Document of The World Bank FOR OFFICIAL USEONLY ReportNo: 38718 BJ - PROJECTAPPRAISAL DOCUMENT ONA PROPOSEDCREDIT INTHE AMOUNT OF SDR 23.5 MILLION (US$35 MILLIONEQUIVALENT) TO THE REPUBLIC OF BENIN FORA SECOND MULTISECTORALHIV/AIDSCONTROL PROJECT March 14,2007 SustainableDevelopment-Western Africa CountryDepartment02 AfricaRegionalOffice This document has a restricted distribution and may be usedby recipients only inthe performance o f their official duties.Its contents may not otherwise be disclosed without World Bank authorization. CURRENCY EQUIVALENTS (Exchange Rate Effective February 20,2007) CurrencyUnit = CFAF US$1 = 515CFAF SDRl = US$1.48543 FISCAL YEAR January 1 - December31 ABBREVIATIONS AND ACRONYMS AAA Analytical and Advisory Activity AfDB African Development Bank AIDS Acquired Immune Deficiency Syndrome AGeFIB Grassroots Initiative Financing Agency (Agence de Financement des Initiatives de Base) ALCO Abidjan-Lagos Comdor ANC Antenatal Care APH Action Pro Humanitad ARV Anti-Retroviral (Drugs) ART Anti-Retroviral Therapy ASAP AIDS Strategy andAction Planning Service BCC Behavioral Communication for Change CALS Sub-district level HIV/AIDS Control Committee (Comitt d 'Arrondissement de Lutte contre le VIH/SIDA) CAA Autonomous Amortizing Coffer (CaisseAutonome d 'Amortissement) CAME National Drugs andMedical Supplies Administration CAS Country Assistance Strategy CBO Community-based Organizations CCLS Communal HIVIAIDS Control Committee (Comitd Communalde Lutte contre le nH/SIDA) CDD Community DrivenDevelopment CDLS DepartmentalHIV/AIDS Control Committee (Comitt Dtpartemental de Lutte contre le V I H N D A) CCM Country Coordination Mechanism CNLS NationalHIV/AIDS Control Committee (Comitt National de Lutte contre le SIDA) CNRMP NationalCommission ofPublic Procurement Regulation CPAR cso Country Procurement AssessmentReport Civil Society Organizations CVLS Village HIVIAIDS Control Committee (Comitt Villageois de Lutte contre le VIHBIDA) CWMP cws Clinical Waste Management Plan Commercial Sex Worker DFID Department for InternationalDevelopment(UK) DNMP NationalDirectorate for Public Procurement DPL Development Policy Lending FBS FixedBudget Selection FMR Financial Management Report FU Financial Unit GAMET Global Monitoring and Evaluation Team GDP Gross Domestic Product GFATM Global Fundto fight AIDS, Tuberculosis, and Malaria GIP- ESTHER Therapeutic Solidarity inHospitals" Public InterestGroup (Groupement d'Intdre^tPubZic- Ensemble Solidaritt TMrapeutiqueHospitalikre en Rtseau) GPN GeneralProcurement Notice HIV HumanImmune Deficiency Virus HPP Health andPopulation Project I C Individual Consultant ICB International Competitive Bidding ICR Implementation Completion Results 11 IFR InterimFinancialReport IDA InternationalDeveloDmentAssociation FOROFFICIAL USE ONLY IEC InformationEducationand Communication IGA IncomeGeneratingActivity IDP InternallyDisplacedPeople ISA InternationalStandardonAuditing ISR Implementation Status Report LCS LeastCost Selection LIB LimitedInternationalBidding MAP I MultisectoralHIViAIDS PreventionProjectinBenin MAP I1 SecondMultisectoralHIViAIDS PreventionProjectinBenin M&E Monitoring andEvaluation MOH Ministry ofHealth MCSP MalariaControlSupportProject MSF DoctorsWithout Borders (Mkdecins SansFrontikre) MDM Doctorsofthe World (Mbdecins du Monde) NBC NationalCompetitionBidding NGO Non-governmentalOrganization 01 Opportunist Infection PA ProjectAdministration(of MAP 11) PMTCT PreventionofMother-to-ChildTransmission PNLS NationalHIV/AIDS ControlProgramme(Projet National de Lune contre le SIDA) PLWHA PeopleLivingwith HIV/AIDS PPLS PlurisectoralHIViAIDS Project (also calledMAPI) PRSC PovertyReductionStrategyCredit PSI PopulationServiceInternational PSO Public Sector Organization RFP Requestfor Proposal QCBS QualityandCost BasedSelection SBD StandardBiddingDocuments SA1 SupremeAudit Institution SIDAG NationalServicefor Free VoluntaryandAnonymous Testing SIL Specific InvestmentLoan SPiCNL Permanent SecretariatofNationalHIViAIDS ControlCommittee SPN SpecificProcurementNotice SOE Statement ofExpenditure SOLTHIS Therapeutic SolidarityandInitiativesfor HIV/AIDS (Solidariti Thhdrapeuh'que Internationalepour le Sida) STI Sexually TransmittedInfection ovc OrphansandVulnerable Children TB Tuberculosis TOR Terms ofReference TOT Training ofTrainers TTL Task TeamLeader UNAIDS JointUnitedNationsProgramonHIV/AIDS UNGAS UnitedNationsGeneralAssembly Special SessiononHIV UNICEF UnitedNationsChildren'sFund UNFPA UnitedNationsPopulationFund USAID United States Agency for InternationalDevelopment UNDP UnitedNationsDevelopmentProgram VCT VoluntaryCounselingandTesting WHO World HealthOrganization WFP World FoodProgram Acting Vice President: Hartwig Schafer CountryManagermirector: JosephBaah-DwomoWJames P.Bond Acting SectorManager: Franqois Le Gall Task TeamLeaders: NicolasAhouissoussi, Ayite-Fily D'Almeida iii This document has a restricted distribution and may be used by recipients only in the performance o f their official duties. Its contents may not be otherwise disclosed without World Bank authorization. REPUBLICOFBENIN SecondMultisectoralIV/AIDSControlProject CONTENTS Page A. STRATEGIC CONTEXT AND RATIONALE 1 1. Countryandsector issues 1 2. Rationalefor Bankinvolvement 5 3. Higher-levelobjectivesto which the projectcontributes 5 B. PROJECTDESCRIPTION 6 1. Lendinginstrument, 6 2. Programobjective and key indicators 6 3. Projectcomponents 7 4. Lessonslearnedand reflectedinthe projectdesign 9 5. Alternatives consideredand reasonsfor rejection 11 C. IMPLEMENTATION 12 1. Partnershiparrangements 12 2. Institutionaland implementationarrangements 12 3. Monitoringand evaluationof outcomes/results 14 4. Sustainability 16 5. Criticalrisks and possible controversial aspects 17 6. Credit conditionsand covenants 19 D. APPRAISAL SUMMARY 19 1. EconomicandFinancialanalyses. 19 2. Technical 20 3. Fiduciary 20 4. Social 21 5. Environment 22 6. Safeguards Policies 23 7. Policy Exceptions andReadiness 23 Annex 1:Countryand Sector or ProgramBackground 24 Annex 2: Major RelatedProjectsFinancedby the Bankand/or other Agencies 28 Annex 3: ResultsFrameworkand Monitoring 31 Annex 4: DetailedProjectDescritption 37 Annex 5: ProjectCosts 45 Annex 6: ImplementationArrangements 46 Annex 7: FinancialManagementandDisbursement Arrangements. Summary 50 Annex 8: Procurement Arrangements 60 Annex 9: EconomicandFinancialAnalysis 67 Annex 10: SafeguardPolicy Issues 72 iv Annex 11:ProjectPreparationand Supervision 73 Annex 12:Documentsinthe ProjectFile 75 Annex 13: Statement of LoanandCredits 76 Annex 14:Countryat a Glance 77 Annex 15:MAP (IBRD 33372) 79 V BENIN SECOND MULTISECTOML HIV/AIDS CONTROL PROJECT PROJECT APPRAISAL DOCUMENT AFRICA AFTS3 Date: March 14,2007 Team Leaders: Nicolas Ahouissoussi, Ayite- Fily D'Almeida Country Director: James P. Bond Sectors: Health(75%); Central government Sector ManagedDirector: Francois G. Le Gall administration (15%);0ther social services (5%); Sub-national government administration (5%) Themes: HIV/AIDS(P) Project ID: PO96056 Environmental screening category: Partial Assessment LendingInstrument: Specific InvestmentLoan [ ] Loan [XI Credit [ 3 Grant [ ]Guarantee [ ]Other: For Loans/Credits/Others: Total Bank financing (uS$m.): 35.00 Borrower: Government of Benin ResponsibleAgency: Comitk National de Lutte contre le VIWSIDA 06 BP 2586 Cotonou Benin Tel: 229-21 32 27 27 mvkiki@vahoo.fr iY 2008 2009 I 2010 I 2011 I 4nnual II 1 Estimateddisbursements (Bank FY/US$m) 8.75 I hmulative) 8.75 1 9.75 I 18.50 I 10.50 I 29.00 1 6.00 I 35.00 1 Project implementation period: Start July, 2007 End: June, 2011 Expectedeffectiveness date: June 30,2007 Expected closing date: December 31, 2011 Does the project depart from the CAS incontent or other significant respects? [XIYes [ 3 N o vi Ref: PAD A.3 Does the project require any exceptions from Bank policies? Ref: PAD D.7 [ ]Yes [XINO Have these been approvedby Bank management? [[ ]Yes [XINO ]Yes [ IN0 I s approval for any policy exception sought from the Board? Does the project include any critical risks rated "substantial" or "high"? Ref: PAD C.5 [XIYes [ ] N o Does the project meet the Regional criteria for readiness for implementation? Ref: PAD D.7 [XIYes [ ] N o Project development objective Ref: PAD B.2, TechnicalAnnex 3 The development objectives o f the proposedproject are derived from the country's strategic plan for fighting HIV/AIDS and its effects, and for preventing the further spread o f HIV/AIDS by means o f a multisectoral program approach. They are essentially similar to those under the predecessor project. Thus, complementingthe activities financed by other sources, the purpose i s to help the Benin Government implement its new 2006-2010 National Strategic Framework for boosting its national response to HIV/AIDS by contributing to increasing and improving the coverage and utilization o f prevention services, treatment and care for specific high-risk and vulnerable groups. More specifically, the project will contribute to: (a) strengthening access to and increasing utilization o f prevention services for vulnerable groups (women, youth, etc.) and the high-risk groups such as the commercial sex workers and staffs o f some key ministries; (b) improve access and utilization o f treatment and care services for HIV/AIDS infected and affected persons, notably those living with HIV/AIDS (PLWHA), and orphans and vulnerable children (OVC); and (c) consolidate the coordination, management, and the monitoring and evaluation of the national response to HIV/AIDSfor its sustainability. Project description[one-sentence summary of each component] Ref: PAD B.3.a, Technical Annex 4 The Project has three components: (1) Social mobilizationand HIVprevention service; (2) Access to treatment, care and impact mitigationservices; (3) Coordination, management, and monitoringand evaluation. Component 1i s to provide funds for further scaling up o f HIV/AIDS prevention efforts in Benin; Component 2 is to provide support to targeted activities relatedto prevention, treatment and care, and research; Component 3 is to ensure proper Project management and coordination mechanisms. Which safeguard policies are triggered, ifany? Re$ PADD.6, TechnicalAnnex I O Environmental assessment (OP/BP 4.01) Significant, non-standardconditions, if any, for: Ref: PAD C.7 Boardpresentation: April 5,2007 Board Conditions: N o conditions for Board Loadcredit effectiveness: N o non-standard conditions Covenants applicable to project implementation: n.a. vii A. STRATEGIC CONTEXT AND RATIONALE 1. Countryandsector issues 1. Country Issues. Benin has a population o f about 7.2 million and i s one o f the poorest countries in the world, ranked as number 153 out o f 173 in the 2002 Human Development Report. Because it i s also one o f the most indebted countries, it i s difficult to obtain additional investments. Poverty rose from 26.5 percent in 1996 to 33.8 percent in 2002. The incidence o f poverty varies substantially between the sexes and by type o f municipality and region. Life expectancy averages only 59 years. Fightingpoverty is the main objective o f the Government's development strategy (See Annex 1). 2. Healthand HIV/AIDSsituation inBenin. Tropical diseases flourish inBenin; malaria, infections o f the respiratory system and diarrhea together account for about 60 percent o f hospital or health center consultations. Inaddition, outbreaks o f cholera and meningitis occur frequently. In recent years, HIV/AIDS has become an increasingly important reason for people inBenin to seek medical care. 3. Nonetheless, Benin has a relatively low incidence o f HIV/AIDS,but it i s considered as a generalized epidemic'. Among the adult population from 15 to 49 years o f age the prevalence o f HIV/AIDS i s estimated at about 2 percent, meaning that there are about 78,650 seropositive persons. According to the Government's National Strategic Plan for Fighting HIV/AIDS2006-2010, theprevalence rate for the past four years hasbeen quite stable, with a slightly rising trend: 1.9 percent in 2002; 2.0 percent in 2003; 2.0 percent in 2004; and 2.1 percent in 2005 of the total population o f 7.2 million. The respective trend among the youth (15 to 24 years) does not differ substantially during these four years: 1.7, 1.9, 1.3 and 2.2 percent. In2005, there were 8,480 new reported cases o f HIV infection, 1,890 children born with HIV, and 8,270 deaths from AIDS, resulting in36,740 orphans (children who lost their mother, father, or both). Cumulatively the number o f HIV/AIDS deaths as o f 2005 was 60,300. The HIV/AIDS prevalence rates in the various regions o f Benin range from 0.6 percent to 4.1 percent in 2005. Among vulnerable groups such as commercial sex workers, tuberculosis patients, and pregnant women, the rates were 25.5, 16.7 and 2.0 percent in 2005 respectively. Among pregnant women the rate ranged from 1.6 percent in rural areas to 2.4 percent inurban areas. 4. Government's obiectives and strategies in the sector. The Government continues to be strongly committed to the fight against STI/HIV/AIDS, with strong support from the Office o f the President. Inrecent years the Government has increased its budgetary allocation for the fight against HIV/AIDSunder the Ministry o f Healthbudget from US$l.O million in 2002 to about US$3.6 millionin2005, which is still modest to the actual requirement to fight the epidemic. In 2000, the Government established the National AIDS Committee ("Cornit6 National de Lutte Contre le SIDA" or CNLS) and appointed a Permanent Secretariat ' The epidemic should be treated as "generalized" rather than "concentrated." The percentage differences between the different regions' prevalencerates are relatively small, varying ftom low 0.3% inthe Northto not-so-high 3.3% inthe South, with an average o f 2% for the country. Also between rural and urban areas the differences are not large (1.6% versus 2.4%). The epidemic already appears inthe remotest rural regions, and is likely to spread there more (as has happened inUganda, reversing the earlier declining trend). The high percentages among prostitutes, people with tuberculosis (with prevalence rates of 27.9% and 16.3% as o f end-2005) indicate some concentration in certain population groups, but these groups are relatively small compared with the overall population. Differences between different departments for prostitutes are not great, varying from 22% to 37%. For the youth (15 to 24 years o f age), the prevalence rate at 2.2% is near average (for women even lower at 1.3%). This data is from the 2005 sentinel surveillance report. 1 (SP/CNLS) to coordinate the implementation o f the HIV/AIDS programs. A thematic group (comprised o f representatives from the UNagencies, the World Bank, and national and local stakeholders) was established under the auspices o f UNAIDS to advise the Government in developing and implementing its response to the epidemic. A National Strategic Plan for HIV/AIDS (2001-06) and a Monitoringand Evaluation (M&E) Planwere adopted. 5. The Government's National Strategic Plan for HIV/AIDS for the period 2001-2005 had, in brief, the following objectives: (a) strengthen the prevention o f sexually transmitted, blood-transfusion and drug-injection-induced, and mother-to-child transmitted infections o f HIV; (b) improve the medical and psychosocial treatment, care, and support of people infected with and affected by HIV/AIDS; and (c) reduce the economic and social impacts o f HIV/AIDS among the population. Two important lessons learned during implementation of this strategy (and the simultaneous Multisectoral HIV/AIDS Project (MAPI) that those were infected and affected by HIV/AIDS can be reached through social mobilization efforts and the use o f multiple channels, and that such social mobilizationcan be organized effectively in a relatively short time (other lessons are mentioned in Section B.4). These as well as other lessons learnedaffected the preparation o f the National Strategic Planfor FightingHIV/AIDS 2006-2010 (see below). 6. An institutional analysis was preparedas part of the revision of the national strategic framework, and the recommendations from this analysis were used to correct identified weaknesses under this project (MAP 11).The country has made significant progress towards attainment o f the "Three Ones" principle, for instance, having one monitoring and evaluation framework agreed by all partners. A national Monitoring and Evaluation (M&E) plan was completed inearly 2006, which will be broadly tested inearly 2007 and its efficiency will be proven during the first year o f the project. Also, as already mentioned, the country has prepared and adopted in May 2006 a new National Strategic Framework and an operational plan for HIV/AIDS, setting the broad parameters for the national response and identifying a core set o f national indicators for monitoring. The UNAIDS-sponsored AIDS Strategy and Action Planning Service (ASAP) support, with its evidence-based, prioritized, and evaluated approach, was important inhelpingBeninprepare the new strategy and operational plan. 7. The Government has persuaded numerous external and internal partners to finance the necessary programs against HIV/AIDS (see Section C.1) with substantialresults. A major contribution for implementing the Government's strategies came from the first IDA-financed multisectoral AIDS project (MAP I,in Benin called PPLS--"Projet multisectoriel de lutte contre le VIH/SIDA"), which successfully scaled up the country's fight against HIV/AIDS using such instruments as (i) responses"; (ii) "local prevention programs by public-sector ministries and agencies; and (iii) mobilization o f NGOs, local radio stations, and public- sector organizations, including the health sector, for which it provided capacity building, equipment for health centers, and even antiretroviral (ARV) drugs. The project covered all the 77 communes (municipalities) and funded subprojects in more than 3,100 towns and villages. The project financing, along with the efforts o f the Government and the donor group, was no doubt instrumental in keeping the HIV/AIDS prevalence rate at a relatively low level. 8. Furthermore, Benin achieved concrete results inthe 2005-2006 period, such as: the establishment o f 29 Voluntary Counseling and Testing (VCT) sites (out o f the 77 anticipated sites to reach a nationwide coverage) that have tested 101,852 people, and 183 Prevention o f Mother-to-Child Transmission (PMTCT) sites have served 69,220 pregnant women, of whom 1,705 were identified as seropositive. These PMTCT sites are integrated into the Antenatal 2 Care Clinics. The number o f treatment sites has increased from only three inCotonou in2003 to 48 sites in 2006 nationwide, including religious health facilities and NGO-operated treatment and private hospitals. As many as 7,447 patients are receiving antiretroviral therapy (ART),comprising 50 percent ofthe 15,000 peopletargetedfor 2010, andan additional 6,706 persons, including 900 children, are receiving care for opportunistic infections. Safety o f blood transfusion i s secured for 100 percent of HIV tests. Tuberculosis and HIV (TB-HIV) are tested at 18 integrated sites and 51 TB treatment centers are proposing systematic HIV testing, expecting a highacceptability rate among the population. 9. However, availability o f financing or the scale-up programs do not meet the estimated real needs. For example, the capacity-building programs so far have served only the public-sector health staff incertain zones. The 38 VCT sites, o f which 29 are operational, are still insufficient given that the need for national coverage i s 77. The referral center i s not fully functional and needs to be strengthened. Security of blood transfusions needs to be reinforced and expanded to cover all health centers in Benin. The goal o f universal access to prevention and treatment i s still far from being realized. The laboratory system needs to be reinforced and the quality services for people under ARV must be ensured. In addition, the coordination mechanism under the Permanent Secretariat o f the National HIV/AIDS Control Committee (SP/CNLS),* as well as the monitoring and evaluation system, still need to be strengthened in order to help establish or consolidate in the HIV/AIDS sector the "Three Ones" principle (i.e. common national leadership for the fight against HIV/AIDS, one national strategy for all projects and programs, and a uniform M&E) (See Annex 9- Economic and Financial Analysis). 