THE ANALYSIS 2. Three major assumptions have been made for the preliminary analysis. First, it has been assumed that "herd immunity" effects and falling marginal costs on increased cost-effectiveness (CE) will apply to the spread of the HIV/AIDS epidemic. In other words, there is a multiplier effect from the interventions. "Herd immunity" effects have been observed with vaccines programs: it is the point at which the force of infection falls below one and incidence starts to drop, despite a proportion of the population remaining un-immunised. This is due to the fact that the rate of infection is a function of the proportion of people in the population who are infected. As this proportion gets smaller, it becomes ever less likely for the non-immunised will become infected. With respect to HIV/AIDS, it is thought that if a high enough proportion of the sexually active population changes its sexual behavior and/or starts wearing condoms during casual sex (because of intervention programs), this could benefically effect the infection rate of those who have not been involved with the interventions, and/or have not changed their sexual behavior. The result is that as one more unit of intervention is undertaken, slightly more than the equivalent numbers of cases of infection are averted as coverage of the intervention increases (see Figure 1 below for divergence from the linear of cases averted as coverage increases). -40 - $/Cases k Figure 1: Falling Marginal Costs on Increased CE in HIV \, ~~~~~~~~~~CE ratio Cases Marginal Co C) X / / l~~~~~~~inear Cases Averted . . Coverage/t 3. The second assumption is that the costs of interventions will fall over time (t). Many of the interventions included in the HAARP are unlikely to cost the same every year, after the program reaches full coverage (in this analysis, in Year 4). The costing model for the Stepping Stones project shows that incremental costs fall over time once training activities have been introduced and established within communities. Other examples are youth education programs for all enrollees, workplace and commercial sex worker interventions, where significant institutional turnover is likely to be low and where repeat interventions may not be required. Nevertheless falling costs over time have not been assumed in the model. This would yield a cost curve closer to that shown in Figure 1. 4. The third assumption is with regard to the trends used for predicting the future incidence of HIV in The Gambia. Two scenarios of HIV prevalence have been chosen after discussions with HIV/AIDS experts from MRC, WHO, and the Government of The Gambia. The first is an exponential growth with the rate of incidence doubling every five years. and the second takes the same growth rate but flattens out at 7%. The latter has been more closely associated with the spread of the disease in West Africa. The expected effect from the introduction of an intensive prevention program has been assumed as the flattening out of incidence by the time coverage reaches 100% after four years, at around 2.5%. Only HIV-1 has been included in the model. The time from HIV-1 infection to AIDS is estimated at 8 years, and the life expectancy from this point is estimated at 2 years. The three trends shown in Figure 2 below are a worst-case scenario from Eastern and Southern Africa where an exponential growth has been seen (heavily broken line), a West African example based on data from Cameroon (intermittent broken line) and the anticipated effect of the prevention program that holds prevalence constant after reaching 100% coverage after 4 years (straight line). - 41 - Figure 2: The tree tends used to estmate hAture HIV prevalence in Fe model 45 00% 40 OC% 35 00% 30 00% 235 O% 20 0c% 15 QC% 1000% 5 00% 1995 2000 2005 2010 2015 2020 2025 2530 CALCULATIONS USED IN THE ANALYSIS 5. The cost of HIV/AIDS prevention activities. This is simply the PTG (population target group) x unit cost x coverage rate for each year. Where there is no better local data, the unit costs from the World Bank HIV scaling up document are used. No attempt has been made to estimate a falling MC/AC (Marginal Cost/Average Cost) curve and so scaling up is done with a flat AC (Average Cost) curve. 6. The cost of continued increase in new infections (health care costs). As with above, where possible local data has been used, whereas where that is not possible the costs from the scaling up paper has been used. Once again a flat cost curve and the formula is simply (prevalence HIV x unit cost) + (prevalence AIDS x unit cost). Costs of treatment are based on only 10% of HIV + being aware of their status and hence receiving the PLHA care package. 7. Expected effect on GNP growth. This is split into three sections: human capital, social capital, and household consumption function (affects on savings). The human capital element has been completed, and social capital and savings have been bundled although the data for this is slim. The human capital is just lost earnings. Here the formula used is "Incidence of AIDS x GNP per capita x % economically active x output elasticity of labor". This will be calculated for four groups: male urban, female urban, male rural, female rural, by year. 8. The social capital sheets will attempt to estimate the effect on increased expenditure on health care (for those members of families with HIV/AIDS) on savings. In addition there will be an effort to calculate the effect on reduced savings on expenditure on education. Data is also lacking on the cost of care falling on a household and the average household expenditure on education in primary and secondary school, and some data on the relative GNP per capita rates from different levels of education received for male/female/urban/rural is also lacking. 9. Net economic benefit. This will be calculated as: - 42 - treatment); and * No attempt will be made to estimate the impact of changes in savings on school enrollment; nevertheless this is likely to be a sizable element of the likely long-term economic impact of HIV in The Gambia. 10. Assumptions for variables. Due to the lack of data available and the time constraints the following assumptions will be made (population group data based on 1993 census (updated by total growth figures for recent years): o Urban commercial sex workers estimated at 1,280; o Formal employment estimated to cover 23,672 (1.8%); o Cost of media campaign estimated at US$0.25 per head; o Unit costs of prevention from all other programs are estimated as in the World Bank MAP reports for poor countries; o Exchange rate of US$1 = 13 Dalasis; o Estimation of incidence from model #2 comes from growth of HIV seen in Uganda; o Estimation of incidence from model #3 comes from growth of HIV seen in Cameroon; o Estimation of impact of prevention program comes from Senegal; o The period of time from infection with HIV to the onset of AIDS is estimated as a mean of 8 years; o The period of time from the onset of AIDS to death is estimated as a mean of 2 years; o The costs of treatment of HIV/AIDS are taken from the World Bank MAP document; o The cost of treatment for people which HIV is limited to 10% of the HIV population as this is the anticipated proportion of the population who are likely to be aware of their status; o GNP per capita is estimated as total GNP divided by the adult working population (15-49); o The differences between the GNP per capita for urban and rural were taken from Treasury figures showing GNP from industry and services separately from GNP from agriculture and census data showing the relative size of the population in the rural and urban areas. From this data it was estimated that GNP per capita in urban areas (industry, services) was 2.64 times greater than the average whereas in rural areas (agriculture) it was 0.3 times the average; o Output elasticity of supply was taken from studies done by the World Bank on agriculture in Africa; and o Employment status was taken for the 1998 Gambia Poverty Survey. RESULTS 11. The results of the preliminary analysis are presented in Table 1 below, in Dalasi (constant 2000 prices). Model # 2 refers to the Eastern and Southern Africa scenario and Model # 3 refers to the Cameroon scenario (Model # I is what we expect to happen in The Gambia should prevention strategies be successful). The negative values of the column "Net cost of prevention program" are savings. -43 - Table I Cost benefic analysis of HV prevention programme (millions dalasi-constant 2000 pries) Model #2 Mbdel #3 Year _cost of Savings due Net cost of Inrease in Net econornic Savings due Ne cost of Irnrease in Net economic prvenbon to redLced prevention GDP due to_ benefit to redLned prevention GOP due to benefrt prao'iTme irci-s progranile b HIV rate infio-6 progranmme low HIV rate 2000 18.46 - 18.46 - -18.46 - 1846 - -18.46 2001 3692 - 392 3.92 - 36.92 - -36.92 2002 55s38 - 55.38 - -55.38 - 5.38 - -55.38 2003 7384 - 73.84 - -73.84 - 73.84 - -7384 2004 73.84 0 06 73.78 - -73.78 _ 0.0 73.78 - -73.78 2005 7384 0.16 73.68 - -73.68 0.16 73.68 - -73.68 20 73.84 0.38 73.46 - -73.46 0.38 73.46 -A-.4 2007 73.84 0.62 73.22 - -73.22 0.62 73.22 - -73.22 2008 73 84 087 72.97 -72.97 0.87 7297 - -72.97 2009 73.84 1.15 72.69 -72.69 1.15 72.69 - -7269 2010 73.84 1,45 72.39 -72.39 145 72.39 - -739 2011 73.84 5.15 68.69 5.50 -63.20 515 68.69 550 -63.20 2012 73.84 14 58 59.26 2129 -37.97 1447 59.37 2129 -38.08 2013 73 84 3292 40.92 53.42 1Z.56 32.23 41.61 53 42 11.82 2014 73684 5545 18.39 93.87 75.48 54.15 19.69 9387 74.17 2015 73.84 74.38 -0.54 128.49 129.03 7241 1.43 128.49 127.06 2016 7384 8734 -13.50 15140 164.90 84.00 -10.16 151.40 161.56 2017 73.84 98 56 -24.72 171.34 196.07 93.75 -19.91 171.34 191.26 2018 73.84 130 25 -%6.41 230.63 287.04 123.85 -50.04 230.63 280.63 2019 73 84 186.78 -1129 33906 452.01 172-48 -98.64 327.10 425.74 2020 73 84 250 52 -176.38 463.78 640.46 196899 -123.15 378.56 501.71 2021 73.84 301.18 -227.34 56204 789.38 17911 -105.27 34722 452.49 2022 73.84 333.29 -259.46 624.80 88426 143.20 -69.36 279 02 348.38 2023 73.84 39988 -326.04 758.13 1,08417 131.94 -68.11 25911 317.21 2024 73.84 526 14 -456231 101601 1,468.30 163.65 -89.81 32669 416.49 2025 7384 684.65 -610.81 134584 1,956.65 213.95 -140.11 434.32 574.43 Sum gains/loss 7,342.28 3,084.90 -44 - Annex 5: Financial Summary THE GAMBIA: HIVIAIDS Rapid Response Project 1) Recurrent costs are approximately 5% of IDA financing costs; 2) Implementation and operational periods overlap The Gambia HIV/AIDS Rapid Response Project (HARRP) (Years Ending December 315') IMPLEMENTATION PERIOD Year I |Year 2 l rer |Ya4 |Year 5 Total Financing Required Project Costs Investment Costs 3.3 2.8 3.4 3.8 1.8 Recurrent Costs 0.3 0.3 0.3 0.3 0.1 Total Project Costs 3.6 3.1 3.7 4.1 1.9 Total Financing 3.6 3.1 3.7 4.1 1.9 Financing IBRD/IDA 3.3 2.9 3.4 3.8 1.8 Government 0.15 0.1 0.15 0.15 0.05 Central - - - - - Provincial - - - - - Co-financiers - - - - - User Fees/Beneficiaries - - - - - Others 0.15 0.1 0.15 0.15 0.05 Total Project Financing 3.6 3.1 3.7 4.1 1.9 OPERATIONAL PERIOD Year I Year2 Year3 Year4 Year5 Total Financing Required Project Costs Investment Costs 3.3 2.8 3.4 3.8 1.8 Recurrent Costs 0.3 0.3 0.3 0.3 0.1 Total Project Costs 3.6 3.1 3.7 4.1 1.9 Total Financing 3.6 3.1 3.7 4.1 1.9 Financing IBRD/IDA 3.3 2.9 3.4 3.8 1.8 Govermment 0.15 0.1 0.15 0.15 0.05 Central - - - - - Provincial - - - - - Co-financiers - - - - - User Fees/Beneficiaries - - - - - Others 0.15 0.1 0.15 0.15 0.05 Total Project Financing 3.6 3.1 3.7 4.1 1.9 -45 - Annex 6: Procurement and Disbursement Arrangements THE GAMBIA: HIVIAIDS Rapid Response Project Procurement General. 