Documentof The World Bank FOROFFICIALUSEONLY Report No: 25761 - TA PROJECTAPPRAISAL DOCUMENT ONA PROPOSEDGRANT INTHE AMOUNT OF SDR 54.1 MILLION (US70.0 MILLION EQUIVALENT) TO THE GOVERNMENT OF THE UNITEDREPUBLIC OF TANZANIA FORA MULTI-SECTORAL AIDS PROJECT INSUPPORTOF THEFIRST PHASEOFTHE TANZANIA MULTI-SECTORAL HIV/AIDSPROGRAM JUNE 10,2003 Human Development 1 Country Department 4 Africa Regional Office This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not be otherwise disclosed without World Bank authorization. A CURRENCY EQUIVALENTS (Exchange Rate Effective May 5,2003) Currency Unit = Tanzania Shilling Tshs. 1:00 = US$0.00966 US$l:OO = Tshs 1035.0 FISCAL YEAR July 1 -- June 30 ABBREVIATIONS AND ACRONYMS ACTafrica AIDS Campaign Team for Africa AIDS Acquired ImmuneDeficiency Syndrome APL Adaptable ProgramLoan CAG Controller and Auditor General CAS Country Assistance Strategy CBO Community Based Organization CFAA Country Financial Accountability Assessment cs Civil Society CSF Civil Society Fund FMR Financial Monitoring Report FMS Financial Management System FY Fiscal Year GDP Gross Domestic Product GFATM Global Fundto fight HIVIAIDS, Tuberculosis and Malaria GOT Government of Tanzania GPN General Procurement Notice HCWMP Health Care Waste Management Plan HIV Human Immunodeficiency Virus IBRD International Bank for Reconstruction Development HSDP Health Sector Development Program IDA International Development Association IEC Information, Education and Communication IFMIS Integrated Financial Management InformationSystem JAPR Joint Annual HIV/AIDS Performance Review LGAs Local Government Authorities M A P Multi-Country HIV/AIDS Program MDAs Ministries, Departments and Agencies M O H MinistryofHealth MOHSW MinistryofHealthand Social Welfare MTEF Medium-Term Expenditure Framework MTP-I FirstMediumTerm Plan MTP-I1 Second MediumTerm Plan MTP-I11 ThirdMediumTermPlan M & E Monitoring and Evaluation NACP National AIDS Control Program NGO Non-governmental Organization NMSF National Multi-sectoral Strategic Framework FOROFFICIALUSEONLY NORAD Norwegian Agency for InternationalDevelopment ovc Orphans and Vulnerable Children 01 Opportunistic Infections PEP Post Exposure Prophylaxis PER Public ExpenditureReview PLWHAS Persons Livingwith HIV/AIDS PMO Prime Minister's Office PORALG President's Office, RegionalAdministration and Local Government PPA Public Procurement Act PRA Participatory RapidAppraisa PRSP Poverty Reduction Support Program RFA Regional FacilitatingAgency STI Sexually TransmittedInfections SWAP Sector Wide Approach TACAIDS Tanzania Commission for AIDS TASAF Tanzania SocialAction Fund TB Tuberculosis TSH Tanzania Shillings UNDP UnitedNations DevelopmentProgram UNESCO UnitedNations Education, Scientific & Cultural Organization UNICEF UnitedNations InternationalFundfor Children USAID UnitedStates Agency for International Development USD United States Dollars VCT Voluntary Counseling and Testing WHO World Health Organization ZAC Zanzibar AIDS Commission ZACP Zanzibar AIDS Control Programme ZPRP Zanzibar Poverty ReductionPlan Vice President: Callisto Madavo Country Director: Judy M.O'Connor Sector Manager: Dzingai Mutumbuka Task Team Leader: Albertus Voetbern This document has a restricted distributionandmay beused by recipients only in the performance of their official duties. I t s contents may not be otherwise disclosed without World Bank authorization. FOROFFICIALUSEONLY TANZANIA MULTI-SECTORAL AIDS PROJECT CONTENTS A. ProgramPurpose and Project Development Objective Page 1. Programpurpose andprogramphasing 2 2. Project development objective 2 3. Key performance indicators 3 B. Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported by the project 4 2. Main sector issues and Government strategy 4 3. Sector issues to be addressedby the project and strategic choices 8 4. Programdescription and performance triggersfor subsequent loans 12 C. Program andProject Description Summary 1. Project components 12 2. Key policy and institutional reforms supported by the project 17 3. Benefits and target population 17 4. Institutional and implementation arrangements 19 D.Project Rationale 1. Project alternatives considered andreasons for rejection 24 2. Major related projects financed by the Bank and/or other development agencies 24 3. Lessons learnedandreflected inthe project design 26 4. Indications o frecipient commitment andownership 28 5. Value added o f Bank support inthis project 28 E. Summary Project Analysis 1. Economic 28 2. Financial 29 3. Technical 30 4. Institutional 30 5. Environmental 33 6. Social 34 7. Safeguard Policies 35 This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not be otherwise disclosed without World Bank authorization. A. Program Purpose and Project Development Objective 1. Programpurpose and program phasing: N / A 2. Project development objective: (see Annex 1) The project will provide grant financing to support Tanzania's NationalPrograms on HIV/AIDS for both the Mainland and Zanzibar governments -- which -- aims to reduce the spread o f HIV inthe general population o f Tanzania through multi-sectoral action involvingGovernment, Non-Government, Civil Society and community organizations. The project has been developed within the framework ofthe umbrella Multi-Country HIV/AIDS Program(MAP-11) for the Africa Regionapproved by the Boardo f Directors o f the World Bank Group on December 20,2001, and it has beendesigned incollaboration with other development partners, some of whom will be co-financing certain components. This collaboration has greatly benefited the project design, with these partners participating inthe design of every project component to ensure complementarity with other financing to support the NationalProgram. The project objective i s to scale up and accelerate the national response to HIV/AIDS to reduce the spread of HNinthe general population o f Tanzania, supporting activities inthe priority areas o f prevention and mitigation o f socio-economic impact at individual, household, and community levels as well as strengtheningthe national capacity to respondto the epidemic. _ _ ~ M A P Eligibility for Country Participation How Eligibility Criteria were met by Tanzania - Satisfactory evidence o f a strategic approach to - The National Multi-sectoral Strategic HIV/AIDS. This would typically be demonstrated Framework (NMSF) on HIV/AIDS has been by a coherent national, multi-sectoral strategy and developed in a consultative manner with broad action plan for HIV/AIDS prevention, care and involvement and support from all major treatment which has been developed through a stakeholders. The final Strategy was participatory approach usingsocial assessment circulated inFebruary, 2003. techniques. It could also be demonstrated by having a participatory strategic planning process underway with a roadmap andtimetable. - A highlevel coordinatingbody such as a national - Parliament passedthe TACAIDS Act in HIV/AIDS council or equivalent has been November, 2001, establishingthe Tanzania established to oversee the implementation o f the Commission for AIDS under the Prime strategy and action plan. This body should Minister's Office. This body was inaugurated encompass broad representation o f key stakeholders, inFebruary, 2002, withbroadrepresentation of including persons living with HIV/AIDS. stakeholders -- all but two members are from outside Government. - Government has agreedto use appropriate - The Government has agreed to channel implementation arrangements to accelerate project resources through a streamlinedprocedure to implementation, such as channeling grant funds for respective beneficiaries, with many financial HIV/AIDS activities directly to communities, and management functions beingoutsourced to outsourcing financial management and procurement FacilitatingAgencies. where necessary. - 2 - - Government has agreed to use and fundmultiple - The project supports the implementation of implementation agencies, especially the NMSF which hinges onthe involvement community-based and non-governmental and support o f multipleimplementingagencies organizations. from all sectors and layers o f society. 3. Key performance indicators: (see Annex 1) The project will support a programmatic approach to Monitoring& Evaluation. Inthat context, the partners have agreed to work towards joint reviews within ajoint Monitoring & Evaluation framework, complete with common indicators. The elaboration o f thisjoint framework will be supported under the project. Prior to the finalization o f this framework, a project-specific logframe has been developed which i s strongly influencedby the logframe for the national program which was developed at the October, 2001, Logframe Workshop. The following set o f indicators have been adopted for the interimpurposes o f this specific project. A. OutputIndicators All public and private primary, secondary andhigh schools are usingschool curricula that incorporate HIV/AIDS ina skills based learning approach by the end o f the second year o f the project. The number of reported people livingwith HIV/AIDS who are receiving some form of home or community based support increased by 25% inthe first year, 50% inthe second year and over 75% by the end o f the project life. All participating Ministries are implementingtheir respective HIV/AIDS work plans by the endof the first vear o f the oroiect HIV positive pregnant women have access to preventive treatment for mother to child transmission (PMTCT) o f HIV in 30% o f public hospitals by the second year o f the project The numberof condoms sold through social marketing outlets or distributedinTanzania is increased by......(TBD after baseline exercise) 75% o f districts are implementing their respective HIV/AIDS plans formulated with stakeholder and community participation by the endo f the second year The proportion o f districts inwhich voluntary counseling and testing (VCT) services i s being /providedincreased to 100% by the endo f the Droiect I B. ProcessIndicators Adequate quantities o f essential drugs for treatment o f sexually transmitted infections are available in all public health facilities The total value o fproject contracts with communities, NGOs, associations of people livingwith HIV/AIDS, private sector agencies, etc, increased by 30% each year. IDistricts submittingacceptable accounting and expenditure reports increased by 30% each vear I C. Impact Indicators HIV prevalence among women attending ante-natal care clinics reducedby ....% by end o fthe project (TBD after baseline exercise) The number of menaged 15-49years treated for sexually transmitted (urethritis) infections inthe - 3 - previous 12 months increased from ....% ....by the to endofthe project (TBD after baseline exercise) The proportion o f 15-19 year old boys and girls that report being sexually active reduced from ....%to ....%by the end oftheproject (TBD after baselineexercise) The proportion o f men/women aged 15-49 who report usinga condom intheir last act o f sexual intercourse with a non-regular partner duringthe previous 12 months increased from...% to....% by....year (TBD after baseline exercise) The percentage o f sexually active people reporting having non-regular sexual partners over the previous 12 months reduced from % to ... .....%by year by the endo f the project (TBD after baseline exercise) B. Strategic Context 1.Sector-related Country Assistance Strategy (CAS) goalsupported by the project: (see Annex 1) Document number: 20728 Date of latest CAS discussion: June 15, 2000 The principal goal o fthe present CAS for Tanzania is to assist the Government to resume progress made on poverty reduction inthe late 1980s. It specifically identifies the spread o f HIV/AIDS as having had tragic consequences for the country, with the emergence o f HIV/AIDS as a multi-sectoral development issue severely hampering efforts to alleviate poverty. About halfthe hospitalbeds are occupiedby patients with HIV/AIDS related illness and the number o f orphans due to HNIAIDS exceeds 1.5 million and i s increasing. Without effective action, Tanzania's GDP in2015 could be 15-20 percent lower than it would have been without the HN/AIDS epidemic, and GDP growth is estimated to be 1.O to 1.5 percentage points lower than it would be inthe absence o f the HIV/AIDSepidemic. Tanzania i s eligible as a recipient o f IDA Grants inthe "Other Poor Countries" category as an IDA-only country with a Gross National Product equal to or less than US$360 per annum. The total IDA Grant allocation for Tanzania for FY03 i s US$102.2 million and, inadditionto the allocation to this HN/AIDS project, provisions for the use o f IDA grants have been made to finance a US$32.2 million portion o f the proposed Poverty Reduction Strategy Credit. 2. Main sector issues and Government strategy: TANZANIA MAINLAND: The first AIDS cases inTanzania were recordedin 1983. Since then the epidemic has increased to a level where it i s estimated that 12% o f the sexually-active adults (15 -49 years old) inthe country are infected. HIV prevalence among pregnant women attending ante-natal clinics for the first time ranges from 4.2 -32.1%. Approximately two million people are estimated to be living with HIV/AIDS, and thousands have already died o f AIDS-related diseases. Adult mortality inTanzania has increased considerably inrecent years due to HIVIAIDS, and it i s estimated that AIDS i s now the leading cause o f death among adults. The modest child mortality decline duringthe 1980s and early 1990s has been reversed due to HN/AIDS. Inaddition, life Expectancy at birthby 2010 will be reduced to 47 years as opposed to the projected 56 years without AIDS, and there i s a rapidly increasingproportion o f children under 15 who are orphans. By 2000, 1.1% had lost bothparents; 6.4% hadno father and 3.5% no mother. HIV/AIDShas also had an impact on the occurrence o f tuberculosis which i s having a significant resurgence with unusual presentation and a tendency to emergence o f multi-drugresistant strains. - 4 - The HIV epidemic inTanzania has affectedboth urban and rural areas. The peak age group o f infected females i s the 25-29 year old group, while among males it i s the 30-34 year old group. Generally females acquire HIV infection at an earlier age compared to males. A survey in 1999 found that the under-five mortality rate, including child and infant mortality rate, has not decreasedover the past three years, and this is attributedto the HIVIAIDS epidemic. The volume of data and informationon the impact ofAIDS on Tanzania i s relatively small compared to what i s available for some other countries inthe region. More detailed informationon the effects o f HIVIAIDS on Tanzanian society and comprehensive surveillance data are not yet available. However, the results o f a comprehensive household survey (2000/01) are available .This informationwill enable decision-makers to betterunderstand the nature o f the epidemic inTanzania, its effects, and how the National Programcan be fine-tunedto battle the epidemic most effectively. The informationindicates that widespread illness and death due to HIV/AIDS are likely to leadto future GDP growth being lower. Presently, some o f the most productive age-groups insociety are bearingthe greatest diseaseburdenfrom HIV, and the productive sectors are experiencing a loss o f skilled labor, increasingcosts for recruitment and benefits, and reduced revenue. HIV/AIDS, negatively impacts all aspects o f development, compromising all other measures intended to reduce poverty. HIV/AIDS can drive households into poverty when their assets (e.g., livestock) are sold to cover the costs o f medical care, or when the available labor force becomes insufficientto tend to the necessary agricultural activities. Measures to reduce poverty among already vulnerable groups are likely to fail inthe current environment where HIV prevalence i s high. Therefore, prevention and mitigation o f HIVIAIDS i s central to an effective poverty-reduction strategy, while poverty reduction in itself i s neededto mitigate the socio-economic impact that the epidemic imposes on society. Poverty contributes to the spread o f HIVIAIDS. The impact o f poverty on women drives them to adopt coping mechanisms that may include increasedrisk exposure (e.g. commercial sex). Poverty also limits the scope for long-term development prospects, thereby reducing the barriers for taking otherwise unacceptable risks. The limitedaccess to formal education o f this increasingly substantial cohort o f children, particularly girls, may well provide fertile ground for poverty and increased risk o f exposure to HIV.O fparticular concernis the situation ofvulnerable children andyouth inTanzania. The effects of poverty are especially felt among the children, and there i s little doubt that the HIVIAIDS epidemic has significantly worsened their situation. GovernmentResponseto the HIV/AIDSEpidemic History: InTanzania, the presence o f HIV/AIDS was recognizedquite early on, primarily as a health issue, but the response to HIV/AIDS underestimated the extent to which it would spread and the devastating impact it would have on social and economic development. Institutional efforts to control the spread o f HIV inTanzania date back to 1985 when a Short-Term Planwas prepared by the Ministryo f Health for 1985 and 1986. Since 1985, three national plans have been formulated to guide the Tanzanian National AIDS Control Program. The FirstMediumTerm Plan (MTP-I) covered 1987- 1991, the Second Medium Term Plan (MTP-11) covered 1992 - 1996, and the ThirdMediumTerm Plan (MTP-111) covered 1998 - 2002. Despite these strategic plans covering all sectors, there has been little progress in actually mounting a multi-sectoral effort to address the epidemic. However, the consistent efforts o f the National AIDS Control Program (NACP) inthe Ministry o f Healthhave yieldeda strong foundation from which Tanzania Commission for AIDS (TACAIDS) will be able to launch a truly multi-sectoral national response. Furthermore, significant progress has beenmade by government over the past year aimed at puttinginplace the institutional framework requiredto effectively scale-up the response against HIV/AIDS inTanzania. - 5 - Recent Developments:There i s growing commitment among national and local leaders -- political, religious and commercial -- to encourage all members o f society to play a role in stopping the spread o f HIV and care for those affected. The President of the UnitedRepublic ofTanzania, Hon. Benjamin Mkapa, established the Tanzania Commission for AIDS (TACAIDS Act o f January, 2002) .The Commissioners were inaugurated inFebruary, 2002, comprisedmainly o f non-government representatives. This body i s expected to provide the strategic leadership necessary to galvanize the national social movement to effectively reduce the spread o f HIV/AIDS. Inaddition, a national policy on HIViAIDS that cuts across disciplinary and institutional sectors to provide the framework for a national response has been adopted and has beentranslated into a national strategic framework. This framework has been finalized and i s inthe process o f beingtranslated into Swahili .Furthermore, the Poverty Reduction Strategy includes HIV/AIDS as a central development challenge requiringthat all sector and local government plans address this issue, and this is reflected inthe TACAIDS Act's establishment o f HIV/AIDS Committees at the local government level. The HIPC debt initiative, with its objective of enabling the Government to use resources previously dedicated to debt service to increase expenditures on poverty-reducing expenditures, has also fortified the resources dedicated to HIV/AIDS. However, expenditures on HIV/AIDS has increasedby an even larger amount than provided for under HIPC, with financing o f HIV/AIDS programs under the Government increasingalmost two-fold between FY2001/2002 and FY2002/2003. Moreover, the Government increased its share o f total funding for HIV/AIDS from 20% inFY2001/2002 to 33% inFY2002/2003. The Government o f Tanzania has requested access to IDA resources within the framework o f the umbrella M A P for the Africa Region. Tanzania is eligible for M A P fundingas it satisfies the M A P criteria outlined above. ZANZIBAR Zanzibar has a different Government structure for domestic issues, and have established their own AIDS Commission. Therefore, while it i s considered essential that the project provide support to Zanzibar (includes the islands o f Unguja and Pemba) as well as the mainland, the administrative reach o f TACAIDS and the structures for implementing the other components does not extend to Zanzibar. Therefore, a separate allocation has beenmade for support to the HIV/AIDS Programon Zanzibar. The Government o f Zanzibar launched a mediumterm plan (MTP 111) inMay 1999. The plan aimed at creating strong partnership at all levels o f society to take specific and appropriate action inresponse to HIV/AIDS and STDs. Despite financial constraints, the government succeeded (with donor support) in implementing a "limited" STD project inZanzibar, which includes input from Medicos del Mundo and WHO on the training o f healthcare providers on the syndromic management o f STIs. Technical support for capacity development is given to a technically limitednumber o f healthcare providers and localNGOs to establish VCT centers. However, wider coverage and quality improvement o f the service is yet to be achieved. The Government o f Zanzibar has preparedthe Zanzibar Poverty Reduction Plan (ZPRP) as a first stage o f its Vision 2020, a strategy to eradicate "absolute" poverty by addressing some key determinants such as lack o f employment among women and youth together with migration o f young people to the urban areas. HIV/AIDS is a priority health and social problemto be addressed inthe ZPRP strategy. The multi-sectoral nature o f action against HIV/AIDS requires the government to start buildinginfrastructure, interms o f human resources, to mitigate its effects. The HIV/AIDSepidemic has continued to escalate inZanzibar since the first three cases were diagnosed in 1986. According to the MinistryofHealthand Social Welfare (MOHSW) surveillancereport on HIV/AIDS/STDs (No. 3-2000), HIV/AIDS among pregnant women at antenatal care (ANC) clinics has doubled from 0.3% inmid 1980s to 0.6% in 1997, and the trend i s on the increase. Inaddition, among STD clients tested for HIV, 5.6% were positive. Among TB patients, 25.5% tested positive, with 22% in - 6 - the age group o f 14-22 years. School dropouts due to teenagepregnancies are increasingly becoming a social and economic problem. In 1998,7% o f total school dropouts were due to pregnancy (MOHSW report, No.3-2000). A recent behavioral study conducted by Africare (2002) revealedthat: 0 75% o f young people surveyed do not know the correct signs and symptoms o f STDs 0 78% of youth respondents from Pemba perceive condoms as socially unacceptable compared to 37% o f the respondents from Unguja 0 Among the youth respondents who reported having had sex, 65.4% have never useda condom during sexual intercourse 0 The concept of safe sex is unknown to 62% of the youthrespondents 0 The majority o fyouth respondents (74%) do not perceivethemselves to be at risk o f contractingHIV At aprevalence rate o f less than two percent for HIV (validation study 2002), Zanzibar maybe considered a low prevalence area. However, the Zanzibar government and community face a great challenge to not only maintain a low HIVIAIDSprevalence but to reduce it further. Intime, ifthe situation continues unabated, it will leadto disastrous consequenceswith large increases in adult morbidity and mortality, as i s the case throughout most o f sub-Saharan African countries along with the associated fall inGDP and the decline inthe national economy. The Government established the Zanzibar AIDS Control Programme (ZACP) underthe MOHSW in 1987, as implementing and coordinating body o f HIV/AIDS activities. More recently (June 2002), the government enacted a law that established the Zanzibar AIDS Commission (ZAC) to take over the responsibilities that the ZACP had untilnow inareas o f advocacy, resource mobilization, monitoringand evaluation and coordination. Inthe process, the government redefined ZACP's role as the secretariat to the ZAC as well as strengthening the health sector inmitigatingthe HIV/AIDSpandemic. The Government o fZanzibar has shown a strong commitment to address the basic health needs o fthe country. Inorder to sustain this commitment, the government has identified the following areas to be the health priorities for the bridgingperiodo f 2003/04 untilthe completion o f the MediumTerm Plan IV. The six sectors identified are contained within the Chief Minister's Office -ZAC; MOHSW; the MinistryofEducation, Culture and Sports; the Ministry ofEmployment, Youth, Women and Children; the Mufti'sOffice; and ZANGOC. As HIV/AIDSaffects all sectors, its controldemands a well-coordinated response. Inits infancy, ZAC needs to develop the necessary human and institutional capacity to execute its functions accordingly. ZAC needs strengthening with additional technical staff that has an appropriate mix o f skills to effectively performthe following functions: (i) Policy formulation, application and coordination; (ii) Progradproject management, coordination, monitoring and evaluation; (iii) HIVIAIDS advocacy and mainstreaminginto national and sectoral policies; (iv) Collect, store and disseminate data; and (v) Create a platformfor exchange of best practices. Ministerial and District AIDS Committees have been established but most o f them are not yet effective. Urgentactions needto be taken to activate these committees and buildthe capacities of government and non-government institutions as well as reinforcing district response initiatives. - 7 - 3. Sector issues to be addressed by the project and strategic choices: Sectoral background: With the recognition o f the impact o f the HIV/AIDS epidemic on every sector and all development programs, it has become evidentthat the existing sectoral responses do not add up to a concerted response. TACAIDS is a new and emerging institution, mandated to coordinate and monitor the national response to HIV/AIDS. With the understanding that TACAIDS will not be an implementing agency, the project will support TACAIDS to carry out its mandate while assigning responsibilities for implementation and financial accounting directly to the implementing institutions. The Local Government ReformProgram inTanzania has established a decentralized structure for the delivery o f services through Local Government Authorities. The project will take advantage o f this structure to strengthenthe implementation of HIV/AIDS activities at all levels of Government through the Public Sector Fund. Furthermore, the Community AIDS Response Fundwill channel resources to communities, religious organizations and NGOs to help extend the reach o f the National Program down to the most decentralizedlevels. Finally, inorder for the IDA resources to be fully complementarywith other grant funding, there is needfor a flexible approach and good coordination. For this purpose the establishment o f a Joint HIV/AIDS Financing Committee was agreed at during appraisal. This committee will serve as a platform for joint financing and other implementation arrangements, ensure appropriate inthe MTEF, PER and PRSC processeswhere it relates to HIV/AIDS, and explore options for pooledfinancing arrangements. While this coordination function falls within the mandate o f TACAIDS, this committee would provide a forum for TACAIDS to collaborate on these arrangements with development partners. The project will be based on annual workplans to allow for timely changes inthe light of grants forthcoming with donor coordination by TACAIDS facilitated under their component. Ensuring an Effective and CoordinatedResponse combined with Rapid Institutional and Organizational Development. The Tanzania NationalMulti-Sectoral Strategic Framework on HIVIAIDS will be the key national document that defines the national priorities and strategic goals for accelerating and expanding the HIV/AIDS Response inTanzania. It embraces a large number o f stakeholders and all ministries in developing the new response. Some ministries have developed sector-specific plans for integrating HIV/AIDS into their work programs, both interms o f workplace interventions to protect their own staff and measures to incorporate HIV/AIDS activities into the delivery o f their core services. It i s anticipated that the strategic directions will evolve as the lessons learned from the new approach o f a multi-sectoral response are absorbed. The coordination and monitoring andevaluation o f this intensifiedresponse pose challenges that the project will assist by supporting TACAIDS to carry out their mandate. At decentralizedlevels, the project will support the establishment, capacity buildingfor, and functioning o f HIV/AIDS Technical Committees in Local Government Authorities. It will also ensure that community-level efforts, financed through the project's Community AIDS Response Fund, are coordinated and consistent with the national response through the use o f FacilitatingAgencies (see Section C.1) to fortify the link among the various levels. The project will complement other resources that are, or may become, available to support the implementation o f the national program, such as resources underthe Global Fundto fight HIV/AIDS, Tuberculosis and Malaria (GFATM). This complementarity will be required to support a program that is capable to adapt to rapidchanges and lessons learned. Inaddition, and incontrast to the limitations o f many other sources o f funding, the project will focus on puttinginplace the basic infrastructure for an expanded and multisectoral response, knowledge sharing and systems strengthening. "Scaling Up" of Existing Good Practices: One o f the primary objectives o f the umbrella M A P program i s to facilitate the scaling up o f existing good practices in client countries. Tanzania has had some positive experience in that there are communities inwhich the epidemic appears to be indecline. The project will provide resources to enable the Government to build on these islands o f good practice and replicate them. - 8 - ThePrevention of New HIV Infections: Reducing the incidence o f HIV is the single most important strategic priority to address the epidemic. Strategies and activities to achieve this vary according to the target population and encompass health education, sex education, anticipatory guidance for children and parents, peer support programs, behavior-change interventions, the promotiono f condom use, voluntary counseling and testing, the promotion o f abstinence, the prevention o f mother-to-child transmission, the reduction o f susceptibility through treatment o f sexually transmitted infections, the screening o fblood before transfusion, post-exposure treatment for rape-victims, etc. The implementing agencies will be expected to put special emphasis on three target groups for prevention activities to be funded under the project: a) the poor and vulnerable (e.g., women, youth and children); b) those inwhom significant investments will be made or have been made (e.g., new recruits, school and universityentrants, employees); and c) high risk groups, both in terms o f gettinginfected as well as transmitting HIV (e.g., commercial sex workers, migrant workers, truck drivers, migrant construction workers). The extent to which the various implementingagencies will be involvedwith any giventarget group will depend on their respective mandates and access to these groups. Major roles are anticipated for the education sector (children, school and university entrants, employees), the private sector (employees, new recruits, migrant workers), public sector institutions (employees, new recruits), especially those with important extension services like agriculture, police, defense, health, and livestock (rural poor and vulnerable), and NGOs/CBOs (commercial sex workers, women, the poor, street children). TACAIDS and Local Government AIDS Coordinators will coordinate these activities, promote consistency inthe various approaches, and disseminate experiences and best practices. Mitigating the Socio-Economic Impact of the HIV/AIDS Epidemic: The HIVtAIDS epidemic inTanzania has significant impact on individuals, households, businesses, public institutions, and whole sectors. The growing number o f orphans poses an enormous challenge for the social sectors. Reachingthem inorder to providejust the very basic nutrition, health and education services already constitutes a significant problem. Coping mechanisms for households are stretched to the limit, and businesses findthemselves confronted with increased costs for social benefits, a high turnover o f staff, and a less- productive workforce. Whole sectors such as health, agriculture, and education now realize that their usual service delivery mechanisms and the content o f those services will have to be revisited, adjusting their programs to the new circumstances causedby HIV/AIDS. Implementation o f the NMSF includes measures to be supported by the project to mitigate these effects o f the epidemic, includingthe design and promotiono f social safety nets for those affected by HIV/AIDS. Orphans and Vulnerable Children: Children are a particularly vulnerable group among those affected by the AIDS crisis inTanzania. An estimated 1.5 millionchildren have already beenorphaned as a result o f HIV/AIDS. As a result o f the lag periodbetween the parents' infectionand death, the number o f orphans due AIDS i s expected to continue to rise over the next 10years. The orphans crisis exerts considerable strain on the existing extended family structure and the whole social systeminthe communities through increasinghousehold dependency ratios, school enrollments and multi-generational poverty traps. Children orphaned as result o f AIDS are likely to suffer from loss o f schooling and educational opportunities, failure to be immunized or to receive health care, increased malnutrition, increased demand for labor, loss o f family and identity, depression, and overall reduction in well-being. In recognition o f these special problems, the project recognizes that support for community-based responses targeting orphans i s a desirable and economically feasible intervention. Through the Community AIDS Response Fundcomponent, community-basedinitiatives that help to address the education, health and social needs o f the orphans will be given due attention. Through the Public Sector Fundrelevant ministries (Education, Community Development) will be supported as well and TACAIDS will facilitate the coordination o f all these contributions. - 9 - Increasing Access to Care and Supportfor ThoseInfected or Affected by HIV/AIDS: An estimated two millionHIV infected people are currently living inTanzania. To provide at least a basic, sustainable, but meaningful package o f care and support to those infected or affected by HIV/AIDS poses enormous economic, social, ethical, and organizational challenges to Tanzanian society. While there are great efforts undertakenby families, communities, the Government, and its development partners to address the issues involved, there remains ahugeand growing demand. The project will support activities that increase access to social support services, such as patient support groups coordinated by the Network of People Livingwith HIV/AIDS, and initiatives to provide care and support for orphans. Activities will be formulated that will protect the human rights o f those infected or affected, including the articulation o f policies that guard against discrimination inemployment practices and access to benefits. Access to Anti-Retroviral treatment will initially be limited as a clear policy on increasing access to ARVs is lacking. The project will support the elaboration o f such policy. The strengtheningo f the infrastructure necessary for the administration o f ARVs, the financing o f ARV treatment for Post-Exposure Prophylaxis for victims of gender based violence and occupational exposure, and the financing o f ARV treatment for the prevention o f Mother-to-ChildTransmission, including the treatment o f the parents, will be eligible expenditures under the project awaiting the finalization o fthe ARV policy. Promoting an Enabling Socio-Cultural Environmentfor a Multi-sectoral Response: One o f the key reasonsfor a broader approach to the HIVIAIDS issue i s the influence o f socio-cultural norms and values on the spread o f the disease. Efforts will be made to promote socio-cultural norms, values, and beliefs that are consistent with the reduction o f HIV transmission, and that protect the human rights o f those infected or affected by HIV while at the same time being culturally sensitive. TACAIDS coordinated activities are expected to pursue this objective through education, advocacy, counseling, consultation, and intensifiedenforcement o f both customary and written laws, particularlywith respect to gender-specific issues. The reduction o f stigma will receive special attention as it constitutes an important obstacle for affected individuals and households to access support and care services. The project will support such efforts through both the financing o f work-programs o f the implementing partners o f TACAIDS and o f activities directly coordinatedby TACAIDS on this issue. Use o f indigenous knowledge and practices to positivelychange behaviors, for example initiation and marriage rites and ceremonies, will be explored as to provide fora for HIV prevention activities. Women are especially vulnerable to HIV infection due to a variety o f social and biological factors. The Government will work with community agencies to provide support for activities that reduce the risk o f HIVinfectionamong women, such as basic educationon sexual andreproductive health, HIV,andSTIs; activities for youth designed to delay sexual debut; harmonizing the age o f consent, marriage, and maturity to 18 years; encouraging voluntary testing; and empowering women on matters pertaining to access to information, employment, and economic/social recognition. A large percentage of new HIV infections occur among youth, particularlyyoung women (15-19 years). TACAIDS, in close cooperation with the education sector, will provide guidance inthe development o f culturally, morally, and scientifically acceptable AIDS education programs for youth inand out o f school and advocate for the protection o f youth against behaviors that place them at increased risk o f HIV infection. These activities will be supported boththrough the financing o f work-programs and activities coordinatedby TACAIDS. Provision of Anti-Retroviral Therapy: The use o f anti-retroviral therapy against HIV/AIDS i s still evolving, and there are research efforts going on inthe region as well as internationally. There are ethical and moral issues o f deprivingtheir use where they are available. The project will not be prescriptive as to whether the drugs are used. There are no major controversies expected inthis regard. - 10- More generally, resources under the project couldbe used to increase access to care and to increase the capacity o f the health care system to provide and administer these services. Specifically, the financing o f anti retroviral drugs to prevent parent to child transmission or for Post Exposure Prophylaxis (PEP) under WHO/UNAIDS guidelines will be considered under the project. Ifthe government decides to use IDA Grant proceeds for this purpose, the project would finance training o f health care personnel inthe use o f anti-retroviral therapy, as well as the costs incurred with the respect to the necessary laboratory support, according to clear clinical management protocols to be agreed with WHO, UNAIDSand other technical agencies. The proposedsubregional MAP grant to support capacity buildingin HIV/AIDS prevention, care, and treatment among health care professionals inEast Africa would provide an opportunity to promote regional standardsand practices. This issue also requires the formulation o f a coherent national policy on the prevention o f mother to childtransmission, on Post ExposureProphylaxis for rape victims and health workers and on equity issues related to access to anti-retroviral treatment. The considerations to be taken into account for the prevention o f mother to child transmission will include promotiono f breast feeding versus alternate feedingfor infants, the social stigmatization that may arise, the side effects and resistance development from inappropriate use o f the drugs. The adequacy o f the legislation and law enforcement concerningrape and sex with minors will be addressedinthe context o f the Post Exposure Prophylaxis. Cost-effectiveness studies o f suggestedinterventions will be supported under the project. Research: Developments inthe area o f HIVIAIDS are occurring rapidly, as related to new approaches in the field o f prevention as well as inrelation to treatment and care. Studies are needed to establish the effectiveness, feasibility, affordability, and appropriateness o f these inthe Tanzanian context. In addition, in order to develop an appropriate response, impact assessments that quantify specific changes due to HIV/AIDS are neededinvarious sectors. TACAIDS has the mandate to set the priority research agenda, and the project will consider supporting studies that may lead to a more effective and efficient response to the epidemic. It is anticipated that studies related to mother-to-child transmission, women-controlled methods for HIV and STI prevention such as microbicides, and impact studies will be supported. Piloting the use o f prophylaxis against Opportunistic Infections (01),and the development o f a syndromic 01management protocol for adults and children with HIV/AIDS would also be considered for support as research activities. Specific Gender Strategy: The HIVIAIDS epidemic inTanzania has an important linkto gender relationships inthe society. Young girls tend to engage insexual activities earlier than their male counterparts. They also enter into relations with older more experienced menwho are more likely to have been infected. The females intwo partner unions are also less likely to perceive beingat risk and less likely to report sexual activity with non-regular partners when compared with their male counterparts. After the death o f their male partners, females are more likely to lose control over the properties o f the deceasedthereby becoming even poorer. Whenparents are illor have died, girls are the more likely to drop out o f school to care for the sick parents or the younger siblings. When placed in foster homes, girls are much more likely to be sexually abused. Physical violence, the threat o f violence, and/or fear o f abandonment can act as substantial barriers to women innegotiating condom use, discussing fidelity with partners, or in leaving relationships perceived to place them at increased risk o f HIVinfection. The plight o f men with regards to HIViAIDS can easily be ignored inthe face o f the enormous problems faced by women. But boys and young menare still brought up in an environment inwhich social values, education and peer pressures endorse and infact encourage multiple and casual sexual relationships. To address the HIV/AIDS epidemic successfully, it will be essential to consider the role o f gender in increasingthe vulnerability and impact o f HIV/AIDS. - 11 - This project will mainstreamgender considerations into all its components. Communityactivities that focus on the prevention o f HIV specifically targeting the female or male population will be encouraged. Reducing the HIV prevalence in the teenage girls population will receive highpriority and a concerted effort will be made to involve activities targeting older meninbringingabout this change. Community driven activities that focus on the care o f women, girls and widowers affected by HIV/AIDSwill be supported. All the Ministries, Departments and Agencies (MDAs) with HIV/AIDS activities intheir work plans will need to have gender specific activities as well. The Ministryo f Education can take proactive measuresto ensure that girls affected by the HIViAIDSepidemic themselves or their families have adequate support mechanisms to continue with their education. Research activities which address the questions o f gender role inHIV transmissionwill also be promoted. 4. Program description and performance triggers for subsequent loans: N/A C. Program and Project Description Summary 1. Project components (see Annex 2 for adetailed description andAnnex 3 for a detailed cost breakdown): The Tanzania Multi-Sectoral HIV/AIDS Projectwill finance a US$70 millionshare o fthe Government's National Program for HIV/AIDS over a period o f five years between 2003 and 2008. The purpose o fthe Government's program is to reduce the spread of HIV inthe general population o f Tanzania through multi-sectoral action involving Government, Non-Government, Civil Society and community organizations. The purpose o f the project i s to scale up and accelerate the nationalresponse to the HIV/AIDS epidemic taking into account the priorities identifiedinthe HIV/AIDS policy and the National Multi-sectoral Strategic Framework on HIVIAIDS (NMSF). The project will support activities inthe priority areas o f prevention and the mitigation o f the health and socio-economic impact o f HIV/AIDS at individual, householdand community levels, as well as the strengthening o f national capacity to respond to the epidemic. Inaddition, both the National Program and project-financed activities will place particular emphasis on targeting vulnerable groups. Activities to be supportedby the project will be coordinated by the Tanzania Commission for AIDS (TACAIDS) and the Zanzibar AIDS Commission (ZAC) on Zanzibar, and these activities will be implemented by community groups and public andprivate service agencies. The project i s designed within a multi-sectoral framework, under the Multi-Country AIDS Program (MAP) for Africa, which addressesthe HIV/AIDS epidemic within a broad context. It i s a program to support the Governmentto implement an expanded response to HIV/AIDS through community-based initiatives and also by mainstreamingHIV/AIDS into the work programs o f all Ministries, Departments and Agencies (MDAs) and local government authorities. It i s also intendedto sensitize the private sector to the need for greater attention to the issue. The support for community-based initiatives would involve HIV/AIDS preventionprograms through peer education, IEC activities, and the provisiono f support for Voluntary Counseling and Testing(VCT) services. The care o f orphans, widows and home-based care for Persons Livingwith HIV/AIDS(PLWHA) are also expected to be included among the community-based initiatives. The project will have the following four components: -12- 1. CommunityAIDS Response Fund 2. Public Sector Fund 3. TACAIDS InstitutionalSupport 4. Zanzibar HIV/AIDS Support Component 1. Community AIDS Response Fund (CARF). This component will focus on social mobilization and community level responseto HIVIAIDS. A fund will be set up to expand and strengthenHIV/AIDS activities beingcarried out by communities and Non-Government Organizations (NGOs), includingEmployers and Workers' organizations, Community Based Organizations (CBOs), private sector, religious sector, persons livingwith HIV/AIDS (PLWHA). Activities to be funded will include the full spectrumo f HIV/AIDS activities within the broad groups o f prevention, care and support and mitigation o f socio-economic impact. There will be clearly-defined eligibility criteria for organizations to be funded underthis component; these criteria have been elaborated inthe Operational Manual. Groups which receive fundingwill be encouraged to focus, but not necessary limit, their activities to the most vulnerable groups which include: people livingwith HIVIAIDS (PLWHA), hospital workers, orphans, youths, commercial sex workers and truck drivers. The conceptual basis for this component i s that the factors that determine the spread o fthe HIV are only to a limited extent under the influence of government. Where traditional and culturalvalues and practices are o f critical importance, Civil Society has to play an important role as a vital partner inthe response to the epidemic. Civil Society organizations sometimes better understand the needs andproblems o fpeople, and therefore are ina better positionto effect behavioral change, empowerment and ownership. They can be innovative and flexible and therefore fast reacting. For the purpose o f this project, Civil Society Organizations are self-defined community groups that share a common interests for a specified purpose. They can be organized by age, gender, profession etc. and include organized groups like villages, workers' associations, community-based organizations, faith-based organizations, and NGOs. There will be a cap on the number of grants for sub-projects costing more than USS5,OOO to ensure a community-level focus; therefore, it is expected that larger NGOs or national organizations would largely access these hnds only to the extent that they pair up with individual communities. Private sector organizations will also be eligible to access the Community AIDS Response Fund. The Community AIDS ResponseFundwill be facilitated mostly through existing Government structures. Local Government Authorities (LGAs) will receive training intwo areas: (i) the integration o f HIV/AIDS activities into their LGA workplans (see Public Sector Fund component); and (ii) training o f Local Government teams on participatory approaches for the appraisal and approval process o f the Fund, monitoring and evaluation, cross sectoral cooperation, and community mobilization. These local government teams will then mobilize communities to access these funds, and the Local Government AIDS Coordinator will follow upon sub-project implementation. They will also identifyNGOs and other groups that can support communities inthe formulation and implementation o f sub-projects. A Facilitating Agency will be contracted at the Regional level (with Regions definedconsistent with Tanzania's administrative structure) to support the Government inthe administration o f the Fund. Sub-project proposals will be submittedto the HIVIAIDS Technical Committee (or the LGAswhere the HIV/AIDS committee is not yet established) for technical appraisal, and then proceed to the Local Government Authority for final approval. The approved proposal will -13- thenbe forwarded to the FacilitatingAgency for Disbursementand to TACAIDS for informationpurposes only. Inthe case o f sub-projects exceeding US$5,000, the proposals will go to the Region or to TACAIDS for final approval, dependingon the total cost. The beneficiary will sign an ImplementationAgreement with the Facilitating Agency, which will perform fiduciary oversight o f sub-projects, provide training, inform LGAs when funds are disbursed, andprovide reporting bothupwards to TACAIDS and downwards to LGAs. Other donors will provide co-financing for the services o f the FacilitatingAgency inspecified districts. Refer to Annex I1for additional informationon the contracting o f RFAs. This component will complement the IDA-financedTanzania Social Action Fund(TASAF), and efforts will continue throughout supervisionto ensure that the two remain complementary as part o f a coherent program o f IDA-financed support. The main differences betweenthe two modes o f support, both targeting community-level beneficiaries, i s that (i)TASAF does not cover the entire country, and (ii) with the intensive support provided by TASAF project staff inevery TASAF district, the Social Fundchannels funds for sub-projects through Local Government Authorities. The replication o f this by hiringover 100MAP-financedpersonnel at the district level was rejected early inpreparation infavor o f the contracting o f RFAs as described above. Underthe Zanzibar component, however, giventhe much smaller scale, the community fund support is likely to replicate the TASAF arrangement or possibly even channel funds through TASAF. Component 2. Public Sector Fund. This component will comprise a fund to scale up and strengthen prevention, care, support and mitigation o f the social economic impact o f HIV/AIDS through programdactivities o f the public sector. It will support public sector institutions to protect their own personnel from the impact o f HIV/AIDS and, when applicable, to integrate HIV/AIDS activities into their core business. Sub-contracting by ministries, localauthorities andparastatals will be encouraged inorder to make the best use of the implementation capacity that may be available outside the public sector. Eachpublic sector agency will define a work programwhich, as a minimum, will address issues regarding HIV/AIDS among its employees. Public agencies will also be expected to extend HIV/AIDS services to their clients and neighboring communities. This component will provide the following types o f support: Support to Ministry of Health: The largest share o f funds under this component will be dedicated to supporting the Ministry o f Healthinits unique role incombatting the epidemic. This support will partially finance the Ministry'sHIV/AIDS workplan, which has been developed incollaboration with the Ministry'sdevelopment partners and reviewedduringthe annual Sector Review. It comprises prevention activities, medical interventions, the procurement o f HIV/AIDS commodities and services, and support by the Ministryo f Healthto other partners inthe multi-sectoral campaign against the disease. Giventhe special nature o f this sub-component, the application o f funds will be for a broader range o f purposes than provided for under the guidelinesfor other ministries. The TMAP funds will complement those from other partners, as well as from the IDA-financedHealth Sector Development Program (HSDP) which will provide an additional US$1.5 millionto the Ministry o f Healthin support o f HIVIAIDS activities in FY04, as reflected in the FY2003/04 MTEF. While the HSDP is coming to a close, the secondphase o fthis APL, planned for delivery inFY04, will allocate additional funds to HIV/AIDS inthe health sector program over the next three years to helpbridgeany financing gaps. Support to MDAs (other than Ministry of Health): All MDAs will receive support toward the - 14- implementation o f their comprehensive HIV/AIDS workplans. All support to the Ministryo f Health will flow through this component, includingfinancing of HIV/AIDS-related commodities. Some ministrieswith advanced workplans and responsibility for the highest priority areas underthe MTP-I11will receive comprehensive workplan support duringthe first year. The remainder o f the ministries will receive more limitedworkplan support - focused mainly on workplace interventions to protect their own personnel - duringthe first year, and more comprehensive support duringthe second year. Technical Assistance has beenmade available to all ministries, financed from the PHRD grant, inidentifying the sections o f the workplan to be financed inthe first year. Additional technical assistance will be provided by TACAIDS in the first year to support those ministries which will not qualify for comprehensive workplan support during the first year inorder that they may be prepared to access this comprehensive support duringthe second year. Such comprehensive support i s expected to address the following two broad areas: h (a) The internal impact of the HIV/AIDS epidemic on the specific ministry: The extent to which HIVIAIDShas affected the quality, quantity and substanceo favailable services, the ability to supply the required services, the organization o f the sector, the role o f service providers, human resources policy and management practices, the planning and management o f sector resources, and the availability o f resources to the sector would provide the framework for assessingthe internal impact o f the epidemic on the specific line ministry. (b) The external impact of the HIVIAIDS epidemic relative to the work of the specific ministry: The extent to which the specific sector can contribute to the preventionof further spread of HIV inorder to protect both its staffand target populations, and the increase inaccess to and use o f care and support for the affected or infected among staff membersand their families. The workplans beingprepared by sectors after the NMSF will be funded. Ingeneral, the range o f activities that are expect to be considered within the ministryworkplans include the following: (a) Capacity Buildingfor the mainstreamingo f HIVIAIDS-related activities into the ministry workplan; (b) Information, Education and Communication (IEC) campaigns for staff and client awareness, promote condom use, and provide for a sustainable behavior change among its staff and the clients by extension; (c) Promote access to condoms for staff; (d) Impact studies to investigate the qualitative and quantitative consequenceso f the epidemic on specified (sub-)sectors and analyze possible and appropriate responses; and (e) Policies regarding the posting and location o f staff, and the impact o f temporary work camps. Inaddition to the above, each ministrywill conduct activities specifically relevant to its areas of comparative advantage. More details are available inthe actual workplans. Support to Local GovernmentAuthorities (LGAs): LGAs will also receive support for the implementation o f HIV/AIDS workplans, which will be integrated into the LGA workplan as prepared during the existingannual planning exercise. The only things that are proposed to be added or changed are as follows: (i) HIV/AIDS activities will be integratedinto the non-health sector - 1 5 - components o f the LGA workplan; (ii) HIV/AIDS Technical Committee, as constituted under the the TACAIDS Act, will play a coordinating function; (iii) HIV/AIDS Technical Committee will the extract the HIVIAIDS activities from all sectors into a parallel HIV/AIDS workplan to facilitate review by TACAIDS; and (iv) a consolidatedHIV/AIDS Fundwill be established at the District Level. The funds for all sectors will be heldin the ConsolidatedFundaccount # 2, which i s envisioned to hold funds from all sources o f financing for HIV/AIDS activities at the LGA level. The Facilitating Agency contractedunder the Community AIDS ResponseFundwill provide Technical Assistance to the personnel from the non-health sectors at LGA level to facilitate the integration o f HIV/AIDS activities into their workplans. The LGA workplans will be intendedto complement those o f the ministries and will focus on a similar, though narrower, range o f activities. Component 3. TanzaniaAIDS Commission Institutional Support. The project will support the Tanzania Commission for AIDS (TACAIDS) to fulfill its national HIVIAIDS coordination mandate as provided by the TACAIDS Act. This mandate has beenelaborated and well articulated in several documents (see Annex 8) and there is broad consensus on the responsibilities assigned to the Commission. These evolve mainly around advocacy, providing leadership for the multi-sectoral response to HIVIAIDS, coordination and monitoring and evaluation. TACAIDS is not envisionedto have implementation or fundingresponsibilities. The project design acknowledges TACAIDS' mandate and appropriately creates opportunities for support to TACAIDS to carry out its mandate. Support, inparticular, will be givento TACAIDS for (i) establishment o f an effective secretariat and networks at the regional and district levels; (ii)establishment of financial management and procurement systems; (iii) resource mobilization; and (iv) monitoring& evaluation systems. TACAIDS is located in the Prime Minister'sOffice (PMO). While TACAIDS i s not an implementing agency, its role inthe national program will requirethe TACAIDS Secretariat to fulfill certain implementation-relatedfunction, and the IDA Grant will support it to do so by financing additional staff. The TACAIDS Secretariat will undertake centralizedprocurement and disbursement functions including(i) procurement planning, (ii) facilitating disbursements from the Special Account, (iii) processing o f withdrawal applications to the IDA Grant. TACAIDS plans to out-source the implementationo f activities such as procurement to the extent possible, without dissociating itself from the responsibility for initiatingthe activity and the end-result. Inpractice this means that TACAIDS would be responsible for the Terms o f Reference for the contractor and for the quality assessment o f the endproduct. Component 4. Zanzibar HIWAIDS Support: Zanzibar has a different Govemment structure for domestic issues, and has established their own AIDS Commission. Therefore, while it is considered essential that the project provide support to Zanzibar as well as the mainland, the administrative reach o f TACAIDS and the structures for implementingthe other components does not extend to Zanzibar. Therefore, an allocation has been made for support to the HIV/AIDS Programon Zanzibar. Given that Zanzibar i s less advanced in the establishment o fthe necessary structures for preparation ofthis component, the details o f this component are expected to be elaborated largely during the first year o f the project's implementation; however, the smaller scale of Zanzibar has made a more flexible, dynamic response possible. Thus, preparation is currently accelerating ahead o f schedule, though still likely to commence later than support to the mainland. Though on a smaller scale, this component will provide the same type o f support to Zanzibar as i s providedto the mainland underthe other three components: (i) Support to the Zanzibar AIDS Commission (ZAC); (ii) Support to the Public Sector, specifically MDAs with significant support to the MinistryofHealth; and (iii)Community Fund. Itis merelythe implementation a - 16- arrangements which are expected to substantially differ from the mainlandprogram, as these will be tailored to the situation inZanzibar. Given that the ZAC i s located inthe Chief Minister's Office, this office will parallel the functions of the PMO inthe mainland components o f the project. 20.0 45.7 3. Tanzania AIDS Commission Institutional Support 21.4 4. Zanzibar HN/AIDS Support 7.1 5.7 100.0 100.0 2. Key policy and institutionalreformssupportedby the project: This project i s a multi-sector operation that will support the following key policy and institutional changes. It will neither address long-term sector and institutional reforms within any one sector nor will it include conditions linkedto macroeconomics or individual sector policies. It will assist the Government in: 0 Making the National HIVIAIDS Program truly multi-sectoral by mainstreaming HIV/AIDS control into the action plan o f every Government Ministry and Local Government Authority, and by strengthening capacity of the Tanzania Commission for AIDS (TACAIDS) for overall national coordination; and 0 Ensuringthat the national HIV/AIDS activities have broadparticipation byproviding for private and civil society participation and by empowering communities to design and implementtheir own responses. 