10. The Government's new strategic plan for fighting HIV/AIDSin the period 2006-10, prepared during 2005-06 inbroad consultation with the donor group and stakeholders inthe country and plannedto be reviewed annually, has the following general objectives: Promote an environment that i s favorable for multisectoral approaches, broad engagement o f stakeholders, sustainability o f efforts, and efficient coordination to fight the pandemic within the framework of the "Three Ones" approach. Reduce the prevalence rate o f HN/AIDS among the youth between 15 and 24 years o f age by at least 25 percent and among the vulnerable population notably women, sex workers, mobile population, and unformed personnelby 50 percent by 2010. Reduce the prevalence rate o f STI among the general population, notably the vulnerable groups by at least 30 percent by 2010. Strengthen the bio and blood transfusion security and minimize the transmission of HIVintraditional andmedicaltreatment centers. Reduce the proportion o f infected children born from seropositive women by at least 50 percentby 2010. Promote the voluntary counseling testing (VCT) ensuring confidentiality. Ensure adequate medical care to adults and infected children by HIV including biologicalmonitoring. Reduce the overall impact o f HIV/AIDS among the persons infected or affected, especially for orphans and vulnerable children. Increase the proportion o f orphans and vulnerable children in households benefiting from at least one external support from 3 to 50 percent by 2010. Strengthen strategic information for orienting the national response. / Secrktariat Permanent de Comitk National de Luttecontre le SIDA. 3 Set up the monitoringand evaluation system. 11. The Government plans to achieve these objectives through a number o f approaches. They include the appropriate activities o f the Ministry o f Health, including free or subsidized provision o f ARV medications. To prevent HIV/AIDS and to care for persons infected and affected by HIV/AIDS, the Government plans to work through the public sector in general and through civil society organizations (particularly those dealing with persons living with HIV/AIDS), private-sector firms and stakeholders in all walks of life, and concerned populations at all levels o f the communal structure in the country. The highest priorities in terms o f funds to be used are: (a) prevention and testing, and (b) support to persons infected and affected and promotion o f respect o f human beings. Also a highpriority is set to upgrade and strengthen the Permanent Secretariat o f the CNLS, thus facilitating its unquestioned leadership inthe sector. 12. Constraints and issues. Although the Government i s fully committed to fighting HIV/AIDS-indeed, the President o f the country chairs the oversight committee-the following problems need to be addressed if the objectives are to be attained: (a) the resources available cannot finance all the plans (for scale up or the national strategic plan) and multi- donor assistance, so forthcoming inthe past, i s not secured yet for the next five years; (b) the Permanent Secretariat o f CNLS has insufficient funds to operate effectively at both central and decentralizedlevels; and (c) HIV/AIDS-relatedactivities are inadequately coordinated by the SP/CNLS, which, however, has now beenrecognized as the sole authority. Scaling up the civil society response i s not likely to be a problem in Benin, as this approach was already successfully implementedduringMAP I. 13. Late in the previous planning period, the Government vowed to provide antiretroviral medication (ARV) free o f charge to all seropositive persons who need such medication. However, the main problem in this respect, as well as for all strategies o f prevention, treatment and care, has been that the Government must rely on external funds to finance the necessary purchases (such as drugs, supplies and consumables) and related activities since it can only provide a very modest contribution for treatment (equivalent o f US$3.6 millionin2005). 14. Comuliance with reueater requirements. The Multi-Country HIV/AIDS (MAP 11) Program for the Africa Region (Report No. P7497 AFR, December 20,2001, pp. 22-23) set forth the criteria that must be met by a country to benefit from the program. For the M A P I project, Benin met the conditions o f participation in the World Bank's multisectoral program for Africa. Also, the outcome o f M A P Ijustifies continued Bank Group assistance, since its Implementation Status Report (ISR) ratings were consistently satisfactory and the Implementation Completion Report (ICR) confirmed that its development objectives were attained. Benin also met the conditions set for repeater projects in the sector, including the following: (a) the existence o f one national HIV/AIDS strategy and one national HIV/AIDS authority; (b) a national uniform M&E system that will be employed for all multi- or bilaterally assisted projects; (c) a proven willingness to integrate performance considerations into fund allocation and disbursement decisions, including the use o f "report cards" at the village and community level for the stakeholders to evaluate the subprojects and its implementers' performance; (d) the procedures for providing technical support to subprojects have been established (inthe form of usingNGOs as "Organismes d'Appui au Lancement"); and (e) the guidelines have been established for subproject preparation and implementation, and quality assessment.Benin also presented a formal request to the World Bank for a second Credit to fight HIV/AIDS. 4 Further informationon the country and sector issues i s inAnnex 1. 2. Rationale for Bankinvolvement 15. The World Bank has been the single largest source o f funding for HIV/AIDS prevention and care during the past four years in Benin, and has accumulated more experience in dealing with its many facets than any other support program. Although the Global Fund will provide more funds in the coming years, the Bank's comparative advantages-particularly in working with the non-health sector and in mainstreaming and unifyingthe coordination arrangements of HIV/AIDS-are likely to continue. Furthermore, with the experience gained in the region (especially in the multisectoral approach during M A P Ias well as in community-based operations) the Bank, incollaboration with UNAIDS, can help Benin harmonize donor contributions, develop and consolidate a multisectoral approach, promote strong coordination under SPICNLS, and support development o f unified monitoring and evaluation arrangements. The Bank would therefore be instrumental in assuring the effectiveness o f the "Three Ones" principles. In addition, the World Bank's experience in community mobilization would help accelerate the prevention activities, especially among young people, high-riskgroups, and vulnerable populations. 16. Although the partners have been important in financing the fight against HIVIAIDS, commitments beyond the year 2006 are insufficient, leaving a large gap between the needs estimated in the draft Strategic Plan 2006-10 and the funds committed (the need estimates, exceeding US$240 million, are further analyzed in Annex 9). Except for the Global Fund which has committed a total o f US$68 million until 2010, only four other contributions are certain: US$4 millionper year until2008 by AfDB; US$.88 million until 2010 by Denmark; US$7 million until 2010 by USAID; and US$45.6 million until 2010 by Global Funds for five countries (Abidjan-Lagos Corridor). Thus the gap amounts to some US$160 million for the period 2006-10. The Global Fundplans to finance mainly the activities o f the Ministry o f Heath, and therefore the major gaps are in all other activities, such as: (i)the public sector, private-sector and community-based programs to prevent HIV/AIDS; (ii)psychosocial, economic, and physical care and support o f persons infected and affected and o f vulnerable groups (including sex workers, and orphans); (iii)national and local-level coordination and programming; and (iv) monitoring and evaluation. The most critical gaps have been identified and quantified during project appraisal. If the gap still exists after the Government's efforts to engage enough partners, the Government i s expected to adopt an evenmore targeted approach, focusing on the epicenters o f the disease. 17. With the planned IDA financing o f US$35 million over the next four years, the proposed project would fill nearly 20 percent of the funding gap estimated in the national strategic plan. As inthe past, the World Bank Group's funding and involvement inthe fight against the pandemic would assist to attract additional funds from other development partners. 3. Higher-level objectives to which the project contributes 18. The project would directly support the Government's objectives in its fight against HIV/AIDS. Because o f the World Bank's comparative advantages, especially through its involvement in various sectors in Benin and experience in support to decentralized community-based projects, and in the HIVIAIDS sector, M A P I1 would be an important 5 instrument for the Government inits national effort to fight HIV/AIDS and poverty in a truly multisectoral and community-oriented manner. 19. The current Country Assistance Strategy (CAS) echoes the Government's priorities and has listed HIV/AIDS as a major problem that could, if not addressed, have disastrous consequences for Benin's development and poverty reduction objectives. The CAS indicated that prevalence rates were considerably higher for women than for men among the 15 to 24 age group (2.2 versus 0.9 percent) and emphasized that potential future projects must address the gender issue. The CAS also suggested that it was possible to maintain a low prevalence rate through 2015, assuming full implementation o f the national strategic plans and a multisectoral approach. B. PROJECTDESCRIPTION 1. Lendinginstrument 20. The lending instrument proposedfor the project is a Specific Investment Loan (SIL), provided as a Credit. The Country Financing Parameters, approved on May 12, 2005, allow for up to 100 percent financing o f HIV/AIDS projects, including taxes. The financing parameters also allow for recurrent cost financing where required, provided that the implications o f recurrent cost financing on Benin's fiscal situation and debt sustainability are taken into consideration. 2. Programobjectiveand key indicators 21. The development objectives o f the proposed project are derived from the country's strategic plan for fighting HIV/AIDS and its effects, and for preventing the further spread o f HIV/AIDS by means o f a multisectoral program approach. They are essentially similar to those under the predecessor project. Thus, complementing the activities financed by other sources, the purpose i s to help Benin's Government implement its new 2006-2010 National Strategic Framework for boosting its national response to HIV/AIDS by contributing to increase and improve the coverage and utilization o f prevention services, treatment and care for specific high-riskand vulnerable groups. More specifically, the project will contribute to: (a) strengthening access to and increasing utilization o f prevention services for vulnerable groups (women, youth, etc.) and the high-risk groups such as the commercial sex workers and staffs o f some key ministries; (b) improve access and utilization o f treatment and care services for HIV/AIDS infected and affected persons, notably those living with HIV/AIDS (PLWHA), and orphans and vulnerable children (OVC); and (c) consolidate the coordination, management, and the monitoring and evaluation of the national response to HIV/AIDS. 6 22. Key performance indicators to measure the achievement o f the development objectives are as follows: Component One: Social Mobilization and HIV PreventionServices 1. Number o f subprojects financed targeting vulnerable populations, high risk groups and geographic hot spots. 2. Number o f public sector organizations supported and implementing HIV interventions. 3. Number o f persons reached with community outreach and support and IEC/BCC programs. 4. Number o f condoms sold/distributed. Component Two: Access to Treatment, Care, and Impact Mitigation Services 1. Number o fpeople with advanced HIVinfection receivingARV combination therapy. 2. Number o f people with advanced HIV infectionreceivingpsychosocial care. 3. Number o f PLWHA receivingnutritional support. 4. Number o f pregnant women receiving a complete course o f ARV prophylaxis to reduce the risk o f mother to child transmission o f HIV. 5. Number o f orphans and other vulnerable children whose households have received care and support inthe last 12months. Component Three: Coordination,Management, and Monitoringand Evaluation 1. Annualjoint workplan review andwork planning exercise by all donors (under the coordination o f SP/CNLS. 2. Number and Percentage o f CDLS andmunicipal committees operational. 3. Number o fpersons trained inHIV service delivery. 4. Percentage and number o f implementing agencies (public sector and civil society) submittingtimely quarterly monitoringand financial reports. 3. Project components 23. M A P I1would contribute to the national program within the annual action plan and budget using subproject grants and quarterly allocations, as appropriate. The project would act as "the lender o f last resort," i.e. the project support would be provided to activities inthe national strategic plan that are not covered by other financiers or are covered partially. Inthe allocation o f funds, the comparative advantages o f Bank-financed HIV/AIDS projects would be taken into account (see Section A.2). Although preventive and support actions are necessary for the entire population, the project would specifically reserve some funds for targeting high-risk and vulnerable groups such as PLWHAs, orphans, children, and sex workers. On this basis the project would contain the following components, which are similar to those inMAP Iand are further described inAnnex 4. Component 1: Social Mobilization and HIV Prevention Services 24. This component would provide funds for further scaling up o f HIV/AIDS prevention efforts in Benin, particularly for activities relating to information, education, and communication (IEC) and engendering behavioral change, for care o f infected and affected persons, and for the social marketing o f condoms. Activities under this component will be 7 primarily carried out as subprojects by local communities, civil society organizations (CSOs), community-based organizations (CBOs), nongovernmental organizations (NGOs), and the private sector to support: (i) living with HIV/AIDS (PLWHA), vulnerable groups persons such as OVCs, youths, and commercial sex workers; and (ii) to provide psychosocial and economic support to infected and affectedpersons. Support will be providedto some targeted key non-formal sector groups, such as the motorbike taxi operators who (by virtue o f their business) may be vulnerable to HIV infection, or groups such as the young female vendors along the roads who sometimes also engage inclandestine commercial sex work. 25. Support will also be provided to the public sector through financing their action plans (especially the five key ministries such as the Ministries o f Defense and related uniformed personnel, Education, Youth and Culture, Family, Women and Children, and Agriculture) that deal with groups that are considered vulnerable and can also contribute significantly to behavior change. The vulnerable groups have been defined by the SP/CNLS personnel, and the criteria for them will be included in the project operations manual to ensure that they meet the requirements o f the national strategic framework and that they are clearly understood by all stakeholders. It will also be necessary to ensure that there i s no duplication o f activities funded by the Global Fund. Thus, all funding proposals will need to indicate other sources o f financing for the proposed program, which areas or activities are being addressed by the Global Fund, and which ones will be addressed specifically by the World Bank financing. Component 2: Access to Treatment, Care, and Impact Mitigation Services 26. Under this component the project will complement funding provided by the Global Fundand other financiers and provide support to targeted activities with the view o f helping the country achieve the ultimate goals o f care and treatment o f HIV/AIDSinfected people, as spelled out in the national HIV/AIDS Strategic Framework 2006-2010. The component will be implemented by the Ministry of Health's National HIV/AIDS Control Program (PNLS). Activities will cover the following main areas: 27. Prevention. The project will finance: (i)the establishment o f new voluntary counseling and testing centers, the acquisition o fmaterials and reagents needed intesting, the purchase o f equipment to testing laboratories, and training o f their staff; (ii) the strengthening o f the health-sector staff capacity inprevention o f mother-to-child transmission management; (iii) support to safetyofbloodtransfusionbyequippingbloodbankswithlaboratory the equipment and by acquiring two mobile laboratories to support the implementation o f health advanced strategies; (iv) the promotion o f the methods o f diagnosing and treating STIs among highrisk groups and procurement o f drugs, reagents, other materials, and condoms for prevention and treatment o f STIs and opportunistic infections; and (v) the implementation o f activities underscored inthe Clinical Waste ManagementPlan (CWMP). 28. Treatment and care. The project will finance: (i) procurement of ARV, related the drugs, reagents, consumable materials, and other requirements for treatment o f HIV patients; (ii) support to capacity buildingactivitiesfor healthstaff at all levels ofthe health the pyramid for diagnosis, care and treatment o f STIs, HIV/AIDS and Opportunist Infections, as needed; (iii) the restructuring o f selective health facilities in order to facilitate the integration o f HIV/AIDS related activities (VCT, care and treatment) to other basic health services such as Antenatal Care (ANC), TB and Malaria; (iv) the nutritional care for infected and affected persons, including children, and o f training in sound nutrition practices to PLWHA; and (v) the improvement o f the quality o f treatment facilities. 8 29. Research. The project will support: (i)the strengthening o f epidemiological surveillance, monitoring and evaluation o f health activities; (ii) the operational research, strengthening o f collaboration between traditional and modern medicine; and (iii)the promotion o f research on plants used for traditional medicines and on their potential usefulness intreatment o f STIs, Oh, and HIV/AIDS. Component3: Coordination, Management,andMonitoringandEvaluation 30. Various studies have concluded that the coordination mechanism under the SP/CNLS was short o f staff and resources to lead the nationwide fight against HIV/AIDS. The project would provide funds to strengthen the SP/CNLS so it can carry out its role, especially in coordinating and harmonization o f HIV/AIDS operations and implementingthe "Three Ones" principles. For one element o f the "Three Ones"-a nationally functioning monitoring and evaluation system-UNAIDS and GAMET have jointly financed development o f the national M&E framework that was completed in early 2006. The project would help finance the implementation o f a national M&E system using the national framework inthe country. 31. The project will support further strengthening o f the health information and surveillance systems, including the use o f information for decision making. The project will provide support for: (i)periodic behavioral and biological surveillance among general population and high risk groups; and (ii) periodic surveys on service quality, and analytical worklimpact evaluations at midterm and end o f project. Inorder to ensure effective targeting o f high risk groups, the project will conduct vulnerability mapping and special research to appropriately define and stratify high risk groups and their locations and other operational research to ensure appropriateness o f behavior change messages and increased awareness on how to access services. 32. Furthermore, the project would support capacity building in SP/CNLS and decentralized units (regional and local committees). This component would also support project administration (PA) and management, including capacity strengthening and policy and technical support, management and advocacy training, and the operating expenses, as well as recruitment o f a financial management agency to ensure effective flow o f funds to subprojects. Project administration will be placed under the direct tutelage o f the Permanent Secretary with a project administrator who will report to the Permanent Secretary. 4. Lessonslearnedandreflectedinthe projectdesign 33. Main lessons from Analvtical and Advisory Activities (AAA). In 2005 the World Bank's Operations Evaluation Department (OED) carried out an evaluation o f multisectoral HIV/AIDS projects (MAP) in Africa. OED concluded that the MAPs, in general, played an important role in scaling up the fight against HIV/AIDS. It also pointed out that the MAPs contributed to setting priorities among the national HIV/AIDS strategies and in emphasizing a need for cost-effectiveness and results. The report also revealed that the individual country M A P was based on insufficient analytical work and that coordination and monitoring and evaluation (M&E) are weak. Lessons from implementing MAP projects presented in the World Bank's "Turning Bureaucrats to Warriors" were adapted for the Benin context and have been integrated inthis document. 9 34. Experience from the Benin social sector has shown that strong coordination, comprehensive and systematic monitoring, and supervision are particularly essential because there are so many participants in the health and HIV/AIDS sectors (i.e. public, private, and religious sectors, external donors, local leaders, beneficiary groups, and decentralized civil servants). 