1.1. A Country Procurement Assessment Review (CPAR) for the Gambia was carried out in 1998. National procedures for procurement of works, goods, and services were found to be wanting in several areas.. The Government has responded recently by making some changes in its Financial Instructions but further revisions are needed to make the procedures more satisfactory. Follow-up Bank assistance is being considered to help in the preparation of a procurement code. So far, findings of the CPAR remain valid. In general, Gambian's procurement laws and regulations do not conflict with IDA Guidelines. No special exceptions, permits, or licenses need to be specified in the Credit since the Gambia's procurement practices allow IDA procedures to take precedence over any contrary provisions in local regulations. 1.2. Civil Works and Goods financed by IDA will be procured in accordance with Bank's Guidelines under IBRD Loans and IDA Credits (January 1995 revised in January and August 1996, September 1997, and January 1999), and Bank Standard Bidding Documents, and Standard Evaluation Report will be used for ICB. National Competitive Bidding (NCB) advertised locally will be carried out in accordance with the Gambia's procurement laws and regulations, acceptable to IDA, provided that they assure economy, efficiency, transparency, and broad consistency with key objectives of the Bank Guidelines. For NCB procedures, the Government gave assurances during negotiations that: (i) methods used in the evaluation of bids and the award of contracts are made known to all bidders and not be applied arbitrarily; (ii) any bidder is given adequate response time (four weeks) for preparation and submission of bids; (iii) bid evaluation and bidder qualification are clearly specified in bidding documents; (iv) no preference margin is granted to domestic manufacturers; (v) eligible firms are not precluded from participation; (vi) award will be made to the lowest evaluated bidder in accordance with pre-determnined and transparent methods; (vii) bid evaluation reports will clearly state the reasons to reject any non-responsive bid. 1.3. Consultant Services contracts financed by IDA will be procured in accordance with the Bank's Guidelines for the Selection of Consultants by World Bank Borrowers (January 1997 revised in September 1997, and January 1999). The standard Request for Proposal, as developed by the Bank, will be used for appointment of consulting firms. Simplified contracts will be used for short-term assignments, i.e. those not exceeding six months, carried out by firms or individual consultants. The Government was briefed during the appraisal mission about the features of the new Consultants Guidelines, in particular with regards to advertisement, bid opening and various steps of IDA reviews. 1.4. Community Participation in procurement will be based on the Bank's Simplified Procurement and Disbursement Procedures for Community-Based Investments. 1.5. Given the urgency of the project, a General Procurement Notice (GPN) for the first year of operations will be prepared and issued in the United Nations Development Business (UNDB) website without the need for hard-copy publication, as well as in the local newspapers to advertise for any ICB for works and goods, and for major consulting assignments, to obtain expressions of interest. The requirement for printed publication of GPN has been waived by the RPA office. The detailed GPN for the subsequent years will be prepared for the project and published in the UNDB. It will be updated annually for all outstanding procurement. Specific Procurement Notices (SPN) and Expressions of Interest (EOI) will be prepared for - 46 - the individual procurement actions where necessary. 1.6. The program elements by disbursement category, their estimated costs, and procurement methods are summarized in Table A below. Thresholds for procurement methods and prior review are summarized in table B below: -47 - Procurement methods (Table A) Table A: Project Costs by Procurement Arrangements (US$ million equivalent) \: Exp ueCPategoy NOB O N... Tota Cost 1. Works 0.00 0.35 0.00 0.00 0.35 (0.00) (0.30) (0.00) (0.00) (0.30) 2. Goods 0.70 0.45 0.60 0.00 1.75 (0.65) (0.40) (0.45) (0.00) (1.50) 3. Services 0.00 0.00 4.10 0.00 4.10 (0.00) (0.00) (4.10) (0.00) (4.10) 4. Community Grants * 0.00 0.00 7.50 0.70 8.20 (0.00) (0.00) (7.50) (0.00) (7.50) 5. Operating Costs 0.00 0.00 1.00 0.00 1.00 (0.00) (0.00) (0.80) (0.00) (0.80) Unallocated 0.00 0.00 0.80 0.00 0.80 (0.00) (0.00) (0.80) (0.00) (0.80) Total 0.70 0.80 14.00 0.70 16.20 (0.65) (0.70) (13.65) (0.00) (15.00) ' Figures in parenthesis are the amounts to be financed by the IDA Credit. All costs include contingencies 2 Includes civil works and goods to be procured through national shopping, consulting services, services of contracted staff of the project management office, training, technical assistance services, and incremental operating costs related to (i) managing the project, and (ii) re-lending project funds to local government units. * Community grants include $2.0 million in small civil works contracts. Community grant contributions from Beneficiaries are only provisional estimates based on information available to date. Prior review thresholds (Table B) -48 - TABLE B: Thresholds for Procurement Methods and Prior Review 1. Works >100 ICB US$0.00 <100 NCB Post Review 2. Goods >100 ICB US$0.20 <100 NCB Post Review <20 National & Post Review International shopping 3. Services a) Firms >100 QCBS/LCS/CQ US$0.70 <100 QCBS/LCS/CQ Post Review b) Individuals >50 3 CVs US$0.60 <50 3 CVs 4. Miscellaneous _II Total value of contracts subject to prior review: US$1.50 2.1. Civil works. No large civil works are scheduled for the project. Civil works contracts include the construction of 5 Reproductive Health Clinics scattered throughout the country and are unlikely to attract foreign contractors. Costing less than US$100,000 per contract, up to aggregate of US$0.35 million, they would be procured through National Competitive Bidding (NCB) procedures in accordance with procedures described in the Project Operations Manual (POM) and acceptable to IDA. Contracts for small works under Component- 4 will mostly be works relating to small community structures such as PLWHA care centers, youth facilities, community meeting facilities etc. These small works are estimated to cost less than US$20,000 per contract, up to an aggregate amount of US$2.0 million. They would be procured under lump-sum, fixed-price contracts awarded on the basis of quotations obtained from three qualified domestic contractors invited to bid. The invitation will include a detailed description of the works, including basic specifications, the required completion date, a basic form of agreement acceptable to IDA, and relevant drawings where applicable. The award would be made to the contractor who offers the lowest price quotation for the required work, provided he demonstrates he has the experience and resources to complete the contract successfully. 2.2. Goods. The total cost of goods is estimated at US$4.07 million for the project. Procurement of goods will be bulked where feasible into packages valued at US$ 100,000 equivalent or more per package and will be procured through International Competitive Bidding (ICB). Preference for domestically manufactured goods will apply in accordance with the World Bank Guidelines. Contracts for office furniture and equipment, vehicles and materials locally available which cost more than US$20,000 but less than US$100,000, up to an aggregate amount of US$1.0 million would be procured through National Competitive Bidding (NCB) procedures acceptable to IDA. Procurement of laboratory equipment, furniture for NAS, DACs and line Departments, printed materials for IEC, and other instructional materials costing less than US$ 20,000 up to an aggregate amount of US$0.35 million equivalent will be -49 - procured through prudent International Shopping and National Shopping in accordance with provisions of paragraph 3.5 and 3.6 of the Guidelines. These aggregate limits do not include contracts under Component-4. 2.3. The procedures followed, and total aggregate amount for all shopping methods under the project, will be reviewed after six months of project operations. Depending on performance and the results of the review, the total aggregate amount may be adjusted where necessary. Standard request forms and establishment of guidelines for conducting the shopping methods (as per the June 9, 2000 Memorandum "Guidance on Shopping") should be prepared and included in the POM. 2.4. Procurement of spare parts, operating expenditures, minor off-the-shelf items, generic pharmaceuticals and other specialist equipment and proprietary items costing less than US$5,000 equivalent per contract up to an aggregate of US$0.50 million equivalent, may be procured directly from manufacturers and authorized local distributors. 