3. Benefitsand target population: The project is expected to helpreduce the spread of HNIAIDS, improve care o fthose with AIDS and mitigate the socio-economic impact o f the epidemic. By scaling up ongoing efforts inthe fight against HIV/AIDS and involving all sectors and players at all levels o f society, the benefits will include: (a) Reducednew HIV infections arising from : behavior change (increased age at sexual debut; reducedpartners, use o f condoms); more effective treatment o f sexually transmitted disease; use o f voluntary testing and counseling services; among others. This should result inreduced expenditures on health care and other related costs o f living with HN/AIDS. (b) Improvedcare for People LivingWith HIV/AIDS (PLWHA): better diagnosis and treatment o f tuberculosis and other opportunistic infections and improvednutrition. This should enable PLWHA's to live longer and healthier lives. (c) Improvedability o f households and individuals to preventor cope with HIV/AIDS. Material and other support from the project should help household expenditures and mitigate other consequences: reduction inhouseholdproduction arising from the needfor householdmembers to look after those that are ill;depletion o f household savings and assets; increase inthe number o f orphans as well as children leaving school to look after the illor replace lost householdheads. Support inthe form o f income transfers, school fees and other relatedprograms will help to -17- redress the current suffering. (d) Increased community and national empowerment for a stronger response to the HIV/AIDS epidemic. (e) Increased capacity at the national, regional ,district, community and householdlevels to better respond to the HIV/AIDSepidemic. (f) Reducedpoverty due to improved income and food security particularly invulnerable groups such as orphans, widows, and PLWHAs. (g) Increased economic productivityand better standards o f living due to a reduction inthe loss o f human capital to AIDS. TargetPopulation. The project targets the whole population because o f the advanced stage o f the epidemic inTanzania. However, certain groups will receive more focus because o ftheir vulnerability to HIV/AIDS or its socio-economic impact. The following groups have been identified for specific focus: (a) Orphans and widows (b) Groups with tendency to highprevalence levels: commercial sex workers, truck drivers (c) The youth and especially young girls who are most vulnerable (e) Children through support to efforts aimed at reduction inmother-to-child transmissiono f H N (f) People infectedby HIV. Since the intentioni s for the whole population to be reached, informationprovisionthrough different channels (mass media, focus groups, peer groups, etc.) will be strengthened. Services that cut across the different key interventions such as health services, voluntary testingand counseling, provision o f condoms and other services will be strengthened. The involvement o fNGOs and other civil society organizations is aimed at ensuring that all the different groups are reached. The opportunity providedfor these groups to put forward proposals for funding at the national and local levels will ensure that all groups are reached. The gender dimensions o f the epidemic will be addressedinthe identification of the differentgroups o f women, particularly widows and female commercial sex workers needing support from the project. Distribution of support to households will take into account the fact that women are disadvantaged in access to household incomes and assets. Work place interventions will ensure that women's particular needs are met interms o f access to information, services (e.g. voluntary testing and counseling, reproductive health services that are responsive to their needs) legislation and regulations that protect women. Sensitizationof leaders and employers in the gender dimensions o f the epidemic will be conductedat all levels: national; provincial, district and community levels. - 1 8 - 4. Institutionaland implementationarrangements: InstitutionalArrangements: The Prime Minister's Office (PMO) will be the custodian of the proposed project (The Chief Minister's Office inZanzibar), and the Permanent Secretary inthe Prime Minister's Office will have overall responsibility for accounting for resources provided by the project. Coordination o f activities and responsibilities for the National HIV/AIDS Programwill rest with the Tanzania Commission for AIDS (TACAIDS), which is also housed inthe Prime Minister's Office, and the Zanzibar AIDS Commission (ZAC) whose functions will largely mirror those o fTACAIDS on the mainland. TACAIDS/ZAC will execute its functions through its Secretariat headed by the Executive Chairman o f the Commission o f TACAIDS and the Executive Director o f ZAC. The Grant will provide support for limitedadministrative functions such as procurement, financial management, and disbursement functions, as described above. The TACAIDS/ZAC Commission will be responsible for providing strategic direction and policy leadership, as well as identifyingregional and district networks to be utilizedby TACAIDSIZAC. The Secretariat will be responsible for ensuring consistency o f all aspects o f the national response with the national strategy, day to day coordination o f the program, mobilizationo f resources, and monitoringand evaluation. The Secretariat will prepare and present annual work plans and regular progress reports, includingfindings from monitoring and evaluation, to the Commission. Where necessary, TACAIDWZAC may arrange for activities to be contractedout where others have a comparative advantage. On the mainland, TACAIDS will have responsibility for coordinating activities implementedby civil society under the Community AIDS Response Fund, while the administration o f the Fundwill be contractedout to FacilitatingAgencies on a regional basis. Once LGAs have approved sub-projects for funding, the Facilitating Agency will disbursethe funds to the sub-project's bank account and follow-up to fulfill its fiduciary responsibilities. Modalities for disbursementswill be agreed upon and clearly spelled out inthe Operations Manual. TACAIDS will also contract out to FacilitatingAgencies the function o f buildingcapacity within LGAs and local NGOs to support the Community AIDS Response Fund. The Permanent Secretaries o f MDAs intheir capacity as accountingofficers will ensure that programand project activities are aimed at mitigatingthe impact o f HIV/AIDS intheir sectors and that prevention activities are integrated into sectoral workprograms. The Permanent Secretary will ensure that the use o f project resources i s applied to the intendedpurposes and towards eligible expenditures. The HIV/AIDS Focal Person inthe MDAs will coordinate the implementation o f project activities at the level o f the individual ministry. Similarly, the Executive Chairman inTACAIDS will ensure that the use o f project resources i s applied to the intendedpurposes and towards eligible expenditures. He will be responsible for the submission o f annual workplans andregular financial and implementationprogress reports. Inaddition, it i s foreseen that TACAIDS will consolidate the reports o f the various projects and programs, and organize annual reviews for all partners and stakeholders. The underlying principles behindthe institutionalarrangements proposed for the project are simple and aim to: (i) As muchas possible, avoid creating new institutional structures anduse existingmeans for coordination and project implementation; (ii) Support TACAIDS to carry out its institutionalmandate o f program coordination and monitoring & evaluation; and (iii) Support agreed channels to provide efficient flow o f funds to the implementing agencies. -19- National Level Coordination The project will work largely through existing and established structures for the national level coordination. The multi-sectoral Tanzania AIDS Commission (TACAIDS) has been established and will be the central coordinatingbody for project activities at the national level. The Executive Chairman o f TACAIDS and the Commissioners were appointed inJanuary, 2001, and February, 2002, respectively. Key staffposts within the Secretariat were filled inlate 2002, and the Secretariat was fully staffedby January, 2003. TACAIDS will provide broadpolicy guidance for the National HIV/AIDS program, supported by the Secretariat. TACAIDS is expected to coordinate with stakeholders both within and outside o f Government on policy issues related to the overall national response to HIV/AIDS. The TACAIDS Secretariat will be responsible for the program coordination and monitoring& evaluation for the nationalprogram. Management responsibility for technical aspects o fthe project will lie with TACAIDS, while the non-technical, administrative functions handled by TACAIDS will be kept to the minimumpossible. TACAIDS will have approval authority for all project activities. For the TACAIDS work program, to be financed by the TACAIDSInstitutional Support Component, a proposalwill be made by the Secretariat and submittedto the Commission for approval. At the program level, the establishment of a Joint HIV/AIDS Financing Committee has been agreed. This Committee, under the Chairmanship of TACAIDS will bringtogether the technical and financial partners supporting the program. Itwill serve as an advisory body to TACAIDS andmonitor the physical progress o f the program, the use o f resources, and the commitments for support by the various partners and elaborate joint financing plans and mechanisms. Decentralized Level Coordination The Community AIDS Response Fund: Community responseswill be coordinated as outlined in Section C.l above. This component will be community driven, and the exact nature o f which projects will be fundedcan only be determinedbasedon receivedresponses fromthe communities selected from a menu o f broadly-definedactivities. The process starts when a community prepares a proposal for fundingo f an HIV/AIDS activity under the Fund. A facilitating NGO may assist the community inthe proposal preparation ifrequested. The proposal i s channeled to the existingLocal Government participatory appraisal team for appraisal and to the Local Government HIV/AIDS Committee for approval. ThePublic Sector Fund Component: As outlined above, there will be no separateworkplan process for the project. For both MDAsand LGAs, preparationof HIV/AIDSworkplans to be financedby the project will be incorporated into the existing annual planning and budgetingprocess. The coordinationo f the Zanzibar Component will be according to the structures o fthe newly-established Zanzibar AIDS Commission as it takes shape. As described above, this component and its implementation arrangements will be elaborated during the first year o f the overall project. Project Monitoring The overall aim o f the programis to reduce the spreado f HIV and mitigate its impact. The short term objective o f the project i s to increase the use o f HNprevention, care and impact mitigation services by targeted vulnerable groups through activities under the four project components. Duringpreparation, a logicalframework was finalized for the project, andjoint performance indicators were agreed upon for the project inputsloutput and also for the outcomes/impact according to established guidelines. A detailedperformance monitoringplan was developed on the basis o f the logical framework and the selected indicators. The project will support the establishment o f an M&E systemwithin TACAIDS to - 20 - performthe critical task o f monitoring and evaluation duringproject implementation. The system will providevaluable informationfor program management, and for other stakeholders and external parties. The aim o f the M&E system will be to provide: (i) Easily accessible, timely information on the Program Inputs, Process, Outputs and Outcomes so that Program Management can be responsive, ifnot proactive. (ii) Identify intra-country variations inHIV/AIDSepidemiology to support the design of effective HIV/AIDS Prevention, Care and Impact mitigation operations. (iii) Engage stakeholders by sharing informationon progress made, lessons learnt and improvements to be done through a participatory evaluation o f project activities at all levels. This would provide a basis for information to be shared and compared with others nationally as well as inthe sub-region. (iv) To document the best practices. Project Evaluation Once the M&E systemfor the national program is finalized, one o f the first priorities o f TACAIDS will be to determine whether the data now emergingprovides a sufficient baseline for the program impact and outcome indicators. Ifnot, then these data will be collected from the onset o f the project. The program evaluation process will evolve around the annual reviews, when the existing data collected through the monitoring and evaluation systemby the M&E staff inTACAIDS will be collated and analyzed specifically relative to the achievements o f the goals set by the project and program. Duringthe project preparation process, an attempt was made to set realistic and achievable targets. While project progress will be monitoredregularly, through the annualreviews it shouldbe possible to evaluate definitively whether the project is moving inthe rightdirection or not and, at the endo f the project, to assess its impact. Inthe event that significant weaknesses appear, the annual reviews will provide a timely opportunity to address them. It i s expected that these reviews as well as the final evaluation o f the project will be participatory, and that the final evaluation will include a beneficiary assessment. Supervision Local Government Authorities, representing each sector and the President's Office, Regional Administration and Local Government (PORALG) will supervise project activities at district and sub-district levels. Staff from the TACAIDS Secretariat, cooperatingpartners and the Bank's Task Team will make sample visits to the field to monitor the performance o f implementingagencies at peripheral level. TACAIDS will monitor overall program implementation and meet regularly with HIV/AIDS focal persons o f the various ministriesto discuss progress under each line ministry. TACAIDS, will organize annual project reviews to assess the performance o f the program, including this project, its components and its contribution to the national effort to reduce the spread andimpact of HIV/AIDS. Specific areas o f the review will include technical and operational aspects of implementation. Programreviews will be carried outjointly by TACAIDS and development partners. The reviews will draw on the informationgenerated from routine monitoring, the studies conductedand any other relevant information. Project reviews will culminate instakeholder meetings that will form a basis for planning for the next year. These meetings will be usedto share informationon trends, best practices and to provide general technical information. The World Bank's Task Team charged with the -21 - supervision will cooperate closely with all cooperatingpartners involved and will provide multi-sectoral expertise. Inview o f the new institutional structures beingput inplace, the multiplicity o f implementing agencies and the consequent need for broad consultations, participation and coordination an intensive supervision strategy is proposed (see Annex 4: Monitoring & Evaluation) as essential to the success o f the project. Inview ofthe number ofimplementingagenciesinthepublic sector and civil society community, from the national level downto the district level, implementation and supervision activities will be intensive. Support and supervision activities will be provided by the Bank Task Team and other stakeholders, includingbilateral and multilateral organizations. Additional support will also come from the Bank teams that are supervisingthe Social Action Fundproject, the HealthSector Development Program, the Primary EducationDevelopment Program, the Human Resources Development Project, the Agricultural Sector Management Project, the Agricultural Research Project, the Roads I1project, and the Railways Restructuring Project. Bank management will allocate supervisionresources from the Bank for this project above the standard supervision coefficients, as demonstrated inthe increased supervisionbudgets provided to M A P projects already under supervision. ProcurementArrangements TACAIDS, MDAs and local government authorities will procure works, goods and services inrelation to the respective activities, inaccordance with government procurement regulations and the Bank's Guidelines: Procurement under IBRD Loans and IDA Credits (January 1995 and revised in January and August 1996, September 1997, and January 1999), inparticular Section 3.15, Community Participation in Procurement. Consulting services by firms, organizations, or individuals financed by IDA will be contractedinaccordance with the Bank's Guidelines: Selection and Employment of Consultants by World Bank Borrowers (January 1997, revised in September 1997, January 1999, and May 2002). Communities will use the Bank's simplifiedProcurement and Disbursement Procedures for Community-Based Investments to procure goods or services neededto implement their respective community-led HIV/AIDS initiatives under the Community AIDS ResponseFund. Giventhat most grants will be less than US$5,000, communities will use "local shopping'' as the standard procurement method. To facilitate speedy import o f items valued at less than US$lOO,OOO equivalent requiredurgentlyfor diagnosisltreatment and institutional strengthening,contracts may be made based on international shopping and national shopping procedures, respectively, per IDA Procurement Guidelines (Clauses 3.5 and 3.6) or through procurement from the UnitedNations (i.e., IAPSO, UNFPA, UNICEF, WHO), provided contract awards are made within 12 months o f the project effectiveness date. Giventhe urgency ofthe project, a wide-ranging General Procurement Notice (GPN) for the first year o f operations will be placed on the UnitedNations Development Business web site without a need for hard-copy publication. The government will prepare a procurementplan for the first year o f project operations to be included inthe Procurement Manual. The plan will include relevant information on goods, works, and consulting services under the project as well as the timing o f each milestone inthe procurement process. The procurement schedule will be updatedevery quarter and reviewed by IDA. Procurement performance (including sub-project procurement activities) will be assessed on an annual basis (inthe form o f procurement/physical audits by an external agency). Inaddition to the formal annual audits, ad-hoc procurement reviews will be conductedwhen necessary. - 22 - FinancialManagement A guidingprinciple inthe design of the financial arrangements for this project hasbeento utilize existing structures and procedures to the extent possible. Therefore, with the exception o f the C A W (for which the arrangements have been summarized above), all funds will flow through existing government systems according to the channels established for GOT`Sown funds. Given the lack o f capacity at the LGA level and the measures that would have beennecessaryto shore up that capacity to implement CARF through the existing government channels, it was decided, inkeepingwith the principles ofthe umbrellaMAP, that extraordinary implementation arrangements were warranted to facilitate the community-level response. The Bank standard procedures for accounting and auditing will apply to the funds disbursedto either public or privateinstitutions, as set out inFinancial Reporting and Auditing of Projects Financed by The WorldBank. Under the supervision o f the Principal Secretary (PMO) as the controlling officer, the Director o f Finance and Administration inthe TACAIDS Secretariat will be responsible for ensuring that financial management and reporting procedures under the project will be acceptable to the Government, the World Bank and ifapplicable other cooperatingpartners. The Financial Management System (FMS) objective will be to helpmanagement in spending the resources aimed at ensuring economy, efficiency and effectiveness by reaching the intended beneficiaries and achieving the set objectives. Specifically, the FMS mustbe capable o f producing timely, understandable, relevant and reliable financial information that will allow management to plan, implement,monitor and appraise the Project's overallprogress or lack o f it. The FMS that has beendevelopedi s computerized. The systemis beinginstalled by Treasury, which will train all staff inthe operation o f the system and basic bookkeeping. RFAs are expected to conduct training on basic bookkeeping for the communities; the availability o f relevantly qualifiedand experienced staff inthe FacilitatingAgencies, MDAsand support staff and the communities; capacity building;the establishment of a FixedAssets Register and a Contracts Register; separate Special and TshillingAccounts will be operated and these will be reconciledmonthly; quarterly reporting of financial information; cash flow management includingvariance analysis; Programactivities will be periodically reviewed by the Internal Audit Department inconjunction with the Monitoring & Evaluation staffwithin TACAIDS; an annual external audit will be undertaken on terms o f reference acceptable to the Bank. Byproject effectiveness, TACAIDS will not have inplace a FMS that canprovide, with reasonable assurance, accurate and timely informationas requiredby the Bank for FMR-based disbursementsi.e. the Financial Management Report (FMR). Thus, existing disbursementprocedures, as outlined inthe Bank's DisbursementHandbook, will be followed i.e. Direct Payment, Reimbursementand Special Commitments. A financial management review o f the Project's progress can be made by a World Bank Financial Management Specialist within 12 months o f credit effectiveness. The following are members o f staffinthe accounting department at TACAIDS : The Director Of Finance is responsible for the overall management of the department. She reports to the Executive Chairman. She i s currently supported by an Accountant who i s responsible for preparing the unit's accounting information, and another AccountantICashier who deals with programcash issues I i s the paymaster. - 23 - Disbursement Procedures All disbursements against expenditures contracts with the civil society organizations and the private sector will be made against statements o f expenditure (SOEs) and i s subject to sample ex-post financial, physical, and technical audit to be carried out by financial and technical consultants appointedby the Auditor-General and employedby the TACAIDS Secretariat. All procurement contracts not subject to IDAprior review will be disbursedagainst SOEs and documentationwill be retainedby TACAIDS and made available for review by IDA financial management and procurement specialists and project financial and procurement auditors. At Mid-Term, TACAIDS and IDA, together with other development partners, will review the financial management and disbursement arrangements to determine ifcommon financing and disbursement arrangements would be feasible inthe second halfo f the project, Inthe case of the community-driven HIV/AIDS initiatives under the Community AIDS ResponseFund, there will be pre-financing o f expenditures, as communities are unlikelyto start contracting without the assurance o f funds. All disbursements against expenditures under this component will be subject to ex post financial and physical audits, on a sample basis, to be carried out by financial and technical consultants employed by the TACAIDS Secretariat. D. Project Rationale 1. Project alternatives considered and reasons for rejection: This project is a Sector InvestmentLoanunder IDA'SMulti-CountryHIV/AIDS Program (MAP) for the Africa Region and i s in accordance with the Bank's regional HIV/AIDS strategy "IntensifyingAction Against HIV/AIDS inAfrica: Responding to a Development Crisis". The overall M A P design i s using the lending instrument o f an APL. A "vertical" APL for individual countries, incombination with the "horizontal" APL for Africa was an alternative proposedand rejected (see M A P PAD for further details). Giventhe MAP context, no alternativeproject designs would be appropriate. The IDA assistanceis aimed at filling the existingfunding gap for the Tanzania National HIV/AIDS Program, and not to replace other available funds. 2. Major related projects financed by the Bank and/or other development agencies (completed, ongoing and planned). Numerous actors are involvedinHIV/AIDS in Tanzania, often through multipleoperations. The IDA projects are mainstreaming HIV/AIDS activities throughout the portfolio, so most projects inthe country are related to some degree. Under the proposedproject, this will intensifyas additional support i s given to the various sectors for HIV/AIDS, and particular efforts are made to incorporate the planned use o f these resources into the main planning process for the respective ministries. Inthe sectors which are supported through a Sector Wide Approach (SWAP), this will involve concentrated effort to weave HIV/AIDS activities into the fabric o f the sector plans, both in order to maximize effectiveness in combatting HIV/AIDS and so as not to be counterproductive to efforts made under SWAps to have a single, comprehensive planningprocess. Fromthe major funding sources alone, numerousprojects have been identified (as summarized below) and the external resources, includingthose from IDA, to support the current program are sizeable. Notwithstanding this large number o f projects and significant resource flow, a sizeable funding gap remains. Further, this large number o f projects and partners presents both an opportunity for receipt o f a wide-range o f support and expertise, but also a challenge for effective coordination. The government has facilitated coordination between the partners duringpreparation and established procedures are inplace to ensure that this continues. - 24 - Implementation experience inTanzania is good, with strong performance in several projects which are already implementing at the community level that the proposed project hopes to reach. Steps have been taken to ensure that the relevant lessons from these projects are reflected inthe design. The established practice o f supporting sectors through Sector Wide Approaches has beenadapted to this multi-sectoral effort interms o f the level of coordination the various actors aspire to maintain. I Latest Supervision Sector Issue I Project (PSR) Ratings (Bank-fhance projects only) Implementation Development Bank-financed Progress (IP) Objective (DO) Human Resource Development Human Resource Dev. S S Health Care Health Sector Development S S Program Social Protection Social Action Fund S S Transport-Roads Roads I1 S S Transport-Railways Railways Restructuring S S Rural and micro finance Rural and micro financial S S services Agricultural Research Agriculture Research S S Agricultural Sector Development Agricultural Sector S S Management Project Other developmentagencies USAID Voluntary HealthProject BelgianEmbassy Various HIVIAIDS Projects European Union Support to NACP NORAD Support to NACP (local initiatives in districts), UNICEF, andWAMATA JICA NACP: Blood Safety; UMATI Dutch Embassy TANESA; TACAIDS Condom Social Marketing Danish Embassy Support to Ministryo f Health UNDP Various Activities UNFPA Various Activities UNICEF Various Activities WHO Contributions to UNDAF HIV/AIDS Joint Program UNAIDS Various Activities ILO Contributions to UNDAF HIVIAIDSJoint Program WFP Contributions to UNDAF HIVIAIDS Joint Program FA0 Contributions to UNDAF HIVIAIDS Joint Program UNESCO Various Activities ory) - 25 - 3. Lessonslearnedand reflectedinthe project design: International experience on HIV/AIDS, and especially regional experience from countries like Uganda and Senegal, ongoing Bank supported HIV/AIDS projects inAfrica within the M A P and country specific efforts inTanzania, have been reflectedinthe project design. Key lessons learned from all this experience are outlinedbelow. Politicalleadership and commitment: International experience has taught the world that political leadership and commitment i s a key issue inmobilizing national and donor resources for the fight against the HIV/AIDS epidemic. The Government o f Tanzania has indicated its firm commitment to the fight against HIVIAIDS. The people o f Tanzania are among the hardest hitby the epidemic, and the political as well as the economic imperatives for faster growth will not be realized ifthe HIV/AIDS situation does not improve. Effective action requires national leadership and political commitment at the highest levels. The successful examples o fcontrol of the HIV epidemic incountries like Senegal and Uganda arose because o f the political leadership drivenby good epidemiological data, effective programs and a vibrant activist civil society participation. Inthe Tanzania situation, there i s unanimity among the leadership, on the needto tackle the epidemic effectively. Vulnerabilityfactors are key drivers of the epidemic: The HIV/AIDS epidemic is driven by underlyingvulnerability factors among populations. The combination o fpoverty, gender disparities and informationasymmetry provide very fertile soil on which the sown seed o f HIV can rapidly grow and blossom. Therefore, any attempt at controlling the epidemic will have to address the vulnerability factors. This project will among others, focus on the vulnerable groups, includingthe youth, orphans, PLWAs, women and widowers inprevention and impact mitigation efforts. Communityparticipationas a process of empowerment: The communities affectedbythe HIV/AIDS epidemic find themselves facing multifaceted challenges, and with very thinresources and capacity to respond. Inaddition, short term focused strategies may not meet the needfor long term rehabilitation and healing inthose communities. Community participation engages the people ina partnership to fight the epidemic. With externalresources andthe buildingof local capacity, the communities will bemore empowered intheir response to HIV/AIDS. Such a response i s also more likely to be sustainable inthe long term. This project will have a specific component on community-led HIV/AIDS initiatives. Multi-sectoralapproach: Ithas been widely recognizedthat the HIV/AIDS epidemic extends far and beyondthe health sector. The multi-dimensional nature o f the epidemic and its impacts warrant a change inparadigmfrom a biomedical to a development one. Inthis context, the multi-sectoral approach inHIV prevention, care and mitigation offer best chances o f success. This project will involve the active participation o f all sectors at all levels. Focuson knowledgebuildingand evidencebasedinterventions: When compared to the HIV/AIDS situation inthe developed countries, there is a huge deficit of knowledge, best practices and resources on which to build strong evidence based prevention and care interventions. There is still lack o f consensus on areas such as preventing Mother-To-Child-Transmission, Anti-RetroViral Therapy, Use o f Vaginal microbicides, STItreatment and prophylaxis and treatment o f opportunistic infections. As such, this project will adopt a cautious approach by initially supporting well designed research activities on these unclear issues rather than committing to a particular intervention. The findings o f such research activities couldprovide firmer basis for specific interventions and can be shared country-wide, regionally and internationally. The useof indigenousknowledgeand practices: Indigenous knowledge andpractices includingdrama - 26 - could also be complementary inthe efforts to fight HIV/AIDS. InMozambique, the involvement o f traditional knowledge workers (healers) inawareness creation ina psychologically and socially sensitive area like sexuality had higher impact at lower cost. InTanzania, the integration o f traditional healers in AIDS prevention and mitigationstrategies has already been attempted to increase access o f services for poorer families. Along similar lines, the Bank i s currently piloting the use o f traditional channels o f communication ("griot" network) to deliver culturally congruent messages inprevention o f HIV/AIDS in West Africa. Local practices o f looking after HIV/AIDSorphans inthe community among foster parents, grandparents, or other relatives, have also been usedsuccessfully inUganda, Zimbabwe, Kenya, Malawi and Zambia to cater for orphans without separating them from their communities. Inthis regard, this project will encourage access to and use of appropriate indigenousknowledge andpractices that have been shown to work in the fight against HIVIAIDS. Role clarity betweenTACAIDWZAC and implementingagencies: There are experiences from other countries which show that channeling significant resources to institutions that were set up to coordinate and monitor project activities, introduces a temptation for those institutions to venture into implementation. Inthe Tanzania situation, TACAIDS and ZAC have been established explicitly to coordinate and monitor the national response to the epidemic and not to implement. TACAIDS will be supported under the project to coordinate and monitor the activities, whereas a wide spectrum o f agencies and institutions will be supported to implement the project activities. Complexityof supervisionof MAP projects: Giventhe innovative MAP approach andmultitudeo f stakeholders and partners, leading to relative complexity o f the projects, supervision o f M A P projects deserves more attention and resources than the average projects. The experience so far gained suggests that supervision teams for M A P projects should draw on the resources o f partners, particularly bilaterals and other stakeholders. The composition o f the supervision teams should also be multi-sectoral. Robust Monitoringand Evaluation: The key features of MAP are the scaling upo fmulti-sectoral programs and effective interventions, which require robust monitoring and evaluation systems. The monitoring and evaluation plan needs to be developed through a participatory process as a number o f stakeholders will be involved in implementation, monitoring and evaluation activities according to their areas o f expertise. Sufficient resources and skills should be made available for monitoringand evaluation o f projects inthe MAP, includingthis project. GoodDonor Co-ordination: As Tanzania has experienced invarious sectors within the context o f a sector-wide approach, effective coordination among development partners can significantly reduce the transaction costs to the government related to the management of externally fundedprograms. Common arrangements for programreviews, monitoringand evaluation, planning o f financial and technical assistance, support missions, funding o f programs or program components are all areas that will be pursuedin close cooperation with the TACAIDS, UNAIDS and other partners. - 27 - 4. Indications of recipient commitmentand ownership Realizing the devastation o f the HIVIAIDS epidemic, the political leadership o f Tanzania speaks out increasingly forcefully on the needto urgentlyintensifythe response to the epidemic. As an integral part o f the country's overall development program and strategy, it has therefore developed the National Multi-Sectoral Strategic Framework (NMSF) on HIVIAIDS ina collaborative effort betweenthe Government and its partners. Based on the agreed principles and strategic directions contained inthis document, the Government endorsed the initial project concept. TACAIDS was established under the Prime Minister's Office to facilitate the coordination o f the multi-sectoral approach to HIV/AIDS inthe country. All sectors have long been involvedto some degree, with each having prepared its Third MediumTerm Plan for HIV/AIDS (1998-2002), and these plans are beingupdatednow for support under the project. Onthe project design, consultations have been heldwith all the Government ministries, all o f which have longhad an HIV/AIDS focal person who will serve as their liaisonto the project, and the project was broadly endorsed. Finally, the Executive Chairman and Commissioners o f TACAIDS, as well as the newly-appointed staff o fthe TACAIDS Secretariat, have strongly endorsed the project and its design. 