35. Lessons from the previous proiect (MAP VPPLS). The Analytical and Advisory Activities (AAA) studies conducted in Benin and other studies, including the project ICR, have confirmed the positive impact o f PPLS (MAP I) Benin. An important lesson i s that in persons infected with and affected by HIV/AIDS can be reached successfully through community mobilization and the use o f multiple channels. The process i s demanding as hundreds o f civil society organizations must be involved and trained (652 under M A P I), thousands o f community-based groups established (3,137), national and local associations for people livingwith HIV/AIDS(PLWHAs) established and supported(33) and nearly all o f the government's administrative infrastructure engaged; but it can be done with good planning and management and with innovative approaches. MAP Iwas the main financing source for HIV testing in the whole country, facilitating the test for 202,000 persons (1,223 o f whom tested seropositive). It supported capacity building in the health sector, provided equipment for health centers, and even financed provision o f ARV drugs toward the end o f the project. The same component also provided sensitization and other services to the staff infected with or affected by HIV/AIDSin40 non-healthpublic ministries and agencies. 36. Africa-wide studies and Benin-specific assessments, including the ICR o f MAP I, have similarly pointed out the weaknesses in coordination and M&E. The PNLS (MOH) and various bilateral agencies and NGOs implemented their own programs without coordinating with CNLS, while the Global Fund program was supervised by a separate Global Fund committee with no involvement o f the CNLS or its Permanent Secretariat. A unified M&E system for HIV/AIDS was developed throughout the whole project phase, which is now ready for use, and will be adjusted as necessary under this project. Whereas responses by some public-sector agencies, such as those o f the Ministries o f Defense and Youth, were effective, responses by others were weak. All these shortcomings are either being corrected or will be addressedby this repeater project. 37. Monitoring and Evaluation at the national level is now better defined and streamlined through the development o f one agreed national M&E framework and operational plan. Specific to the project, three levels o f outcome indicators have been identified to track results related to: (a) increase in service availability and utilization of services; (b) improved HIV/AIDS knowledge and risk reduction behavior among target populations; and (c) improvement in donor coordination and harmonization. In addition, impact analysis will be conducted during the life o f the project to further generate information on its achievements. 38. ' Key lessons learned from M A P Iare that: (a) the participatory approach works well and the communities are very engaged in the self-evaluation process for sub-projects and community action plans; (b) community engagement for the promotion o f HIV testing was widely accepted and generated overwhelming demand for testing at the health centers, which were, however, not well-equipped to respond to the rapidly increasing demand; and (c) stigma reduction is possible and was accepted by communities through appropriately designed messages disseminated through public service messageson TV and radio. 10 39. Although project results were encouraging, it i s too soon to assess their impact. However, the ICR mission carried out in September 2006 confirmed that because the project development objectives were attained and outcome and output objectives reached or exceeded, the impact o f M A P Ii s promising. DuringMAP 11, it should be possible to better assess the impacts o f M A P I, because o f the new nationwide M&E system and because partly the indicators under M A P I1would be similar to those used under M A P Iand allow for identification o f changes inbehavior resulting from M A P Iinterventions. 5. Alternatives considered and reasons for rejection 40. N o new project. Because several other donors are active in the HIV/AIDS sector in Benin, the first alternative considered was to have no follow-on project for M A P I. However, although the commitments by other donors, especially the Global Fund, are substantial, they cover less than one-half o f the needs estimated by the Government in preparing a four-year request to the Global Fund. As explained earlier, the World Bank's contribution will still be necessary, not only for supplementary financing, but also as encouragement to other donors to continue their commitments, which ended in2006. 41. Shared fund. The second alternative considered was an approach under which all contributions would be placed into "a shared fund." However, the appraisal mission considered this approach to be impractical at this stage because the donors are not yet willing to release their funds into a common basket and because the Global Fund program i s too advanced to retreat in its arrangements. At the same time, all donors have expressed a willingness to work under a common strategy and program and under a common oversight o f CNLS. They have also indicated that planning, implementation, and M&E could be carried out within a future nationwide program. 42. Financing through PRSC. Increasing the amount o f the Poverty Reduction Strategy Credit (PRSC) to facilitate the need to scale up HIV/AIDS control was analyzed, but it was also rejected. HIV/AIDS i s already an integral part o f Ministryo f Health strategy and as such i s included in PRSC. However, given the multi-sectoral aspects o f the HIV/AIDS control program, the impact o f unfavorable economic environment leading to a drastic cut in the budget as has been the case during these past years, both the Government and the Bank acknowledged that budgetary constraints will not permit an effective scaling up o f the HIV/AIDS operations. Separate financing would take into account the technical specificities o f HIV/AIDS control, give greater flexibility, and boost HIV/AIDS response to achieve tangible results in the four-year period of the follow-on project. This would also reduce the risks for the program implementation should PRSC progress be slower than expected. 43. The selected alternative i s a specific investment project (Credit) that would support investments, essentially similar to those under MAP Ibut in different proportions, with the intention o f filling the investment gap left by other financiers or donors, including those in the formal health sector (National HIV/AIDS Control Program - PNLS). The project would contain a substantial element o f a program approach inthe sense that it would be carried out under the overall oversight o f CNLS and would support implementation o f the "Three Ones" principles. A significant part o f project funds would go as grants to subprojects proposed by civil society organizations, including the private sector. Carefully selected and well- performing public-sector agencies that are less supported by other donors also would get funds to finance their strategic plans against HIV/AIDS. The project would also target some 11 funds to reach high-risk and vulnerable groups such as orphans, other children, and sex workers, and support capacity buildinginCNLS and regional and local committees. C. IMPLEMENTATION 1. Partnershiparrangements 44. Activities bv other partners. Numerous partners have joined in the fight against HIV/AIDS in Benin. Besides the World Bank Group, the partners include the Global Fund, which is the largest contributor in 2006 with about US$17 million. United Nations agencies (UNICEF, UNDP, WHO, UNAIDS,UNFPA, and WFP) also are expected to participate with smaller amounts directed to specific geographic/administrative areas; their annual allocations range from US$40,000 to US$110,000. In addition several bilateral partners, including the USA (USAID), France, Canada, Germany, Belgium, Switzerland, and some international NGOs (PSI, Africare, Care International, MSF, MDM, APH, GIP-ESTHER, SOLTHIS, etc.) have supported complementary interventions in specific geographic/administrative areas, with allocations ranging from US$70,000 to US$1.95 millionper year (see Annex 2). 45. Altogether these interventions have achieved substantial results: (a) more than two- thirds of the health centers are providing mother-to-child transmission prevention services; (b) nearly 100 percent of blood transfusions are tested for HIV; (c) condom use has significantly increased within the high-risk groups such as sex workers; (d) the number o f patients receiving ARV treatment has risen from 430 in July 2003 to 8,087 in 2006; and (e) the number o f patients treated for sexually transmitted diseases (STI) has significantly increased. However, although the contributions by external agencies are important, they are still inadequate to meet the needs in the sector, which i s estimated at US$160 million during the planning period2006-2010 (as mentioned in Section A.2). 46. Issues renardinn potential partnerships and cofinancinn. Although all partners agree on the need to promote the "Three Ones," the other partners are not yet ready to pool funds under one program. However, they are willing to plan annual activities and budgets together under the guidance of CNLS, as well as to participate injoint implementation supervision missions (this practice already started during M A P I). Inother words, they have accepted a program approach, but with earmarked funds. Further coordination opportunities include: (a) usingcommonimplementation channels for project/program implementation, (b) carrying out joint annual reviews, and (c) performingjoint fiduciary assessments. However, there are still challenges anticipated with the partnerships, including several partner interventions that have recently ended or will soon end. The closed projects include the successful SIDA 3 Benin project supported by CIDA that has worked with commercial sex workers and their clients since 2001 and the Population Service International (PSI) program on social marketing o f condoms among youth which will close at the end of 2007. The experiences of these programs are being incorporated into M A P I1to ensure continuation,of the key lessons and experiences on behavior change communication. 2. Institutionaland implementationarrangements Institutionalarrangements 47. The organizational setup o f the project would remain as it was during the predecessor project. M A P I1would be placed under the oversight o f the National HIV/AIDS 12 Control Committee (CNLS), the highest HIV/AIDS coordination body in Benin, which also oversees other HIV/AIDS projects and programs. CNLS consists o f representatives o f the public and private sectors and civil society organizations, and operates under the direct authority o f the President o f the Republic. It comprises three main bodies: (a) a decision- making plenary assembly; (b) a Permanent Secretariat, a technical and multisectoral unit; and (c) a consultative group composed o f the Vice Presidents, the Permanent Secretariat and donors (see details in Annex 6). The project would help strengthen the secretariat and field organization o f CNLS, including support to a unified and national monitoring and evaluation system (see the proposedcomponents in Section 4 (d)). CNLS has established a decentralized setup consisting o f multisectoral committees at the departmental, commune, "arrondissementy' and local levels, which would support project activities, help review, and approve HIV/AIDS activities in their respective administrative areas as authorized. (More informationon CNLS and the structures and procedures appears inAnnexes 6,7, and 8.) 48. While SP/CNLS would oversee the new project, it would not be responsible for daily operations. However, given that the Permanent Secretariat o f CNLS (SP/CSNL) will be the actual representative o f the credit recipient, i.e. the Government, the Permanent Secretariat will be the mainauthority v i s - h i s the Bank andthe Government. 49. The operational management o f the new project would be carried out using the type o f staff recruited under MAP I,with some minor modifications, to complement the existing staff capacities in the SP/CNLS. Project funds would be used to hire a few private-sector professionals and consultants, but would be included in the SP/CNLS staff. Like CNLS, Project Administration (PA) would have no execution functions. Its role would be to (i) provide leadership for project implementation; (ii) develop the annual work programs and budgets for approval o f CNLS and the World Bank; (iii) subcontract implementation of project activities to public-sector agencies and private and civil society organizations; (iv) oversee the monitoring and evaluation o f project operations, supervision o f the Financial Management Agency (FMA) (see the section on Implementation arrangements), and regular submission of data to the CNLS M&Eunit; and (v) prepare periodic reports to CNLS and the World Bank. The PA would also provide technical assistance and make sure that project activities are carried out efficiently and in accordance with agreed-upon procurement and other procedures. The P A will comprise mainly o f a Project Coordinator, a Health Specialist, a Social Mobilization Specialist, a Monitoring and Evaluation Specialist, a Chief Accountant, an internal Auditor, and a Procurement Specialist. 50. Ministry of Health. M O Hhas the mandate to oversee all health-related aspects o f the HIV/AIDScampaign in the country, including implementation of the activities financed by the Global Fund.M O H would receive M A P I1funds to supplement the resources provided by the Global Fund on the basis o f annual plans and budgets approved by CNLS. The implementation of the technical activities depending on MOH will be monitored by the National HIV/AIDS Control Program (PNLS). The Procurement Unit o f the Ministry would take care of all purchases o f medicines and medical equipment. (The details o f the MOH activities financed by the project are given inAnnex 4.) ImplementationArrangements 51. Much o f the project would be implemented through subprojects initiated by CSOs, CBOs, NGOs, private-sector entities, faith-based organizations, and others engaged in fighting HIV/AIDS.ARV medications and medical supplies would be purchased through a central procurement system supervised by MOH. The project would contract out a local 13 financial management agency for the entire process o f financial assistance to CBOs and NGOsthat implement social mobilization activities, and this agency would act as a financial intermediary. Other project activities would be carried out by the beneficiary agencies, such as selected ministries, subproject units themselves, or their support organizations that have been granted funds from project resources. 52. Subprojects inthe field would be approved and implemented in accordance with the procedures developed and fine-tuned under M A P I.Interested organizations (village organizations, NGOs, civil-society organizations, etc.) would draft a community action plan or subproject plan and financing application. Regionally experienced NGOs, confessional agencies, traditional associations, and private-sector organizations could provide technical support for these tasks, if necessary. The applications would be reviewed and approved or rejected by the CNLS' decentralized units (village, communal, or regional HIV/AIDS committees) in accordance with the size o f the proposed subproject and the authorization level o f the respective CNLS unit. The regional staff o f the financial management agency mentioned above would provide assistance in progradsubproject development, accounting, disbursement o f finds for community-level plans, financial reporting, and perhaps even monitoring o f implementation o f subprojects or community action plans. As mentioned, the organizations that initiate the action plans or subprojects would be responsible for implementing them. SP/CNLS and the contracted financial agency would ensure that all participants in the process follow the procedures o f the Operation Manual and agreements with the World Bank. All the relevant project implementation entities (CNLS and its decentralized units, PA, FMA) will have the right to inspect, by themselves, or jointly with the Bank, if the Bank shall so request, the goods, works, sites, plants and construction included in the subproject, the action plan, the operations thereof and any relevant records and documents. Inaddition, these entities will have the right to suspendor terminate the right o f the relevant CBO, CSO, and public sector organization (PSO) to use the grant for the subproject upon failure by the relevant CBO, CSO, and PSO to perform any o f its obligations under the Credit Agreement. 53. Because some vulnerable groups are not well organized or organized at all, the project would help them organize themselves (as was done in the past for PLWHA). Secondly, the project would proactively call for proposals from organizations and agencies working with the identified vulnerable and high-riskgroups. 54. Other implementation aspects. Modalities for carrying out finance, procurement, and disbursement activities are detailed inAnnexes 6, 7, and 8 and the respective sections o f the Operations Manual. 3. Monitoring and evaluation of outcomes/results 55. Status o f National Monitoring and Evaluation System: Project-specific monitoring was carried out duringthe M A P Iessentially as intended, but without the benefit o fa national M&E system to guide national M &E efforts and activities. In recognition of this and to initiate the process o f developing a national M&E System, M A P Isupported the recruitment o f a local firm to work with CNLS and partners to develop a national M&E framework for the country. To further support the process, UNAIDS and GAMETNB jointly recruited another local consultant, placed under the direct supervision o f the UNAIDS Country Coordinator, to ensure that key requirements and processes (including indicators) are aligned to the National Response and international reporting requirements and reflect the specific situation o f the country with respect to evidence-based targeting o f high-riskgroups such as 14 sex workers. Through all o f these efforts, the draft national M&E framework was completed and validated in April-May 2006. The requirement o f the M&E system is now ready for implementation, which will commence at the sub-national levels in January 2007. The national M&E indicators will be reviewed annually innational M&Emeetings o f all partners, donors and stakeholders, and the indicators for the project may be further re-aligned based on the outcomes o f national M&Ereviews. 56. Monitoring and evaluation o f progress toward project objectives will rely on a combination o f routine health services data, monitoring data on HIV/AIDS program activities, periodical behavioral and biological surveillance surveys and periodic surveys on the coverage and quality o f services. Local research institutes will be subcontracted to conduct evaluations and operational research. The Bank will also undertake linked impact analysis/evaluation studies to further generate evidence o f project outcomes and impact. The project will support efforts to further improve reporting at the decentralizedlevels and the use o f data for improved decision making both for health sector and multi-sectoral HIV/AIDS activities. Technical capacity and oversight for monitoring and evaluation at the central and decentralizedlevels will be further strengthened. 57. Routine Program Monitoring; at the National and Decentralized Levels: The national HIV/AIDS program is the ultimate responsibility o f the CNLS. The SP/CNLS, through its strengthened M&E unit and the decentralized structures (CDLS, CCLS), will be responsible for implementing and coordinating the national M&E system. Coordination activities (data analysis and sharing) and supervision will be covered by the CDLS action plans. The M&E unit will be incharge of implementinga system for reporting data and usinginformationfor managing the national program in the context o f the "Three Ones" principles, and also for specific monitoring o f the M A P I1project. Financial monitoring will be done by the FMA under the supervision of the SP/CNLS financial unit, through its central and decentralized units. Technical and financial monitoring will be linked, and the decentralized FMA units will therefore need to work closely with the CDLS and the CCLS. The progress achieved under M A P Iin tracking project progress at the community level will be reinforced and the SP/CNLS will explore the appropriateness and possibility o f contracting out a "community monitoring mechanism" for on-going supervision and quality assurance at the community level to NGOs already trained under M A P I. 58. Itis envisaged that an adequate amount of the total programcost will be allocated to M&E; however, a good portionofthese outlays will be financed under other components, for example: (i) second-generation surveillance o f target groups and costs o f the sentinel surveillance systems will be financed under Access to Treatment and Care component; and (ii) "community monitoring" mechanismcouldbefinancedbytheSocialMobilization the Component. The remaining expenses will be financed under the present subcomponent, which will cover the "machinery" o f the M&E system: equipment for data processing and logistics, recruitment o f competent human resources, technical assistance, training and workshops, supervisory missions, coordination activities, and M&Eoperating expenses. 