2.5. Given the urgency of the project, and to facilitate speedy procurement of items required urgently for institutional strengthening, specific contracts for Component I related to drugs, medical supplies, kits, and condoms; computers and accessories, office equipment may be procured from the (c) United Nations Agencies (i.e., UNFPA, UNICEF, WHO, WFP, IAPSO) in accordance with para. 3.9 of the Procurement Guidelines. All contracts under the above-stated "Emergency Requirements" must be concluded within 12 months of the Credit Effectiveness date. The list of these items and their estimated value should be agreed upon with IDA as per the approved Procurement Plan. The procurement and timely distribution of the goods will be the responsibility of NAS. 2.6 Grants to community-based sub-projects. The CCSI will finance community and civil society HIV/AIDS-related activities, such as IEC, minor repairs or works, purchase of generic drugs, Family Life Education (FLE) books, food rations and medical supplies (e.g. gloves, plastic sheets), care and support for PLWHAs their dependents and orphans, HlV/AIDS-prevention promotion, youth activities, income generating activities for PLWHAs and their dependents. Funding for these activities will be in the formn of grants. 2.7. Work programs under Component 4 will depend on applications received from communities, NGOs, line Departments and private organizations against a positive list of activities. It is not possible to deternine the exact mix of goods, small works, and services to be procured under these activities due to their demand-driven nature. Therefore, the types of activities to be financed under these activities and their procurement details will depend on the needs identified by communities. 2.8. The Bank Guidelines for Simplified Procurement and Disbursement for Community-Based Investments will be used in the design of procurement under this aspect of the project. The NAC through NAS will be responsible for ensuring compliance with these guidelines, and ex-post reviews of random sub-projects will be conducted periodically by the Bank and independent consultants appointed by the NAS. Simplified procurement and disbursement procedures for community-based programs, including the positive list of items qualifying under this component, will be developed and included in the Project Operation Manual (POM) and CCSI Operations Manual, for approval by IDA. The CCSI Operations Manual will include procedures for IDA prior review thresholds for NGOs, private sector, and other community initiatives. - 50 - Consultants services 3.1. Consultant Services. The consulting services required will be mostly in the areas of H1V/AIDS education, IEC/BCC, applied research, training, community development, financial management, monitoring and evaluation, information dissemination, auditing, and accounting. It will also include the selection of the Agency responsible for designing and implementing an integrated community awareness and action approach like "Stepping Stones". The exact mix (types of consultancy, budgets, procurement methods) will be discussed and agreed annually during joint reviews. Consultants will be hired through competition based on (i) Quality-and Cost-Based Selection (QCBS) among qualified short-listed firms, by evaluating the quality of the proposals before combining quality and cost evaluation, by weighting and adding the quality and cost scores. (ii) Least Cost Selection (LCS) in accordance with para. 3.1 and 3.6 of the Consultant Guidelines, will be used for audit contracts costing less than US$ 100,000; the firm with the lowest price will be selected, provided its technical proposal received the minimum mark. Selection based on consultant's qualifications may be used for the selection of research institutes, training institutions, and for assignments that meet criteria set out in para 3.7 of the guidelines. (iii) Consulting services meeting the requirements of Section V of the Consultant Guidelines will be selected under the provisions for the Selection of Individual Consultants (IC) which is basically through comparison of the CVs of at least 3 qualified individuals; and (iv) Single Source Selection (SSS) will be used for (a) the hiring of the local Contract management agency (GAMWORKS) in charge of the construction of the 5 reproductive health clinics (b) for specific tasks that meet criteria set out in para 3.8 to 3.11 of the guidelines, and (c) for consulting assignments costing less than $5,000 up to an aggregate of US$0.50 million. The NAS would ensure that procurement notices are widely publicized to get candidacies from consultants (firms and individuals). Based on agreed upon criteria, the NAS will maintain and update a list of consultants which will be used to establish short-lists. 3.2. To ensure that priority is given to the identification of suitable and qualified national consultants, short-lists for contracts estimated under US$100,000 or equivalent may be comprised entirely of national consultants (in accordance with the provisions of paragraph 2.7 of the Consultant Guidelines), provided that a sufficient number of qualified firms (at least three) are available at competitive costs. However, if foreign firms have expressed interest, they will not be excluded from consideration. The Standard Request for Proposal (RFP) as developed by the Bank will be used for requesting proposals, and for selection and appointment of consulting firms. Simplified contracts will be used for short-term assignments-simple missions of a standard nature (i.e., those not exceeding six months) carried out by individual consultants or firms. The Govermment was briefed during appraisal and negotiations about the special features of the new guidelines and the RFP, in particular with regard to advertisement, public bid opening, and evaluation criteria. 3.3. Training, workshops, and study tours. The total cost of these activities is estimated at US$1.60 million for the project. Training, workshops, conference attendance and study tours will be carried out on the basis of approved annual programs that will identify the general framework of training or similar activities for the year, including the nature of training/study tours/workshops, the number of participants, and cost estimates. All out of country long-term training which is over 3-months will be subject to IDA approval. Post-reviews of in-country training will be conducted from time to time to review the selection of institutions/course contents/trainees and justifications thereof, and costs incurred. IDA Reviews 4. 1. IDA-financed contracts for goods and works above the threshold value of US$ 100,000 equivalent will -51 - be subject to IDA's prior review procedures. Draft standard bidding document formats for NCB will be reviewed and agreed upon with IDA. Prior IDA review will not apply to contracts for the recruitment of consulting firms and individuals estimated to cost less than US$100,000 and US$50,000 equivalent, respectively. However, the exception to prior review will not apply to the Terms of Reference of such contracts, regardless of value, to single-source hiring, to assignments of a critical nature (such as audits) as determnined by IDA, or to amendments of contracts rising the contract value above the prior review threshold. For consultants contracts estimated to cost less than US$100,000, but more than US$50,000, opening the financial envelopes will not take place prior to receiving the Bank's no-objection to the technical evaluation. 4.2. Documents related to procurement below the prior review thresholds will be maintained by the Government for ex-post review by auditors and IDA supervision missions. The first three NCB contracts and first five contracts with Communities financed under Component 4 will be subject to prior review during the first year of the Project. Emergency procurement for goods will require prior review by IDA. 4.3. All thresholds stated in this section will be reviewed by the Borrower and IDA on an annual basis. Modifications may be agreed upon, based on performance and actual values of procurement implemented. Amendments to the Development Credit Agreement may be proposed, as necessary. Procurement implementation arrangements 5.1. The overall coordination of project implementation will be done by the NAS, with each line Department and NGO/CBO responsible for implementation of their relevant work programs. Major procurement such as vehicles, office and medical equipment will be handled by NAS. Procurement of items related to IEC/BCC materials, workshops, training, and operations will be handled by the line Departments and DACs using the specified procurement methods identified for the project. Ownership of the signed contracts and contract management will be with respective line Departments and DACs. An assessment of procurement capacity of NAS, DAC and line Departments was done (see assessment report below). An action plan was agreed upon to be completed before Credit effectiveness. 5.2. Fifty percent of the project funds are allocated to Component-4. The procurement plan for the first year was prepared during appraisal and will be finalized before Effectiveness. It is based on the initial needs of the NAS, DACs and line Departments. Costs beyond Project Year 1 for the subsequent years are only indicative. The exact mix of procurement will be determined on an annual basis during the annual joint reviews between NAC/NAS, IDA, and other partners, where a draft procurement plan for the following financial year will be presented and agreed upon. During 2001 the detailed procurement plans for subsequent years will be developed and submitted to IDA for review and approval. The plan will include relevant information on goods, works, and consulting services under the project as well as the timing of each milestone in the procurement process. The procurement schedule will be updated semi-annually for the first eighteen months, and quarterly thereafter for PMR based disbursements. These plans will be reviewed by IDA supervision missions. Project Operations Manuals: Procurement 6.1. The Project Operations Manual prepared by the Borrower will include a specific section on Procurement detailing: (i) procedures for planning, calling for bids, selecting contractors, consultants, and vendors, and awarding contracts; (ii) internal organization for supervision and control of works; (iii) procedures for handing over completed works. - 52 - 6.2. The Government has submitted to IDA a draft Procurement Plan for the first year. The Government gave assurances that it will (a) use the Bank's standard bidding documents, (b) apply the agreed procurement procedures and arrangements, and (c) annually review the procurement plan with IDA. Procurement Capacity Assessment. Overall Procurement Risk Assessment: High 7X Average Low Frequency of procurement supervision missions proposed: Once every 6 month(s) (includes special procurement supervision for post-review/audits). Post