5. Value added of Banksupport inthis project: The Bank has taken the lead inthe re-orientation of the response to the HIV/AIDS epidemic from a medical issue to a development one. The September 1999 launch o f the Bank's regional AIDS strategy, "Intensifying Action Against HIV/AIDS inAfrica," was well receivedbyboth the Government andthe private sector, as well as by bilateral and multilateral donors. Through the Bank's Global HIV/AIDS Unit and the regional AIDS Campaign Team for Africa (ACTufrica), UNAIDS, and other partnerships, the Bank i s well positioned to make regional issues and experiences available to the project. The existing HIV/AIDSProgramhas to be scaled up by mainstreamingprogram activities to all the MDAsand other non-health government agencies at national and local government levels, andbymaking better use o f the capacity of community organizations and civil society organizations such as churches, trade unions and private businesses. While the costing o f Tanzania's NMSF i s not complete, it has become evident that the Government resources and the combined pledgesby other cooperating partners cannot adequately address the financing needs and that a substantial injection of resources and technical assistance from IDA i s required to sustain the current progress and to reduce HIV/AIDS prevalence and its impact on socioeconomic development. Government of Tanzania budgetary resources to contribute to the program are expected to increase significantly through additional funds that are beingmade available under the HIPC Initiative. The IDA funds will contribute to filling the funding gap. The project will complement other resources that are, or may become, available to support the implementation o f the national program, such as resources from bilateral partners and the Global Fundto fight HIV/AIDS, Tuberculosis and Malaria (GFATM). This complementarity will be requiredto support a program that i s capable to adapt to rapidchanges and lessons learned. Inaddition, and incontrast to the limitations o f many other sources o f funding, the project will focus on puttinginplace the basic infrastructure for an expanded and multi-sectoral response, knowledge sharing and systems strengthening. E. Summary ProjectAnalysis (Detailed assessments are inthe project file, see Annex 8) L? Cost benefit 1. Economic(see Annex 4): NPV=US$ million; ERR = % (see Annex 4) n ii Cost effectiveness Other (specify) The detailed economic analysis o f HIVIAIDS has been carried out under the M A P umbrella project (see - 28 - Annex 5 o f the Project Appraisal Document for the Multi-Country HIV/AIDS program for the Africa Region-Report No. 20727 AFR, and paragraphs 76-78 o f the same document). The analysis includes an overall assessmento f the impact o f HIV/AIDS on economic development and poverty and showed that a reduction inAIDS-related deaths would likely increase growth o f GDP. The data usedinthe analysis included the Tanzania HIV/AIDS information. This section only highlights some key points for the Tanzania Multi-Sectoral AIDS Project. The HIV/AIDSepidemic has gone beyondhealth and hasbecome a serious socioeconomic development issue. HIV/AIDS affects an economy through (a) reducing productivity; domestic savings and economic growth; and (b) increasingcosts o f treatment and care for both affected households and the society as a whole. Tanzania i s one o f the severely-affected countries. An estimated 12 percent o f Tanzania's adult population is HIV positive, and over 1.5 millionchildren have beenmade orphans by the epidemic. It i s estimated that Tanzania's Gross Domestic Product (GDP) could be 15-20 percent lower by 2015 with the HIV/AIDS epidemic than it would have beenwithout it. AIDS strikes people intheir most productive age, reducing both the size and growth o f the nation's labor force, increasing absenteeism due to illness and time taken to attend funerals, increasinglabor turnover and generally reducing productivity. The care and treatment for AIDS impose enormous costs on households and the society at large. Households with AIDS patients are likely to lose the income o f their members (often the main breadwinner) in addition to facing an increase inmedical expenses, and the expenses related to burials. Some households are forced to withdraw their children from schools inorder to save money as one o f their coping strategies. The economic benefits o f the proposedAIDS control project are multifold. First, since this project aims to scale up interventions in HIV/AIDS control and mitigation, the majority o f Tanzanians will directly and indirectly benefit from increased access to HIViAIDS prevention, treatment, care and mitigation activities. Secondly, new HIV infections will be reduced, due to an expansion in coverage o f the package o f HIV/AIDS prevention activities supported by the project. Thirdly, people livingwith HIV/AIDS can lead a longer and more productive life by benefitingfrom better management o f opportunistic infections and access to nutritional supplements; and therefore, less loss inproductivity and income and reduced costs for treatment and care. Fourthly, the support to the community responses will improve the care for orphans and increase their school attendance. As the analysis in Annex 5 o f the M A P PAD showed, a reduction inAIDS-related death rate and improvedcare for PLHA would likely increase the country's economic growth rate by reversingthe losses in productivity. Inaddition, there will be the direct benefit to vulnerable groups such as teenage girls, orphans, PLHA andpregnant women. 2. Financial(see Annex 4 and Annex 5): NPV=US$ million; FRR = % (see Annex 4) See paragraph 79 o f the project Appraisal Document for the Multi-country HIV/AIDS Program for the Africa region(Report No. 20727 AFR). Fiscal Impact: With aportion o fthe resdurces directed at community interventions, civil society organizations, and outsourcing, the fiscal impact o f the program should be manageable with the exception o f any ARV therapy which might be financed underthe grant and which would generate considerable recurrent costs. As part o f the process for considering whether to finance such interventions from the grant, IDA will emphasize to the Borrower that the additional recurrent costs would need to be borne by the Government or others to ensure that patients receiving treatment continue to be able to do so for the duration o f their lives. A full analysis o f the recurrent cost implications would - 29 - factor into any decision as well, as would the experiences o f neighboring countries. 3. Technical: The project will assist the government to implementthe strategic HIV/AIDS control interventions which are accepted as priorities for the national program and which have been shown to be both cost-effective and affordable under the Tanzanian economic and fiscal situation. The project will finance health manpower training and supplies for the use o f standard clinical management protocols, as recommended by UNAIDS or WHO. Such standardswill be usedinvoluntary testingand counseling, inpreventionof parent to child transmission, inprevention o f opportunistic infections, and inthe clinical management o f sexually transmitted diseases and the prevention and treatment o f opportunistic infections. Financingof anti-retroviraldrugs The financing o f anti retroviral drugs (ARVs)under the project will initially only be considered for the purpose to prevent mother-to-child transmission or for Post-Exposure Prophylaxis (PEP) under WHO/UNAIDS guidelines. However, the scope o f financing o f ARVs can be extended when an agreed policy on access to ARV treatment has been elaborated that appropriately takes into consideration the crucial issues of equity and affordability. Ifthe government decides to use Grant proceeds for this purpose, the project could also finance training o f health care personnel inthe use o f anti-retroviral therapy, as well as the costs incurred with the respect to the necessary laboratory support, according to clear clinical management protocols to be agreed with the UNAIDS and other technical agencies. This issue also requires the formulation o f a coherent national policy on the prevention o f mother-to-child transmission, on Post-Exposure Prophylaxis for rape victims and health workers and on equity issues relatedto access to anti-retroviral treatment. The considerations to be taken into account for the prevention o f mother-to-child transmission will include promotion o f breast-feeding versus alternate feedingfor infants, the social stigmatizationthat may arise, the side effects and resistance development from inappropriate use o f the drugs. The adequacy o f the legislation and law enforcement concerning rape and sex with minors will be addressedinthe context o f the Post-Exposure Prophylaxis. Cost-effectiveness studies o f suggestedinterventions will be supported under the project. Chemoprophylaxisand Treatmentof OpportunisticInfections Research on the cost-effectiveness o f alternative interventions for the clinical management o f HIV/AIDS, STDs and opportunistic infection, includingthe piloting o f chemoprophylaxis for opportunistic infections, would be areas that couldbe supported under the project. The rising incidence o f tuberculosis (TB) inthe country i s a direct consequence from the raging HIV/AIDS epidemic. Project resources can be flexibly applied to supplementthe national program in the control o f the opportunistic infections, including TB. 4. Institutional: 4.1 Executing agencies: The distinction between the coordination role of the national program by TACAIDS, and the administration o f project activities by MDAs and other implementing agencies have been agreed to in order to avoid overlap in responsibilities, with a minimumo f administrationbeingundertaken by the TACAIDS Secretariat. The lines o f responsibility between coordinating and the various implementing agencies will be defined and reflected inthe Operational Manual. Many o f the institutions involvedwith the project are new or, to varying degrees, new to the tasks assigned to them. Some MDAs, such as the MinistryofEducation andCulture andthe MinistryofHealthhave beeninvolvedinthe responseto - 30 - HIV/AIDSandmade significant progress inelaboratingtheir role. Others have not been as involved, and the project will support TACAIDS inmobilizingand supportingthe various ministries. The National AIDS Control Program (NACP) inthe Ministry o f Healthhas a vital role to play, but it i s still growing into its revised role since the creation o f TACAIDS. TACAIDS i s a new institutionand expectations relatedto its effectiveness during the early stages o f project implementation will need to be modest. With this inmind, the project will finance technical assistance inbothprocurement and financial management to support the project inthe interimuntilTACAIDS capacity can be brought up to the required level. 4.2 Project management: Different degrees o f capacity with the various implementingagencies and actors are anticipated, and the project will make substantial provisions for capacity buildingin all components. The executing agencies for the project will include the community organizations, the non-governmental organizations, Local Government HIV/AIDS Technical Committees and the respective MDAs. The Public Sector Fundand the Community AIDS ResponseFundwill provide important support for the capacity buildingat the district and community levels. 4.3 Procurement issues: Tanzania Government (mainland) has long realizedthe importance o f public procurement to the economic development of Tanzania and hence to the fulfillment o f key objectives withinthe national Poverty Reduction Strategy. To this effect, Tanzania was one o f the first countries in sub-Saharan Africa to enact a law modeledon the UNICITRAL model law. Since 1996, when the first Country Procurement Assessment Report (CPAR) was carried out, the Government has beenworking closely with the World Bank and other development partners to enhance the economy and efficiency o f its procurement system and to make it more transparent and accountable. The 2003 CPAR carried out in December 2002 and January 2003, lookedat all areas public procurement operations, includingthe legislative framework, the performance o f regulatory functions, the enforcement regime, the capacity o f public sector institutions to conduct procurement, and effects of corruption on procurement. It formed an integral part o f the World Bank's activities inTanzania as presented in the Country Assistance Strategy (CAS) o f 2000 and serves a number ofits keythemes, particularly higher economic growth, poverty reduction and institutional reforms to improve governance. The CPAR's key findingsare summarized inthe following paragraphs. Despite the economic benefits mentioned above, procurement has not to date beenconsidered to be a core function o f the Government, worthy o f specialized staff and dedicated organizational units. The legal framework for public procurement inTanzania i s intransition. While some very important steps in the rightdirection have beentaken with introduction ofthe Public Procurement Act (PPA) inJuly 2001, there remain some critical outstanding issues, particularlyconcerning access to complaint and dissemination o f legal texts. Overall, and comparedto other countries inthe region, the legal framework for public procurement i s updated and adequate. The Local Government Authority has prepared its Regulations in line with the public procurement law. These Regulations were publishedinthe Government Gazette o f March 12,2003. This will clear the legal confusion and contribute to reduction o f malpractice inlocal government procurement system. Currently, aggrievedbidders have very limited access to complaints mechanism. The Bank has recommended to the Government that a credible complaints mechanismshould be introducedby strengthening the complaints handling ability o f the Regulatory Body and establish the Public Procurement Appeals Authority, already entrenched inthe legislations, to provide a functioning avenue o f complaints for bidders. The single most important issue on the legal framework i s lack o f dissemination and proper application o f rules. After a period o f carving out the new rules, the country i s now focusing on making those rules work, by developing enforcement mechanism. -31 - The knowledge o fprocurement rules and capacity to apply these rules is very poor inmost of the procuring entities. Procurement audits are seldom performedand the consequences for breach o f procurement rules, outside corruptioncases, are minimal. The public access to informationi s one o f the cornerstones o f sound procurementpractice. Procuring entities are presentlyutilizing a number o f different media for advertising procurement opportunities, making access to information and enforcement o f the rules on advertisement difficult. The Bank has recommended to the Government that a central media for publicationo f procurement information, a Procurement Journal, should be established, supplemented with an Internet informationsite. At present, the Central Tender Board(CTB) holds bothexecutive and regulatory powers, which contributes to an unstable situation where the CTB on one handparticipates inthe procurement procedure and on the other handmonitors the same procedures. The executive role o f the CTB also leads to lack o f accountability and responsibility at the level o f the ministerialtender boards and the ministerial Accounting Officers, who are otherwise responsible for the budget, but not for procurement underthat body. Based on the CPAR findings, the procedures and practices of procurement inZanzibar are fallacy; they lack proper legal framework. At present procurement, apart from donor funded procurement, is conductedon an ad hoc basis leaving extensive discretion to the Accounting Officers inthe Ministries. While some of the procuring entities are applying the rules of the new Treasury Instructions, others have simply adopted their own procedures. Procurement is carried out inaccordance with former and now void rules. The legal framework for public procurement is inadequate due to deficiencies inthe present Act and missingregulations. There i s an Act to establish a Central Tender Board (CTB), but the Act only provides for the organization, and does not deal with any of the procedures o f procurement. While the Central Tender BoardAct became effective on July 1,2002, the relevant regulations have not yet beenissued. Although, established by Act, CTB i s not yet functioning since the members have not been appointed. Procurement capacity assessmentand the project's procurement riskincludingmitigation measuresare discussed inAnnex 6. 4.4 Financial management issues: The financial management assessment carried out duringthe appraisal mission revealedthat TACAIDS beingone of the implementingagencies has developed a satisfactory financial management arrangement to be able to start the project implementation. However, inorder to have an effective financial control at the proposed project, two key areas needto be strengthened namely: (i) the accounting systemto be fully operational; and (ii) accounting department fully staffed. An agreement will be reached with the the government on the remaining steps that needto strength the FM systemas mentioned inthe financial management plan. Detailed description o f the financial management arrangements for the project is presentedinAnnex 6. The financial management assessmentfor ZAC will be carried at a later date to be agreed during the negotiation. The overall financial risk is ratedmoderate, there are no highor substantial risks identified. (Refer annex 6(b) summary risk assessment) Responsibility for the financial management o f the project lies with the Prime Minister's Office (Mainland) and the Chief Minister's Office (Zanzibar), through TACAIDS and ZAC respectively. The accounting officer for the funds will therefore be the permanent secretary ineach o f the ministries identifiedabove. Accounting systems and the relatedpillars o f internal control are derived from normal GOT structures. Although some competent key staff have already been hiredat TACAIDS, the hiring process needs to be accelerated inline with the intention to go live with the project early inthe new financial year. - 32 - The government IntegratedFinancial Management InformationSystem (IFMIS)will be usedby TACAIDS. The hardware is largely inplace, but urgent arrangements need to be made for the installation o f the software. Meantime, the project i s using Microsoft Access as the stand-in accounting software. This i sjust a database, not designed specifically for handling accounting information, and i s therefore fraught with weaknesses and inadequacies. Immediate steps need to be taken to install the government wide system inorder not to create a parallel system, as well as generate a backlog that will needto be capturedinto the GOT systemafter the fact. TACAIDS and ZAC will be required to produce Financial Monitoring Reports (FMRs). The design o f these needs to be expedited, and agreement thereon must nonetheless be reached by negotiation. The Auditor General o f Tanzania i s the designated auditor o f all government finances. It i s therefore expected that the TMAP will be no exception, although the formal arrangements and audit TORSare still to be reviewed. The accounting year will follow the Government o f Tanzania fiscal year, with the audited financials falling due six months after the end o f the fiscal year. Disbursement The project i s expected to operate five bank accounts as follows: (i) IDA grant account in The Washington (USD / SDRs) for transfers to the project's USD Special Account (below) and the costs o f any direct payments; (ii) Two Special Accounts (USD) heldat a commercial bank acceptable to IDA, one each for TACAIDS and ZAC, for USD transfers from the IDA grant account, and onward transfers to the local currency accounts, and any USD payments; (iii) local currency (T shilling) accounts at Two commercial banks acceptable to IDA, one each for TACAIDS and ZAC, for receiving transfers from the Special Accounts, and makingT Shillings payments to the GOT Treasury, RFAs, and other suppliers. Counterpart part funds will also be deposited into these accounts. (iv) Disbursementsfrom the grant will initially be made based on traditional disbursement methods (Le. from the Special Account with reimbursements made based on Statements o f Expenditures (SOEs), as well as direct payments from the Grant Account where appropriate). This situation i s only expected to hold untilFMRs producedby TACAIDS and ZAC are deemed satisfactory enough to be the basis o f disbursement. (see Annex 6 for the detailed financialmanagement action plan). 5. Environmental: Environmental Category: B (Partial Assessment) 5.1 Summarize the steps undertaken for environmental assessmentand EMP preparation (including consultation and disclosure) and the significant issues and their treatment emergingfrom this analysis. The project is not expected to generate any major adverse environmental effects. Possible environmental risks include inappropriate handling and disposal o f hazardous medical waste, including sharp needles, and especially inadequate management o f the respective disposal sites inurban or peri-urban areas, where domestic and medical waste may be mixed and where scavenging is common. The project will finance training o f health care professionals, o f traditional birthattendants and traditional healers, and of community workers delivering care to HIV/AIDS patients. This training will include instruction on appropriate separation, transport and disposal o f hazardous medical waste. The project will finance the revision o f existinghealth sector guidelines on appropriate management o f hazardous medical waste at medical facilities and at disposal sites to include the relevant dispositions regarding HIV/AIDS, and on occupational safety guidelinesfor health care workers. The Ministryo f Health's Medical Waste Management Plan has beenpublicly disseminated duringa three-day National Workshop inMorogoro on March 13, 14 and 15,2003. The project might supply drugs and antibiotics for Sexually Transmitted Infections, Tuberculosis or HIV through the Ministryo f Health's workplan. Inthe event that such drugs are deemednecessary and the - 33 - government requests to allocate funds for such purpose, appropriate mechanisms will be put inplace to ensure that drugs are appropriately used, and that resistance development i s monitored through surveillance. Microbial and viral resistance to antibiotics and antiviral drugs couldpose a challenge to the micro-environment, if such drugs are not used properly. The potential contribution o f the project to this riskis considered minimal at this time. 5.2 What are the main features o f the EMP and are they adequate? A Medical Waste Management Planhasbeenprepared, cleared by ASPEN, andhas been disclosed in-country and at the World Bank Infoshop. N o additonal environment assessment is required. 5.3 For Category A and B projects, timeline and status o f EA: Date o f receipt o f final draft: N o additional EA i s required, the Government's Waste Management Plan was receivedon February 24,2003. 5.4 How have stakeholders been consultedat the stage of (a) environmental screening and (b) draft EA report on the environmental impacts and proposed environment management plan? Describe mechanisms o f consultation that were usedand which groups were consulted? Interviews and consultations with a large number and variety o f stakeholders were conducted, including the Vice President's Office, city council members, district council members, dumpsite managers, health facility staff, community members, Ministryo f Healthofficials, Multinational (WHO, UNICEF) and bilateralpartners, NGOs (e.&. Medecins sans Frontibres) and private sector representatives. After the draft Waste Management Plan was elaborated a workshop was organized to bringall these stakeholders together in order to provide final comments. 5.5 What mechanisms have been established to monitor and evaluate the impact o f the project on the environment? Do the indicators reflect the objectives and results o f the EMP? Inaddition to the HealthCare Waste Management Plan (HCWMP), a set ofNational Guidelines were developed and the training of national staff in these guidelinesis key inthe monitoring o f the implementation o f the HCWMP. Inview o f the existing technological limitations relatedto the monitoring o f air quality and pollution, the HCWMP focuses on the reduction o f hospital waste and on developing sanitary landfills as opposed to incineration. With regard to the same technological limitations in the monitoring o f underground water, guidelines and indicators focus on the distance betweenpits and any source of water. The indicators and monitoringmeasuresreflected inthe HCWMP and the National Guidelines are considered appropriate. 6. Social: 6.1 Summarize key social issues relevant to the project objectives, and specify the project's social development outcomes. The project i s expected to have a positive social impact by assisting and empoweringpeople and institutions to deal more effectively with the HIV epidemic. People living with HIV/AIDS and their families will have an opportunity to receive bettersocial support from their communities, civil society organizations and the Government. Families o f people living with HIVIAIDS are vulnerable to economic and human rights abuses in the absence o f legislation and social norms that can protect them. The project will support and enhance the development o f community norms that will protect people living with HIV/AIDS. The project will involve key stakeholders, - 34 - including civil society organizations and people living with HIV/AIDS inthe development o f such social protective measures. 6.2 Participatory Approach: How are key stakeholders participating inthe project? The Tanzania Multi-sectoral HIV/AIDSProject is developed on the basis o f the Tanzania NMSF. Consultation with key government, non-government, international stakeholders, and groups o f people living with HIVIAIDS, took place during the development o f the HIV/AIDS plan and national policy framework and will continue duringthe implementation of the project. Duringproject preparation, consensus-building exercises to involve major stakeholders to gain consensusaround the project concept document, project design and implementation arrangements were held. A Social Assessment was conducted to ensure the reacho fthese consultations reached to all levels intendedto benefit from the project. Duringproject implementation, communities will be able to express their needs through Community HIV/AIDS projects and to participate as active partners inproject implementation, adding ownership, transparency and accountability to the project. 6.3 How does the project involve consultations or collaboration with NGOs or other civil society organizations? Consultations with civil society organizations on the concept of the project have beenconducted, and further consultations duringproject implementation, monitoring and evaluation will continue. NGOs and other civil society organizations will implement a significant part o f the project, supporting government agencies and communities in the implementation o f project activities. Civil society organizations will also be consulted inthe annual project reviews, inthe mid-termreviews and duringthe summative evaluation of the project. 6.4 What institutional arrangements have been provided to ensure the project achieves its social development outcomes? The Tanzania Commission for AIDS i s a multi-sectoral organization integratingrepresentatives from different Government agencies, from civil society and from people living with HIV/AIDS. The Project supports the development o f relevant social initiatives to protect the most vulnerable i.e. women, young people (especially adolescent girls) and people living with HIV/AIDS. A baseline survey will be conducted duringthe first year o f implementation o f the project, which will be continuedbefore mid-termand closure. Phasedsocial assessments on specific groups and areas will be conductedduringproject implementationto monitor progress according to agreed indicators and to improve strategies for HIV prevention. 6.5 How will the project monitor performance interms of social development outcomes? Genderand orphan specific indicators have beenincluded amongthe project performance indicators. 