59. Euidemiolovical Surveillance (Biological, Behavioral, and Combined) and Operations Research: The project will support epidemiologic surveillance and operations research for tracking o f epidemic drivers and trends in order to ensure effective targeting o f HIV prevention efforts. Because the epidemic is currently generalized in Benin, epidemiological surveillance will cover the general population as well as "bridge" populations and high-riskgroups. The project will support (i) expansion o f the population for surveillance through a vulnerability mapping exercise to identify additional groups to include in surveillance, and to refine the targeting of intervention groups and geographic hot spots; and (ii)operational research based on a priority agenda and coordinated activities to produce a database o f research outcomes. 60. The Epidemiological Surveillance component is well supported through the new fiffh-round project o f the Global Fund.The IDA Credit will provide funding for (i) biological surveillance o f CSW; (ii) second-generation surveillance; and (iii)dissemination o f epidemiological reports. 61. Constraints and Challenges to be addressed in transitioning; M&E responsibility to CNLS: With the transitioning o f overall project implementation to CNLS, several challenges have been identified which, if resolved, would aid successful implementation o f the national M&E system and effective results tracking and reporting of the MAP I1 project. These inadequate staffing of the M&E unit o f the SP/CNLS and weak capacity o f existing staff; SPKNLS staff lack experience with procedures and lessons learned in managing and monitoringM A P projects; lack of direct collaboration between the decentralized units of the CNLS and the FMAlocaloffices; decentralizedunitso f the CNLS are not operational (lack o f staffingand dedicated human resources to conduct monitoring operations). In order to address these challenges SP/CNLS will: (i) defineimplementationframeworksforthesubsystemsneededfortracking projects managed by the SPKNLS in order to avoid duplication o f reporting and to make project interventions traceable; (ii) establishaclearoperationalframeworkforroutingdata(dataflow) from the community to the central level; (iii) upgrade data processing and analysis and use the information for management and decision-making by field personnel and the central and decentralizedentities; (iv) strengthen the subsystems that will feed into the national system and enhancing the quality o f interventions by improving standards and technical protocols andprovidingadequate supervision and training; and (v) improve the management o f national response at the decentralized level by strengtheninginstitutional capacities. 4. Sustainability 62. Government commitment and ownership. The Government and other stakeholders are strongly committed to fighting the threatening HIV/AIDSpandemic. Inrecent years, the Government has increased its budgetary allocation for the fight against HIV/AIDS to about US$3.6 million, still a modest amount compared with the needs in this sector. For the predecessor project, Benin met the conditions o f participation in the World Bank's multisectoral program for Africa, and it has now met the conditions set for repeater projects inthe sector (see Section A.l), including development o f a unique, national, fully functional M&E system, which is ready to be implemented for MAP I1and other donors' projects and programs. The national strategic framework for 2006-10, along with an operational plan in the form o f a national program with unifiedM&Eindicators, is also ready. 16 63. Although the Government has been committed to fighting HIV/AIDS, two main problems remain: (a) insufficient funding to the Permanent Secretariat o f CNLS at both central and decentralized levels; and (b) insufficient coordination o f all HIV/AIDS-related activities by the Permanent Secretariat o f CNLS, although it has been recognized as the sole authority. An institutional analysis has been done as part o f the revision o f the national strategy framework, and recommendations to correct identified weaknesses would be acted on under the MAP 11. 64. Sustainability. The extensive capacity and institution buildingthat took place during the past four years, largely facilitated by MAP I,provides a basis for organizational and institutional sustainability, provided that continued financing i s forthcoming. However, Benin being one o f poorest countries inthe world, its Government can provide only a fraction of the costs needed to effectively fight HIV/AIDS. For the foreseeable future, there i s general understanding within the international community that an effective and sufficient response to the epidemic depends largely on the sustained financial support o f multilateral and bilateral agencies. However, as noted earlier, the Government has already started to increase its own financial contributions for the fight against HIV/AIDS and duringreview and approval of the National Strategic Plan for HIV/AIDS. The Government also indicated that it will further increase its funding for the purpose. In addition, means to reduce the costs involved in HIV/AIDS prevention, care, and treatment would need to be studied because reduced costs would make the entire campaign more sustainable. An example would be to get as many parents as possible tested, especially mothers, and if detected to be infected, include them into treatment groups to reduce the number o f future orphans. 65. Social sustainability. Social sustainability i s based mainly on two aspects: (a) all stakeholders have been incorporated into the various oversight, advisory, and decision- making bodies relating to HIV/AIDS; and (b) a huge network o f local committees has been established and trained under the predecessor project. The follow-on project would continue their involvement inproject-financed operations and even cover those villages that were not involvedinM A P I. 5. Critical risksandpossiblecontroversialaspects 66. Risksrelating; to development objective. All partners and stakeholders have accepted the general approach o f the fight against HIV/AIDSinBenin,butthere are potential risks: the CNLS has too little staff, donors tend not to fully accept the authority of the strengthened CNLS and implement activities outside their sphere o f knowledge, and uncertainties remain about the extent to which the M&Esystem needs further improvement (see table below). 17 Other Relevantrisks Risks Risk Risk-Mitigating Measures Rating PNLS under MOHhas traditionally S The project would provide policy and carried out its own programs and i s now financial support to CNLS to supportedby the management unito f the strengthen the agency at all levels. Global Fund.Itmay be difficult for CNLS would only require from PNLS PNLS to accept the oversight role o f the that it would, like other HIV/AIDS smaller and newer organization (CNLS); projects and programs, submitits this friction couldreduce the effective annual action plans for CNLS review use o f HIV/AIDS funds. and approval, and provide data for the uniform M&E system. Also, GFATM portfolio manager and CCM staff shouldbe included as participants in MAPI1supervisionmissions. Ifnationalleadership underCNLS cannot S Itisvital to strengthen the leadership be strengthened, there is a danger that o f CNLS at all levels, to require the activities would be spread thinly across project administration unitto fund municipalities rather than be distributed only effective subprojects, and to inaccordance withneed-basedcriteria. target funds adequately to high-risk The results would be highrelative costs groups. The Permanent Secretariat o f and inadequate targeting to high-risk CNLS should become the body groups. making agreements for distributing funds for all activity groups relatingto HIV/AIDS. Ifthe M&Esystem shouldcontinuetobe M All stakeholders have now agreedto a weak, it would be unable to provide the single national framework which leadership and management with includes international, national and adequate information to modify the sub-national results tracking and course o f actions when needed. reporting requirements and will report to CNLS usingthe same format. The results arrangement for the project complies to this agreement andproject levelM&Ecould, through improved follow-up and supervision, facilitate progress inthe national M&E system. Legend: H-Highrisk; S -Substantialrisk; R, .Moderaterisk;N-Low or negligible risk 18 6. Creditconditionsand covenants Conditionsfor effectiveness 67. The effectiveness conditions consist of the following: The Recipient has adopted the updated Project Implementation Manual, the Administrative, Accounting and Financing Manual, and the Monitoring and Evaluation Manual, all inform and substance satisfactory to the Association. The Recipient has established the PA in a manner and with functions and resources satisfactory to the Association, and with the following staff: a Project Coordinator, a Health Specialist, a Social Mobilization Specialist, a Monitoring and Evaluation Specialist, a Chief Accountant, an Internal Auditor, and a Procurement Specialist, all appointed in accordance with the provisions o f this Agreement. The Recipient has recruited an independent audit firm and the Financial Management Agency in accordance with the provisions o f this Agreement, both employed under conditions satisfactory to the Association. The Project Account has been opened and an initial contribution o f FCFA 20 million has been deposited therein to pay allowances to the SP/CNLS' civil servant staff. The Recipient has established an accounting and financial management system for the Project satisfactory to the Association. D. APPRAISAL SUMMARY 1. EconomicandFinancialanalyses. 68. Economic analysis on HIV/AIDS has been carried out under the Second Multi- Country HIV/AIDS Program for the Africa Region (Report No. P7497). It provides the economic justification for Benin M A P 11. The report concludes that HIV/AIDS reduces the value o f three important factors o f economic growth: physical, human, and social capital. The analysis inthe report includes an overall assessmento f the impact o f HIV/AIDS on economic development and the cost-benefit o f HIV/AIDS interventions, showing that a reduction in AIDS-related deaths would increase the growth o f GDP. As elsewhere in Africa, HIV/AIDS in Benin intensifies poverty because infected people have shorter economically productive lives. 69. The fiscal impact o f the project is expected to be modest. Only a small amount (US$l50,000) in cash would be required for Government counterpart, which will therefore not impose a financial burden on the Government. Civil works would be minimal and primarily restricted to the renovation o f laboratories in existing health centers and an administrative building for hosting the SP/CNLS. Because M A P I1 would finance the expansion, capacity building, and operating costs o f CNLS and Project Administration and staffing o f the Project Administration, some supplemental costs relative to the original project would be involved. As detailed in the "sustainability" section above, however, the international community is expected to finance most o f the response to the HIV/AIDS 19 epidemic for the foreseeable future. As also mentioned earlier, the partners have been helping to finance the fight against HIV/AIDS, but their commitments beyond the year 2006 are insufficient, leaving a large gap between the needs as estimated in the draft Strategic Plan 2006-2010 and the funds committed (the need estimates, which exceeds US$160 million, are further analyzedandpresentedinAnnex 9). 2. Technical 70. The design of the Benin M A P I1takes into account the experience gained during M A P I.The project identification team benefited from the UNAIDS Thematic Group in Benin for the project's technical content. The design follows the MAP principles and the national strategy against HIV/AIDS, which reflects a consensus among all stakeholders. The project has incorporated the best internationally accepted practices for HIV/AIDS responses as set forth inUNAIDS guidance on HIV/AIDS and inM A P guidelines o f the World Bank's Africa Region. These practices have been tailored to the Benin context in designing the project and in developing the M&E system. The M&E activities have been strengthened through the collaboration o f the World Bank and UNAIDS and will continue under the new project. 71. The UNAIDS Thematic Group would continue to advise the CNLS and Project Administration during project implementation. At all times the PA can apply for technical support from the partners o f the UNAIDS Thematic Group or from the UNAIDS Secretariat. Independentconsultants will handle annual technical audits. 3. Fiduciary 72. Financial management. The midterm review o f M A P I,subsequent supervision reports, and ICR have concluded that the financial management system o f the predecessor project has, ingeneral, worked satisfactorily. Also, the financial monitoringreports have been considered satisfactory and have been regularly submitted to the World Bank. Most o f the project activities have taken place in the field, and funds for their implementation have usually been disbursedon time. Annual audits by external auditors have beenunqualified. 73. A "Country Financial Management System" (Country FM system) that has been approved for Benin would be gradually implemented for the project as part o f the budgetary and public financial management reform o f the country. Under this system, individual projects would continue to have financial management and procurement units, but the Permanent Secretariat o f CNLS would have a central unit for these functions. This arrangement i s designed to improve efficiency and economies o f scale, and offers an opportunity to better coordinate these activities and carry out programming o f HIV/AIDS operations in general. (Each project would still have a finance officer with signature authorization.) It is uncertain how soon the Country FM system will be implemented. Therefore, for the time beingthe financial management system used for this project would be in line with the other IDA-financed projects in Benin (MAP I,ALCO, Malaria Booster Program). The project data would be recorded ex-ante into the Country FMsystem once it is implemented. The financial management capacity o f projects under CNLS and the competencies already available have beenanalyzed and are presented inAnnex 7. 74. During the project period, Benin should move toward "programmatic approach," includingconducting annual assessmento f the activities carried out duringthe past year, joint 20 review o f the findings with development partners and stakeholders, preparation o f an annual plan for the following year, and allocation o f funds from the project and other donors. 75. The project's financial statements would be audited annually by independent and qualified auditors acceptable to the World Bank, in accordance with International Standards o f Auditing. New auditors should be recruited prior to effectiveness. The audit report would be submitted to IDA not later than six months after the end o f each fiscal year. Financial management arrangements are detailed inAnnex 7 and inthe Operations Manual. 76. Procurement. Essentially the same procurement arrangements detailed in the Operations Manual for M A P Iwould be applicable for MAP I1 as well. The Operations Manual was reviewed at appraisal and its updating will be a condition o f effectiveness o f the project. Procurement operations under M A P Ihave been satisfactory. The main systemic concern noted at the 2005 midterm review, relatedto long delays inhandling the procurement process at the Ministry o f Finance and Economy, are apparently due to manpower shortages in the respective unit of the Ministry.The problems noted inMAP Iprocurement, such as shortcomings inthe local shopping processes, have since beenrectified. 77. As already mentionedunder the proposed "Country Financial Management System", the Permanent Secretariat of CNLS would have a special unit for financial management and procurement, while the individual projects would still have their existing financial and procurement officers. This system would also be applicable to MAP I1procurement. The procurement arrangements for MAP I1are explained inAnnex 8. 4. Social 78. The project i s expected to have a positive social impact by raising the awareness o f targeted high-riskand vulnerable groups (e.g., commercial sex workers, OVC, women, youth, the military including other uniformed personnel such as the police force, and students) and encouraging safe sex behavior among the community through large IEC programs. The social mobilization component o f the project should have beneficial effects in assisting and empowering individuals, communities, and CSOs to deal more effectively with the disease by: (i) increasing community awareness and accountability surrounding HIV/AIDS; (ii) addressing the critical needs/support to OVC and PLWHA in terms o f psycho-social and medical support; (iii) ensuring socio-economic support o f HIV/AIDS infected or affected households; and (iv) providing substantial support to targeted line ministries to implement their action plans. 79. ParticiDatorv Approach. The preparation process o f the Benin M A P I1was highly participatory with extensive work and consultation among the key stakeholders: CNLS staff, selected line ministryrepresentatives, PLWHA, representatives o f international and national NGOs, multilateral and bilateral donors, and resource people from other projects and programs which deal with particular HIV and AIDS challenges. Most important was the active participation o f PLWHA through the whole preparation process. During implementation, communities will develop their own priority HIV/AIDS action plans through a participatory diagnosis undertakenwith the support o f experienced NGOs. They will design and implement their own HIV/AIDSprevention activities based on these actions plans. Some targeted NGOs (principally those specialized in working with commercial sex workers) will buildprograms to support community efforts to reduce risky sexual behavior. CBOs, NGOs, associations, and line ministries will also participate by implementing their own action plans targeting their specific vulnerable groups. 21 80. Consultations or collaboration with NGOs or other civil society organizations were an integral part o f project design and are expected to play an active role in project implementation. They will provide capacity building support and will assist communities in the design, implementation, and monitoring o f community-led initiatives. NGOs as service providers ("`prestataires des services") are also likely to be involved in surveys and training o f trainers. The participatory approach used during the project identification and appraisal mission will be continued and expanded during project implementation, following the same approach as M A P I,whereby CBOs, NGOs, and PLWHA will be included on HIVIAIDS local steering committees for the review and approval o f subprojects. 81. Because the HIV/AIDS epidemic is still limited in Benin, its spread can still be curbed. In addition to disseminating information to the general public about the dangers o f HIV/AIDS and the measures that can be taken to avoid this disease, M A P I1i s designed to reach the groups most at risk, which include sex workers, orphans, other children, and infected and affected people. It will empower these groups to undertake HIV/AIDS prevention, care, and support activities, reduce transmission, and limit the severe socioeconomic impact o f HIV/AIDS, including stigmatization. Social-sector studies carried out, such as a sociological study on beneficiaries and new studies on sexual and socio- cultural behavior will be used to fine-tune project-financed activities to prevent and treat HIV/AIDS and other sexually transmitted disease, as well as to study the effect o f such diseases onpoverty. 82. The new national monitoring and evaluation system has been designed to ensure adequate targeting o f project activities, including social impacts. The project i s expected to have positive social effects for particularly HIV/AIDS-vulnerable populations and groups. The project's support for efforts to improve HIV/AIDS prevention, care, treatment, and mitigation in .all regions o f the country would enhance social development among underserved target populations. As already indicated, the project would contribute to destigmatization o f HIV-positive people, provide greater empowerment, inclusion, and security for vulnerable groups, and reduce gender inequities and discrimination. 