The World Bank National AIDS Control Support Project (P130299) REPORT NO.: RES39216 DOCUMENT OF THE WORLD BANK RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF NATIONAL AIDS CONTROL SUPPORT PROJECT APPROVED ON MAY 1, 2013 TO DEPARTMENT OF ECONOMIC AFFAIRS HEALTH, NUTRITION & POPULATION SOUTH ASIA Regional Vice President: Hartwig Schafer Country Director: Junaid Kamal Ahmad Regional Director: Lynne D. Sherburne-Benz Practice Manager/Manager: Trina S. Haque Task Team Leader(s): Ronald Upenyu Mutasa, Suresh Kunhi Mohammed The World Bank National AIDS Control Support Project (P130299) I. BASIC DATA Product Information Project ID Financing Instrument P130299 Investment Project Financing Original EA Category Current EA Category Partial Assessment (B) Partial Assessment (B) Approval Date Current Closing Date 01-May-2013 31-Dec-2019 Organizations Borrower Responsible Agency National AIDS Control Organisation, Department of AIDS Department of Economic Affairs Control,Central Medical Services Society Project Development Objective (PDO) Original PDO The Project Development Objective (PDO) is to increase safe behaviors among high risk groups in order to contribute to the nationalgoal of reversal of the HIV epidemic by 2017. Current PDO The Project Development Objective (PDO) is to increase safe behaviors among high risk groups in order to contribute to the national goal of reversal of the HIV epidemic Summary Status of Financing Net Ln/Cr/Tf Approval Signing Effectiveness Closing Commitment Disbursed Undisbursed IDA-52360 01-May-2013 18-Jun-2013 22-Jul-2013 31-Dec-2019 255.00 174.78 62.43 The World Bank National AIDS Control Support Project (P130299) Policy Waiver(s) Does this restructuring trigger the need for any policy waiver(s)? No I. SUMMARY OF PROJECT STATUS AND PROPOSED CHANGES 1. This Project Paper seeks Regional Vice President’s approval to extend the closing date of the India National AIDS Control Support Project (NACSP, P130299) by six months, from December 31, 2019 to June 30, 2020. With this proposed extension, the closing date would be extended by 2.5 years (cumulative) from the original closing date of December 31, 2017. The project was restructured in May 2017 to extend the closing date by two years, from December 31, 2017 to December 31, 2019. 2. The project was restructured to process the changes in institutional arrangements and revisions to the results framework. Currently total disbursement is USD 169.5 million, which is 73.1 % of the project’s total IDA allocation of USD 231.8 million. 3. The NACSP is the fourth engagement of the World Bank in its 27-year partnership with NACO for HIV/AIDS programming in India. The NACSP has national and global significance and India’s national response to the HIV epidemic has been hailed as a success story. It is thus crucial to ensure smooth completion of NACSP, document lessons from this important program, and ensure sustainability of project gains. Though national HIV prevalence remains low at 0.22%, the epidemic is concentrated among high-risk groups (HRGs) with higher prevalence, including female sex workers, men who have sex with men, injecting drug users, and transgender people. Only continuity of both prevention and treatment efforts will eliminate HIV/AIDS in India, and these approaches must be implemented synergistically. 4. The Project Development Objective (PDO) remains Satisfactory and the NACSP is on track to achieve end-of- project targets. Based on 2016 NACO data, all three PDO indicators have surpassed targets for fiscal year 2017-2018. Updated Behavior Surveillance Survey-Lite (BSS-Lite) data will be available in March 2020. Overall implementation progress is rated as Moderately Satisfactory and actions agreed with NACO during the July 2019 mission are either achieved or on track to meet timelines. The project’s overall risk rating is Moderate. 5. Over the past year, NACO has progressed implementation of project activities. Project turnaround following slow implementation between 2016 and 2017 has been satisfactory, with sustained momentum in implementation of activities across all NACSP components. At the same time, technical progress on priority NACSP interventions to scale up the seek, test, and treat approach—in line with national strategy and global best practices—and strengthening of NACO’s institutional capacity are on track. A direct result of strong NACO leadership and technical and fiduciary teamwork, this progress has translated into increased project disbursement. Disbursement was 54% of the total allocation in January 2019, but by October 2019 had increased to 73.1%. The proposed extension will provide a good opportunity for NACO to ensure continuity of critical targeted interventions (TI) and to ensure sustainability beyond Bank support. The TI program is being implemented by non-governmental organizations (NGOs) under contract with NACO. 6. The rationale for the extension is that it will allow sufficient time for NACO to: The World Bank National AIDS Control Support Project (P130299) a. Synchronize timelines of NGO contracts for TI with the end of the GOI’s fiscal year (i.e. March 2020), ensuring uninterrupted services to the target population: The proposed extension will help align TI activities with the GOI’s financial year, which runs from April to March. Current NGO contracts are scheduled to end in December 31, 2019, three months prior to the end of the GOI’s fiscal year. The extension would ensure that TIs continue uninterrupted until the end of the project, which will allow time for NACO to shift completely to domestic financing before NACSP ends in June 2020. b. Transition institutional arrangements for TI programs financed by domestic resources: NGOs implementing TI are supported by Technical Support Units (TSUs) for capacity building and supportive supervision. These TSUs have traditionally been financed by partners. The proposed extension will ensure that financing of these TSUs is transitioned from the NACSP to domestic budget during the first quarter of the next GOI financial year. c. Undertake evaluation surveys to inform achievement of NACSP results: For a more recent update of the indicators that track the PDO, a shorter version of the behavioral surveillance survey (BSS) called BSS-LITE is underway and results are expected in March 2020. BSS-LITE results will provide end-line data for NACSP’s population-based indicators that rely on surveys. This data is important not only to assess the PDO but also to create a storyline for the 27-year India-World Bank partnership in HIV/AIDS programming. Another important activity is the pilot for mapping and revising HRG estimates; the last such estimation was done in 2009. NACO is currently implementing a pilot in four states for mapping and size estimation of HRGs. The updated HRG population size estimation will allow for appropriate expansion and coverage of HIV prevention activities, and assist the government to be as strategic as possible in its approach to addressing HIV/AIDS. 7. The project closing date is proposed to be extended by six months, from December 31, 2019, to June 30, 2020. Consequently, project disbursement estimates will be revised to reflect expenditures to be incurred during the extended period. No other project changes are proposed. 8. During the extended period, no new activities will be initiated; ongoing activities, like implementation of the HIV testing and treating approach at scale, Targeted Interventions, BSS-LITE, and size estimation, will be completed. With this adjusted workplan and project closing date extension to June 30, 2020, the undisbursed balance of USD 62.3 million is expected to be fully disbursed by the close of the NACSP. II. DETAILED CHANGES LOAN CLOSING DATE(S) Original Revised Proposed Proposed Deadline Ln/Cr/Tf Status Closing Closing(s) Closing for Withdrawal Applications IDA-52360 Effective 31-Dec-2017 31-Dec-2019 30-Jun-2020 30-Oct-2020