7. Safeguard Policies: - 35 - Involuntary Resettlement(OP/BP 4.12) 2 0NO Yes Safety of Dams(OP 4.37, BP4.37) C; Yes 0 NO Projectsin InternationalWaters (OP 7.50, BP 7.50, GP 7.50) aYes0 NO ProjectsinDisputedAreas (OP 7.60, BP 7.60, GP 7.60)* I \ w~ Yes NO 7.2 Describe provisions made by the project to ensure compliance with applicable safeguard policies. The project complies with all Bank's safeguard policies, includingthose described above. No additional Environmental Assessment is required; however, a Health Care Waste Management Plan was requiredto be prepared and publicly disseminated prior to Appraisal, and this requirement has been fulfilled. F. Sustainability and Risks 1. Sustainability: The Government o f Tanzania has demonstrated its firm commitment inthe fight against the HIV/AIDS epidemic. InDecember, 1999, President Mkapa declared the HIVIAIDS epidemic a "National Disaster" and called on the entire nation, especially political, civil, and religious leaders, to take more aggressive measures to reign inthe epidemic. This highlevel commitment has provided an encouraging environment for the fight against HIV/AIDS, and led to the inclusiono f HIV/AIDS as a key item inboth the national Public Expenditure Review and the Poverty Reduction Strategy Paper. The new institutional framework establishingthe Tanzania Commission for AIDS (TACAIDS) provides the focal point for coordination o f efforts at the national level. The National Multi-Sectoral Strategic Framework on HIV/AIDS will consolidate HIV prevention and mitigation efforts within the context o f a national strategy. This project will buildon the existing frameworks, along with other partners, to support the prevention o f HIV and the mitigation o f its impact. Furthermore, it seeks to scale up existing HIV/AIDS activities that involve communities, civil society organizations and inparticular, organizations o f people livingwith HIV/AIDS. The main thrust behindthe National Strategy is the requirement for integrated, people-centered, culturally sensitive andprioritized approaches. The combination o f the community-oriented multi-sector approach, a strong high-level government commitment, substantial capacity building, and the willingness o f the donor community to enter into the partnership against AIDS inTanzania make for the reasonable expectation ofthe project's sustainabilitv beingconsidered in the short to mediumterm. The proposedprogram will be usedto leverage additional resources, as has already been demonstrated by the increasedpledges o f development partners to support TACAIDS. Expanding ownership for the responsibility to respondto the challenges that the HIVIAIDS epidemic poses i s at the core o f the project and will create additional capacity and spread the budgetary burdenover a larger number o f sources o f financing. The capacity of the program to demonstrate results inboth aspects will be crucial for the sustainability over an extended period o f time. Inaddition to the measureselaborated below to mitigate specific risks, IDA will seek to mitigate the overall risk and ensure successful implementation by (i) providing additional resources for supervision which exceed the standard supervision coefficients; (ii) conduct supervision with teams comprised o f specialists from various sectors and, inparticular, specialists inkey areas such as financial management, procurement, and monitoring & evaluation; and (iii) maintain close collaboration with development partners and stakeholders. - 36 - 2. Critical Risks (reflecting the failure of critical assumptions found inthe fourth column of Annex 1): Risk Risk Rating I Risk Mitigation Measure 'rom Outputs to Objective 'he sociocultural andpolitical S There is already a high-level political nvironment i s not conducive to promote commitment to the fight against HIV/AIDS. In he behavioral changes necessaryin order to sustain the current level of support, the ightingthe spreado fthe epidemic and project will work in a participatory manner nitigating its impact. with other donors to keep HIV/AIDS inthe forefront o f public discourse and encourage more openness. Civil society, community leaders will be involved very early inproject implementation so as to facilitate a more conducive environment for the fight against HIV. :he stated government political and S Bykeeping HIViAIDS at the forefront of inancial commitments do not public policy agenda and encouraging dialogue, naterialize. the government will be more likely to follow through on its commitments and the communitj drive more likely to be sustainable. The mainstreaming of HIV prevention and mitigation activities inall sectors will also engender more attention from the government and political leaders, and its inclusioninthe PER and PRSP will ensure it remains highon the agenda. :rom Components to Outputs 'roject will operate through unproven S The project provides for extensive capacity ;tructures and may encounter buildingat all levels, particularly inTACAIDS mplementation delays Furthermore, the project has been designed to ramp up gradually and not overwhelm the nascent capacity of TACAIDS. Other aspects lofthe project rely heavily on existing i structures andprocesses. ;oca1 Government, Community S The Facilitating Agencies will provide training irganizations and civil society are not to these decentralized levels to enhance nobilizedand lack the capacity to plan, capacity to plan, implement and evaluate mplement and evaluate activities tailorec activities. Financial Management will be a 'or HIV prevention and care among particular focus o f the training. The project mlnerable groups. This lack o f capacity will use simpler but credible procurement, :odd result infiduciary problems disbursement andfinancialaccounting mechanisms for these levels. Slow release o f funds to implementing M The PMO will be the custodian o f the project, igencies and funds will be released directly to beneficiaries. TACAIDS will monitor and include inproject reports the turn around time - 37 - for processing the funds. Overall Risk Rating S There i s sufficient experience, both within and outside the Bank, to warrant a cautious assessmento f the overall uroiect risk, which i s considered substantial. The major risks faced by the project include the following: The implementationof the project at decentralized levels will provide the most responsive way to reach the frontline o f fightingthe epidemic. There will be the need for significant financial commitment from both the public and private sectors inthe fight against HIV, and such commitments will needto be sustained. A potential risk is the proiect resources being overwhelmed by the demands arising from the continued epidemic. Inorder to mitigate this risk,the project will work on expanding co-financing arrangements with other donors. The Government o f Tanzania's commitments incounterpart funding will needto be kept. The continuation o f donor suuuort is crucial to the achievement o f the goal ofreducingthe spread o f HIV and the mitigation o f its impact. This project focuses on institutionaland community responses, whereas fightingthe HIV epidemic demands substantial efforts inother areas especially for resources targeted to the provision o f drugs, condoms and other supplies. The involvement o f IDA will likely encourage other donors to provide more resources that will be needed for stemmingthe epidemic through cost-effective, well coordinated partnerships. The project i s expected to ride on significant involvement by NGO/CBOs and the communities. The organizations o f PLHA will have to assume prominence inadvocacy as well as direct involvement in the implementation of the community initiatives. As such, the socio-cultural environment will needto be conducive for themto do so without beingstigmatized. Becausethe project i s targeted to vulnerable populations, it will be important that the institutional mechanisms exist to ensure that the benefits reach the intendedbeneficiaries, andthat social stigma as well as discriminatory practices are minimized. The project will bringtogether the various stakeholders inaddressing and creating the appropriate environment for its efforts. 3. Possible Controversial Aspects: 1. Condom uromotionversus abstinence: There is a likelihood that the debate on the promotion o f condoms as a means to prevent HIV transmissionand the alternative o f promotingabstinence among the youth will continue inTanzania for a periodextending into the project's implementation. It is, however, unlikelythat any major controversy will be spurred on the issue by reason o fthe project. The majority o f Tanzanians support the use o f condoms as means of preventingHIV/AIDS, and the available research evidence strongly supports their use as a practical step inpreventingHIV infection. 2. Provision o f Anti-Retroviral Therapy: The use o f anti-retroviral therapy against HIV/AIDS i s still evolving, and there are research efforts going on in the region as well as internationally. There are ethical and moral issues of deprivingtheir use where they are available. The project will not be prescriptive as to whether the drugs are used. There are no major controversies expected inthis regard. More generally, resources under the project could be used to increase access to care and to increase the capacity o f the health care systemto provide and administer these services. - 38 - G. Main Grant Conditions 1. Effectiveness Conditions (a) the Recipient has opened Project Account A and deposited therein the initial deposit; (b) the Recipient has adopted and furnishedto the Association the PIP, includingthe procurement plan for the first year o f Project implementation, ina form and substance that i s satisfactory to the Association; (c) the Recipient has adopted and furnishedto the Association the POM, ina form and substance that i s satisfactory to the Association; 2. Other [classify according to covenant types used in the Legal Agreements.] DisbursementConditions for Individual Components: Community AIDS ResponseFund(CARF) (a) By region, each region shall have contracted a Facilitating Agency as described above andthat facilitating agency shall have opened the necessary commercial bank accounts before any C A W funds can be disbursedto that region; (b) Any sub-project over US$lOO,OOO mustbe subject to the Bank's prior review. Zanzibar HIV/AIDS Support: (a) A Project Operations Manual exclusive to this component (b) Financial management capacity assessment and procurement capacity assessmentof implementing structures (c) Project Account B has been opened and the Initial Deposit paid into the Project Account (d) A Medical Waste Management Planfor Zanzibar H. Readinessfor Implementation 0 1.a) The engineering designdocuments for the first year's activities are complete and ready for the start o f project implementation. 1.b) Not applicable. 32.Theprocurement documents for the first year's activities are complete and ready for the start o f 13. project implementation. The Project ImplementationPlan has beenappraised and found to be realistic and of satisfactory quality. 4. The following items are lackingand are discussed under loan conditions (Section G): (i) Final Project Implementation Plan (draft reviewed at Appraisal) I. Compliancewith Bank Policies a 1. This project complies with all applicable Bank policies. 2. The following exceptions to Bank policies are recommended for approval. The project complies with all other applicable Bank policies. - 39 - - .O'Connor Team Leader Sector ManagedDirector Country ManagerlDirector - 40 - Annex I:Project Design Summary TANZANIA: Multi-SectoralAIDS Project [fromGoal to Bank Mission) Country continues to maintain the record o fpolitical stability. efforts to fight HIVIAIDS. Government implementation capacity continues to improve. [from Pu'rposeto Goal) NIA Project Development Outcome I Impact IProject reports: (from Objective to Purpose) Objective: Indicators: Reduce the spread o f By 2004, reduce from--% to HIV Surveillance reports, Government and stakeholders HIVIAIDS inthe general --%the HIV prevalence Project Reports continue to have interest and population o f Tanzania among women attending commitmentto HIVlAIDS ante-natal care clinics. prevention, care and support. By 2007, reduce from --%to --% the HIVprevalence among women attending ante-natal care clinics. By2007, reduce from --%to STD Surveillance reports, Syndromic approach to --%the rate o freported Project Reports, syphilis treatment o f sexually positive syphilis tests in surveillance report transmitted diseases is women aged 15-49 years in sustained across the country. Ante natal clinics inthe I previous 12 months. By 2007, reduce from --%to STD Surveillance reports, IEC achieves the desired --%the proportion o f 15-19 National Surveys, Project change in cultural norms abou old boys and girls that report Reports sexual activity among the being sexually active. youths I By2004, increase from --%to National Surveys, Project Key opinion leaders, including --%the proportion o fmenand Reports cultural and religious leaders, women aged 15-49 who report do not oppose the promotion using a condom intheir last o f condoms among sexually act o f sexual intercourse with active people a non-regular partner during the previous 12 months. By 2007, increase from --% to --YOthe proportion o fmen and -41 - women aged 15-49 who report using a condom intheir last act o f sexual intercourse with a non-regular partner during the previous 12months. By 2007, reduce from --%to National Surveys, Project tEC achieves behavior change --% the percentage of sexually Reports regarding multiple sexual active people reporting having partners non-regular sexual partners over the previous 12 months. ditigate the health and By2007 reduce by 30% the Special studies o f subset o f The rate o f orphanhood does ocio-economic impact o f dropout rate o f orphaned districts not outpace the rate o f 1IViAIDS at individual, children inprimary school providing assistanceto iousehold and community orphans evels By 2007 increase from 30% to Special studies o f subset o f PLWHA are not afraid o f 50% the proportion o f districts providing their name and PLWHA identified inthe home addresswhen attending districts that are receiving health services for treatment some form o f home or community-based support I itrengthen the capacity o f IBy 2007 all districts are Project data All districts are aware of the iommunities, civil society and implementingintegrated urgency to take action ;ovemment to respond to the HIViAIDS work plans multi-sectorally :pidemic htput from each Output Indicators: Project reports: (from Outputs to Objective) :omponent: .Community AIDS By2004, at least 1,000 Facilitating Agencies Reports People living with HIViAIDS tesponse Fund community basedinitiatives are not stigmatized. lIViAIDS prevention, care, on HIV/AIDS supported. md support activities initiated )yCommunities and Civil iociety organizations are trengthened. By 2004, the percentage of FacilitatingAgencies Reports, Facilitating Agencies active districts inwhich community TACAIDS Reports and effective inall districts based initiatives related to HIViAIDS prevention, care and support are funded increased to 100%. By 2005, the percentage o f Ministryo fHealth and Confidentiality o f client districts inwhich voluntary TACAIDS Reports information is observed by counseling and testing services voluntary counseling and are provided increasedto testing service providers. 100% Minimumstandards for Voluntary counseling and testing centers are established. By 2005, the total value o f FacilitatingAgencies Reports Communities and Civil - 42 - project contracts entered into Society organizations develop with communities, NGOs, :he capacity to absorb associations o fpeople living mdaccount for the resources. with HIVIAIDS andprivate sector agencies is no less than 40% o f all contracts entered into over the previous twelve months o f the project. !. Public Sector Fund IIVIAIDS prevention, care, By 2004, at least 50% o f all [inistryo fEducationreports rraining is given to teachers .ndsupport activities carried primary, secondary and high 3n the skills basedapproach to utbypublic sector agencies schools are using national leaming about HIVIAIDS. .re strengthened across school curricula that ectors. incorporate HIViAIDSina skills basedlearning approach. ACAIDS Reports By 2005, all Ministries have Ministriestake genuine and are implementing their awnership o f their respective respective HIViAIDSwork HIViAIDS plans. plans. By 2007, increase from -- to -- Iinistryo fHealth Reports The cost of anti-retroviral the number o f HIV positive drugs continues to fall. pregnant women receiving preventive treatment for Mother To Child Transmission (MTCT) o f HIV. ACAIDS Reports, RALG By2004, 15% o fdistricts have Decentralized project and are implementing their implementationmechanisms respective HIViAIDSplans, empower districts and other formulated with stakeholder local stakeholders. participation. linistryo fHealth, RALG By 2004, the number of National essential drugs polic> districts which report continues to support the stock-outs o f essential drugs effective distribution o f for treatment o f sexually pharmaceuticals. transmitted infectionsreduced by 60%. loH Reports, RALG By2004, the percentage o f Districts which need assistancc districts that offer safe blood are offered the necessary supply sustained at 100%. training infinancial management. By2004, the national network o f PLHAs represented in all regions. By2006, at least 6 legal aid centers for PLHAs and their relatives established. By2005, at least four centers - 43 - for the monitoring o f the use o fARVs established. By2004, all districts receiving project fundingare submitting acceptable district accounting and expenditure reports. I. Tanzania AIDS :ommission Institutional iupport qational HIViAIDS By 2004, institutional 'rogram Review Reports :ommission staff are recruited ioordination functions o fthe arrangements for the I a competitive and :anzania AIDS Commission coordination o f HIViAIDS .ansparentmanner. Ire effectively implemented. related activities established at all levels By 2003, Joint HIViAIDS 'rogram Review Reports ProgramReviews effective. By2004, ajoint program 'rogram ReviewReports monitoring and evaluation framework inplace and functioning. By 2005, ajoint mediumterm 'rogram Review Reports financing framework inplace and functioning. By2005, timely expenditure reports are available from all major partners that finance part o fthe national program. By2004, there is no increase, 'rogram Review Reports :here is no political incomparison to the previous nterference inthe processing year, inthe tum-around time ifrequests for project funds. for processing requests for funds under Civil Society Fundand the Public Multi-Sector Fund respectively. 'roject Components / Inputs: (budget for each Jrojectreports: from Componentsto iub-components: component) lutputs) . Community AIDS Response US$15.0 million 'roject data knd !.Public Multi-Sector Fund US$40.0million 'roject data I.Tanzania AIDS US$6.0 million 'roject data :ommission Institutional ;upport - 44 - $. Zanzibar HIV/AIDS JS$5.0 million Project data support - 45 - Annex 2: Detailed Project Description TANZANIA: Multi-Sectoral AIDS Project The Tanzania Multi-Sectoral HIViAIDSProject will finance a US$70 million share o f the Government's National Program for HIV/AIDSover a period o f five years between 2003 and 2008. The purpose o f the Government's program is to reduce the spread o f H I V inthe general population o f Tanzania through multi-sectoral action involving Government, Non-Government, Civil Society and community organizations. The purpose o f the project i s to scale up and accelerate the national response to the HIV/AIDS epidemic taking into account the priorities identifiedinthe HIV/AIDS policy and the National Multi-sectoral Strategic Framework on HIV/AIDS (NMSF). The project will support activities inthe priority areas ofprevention and the mitigationofthe health and socio-economic impact of HIV/AIDS at individual, householdand community levels, as well as the strengthening o f national capacity to respondto the epidemic. Inaddition, both the National Programand project-financed activities will place particular emphasis on targeting vulnerable groups. Activities to be supported by the project will be coordinatedby the Tanzania Commission for AIDS (TACAIDS) and the Zanzibar AIDS Commission (ZAC) on Zanzibar, and these activities will be implemented by community groups and public and private service agencies. The project is designed within a multi-sectoral framework, under the Multi-Country AIDS Program (MAP) for Africa, which addressesthe HIV/AIDS epidemic within a broad context. It i s a program to support the Government to implement an expanded response to HIV/AIDS through community-based initiatives and also by mainstreamingHIV/AIDS into the work programs o f all MDAsand local government authorities. It i s also intended to sensitize the private sector to the need for greater attention to the issue. The support for community-based initiatives would involve HIV/AIDS preventionprograms through peer education, IEC activities, and the provision o f support for Voluntary Counseling and Testing(VCT) services. The care of orphans, widows and home-based care for PersonsLivingwith HIV/AIDS (PLWHAs) are also expected to be includedamong the community-based initiatives. The project will have the following four components: 1. Community AIDS ResponseFund 2. Public Sector Fund 3. TACAIDS Institutional Support 4. Zanzibar HIV/AIDS Support By Component: Project Component 1 US$14.00 million - CommunityAIDS ResponseFund (CARF). This component will focus on social mobilization and community level response to HIVIAIDS. A fund will be set up to expand and strengthen HIV/AIDS activities beingcarried out by communities andNon-Government Organizations (NGOs), including Employers and Workers' organizations, Community Based Organizations (CBOs), private sector, religious sector, persons livingwith HIV/AIDS (PLWHAs). Activities to be funded will include the full spectrum o f HIV/AIDSactivities within the broad groups o f prevention, care and support and mitigation o f socio-economic impact. There will be clearly-defined eligibility criteria for organizations to be funded under this component; these criteriawill be elaborated inthe Operational Manual. Facilitating Agencies will mostly be selected through QCBS on regional basis. An FA could cover one regionor more (NB: Region refers to the regions definedinthe administrative structure o f Tanzania). In some cases, RFAs may be on boardalready, in which case a M O Uwill be -46- signed with TACAIDS. Groups which receive fundingwill be encouraged to focus, but not necessary limit, their activities to the most vulnerable groups which include:people living with HIViAIDS (PLWHA), hospital workers, widows, orphans, youths, women-led households, commercial sex workers and truck drivers. The conceptual basis for this component is that the factors that determine the spreado fthe HIV are only to a limitedextentunderthe influence of government. Where traditional and cultural values and practices are o f critical importance, Civil Society has to play an important role as a vital partner inthe response to the epidemic. Local communities and civil society organizations sometimes better understand the needs and problems o f people, and therefore are in a better position to effect behavioral change, empowerment and ownership. They can be innovative and flexible andtherefore fast reacting. For the purpose of this project, Civil Society Organizations are self-defined community groups that share a common interests for a specified purpose. They can be organized by age, gender, profession etc. and include organizedgroups like villages, workers' associations, community-based organizations, faith-based organizations, and NGOs. There will be a cap on the number o f grants for sub-projects costing more than USD 5,000 to ensure a community-level focus; therefore, it i s expected that larger NGOs or national organizations would largely access these funds only to the extent that they pair up with individual communities. Private sector organizations will also be eligible to access the Community AIDS ResponseFund. The Community AIDS Response Fundwill be facilitated mostly through existing Government structures. Local Government Authorities (LGAs) will receive training in two areas: (i) the integration o f HIViAIDS activities into their LGA workplans (see Public Sector Fund component); and (ii) training o f Local Government Participatory RapidAppraisal (PRA) the teams on the appraisal and approval process for the Fund, monitoringand evaluation, cross sectoral cooperation, and community mobilization. These PRA teams will then mobilize communities to access these funds, and the Local Government AIDS Coordinator will follow up on sub-project implementation. The PRA teams will also identifyNGOs and other groups that can support communities inthe formulation and implementation of sub-projects. A FacilitatingAgency will be contractedat the Regional level to support the Government inthe administration o f the Fund. Sub-project proposals will be submittedto the HIViAIDS Technical Committee (or the LGAswhere the HrViAIDS committee i s not yet established) for technical appraisal, and then proceedto the Local Government Authority for final approval. The approvedproposal will thenbe forwarded to the FacilitatingAgency for Disbursement and to TACAIDS for informationpurposes only. The beneficiary will sign an Implementation Agreement with the FacilitatingAgency, which will performfiduciary oversight of sub-projects, inform LGAs when funds are disbursed, and provide reporting both upwards to TACAIDS and downwards to LGAs. Other donors will provide co-financing to for the services o f the FacilitatingAgency in specified regions. Ingeneral, as notedearlier, RFAs are expected to be selected through QCBS as definedinthe World Bank Procurement Guidelines, and they are expected to be selected from large, umbrella NGOs o f Tanzanian or International Origin. Private sector consulting firms would also be eligible to submit proposals, and the final arrangement is likely to vary by region. In several regions, there are already organizations inplace which are either fulfilling similar functions or are uniquelysuited to fulfill the FA function. Since many o f these are donor-financed structures, it i s anticipated that the respective donor will provide the necessary co-financing or parallel financing for these organizations to serve as RFAs. Under such arrangements, the financing for sub-projects disbursedby the RFAs would come from TMAP, -47- while the cost o f the FA services would be borne by the donor. Regardless o f the type o f organization selected, no FA would be permittedto disburse funds to any community sub-project with which it, or any affiliate, i s associated. While the flow o f funds will be governed by extraordinary implementation arrangements, the CARF will be incorporated into the existing LGA annual planning process by includingan estimate for amount of support to sub-projects expected duringthe year, and then by capturing the actual disbursements to specific sub-projects as they are reported by the Facilitating Agency. This will enable the Fundto function on a rolling basis without bypassingthe Local Government annual planning process. The funds to support the sub-projects will flow from Treasury, through TACAIDS, to the respective RFAs who will then disbursethe funds in accordance with the procedures defined inthe Operations Manual for RFAs. Although it will be difficult to specify which activities will be fundedunder this component, the broadrange o f activities to be supported include: Support for the community-based sub-projects which have been prepared and submitted through the agreed-upon institutional structure. A careful balance will be maintained among the sub-projects betweenprevention, care and impact mitigation activities. At the same time, a deliberate effort will be made to ensure that activities under this component will reach national coverage as quickly as possible. The training o f community volunteers, peer educators and trainer o f trainers inHIV related counseling. This would generate a critical mass o f capable community members who will provide counseling for HIVprevention, post-test counseling for those infected and also to optimize the care and support available to PLWHA, orphans, widows and other vulnerable groups. HIV Support groups: These support groups would be formed by organizations of people living with HIV/AIDS and are an important forum for providingpsychological and material support to the PLWHA. Support for Orphans and Vulnerable Children (OVC): One o f the tragedies resulting from the HIV/AIDS epidemic inTanzania i s the increasingnumber o f orphans and other vulnerable children inthe population. These children are less likely to be enrolled inprimary schools and even when enrolled, are more likely to drop out. The project will support community-based initiatives that focus on making it possible for OVCs to remaininschool. Inparticular, attention will be givento the school attendance among females. Support will be givento initiatives that make special provisions for the OVCs to attend school or to support their foster families inorder that the children can attend school. -48- (e) Scaling up o f ExistingActivities: Successful interventions inthe following areas will also be scaled up with the support o f the Fund: (i) dissemination o f information, (ii) promotion o f safer sexual behavior, (iii) encouragement of condom use and their availability, (iv) reduction o f stigma and increased acceptability o f PLWHA, (v) care and support o f PLWHA and their families, and (vi) advocacy for legal and human rightsprotections for PLWHA. Project Component 2 US$32.00 million - PublicSector Fund.This component will comprise a fundto scale up and strengthenprevention, care, support and mitigation o f the social economic impact o f HN/AIDS through programs/activities o f the public sector. It will support public sector institutions to protect their own personnel from the impact o f HIV/AIDS and, when applicable, to integrate HIV/AIDS activities into their core business. Sub-contracting by ministries, local authorities and parastatals will be encouraged in order to make the best use o f the implementation capacity that may be available outside the public sector. Eachpublic sector agency will define a work program which, as a minimum,will address issues regarding HIV/AIDS among its employees. Public agencies will also be expected to extend HIV/AIDS services to their clients and neighboring communities. This component will provide the following types o f support: Support to Ministy of Health: The largest share o f funds underthis component will be dedicated to supporting the Ministryo f Health in its unique role in combatting the epidemic. This support will partially finance the Ministry'sHIV/AIDS workplan, which has been developed in collaboration with the Ministry'sdevelopment partners and reviewed duringthe annual Sector Review. It comprises prevention activities, medical interventions, the procurement o f HIV/AIDS commodities and services, and support by the Ministryo f Healthto other partners inthe multi-sectoral campaign against the disease. Given the special nature o f this sub-component, the application o f funds will be for a broader range o f purposes than providedfor under the guidelinesfor other ministries. Support to MDAs (other than Ministy of Health): All MDAswill receive support toward the implementation o f their comprehensive HIV/AIDS workplans. A few ministries with advanced workplans and responsibility for the highestpriority areas underthe MTPIIIwill receive comprehensive workplan support duringthe first year. The remainder o f the ministries will receive more limitedworkplan support -focused mainly on workplace interventions to protect their own personnel-duringthe first year, and more comprehensive support duringthe second year. Technical Assistance has been made available to all ministries, financed from the PHRD grant, inidentifying the sections of the workplanto be financed inthe first year. Additional technical assistancewill be providedby TACAIDS in the first year to support those ministries which will not qualify for comprehensive workplan support duringthe first year inorder that they may be prepared to access this comprehensive support duringthe second year. Such comprehensive support is expected to address the following two broad areas: (a) The internal impact of the HIV/AIDS epidemic on the specific ministry: The extent to which HIV/AIDS has affected the quality, quantity and substance o f available services, the ability to supply the required services, the organization of the sector, the role of service providers, human resources policy and management practices, the planning and management o f sector resources, and the availability o f resources to the sector would provide the framework for assessingthe internal impact o f the epidemic on the