5. Environment 83. The proposed project has been classified as Category B for environmental screening purposes given the risks associated with the handling and disposal o f medical and general health waste. This project is not expected to generate any major adverse environmental impacts. Possible environmental risks include inappropriate handling and disposal of hazardous medical waste, including sharp needles, and especially inadequate management o f the disposal sites in urban or peri-urban areas, where domestic and medical waste may be mixed and where scavenging is common. The project will help minimize the danger o f poor 22 segregation and disposal o f health care waste by financing the procurement and monitoring o f equipment (including incinerators) and facilities. 84. To address the potential negative impact consistent with the requirements o f the triggered safeguard policy, i.e., preparation o f an environmental assessment, the National HIV/AIDS Control Committee (CNLS) revised the Medical Waste Management Plan (MWMP) for MAP I to capture project objectives, components and implementation arrangements. The new MWMP for the proposed project makes adequate recommendations regarding capacity-building needs, training, and awareness building to ensure its proper and effective implementation. 85. Staff/personnel of all health facilities (public, private, religious and others) will be trained in the management o f medical waste to ensure that they utilize the same practices. The necessary equipment, additional materials and training expenses will be covered either through the MOHbudget or Component 2 o f this project. An environmental health specialist at the Sanitation Department o f the Ministry o f Health will be responsible for following up the MWMP recommendationsduringproject implementation. 6. Safeguards Policies 86. One safeguard policy was triggered by this project: Environmental Assessment (OP/BP 4.0 1). The appropriate safeguard instrument, the Medical Waste Management Plan was prepared. The MWMP was disclosed in-country and the Bank's Info Shop prior to appraisal. Safeguard Policies Triggered by the Project Yes N o Environmental Assessment (OP/BP 4.01) [X 1 [I NaturalHabitats (OP/BP 4.04) [I [X 1 Pest Management (OP 4.09) [I [X 1 [X 1 Cultural Property (OPN 11.03, beingrevisedas OP 4.11) [ ] Involuntary Resettlement (OP/BP 4.12) [I [X 1 IndigenousPeoples (OP/BP 4.10) [I [XI Forests (OP/BP4.36) [I [X1 Safety o f Dams (OWBP 4.37) [I [X 1 Projects inDisputedAreas (OP/BP 7.60)* [I [X 1 Projects on International Waterways (OP/BP 7.50) [I [X 1 7. Policy Exceptions and Readiness 87. The proposedproject does not require any exceptions from Bankpolicies onrepeater projects. After appraisal, the project i s considered ready for implementation, because M A P I was implemented satisfactorily and within the original schedule. By supporting theproposed project, theBank does not intend toprejudice thefinal determination of theparties' claims on the disputedareas 23 Annex 1:Country and Sector or ProgramBackground Benin: SecondMultisectoralHIV/AIDS ControlProject Country and DevelopmentIssues. 1. Benin has a population o f about 7.5 millioninan area o f 114,763 square kilometers. It is one of the poorest countries inthe world, listed as number 153 out of 173 inthe 2002 Human Development Report published by the United Nations. Because Benin is also one of the most indebted countries, it i s problematic to obtain additional investment. The incidence o f poverty rose from 26.5 percent in 1996 to 33.8 percent in 2002. Poverty varies substantially according to sex, type o f municipality, and region. About 56 percent o f the people work inagriculture. Life expectancy i s low, 59 years. 2. Administratively, Benin i s divided into 12 departments and 77 communes. The departments are: Atacora, Atlantique, Borgou, Couffo, Les Collines, Donga, Littoral, Mono, Oukm6, Plateau, and Zou. The number o f villages i s estimated at about 3,800. The Government's development strategy centers on fighting poverty. HIV/AIDS situation inBenin 3. Tropical diseases--malaria, infections of the respiratory system, and diarrhea--are the most common ailments inBenin, accounting for about 60 percent o f hospital or health-center consultations. In addition, there are frequent epidemics of such diseases as cholera and meningitis. Inrecent years, HIV/AIDS has become an increasingly important health problem. 4. Benin has a relatively low HIV/AIDS prevalence, estimated at 2.0 percent among the adult population between the ages o f 15 and 49, which translates into about 78,650 seropositive peksons in 2005. In 2005 there were 8,480 new cases o f HIV infection, 1,890 children born with HIV, and 8,270 deaths from AIDS-resulting in 36,740 orphans having lost their mother, father, or both. As is the case with poverty, there are notable differences between the regions, with the prevalence varying from 0.6 percent to 4.1 percent in 2005. This rate was highest in vulnerable groups such as commercial sex workers (25.5 percent in 2006), persons with tuberculosis (16.7 percent in 2004). Altogether 101,852 clients have attended VCT in 2005 and been tested; 70,391 pregnant women have received PMTCT services inante natal care clinic, where the sites are integrated; and 8,087 PLWHA are under treatment by ARV and 7.296 in the active list, are receiving care for IO. Safe blood transfusion i s 100 percent secured for HIV test only for 100,000 units. There i s a need for reagents for hepatitis B and C and more unitsto cover the country. 5. Ministry of Health. MOH has a mandate to oversee all health-related aspects o f the HIV/AIDS campaign in the country, including implementation of the activities financed by the Global Fund. The personnelinBenin for all medicalpurposes include about 1,025 doctors (one doctor for each 7,377 inhabitants), 3091 nurses (one nurse per 2,446 inhabitants), 5,450 midwives (one midwife per 1,3 17 inhabitants), and 435 laboratory technicians (one technician per 17,38 linhabitants). However, these overall figures hide the enormous differences between the regions. The Global Fund i s supporting some personnel as contractual to support VCT, PMTCT, care and treatment. 24 Government's obiectives and strategies inthe sector 6. Government's actions. The Government at the highest level continues to be strongly committed to the fight against STI/HIV/AIDS. Inrecent years the Government has increased its budgetary allocation for this fight to about US$3.6 million, but that amount i s modest compared to the needs inthis sector. In2000 the Government established the National AIDS Commission (`Tomiti national de lutte contre le SIDA" or CNLS) and appointed a Permanent Secretariat to coordinate implementation o f the HIV/AIDS program. A thematic group made up of representatives from the UNagencies, World Bank, and stakeholders was established under the auspices o f UNAIDS to advise the Government on developing and implementing its response to the epidemic. An institutional analysis has been done as part o f the revision o f the national strategy framework and the recommendations to correct identified weaknesses will be implemented under the M A P 11.A national M&E system was put inplace during 2006 and will demonstrate its efficiency during the first years o f the new project. Similarly, a new national strategic framework and operational plan, inthe form o f a national programwith unified M&Eindicators, was completed inMay 2006 (see below). 7. The first HIV/AIDS strategic plan. The Government has successfully persuaded many external and internal partners to finance the necessary HIV/AIDS programs, and substantial results have been achieved. Since 2002 Benin's development partners have offered strong technical and financial support. The biggest contributor has been the World Bank Group through PPLS, followed by the Global Fund (its second round), different agencies o f the UN family, and bilateral development partners such as USAID, the German KFW, and Canada (Project SIDA 3). The actions taken within the framework o f the HIV/AIDS Strategic Plan for 2002-2006 have concentrated mainly on (a) strengthening the prevention o f sexually transmitted, blood-transfusion and drug-injection-induced, and mother-to-child transmitted infections o f HIV; (b) improving the medical and psychosocial treatment and care o f people infected with and affected by HIV/AIDS, includingorphans; and (c) reducing the economic and social impacts of HIV/AIDS among the population. 8. Interventions directed toward selected themes have achieved substantial results. For instance, training o f health personnel has facilitated substantial expansion o f HIV/AIDS tests. Moreover, two-thirds o f the training in sanitation has related to the prevention o f mother-to- child transmission (MTCT) o f the human immunodeficiency virus, and 100 percent o f the blood donated for transfusions inmajor health facilities is tested for the virus. The rate o f use o f condoms has increased in high-risk groups such as sex workers. Most remarkably, the numberofAIDS patientsreceiving antiretroviral (ARV) drugsjumped from 430 inJuly 2003 to 6,000 by the end o f 2005. Inaddition, the number o f persons treated against opportunistic diseaseshas increased every year. 9. The first IDA-financed multisectoral AIDS project (MAP I, PPLS) made a major or contribution to implementing the Government's strategies, successfully scaling up the country's fight against AIDS. Under "local responses," the project covered all 77 communes (municipalities) and funded subprojects in more than 3,100 communities, reaching about 61 percent o f the population. Furthermore, the project mobilized 652 NGOs and 52 local radio stations for the fight against AIDS, and helped establish 34 associations for people living with HIV/AIDS (PLWHAs), Under the "public sector organizations including health-sector response," PPLS was the main source of funds for HIV testing in Benin throughout the project's four-year duration, testing altogether 202,000 persons. The project supported 25 capacity building in the health sector, financed the provision o f ARV drugs, and provided equipment for health centers. The same component also provided sensitization and other services to staff infected with or affected by HIV/AIDS in 40 non-health public ministries and agencies. Financing by PPLS, along with the efforts o f the Government and the donor group, was no doubt instrumental inhelpingto keep the HIV/AIDS prevalence rate at about 2 percent amongpeople ages 15 to 49. 10. However, these results are still far from adequate when compared with the estimated real needs. For example, the capacity-building programs carried out inthe health sector thus far have reached only the public-sector health staff in certain zones. Mother-to-child transmission prevention covers only 58 health centers in five o f the 34 sanitary zones in Benin. The ARV program serves only 7,447 patients, against a target o f 15,000 for 2010. The security o f blood transfusions needs to be reinforced and expanded to cover all health centers. Universal access for treatment and care i s still far from a reality. Thus, extensive programs will be needed to prevent MTCT, to treat sexually transmitted and opportunistic infections, and to provide all persons living with HIV/AIDSwith appropriate medicines, includingARV drugs. In addition, the coordination mechanism under the SP/CNLS, as well as the monitoring and evaluation system is still weak and needs to be strengthened, especially for ensuring effective implementation o f the "Three Ones" principles. 11. Strategic Plan 2006-2010. The Government's new strategic plan for fighting HIV/AIDS, prepared during 2005-2006 in broad consultation with the donor group and stakeholders for the period 2006-2010, has the following general objectives: Promote an environment that i s favorable for multisectoral approaches, broad engagement o f stakeholders, sustainability o f efforts, and efficient coordination to fight the pandemic within the framework o fthe "Three Ones" approach. Reduce the prevalence rate o f HIV/AIDS among the youth between 15 and 24 years o f age by at least 25 percent and among the vulnerable population notably women, sex workers, mobile population, and unformed personnelby 50 percent by 2010. Reduce the prevalence rate o f STI among the general population, notably the vulnerable groups by at least 30 percent by 2010. Strengthen the bio and blood transfusion security and minimize the transmission o f HIV intraditional andmedicaltreatment centers. Reduce the proportion o f infected children born from seropositive women by at least 50 percent by 2010. Promote the voluntary counseling testing (VCT) ensuring confidentiality. Ensure adequate medical care to adults and infected children by HIV includingbiological monitoring. Reduce the overall impact of HIV/AIDS among the persons infected or affected, especially for orphans and vulnerable children. Increase the proportion o f orphans and vulnerable children in household benefiting at least one external support from 3 to 50 percentby 2010. Strengthenstrategic information for orienting the national response. Make it operational the monitoring and evaluation system. 12. Strategic areas ofactions. The instruments that the Government plans to use for achieving these objectives include all the appropriate activities of the Ministry o f Health, including free or nearly free provision o f ARV medications. To prevent the spread o f HIV/AIDS and to care for persons already infected with and affected by HIV/AIDS, the 26 Government plans to involve the public sector in general; civil society organizations, particularly those dealing with persons living with HIV/AIDS; private-sector firms; stakeholders in all walks o f life; and the concerned populations at all levels o f the communal structure throughout the country. 13. Constraints and issues. Although the Government i s fully committed to fighting HIV/AIDS--infact, the President of the country is the chairman of the highest oversight committee in the fight--three constraints need to be addressed if the objectives are to be attained: (a) there are limited resources to finance all the plans; (b) there i s insufficient funding to the Permanent Secretariat of CNLS at both central and decentralized levels; and (c) coordination o f all HIV/AIDS related activities by the SP/CNLS remains inadequate, although recently it has beenrecognized as the sole authority incoordinating these activities. 14. As mentioned, the Government has determined that ARV drugs should be provided free o f charge to all seropositive persons who need such medication. Unfortunately, the Government must rely on external funds to buy and dispense the drugs because the Government itself can contribute only modestly (the equivalent o f US$3.6 millionin2005 for all HIV/AIDSpurposes). 27 Annex 2: Major RelatedProjectsFinancedby the Bank and/or other Agencies Benin: SecondMultisectoralHIV/AIDS ControlProject 1. Over the five past years numerouspartners havejoined inthe fight against HIV/AIDS and a good collaboration mechanism has been set up under the auspices o f the UNAIDS. Besides the World Bank Group, the partners include the Global Fundand the United Nations agencies (UNICEF, UNDP, WHO, UNAIDS, UNFPA, and WFP). In addition, several bilateral partners, including the USA (USAID), France, Canada, Germany, Belgium, Switzerland, and some international NGOs (PSI, Africare, Care International, MSF, MDM, APH, GIP-ESTHER, SOLTHIS, etc.), have supported the fight. All the different interventions financed by these partners have been in line with the first National Strategic Framework 2002-2006 and have contributed to a large extent to the implementation o f this strategic plan. 2. The Bank has been and i s supporting the Benin health sector through four major operations: Budgetary Support since 2004; the HIV/AIDS Multi-sector Project (MAP I); the Healthand Population Project (HPP); and MalariaControl Support Project (MCSP). Budgetary Support: IDA'S budgetary support aims to improve overall sector management and equitable access to basic quality services with particular aim of reducing child and maternal mortality. MAP I:The project was supported by an IDA Credit o f US$23 million and it closed in September 2006. The purpose of MAP Iwas to help the Government of Benin implement a countrywide program against HIV/AIDS. On the ground there were concrete results in terms o f creating awareness among the general population, buildingstrong partnership with civil society organizations, scaling up accessto VCT, treatment, and protection of the rights o f PLWHA. The prevalence rate o f the epidemic has been stable compared to 2002. The implementation o f MAP Ishowed that availability o f resources combined with strengthening o f capacities and involving various stakeholders and partners produce positive results. These conditions are built inthe new follow-onproject. HPP:The project was supported by an IDA Credit of US$27.8 million and it closed inDecember2002. Its purpose was to assist the government inits goal to improve the health status of the population by providing better quality o f and easier access to services likely to improve the health level in local communities. The project was the first attempt to a decentralized project management approach. It had a significant impact on assistinginreorganizingthe heathpyramid. MCSP: With an IDA Grant of US$31 million, this project intends to support the implementation o f the national 2006-2010 malaria control program over the next four years. The success o f the project will be reflected in the overall increased access to, and utilization of, an effective package of malaria control interventions to reduce morbidity and mortality ffom malaria. 28 Other donors' interventions 3. Other donors' interventions specific to HIV/AIDS control are summarized in the following table. Partners'Interventions FIELDSOFINTERVENTION PARTNERS FINANCING DURATIOI INUS$ Prevention, testing and PLWHA support Global Fund 17,726,16 1 2004 - 2007 Abidjan-Lagos Comdor Project: Prevention, World Bank 17,900,000 2004 2007 - treatment, support and care services, coordination, strengthening capacity building andpolicy development (Cote d'Ivoire, Togo, Ghana, Benin, andNigeria) Prevention, IEC, capacity buildingo f UNDP 2,000,000 2004 2008 - decentralizedstructures and associations, legal framework Capacity building,prevention, awareness and WHO 150,000 2004 - 2005 communication Survival, education, protection, monitoring 1,200,000 2004 - 2008 and evaluation includingPMCTP, support and UNICEF care o f PLWHA LPrevention, IEC, social marketing o f condoms FNUAP 2,500,000 2002 - 2006 2003 - 2008 Prevention, IEC, institutional support to SP- BHAPP / 4,500,000 CNLS and PNLS AFRICARE / USAID Prevention, IEC and social marketing o f PSI/ USAID 4,000,000 2004 - 2005 condoms Prevention, awareness, IEC, training and GTZ/ USAID 371,519 2004 - 2007 supporting field activities, condoms purchasingthrough PSI Prevention, IEC, testing and support and care SIDA3 / 2,091,138 2001 2006 - o f STI CANADA Cultural communication strategy Swiss 108,277 2004 - 2006 Cooperation Bloodtransfusion security BELGIUM 1,887,925 2004 - 2006 Cooperation Prevention, information, counseling, testing 943,973 2001 - 2005 and epidemiologic monitoring Cooperation I Prevention, IEC, counseling, testingand 1I French MSF 4,953,592 2002 - 2007 support and care o f PLWHA FRANCE IEC, support and care at the community level _ _ CRS / 310,000 2004 - 2006 CAFOD/ SCF FRANCE Preventiono f HIVIAIDSby blood transfusion Care 705,657 2004 2006 - inclinics managedbyNGOsmembers of International/ ROBS USA Awareness, IEC, event information inpoor HCR/Racines 129,360 2004 - 2006 township o f Cotonou 29 Donor coordination 4. Duringthe project period, the Government will be encouraged to continue to make progress on donor coordination. Among the external partners, the natural leader inthis effort i s UNAIDS and its Benin office. All partners will be important in this effort, but it would be particularly important to get the financiers with substantial commitments on board, including the Global Fund, whose coordination committee members were invited to appraisal of M A P I1to ensure abetter collaborationbetweenthe two projects. The specific mechanismof donor coordination will include: (a) a common implementation process; (b) joint country led annual reviews; (c) development of a common national procurement plan; and (d) full implementation o f the "Three-Ones" principles. 30 & 0 8 5 B8E s m' U w88 i3 C 0 8 8 U 8D BB j@ og b o 3 m N m m u 2 2' 0 E s tz m I I I m m I I I I 0 0 0 0 0 0- 8 0 0 3 0 0 2 '". i 3 3 0 0 0 s 0 0 0 3 n N 8 0 d d 0 8 0 I 8 0 3 0 n 0 0 N 0 w d 0 a. 8 3 0 0 v) b 3 3 d 0 0 0 I 0 0 0 3 8 2 0 0 m 0 3 a. 2 \o 3 0 0 0 a. m Q\ 2 N -4 2 \o n 9 N f ri d - VI !i z Y Y VI U u 5 u5? i I ii g U fU ; c m z $ m -? 4 42 2I c c 0z! 0 0 1 30 -6n + n e c e 0 8 s8 0 00 0 0 m f4 m z 0-. 