Reviews will apply to one (1) contract out of four (4) not subject to prior review. Also, the first three NCB contracts and first five grant contracts financed under Component 4 will be subject to prior review. Summary of Findings and Actions. See table below - 53 - Assessment Risk Assess ment Item Assessed N P F Satis- Major Weaknesses L A H Actions Proposed U O A fac- 0 V I Proposed Completion L OI tory W E G Date L R R_. (a) Legal Aspects ________ (i) Laws & X Sections of the X A CPAR was Before end of Regulations Financial Instructions conducted in 1998 FY01 dealing with but follow-up action procurement and the needs to be agreed new draft Procurement upon and code needs major implemented revisions to ensure adequate coverage of essential procurement __________ _ __ aspects. _ I (ii) NCB X No standard bidding X Use of Bank Standard To be agreed at Procedures documents for works bidding documents negotiations and goods. and Request for and used Proposals throughout proj ect ____________________ ____________________ implementation (iii) Intemal codes X See # (i) above. There X Development of a Before credit and manuals is no procedure manual Project Operational effectiveness, yet under HARRP. Manual (POM) which and updated ensures adequate during project coverage of implementation procurement, as necessary. including a computerized contract management system integrated into the financial management system to be developed by the Financial Management Agent (FMA) to be recruited under NAS. (b) Proc. Cycle Mgmt. _____ _ _ _ -54 - (i) General handling _ Lack of understanding - i An initial Initial of new features of bank procurement training procurement procedures program will be training implemented for program will be NAS and other implemented participating for NAS and agencies. other participating An SOE review and agencies during procurement post first half of year review of the ongoing 2001. operation to be SOE and conducted to identify procurement further deficiencies post review and training needs. conducted as Also the use of Bank part of the first standard evaluation supervision reports for mission, and goods/works will be continually made a requirement during project under the HARRP implementation. (ii) Procurement X Except for Departments X The procurement plan Before credit planning hosting WB funded for NAC/NAS and effectiveness projects, most line other participating for the first year Departments, as well as agencies shall be of operations DCCs and prepared and and continually, municipalities are not submitted to IDA for throughout familiar with review. This plan project procurement planning will be extended to implementation and scheduling, subsequent years and _ _ - _ _ _ updated regularlv. (iii) Preparation of X No standard bidding X Use of Bank Standard Agreed at documents documents exists for bidding documents. negotiations. NCB, and preparation Procurement training Training of biding documents program will be program to be often shows lack of designed to cover this provided once understanding of aspect. NAS is fully Bank's procurement staffed. I I _pDolicies and Drocedures. _ (iv) Management of _ X process I X i (v) Bid evaluation X Bid evaluation reports X Use of standard To be agreed at often show a lack of evaluation reports negotiations understanding of Bank developed by the and requirements Bank is necessary. implemented Training would also throughout address this issue. project implementation Training program to be delivered once NAS is fully _________________ ____ _ ________ _______________________ _ _______________________ staffed - 55 - (c) Organization and Functions _ (i) Organization of X X unit and functions _______ (ii) Internal X Lack of internal X POM will address Draft POM manuals and manuals and this issue. prepared and instructions instructions for the submitted for HARRP IDA review before Credit ______ _ _ _Effectiveness (d) Support and Control Systems _______ (i) Auditing X No project auditor as X Project auditor will During first half yet be contracted by NAS of 2001 (ii) Legal assistance __ _ X X _ _ (iii) Technical and X X administrative controls _______ (iv) Code of ethics X _ X__ X__ . (v) Anticorruption X X initiatives _______ (e) Record keeping X Copies of records are X Proper filing of Organization of often scattered in project procurement the filing separate files which records for system to be makes retrieval completeness and achieved by difficult. Evidence of easy retrieval. All July 2001. competition under the records documenting Local Purchase Order the procurement (LPO) procedure not on process shall be kept file (pro-forma invoices in one location. of losing bidders are Filing cabinets will often discarded after be acquired under the selection of the winner) Credit as necessary to organize the filing system for HARRP _______ _____________________ _ _ operations. (i) Public notices X X I (ii) Bidding _ - X X documents (iii) Bid opening - - X X information (iv) Bid evaluation X X _ _ reports _____ __ _ _ (v) Formal appeals X X and outcomes XI (vi) Signed contract X X _ _ documents (vii) Claims and X X dispute resolution records _____ ___ _ - 56 - (f) Staffing _____ _ ____. (g) General Procurement Environment _____ _ _ __ (i) Promoting a X X culture of accountability __ __ _ (ii) Reputation of X X procurement corps (iii)Salary structure (iv) Freedom from X X political interference (v) Existence of X Absence of a X A Procurement Recruitment to experienced and procurement specialist Specialist will be be completed capable staff recruited at the NAS by NAS to take the lead in Director after procurement and Credit provide assistance to effectiveness. other components as (vi) Clear written Xi X POM will address Draft POM standards and this issue. prepared and delegation of submitted for authority IDA review Before Credit _ _ _ _ _ ~~~~~~~~~~~~~~~~effectiveness (vii) Sound X X Procedures manual Draft POM budget/financial will address this prepared and systems issue. submitted for IDA review Before Credit ________ _____ __ __ _ _ _ _ _ _ _effectiveness (h) Private X Sector Assessment _______ (i) General X Bidding documents - _ X Use of Bank Standard Use of Bank efficiency and often contain unclear bidding documents Standard predictability evaluation criteria will be required. bidding First three bidding documents documents for NCB agreed at will be subject to negotiations prior review by IDA Procurement Procurement training training to be program will be implemented as designed to cover this soon as NAS I_aspect. staff is in place. (ii) Trans arenc X y Same as above _ X Same as above Same as above (iii) Quality of X X contract mgmt. - 57 - Prior Review Thresholds Proposed Overall Risk Assessment Goods US$ 100,000 (equivalent) High X Works US$ I0QQ (equivalent) Average Consulting firms US$ 100,000 (equivalent). Individuals Low US$50.000 (equivalent) Post Review Ratio: One in Four contracts Frequency of procurement supervision missions proposed: Form prepared by: Amadou Tidiane Once every six months by either Country Office procurement Toure, Senior Procurement Specialist staff or procurement specialist from HQ during supervision missions. Procurement audits shall also be conducted every two years Signature: Date: November 23, 2900 Comments: Based on the capacity assessment carried out during the appraisal mission in November 2000, it can be concluded that Line Departments and Divisional/municipalities level require improvement in areas of bidding document preparation, bid evaluation, and procurement filing. In general, line Departments with prior Bank experience (Health; Agriculture; Education) have better understanding of Bank procurement requirements, compared to other line Departments or divisional comrimittees and municipalities. An action plan was agreed to address areas where the existing structures still need to be strengthened to meet performance criteria for PMR-based disbursement. The action plan includes (i) Hiring of a procurement specialist under NAS who will play the lead role in the handling of major procurement, including planning and implementation, quality control, and assistance to the procurement units of other participating agencies; (ii) Development of a Project Operations Manual (POM) to ensure adequate coverage of procurement, including a computerized procurement and contract management system integrated into the financial management system; (iii) Organization of a filing system to ensure availability of, and easy access to procurement records, and (iv) training of staff on Bank procurement procedures and the use of Bank standard bidding documents. Also, as part of the TORs of the Financial Management Agent (FMA) to be recruited by the NAS, simplified procedures and standardized documentation for Community and Civil Society Initiatives will be designed and the necessary training provided to the signatories of the communities, so that they can canry out the procurement function in a manner acceptable to the Govermment and the Association. In addition, the Credit will finance capacity building for specific training and strengthening needs of the CBOs/NGOs. Staffing gaps will be addressed through the hiring of Contract Management Agency to handle civil works procurement; and the use of UN agencies for the procurement of most goods (condoms) and equipment (such as vehicles) for the initial needs of the project. Given the complexity of the organizational set up and the diversity of implementing agencies, project implementation will require extensive supervision. Therefore, it has been agreed that one in four contracts not subject to IDA prior review would be subject to post-review by the Bank . Also, a procurement audit is envisaged every two years. - 58 - Disbursement Allocation of credit proceeds (Table C) Disbursementprocedures Specific disbursement procedures will be developed for the HARRP to address the need for rapid response. The key considerations defined for the Multi-country HIV/AIDS Program will apply to the HARRP. These considerations are: a) a link between physical progress and project expenditure, b) the need for a sufficient balance in the Special Account to cover decentralized and emergency activities, and c) an efficient and effective flow of funds to meet the needs of the project during a relatively short implementation period. Funds will be disbursed from IDA into a single Special Account administered at central level, on behalf of the NAS by the Financial Management Agent(FMA). The initial deposit