specific line ministry. (b) The external impact of the HIV/AIDS epidemic relative to the work of the specific ministry: The extent to which the specific sector can contribute to the prevention o f further spread o f HIV inorder to protect both its staffandtarget populations, and the increase inaccess to and -49- use o f care and support for the affected or infected among staff membersand their families. The workplans prepared during 2000 [NACP facilitated] and recompiledby TACAIDS in August, 2001, will be taken forward and finalized as the basis for support under this component. Ingeneral, the range of activities that are expect to beconsidered within the ministryworkplans include the following: (a) Capacity Buildingfor the mainstreamingo f HIV/AIDS-relatedactivities into the ministry workplan; (b) Information, Education and Communication (IEC) campaigns for staff and client awareness, promote condom use, and provide for a sustainable behavior change among its staff and the clients by extension; (c) Promote access to condoms for staff; (d) Impact studies to investigate the qualitative and quantitative consequences o f the epidemic on specified (sub-)sectors and analyze possible and appropriate responses. Inaddition to the above, eachministrywill conduct activities specifically relevantto its areas of comparative advantage. More details are available in the actual workplans. Support to Local GovernmentAuthorities (LGAs): LGAswill also receive support for the implementation o f HIV/AIDS workplans, which will be integratedinto the LGA workplan as prepared duringthe existingannual planning exercise. The only things that are proposedto be added or changed are as follows: (i) HIV/AIDS activities will be integratedinto the non-health sector components o f the LGA workplan; (ii) the HIViAIDS Technical Committee, as constituted under the TACAIDS Act, will play a coordinating function; (iii) HIV/AIDS Technical Committee will the extract the HIV/AIDS activities from all sectors into a parallel HIViAIDS workplan to facilitate review by TACAIDS; and (iv) a consolidated HIV/AIDS Fundwill be established at the District Level. The funds for all sectors will be heldinthe Consolidated FundAcct. # 2, which is envisioned to hold funds from all sources o f financing for HIV/AIDS activities at the LGA level. The FacilitatingAgency contractedunder the Community AIDS ResponseFundwill provide Technical Assistance to the personnel from the non-health sectors at LGA level to facilitate the integration o f HIV/AIDS activities into their workplans. The LGA workplans will be intendedto complement those o f the ministries and will focus on a similar, though narrower, range o f activities. Processfor non-Health MDAs: As mentioned above, MDAswill be divided into first tier and second tier ministries based on their readiness for implementation, rather than on need or importance. Firsttier ministries will receive support for the implementationof their comprehensive workplans (to support both workplace interventions and the integration o f HIViAIDS activities into their core business) inthe first year, while second tier ministries will receive support for workplace interventions inthe first year along with technical assistance to prepare them to join the first tier ministriesinYear 2 o fthe project. This categorization will also facilitate implementation, as it would overload TACAIDS to coordinate comprehensive support to all ministries inthe first year. First tier ministries will include Ministry o f Health, Ministryo f Education & Culture, Ministryo f Community Development, Gender & Children, Ministry o f Labor, Youth Development & Sports, and Ministryo f Science, Technology & Higher Education. - 50 - The existing ministerial workplans which were completed as part o fthe MTPIIIexercise will be the basis for support, with all ministries receiving technical assistance to update and strengthen them for the first year, and inthe case o f second tier ministriesto select those activities eligible for financing inYear 1. Dueto the specialized role ofthe MinistryofHealth, the procedures and guidelinesfor their workplan will be different from those that apply to the other ministries. Giventhat the workplans for the respective ministries should cover any parastatals, independent departments, etc. attached to the relevant ministry,these entities will be includedinthe consultative process o f formulating the workplans. This process will also include broad consultation throughout the relevant ministry. As stated above, individual TA has been given to each ministryto facilitate the finalization o f at least the first year workplan. Processfor Local GovernmentAuthorities (LGA): The formulationo f LGA workplans will be integratedinto the existing planning process whereby villages feed their plans upwardto the Ward level, where the plans are compiled and fedupwardto the LGA level, thus ensuringbroad-based input into the LGA workplans. At the LGA level, each sector compiles a workplan, andthese are thenassembled into a comprehensive LGA workplan which i s submittedthrough PORALGchannels for approval. Giventhat the Community AIDS Response Fundprovides support mainly at the village level, the project will thus provide a continuous loop o f support through all levels of Government and non-Government organization. The linkages at the village level, and the extent to which Civil Society activities are reflectedinthe public sector workplans, are elaborated under the Community AIDS Response Fund. As is currently the case, the sector teams at the LGA levelwill receive technical andpolicy guidance only from their respective MDAs. The MDAs will receive technical assistance to ensure that appropriate guidance i s given to LGAs on HIV/AIDS-related issues, and the non-health sector teams at the LGA level will be provided technical assistanceto facilitate the integration of HIV/AIDS activities into their respective workplans. This TA i s proposedto be provided by the FacilitatingAgency, as detailed inthe Community AIDS Response Fund. As mentioned above, the following new features are proposed to be introduced intothis planningprocess. First,the HIV/AIDS Committee, proposed under the TACAIDS Act to be established at the LGA level, shall have a coordinating (but not approval) responsibility for the LGA workplan and will extract all the HIVIAIDS activities from the LGA workplan into a summary HIV/AIDS workplan to facilitate review by TACAIDS. Support to LGAswill be rolled out nationally inthe second year o f the project given the implementation workload and the need to secure technical assistance. However, TACAIDS i s consulting with other development partners to prepare a limitednumber o f LGAs for workplan support inYear 1, thus serving as a pilot which would informand facilitate the broader introductiono f LGA support inthe second year. Role of TACAIDS Under the Public Sector Fund, the following functions havebeen assumedto be fulfilled by TACAIDS: 1. Annual Review and Approval o f Workplans, and request disbursement o f funds from Treasury 2. Coordination among workplans to avoid overlap (with particular regard to ministerialworkplans) 3. Technical Assistance to ministriesand LGAs (at least infirst year) in preparation o f workplans 4. Preparation o f IEC inventory as noted above 5. Allocation o f Resources, as noted above -51 - Project Component 3 US$15.00 million - TanzaniaAIDS CommissionInstitutionalSupport and Program Administration. The project will support the Tanzania Commission for AIDS (TACAIDS) to fulfill its national HIV/AIDS coordination mandate as provided by the TACAIDS Act. This mandate has been elaborated and well articulated inseveral documents (see Annex 8) and there is broad consensus on the responsibilities assigned to the Commission. These evolve mainly around advocacy, providingleadership for the multi-sectoral response to HIV/AIDS,coordination and monitoring & evaluation. TACAIDS is not envisionedto have implementation or funding responsibilities. The project design acknowledges TACAIDS' mandate and appropriately creates opportunities for support to TACAIDS to carry out its mandate. Support, inparticular, will be given to TACAIDS for (i) establishment o f an effective secretariat and networks at the regional and district levels; (ii) establishment o f financial management and procurement systems; (iii) resource mobilization; and (iv) monitoring & evaluation systems. TACAIDS i s located inthe Prime Minister's Office (PMO). While TACAIDS i s not an implementing agency, its role in the national programwill require the TACAIDS Secretariat to fulfill certain implementation-relatedfunction, and the project will support it to do so by financing additional staff. The TACAIDS Secretariat will undertake centralized procurement and disbursement functions including: (i) procurement planning, (ii)facilitating disbursements from the Special Account, and (iii) processing o f withdrawal applications to the IDA Grant. TACAIDS plans to out-source the implementation o f activities such as procurement to the extent possible, without dissociating itself from the responsibility for initiating the activity and the end-result. Inpractice this means that TACAIDS would be responsible for the Terms o f Reference for the contractor and for the quality assessmento f the endproduct. Inview ofTACAIDS mandate, its anticipatedmodus operandi and its comparative advantages, the following non-exhaustive list o f activities have been identifiedas being eligible for support under the project: Activities related to institutional strengthening: 1. Induction/ orientation workshops andretreats for TACAIDS/PMO/Treasury staff, Regional Administrative Secretaries, District Executive Directors andmembers of standing HIV/AIDS Committees. 2. Procurement: Office furniture, equipment and transport; Office space. 3. Training for public sector and non-government personnel. Corefunctions, directly related to TACAIDScarrying out its mandate: 1. Policy dissemination and (further)elaboration of strategies: (a) Consultative workshops; (b) Printing; and (c) Distribution. 2. Development o f Guidelines for ProgramDirection: (a) Appraisal o f programs, proposals, and projects; (b) Program advice to implementing partners. 3. Advocacy and Social Mobilization: (a) Regular meetings with the media; (b) Mass media activities; and (c) Meetings with / mobilization o f Members o f Parliament. 4. Co-ordination: (a) Organizationof Joint National HIViAIDSProgramReviews; (b) Behavior Change Communication Strategy Development; and (c) Organization o f Joint Partner HIV/AIDS Program Financing Plans. 5. Monitoring and Evaluation: (a) (Further) M&E System Development; (b) Data Analysis and InformationDissemination; and (c) Performance Monitoring o f implementing partners. Functionsfor which TACAIDS has a comparative advantage as derivedfrom their mandate: 1. Monitoring and Evaluation: Initiating surveys related to cross sectoral issues; 2. Co-ordination / Informationdissemination: Establishing a National HIV/AIDS InformationCenter; 3. Advocacy and Social Mobilization: Activities relatedto stigma reduction; 4. Resource Mobilization and allocation; 5. Facilitate Technical Assistance to sectors. Project Component4 US$S.OO million - Zanzibar HIWAIDSSupport: Zanzibar has a different Government structure for domestic issues, and has established the Zanzibar AIDS Commission ( ZAC). Therefore, while it i s considered essential that the project provide support to Zanzibar (including Pemba) as well as the mainland, the administrative reach o fTACAIDS and the mainland structures for implementingthe other components do not extend to Zanzibar. Therefore, an allocation has beenmade for support to the HIViAIDS PrograminZanzibar. It i s envisioned that this support will mirror the support provided to the mainland through the first three components o f this project, i.e.(i) Community AIDS Response Fund; (ii) Sector Fund; and (iii) Public Support to ZAC, though on a smaller scale. However, given that Zanzibar i s less advanced inthe establishment o f the necessary structures for preparation o f this component, the details o f this component will be elaborated duringthe first year o f the project's implementation with a detailed project operations manual and financial assessment/procurement assessmentof implementing entities as a disbursement condition. The preparation of Medical Waste Management Plan covering Zanzibar will be an additional disbursement condition. That said, the smaller scale of Zanzibar has made a more flexible, dynamic response possible. Thus, preparation i s currently accelerating ahead o f schedule, though still likely to commence later than support to the mainland. Giventhat the ZAC i s located inthe Chief Minister's Office, this office will parallel the functions o f the PMO inthe mainlandcomponents o f the project. - 53 - Annex 3: Estimated Project Costs TANZANIA: Multi-SectoralAIDS Project Civil Society Fund 14.00 0.00 14.00 Public Sector Fund 20.00 12.00 32.00 TACAIDS Institutional Support 13.00 2.00 15.00 Zanzibar HIViAIDS Support 3.50 1S O 5.OO Total Baseline Cost 50.50 15.50 66.00 Physical Contingencies 1.oo 1.oo 2.00 Price Contingencies 1.oo 1.oo 2.00 Total Project Costs1 52.50 17.50 70.00 Total Financing Required 52.50 17.50 70.00 Grantsto Communities 14.00 0.00 14.00 Goods 8.00 12.50 20.50 TechnicalAssistance, Services, Training,and Workshops 8.00 26.50 34.50 Works 0.50 0.00 0.50 IncrementalOperating Costs? 0.50 0.00 0.50 Total Proiect Costs1 31.OO 39.00 70.00 I Total Financing RequiredI 31.00 I 39.00 I 70.00 I Identifiable taxes and duties are 0 (US$m)and the total project cost, net o f taxes, is 82 (US$m). Therefore, the project cost sharing ratio is 0% o f total project cost net of taxes. - 54 - Annex 4: Monitoring & Evaluation TANZANIA: Multi-Sectoral AIDS Project The main objectives of the National HIV/AIDS Multi-sectoral Strategic Framework (NMSF) provide the outline for the main areas o f focus inthe different sectors. The vision o f the overall response is a country free from the threat o f HIV/AIDS and which cares for and support all those who are infected and affected by HIV/AIDS. The NMSF states that the overall responsibility for M&E at the National level rests with TACAIDS and, specifically, with the M&EDirectorate. This Directorate has now been established. An Annual Performance Report o f the National Responsewill be a major document produced by TACAIDS incollaborationwith allthe partners inthe Response. The NMSF highlightsnine strategic goals that shouldbe addressedduringthe 2003-2007 period. These goals have beendecided through wide ranging consultation and with a view to consistency with international agreements and existingsectoral priorities. The goals cover the main thematic areas o f prevention, care and support and mitigation o f socio-economic impact. 0 Goal 1- reduce the spread o f HIV inthe country; 0 Goal 2 -reduce HIV transmissionto infants; 0 Goal 3 - Political and government leaders consistently give highvisibility to HIV/AIDS intheir proceedings and public appearances; 0 Goal 4 - Political leaders, public and private programs, projects and interventions address stigma and discrimination and take human rights o f persons living with HIV/AIDS into account; 0 Goal 5 - HIV/AIDS concerns are fully integratedand prioritizedinthe National Poverty Reduction Strategy and Tanzania Assistance Strategy; 0 Goal 6 - Reduce the prevalence o f STIs inthe population; 0 Goal 7 - Increase the knowledge o f HIV transmission inthe population; 0 Goal 8 -Increase the number o f persons living with HIV/AIDS who have access to a continuum o f care and support from home/ community to hospital levels; 0 Goal 9 - Reduce the adverse effects o f HIViAIDS on orphans. Itis recognizedthat the health sector will play a keyrole inthe National Responseand a HealthSector HIV/AIDS strategy has recently been developed (2003). Three goals have beenarticulated: 0 To scale up the health sector response to HIV/AIDS and strengthenthe health system capacity to support HIV/AIDS interventions; 0 To promote access and utilization o f affordable and essential interventions and commodities for HIV/AIDS; 0 To improve the quality o f HIV/AIDS interventions to the general public, PLWHA, health care providers and other vulnerable populations. This is an ambitious agenda and one that will require a comprehensive systemfor tracking progress over the next few years. The M&Eframework developed by the M&ETask Force under the chairmanship of TACAIDS has established a set o f indicators that link directly to these main strategic objectives drawing on work already undertaken at National and Sectoral level. - 55 - TACAIDS and Co-ordinationofMonitoring and Evaluationactivities The M&Ecomponent o f the National Responseis to be coordinatedby the TACAIDS M&EDirectorate which as been recently established and staffed. Since January this team has been working on establishing its leadership and coordination role for the National Response. Work on this i s progressingwell with the early convening o f a Multi-sectoral Task Force on M&E. This Task Force includes participation from: VPO (responsible for PRSP), M o H (NASCOP), UNAIDS, TACAIDS, UNDP, World Bank, PMO, AMREF. Keydocuments from all stakeholders were used as a basis for work on M&Eissues: PRSP, UNGASS, National Multi-sectoral HIV/AIDS Strategy, Tier 1Ministry documents. A local consultant was engaged to assist in developing the first draft M&Eframework document and report back to the Task Force. By TMAP Appraisal the draft M&E document presented had been through a number o f versions and benefited from a consultation exercise with Task Force members. Assessment of the Monitoring and EvaluationComponent AppraisalTargets For TMAP Appraisal a set o f targets were set duringthe December 2002 mission: 0 that a Monitoring and Evaluation Unitbe established and functioning inTACAIDS; 0 that a core set o f indicators for measuring progress o f the National Responsebe drafted; 0 that a Monitoring and Evaluation Framework document for the National Responseby drafted; 0 that Terms o f Reference for a baseline study for the National Response be drafted; 0 that Terms o f Reference for the Joint HIV/AIDS Performance Reviewprocess be drafted (this later was not included inthe Aide Memoire list o f targets for Appraisal but agreed as important). The Appraisal team lookedindetail at progress on all these targets together with the TACAIDS team duringthe missionand it was agreed that all M&E appraisaltargets hadbeen met to an appropriate standardfor Appraisal. The main comments on each target are givenbelow: Monitoring and evaluation unit established and functional. Interms o f staffing the M&E unit has been established. An M&E Director took up post on November 12002 and appointed an M&EOfficer and Research Officer on January 15 2003. These officers are now inpost. The IT Officer was appointed in mid-April. This meansthe fullteam is established. In-service capacitybuildingis plannedand included inthe three year TACAIDS workplan. Agreement on kev indicators. A core set o f performance indicators for the National HIV/AIDSResponse has been established and i s described inthe draft TACAIDS Monitoring and Evaluation Framework document (March 2003). An M&E Task Force has been established. The draft indicator set i s a compilation of sectoral and cross-cuttingmeasures covering input,process, output and outcome indicators. Each indicator i s elaborated for characteristics, source and data quality issues. This indicator set i s intendedto form the basis o f the annual report on progress inthe National HIV/AIDS Responseto be coordinated and compiledby the TACAIDS Secretariat. This annual report will be produced intime for the Joint (Annual) HIV/AIDS Performance Review (JAPR) that i s planned for late March/ early April 2004 and then annually thereafter. The report for the JAPR 2004 will cover progress achieved during the calendar year 2003. TACAIDS recognizes the needfor flexibility inthe core indicator set as well as the constraints that currently exist incompiling an accurate andhighquality data set. For this reason the set o f indicators is kept as draft and may be altered on the basis o f experience duringthe baseline exercise and evolution o f the National Response. The framework document also emphasizes the need for disaggregated data by age, sex and socio-economic status as far as possible. This will clearly be a challenge that is reviewedduringthe pilot baseline data collection exercise. The M&E Task Force will need to review this issue once the findings are available. - 56 - Terms o f reference for a baseline exercise. A draft TOR for the baseline exercise was presented inthe M&E Framework document. Followingappraisal discussion this has beenmodifiedand a revisedTOR has been drafted and presented. This meets appraisal requirements. The TOR focuses on developing a baseline for the monitoringo f progress inimplementation o f the National HIV/AIDS Response. The baseline will focus on the core indicator set as mentioned above. An initial trial baseline exercise covering 2002 will be undertaken inthe coming months. This will provide useful experience for the formal 2003 baseline exercise to be presented as a National HIV/AIDS Progress Report intime for the March 2004 JAPR. The trial baseline will require technical assistance support to the M&EUnitdue to the considerable workloadthat this will involve. The TACAIDS team aims to have a draft available for comment by September 2003. Draft M&E Framework document. Considerable work has gone into this framework. The appraisal discussions identifiedsome areas where further work was needed and these were conductedduringthe appraisal period. A reviseddocument has beenprovidedby the TACAIDS team. The structure o f the document i s appropriate and it addressesall the main elements o f an M&E framework effectively. The framework provides an overview o f all aspects o f M&E that will be o f use to all stakeholders involved in implementation o f the NationalHIViAIDS Response as they prepare their own specific M&Eplans. The document provides linkages between different demands for informationfrom intemational commitments such as the UNGASS report down to financial and management information for local implementers and district coordination committees. An overview o f the different components o f the system, types o f information and indicators to be usedand roles and responsibilities i s outlined inthe document. The framework i s for the National Response as a whole and no separate project level M&E systems are advocated. This holds true for the TMAP and this is in line with the principles on which TMAP is based. TMAP is seen as part o f the overall Response and as such funds from TMAP are proposed for certain areas o f support such as short term technical assistance to the TACAIDS M&Eteam for specific activities. Joint (Annual) HIV/AIDS Performance Review. TORSfor this review process have been drafted as part o f the M&E Framework document. These outline an appropriate process that involves an initial Technical Review on key issues concerning implementation o f the National HIV/AIDS Responsethat would precede and feed into the Main Review involving GOTand all key stakeholders. The 2-3 day Main Review will bringtogether all the main stakeholders to discuss progress and the way forward, make recommendations and agree annual milestones for implementation. Key issuesdiscussed at Appraisal The technical appraisal of the M&Esystem and framework as put forwardby TACAIDS was undertaken and a set o f key issues explored: Issue 1: I s the M&EFrameworkfor the NationalResponse appropriately structuredand does it cover all the main areas of a multi-sectoralresponse? The M&E framework is basedon the priority strategies identifiedinthe NationalHN/AIDS Multi-sectoral Strategic Framework and the National HIViAIDS Policy. It i s also designed to ensure consistency with the various sectoral strategic plans such as the newly drafted Health Sector HIV/ALDS Strategic Plan. The M&E Framework identifies a set o f indicators that cover a numbero f key types o f information on outputs, outcomes, program management and financial management. The need for information at each level o fthe system i s advocated as i s the need for clarity on the source o f information and who i s responsible. The framework clearly focuses on the need to use existing sources o f informationwherever possible and to work to building capacity and strengthening these existing sources. Where clear gaps exist these should be filled. TMAP i s designed to support the development o f the overall M&E framework and does not specify any separate or parallel M&Erequirements. - 57 - Components o f the M&E Framework: The M&EFramework has four main components: surveillance; surveys, studies and research; Routine information systems; program management; Financial management. The framework document outlines the importance o f each o f these sources o f information and also highlightsthe strengths and weakness that exist. The framework also recognizes the need for differenttypes o finformationat different levels and within the core national indicator set this is reflected by includinginputsand process indicators as well as output, outcome and impact indicators. In discussion with the TACAIDS M&EDirector it became clear that work has been started on planning for a number o f key studies and surveys. The surveillance systems are beingreviewed and further discussions will be heldon developing second generation surveillance and the NSS. The THIS (HIV/AIDS Indicator survey) is another activities that i s being plannedthat should provide new data o f importance for definingand tracking the state o f the epidemic. Issue 2: I s there a realistic approachto trackingprogressof the NationalResponse? It is clear from the work undertaken by the TACAIDS Directorate and the M&E Task Force since December 2002 that there is a recognition o f both the importance o f M&E and the major challenges ahead. The framework i s a practical document that provides a good initial overview o f the system needed and constraints that exist. The framework outlines a draft set o f core indicators for the National Response and keeps these open for review especially pendingthe pilot baseline exercise that is due to take place later in2003. This i s a sensible approach that recognizes that currently the overview o f informationavailable is not well understood. The baseline TORSare well thought out and should provide a good process for further development of informationon progress in the National Response. The pilot exercise will allow definition o f responsibility and check consistency o f indicators proposed and feasibility o f collection. Issue3: Does the frameworkaddressthe differentroles and responsibilitiesof stakeholdersin collection, synthesis,analysisand disseminationof datahformation? The draft framework contains a section that outlines the mainroles andresponsibilities at different levels. This i s presentedtogether with a chart that indicates the proposedflow o f information from community to TACAIDS and the reverse. The document highlightsthe importance o f sharing o f informationand a good understanding o f what information is requiredat each level and for what purpose. For instance it recognizes that while considerable informationmay be collected at district level only periodic summarized informationneeds to be reported on to highlevels. Inthe same way it calls for better dissemination o f informationgenerated through special surveys, studies and research down to implementing partners rather thanjust staying inthe hands o f people at central or international level. Issue4: Does it linkinwith the GOTplanningand budgetaryframework? The framework document has beendevelopedwith an understanding of the need to be coordinatedwith the government planning and budgetingcycle. The main way that this is acknowledged inthe document i s through the outlining o f the importance o f a Joint Annual HIV/AIDS Performance Review (JAPR) process. The timingo f this i s considered and aims to allow conclusions and recommendations to be considered inthe budgetnegotiations and MTEFreview process. Issue 5: The way forward The Appraisal was also used as an opportunity to discuss some o fthe important next steps for taking forward the M&E component. The TACAIDS M&E Directorate is developing detailed workplans and some o f the key issues to be included are: 0 M&Eneeds assessmentand training exercise. Initial TOT andthentraining at LGA level; 0 Initial baseline exercise (2002 data) to pilot test core national response indicator set; - 58 - e Develop outline for annual report on HIV/AIDS National Response; e IntroduceNational Stakeholder Forummeetings; e Begin consultation on TORS for the JAPR; e Review national databaserequirementsfor storage o f information on the National Response. Review CRIS system andprepare UNGASS report; e Work with RFAs when appointed on M&Erequirementsand capacity buildingfunctions; e Participate inPoverty Monitoring Group. A summary planof work presentedby TACAIDS includesprovisionfor some of the key monitoring and evaluation tasks to be undertaken over the next year and work has been done to highlightwhich of these actions are to be funded under TMAP. - 59 - Annex 5: Financial Summary TANZANIA: Multi-SectoralAIDS Project Years Ending II IMPLEMENTATIONPERIOD Year1 I Year2 I Year3 IYear4 IYear5 IYear6 IYear 7 Total FinancingRequired ProjectCosts Investment Costs 5.5 8.0 15.1 15.3 15.0 0.0 0.0 Recurrent Costs 2.7 4.2 5.0 5.2 6.0 0.0 0.0 Total ProjectCosts 8.2 12.2 20.1 20.5 21.0 0.0 0.0 Total Financing 8.2 12.2 20.1 20.5 21.0 0.0 0.0 Financing IBRDllDA 6.5 9.9 17.5 17.8 18.3 0.0 0.0 Government 0.7 1.3 1.6 1.7 1.7 0.0 0.0 Central 0.7 1.3 1.6 1.7 1.7 0.0 0.0 Provincial 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Co-financiers 1.o 1.o 1.o 1.o 1.o 0.0 0.0 User FeeslBeneficiaries 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total ProjectFinancing 8.2 12.2 20.1 20.5 21.0 0.0 0.0 Main assumptions: - 60 - Annex 6: Procurement and DisbursementArrangements TANZANIA: Multi-Sectoral AIDS Project Procurement Tanzania's ProcurementEnvironment 1. Procurement in Tanzania i s in a reformstage. The Government enacted the Procurement Law in February 2001replacing all previous procurement legislation. The Act became effective on July, 1,200 1. Intandem, the Governmentalso issuedthe Regulations intwo parts: (a) Procurement ofGoods and Works; and (b) Selection and Employment o f Consultants. The Act includes most o f the features o f good public procurementpractice i.e. (i) effective and wide advertising o f upcoming procurement opportunities; (ii)public opening o f bids; (iii)pre-disclosure o f all relevant information including transparent and clear bid evaluation and contract award procedures; (iv) clear accountabilities for decision making; and (v) an enforceable right o f review for bidders when public entities breach the rules. 2. InmidNovember 2002, the Governmentissued a set of Standard Tender Documents. These comprise: (a) Procurement o f Goods through ICB; (b) Procurement o f Health Sector Goods; (c) Standard Request for Proposals; (d) Procurement of Works through NCB; and (e) Procurement o f Works, Smaller Contracts. These documents were reviewed by a consultant as part o f the 2003 CPAR for Tanzania and found to be inline with the Bank's Standard BiddingDocuments (SBD). 3. The Public Procurement Act (PPA) covers procurement inboth central government and local authorities, though the latter i s coveredby specific Local Government Regulations, to be issuedunder the Local Government Finance Act. The local government authority has finalizedthe draft Regulations and Procurement Manual, which are inline with the new procurement law. A remarkable change inthe new local government regulations i s the change o f composition o f the local government authority tender board o f which the councilors have been entirely removed from the procurement process. 