3 3 - 0 0 5 E - Y 0 a 8 0 m! 0 i 8sm + m I- 4 i 00 Zrn s 3 0 0 0 e - 'Ef 0 0 0" 0 0 m E + fe 0E I s n c 18 + n E 0 1 0 0 ce 0 0 i e c f4 a 0 0 -E2 sm ru 0 c c e e 5 - Monitoring, Supervision, Feedback Routing of Dataand Reports CNLS + Development Partners Sharing andDisseminationof Reports PermanentSecretariat of CNLS Validation of Reports Community and (National level) QUARTERLY Non-Health Sector (National level) I I Restricted SP/CDLS and departmental AGFIE Approval of Reports QUARTERLY Health: Community and Non- Services/ CIPEC Decentralized HealthSector pepartmen+ level) Reports and Data (Departmentallevel) _I II I Departmental Support Unit Periodic data capture: Computerized szlstm (technicaVfinancia1 H e a l t h Decentralized CCLS and HealthZone Community and I Services Committees ((Pool AIDS )> Non-Health Sector (Municipal level) Collection/ Analysis of I/ ' II monitoringreport forms (Municipal level) MONTHLY \ 1' I I I \ , NeighborhoodAIDS committees Participatory Community Monitoring (see PPLS project) Completing monthly monitoringreport forms Completingactivityreport fo m s Front-line communityparticipants I 36 Annex 4: Detailed Project Description Benin: Second Multisectoral HIV/AIDS Control Project 1. As its predecessor project PPLS (MAP I)did, MAP I1 would contribute to the national multisectoral program within an annual action plan and budget, using subproject grants and quarterly allocations as appropriate. The project would support activities in the national strategic plan that are not covered, or are covered only partially by other financiers such as the Global Fund, African Development Bank, U S Government and UNagencies. The comparative advantages o f Bank-financed HIV/AIDS projects would be taken into account in allocating funds. Although the entire population needs preventive and support interventions, the project would specifically target funds to high-risk and vulnerable groups such as orphans, youth, and sex workers. The drivers o f the epidemic have been identified in the Benin 2006-2010 national strategic framework, including weak knowledge and awareness o f risk and transmission mechanisms for HIV among youth (only 36.8 percent o f youth aged 15- 24 were able to identify three methods o f preventing sexual transmission o f the HIV virus and reject inaccurate beliefs about HIV transmission), the highmobility o f the population, the early onset o f sexual behavior among youth with multiple partners o f various ages, and high prevalence rates o f sexually transmitted infections. Based on the above drivers, the vulnerable and high-riskgroups were clearly identified as PLWHAs, OVCs, youth, women, commercial sex workers, and uniformedpersonnel. Another potential target group i s young women inthe age group 15 to 29 years, where the overall prevalence rate i s as low as 1.3 percent but prevalence levels separated by age indicate that the rate among young women aged 24-29 i s substantially higher. Component 1:Social Mobilization and Prevention Services (US%12.16 milliodIDA US$11.90 million) 2. Under this component the project would provide funds for interventions to continue to scale up HIV/AIDS prevention efforts, particularly for activities relating to information, education, and communication (IEC) leading to behavioral change; for care and support o f infected and affected persons; to support promotion o f health services not under MOH, and for the distribution and social marketing o f condoms. All sub-projects and action plans will be reviewed and approved on the basis o f how much they will contribute towards achieving the key indicators and targets for the project. To ensure that priority is given to the highrisk and vulnerable groups, it is assumed that over 50 percent o f the financing under this component will fund activities targeting these groups. All activities described below will be undertakenincollaboration withpartners, to ensure that there is no duplication o f funding. SubcomDonent 1 (a): Supuort for communitv and NGO mevention activities to encourage behavior change 3. The subcomponent would fund subprojects and community action plans dealing with HIV/AIDS prevention and behavior change activities and providing support to vulnerable groups such as orphans, women, youth, TB patients, and commercial sex workers. The component would aim to increase and scale up prevention efforts undertaken during MAP I, but with a specific focus on reaching the vulnerable groups with interventions designed to encourage behavior change in a participatory fashion. The subcomponent would also help consolidate and increase the number of "caisses de solidarite`" and train their committee members ("porte paroles") in evaluating sub-projects and identifying good practices to be replicated. Furthermore, it would help establish advisory groups to help implement the 2006- 37 2010 HIV/AIDS strategy including various associations, for instance, for PLWHA and commercial sex workers. Financing for activities under this subcomponent will be provided for varying periods o f time, depending on the implementing partner, in order to ensure that activities can be sustained and produce the desired results, but additional funding for each subsequent periodwill be onthe basis of past performance inachieving the intendedresults. (i) Promoting access to HIV/AIDSprevention information and servicesfor all. A participatory approach was used to prepare the community action plans financed under MAP Iin communities (villages, town and city quarters, and for professional groups) whereby communities were engaged in the design, implementation, and evaluation o f interventions. The same approach would be used in all community subprojects for both old and new communes, focusing in particular on the `zones' with highvulnerability based on the existing epidemiological data, such as Altantique, Mono, Littoral, Oueme regions, and major urban areas where the prevalence i s above the national average. The subcomponent would provide financial assistance to CSOs and NGOs that carry out prevention activities in communities. Priority would be given to CSOs that deal with PLWHA, commercial and clandestine sex workers, youth and adolescents, women, and traditional healers and midwives. NGOs that direct their activities to vulnerable groups such as fishermen, drug users, transport workers, refugees, and amulet vendors would also be assisted. The activities financed would include: (i) prevention activities relating to HIV/AIDS and reductions in STI (training will be provided to NGOs and CSOs leaders on the norms and procedures for fighting STIs and behavior change interventions developed under MAP I); (ii)advice and promotion of voluntary HIV/AIDS testing; (iii) promotion o f the use o f condoms (both o f male and female condoms); (iv) strengthening prevention messages and utilization o f prevention mechanisms among youth and women; (v) intensification o f communication that encourages changes in sexual behavior and patterns; (vi) promotion o f communication between various associations, including those o f traditional healers; and (vii) support to local radio stations for their HIV/AIDS-relatedprograms. These activities have been identified as being particularly relevant to ensuringbehavior change inthe vulnerable groups since it was already identified under MAP Ithat the use of public service messages delivered by radio and TV and the use o f community activities to encourage testing were highly effective. Public service messages o f this type were so successful that they generated an overwhelming demand for testing at the health centers, who were not equipped to handle the demand. The activities of national and "departmental" NGOs with proven experience and expertise in reaching high-risk groups such as professional and clandestine sexual workers, men having sex with men, or doing social marketing activities among the vulnerable groups, will also be financed to implement larger scale activities. Funding of these NGOswould be based on clearly defined terms o f reference indicating results to be achieved and usingperformance-based contracting. (io Priority Line Ministries. The subcomponent would support action plans preparedby line ministries inthe public sector. The component would finance annual action plans prepared by Focal Point Units in the key ministries and approved by SP/CNLS, targeting the client groups o f the key ministries. The key ministry action plans would include: (i)prevention activities for raising awareness; providing communication that encourages changes in sexual behavior and practices; (ii) advice and promotion o f voluntary HIV/AIDS testing; (iii) advocacy, communication, and 38 availability o f information and guidance on HIV/AIDSmatters inthe ministries; and (iv) offering psychosocial counseling o f infected persons. The Ministries of Education, Youth, Family, Women and Children, and Agriculture have been identified as those that could be most effective in reaching the greatest coverage and target vulnerable groups for prevention and care. The Ministry o f Defense has also been identified as a key ministry and will also be used to support activities for personnel that are located within other ministries but represent the vulnerable group o f uniformed personnel, such as policemen, park rangers, and border patrol officers, and who oftenutilize the Ministryo f Defensehealth facilities. The Ministryo f Family, Women and Children will be supported to ensure their role in coordinating and supervising the quality o f NGO interventions fimded under subcomponent l(b) for the care and support o f OVCs. The Ministry will not finance NGOs directly, but their action plan will define how they will be integrated in the approval and supervision process for OVCs subprojects to provide the necessary technical expertise and guidance on best practice for OVC care and support. This Ministry will also be critical in encouraging changes in cultural and male behavior patterns that contribute to increased HIV vulnerability in the society. The SP/CNLS will determine whether the action plans would be funded on an annual basis or would be funded for the period o f the project and identify how performance will be measured for these ministries. This subcomponent may still continue to finance the action plans o f other non-critical ministries as was done under MAP I,but these action plans would be much smaller than before and would need to be proven as effective interventions for activities within the workplace. (iii) Capacity building. Besides financing subprojects, effective implementation o f the subcomponent would also require capacity building at several levels. Capacity- buildingactivities would include (generally as part of subprojects), standardization of the participatory approach at the local level, and strengthening of institutional and technical capacities in community organizations, CSOs, and various HIV/AIDS- related associations. NGOs would be recruited, when needed, to provide technical capacity buildingto the local communities on how to prepare better action plans with identified results and targets contributing to the overall results framework, implement them effectively, and carry out "self-evaluation" (evaluation of subprojects and their implementation by beneficiaries). The activities would benefit committee members in communities, "agents d 'accompagnement," radio producers and speakers, and staffs o f CSOs and HIV/AIDS-relatedassociations. (iv) Intensijkation of the fight against HIVUIDS in the workplace. The subcomponent would finance activities that (a) improve the advocacy, communication, and availability o f advice in the workplace concerning HIV/AIDS; (b) increase prevention and understandingo f HIV/AIDSand the effects o fHIV/AIDS on infected persons; and (c) reduce the stigma o f the HIV infection. The activities to be financed would include training, development o f communication programs, development o f workplace strategies and policy regulations on HIV/AIDS, and mitigation o f the impact on PLWHA. Some key non-formal sector groups would be targeted, such as the motorbike taxi operators who by virtue o f their business may be vulnerable to HIV infection, or groups such as the young female vendors along the roads who sometimes also engage inclandestine commercial sex work. 4. Health personnel o f the public, private, and religious organizations are particularly vulnerable because they are constantly exposed to HIV intheir workplace, and often unaware 39 o f their own risk and how to protect themselves. The Ministry o f Health has already initiated activities within the public sector to train health personnelon reducing their exposure to HIV inthe workplace andwillbe supportedto extendthis trainingto allhealthpersonnelinBenin, even outside the public sector, in conjunction with the Global Fund support. The subcomponent would also improve policy knowledge, training in biomedical waste management and help protect health personnel against infection from such waste. Training will be provided on improvingmedical waste management inhealth facilities and appropriate use o f waste management equipment provided under Component 2 and under the Benin PRSC. Subcomponent 1(b): Support for impact mitigationactivities for OVCs and PLWHAs 5. This subcomponent will allow for support to be provided directly and indirectly to mitigate the impact on people living with HIV and orphans and vulnerable children infected and affectedby the epidemic (including psychosocial and economic support). 6. During MAP I,faith-based and charitable organizations proved to be effective in caring for HIV/AIDS-infected and -affected people. Under this subcomponent financing would be made available for subprojects for looking after infected and affected people and operated by faith-based and other organizations. These may be private, religious organizations or other association-run health centers that have been accredited by the MinistryofHealth PNLS unitto provide (i) treatment andmanagement ofopportunistic ARV infections and that take care o f AIDS patients; (ii) look after infected children; (iii) provide nutritional support to families struck by AIDS; or (iv) provide psychosocial care and counseling to individual patients or families. There are several such institutions that are already providing ARV care, are recognized as providing high quality services and often present the closest option for ARV services to PLWHAs, but are now limited intheir ability to scale up services to more patients because o f the question o f payment. Project assistance would subsidize existing or new activities for these purposes. This support will be provided directly to these facilities on the basis o f the identified number o f patients treated at the facility over a given period o f time. Further details on this will be provided in the project operations manual. 7. Inorder to ensurethat the project reachesthe intendedbeneficiaries andhas animpact directly on the people living with HIV, this sub-component will also support the activities o f the PLWHA associations at departmentaland national level and their networks, to ensure that they have a voice inpolicymakingand inactivities that are intendedto benefit them. 8. Inaddition, this subcomponent allows for PLWHA to benefit from income-generating activities (IGAs) that will be funded through the PLWHA associations for the benefit o f indigentmembers or all the members of an association. This IGA support will be provided at no interest in a limited amount (generally about $4,000 for each association) and the associations will be required to reimburse the funding to the financial management agency engaged by the project after a specified period o f time to demonstrate the sustainability and performance o f the IGA. If a PLWHA association i s unable to refund the initial support provided, they will no longer be eligible for IGA support under the project, but if they are successful in refunding the money, they might be funded again. Specific criteria and guidelines will be developed and included in the operations manual to ensure transparency, effectiveness, and the sustainability o f IGAs funded under this sub-component. The financial management agency will provide them with adequate training as well as monitor them to ensure effective implementationo f their selected activities. 40 9. The component will also provide funding for care and support o f orphans and vulnerable children (OVCs), as identified by communities or health centers as being infected or affected by HIV/AIDS. The Ministry o f Family, Women and Children has the responsibility and lead authority to work with OVCs and has put inplace a national minimum package o f support for orphans that the project will also support. This will be done in collaboration with GlobalFundactivities since they have already supported over 5,000 OVCs under the previous Round and intendto support an additional 5,000 OVCs under the recently signed Round 5 grant. The component will support at least 2,500 OVCs inensuring that they have access to this minimum package o f support that has been agreed upon by the Ministry and other partners. The orphans will be supported to ensure that they are able to re-enter into the education system and provide support to purchase their books, uniforms and other necessary school equipment since Benin has a free primary education policy in place. In addition, where there are orphans who are either the heads o f household for child-headed household or where their re-entry into school would not be possible, the component would support them through assistance for apprenticeship fees and equipment to learn a trade. Nutritional support would also be provided to those households that are caring for orphans and needadditional support. 10. All activities under this componentwill be carried out under the auspices of the Local Response unit in the SP/CNLS, in conjunction with the financial management agency that will be managing the transfer o f funds and supervision o f sub-projects. Since this unit currently only has one person and this i s insufficient to achieve the objectives o f this component, the project will finance the recruitment o f a second person to be integrated into this unit to ensure that activities under the component can be successfully camed out and implemented. This person will be responsible for monitoring the progress and reviewing reports for the Social Mobilization component but will also be able to provide assistance in other local response initiatives and assist inproviding the strategic direction and coordination o f the local response within the national strategic framework for 2006-2010. Consultants may also be recruited to carry out certain activities or provide support for capacity building under this component. Financing for the recruitment of a local response specialist, the contract for a financial management agency and other operating expenses under this component are included under the budget for Component 3 (Coordination, Management and Monitoringand Evaluation). Component2: Accessto Treatment, Care, andImpactMitigationServices (US$15.87 million/IDAUS$15.40 million) 11. This component will be monitored by the PNLS/MOH which has the technical expertise and mandated responsibilities in fighting HIV/AIDS and related diseases (epidemiological oversight, preparation and supervision o f voluntary testing, care management protocols for institutional and home care, setting up blood supply and quality assurance, providing drugs for STIs, TB and HIV/AIDS). 12. The objectives o f this component are to enable Benin, by year 2010, to: (i) by increase 10 percent each year the number o f people tested to reach a target o f 600,000; (ii) provide, each'year, ARV treatment to 3,000 HIV positive pregnant women; (iii) provide medical check ups to at least 6,000 CSW at least twice in each year; (iv) provide ARV treatment to 3,300 PLWHA including 900 children; (v) provide biological follow-up services for 6,500 PLWHA under ARV treatment; (vi) provide psychosocial support to 10,000 PLWHA (with the Ministry o f Family Affairs being the implementing agency o f this assistance); (vii) 41 provide nutritional support to 3,300 PLWHA under ARV treatment; and (viii) strengthen the system o f epidemiological surveillance andmonitoringevaluation o f the PNLSMOH. 13. Under this component, the project will supplement the financing provided by the Global Fundand others, in order to help the country achieve the ultimate goals o f care and treatment o f HIV/AIDS infected people as spelled out in the national HIV/AIDS Strategic Framework 2006-2010. 14. To achieve these objectives, the PNLS/MOHwill rely on the following strategies: 0 Moving forward with the decentralization o f the minimum care package through increasing the number o f VCT, PMTCT, care and treatment sites throughout the country inorder to reach as many patients as possible. e Effective integration o f HIV/AIDS related activities with basic care services provided inall healthfacilities (TB-HIV/AIDS,Malaria/HIV/AIDS). 0 Strengthening o f health facilities through the rehabilitation o f main buildings, improvements inthe technical equipment and standards o f laboratories, the provision o f reagents and other medical drugs, and capacity buildingo f health personnel. 0 Strengthening the referral laboratory by rehabilitating its physical facilities and improving its technical capabilities. 0 Decentralization o f laboratory activities with the provision o f two mobile laboratories equippedto provide VCT services. 