into the Special Account will cover IDA financing for the first six months of project implementation. There will be no advance account for the line Departments. The expenses of the latter, related to the activities of the Project, will be paid directly by NAS/FMA from the Special Account based on payment requests sent by the line Departments to NAS. Disbursement of funds to the Divisional/municipal accounts and to individual community and NGO accounts will follow the guidelines for simplified procurement and disbursement for community-based investments issued by the World Bank. Funds will be transferred from the central Special Account to the Divisional/municipal bank accounts based on the sub-projects approved and the annual work programs. Disbursement of funds to the individual communities will be done from the Divisional/municipal accounts following the approval of the sub-projects. For larger sub-projects, disbursement can be done directly from the Special Account to the beneficiaries account given the large amounts involved. The replenishment of funds into the Special Account and divisional/municipal accounts will be administered on behalf of the NAS by the FMA. Use of PMR-based disbursement method The overall project financial management system will include Project Management Reporting capability from the beginning of project implementation. However, it is difficult to make accurate cash forecasts, particularly for the first year, given the nature of the project. Therefore, it is unlikely that the project will be able to use the Project Management Report (PMR) based disbursement method from the beginning of the project. Nevertheless, quarterly PMR reports, including financial, procurement and physical progresss, will be prepared as soon as the project starts. During an interim period of 18 months the PMR will be reviewed and improved and the financial management capacity at all levels will be strengthened. The project is expected to operate under PMR-based disbursement at the end of the 18-months interim period. In the meantime, the project will follow traditional disbursement methods. Allocation of credit proceeds (Table C) The project is expected to be completed over a five-year period according to the categories shown in Table C, and the Credit closing date would be six months after the fifth year to allow payment of last invoices for contracts completed before the completion time. Government counterpart funds needed for each fiscal year to cover the share of investments and recurrent costs not financed by IDA will be deposited by the Government in a Project Account (PA) managed by the NAS, on a quarterly basis. - 59 - Table C: Allocation of Credit Proceeds 1. Civil Works 0.30 100% of foreign expenditures 90% of local expenditures 2. Goods 1.50 100% of foreign expenditures 90% of local expenditures 3. Consultant Services 4.10 100% 4. Community Grants 7.50 100% 5. Operating Costs 0.80 90% 6. Unallocated 0.80 Total Project Costs 15.00 Total 15.00 Use of statements of expenditures (SOEs): Disbursement of the IDA Credit for contracts valued at less than US$100,000 equivalent for civil works and goods, and less than US$] 00,000 for consulting firms (US$50,000 for individual consultant contracts), all incremental operating costs and training, and all CCSI grants under US$100,000 would be made against Statements of Expenditures, (SOEs) for which documentation would be made available for examination by auditors (including technical audits) and by IDA supervision missions. Special account: To facilitate disbursement of eligible expenditures for works, goods, services and grants, the Government will open a Special Account (SA) in the Central Bank of the Gambia to cover IDA's share of eligible expenditures. Authorized allocation of the special account would be US$ 1,000,000 covering an estimated 6 months of eligible expenditures financed by IDA. All expenditures eligible for IDA financing of less than US$ 100,000 equivalent would be paid from the SA. Additionally, the borrower would be authorized to withdraw from the Special Account and deposit into each 90-day Advance account funds to assist Divisional HIV/AIDS Committees (DACs) or municipal equivalents, to pay for goods and services under Part D of the project. NAS will be responsible for submitting monthly replenishment applications with appropriate supporting documentation for expenditures incurred and will retain and make the documents available for review by IDA supervision missions and project auditors. The Special Account will be replenished through the submission of Withdrawal Applications on a monthly basis and will include reconciled bank statements and other documents as my be required, until 18 months after effectiveness of the Credit, after which further deposits to the Special Account will be on a quarterly basis as determined through the Project Management Reporting System. All disbursement will be channeled then through the SA . Under the PMR based disbursement the borrower may choose also to pre-finance project expenditures and subsequently seek reimbursement from IDA. Financial management arran2ements A financial management system, acceptable to IDA, will be established for The Gambia WHV/AIDS Rapid Response Project (HARRP). It will provide accurate and timely information regarding resources and expenditures. The financial management system will include accounting, project management reporting -60 - (financial, procurement and physical progress) and auditing elements. For this purpose, a financial management capacity assessment was done as presented below. The findings of the assessment are taken into consideration to design the proposed financial management system, and an action plan was defined to strengthen the project capacity at all levels to ensure compliance with World Bank Operational Policies and Procedures (OP/BP 10.02) and the Financial Management Initiative. Financial Management Capacity Assessment Scope of the assessment By looking at the implementation arrangements of the Project, there will be basically three major circuits for the flows of funds: one going to the NAS, one to the line Departments through the NAS, and one to the communities/applicants for the CCSI through the DAC. Project funds and accounts will be managed at NAS level, within the line Departments, at DAC, and at the community level. Given these settings, the assessment needs to address the financial management capacity of NAS, line Departments, DAC and the communities. The financial management capacity assessment was conducted during project preparation and updated during project appraisal. Several meetings were held with representatives from the Department of State for Finance and Economic Affairs, the Office of the Accountant General and accounting units of several line Departments to discuss possible options for the financial management arrangements and to review the existing capacity at each level. Field visits to a Municipality and a Division were also organized to assess the capacity at the decentralized level to ensure the feasibility of the decentralized approach of the Project, namely for the CCSI mechanism. In addition, a meeting was held with representatives from an international accounting firm based in Banjul to ensure the existence of adequate capacity in countiy for the outsourcing of the project's financial management. Mainfindings of the assessment NAS: As the administrative, coordinating, and monitoring mechanism for the entire Project, NAS would have the overall responsibility of the project's financial management. Because NAS is yet to be created, it does not have any existing capacity. Setting up a proper financial management system for the not yet established NAS would not fit with the rapid response approach of the project and at the same time address the accountability and internal control requirements. The final option agreed with the Governmuent of The Gambia was therefore to outsource the financial management, initially for a two year period, at which time it would be jointly reviewed by the Government and IDA. This option was discussed with various parties including a reputable accounting firm, and it was confirmed that it would be feasible with local expertise. Line Departments: The review of Government's existing disbursement systems led to the conclusion that these systems do not facilitate timely flow of funds directly to implementing entities. The normal disbursement procedures going through the Treasury are too long and do not fit the need for rapid response of the Project. Each line Department has an accounting unit of variable size depending on the size of the Department. Usually there are a Principal Accountant and Account Clerks appointed by the Accountant General. Most line Departments use below the line accounts to expedite disbursements. There are basically two types of below the line accounts: i) normal below the line accounts whereby the line Departments prepare payment vouchers which are then sent to the Office of the Accountant General to process the payments; ii) self-accounting below the line accounts whereby funds are transferred to a bank account directly managed by the line Departnents which process the payments. Larger line Departments such as Health (DOSH) are also familiar with managing external donors' funds -61 - for projects located in these Depailments. The management of these funds is similar to that of the self-accounting below the line accounts. It is more likely that self-accounting type of below the line accounts will better fit the needs of the project. It was decided that there will be no advance accounts for the line Departments under this project. Line Departments expenses related to project activities will be paid directly by NAS/FMA based on a approved annual budget and payment requests sent to NAS by the line Departments. DAC: Each Division or Municipality has an accounting unit. The accounting unit of the Division and the Municipality visited during project preparation have gained some experience in keeping the accounts of community-based development projects including managing commercial bank accounts and recording and reporting on the expenses. HARRP financial management at the decentralized level will build on this experience. Communitv level: One of the most important aspects of the project is to channel funds directly to the communities through the CCSI mechanism. Funds will be managed directly by the communities. This does not mean that the financial management of