4. The Bank carried out the CPAR in2003. The stakeholders workshop was conductedon January 27 -28, 2003 to discuss the initial recommendations proposedby the Consultant. A few recommendations include, inter alia: (a) To amendthe Public Procurement Law to establish the Procurement Authority responsible for oversight of public procurement; (b) Execution o f procurement to be decentralized to ministriesand departments; (c) Change legal framework to include private sector representatives inthe Public Procurement Appeals Authority; and (d) Replacement o f supplies officers with a new cadre o f procurement specialists inthe civil service's rating system. The final report including all recommendations agreed upon duringthe stake holders workshop has beensubmitted to the Government for implementation. 5. Based on the CPAR findings, the procedures and practices o fprocurement inZanzibar are fallacy; they lack proper legal framework. At present procurement, apart from donor funded procurement, i s conductedon an ad hoc basis leaving extensive discretion to the Accounting Officers in the Ministries. While some o f the procuring entities are applying the rules o f the now Treasury Instructions, others have simply adopted their own procedures. Procurement i s carried out in accordance with former and now void rules. The legal framework for public procurement i s inadequate due to deficiencies in the present Act and missingregulations. There i s an Act to establish a Central Tender Board (CTB), but the Act only provides for the organization, and does not deal with any o f the procedures o f procurement. While the Central Tender Board Act became effective on July 1,2002, the relevant regulations have not yet been issued. Although, established by Act, CTB is not yet functioning -61 - since the membershave not been appointed. As an interimmeasure, the Ministry o f Finance and Economic Affairs will issue instructions authorizing ministries to approve all contracts - essentially legalizing what they are currently doing. Use of Bank Guidelines 6. All works and goods financed underthe IDA grant wouldbe procuredinaccordance with the Guidelines: Procurement under IBRD Loans and IDA Credits,January 199.5and as revised in January and August 1996, September 1997and January 1999. Consultants will be selected inaccordance with the Guidelines: Selection and Employment of Consultants by WorldBank Borrowers, January 1997and as revised September 1997,January 1999and May 2002. National Competitive Bidding(NCB) procedures will be inaccordance with the Public Procurement Act 2001 which are consistent with Bank Procurement Guidelines. 7. The Bank's Standard BiddingDocuments (SBD) will be used for all ICB. The Bank, through a Consultant who was engaged for the 2003 CPAR, reviewedthe Standard Tender Documents prepared for use under the PPA and found themto be acceptable. These STD will be usedfor NCB contracts with modification ifnecessary. The Bank's Standard Request for Proposals (SRFP) would be usedfor all consulting assignments. All the implementingagencies should ensure that each time they are usingthe most current version o f the appropriate SBD or SRFP and standard forms o f evaluation. Less competitive biddingand selection procedures should not be usedas an expedient to by-pass more competitive methods and fractioning o f large procurements into smaller ones should not be done solely to allow the use o f less competitive methods or to avoid Tender Board or IDA review. The detailed procedures to be followed under the Community Aids ResponseFund(CARF) will be described inthe CARF Manual and will be consistent with paragraph 3.15 o f the Bank Procurement Guidelines on community participation inprocurement. Advertising 8. A General Procurement Notice (GPN) is mandatory and will be publishedinthe UN Development Business as providedunder the Guidelines and inDevelopment Gateway Market (Dgmarket). The GPN would be updated on a yearly basis and would show all outstanding ICB and all consulting services estimated to cost USD 200,000 or more. Specific Procurement Notices (SPN) will be required for contracts to be procured under ICB and NCB procedures and for consultant contracts to obtain expressions o f interest (EOI) prior to the preparation o f the shortlist. SPNs will as (a minimum) be published ina newspaper o fwide national circulation. Consultant contracts estimated to cost USD 200,000 or more will be advertisedin Development Business and in DgMarket. Sufficient time would be allowed(not less than six weeks for ICB and not less than 30 days for NCB and 14 days for EOI) to allow adequate time for bidders and consultants to obtain documents and respondappropriately. ProcurementCapacity 9. The Tanzania Commission for AIDS (TACAIDS) and the Zanzibar Aids Commission (ZAC) are responsible for coordinating the national response to HIVIAIDS inthe mainland and inZanzibar respectively. TACAIDS and ZAC will be responsible for implementingabout 30% o f the estimated cost o f the project. Implementation o f about 45% o f the project will be by the various MDAs (including the MinistryofHealthand Local Government Authorities). The remaining approximately 25% will be implementedbyNGOs, CBOs, Faith Based Associations (FBAs) and other civil society organizations through a grants scheme -- theCommunity Aids Response Fund(CARF). The procurement capacity assessment for the implementing agencies have been carried out. TACAIDS and ZAC have had no - 62 - previous experience inimplementing a Bank project, and the project incorporates mitigationmeasures which include hiringo f long term consultant(s) (LTC) on an "on call" basis to provide procurement support and advisory services. Most o f the MDAshave had experience inimplementingBank and other donor-financed projects and have the capacity to carry out procurement under the project. The Ministry o f Health (MOH) inthe mainland and its Medical Stores Department (MSD) have receivedthe support o f several donors and have an adequate supply chain management systemfor health sector goods. MSD operates a computerized stores management systemwhich enables batch tracking. MSD also has the capacity to handle supplies which require a cold supply cycle. The Pharmacy Board registers all drugs and drug suppliers inthe country and i s responsible for ensuring that all drugs in Tanzania are safe and effective and meet the requiredquality standards. The summary assessmentshows a "high risk" for the project and the prior review thresholds have been set to reflect this rating. Procurement Post Reviews (PPRs) will be carried out annually by Bank staff and/or independentauditors. Based on the findings o f the reviews, the prior review thresholds will be reviewed. 10. The project launch workshop will include a sessionon BanklPublic procurement. The focus will be to re-orient key staff on the principles of goodpublic procurement practice. The project also includes fundingfor key staffto attend Bank supported regionalprocurementtraining inESAMIor GIMPA. Procurement training workshops would also be held duringBank supervision missions. The course contents for these training workshops will be guidedby the findingso f the PPRs. ProcurementPlans 11. Each implementing agency has prepared an annual workplan consisting o f a procurementplan which has been consolidated by TACAIDS into an annual procurement plan for the first eighteen months o f the project showing contract packages, and for each package its estimated cost, procurement method and processing times for key activities untilcompletion. The procurementplan for CARF will only show indicative budget per year, but will not include detailed activities since C A W activities will be demand driven. Three months prior to the start of each subsequentfiscal year, TACAIDSIZAC will submit up-dated versions o f the procurement plans inrespect o f the following eighteen months for IDA review and clearance. 12. Any revisions to the procurementplan shall require the concurrence o f IDA. Implementing Agencies shall apply the most competitive method o f procurement appropriate to the circumstances o f the specific procurement as described inthe Public Procurement Act 2001 and the Table below. ImplementingAgencies may select amore competitive methodfor aparticular procurement ifthey wish to do so, however, IDA concurrence will be requiredto use a less competitive method other than the one set out in the agreed Procurement Plan. Absence of this concurrence may result inmisprocurement. Not more than two calendar months after the end o f each quarter, TACAIDS and ZAC shall submit to IDA a Procurement Monitoring Report and a Contracts Expenditure and Progress Report as part o f the Financial Monitoring Report (FMR), providingthe status o f procurement, and expenditure and progress on individual contracts. - 63 - 13. Training, workshops, conference attendance and study tours will be carried out on the basis o f approved annual programs that will identify the general framework o f training and similar activities for the year, includingthe nature o f traininglstudy tours/workshops, the number of participants, and cost estimates. ProcurementImplementationArrangements 14. The Tanzania Commission for AIDS (TACAIDS) and the Zanzibar Aids Commission (ZAC) are responsible for coordinating the national response to HIViAIDS inthe mainland and inZanzibar respectively. TACAIDS and ZAC will contract NGOs to manage and coordinate CARF initiatives. In addition TACAIDS and ZAC will engage consultants to carry out and establish systems including interalia; Monitoring and Evaluation; MIS; Policy and Planning and District Response. The C A W will be managedby Regional FacilitatingAgencies (RFAs). RFAsto be financed by IDA will be selected competitively. Itwas agreed duringappraisal that the Zanzibar Association o f NGOs (ZANGO) will provide facilitating agency services inZanzibar. Each implementing agency will be responsible for procurement planning and processing o f works and goods contracts and the selection o f consultants requiredto implementtheir activities. Scope of Procurement andProcurementmethods 15. N o ICB works contracts are expected underthe project. A limited number o f works contracts estimated to cost more than USD 50,000 but less than USD 500,000 will be procured underNCB procedures. Very small contracts estimated to cost less than USD 50,000 equivalent may be procured by way o f soliciting quotations through written invitations from not less than three qualified contractors. RegistratiodClassification o f contractors may be usedto identifycontractors for such very small contracts. The invitation shall include a detailed description o f the works, basic specifications, the required completion date, a simple form o f agreement acceptable to the Bank, and relevant drawings [where applicable]. Inall cases the award o f contract shall be made to the contractor who offers the lowest price for the required work, and who has the experience and resources to successfully complete the contract. 16. To the extent possible, goods that could be procuredby an implementingagency under one supplier would be groupedinto contract packages, and packages estimated to cost the equivalent ofUSD 250,000 or more would be procured under ICB procedures. Procurement o f goods packages estimated to cost more than USD 30,000 but less than USD 250,000 would be procuredusingNCB procedures. Goods packages estimated to cost less than USD 30,000 would be procuredby shopping on the basis o f comparison o f quotations from at least three eligible and qualified suppliers or from UnitedNations Agencies. Requests for such quotations will include a clear description and quantity o f the goods; as well as requirementsfor delivery time and point o f delivery. ARVs and other drugs for HIV/AIDS may be procuredusingLIB procedures by invitingbids from the WHO list ofprequalified manufacturers. 17. Software and ARV reagents or drugs which are o f proprietary nature may, with IDA concurrence, be procured under contracts negotiated directly with the manufactures/suppliers or their authorized agents. 18. Consulting Services and Training will consist o f various studies and technical assistance to be carried out by both national and international consultants as well as workshops and group discussions. As a rule, consulting firms for all assignments estimated to cost the equivalent o fUSD 100,000 or more will be selected though Quality and Cost Based Selection (QCBS) methodology. Assignments estimated to cost the equivalent o f USD 200,000 or more would be advertised for EO1inDevelopment Business - 64 - (UNDB), inDgMarket andinat least one newspaper ofwide nationalcirculation. Inaddition, EO1for specialized assignments may be advertised inan international newspaper or magazine. Inthe case o f assignments estimated to cost less than USD 100,000 the assignment will be advertised nationally. The shortlist o f firms for assignments estimated to cost less than USD 100,000 may be made up entirelyo f national consultants ifat least three qualified firms are available at competitive costs in Tanzania. However, foreign consultants who wish to participate should not be excluded from consideration. Consultant services estimated to cost less than the equivalent o f USD 100,000 may be contracted by comparing the qualifications o f consultants. Auditors would be selected usingLeast-Cost-Selection procedures. Incase o f assignments requiringindividual consultants, the selection will follow the procedures stipulated in Section V o f the Consultants Guidelines. 19. Training programs and workshops for TACAIDS and ZAC would be packaged inthe project's workplans and budget and items therein procured using appropriate methods. IDA will review and clear training packages as appropriate. 20. The detailed procurementprocedures to be followed underthe Community Aids ResponseFund (CARF) will be described inthe CARF Manual and will be consistent with paragraph 3.15 of the Procurement Guidelines on Community Participation inProcurement. IDA Review 21. All goods contracts estimated to cost USD 250,000 or more, as well as the first goods contract estimated to cost more than USD 30,000 but less than USD 250,000, and works contracts estimated to cost USD 50,000 or more will be subject to the Bank's prior review in accordance with the procedures in Appendix Io f the Procurement Guidelines. Any amendments to existing contracts raising their values to levels equivalent or above the prior review thresholds are subject to IDA review. All contracts awarded on basis o f direct contracting will require prior review and clearance o f IDA. - 65 - 22. All single source selectionwill be subjectto IDAprior review. Consultancycontractswith firms with estimatedvalue ofUSD 100,000 or more, and consultancy contractswith individuals estimated value of USD 50,000 or more will be subject to prior review by the IDA inaccordancewith the proceduresinAppendix Iof the ConsultantsGuidelines. All out of country traininglworkshops will be subject to IDA review. 23. Contractswhich are not subject to prior review will be selectively reviewed by the Bank during project implementation and will be governedby the proceduresset forth inparagraph4 of Appendix Ito the relevant Guidelines. Monitoring and evaluationofprocurementperformance at all levels (national, regional, and community) would be carried out for procurement under the prior review thresholds during IDA supervision missionsand through annual ex-post procurement audits. At a minimum, 1out of 5 contracts managedby the TACAIDSIZAC andthose managedby MDAs will be subject to post review. Inaddition, 1out of 10ofthe grants awardedunder the CARF will be subjectto postreview. Post-reviewsof in-country training will be conductedfrom time to time to review the selectionof institutionslfacilitatorslcourse contentsltraineesandjustifications thereof, and costs incurred. Annual independenttechnical audits (ex-post procurement audits) would: (a) verify that the procurement and contracting proceduresandprocesses followed for the projects were inaccordance with the IDA Grant Agreement (DGA); (b) verify technical compliance, physical completion and price competitivenessof each contract inthe selected representativesample; (c) review and comment on contract administration andmanagement issues as dealt with by participating agencies; (d) review capacity of participating agencies inhandling procurement efficiently; and (e) identify improvements inthe procurementprocess inthe light ofany identifieddeficiencies. The Borrower andIDAwill review all thresholds statedinthis sectionon an annual basis. Amendmentsmay be agreeduponbased onperformanceand actualvalues of procurementimplemented. Amendmentsto the IDA Grant Agreement may be proposedaccordingly. Contract Management and Expenditure Reports 24. As part of the FMR, each implementing agency will submit quarterly reports to TACAIDS and ZAC who will consolidatethe reports and will submit FMRs includingcontract management and expenditureinformationinquarterly reportsto IDA. Procurementmethods(TableA) Table A. Project Costs by Procurement Arrangements (US$ million equivalent) II 0.77 0.11 (0.00) O'O0 II (0.70') II (0.10') I (0.00') I (0.80) I 12. Goods 7.70 4.40 8.32 I 0.00 I 20.42 I (7.00) (4.00) (7.50) (0.00) (18SO) 3. Services 0.00 0.00 39.00 3.70 42.70 (0.00) (0.00) (3 2.40) (0.00) (32.40) 4. Grants to Communities 0.00 0.00 17.00 0.00 17.00 (0.00) (0.00) (15.00) (0.00) (15.00) 5. Incremental Operating 0.00 0.00 1.00 0.00 1.oo costs - 66 - (0.00) (0.00) (0.50) (0.00) (0.50) 6. Unallocated 0.00 0.00 0.00 0.00 0.00 (0.00) (0.00) (2.80) (0.00) (2.80) Total 7.70 5.17 65.43 3.70 82.00 (7.00) (4.70) (58.30) (0.00) (70.00) - 67 - Prior review thresholds (Table B) Table B: Thresholds for ProcurementMethods and Prior Review ' >=50,000 - 500,000 NCB All contracts < 50,000 Price Comparison None All values Direct contracting All contracts 2. Goods >=250,000 ICB/LIB**/UN All contracts incl. HealthSector Goods and Services other than >=30,000 <250,000 NCB/LIB/UN First Contractby IA Consulting Services - <30,000 Shopping/UN None All values Direct Contracting All contracts 3. Services (Consulting) >= 100,000 firms QCBS All contracts Below 100,000, firms QCBS/LCS/SFB/SBCQ None >=50,000 individuals Individual All contracts < 50,000, individuals Individual None All values Single Source Selection All contracts 4. Community Grants All Values Community Participation Grants exceedingUSD (CARF) (inaccordancewith CAW 100,000 ProcurementManual) rota1value of contracts subject to prior review: Overall Procurement Risk Assessment High Frequencyof procurementsupervisionmissionsproposed: One every 6 months (includes special procurement supervision for post-reviewiaudits) *All singlesource contractswill be subject to prior review **LIBwill beusedonly ifthere is alimitednumber of suppliers 'Thresholds generally differ by country and project. Consult OD 11.04"Review of Procurement Documentation"and contact the RegionalProcurementAdviser for guidance. - 68 - Disbursement Allocation of grant proceeds(Table C) 25. Disbursementandwithdrawal proceduresare detailed inthe WorldBank Disbursement Handbook (1992 edition). All disbursementsare subject to the conditions of the IDA Grant Agreement and the proceduresdefinedinthe DisbursementLetter. All applications to withdraw proceedsfrom the IDA Grant account will be fully documentedexcept for expenditures againstcontracts: (i) an with estimatedvalue of US$50,000 each or less for works; (ii) with an estimatedvalue of US$ 250,000 or less for goods; (iii) an estimatedvalue of US$ 100,000 for consulting firms; (iv) with an estimatedvalue with of US$ 50,000 or less for individual consultants; and (v) for all training workshops and study tours, which may be claimed on the basis of certified SOEs. Documentation supporting expenditures claimed against SOEs will be retained at TACAIDS and will be available for review as requestedby IDA supervision missions andproject auditors. 26. The allocation of IDA Grant proceeds are shown inTable C; the proceeds of the IDA grant would be made against 93% of consultant services and training, 90% of all expenditures on all local expenditures for goods and 100%of expenditures on all foreign expenditures for goods, 90% of all expenditureson all local expenditures for works and 100%of expenditures on all foreign expenditures for works, 100%of amounts disbursedfor IDA-financedcomponentsof community initiatives underthe CARF component, and 50% of all expenditures on incremental operating costs. As projectedby the Bank's standarddisbursementsprofile, disbursement would be completedby four months after project closure. Disbursementwouldbe made against standardIDA documentation. Table C: Allocation of Grant Proceeds Expenditure Category ] Amount in US$million 1 Financing Percentage Goods (Parts B & C of Project) 16.10 100%of Foreign 90% of Local Goods (Part D of the Project) 2.40 100%of Foreign 90% of Local Works (Parts B & C of Project) 0.10 100%of Foreign 90% of Local Works (Part Dof the Project) 0.70 100%of Foreign 90% of Local Consultants'services andtraining 30.90 93% (Parts B & C) Consultants'services and training (Part 1.50 93% D') Grantsto Community Initiativesunder 15.00 100%of Amounts Community AIDS ResponseFund Disbursed (CARF) (Part A) Incremental Operating Costs 0.50 50% Unallocated 2.80 JTotalProject Costs 70.00 ITotal II 70.00 II II Special Account: - 69 - 27. To ensure timely and reliable flow o f funds, two dollar Special Accounts will be opened in a commercial bank acceptable to IDA. Special Account A will be for Tanzania Mainlandand Special Account B will be for Zanzibar. IDA funds will be deposited into these two special dollar accounts. The accounts will bereplenishedon the basis of SOEs or specific withdrawal applications to be submittedto IDA on a monthlybasis. Additional details of the operation of theproject accounts is covered under page 75. FinancialManagement A. EXECUTIVE SUMMARY AND CONCLUSION 28. The main coordinating agency, TACAIDS, is a department inthe Prime Minister's Office and is mandatedwith leading the development o f a "national" strategy for addressing the issue o f HIVIAIDS, as well as coordinating its implementation. The grant from the Bank i s expected to go someway towards relieving the obvious pressure on resources for fightingthis most important war. The project i s expected to have four components as follows : 0 The Public Sector Fund, for supporting efforts by MDAsto address HIV I Aids issues within central and local government. 0 The Community Aids ResponseFund(CARF) for direct interventions inthe communities themselves as well as civic organizations and the private sector. 0 The Zanzibar Component for interventions on the islands. 0 Institutional Support o f the Tanzania AIDS Commission. 29. The Bank's support, much like assistancefrom other donors, will come largely as earmarked funds targeting specified activities. This meansthat the funds will be included inthe country's annual budgets (as development aid), and spent through the exchequer, as development expenditure, and such expenditure will follow normal government procedures and controls. TACAIDS will therefore not be a stand-alone `project management unit', but rather a fully integrated arm o f government playing a key role inthe fight against HIV. 30. The GOT accounting system to be usedby the project is now largely computerized on an Integrated Financial Management Information System (IFMIS) called Platinumor EPICOR. This i s a modem, fully integrated systemwith a well-defined chart o f accounts. The systemi s expected to meet all the requirements o f TACAIDS accounting. At the moment however, not enough effort has beenmade by the relevant GOT InformationTechnology (IT) department to installthe system at TACAIDS. The early installation would assist user staff to start learning and mastering the various modules before the volume o f transactions picks up. The failure to install i s despite the best efforts o f the TACAIDS Finance Director to have this done promptly. Meantime, TACAIDS has had to resort to usinga Microsoft Access database as a means o f keeping a recordo f the commission's expenditures for the time being. 3 1. The TACAIDS Finance Director i s new to government service, but has extensive experience working for `non governmental organizations' (NGOs).She will obviously needto invest some time to learn GOT financial procedures, as well as Bank reporting requirements. The accounting department at large is not yet fully staffed, as the Director i s assisted by only two accountants at the moment. Vacancies still to be filled include the post o f Chief Accountant, and two more Accountants (one for justifications, andthe other for transaction validations). The recruitment process will be completed by July, 2003. - 70 - 32. The necessary computer hardware has already beenacquired, save for the server, whose size and specifications the GOT I T department is still to confirm. 33. The project will be requiredto produce Financial Monitoring Reports (FMRs). Indications are that the GOT IFMISwill support the production o f FMRs. An initial attempt at designing these has been made. Agreement on the reports was reached at negotiations. 34. The Controller andAuditor General (CAG) o fthe United Republic o f Tanzania i s the statutory auditor o f TACAIDS. It is however permissible at law for the CAG to sub-contract this role to a private firmof auditors where, inthe opinionofthe CAG, such sub-contracting would expedite theprocess. No decision on sub-contracting out the TACAIDS work has as yet been communicated. The Auditor General o f Zanzibar is the statutory auditor for the purposes o f the Zanzibar component. Summary RiskAssessment: Topic Risk lomments/recommendations Assessment' Inherent Risk I Country Low financial management capacity ingeneral. Implementing Entity II MM Although core staff already inplace, not experienced inrunning similar oroiects. Implementing Entity Internal control framework and org structure not yet fully established. FundsFlow Use o f government reporting structures to trigger replenishment still to be tested. Staffing M Some key positions not yet filled. Accounting Policies and Procedures N Financial management manual, beingfinalized. Internal Audit I N/A Exists but not assessed. External Audit NIA Not yet audited. Financial Reporting and Monitoring M Necessary report formats agreed at negotiations. InformationSystems I" Although the nominated systemis adequate, it has not yet been installed. nor staff trained. Overall Control Risk lM OverallRiskAssessment: Moderate. Success will dependon good working relations with the various govt -71 - departments, and flexibility in staffing to promptly fill current vacancies, as well as possible incremental manpower requirements. 1Key: S = Substantial; M=Moderate; N=Negligible or low; N/A =Not Applicable The accounting system is being installed, and the remaining stafffor the accounting department will be in place by July, and once these actions are complete thefinancial management arrangements above will meet the Bank's minimum requirements for effective financial control at theproposed project. B. ASSESSMENT Project Description Summary Component 1 Community AIDS ResponseFund Component 2 Public Sector Fund Component 3 I Component 4 III Zanzibar HIV Tanzania AIDS Commission Institutional Support / AIDS Support The project's development objectives are: To reduce the spread o f HIVIAIDS in the general population o f Tanzania; Mitigate the socio-economic impact o f HIV/AIDS at individual, household, and community levels; Strengthen the capacity o f communities, civil society, and government to respondto the epidemic. Details are laid out inthe body of the Project Appraisal Document (PAD). Country FinancialIssues 35. The Tanzania Country Financial Accountability Assessment (CFAA) was carried out and completed in the year 2001. The assessmentconcluded that while Tanzania had a "sound systemo f formal rules for financial management and many o f these rules hadbeenrecently updated and strengthened, issues o f noncompliance, limited execution, inadequate monitoring, insufficient capacity, and lack o f enforcement needed to be resolved". The country's financial accountability framework, and therefore financial management, would be considerably more effective and the associated fiduciary risks mitigated, ifthese areas were strengthened. It i s generally accepted that even greater effort has been made to improve financial management and related activities inTanzania since the time of the CFAA report (now two years old). The FinancialManagement System 36. The Tanzania Finance Regulations, Supplement 25 of 2001, in Section 53 of Part IX states that `government accounts shall be kept on a cash basis inorder that the amount o f cash spent on a particular service be compared with the amount authorized be the National Assembly;' and that - 72 - `Any act o frecordingof a liability before it is paid shall be inconflict with the principles of prior approval o f expenditure by the National Assembly;' `No accounting officer shall make any entry inthe accounts o f the government which anticipates the receipt o f revenue or payment o f expenditure;' 0 `Where it is discovered that an accounting officer has taken action which anticipates the approval of expenditure by the National Assembly, such payment shall be treated as `unauthorized expenditure'. TMAP, beingan activity under the direction and control o f the PMO, is a government activity and shall therefore be accounted for on a cash basis. Normal Government o f Tanzania systems and forms shall be used at all times, as shall normal government controls and approvals regimes. Staffing 37. The following are members o f staff inthe accounting department at TACAIDS: The Director Of Finance is responsible for the overall management o f the department. She reports to the Executive Chairman. She i s currently supported by an Accountant who i s responsible for preparing the unit's accounting information, and another Accountanticashierwho deals with program cash issues I i s the paymaster. 38. The accountingdepartment organogram indicates that there should be at least a Chief Accountant levelperson, as well as another Accountant (Reconciliation and Examination).It is also possible that after the volume o f work is fully established, the needfor `regional' JustificationOfficers may needto be considered. 39. For ZAC, the secretariat i s the Zanzibar NACP, whose accounting department i s headedby an experienced Finance Officer.Details o f the time-sharing arrangement between ZAC andNACP for the critical accounting staff are still to be established. BudgetingandAnnualPlan 40. The program implementationplan and disbursement schedule have been drawn up and are included inthe Project Appraisal Document (PAD) and the Project ImplementationPlan (PIP). It i s from this disbursement schedule (as maybe subsequently revised) that annual budgetswill be drawn. The annual budget will be prepared based on the policy guidelinesissuedby the Ministryo f Finance (MOF) o f the GOT each year. The annual estimates will reflect financial requirementso f the project, and the Executive Chairman (TACAIDS) and the Executive Director (ZAC) will have overall responsibility for coordinating the budgetingeffort. Budget timingwill be in accordance with the requirements o f the Government o f Tanzania, as the project budget i s part and parcel o f the overall national budget inthe specific ministriesmentioned earlier. Accounting System and Procedures Financial Management Manual 41. The accounting systems, policies and procedures employed by TACAIDS (mainland), and ZAC (Zanzibar) inaccounting for and managing project funds are documented in the Financial Management Manual for the project. The Financial Management Manual will be usedby: 0 IDA and other donors to assess the acceptability of the project accounting, reporting and control systems; - 73 - staff as a reference manual; and 0 by the auditors to assess project accounting systems and controls and indesigning specific project audit procedures. 