0 Strengthening o f SIDAG (the national service for free voluntary and anonymous testing) to transform it into a national reference and training center for other VCT centers, 0 Integration o f HIV teaching in the curriculum o f medical schools and technical training centers. 0 Strengthening o f activities initiated under other projects (such as SIDA 3 financed by ACDI) targeting highrisks groups such as CSWs andmobilepopulations. 0 Promotion and dissemination o f sound practices in the management o f medical waste inlinewith the policies adopted inthe MedicalWaste management Plan(MWMP). 15. This component will complement funding by the Global Fund and other financiers and provide support to the following activities: Testing ofHIV. The project will finance the establishment, at reasonable cost, o f new VCT centers, materials and reagents needed intesting and by providing equipment to the testing laboratories, as well as by training their staff. Increased accessfor PMTCT. The project would help the health sector extend efforts to prevent mother-to-child-transmission to all zones where the project i s active. The assistance would include (i) strengthening o f the health-sector staff capacity in PMTCT management; procurement o f reagents, medicines, and other requirements such as computers; (ii) monitoring o f and medical, social, and psychosocial support to children born as seropositive; (iii)social mobilizationand sensitization of the population to accept the seropositive children; and (iv) nutritional care o f infected and affectedchildren. Treatment of AIDSpatients. The project would continue to provide medicines for patients who need ARV drugs, an activity started by the predecessor project PPLS. In addition, the project would finance procurement of reagents and consumable materials needed in medical care and treatment o f these patients, and improve the quality o f the treatment facilities. 42 Prevention and treatment of STIs and Oh: The project would accelerate promotion o f the methods of diagnosing and treating o f STIs among high risk groups and procure medication, reagents, other materials, and condoms for prevention and treatment o f STIs and opportunistic infections. Supportfor the safety of blood transfusion. The project would provide reagents and other materials to secure the quality o f blood used for transfusion, improve the technical capacity o f the transfusion personnel, and encourage the sexual fidelity o f blood donors; improvement o f blood security by strengthening blood banks with laboratory equipment and two mobile laboratories will be acquired to support the implementation o f health advanced strategies. Capacity building for health stafat all levels o f the health pyramid for diagnosis, care andtreatment o f STIs, HIV/AIDSand OIs, as needed. Restructuring of selective health facilities in order to facilitate the integration of HIV/AIDS related activities (VCT, care and treatment to other basic health services such as ANC, TB and Malaria). Management of medical waste by financing activities underscoredinthe MWMP. Nutritional support to PLWHA, including training insound nutritionpractices. Strengthening of epidemiological surveillance, operational research, monitoring and evaluation. Support to traditional medicine by financing operational research on ethics used, strengthening collaboration between traditional and modem medicine, and promoting research on plants used for traditional medicines and their potential usefulness in treatment o f STIs, OIs, and AIDS. 15. In carrying out some of these activities, PNLS/MOH may subcontract with civil society organizations, especially with faith-based and charitable organizations that have proven to be effective incaring for HIV/AIDS-infectedand-affectedpeople. Component 3: Coordination, Management, and Monitoring and Evaluation (US$8.72/IDAUS$7.70million includingPPFof US$0.70million) - Subcomuonent 3 (a): Suuport for a unified national and decentralized coordination system and leadershiu o f CNLS. 17. Various studies have concluded that the coordination mechanism o f the Permanent Secretariat o f CNLS and its field organization has had insufficient staff and resources to advocate and lead a nationwide fight against HIV/AIDS. The project would strengthen the SP/CNLS to allow it to carry out its role, especially in implementing the "Three Ones" principles. The assistance would include support to capacity building in CNLS and decentralized units (regional units, communes, "arrondissements," and local committees), procurement o f vehicles and equipment, and funds for technical assistance. Subcomuonent 3 (b): Supuort for a uniform national monitoring and evaluation system 18. UNAIDS and GAMET jointly financed development o f an important element o f the "Three Ones"--the nationally functioning M&E system-that was completed in early 2006. The project would help finance the testing o f this system in early 2007 and its implementation at all levels in the country during the project period. The activities to be supported would include (i) recruitment of additional staff at both central and decentralized 43 level o f the SP/CNLS, necessary equipment and materials, extensive training o f persons involved in M&E; (ii) financing o f collection, processing, and publication of data from operations o f this project and those o f other HIV/AIDS projects; (iii) special studies relating to HIV/AIDS in Benin and evaluation o f project results (under CNLS supervision); and (iv) technical assistance. Subcomponent 3 (c): Financing the coordination and managemento f M A P I1 19. Under the auspices o f CNLS, the project would be managed by a small Project Administration unit (PA), with the support o f a Financial Management Agency (FMA). The project would finance the costs o f these units. The support would include (i) training o f P A and FMA staffs; (ii) administration o f the project, including financing o f FMA activities; (iii) updating and strengthening o f the computerized financial management system; (iv) replacement o f vehicles, equipment, and materials used for project activities; (v) operation of the project-specific M&E system (as part o f the nationwide M&E system, but potentially with additional features and indicators); and (vi) financing o f external audits. 44 Annex 5: ProjectCosts Benin: Second MultisectoralHIV/AIDS ControlProject Local Foreign Total ProjectCost By Component and/or Activity us us us $million $million $million Component 1: Social Mobilization 11.50 0.00 11.50 Component 2: Access to Treatment and Care 05.21 09.79 15.00 Component 3: Coordination, Management, and 06.82 01,.43 08.25 Monitoring and Evaluation PPF 0.36 0.09 0.45 Total Baseline Cost 23.89 11.31 35.20 Physical Contingencies(2-3% needs to be deducted from each component total 0.78 0.35 1.13 Price Contingencies(2-3%--needs to be deducted 0.78 0.34 1.12 from each component total) TotalProjectCosts' 37.45 Interest during construction Front-endFee TotalFinancingRequired 37.45 'Identifiable taxes and duties are US$2.30 million, andthe total project cost, net o f taxes, is US$35.15 million. Therefore, the share of project cost net oftaxes is 93.50%. 45 Annex 6: ImplementationArrangements Benin: SecondMultisectoralHIV/AIDS ControlProject Institutionalarrangementsfor the nationalHIV/AIDS program 1. The highest HIV/AIDS coordination body inBenini s the National HIV/AIDS Control Committee (CNLS), which was originally established under the second medium-term plan in 2000. CNLS oversees all HIV/AIDSprojects and programs inthe country. CNLS consists o f representatives o f the public and private sectors and civil society organizations, and it operates under the direct authority o f the President o f the Republic. 2. CNLS consists ofthree complementary forums: (a) The decision-making plenary assembly o f all members o f CNLS, which annually identifies national program priorities and approves programs and global budgets of the various executing agencies and financing partners. (b) The CNLS Permanent Secretariat, a technical and multisectoral unit o f six professionals seconded from the Government but with no power to execute programs. Its tasks include collating program, plans, and reports o f results from different HIV/AIDS projects and partners, analyzing and consolidating these documents for review and approval by the biannual plenary CNLS, and updating CNLS on the results o f the national monitoring/evaluation programs and relatedresearch. (c) A consultative group composed o f the Vice Presidents o f CNLS and its Permanent Secretariat, with financing partners and donors to be invited as observers, to collaborate on advocacy initiatives and to clarify available financial resources and proposedprograms insupport o f the National HIV/AIDS Strategy. 3. The project would help strengthen the Permanent Secretariat and the field organization o f CNLS, including support to a unified and national monitoring and evaluation system (see Annex 4). CNLS has established a decentralizedsetup consisting o f multisectoral committees at the regional, commune, "arrondissement," and local levels, which would support project activities and help review, approve, and monitor HIVIAIDSactivities intheir respective administrative areas as authorized. Projectimplementationarrangements 4. The new project would be organized essentially as M A P I. A P I1would be overseen M by CNLS, which also oversees the other HIV/AIDS projects and programs in Benin. The Project Administration (PA) would be responsible for facilitating project implementation within the framework o f the National HIV/AIDS Strategy 2006-2010 and the CNLS policies. 5. The new project would use a similar well-functioning structure as was established for MAP 1with minor modifications to ensure full integration with the SPICNLS. PA would employ a few private-sector professionals. Because M A P I1i s larger than M A P Iand both o f its components contain two subcomponents and numerous activities that involve hundreds o f separate contracts and agreements, it i s important for each component to have a person responsible for its implementation. For this purpose, two consultants will be recruited as Component Coordinators. All members of the PA would be recruited by the SP/CNLS on a contractual basis from the private sector, inline with the Government's and the World Bank's procurement guidelines. 46 6. Like CNLS, PA would have no execution functions, but its role would be to provide leadership for project implementation, develop the annual work programs and budgets for approval o f CNLS and the World Bank, subcontract implementation of project activities to public-sector agencies andprivate and civil society organizations, oversee the monitoringand evaluation o f project activities, regularly submit data to the CNLS M&E unit, and prepare periodic reports to CNLS and the World Bank. PA would also provide technical assistance and make sure that project activities are carried out efficiently and inaccordance with agreed procurement and other procedures. The responsibilities for the PA under the project can be grouped into four categories: (a) communications, (b) capacity building, (c) monitoring and evaluation, and (d) financial management. As occurred under MAP I,transfer o f funds to subprojects approved for community-based organizations, NGOs, religious organizations and various associations would be contractedto a Financial Management Agency usingthe World Bank's procurement guidelines. Implementation of the Components Component 1:Social Mobilization and Prevention Services Subcomponent 1 (a): Support for community and NGO prevention activities to encourape behavior change 7. The subcomponent would find subprojects and community action plans dealing with HIV/AIDS prevention and behavior change activities and providing support (including psychosocial and economic support) to persons living with HIV/AIDS (PLWHA), to vulnerable groups such as orphans, women, youth, TB patients, and commercial sex workers. The activities would be carried out by communities themselves in their community action plans, or as subprojects by CSOs, CBOs, NGOs, and private-sector firms. The project would contract NGOs or other CSOs (called "Organismes d'appui au Zancernent") to help CBOs prepare and monitor their subprojects. Larger NGOs would also be contracted on the basis o f explicit terms of reference with performance-based contracting criteria. Activities carried out by the key line ministries would be funded through direct transfer of funds on the basis of annual work plans and financial agreements signed with SP/CNLS. Continued support would be contingent on satisfactory annualperformance. Subcomponent 1(b): Support for impact mitigationactivities for PLWHAs and OVCs 8. Support under this subcomponent would finance activities that provide direct and indirect mitigation support for PLWHAs and OVCs. These activities will be implemented either through NGOs implementing activities for OVCs, through religious and private health facilities providing care and treatment services for PLWHAs, or through associations o f PLWHAs implementing income generating activities. The financial management agency would contract CSOs or NGOsto implementthese activities. 9. Governance in social mobilization: Because the numbers o f implementing units and stakeholders are so large, special arrangements will need to be made for proper governance relating to social mobilization. Besides the inspections and audits carried out by the Financial Management Agent on a sample basis, the project aims at increasing transparency and accountability, especially where it relates to civil society response. The mechanism to increase social accountability would include systematic use o f "score cards" at the subproject level (already in use); publicizing the proposals that are awarded in the public media and 47 local notice boards; using investigators as needed when there i s suspicion; and using`joint CBO/NGO/CSO databases, especially when multiple donors are involved. Component2: Accessto Treatment, Care, and ImpactMitigationServices 10. The Ministry o f Health has a mandate to oversee all health-related aspects o f the HIV/AIDS campaign in the country, including implementation o f the activities financed by the Global Fund. The Ministry's staff would be involved also in all care and treatment activities inthe field, even when implementation o f these activities would be done by other agencies. M O H would receive M A P I1funds to supplement the resources provided by the Global Fund on the basis o f annual plans and budgets approved by CNLS. PNLS in the Ministry of Health would implement the activities financed from the funds of MAP I1and submitquarterly reportsto PA, copiedto CNLS.The ProcurementUnito fthe Ministrywould take care o f all purchases o f medicines and medical equipment. 11. In carrying out some of these activities, PNLS/MOH may subcontract with civil society organizations, especially with faith-based and charitable organizations (religious organizations or other association-run health centers) proved to be effective in caring for HIV/AIDS-infected and -affected people. Component3: Coordination,Management,andMonitoring& Evaluation 12. The Project Administration and the SPKNLS would implement the activities under this component inaccordance with annual work plans approved by CNLS and endorsed by the World Bank. 4. Implementationarrangementsfor monitoringand evaluation 13. The project would provide funds to help SPKNLS implement the "Three Ones" principles, particularly a national, uniform, monitoring and evaluation system. Supported by the development community, UNAIDS and GAMET jointly financed development o f an M&E system that was completed in early 2006. CNLS has an M&E unit that has overall responsibility for the functioning o f the M&E system, but most M&E activities would be contracted out to external agencieshonsulting groups to ensure independent analysis, and to permitprogram performance to be tracked against targets and variations inperformance rates to be detected, in compliance with established protocols. The project similarly provides for surveillance and research to be contracted out as the evolving status o f the epidemic may indicate as necessary. The research initiatives would be complementary to those undertaken by other CNLS partners. 14. As a part of the CNLS monitoring and evaluation system, MAP I1would operate its own M&E system that ensures that all data and information needed in the national system would be forthcoming and that additional data required by the World Bank would be collected. 15. The institutional arrangements are presented inthe following organigram. 48 Institutional Organigram CNLS 4 - 1 DeliberationOrgan I - Permanent Secretariat II i 1 I .. .. I . I . . CDLS -I . m +. ..... .. .. FinancialUnit - E i X E Consultants Community C NGOs . .. ResponseUnit U Other Agencies T ..*. ................ ... I i 1 0 . N A Public Sector A . G PrivateSector ,.. E Association N Etc. CVLS i, EvaluationUnit C I E S Unit 49 Annex 7: FinancialManagement andDisbursementArrangements. Summary Benin: SecondMultisectoralHIV/AIDS ControlProject Summary 1. The objective o f the Financial Management Assessment is to determine whether the entities identified for the implementation o f the MAP I1project, in particular the Permanent Secretariat under the CNLS, have an acceptable financial management arrangement inplace. The assessment includes review o f the entity's system of accounting, reporting, auditing, and internal controls. The entity's arrangement is acceptable if it i s considered capable o f recording correctly all transactions and activities; it supports the preparation o f regular and reliable financial statements, safeguarding the entity's assets and i s subject to a satisfactory auditing process. 2. Financial management assessment was carried out for the CNLS and in particular it accounting arrangements inview o f the needs o f the project. The assessment was carried out jointly by a World Bank Financial Management Specialist and persons responsible for financial management at CNLS, UNDP and AfDB projects. Internal control questionnaires and interviews o f key financial personnel o f CNLS and the projects supervised by CNLS were used as part o f the assessment. 3. Two projects are being implemented under CNLS responsibility: the HIV/AIDS National Strategic Plan Implementation Support Project (Projet d 'appui ci la mise en oeuvre du Plan Stratkgique National de lutte contre le VIH/SIDA) financed by UNDP and HIV/AIDS Fighting Support Project (Projet d'Appui ci la lutte contre le VIH/SIDA) financed by AfDB. Due to the modest size o f the UNDP financed project, the project accountant records financial data on an Excel spreadsheet and sends it to UNDP on quarterly basis. The AfDB-financed project has also recruited an accountant, but although the consultant who will prepare the project financial manual has been identified, he/she i s yet to be appointed. The project will benefit from the MAP Ifinancial management system to be transferredto CNLS. 4. With the proposed arrangement, the Head of the Finance Unit of CNLS will coordinate the overall financial management activities for all projects under CNLS supervision, including M A P 11. However, the day-to-day financial management for the project will be vested inthe chief accountant to be recruited, and the two accountants o f the UNDP and AfDB projects. The financial management arrangements for the purpose o f managing M A P I1 funds will be fully documented in a procedures manual as part o f the financial management (FM) system o f CNLS. 5. The FM and accounting system, used under PPLS just closed, will be transferred to the CNLS during the grace period and will be used for the AfDB project and later for MAP 11.The FMmanual will be preparedhpdatedand the Finance Office will be strengthened by recruiting a chief accountant. Conclusionof FinancialManagementAssessmentsfor CNLS 6. The assessment o f the financial management capacity o f the CNLS Financial Unit will be completed when the PPLS FMsystem will have beentransferredto CNLS. Countrv Issuesfor Benin: OverallFinancialManagement RiskRatings 7. The overall Inherent Risk rating o f the public financial management system in Benin was rated as "High" due to: (i)large proportion o f expenses made using exceptional 50 procedures including excessive use o f payment orders; (ii)weakness o f the control mechanism; and (iii)a poor accounting and financial reporting system. These issues raised in the 2001 and 2005 CFAA reports are being addressed by the Government o f Benin with donor's support. It affects mainly the DPL. Since May 2006, the new Government has taken strong measures to tackle these issues. The abusive use o f the exceptional procedure has been strictly limited. Also with the reform supported by PRSC3, the Government has adopted a new decree to organize the internal control function. The delay in production and audit of Government accounts is still important. Additional measures are being taken to reduce this delay. On the basis o f these measures taken since May 2006 and the positive evolution noted within a very short period, a new assessment o f the riskmaybe undertakenby end of 2007 to appreciate the sustainability o f this evolution. 