the sub-projects should be overlooked. On the contrary, an appropriate financial management system at the community level will help ensure that funds received are used for the purpose intended. As a result of the visits to a municipality and a Division, it was noted that the proposed approach is being implemented in The Gambia. The Local Initiative Fund (LIF) is one example. However, two major concerns were raised: i) the problem of capacity at the community level, which must be addressed through training, ii) the need to specify clearly the reporting requirements, which must be simple to cope with local capacity. Proposed Financial Management, Reporting, Auditing Arrangements NAS will be administratively responsible to produce a quarterly project management report. It will also produce financial reports (as a part of the quarterly report) with the help of the FMA.. Line Departments will administer the approved annual plans through their focal points. These focal points will be responsible for overall project implementation of their respective annual work plans and preparation of project progress reports. NAS will arrange for any technical support needed. DACs will manage matters related to community projects (either approved at the DAC or at the NAC/NAS levels). Financial Management The design of the financial management arrangements will aim at ensuring both timely and reliable flow of funds to the implementing entities at all levels. For this purpose, the financial management of the project at the central level will be contracted out to the private sector (Financial Management Agent- FMA). The FMA will be responsible on carrying out all matters related to the financial management of the project under the supervision of NAS. The FMA will locate staff in NAS who will facilitate the collation of financial statements received from various implementing entities. As instructed by NAS, FMA will manage the principal HARRP accounts, disbursements of funds from them such as advances, replenishments of advances, payments to NAS goods and service providers. In collaboration with the NAS, FMA will also assist the accounts units of participating line Departments and the DACs (or municipality equivalent) in properly maintaining the Project accounts. The financial management arrangements for this project will build on existing accounting units within line Departments, Municipal Councils and the geographic Divisions, under the responsibility of NAS, assisted by the FMA. Terns of reference (TORs) for the selection of the FMA were drafted. They were reviewed by IDA during appraisal and found to be satisfactory. They specify that the selected firm will set up the project's financial management system (including development of the Project Operations Manual and the installation of financial management software) and provide technical support including training and post an - 62 - adequate number and mix of FMA staff at NAS on a permanent basis. It should be noted that with respect to the Community and Civil Society Initiatives, the approval of proposals will be the responsibility of the NAS and DACs (or municipality equivalent), while disbursement will be separate and overseen by the relevant accounting units and the FMA. National HIV/AIDS Secretariat (NAS): Expenses for activities carried out by the NAS will be financed directly from the Special Account administered by the Financial Management Agent. A representative of the FMA and the Director of the NAS, would be signatories for the Special Account (two must sign). In the absence of, or as designated by the NAS Director, the NAS Deputy Director would be able to sign along with the representative of the FMA. Line Departments: For each of the participating line Departments, an accountant from the accounting unit will be specifically designated (based on his/her qualifications), to be responsible for HARRP operations bookkeeping. Financial management, reporting and intemal control procedures applicable within the line Departments will be developed in the Project Operations Manual, which will be prepared by the FMA. Payments will be processed through the Special Account based on requests sent by the line Departments. Payments will be done only after satisfactory controls on the supporting documents are perforned by NAS/FMA. The Project Operations Manual will contain financial management and intemal control procedures applicable to the line Departments. To address the issue of financial management capacity within the line Departments, training will be provided to accountants involved in the financial management of the project. Costs for this training will be financed under the project, under Component I, sub-component b) "Coordination and Administration". In addition, funds will be disbursed to line Department bank on the basis of payment requests reflecting an approved annual budget; and replenishments to line Departments will be approved after adequate docwnentation of the funds provided, and after the FMA Agent performs appropriate controls. Community and Civil Society Initiatives Financial Management: Arrangements for fnancial management of the Community and Civil Society Initiatives will be partly based on experience with the Local Initiatives Fund (LIF), which is being tested under the on-going PHPNP project, as well as other similar efforts. Under the LIF, a bank account is opened at the Divisional/municipal level in a commercial bank and managed by the Divisional/municipal LIF agent (who is the Community Development Officer). Disbursement from the Divisional/municipal bank account to the communities for approved sub-projects is done by check. Books of accounts are maintained at the Divisional/municipal level with the support from the Division or Municipal Council's accounting unit. At the community level, a minimum level of accounting is maintained with the assistance of extension workers to prepare and submit to the Divisional LIF agent, monthly expenditure reports. The LIF Agent at Divisional/municipal level maintains a Cashbook, Monthly Expenditure Report, and Project Ledger in addition to a Bank Reconciliation Statement and Payment Voucher. Mechanisms similar to those described above for the LIF will be implemented for Community and Civil Society Initiatives. A bank account will be opened in a commercial bank for each Division/Municipal Council. A designated qualified accountant from the Divisional/municipal accounting unit will manage it. The signatories for these bank accounts will be the head of the Divisional or municipal HIV/AIDS Committee (DAC) and the designated accountant (two must sign). In the absence of the head of the DAC, the Commissioner/Chairman of the Municipal Council will sign with the accountant. Quarterly budget allocations based on the divisions/municipalities funds allocation and annual work plans will be transferred to the Divisional/municipal bank accounts from the Special Account. Funds will be disbursed from the Divisional/municipal bank accounts to the communities or other approved applicants NGOs, unions, establishments, by check. Communities or other approved applicants will be encouraged to deposit funds received into a bank account (depending on proximity of bank branches), or use a safe to secure the funds. -63 - They will maintain simple book of accounts and report monthly on their expenditures to the division/municipality. There will be publicity regarding the grants made to enhance transparency and accountability. The design of the financial management system at the Divisional/municipal and community levels as well as the accounting procedures and coordination and reporting mechanisms between all levels will be further detailed in the Project Operations Manual. To improve financial management capacity at the Divisional/municipal and community/approved applicant levels, accountants from the Divisional and Municipal Accounting Units and community members as well as other approved applicants will be trained in financial management. Training provided under other projects, particularly at the community level, will be taken into account in the design of the training activities to avoid duplication, ensure better use of resources, and harmonize procedures with other capacity building initiatives. Reporting Each of the line Departments, DAC secretariats and the NAS will prepare Annual Work Programs (AWP), including disbursement forecasts. All Annual Work Programs will be consolidated by the NAS into the Project's overall Annual Work Program, to be submitted to the Bank. Based on AWPs, each line Department and DAC Secretariat will prepare quarterly financial and progress reports. The Financia! Management Agent will prepare the NAS's financial report and consolidate all individual financial reports into the Project's overall quarterly report. DAC financial reports will include transactions in conjunction with other activities financed under the Community and Civil Society Initiatives based on monthly expenditure reports prepared and sent by the communities/approved applicants to the DAC. The Project Operations Manual will further elaborate on reporting requirements. Audit requirements The main characteristic of this project is the relatively large number of bank accounts and the decentralization of the financial management, both of which are aimed at addressing the need for rapid response, given the goals of the project. This situation inevitably increases the level of risk which will be mitigated by outsourcing financial management, and appropriate internal control procedures at all levels. Accordingly, the audit requirements will be commensurate with the design of the Project's overall financial management structure and level of risk. The Project's consolidated annual financial statements and statement of expenditures will be audited by independent external auditors acceptable to IDA according to detailed terms of reference approved by IDA. This audit will also cover controls on the monthly expenditure reports submitted by line Departments and DACs. Audits of the community and other local implementing entities will be performed on a random sample basis. In addition, all sub-projects financed for an amount greater than the equivalent of US$50,000 (subject to be reviewed depending on project performance) will be systematically audited and reported on by the auditors. The auditors' report should be submitted to IDA no later than six months after the end of a fiscal year. The auditors' report should include a management letter to be issued at the end of their audit. - 64 - PROJECT FINANCIAL MANAGEMENT CAPACITY STRENGTHENING ACTION PLAN i1. lnstallation of the pr >c,t' financial mana,m,ent s stem 1.1 Draft terms of reference for the Financial Controller/PHPNP Done selection of the Financial Management with IDA approval Agent 1.2 Request for proposals finalized and PHPNP with IDA approval December 4, 2000 sent out 1.3 Technical and financial proposals PHPNP January 4, 2001 received 1.4 Technical evaluation completed PHPNP/HARRP Focal Point January 5, 2001 1.5 Approval of technical evaluation IDA January 10, 2001 report _ 1.6 Opening of financial proposal and PHPNP/HARRP Focal Point January 12, 2001 award of contract _ . 