42. Specific procedures are documented for each significant accounting function. They are written to depict document and transaction flows, the appropriate filing o f project documents, management approvals and organizational duties and responsibilities. The accounting systemconsists o f the methods and records established to identify, assemble, analyze, classify, record and report the transactions ofthe project, and to maintain accountability for the related assets and liabilities. Accounting System 43. To maintain the efficiency, accuracy and timeliness o f financial reporting and to facilitate management analysis of the financial information, bothTACAIDS and ZAC need urgentlyinstall the government accounting system, Platinum, and ensure staff are fully trained in its operation. The Financial Management Manual makes necessaryreferences to the GOT accounting system. The accounting records will be kept up-to-date, and the financial statements summarizing these will be presented for audit in line with GOT year-end and audit requirements. A bank reconciliation report will be prepared for the individual bank accounts. Inaddition to the quarterly accounts andreports prepared on the cash basis, arecordof commitments should also be kept. Reporting 44. Formats o f the various periodic financial reports to be generated from the financial management system have been developed. There are clear linkages between the information in these reports and the Chart o f Accounts. The financial reports were designedto provide quality and timely informationto project management, implementing agencies, and various stakeholders on project performance. These reports include financial statements (e.g. sources and application o f funds; expenditure classified by project components, disbursement categories, expenditure types and implementing agencies, and comparison with budgets; short-term forecasts o f expenditure; unit costs for key items and comparison with budgets; etc.). The reports closely follow sample formats that are indicated inthe Guidelinesfor Borrowers on Financial Monitoring Reports. The reports will be produced quarterly to support requests for replenishment o f the Special Accounts from the Bank. 45. Annual FinancialStatements for the project will include: a Statement of Sources and Uses of Funds showing funds from IDA, andGOTseparately, an ExpenditureSummary analyzed under the mainheadings and by maincategory o fexpenditures (consistent with the Chart o f Accounts), both for the current fiscal year and accumulated to date; Notes inrespect o f significant accounting policies and accounting standards adopted by management when preparing the accounts and any supplementary information or explanations that may be deemed appropriate by management inorder to enhance the presentationo f a "true and fair view"; SpecialAccount Statement showing deposits and replenishments received, payments substantiated by withdrawal applications, interest that may be earned on the account and the balance at the end of the fiscal year; a Reconciliationbetween the amounts shown as "Received by the Project from IDA and that shown as having been "Disbursed" by them; an Implementation Report, which would be a narrative summary o f the implementation progress for the project; and a Summary of Credit Withdrawalsusing SOEs or FMRs, listing individual withdrawal - 74 - applications by reference number, date and amount. Indicative formats o f these statements were developed inaccordance with IDA requirements by Negotiation. AuditingArrangements Internal Audit 46. The project has an Internal Auditor who reports to the Executive Chairman o f TACAIDS. The auditor i s said to be professionally qualified inthe field o f internal audit, but his qualifications and experience are still to be reviewed, likewise the auditor's job description. External Audit 47. The Auditor General is primarily responsible for the auditing o f all government projects. The audit may be subcontracted to a firm o f private auditors, with the final report being issuedby the Auditor General based on the tests carried out by the subcontracted firm. The external auditor will conduct a year-end audit and review both financial and non-financial performance aspects in some randomly selected sub-projects based on terms o f reference acceptable to the Bank. FinancialFlows BankAccounts 48. The following bank accounts will be opened andmaintainedfor the purposes of carrying out project activities: Special Account A WS$5 million): Operated by TACAIDS, the opening o f this account will be facilitated by the Ministry o f Finance through the Accountant General's Office. The account will be denominated inUS dollars, and can be opened at the Bank of Tanzania (BOT) or a commercial bank acceptable to the Bank. The account will receive disbursements from the IDA grant. Transfers to the mainland's Project Account (below) will originate from this account. Special Account B (US$ 500.000): Operated by ZAC to cater for the Zanzibar component, the account will also be denominatedinUSD, and opened courtesy o f the Ministryo f Finance o f the Revolutionary Republic o f Zanzibar. The account will likewise receive the USD transfers from the Grant Account, and facilitate the T Shillings transfers to the Project Account o f the Zanzibar component. Project Account A: Opened and operated by TACAIDS, this account will be denominated inlocal currency. Counterpart funds and transfers from the Special Account will be deposited into this account inaccordance with project objectives. Inorder to ensure the timely provisiono f counterpart funds, the Government will make the necessary arrangements to deposit into this account an initial amount sufficient for the first two quarters by effectiveness. It i s from this account that transfers will be made to Treasury's Consolidated Fund. Likewise the costs o f institutional support for TACAIDS, as well as transfers to RFA s for the community fund, will be funded from this account. Proiect Account B: Operatedby ZAC, this account will be denominated in local currency. It will receive transfers from the Special Account, as well as the counterpart contributions. Costs o f institutional support for ZAC itself, as well as payments to community sub-projects, will be funded from this account. - 75 - A valid Implementation Agreement betweenTACAIDS I ZAC and each RFA after the normal procurement processeshave been followed. A diagrammatic representation o f the expected financial flows follows: Mainland Funds Flow Mechanism Min o f Finance (Mainland) Office TACAIDS - Line Ministries (excludingPORALG) c 1 Communities - 76 - Zanzibar -Funds Flow Mechanism MinofFinance (Zanzibar) The WB - Grant e Activities Communities ~ CounterpartFunds 49. The GOT will provide counterpart funds ina percentage to be determined. It is recommended that counterpart funding be includedat the budgeting stage o f the process so that the Ministry o f Finance i s aware o f its commitments early and can provide for them as necessary. Disbursements Mainland 1. The Ministryo f Finance, through the Acc. Gen.' s office, approves and opens the USD denominated Special Account on behalf o f TACAIDS. 2. The management and signatories o f the Account are at TACAIDS. The Account receives transfers inby the World Bank from the Grant Account. 3. TACAIDS opens and operates a local currency Project Account for transfers from the Special Account. 4. Usingthe bottomup process, ministries/ local authorities/ communities ingeneral prepare work plans which are reviewed for alignment to the 'national strategy' and available resource by TACAIDS. 5. Approved plans are costed and incorporated into the individual ministries' budget allocations. 6. Based on three months' estimated expenditures, TACAIDS transfers funds from the Special Account to the Project Account for onward transmissionto Treasury. Transfer advice to treasury - 77 - indicates the breakdown o f the beneficiary ministries (MDAs, Ministry o f Local Govt for funds goingto local authorities, and Prime Minister's Office for TACAIDS' own institutional support and funds to be disbursedunderthe Community AIDS Response Fund(CARF). 7. Quarterly, a comprehensive report (to be designedand agreed and FMRbased) to be submitted by beneficiary ministries indicating consumption for the quarter. Supporting documentation submitted with the consumption report to support individual payments above a certain threshold, with the outlays below that thresholdbeingaccounted for on an SOE basis by the ministries (meaning that the ministries retain those vouchers but they should be available for review by TACAIDS audit and monitoringteams when requiredto be produced). 8. All this expenditure going through normal government channels for approval, expenditure and accounting. Reports to TACAIDS purely for justifying expenditures inorder to obtain replenishment o f the treasury advance for ongoing activities. 9. TACAIDS replenishes the funds advanced to the ministries through Treasury based on satisfactoryjustifications per (7) above. The replenishment transfer i s supported by a memo indicatingdetails o f beneficiary ministries based on theirjustifications and needs. 10. Satisfactory Ijustifications' are usedinturn by TACAIDS to support its own withdrawal applications to the World Bank. 11. Maybe to use traditional basis for disbursements untilthe Got IFMIS i s fully established at TACAIDS. FMRs however still compulsory but not usedfor disbursement untilfully tested and approved. 12. For the Community Fund, plans from communities are sent to districts / local government authorities for approval then direct to TACAIDS for processing o f disbursements. Payments by TACAIDS to the communities are made through ' regional facilitating agencies' ineach region (RFAs). RFAsmay assist community planpreparationbut approval is through the districts. Zanzibar As above. Maindifference will be the absence o fboth a specific role for local government. FinancialManagementAction Plan Issue RemedialAction Recommended DueDate Updatingthe The FMMwill be updated to reflect the GOT cash Done Financial accounting system, removing all reference to accrual Management accounting Manual Staffing Additional qualified and competent key staff for July 1,2003 overall coordination, financial management and procurement should be appointed at both TACAIDS and ZAC Reporting Formats o f Financial Monitoring Reports (FMRs) Done Arrangements should be determined and agreed with IDA Chart o f Accounts The Chart o fAccounts should be updatedfor peculiar September 30,2003 transactions to be undertaken under the project. TORSfor the TOR s for the audit o f the project's financial Done external auditors statements should be prepared and cleared by the Bank. - 78 - Effectiveness There are no FM conditions for effectiveness. Supervision Plan 50. A supervisionmission will be conductedat least every six months. The mission's objectives will include that o f ensuringthat strong financial management systems are maintained for the project throughout its life. A review will be carried out regularly to ensure that expenditures incurredby the project remain eligible for IDA funding. The PSR will include a financial management rating for the component. This will be arrived at by the Country Office Financial Management Specialist after an appropriate review. - 79 - Annex 7: Project Processing Schedule TANZANIA: Multi-Sectoral AIDS Project ~~ ~ First Bank mission (identification) 03/19/2001 03119/2001 Appraisal mission departure 03131/0200 0313112003 IINegotiations 04/28/2003 04/28/2003 Planned Date of Effectiveness II 10/01/2003 II II Prepared by: Tanzania Council on HIVIAIDS (TACAIDS), under the Prime Minister's Office, supported by Project PreparationTeam (consultants) and all Ministries, particularly Ministryo f Education, Ministryo f Health, and Ministryo f Community Development, Women's Affairs & Children Preparation assistance: Japanese PHRD Grant (TF07 1014); DFID(technical assistance); CIDA (technical assistance); UNAIDS (technical assistance); USAID (technical assistance); GTZ (technical assistance); The Netherlands (technical assistance) Name Speciality Albertus Voetberg Lead Health SpecialisUTeam Leader Emmanuel Malangalila Sr. Health Specialist Demissie Habte Consultant Philip Gowers Lead Health Specialist Andrew Follmer Operations Officer Rest Lasway Education Specialist Norbert Mugwagwa Lead Operations Officer Mercy Sabai Financial Management Specialist Pascal Tegwa Sr. Procurement Specialist Muthoni Kaniaru Legal Counsel Steve Gaginis Finance Officer David Peters Peer Reviewer Jonathan Brown Peer Reviewer Salim Habayeb Peer Reviewer Mungai Lenneiye Peer Reviewer Victoria Fofanah Program Assistant EvaNgegba Teh Team Assistant EvelyneKapya Team Assistant - 80 - Annex 8: Documents in the Project File* TANZANIA: Multi-Sectoral AIDS Project A. Project Implementation Plan Draft expected April, 2003: final documentation is condition o f Effectiveness B. Bank Staff Assessments Economic Assessment o f M A P Projects -- August, 2000 Integrated Safeguards Data Sheet -- November, 2001 Procurement Capacity Assessment -- March, 2003 FinancialManagement Assessment -- March, 2003 C. Other Tanzania National Multi-SectoralStrategic Framework for HIV/AIDS -- February, 2003 (Draft) Health Sector HIV/AIDS Strategy for Tanzania -- February 2003 World Bank IdentificationMission Aide-Memoire World Bank Project Concept Document -- September, -- (March, 2001) 2001 World Bank PreparationMissionAide-Memoire -- October,2001 World Bank Pre-Appraisal Mission Aide-Memoire -- June, 2002 World Bank-TACAIDS Orientation Mission Aide Memoire -- December, 2002 World Bank Appraisal MissionAide Memoire -- March, 2003 MinistryofHealthWaste Management Plan -- (draft) February, 2003 Inception Reports and Consultant Reports for Project PreparationConsultancies Project Procurement Manual (pending) Reports o f Donors Aid Coordination (DAC) Working Group on HIV/AIDS Meetings Tier One Ministries FirstYear Workplans TACAIDS Monitoring & Evaluation Framework -- March, 2003 Technical Note on Use o f Anti-Retroviral DrugsinTanzania -- March, 2003 *Including electronic files -81 - Annex 9: Statement of Loans and Credits TANZANIA: Multi-Sectoral AIDS Project 16-Apr-2003 Difference between expected and actual Original Amount in US$ Millions disbursements' Project ID FY Purpose IBRD IDA Cancel. Undisb. Orig Frm Rev'd PO58706 2002 ForestConservationand Management 0.00 31.10 0.00 32.21 2.43 0.00 PO02797 2002 TZ SONGOSONGOGAS DEV 8 POWERGEN 0.00 183.00 0.00 175.24 106.03 0.00 PO71012 2002 PrimaryEducationDevelopmentProgram 0.00 150.00 0.00 105.23 37.50 0.00 PO73397 2002 Lower Kihansi EnvironmentalManagement 0.00 6.30 0.00 6.02 1.55 0.00 P047762 2002 RURAL WATER SUPPLY 0.00 26.00 0.00 27.32 2.56 0.00 PO65372 2001 SOCIALACTION FUNDPROJECT 0.00 60.00 0.00 29.46 -2.76 0.00 PO69982 2001 RegionalTrade Fac Pro) -Tanzania 0.00 15.00 0.00 11.39 2.81 0.00 PO50441 2000 RURAL&MICROFIN SVC 0.00 2.00 0.00 1.09 1.06 1.06 PO57187 2000 FIDPII 0.00 27.50 0.00 15.94 15.15 6.05 P058627 2000 Health Sector DevelopmentProgram 0.00 22.00 0.00 4.56 -7.01 0.00 P060833 2000 PUBLICSERV REF PROG 0.00 41.20 0.00 31.61 -9.33 0.00 P002822 2000 TANZANIA PSAC I 0.00 190.00 0.00 81.21 -108.84 0.00 PO49838 2000 PRIVATIZATION 0.00 45.90 0.00 32.25 22.16 0.00 PO47761 1999 TAX ADMINISTRATION 0.00 40.00 0.00 26.31 22.30 0.00 P002804 1998 AGRIC RESEARCH 0.00 21.80 0.00 5.34 4.77 0.00 PO02789 1998 HUMANRESOURCEDEV 1 0.00 20.90 0.00 1.89 0.29 0.00 PO02753 1997 NAT EXT PROJ PH II 0.00 31.10 0.00 2.36 4.60 -1.68 P046837 1997 LAKEVICTORIAENV 0.00 10.10 0.00 3.52 -1.13 0.00 P038570 1997 TZ RIVER BASINMGMSMAL 0.00 26.30 0.00 4.57 6.57 0.00 PO02758 1996 URBANSECTOR REHAB 0.00 105.00 0.00 18.03 21.79 0.00 PO02770 1994 ROADS11 0.00 170.20 63.53 36.38 107.13 35.77 Total: 0.00 1225.40 63.53 651.92 229.63 41.20 - 82 - TANZANIA STATEMENTOF IFC's HeldandDisbursedPortfolio Jun30 2002 - InMillionsUS Dollars Committed Disbursed IFC IFC F Y Approval Company Loan Equity Quasi Partic Loan Equity Quasi Partic 1998 AEF Blue Bay 1.45 0.00 0.00 0.00 1.45 0.00 0.00 0.00 2001 AEF Boundary Hi1 0.20 0.00 0.00 0.00 0.20 0.00 0.00 0.00 1996 AEF Contiflora 0.35 0.00 0.00 0.00 0.35 0.00 0.00 0.00 1998 AEF Drop Zanziba 0.32 0.00 0.00 0.00 0.32 0.00 0.00 0.00 1997 AEF Hort. Farms 0.19 0.00 0.00 0.00 0.19 0.00 0.00 0.00 1998 .... AEF Maji Masafi 0.27 0.00 0.00 0.00 0.27 0.00 0.00 0.00 1996 AEF Milcafe 0.18 0.00 0.00 0.00 0.18 0.00 0.00 0.00 1994 AEF MoshiLthr 0.00 0.19 0.00 0.00 0.00 0.19 0.00 0.00 1999 AEF MusomaFish 1.50 0.00 0.00 0.00 1.50 0.00 0.00 0.00 1997199 AEF Pallsons 0.32 0.00 0.00 0.00 0.32 0.00 0.00 0.00 1995 AEF Tanbreed 0.70 0.00 0.00 0.00 0.70 0.00 0.00 0.00 2000 AEF Zan Safari 0.70 0.00 0.00 0.00 0.70 0.00 0.00 0.00 2002 EximBank 2.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1996 IHP 0.82 0.60 0.00 0.00 0.82 0.60 0.00 0.00 2000 IOH 2.50 0.00 0.00 0.00 2.50 0.00 0.00 0.00 2000 NBC 0.00 10.00 0.00 0.00 0.00 3.44 0.00 0.00 1993 TPS (Tanzania) 5.69 0.87 1.04 0.00 5.69 0.87 1.04 0.00 1991197 TPS Zanzibar 0.00 0.03 0.00 0.00 0.00 0.03 0.00 0.00 1994 Tanzania Brewery 0.00 6.00 0.00 0.00 0.00 6.00 0.00 0.00 1998 Tanzania Jubilee 0.00 0.29 0.00 0.00 0.00 0.29 0.00 0.00 1994 ULC Leasing 0.00 0.38 0.00 0.00 0.00 0.38 0.00 0.00 2001 AEF 2000 Indust 1.60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1996199 AEF A&K Tanzania 0.15 0.00 0.00 0.00 0.15 0.00 0.00 0.00 1997 AEF Aquva Ginner 0.68 0.00 0.00 0.00 0.68 0.00 0.00 0.00 Total Portfolio: 20.12 18.36 1.04 0.00 16.02 11.80 1.04 0.00 Aoorovals Pendine Commitment F Y Approval Company Loan Equity Quasi Partic 2002 EximBank 0.00 1.oo 0.00 0.00 Total Pending Commitment: 0.00 1.oo 0.00 0.00 E - 83 - Annex 10: Country at a Glance TANZANIA: Multi-Sectoral AIDS Project SUb- POVERTYand SOCIAL Saharan Low- Tanzania Africa income Developmentdiamond* 2001 Population,mid-year (millions) 34.5 674 2,511 GNi per capita (Atlas method, US$) Life expectancy 270 470 430 GNI (Atlas method, US$ billions) 9.4 317 1,069 Average annual growth, 1995-01 Population (%) 2.5 2.5 1.9 Laborforce (%) 2.5 2.6 2.3 GNi Gross per primary Most recent estimate (latest year available, 1995-01) capita nroiiment Poverty(% of populationbelownationalpovertyline) 35 Urbanpopulation (% oftotalpopulation) 29 32 31 Life expectancyat birth (years) 44 47 59 - infant mortality (per 7,000live births) 93 91 76 Chiid malnutrition (% of children under5) 29 Access to improvedwater source Access to an improvedwater source (% ofpopulation) 54 55 76 Illiteracy (% of populationage 75+) 24 37 37 - Gross primaryenrollment (% of school-agepopulation) 65 78 96 Tanzania Male 65 85 103 Low-incomegroup Female 65 72 88 KEY ECONOMIC RATIOSand LONG-TERMTRENDS 1981 1991 2000 2001 Economic ratios' GDP (US$billions) 5.5 5.0 9.1 9.3 Grossdomestic investmentlGDP 26.3 17.6 15.8 Exportsof goods and serviceslGDP 14.0 10.3 14.6 15.9 Trade Grossdomestic savingslGDP 13.5 3.0 9.2 7.0 Gross national savings/GDP 22.7 3.9 8.5 6.7 TI Current account balanceiGDP 0.0 -16.5 -9.1 -9.2 interest payments/GDP 0.9 1.1 0.5 1.1 Domestic ~ - investment Total debUGDP 0.0 132.3 81.9 66.2 savings Total debt service/exports 31.2 38.7 14.2 21.1 Presentvalue of debffGDP 28.9 43.2 - Presentvalue of debffexports 189.1 137.0 Indebtedness 1981-91 1991-01 2000 2001 2001-05 (averageannualgrowth) - GDP 3.4 5.2 5.6 5.8 Tanzania GDP per capita 0.6 3.0 2.9 3.6 Low-incomeorouo Exportsof goods and services 9.6 18.4 17.8 2.7 STRUCTURE of the ECONOMY 1981 1991 2000 2001 (% of GDP) Growth of Investmentand GDP(%) Agriculture 45.4 48.1 45.0 44.8 20 T industry 16.2 16.9 15.7 15.8 Manufacturing 10.6 9.0 7.5 7.4 rol Services 38.3 35.0 39.2 39.4 Privateconsumption 73.8 78.1 84.3 83.4 Generalgovernmentconsumption 12.7 18.9 6.5 9.6 Importsof goodsand services 24.4 33.6 23.1 24.6 -GDI "O-GDP 1981-91 1991-01 2000 2001 (average annualgrowth) Growth of exportsand imports(%) Agriculture .. 3.4 3.4 5.4 T industry 4.1 7.3 6.5 Manufacturing 3.4 4.8 5.0 Services .... 3.2 6.0 5.5 Privateconsumption 2.4 -0.9 3.1 Generalgovernmentconsumption 3.6 5.0 6.6 Gross domestic investment -0.9 7.5 5.8 Importsof goods and services 1.3 0.1 8.1 Note 2001 data are preliminaryestimates * The diamondsshow four key indicatorsin the country (in bold) comparedwith its income-groupaverage If data are missing,the diamondwll be incomplete - 84 - Tanzania PRICES and GOVERNMENT FINANCE I 1981 1991 2000 2001 Domesticprices Inflation ("A) (% change) 40 - Consumerprices 25.6 28.7 5.9 5.2 implicit GDP deflator 28.1 7.4 6.7 Government finance (% of GDP, includescurrentgrants) Currentrevenue 19.2 12.3 10.6 11.4 98 97 98 99 00 Currentbudget balance -3.3 -0.2 -0.5 -0.7 Overallsurplus/deficit -13.7 -1.7 -5.4 -4.2 -GDP deflator ' O ' C P I TRADE 1981 1991 2000 2001 (US$ millions) 1 Exportand Importlewis (US$ mlll.) Total exports (fob) 562 394 663 772 Coffee 165 77 84 57 *Oo0 T Cotton 78 63 38 33 Manufactures 60 70 34 56 Total imports(cif) 1,111 1,276 1,592 1,726 Food 104 32 176 169 Fueland energy 261 189 95 106 Capitalgoods 563 579 638 755 Exportpriceindex (1995=100) 103 75 130 136 95 96 97 98 99 00 01 Import price index (1995=100) 93 98 90 100 Exports Imports Terms of trade (1995=100) 112 77 143 136 BALANCE of PAYMENTS 1981 1991 2000 2001 (US$millions) Currentaccountbalance to GDP (X) I Exportsof goods andservices 572 529 1,330 1,487 Importsof goods and services 1,192 1,569 2,094 2,316 Resourcebalance -619 -1,040 -765 -829 Net income 0 -185 -83 -44 Net currenttransfers 510 408 18 15 Currentaccountbalance -110 -818 -830 -858 Financingitems (net) 94 825 1,179 1,058 Changesin net reserves 16 -8 -348 -201 Memo: Reservesincludinggold (US$ millions) 209 974 1,157 Conversionrate (DEC, /ocaliUS$) 8.2 219.2 800.4 876.3 EXTERNAL DEBT and RESOURCE FLOWS 1981 1991 2000 2001 (US$ millions) Compositionof ZOO1 debt (US$ mill.) Total debt outstanding anddisbursed 5,822 6,558 7,440 6,185 IBRD 210 208 11 8 IDA 319 1,434 2,593 2,588 G:475 A:8 Total debtservice 179 207 198 331 iBRD 23 56 5 4 IDA 3 17 52 57 Compositionof net resourceflows Officialgrants 67 685 709 Officialcreditors 524 170 111 125 Privatecreditors 59 -9 Foreigndirectinvestment 193 203 Portfolioequity D:5 C:341 World Bank program Commitments 91 334 329 360 A IBRD - E Bilateral Disbursements 98 181 131 75 B IDA D Other multilateral - F Private Principalrepayments 8 43 37 40 C IMF .- G Short-term --- Net flows 89 137 94 35 Interestpayments 17 29 20 21 Net transfers 72 108 74 14 ueveioDmenIewnomics Y/IY/UZ - 85 - Additional Annex 11: Project Supervision Strategy TANZANIA: Multi-Sectoral AIDS Project Objectives The first year o f implementation for the project i s expected to be FY04. Although the project preparation has been extensive, it i s still anticipated that there will be considerable need for close supervisionduring the initial years ofproject implementation. The main objectives of the supervision inthe first year are to (a) ensure that there i s adequate implementation capacity at the district levels and all the participating line ministries; (b) ensure that TACAIDS has adequate capacity and support to begin carrying out their mandate o f coordination and M&E; and (c) ensure adherenceto appropriate safeguards and fiduciary responsibilities. Strategic focus The supervision strategy will focus on the following critical areas inthe first year. However, as i s the case with the overall project design, flexibility infocus for support supervision will be requiredinorder to be responsive to evolving priorities or emergingproblems. Institutional arrangements for the implementation. The supervisionwill focus on the essential institutional arrangements in order for the project to carry out the plannedproject activities. The role of the FacilitatingAgencies andthe Local Government Authorities and their sub-committees inthe district level coordination o f project activities under the CARF component will be evaluated during the first year o f implementation. The project cycle for the district and sub-district proposals will also be reviewed with regards to efficiency and timeliness o f implementation. At the national level, the evolution o f thejoint mechanisms for Monitoring and Evaluation, Planning and Financing under TACAIDS and the role o f the Joint HIV/AIDS Financing Committee with the participation o f all the donors will both be closely monitored. Duringthe initial stages o f the project there will be a strategic focus on the strengthening and creation o f partnerships - with civil society organizations, private sector organizations and within the public sector for the - implementation o f the national program. Such partnerships are seen as the main vehicle to address concerns about the absorptive capacity to intensify the national response to HIV/AIDS as significant as foreseen under the project. Monitoring and Evaluation. Inamulti-sector project with diverse implementingagencies such as this, it willbe important to have a sound M&E system inplace early duringproject implementation. At the core o f the mandate o f the NAC i s the M&E function for the overall national program. The project will strengthen the M&E capacity within TACAIDS incollaboration with other cooperatingpartners. Duringthe first year, the supervision activities will focus on achieving an adequate level o f functioning for the M&E. It is anticipated that participatory stakeholder meetings will form part o f the annual project reviews for the C A W and Public Sector Fundcomponents. Joint M&E systems, such as beingdeveloped for the Kenya and Zambia programs will be usedto give the TACAIDS the advantage o f sample tools and lessons learned elsewhere. - 86 - Coordination. The core function of TACAIDS i s the coordination of a large range of activities and initiatives implementedby a host o f agencies from the public sector, the private sector and civil society organizations, from national level to decentralized level. The supervision strategy will concentrate on supporting TACAIDS inthis formidable task. Key targets inthe initial year will be the development o f a Joint M&EFramework for the national program, the development o f a model for Joint HIV/AIDS ProgramReviews, the elaboration o f ajoint financing framework for HIV/AIDS, and the functioning o f TACAIDS as the institutionfor joint administrative functions. Procurement. Supervision will provideproblem-solving support on procurement and evaluate whether capacity and procedures for the centralized procurement are inplace. Financialmanagement. Duringthe first year the project, supervisionwill focus onthe establishment andmanagement ofthe two Special Accounts and facilitate timely flow o f funds directly to implementation entities. The argument for the fast tracking o f this project hinges on an efficient and fast-disbursement channel to support the community and multi-sector responsesto HIVIAIDS. Partnerships. Many UNand bilateral agencies under the DAC Group on HIV/AIDS such as UNAIDS, WHO, UNICEF, ADB, EU, DFID, USAID, SIDA, CIDA, GTZ, IrelandAID and the Dutchhave made useful contributions during project preparation. Such contributions resultedinthe proposition for establishingjoint coordination mechanisms. The supervision o f the project will continue to build such partnership and collaboration. Three methods are identifiedto further develop the partnership and collaboration: (i) Joint-missions. The IDA team will participate in the annual joint review o f the national HIV/AIDS program as organizedby TACAIDS and supported by the D A C Group on HIV/AIDS. Whenever there would be need for additional missions, the IDA team will invite other partners to participate inthese supervision missions and reviews o f the project. Donor agencies have experts inthe areathat they may have comparative advantagesto bepartofthe IDA supervisionmission team. (ii) Sharing international experiences and best practices through supervision. Invitingpeople with experiences o f implementingsuccessful HIViAIDS related programs outside to join the mission to share their expertise and experiences. Such support can be provided and financed by the donor community, and (iii) Periodic evaluation o f the partnerships with a view (i) strengthen o f the relations; (ii) to achieve our common goals in Tanzania; and (iii) improving coordination. Duringthe project launch workshop, the IDA team will discuss the options described above with various partners to confirm possible arrangements and support. - 87 - Supervision. The project will need intensive supervision given the large span o f activities, its blend o f public and private sector interventions, and its multi-sectoral as well as its multi-agency nature. In addition, concerns about a limited capacity will require intensive support to develop partnerships for the implementation o f the national program. The project will be implemented by many entities only recently established and whose capacity will need strengthening. A budget o f US$200,000 and a full-time staff based inthe Tanzania Country Office i s needed to supervise the project duringthe first 12 months o f project implementation. The Country Director has already committed to provide a supervision budget o f up to $200,000 duringthe first twelve months of implementation. The project task teamwould consult with the Bank's Global HIV-AIDS Office early on duringimplementation to explore additional financial contributions for M&E. Some o f the skills required for the supervision o f the project will be needed on a regular basis while others will be requiredon an ad hoc basis. It i s therefore proposedto establish a project team, which will emphasize financial, procurement and operational basic needs, complemented by technical specialists, inparticular those covering M&E,communityparticipation, maternal and child needs, sectoral concerns and sub-regional matters. A much more intensive than normal supervision program shouldbe carried out during the first year o f the project to put inplace a sound institutional base and properly begininterventions to be undertakenby this complex operation. Clearly there will be an incubation period for the main new institution, TACAIDS, whose staff will havejust come on board, developing a management culture, preparing terms o f reference, and with limitedWorld Bank procurement/financial management experience. The project team will needto assess--on the ground--whether the indicators levels chosen are realistic, giventhe Tanzania situation and do conform to those inthe Joint M&E framework that will be developed, or need adjustments. The staff inthe Tanzania Country Office will provide support on a continuous basis and will solicit support in specializedareas as required. Project supervision will also benefit from the Bank's: (i) Lead Health Specialist with extensive experience in operations and M A P projects elsewhere; (ii) education team involved inthe Bank's new education sector program; and (iii) the Bank's team inthe Country Office working on the TASAF. In addition there will be an (i) specialist consultant; (ii) M&E implementation specialist to provide longer term support and to troubleshoot implementation issues at an early stage, (iii) maternal and child needs specialist, and (iv) NGO/CBO/communityparticipation specialist. The project team therefore includes the following members: (i) Task Team Leader with experience inHIV/AIDS operations; (ii) healthhutritiodpopulation specialist, (iii) implementation specialist, to help inthe critical first senior half year o f project's implementation; (iv) financial management specialist who will review adherence to Bank procedures with regard to fiduciary responsibilities; and (v) procurement and implementation specialists, responsible for the procurement, implementation, and institutional issues and (vi) sectoral specialists inthe areas o f education, gender, maternal and child needs, and community participation. The project team will be complemented by representatives o f Tanzania's development partners who are active inthe fight against HIV/AIDS. The wide variety o f stakeholders, both interms o f technical focus as well as geographic coverage, poses an enormous challenge to the forging o f a framework for coherent programimplementation. While the various stakeholders work well together under the umbrella o f TACAIDS it was felt that the considerationo f more formal working arrangements including the development o fjoint planning and monitoring processeswould be helpful. This could start with ajoint review o f progress towards the delivery o f the strategic plan. The project team will provide support to the process as well as the content o f the joint program reviews as required. The establishment o f a specific Joint HIV/AIDS Financing Committee with the participation o f all the donors will further facilitate and enhance their role and technical input to the broader project implementation issues. - 88 -