1.7 Approval of financial evaluation IDA January 16, 2001 report and contract award 1.8 Contract signed and work begins PHPNP/FMA January 24, 2001 1.9 Completion of draft Project FMA February 19, 2001 O pe rations Manual and financial management software installed and custom ized . ___ ______ 1.10 Comments on the draft Project Government I IDA February 23, 2001 Operations M anual and financial management software installed and custom ized 1.11 Completion of the installation of FMA March 26, 2001 the financial management software and final version of the Project Operations M anual 1 .12 Training workshop for line FMA TBD Departments, Divisions and Municipalities Accountants who will work on proect _ 2. Selection of the.,projectt's auditors 2.1 Draft terms of reference for the Financial Controller/PHPNP Done selection of the auditors with IDA approval 2.2 Request for proposals finalized and PHPNP November 27, 2000 sent out. 2.3 Technical and financial proposals PHPNP December 27, 2000 received 2.4 Technical evaluation completed PHPNP/Auditor General December 27, 2000 0 ffice 2.5 Approval of technical evaluation IDA January 12, 2001 report 2.6 Opening of financial proposal and PHPNP/Auditor General January 19, 2001 award of contract 0 ffice 2.7 Contract signed PHPNP/FMA January 31, 2001 -65 - Annex 7: Project Processing Schedule THE GAMBIA: HIV/AIDS Rapid Response Project Project Schedule Planned Actual Time taken to prepare the project (months) 5 5 First Bank mission (identification) 08/01/2000 08/01/2000 Appraisal mission departure 11/12/2000 11/12/2000 Negotiations 12/01/2000 12/01/2000 Planned Date of Effectiveness 03/15/2001 Prepared by: The core Gambian HIV/AIDS Technical Group, initially under the auspices of the Department of State for Health and Social Welfare, the National AIDS Control Program and the Participatory Health, Population and Nutrition Project Implementation Unit, various line Departments, and the Office of the President. Preparation assistance: Government financing of the preparation efforts. Signiciant support was provided by NGOs located in The Gambia including the World Evangelisation for Christ (in particular Dr. Gisela Schneider), the Medical Research Council (in particular Dr. Matthew Shaw), and UNAIDS partners. Australian Consultant Trust Funds provided support for identification of innovative preventive strategies (in particular Victor Zbar and Susan Paxton). With respect to developing the project design and operations in particular Nadeem Mohammad (World Bank Consultant' planning and operations management), as well as Negda Jahanshahi (World Bank Consultant, Operations Specialist)., and Jerome Chevallier (World Bank Consultant, Operations Specialist). Australian Grant ITF04060 1: US$50,000 Bank staff who worked on the project included: F Name Speciality tElizabeth Adu Lead Counsel Anwar Bach-Baouab Quality Assurance Advisor Rene Bonnel Health Economist Jonathan Brown Quality Assurance Advisor Adriana Jaramillo Education Specialist John May Population and HIV/AIDS Specialist Southsavy Vilay Nakhavanit Administrative Client Support Ahmadou Moustapha Ndiaye Financial Management Specialist Richard Seifman Task Team Leader Josef Toledano Rural Development Specialist Amadou Tidiane Toure Procurement Specialist Christopher Walker Quality Assurance Advisor KEY IMPLEMENTATION STEPS BEFORE AND DURING PROJECT YEAR 1 - 66 - A. Through Project Launch Deliverables/ Actions Person(s) Responsible Date ( or sooner) Remarks 1. TORs for Financial Management HIV/AIDS Focal Point December 6, 2000 PHPNP Agent (FMA) sent out as RFP. with PHPNP Financing and assistance. assistance. 2. GOTG advertises for NAS Director. HIV/AIDS Focal Point December 11, 2000 PHPNP with PHPNP Financing and assistance. assistance. 3. GOTG submits candidate's CV for HIV/AIDS Focal Point. January 11, 2001 NAS Director. 4. After technical evaluation approval, I HIV/AIDS Focal Point January 16, 2001 GOTG submits FMA contract report for award. 5. GOTG approves formal Cabinet, Finance and December 15, 2001 PHPNP establishment of the NAC/NAS. HIV/AIDS Focal Point. assistance. 6. GOTG submits for non-objection 1 HIV/AIDS Focal Point, March 1, 2001 year PIP; draft Project Operations NAS Director. Manual; 7. Bank account for Special Account Department of State for March 1, 2000 and initial deposit made. Finance. 8. Installation of financial management NAS March 26, 2001 system and procedures ( Project Operations Manual). 9. Project Launch Workshop NAC Chairperson and March 15, 2000 NAS Director B. National HIV/AIDS Strategy and Action Plan - 67 - Deliverables/Actions Person(s) Responsible Date (or sooner) Remarks 1. Review of existing National AIDS Secretariat February 2001 Can begin as policies (NAS) soon as NAS in place 2. Thematic papers NAS and National AIDS February 2001 In advance, leading to draft interim Control Program (NACP) of NACP can strategy the DOSH identify key themes and begin work with PHPNP resources 3. Draft Interim strategy NAC and NAS April 2001 Approved at documents agreed to by regular NAC National AIDS Council meeting (NAC) 4. Divisional and NAS and Divisional AIDS May 2001 Municipality comment and Committees (DAC) consensus workshops 5. Synthesis presentation NAS and NAC July 2001 to NAC. including draft Plan of Action 6. Presentation to potential NAS July 2001 partners for indications of financial and technical support 7. Presentation to National NAC and Office of the September 2001 Assembly for adoption President 8. Execution of Plan of NAC/NAS Begins in March 2001 Action (HARRP fnanced and is ongoing activities) 9. Annual Project reporting NAC/NAS April 2002 Review/revision of Action Plans with partners and potential partners -68 - Annex 8: Documents in the Project File* THE GAMBIA: HIV/AIDS Rapid Response Project A. Project Implementation Plan Revised draft Project Implementation Plan dated November 24, 2000. Multi-country HIV/AIDS Program for the Africa Region, Project Appraisal Document (Report No. 20727 AFR) Gambia Participatory Health, Population and Nutrition Project Appraisal Document (Report No. 17399 GM) October 20, 2000 letter from the Office of The President: "Institutional Arrangements for the Implementation of Gamnbia HIV/AIDS Rapid Response Project" (OP 243/111/01 /Temp/(I 0) B. Bank Staff Assessments Environmental and Social Data Sheet dated October 23, 2000 The Gambia Country Procurement Assessment Report dated October 1998, and The Gambia Procurement Capacity Assessment Report-HIV/AIDS Rapid Response Project dated November 23, 2000 Assessment of Project capacity for PMR-Based Disbursement: The Gambia-HIV/AIDS Rapid Response Project dated November 24, 2000 World Bank/UNAIDS Joint Aide Memoire re The Gambia HIV/AIDS Rapid Response Program Mission (August 4, 2000) and the Joint Statement of the UNAIDS Agencies on HIV/AIDS (November 28, 2000) Series of technical notes and comments produced during project identification and pre-appraisal missions, and during preparation of the Population Policy LIL Enhanced C. Other "Innovative HIV/AIDS Prevention Strategies (October 2000), report by Victor Stanley Zbar and Susan Paxton, Australian Consultant Trust Fund Gambia Report.doc UNAIDS National Programmes "A Guide to Monitoring and Evaluation" (UNAIDS/00. 1 7E) UJNAIDS Technical Note 3 "How Do Communities Measure the Progress of Local responses to HIV/AIDS?" *Including electronic files - 69 - Annex 9: Statement of Loans and Credits THE GAMBIA: HIV/AIDS Rapid Response Project C"A-At6m. G.991rh. F. of 0f f 12* CA-" PF*RU 30 0119. 13t.. pE.c-W -1 Actfl Suof99l, Rl.r h 0hi60 A-,88 h NI11os Ol____' PwtoD 9r*d N ll o s r sw dY 9IIRO IDA CRANT C-1. oStg 049. FR Rod PO 20852 PAR ."I6 S 199I ° 1 ° a 14 0 7 5.5 Po5rg97 PV8TY *S 1999 0 15 0 0 10O3 59 8 P035643 THIRO ES S 1999 0 20 0 0 14 2 32 0 RIt., Re.it 0 53 0 0 386 179 S 5 CAS Annex BS (IFC) for Gambia, The Gambia, The Statement of IFC's Held and Disbursed Portfolio As of 9/30/00 (In US Dollars Millions) Held Disbursed FY Approval Company Loan Equity Quasi Partic Loan Equity Quasi Partic 1994 AEFLyefish 0.36 0 0 0 0.36 0 0 0 1993 AEFNdebaan 0.2 0 0 0 0.2 0 0 0 1984/90 Kombo Beach 0 0 0 0 0 0 0 0 Total Portfolio: 0.56 0 0 0 0.56 0 0 0 Approvals Pending Commitment Loan Equity Quasi Partic - 70 - Annex 10: Country at a Glanee THE GAMBIA: HIVIAIDS Rapid Response Project Sub- POVERTY and SOCIAL The Saharan Low. Lw- Gambia Africa Income Development diamond 1999 PnailAtion mid.vpar (millions) 1 3 f47 2 417 Life expectancy GNP oer caoita tAtlas method. USS) 350 500 410 (4NP (Atlas mnthod. USS billions) 0 43 37t 9RR Averaae annual orowth. 1993-99 Labor force I%l 3.1 2 6 2.3 GNP Gross per primary Most recent estimate /latest vear available. 1993 99 capita e Inrolment Povertv (% of Dooutation below national oovertv line) .. . lJrban nonutatinn (X of ftoal ootuistion) 32 34 31 Life exoectancv at birth (vears) 53 50 60 Infant mnrtalitv (oer 1.000 live births) 76 92 77 Ch-d malnttttition (% of children under 5) 2f 32 43 Access to safe water Access to imoroved water souret (% of oooulabon) 76 43 64 Illitrracv 1% of oooulafion aae 16+) 64 39 39f Gross orimarv enrollment `% Of school-ae ooouration) 77 7B 96 The Gambia Male R7 RS. 102 Low-income group Female i7 71 88i KEY ECONOMIC RATIOS and LONG-TERM TRENDS 1979 19S9 1998 1999 __ Economic raitoa GOP fUSS billions) 0.20 0 28 0 42 0.43 Grnrs dnnmetfi. invostmontlGtDP 291 204 183 178 Trade Fsnnrt.s ot nnndc and nrirvire slRfP 3.S0 88i 1 .S0 6 47 T Gross domestic. savnaosfGOP 10.2 7.S 8.9 Gross natinnal srvinsGnp A 5 8 t11 s '20 Current account balancelGOP -28 7 -8.6 .11.0 -10*8 Domestic Interesl navmrent%fGnP 0 2 1 7 1 2 1i Investment Tntal dtbtlG17P 41 3 1189 1041 10i8s Savings Total debt servicelexgorts 0.4 5.4 6 1 7.1 Presernt valua of iteht/GnP 83 7 58 7 Present value of debU/exoorts .. .. 110 5 99.7 Indebtedness 1979-89 1989-99 1998 t999 t999.03 (average annval arowth1 GOnP 34 8 7 8 49 S f 6 n - The Gambia GNP oer ranita 0 n -a 1 2 0 7 S 1 9 Low-income group Exoorts of aoods and serviceS 2.6 -0 6 16.6 -8 7 9 6 STRUCTURE of the ECONOMY 1979 1989 1998 1999 Growth of investment and GOP %) (% of GDP) AnriculurP 31 0 30 8 31 4 t3 2 Industrv 13 5 12.3 y3.0 12.7 Manuftaturino 41 * 9 5 a 5 4 0 Services 5S.5 56.9 55.6 54.1 to 9t 9f 9 v 98 99 Private rnnsurmntion 75 4 79 9 7R 2 -20 Gepneral onVArnment nonsurmntinn 14 4 12 8 12 A DG - GDP Imoorts of ooods and services 63.3 65.3 61.3 56.3 1979-89 1989-99 1998 1999 GroWth of exports and Imports %) (aversae annual arowth)I Anoriultuir n R 1 5 3 n 165 20 Industrv 3.7 0.9 5.2 3.66 l Mani,facturino 7 9 0 8 1 5 3 n Servicrs 31 41 44 22 o Privati consigmntion -85 3 8 3 4 4 5 S 9 ' tr G eneral novern ment r.rsnumntinn S 0 -4 0 -40 9 8 Gross domestic investment -0.7 4.4 14.1 6.3 |0 Imnorts of nnods and services -8 8 -n 2 15 R -7 R Expons °Imports Gross national oroduct 3.5 3.3 5.1 5.6 Note: 1999 data are preliminary estimates. The diamonds show four key indicators in the countrv (in bold) comoared with its income-arouo averaoe. If data are missina the diamond will he inr.omnletA -71 - The Gambia PRICES and GOVERNMENT FINANCE 1979 1989 1998 1999 Inflation (%) Domestic prikes (% change) Consumer prices 6.1 8.3 1.1 3.8 i Implicit GDP deflator 10.6 13.7 1.1 4.7 Government finance (% of GDP, includes current grants) Current revenue 26.2 19.1 18.0 94 95 96 97 98 9 Current budget balance 7.6 1.3 0.1 GDP deflator ' CPI Overall surplusideficit -1.4 -3.8 -4.6 TRADE (US$ mnillions) 1979 1989 1998 1999 Export and Import levels (USS mill.) Total exports (fob) 47 85 130 120 2 Groundnuts 3 1 T3 299 Fish 3 3 3 Manufactures 150 _ Total imports (cif) 88 109 207 193 1e Food 7 9 9 Fuel and energy 13 10 10 5_ Capital goods 5 14 13 0 3 9 95 Exoort orice index (1995=100) 67 108 109 j 97 'a 99 lmoort Drice irdex (1995=1001 66 110 114 E Exports 'Imports Terms of trade (1995=100) 102 98 96 BALANCE of PAYMENTS fUSS miThbn 1979 1989 1998 1999i| Current account balance to GDP (k) Exportsofgoodsandservices 65 130 213 212 | Imports of goods and services 120 150 278 271 93f Resource balance -55 -20 -65 -59 Net income -3 -17 -8 -7 ill Net current transfers 12 26 20 Current account balance -56 -25 -46 -46 12 * Financing items (net) 56 50 Changes in net reserves -10 -3 -18 Memo: Reserves includina oold fUSS millions) . 26 103 107 Conversion rate (DEC. local/USS) 2.0 7.6 10.6 11.4 EXTERNAL DEBT and RESOURCE FLOWS 1979 1989 1998 1999 fUSS millions) Composition of 1999 debt (USS mill.) Total debt outstanding and disbursed 81 338 439 451 IBRD 0 0 0 0 G 15 IDA 11 87 171 173 Total debt service 0 7 15 17 IBRD 0 0 0 0 s:173 IDA 0 1 3 2 tE_ Composition of net resource flows Official grants 13 48 24 31 Official creditors 20 18 8 2 Private creditors 2 -1 0 0 D:165 Foreign direct investmient 12 15 13 9 0:13 Portfolio equity 0 0 World Bank program Commitments 5 32 38 15 A - IBRD E - Bilateral Disbursements 3 16 3 6 B - IDA D - Other multilateral F - Private Principal repayments 0 0 1 2 c - IMF G - Short-term Net flows 3 15 2 4 Interest payments 0 1 1 1 Net transfers 3 15 1 3 Development Economics 916/2000 - 72 - Additional Annex No.: 11 MONITORING AND EVALUATION ANNEX 11.1. Monitoring and evaluation (M&E) results will be used as key benchmarks to indicate whether or not the project objectives and targets have been achieved. Given the nature of this project, emphasis will be put on monitoring during the initial phase. The results of the M&E activities will guide adjustments and modifications during the project implementation period. The Key Performance Indicators contained in the Project Development Objective of this document as well as the Logical Framework (see Annex 1) will form the basis of designing and administering the M&E tools. The objectives and targets to be achieved during project implementation will be further refined under the Govemmenfs medium term HIV/AIDS Strategy that will be finalized during the first year of the HARRP. 11.2. The implementation of project activities will be monitored by the National HIV/AIDS Secretariat (NAS). The NAS/Planning and Monitoring Specialist (who will be recruited early in the staffing of the NAS), will determine what is to be monitored and which kinds of evaluation will be done at various levels of activity. S/he will compile and consolidate, on a quarterly basis, monitoring information including data related to expenditure and disbursement levels (the latter information will be provided by the Financial Management Agent). The NAS Planning and Monitoring Specialist will rely on formal links with extemal participants for expertise in, and the generation of, M&E information and analysis, including the Central Statistical Office, the DOSH/Epidemiological and Statistical Unit, Divisional and Municipal reporting units, NGOs, private institutions. and other development partners. 11.3 For progress on achieving the project objectives, NAS will focus on the indicators that have been spelled out in the section on Key Performance Indicators and that are consistent with the Logical Framework. In general, NAS will develop, approve, and/or make use of, a data collection system appropriate to monitor the progress of the project with regard to three major yardsticks, namely: (1) Increasing the percentage of 15 to 24 year olds with access to HIV/AIDS Information, Education & Communication (IEC/BCC) and services; (2) The rate of prevalence of HIV among 15 to 24 year olds (currently comparatively low); and (3) The rate of prevalence of HIV among pregnant women (also currently comparatively low). 11.4 NAS will distinguish in its monitoring data collection and analysis between: (a) program outputs; (b) progress towards outcomes (i.e. process indicators); and (c) early indications of trends towards longer term impact. The following constitute the summary indicators for outputs, process, and impact of the program. These indicators are in line with those proposed by UNAIDS in its June 2000 National AIDS Programmes: A Guide to Monitoring and Evaluation, (UNAIDS/00. 1 7E): A. Output Indicators 1. At least 50% of population reached through IEC/BCC programs on WHV/AIDS. 2. At least 5 key line Departments are implementing agreed action plans. 3. The number of sentinel surveillance sites increased by 2 in Project Year 1 and to a total of 8 by the end of the project. - 73 - 4. Community and Civil Society Initiatives (CCSI) disbursements reach at least 75% of planned levels. 5. Access to treatment for STI, TB, and other opportunistic infections available in at least 20% by end of the project. B. Process Indicators 6. The National HIV/AIDS Council (NAC) fully functioning and National HIV/AIDS Strategy and Plan of Action adopted. 7. All seven Divisional HIV/AIDS Committees and Municipality equivalents start implementation of HARRP activities by the end of Project Year 2. 8. Voluntary counseling and testing (VCT) services incorporated into antenatal, TB, and STI services in 50% of health facilities in Western Division by the end of Year I and in 50% of health facilities in the other divisions by Year 5. C. Impact Indicators 9. At least 90% of the population (aged 15-49) aware of HIV/AIDS transmission modes and means of prevention by end of the Project. 10. Use of condoms at last sexual contact among young people ( 15-24) will have increased by 40% by the end of the project. 11. Prevalence rates of HIV and STI contained to present levels. 11.5 The NAS/M&E Specialist will also prepare consolidated semi-annual implementation reports for the overall HARRP program. These implementation progress reports will be submitted every six months to the National HIV/AIDS Council as well as to IDA. Performance evaluation of the program will be conducted every year and will focus on: (i) an assessment of the short term impact of program activities on the HIV/AIDS epidemic, with particular focus on vulnerable groups; and (ii) an operational audit of the program, including activity completion, impact of activities and progress towards sustaining activities. This evaluation will highlight the lessons learned and will be used to improve the efficiency of program implementation, to make adjustments to annual work plans, and to identify improvements for content and implementation procedures for future activities. 11.6 As to the Community and Civil Society Initiatives activities, M&E activities will be contracted out either nationally or in smaller packages, and this will cover not only quantitative but qualitative monitoring, e.g. indicators of progress developed by social groups and/or communities. Since the objective of many Community and Civil Society Initiatives activities will be to change the behaviorof a large number of disparate groups over the short, medium and long term, a process of beneficiary and stakeholder feedback and of social impact monitoring is considered important to the success of the project. In this regard, a series of key social impact aspects will be followed (to complement outputs, process, and impact indicators already mentioned): (a) Identification of key social and cultural development issues: * Linking the key social and cultural development issues regarding STI and HIV/AIDS, particularly with -74 - regard to the outcomes for the poor, youth, women, PLWHAs, and other vulnerable groups; and * Establishing mitigation plans if the project is found to have adverse impact on social groups. (b) Evaluation of institutional and social organizational issues: * Identifying impediments to equitable access to project activities for intended beneficiary groups, especially those that are currently not empowered and/or face other obstacles; and * Recommending strategies for strengthening institutional capacity. These are especially relevant for vital implementation mechanisms of the project that are not well developed and for personnel that are unaccustomed to designing and implementing activities such as those envisaged under the project. (c) Definition of a participation framework: o Linking the key social and cultural development issues regarding STI and HIV/AIDS, particularly with regard to the participationof the poor, youth, women, PLWHAs, and other vulnerable groups; and * Identifying stakeholders whose participation in the project is of strategic importance, including those who hold power over vulnerable groups. -75 - IBRR 22203 Th MeSon ,~~~~~~~. 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