8. The overall control risk for Bank-funded projects is rated as "Moderate". M A P I1will be implemented under CNLS's supervision, but the activities pertaining to the communities will be implemented through a Financial Management Agency - FMA. As an example of such an arrangement, an agency, AGeFIB has already implemented successfully several projects including the Social Funds project (Cr.3073 closed in 2003) and the Civil Society Component of the MAP Irecently closed, and it i s implementing the CDD project (3390/H1208). There i s no significant FM country issue that i s likely to affect smooth implementation o f M A P 11. The Government o f Benin will be the Recipient and will retrocede funds to the SP/CNLS 9. The CNLS Finance Unit (CNLS-FU) staff in the Permanent Secretariat will be responsible for the coordination o f the financial management for all projects under CNLS' responsibility, including the M A P 11, on the basis o f the Administrative, Accounting, and Financial Manual. The financial management system, linked with the project-specific M&E system, will ensure preparation o f semi annual project management reports acceptable to IDA. The CNLS-FU will monitor project disbursements and ensure that they are in conformity with IDA requirements. The Unit will consolidate and prepare the annual financial statements in accordance with internationally accepted accounting principles at the end o f each fiscal year. 10. To ensure timely and efficient disbursement and support for responsible management o f funds to benefiting communities, the Financial Management Agency (FMA) to be contracted will be in charge o f transferring funds to communities or by NGOs, private sector and civil society organizations contracted to implement project activities. It will also transmit to P A accounting and disbursement reports for the activities undertaken by these operators, and assist otherwise communities under Component 1 o f the project. The selected FMA should have local offices inthe six nationalregions and should have an established and sound reputation for responsible and adaptive management in facilitating direct financing to communities. The FMA's local offices should each have at least two staff dedicated to the financial management and other support to M A P 11. 11. At the national level, the financial agreements and contracts which will facilitate the scaling up o f the public sector response under Subcomponents 1 (a) and 2 (b) have been developed under the predecessor project, M A P I.The public-sector organizations would provide reports on financial management performance and program results to PA, which would compile them and arrange for their independent analysis and cross verification. 51 Fiduciarvrisksand actions DroDosedto mitbatethem 12. Mobilization of Government contribution: The mobilization o f counterpart's funds i s a challenge in Benin. Despite the fact that the provision i s made in the budget, it is very difficult to get the funds released due to the Treasury problems. To mitigate this risk, only a small amount was required for counterpart for this project. Nevertheless, the Government allocates substantial resources inthe lines ministries budget to fight AIDS. The only expected contribution will be about US$l50,000 in cash and about US$2.3 million in taxes and civil servants working at SP/CNLS or other related public agencies with salaries paid by the Government. It i s expected that the Government will continue to provide more resources for the fight against HIV/AIDSinthe future. 13. Use o f Country Financial Management: The Government, with its development partners, has launched a budgetary and public financial management reform. The main challenge o f this reform i s the use o f donors' funds/credits/grants through the Public FM system. For the time being, the performance i s still below expectations. During the last two years sectoral ministries, including the priority ministries (Ministries o f Health, Education, Transport, Agriculture, Justice, and Environment) have experienced huge problems to implement their activities due to timely mobilization o f the allocated funds. In addition, information generated through the public FM system is yet to be coherent with the project needs. The country FM system will be used for this project as well as other projects inBenin starting January 2007. The Ministry o f Finance officials insisted that the system that has been putinplace is fully operational and its use will bemandatory. Risk Riskrating MitigationMeasure Integral use o f Country The financing o f HIV/AIDS activities at community Financial Management S level i s not compatible with the slowness, the main System and Standard characteristic o f the standards public expenditures Public Expenditures procedures. Country FMsystem and Standard Public procedures for this Expenditure Procedures will be introduced only project. gradually, depending on their efficiency. Therefore, a specific FMsystem will be designed for this project inline withother IDAfinancedprojects inthe country. The project FMdata will be recordedex ante inthe country FMsystem. External auditors by the Supreme Audit Institution time and i s not yet sufficiently acquainted with the (SAI). World Bank audit procedures. An independent, accredited audit firm will be recruited for the first two years o f the project. Misuse o f grant funds at FMandprocurement trainingwill beprovidedto the Ministries and S beneficiaries. Also the internal control function will Communities. be reinforced with the appointment o f some investigators. Financial and technical audits will be required. Incase o f misuse o f funds, the ministries will reimburse. 52 Audit Arrangements ExternalAudit: 14. The supreme audit institution ("Charnbre des Cornptes") which i s supposed to audit any public fund has a limited capacity in terms o f staffing and experience to audit project financial statements and is not yet sufficiently acquainted with the World Bank audit procedures. Therefore, the Permanent Secretariat of the CNLS will appoint an independent auditor acceptable to IDA for the first two years o f the project. The audit will be conducted in accordance with International Standards on Auditing (ISAs) and under terms of reference acceptable to IDA. For the time being, separate auditors have been appointed for UNDP- and AfDB-financed projects. 15. Duringthe first two years, the appointed auditor will be responsible for the annual audit o f the M A P I1financial statements, and provide an opinion on the (a) project account; (b) transactions on the special account; (c) accounts o f a sample of NGOs; and (d) statement o f expenditures (SOE) and the eligibility o f the expenses withdrawn on the basis o f SOEs. Later, and depending on the additional resources mobilized, CNLS will produce only one consolidated financial statement and the audit scope will cover all the resources managed under CNLS. 16. The auditor will also submit a management letter giving observations and comments, and providing recommendations for improvements in accounting records, systems, controls and compliance with financial covenants in the IDA Agreement. The audit report shall be submitted to IDA within six months o f the end o f the project fiscal year. The recruitment o f the auditor will take place before the Credit effectiveness. 17. Inaddition to the financial audit, a technical audit will be required for the Mid-term review to assess the quality o f goods/equipment purchased and the efficiency, relevance and effectiveness o f the actions to fight against the HIVIAIDSo f components 1and 2. 18. The project's financial statements and Advance Accounts will be audited annually by the external auditors. The project audited financial statements and the FMA audited Financial Statement shall be submitted to IDA no later than six months after the end o f each fiscal year. InternalAudit: 19. The project will support the implementation o f an internal audit function and finance the appointment o f a qualified internal auditor under the SP/CNLS. The internal audit function will cover all projects under CNLS activities. In addition, the project may strongly encourage the appointment o f some investigators (time-based contracts), especially to carry out unexpected controls and investigations based on the suspicions or mismanagement o f subprojects. Acceptable TORSfor the internal auditor and investigator will be submitted to IDAandthe internalauditor will be recruitedprior to effectiveness. Disbursementsand Reporting Disbursement Arrangements 20. The project i s expected to be completed over a four-year period and funds will be disbursed under the Credit in accordance with categories o f expenditures as shown in Table Cybelow. When the project reaches its closing date, i.e. six months after the completion date, the Advance Account total will be recovered in full. A four months grace period may be 53 granted at the Government's request to allow payment o f pending invoices for goods delivered, works completed, and services rendered by the closing date. A computerized accounting and integrated financial management system has been set up for MAP Iand its being sufficient for today's needs will be assessed by the World Bank. As mentioned, a financial management agency will provide assistance to the Project Administration in the field activities duringproject's life and untilall activities are completed. DesignatedAccounts 21. Two Designated Accounts A and B will be opened in commercial banks. The funds will transit through a Central Bank account before they are deposited in the designated accounts interms and conditions acceptable to IDA under the responsibility o f the Recipient. 22. Desimated Account A: Designated Account A will facilitate smooth financial flows for all Credit-related activities. The resources o f this Account will be used for the financing o f subprojects initiated by communities and registered associations (social, occupational, professional, religious groups, NGOs and private sector unions). The project will use the financial management services o f a Financial Management Agency for the transfer o f funds required by these subcomponents. Under the contract between FMA and CNLS six project Advance Accounts will be opened in the six regional offices o f FMA, each covering two departments. As soon as the decision to finance a subproject or action plan has been taken by the local level review and selection committee (an entity completely independent o f FMA) or CNLS, the approved subproject or action plan proposal will be forwarded to the appropriate regional FMA office for financing. After having promptly completed the necessary checks for compliance with financial management procedures, CDLS or CNLS and the departmental FMA offices will then enter into a grant agreement with the authorized representatives of the community o f public sector organization, which will implement the relevant subproject or action plan, and simultaneously release the first tranche o f funds. The release o f the second tranche will be subject to the subproject or action plan's compliance with both program and financial management reporting requirements specified inthe operations manual. 23. The first payment to each o f the six advance accounts managedby the regional FMA offices will be calculated on the basis of an estimated 30 days o f expenses, and the total sum o f this first payment will be requested by the Permanent Secretariat's coordinating unit. The withdrawal requests are submitted by the recipient's representative, the Caisse Autonome d'Amortissement (CAA) to the Association (IDA). Upon the withdrawal request's approval by IDA the funds will be transferred to regional FMA offices as described inthe preceding paragraph. The P A would submit quarterly expenditure reports indicating the sources and use o f funds and accompanied by reconciled bank statements. Replenishment o f these advance accounts will be made on the basis o f the disbursements made to finance the community subproject agreements facilitated by the respective regional FMA office. According to established practice under M A P I,each regional FMA office will be required to provide simple justifying documentation, in the form o f SOEs to ensure replenishment o f their respective sub-accounts. When submittingreplenishment requests, the P A would ensure that the reconciled bank statements for the designated accounts, in a standard format, show the deposits received from IDA, the amount advanced to each decentralizedproject location, the date on which each advance was made and the amount awaiting documentation from each of these locations. In addition, each FMA local bureau will justify the use o f their resources under the Advance Accounts or replenish them on a monthly basis. The allocation in each Advance Account will not exceed CFAF 100 million except for the bureau o f Cotonou (CFAF 250 million). 54 24. An independent CNLS commission will review the action plans of the sectoral ministries, including the MOH and other public institutions' interventions and initiatives (foreseen within these action plans), but requiring small scale funding such as specific training or awareness raising activities, or a work program, o f a series o f various related small-scale initiatives, will also be financed by the designated Account A. In order to avoid the impact o f the slow rate o f mobilization o f human and financial resources usually associated with the public sector, following the approval o f the sectoral action plan, the given ministryor public institution will sign the related financial agreement and open an account in a commercial bank, with the Administrative Director (DA) and the HIV/AIDS focal point o f the ministry or institution being the only signatories. Just as in the case o f the Component 1 subprojects, a first advance payment will then be deposited to the Ministry's or public sector organizatiordagency's account. 25. Designated Account B: Financial flows for non-grant activities The Advance Account B i s intended for financing the Ministry o f Health activities and for project coordination, M&E and management. An independent CNLS commission will review the action plans o f the sectoral ministries, including the MOH, and other public institutions. Following approval o f the plans, provisions will be made for three different categories o f disbursement modalities required: (a) Arrangements for the financing o f the purchase o f medical equipment, medical supplies, laboratory reagents, condoms, IEC equipment, and consultant services for various studies and for technical assistance to support the formulation o f the sectoral action plans fall in this first category. For the purposes o f efficiency and economies o f scale, the established procedures o f IDA (or approved Government procedures) for financing activities with IDA resources will be applied, following the related established procurement requirements, resulting in either Direct Payment or payment from the Designated Account B, with the justifying documentation to be held centrally by the coordinating unit o f the Permanent Secretariat. The responsibility for implementation and monitoring o f a specific activity so financed will be held by the sectoral ministry or public-sector organization, whereas the coordinating unit will merely execute the relevant payments, as per the instruction o f the Ministry or institution, within the context of the given Action Plan. (b) Fundsneededby CNLS and the national, uniform M&E system will be transferred to CNLS' account in quarterly basis according to approved CNLS annual action plan andbudget. (c) The funds needed for project management and the project-specific M&E system will be paid directly from Advance Account B. 26. While shifting to the disbursement based on the Financial Management Report (FMR), the initial allocations would be CFAF 800 million for DesignatedAccount A, and CFAF 500 million for Designated Account B. The World Bank will deposit the above amounts into the DesignatedAccounts upon Credit effectiveness. The Designated Accounts would be used for all payments inferior to twenty percent o f the initial allocation. 27. Further deposits by IDA into the Special Accounts would be made against withdrawal applications supportedby InterimFinancial Reports (IFR). It i s envisaged that the project will have the necessary capacity for using FMRs based disbursement from the outset, in view o f the quality o f financial work under M A P I.If needed, the financial staff will be quickly 55 familiarized with the IFR guidelines and IDA requirements in a week's seminar to be conductedby the task team soon after effectiveness. 28. As a result, the project will withdraw Credit proceeds inform of advances onthe basis o f IFRs, which will enable it to have a high liquidity level and a faster cash flow replenishment that will be necessary to fund its many activities. The ceiling may be adjusted on the basis o f onthe periodic forecasts o f cash flow needs. 29. The following principles will apply: All expenses related to contracts disbursed on the basis of InterimFinancial Reports and the documentation supporting the IFRswill be made available for reviewby Bank supervision missions and by the external auditors at any time. However, expenses amounting to more than 20 percent o f the project's quarterly liquidity needs may be processed as direct payment transactions and or through Special Commitment based on Letters o f Credit (opened by the recipient's bank) in favor o f the suppliers on the request o f project authorities in the usual manner where full documentation will be provided. Transaction-supporting documentation for Interim Financial Reports and any Statements o f Expenditure (if used) will be retained by PA. The primary responsibility for maintaining the records rests on the P A even if contracting the day- to-day financial operations to an FMA. Statement of Expenditure 30. All expenditures against contracts exceeding the following prior-review thresholds will need to be fully documented. - -- US$250,000 for works and goods US$lOO,OOO for consultant services-fims US$50,000 for individualconsultant services Retroactive Financing 31. The project will have retroactive financing amounting to less than 10 percent o f the total IDA financing, which will be documentedon the basis o f SOEs. Reporting 32. The Bank requires projects to prepare interim unaudited financial reports (IFR) (previously referred to as financial monitoring reports (FMRs) in the areas o f finance, procurements including contract details, and project progress. The semi-annual IFRs will include; The Semi-Annual Financial Reports, consisting o f Sources o f Funds and their Uses, Statement o f Uses o f Funds by Project Components and Activities, Special Account Reconciliation statement and a six-month Project Cash Forecast where needbe. Semi-Annual Project Progress Report consisting o f Output Monitoring Report on contract management and on Unit o f Outputbyproject activity. Semi-Annual Procurement Report, consisting o f procurement process monitoring and contract expenditure reports for goods, works and consultants' services. The 56 report compares procurement performance against the plan agreed at negotiations and appropriately updated at the end o f each quarter. The report should also provide any informationon complaints by bidders, unsatisfactory performance by contractors and any contractual disputes. 33. The project coordinator with the Finance Unitswill be responsible for preparing and submittingthe IFRrequired to be produced under the project and submit copies to the Bank within 45 days o f the end o f each six months. The contents and format o f the IFRs were agreed at negotiations. Allocationof CreditProceeds Flow of funds: (See the Graphbelow) 34. InBenin, the CaisseAutonome d'Amortissement(CAA) is the assigned representative o f the Recipient for the mobilizationof IDA funds. Withdrawal requests are prepared by the Head of the CNLS Financial Unit, signed by a designated signatory or signatories (the signature authorization letter i s signed by the Minister o f Finance), and sent to the Bank for payment. The following chart shows the flow of funds among the different partners. Accountingpoliciesand procedures 35. IDA Credit, will be accounted for by the project on a cash basis. This will be documented with appropriate records and procedures to track commitments and to safeguard assets. Accounting records will be maintained in local currency. The Chart o f accounts will facilitate the preparation o f relevant quarterly and financial statement including information on the total project expenditures, the financial contribution Erom each financier and expenditure by componentlcategory. SupervisionPlan. 36. Supervision activities will include (i) review o f quarterly FMRs; review o f annual audited financial statements and management letter as well as timely follow-up o f issues arising; (ii)annual SOE review; participation inproject supervision missions as appropriate; and (iii) updating the FM rating in the Implementation Status Reports (ISR). 57 ................ CREDITACCOUNT WASHINGTON I - ................. CENTRAL BANK I. I I I RSFlDPDlDRF Suppliers .. Acco unts 0 A **** 0 CNLS f f 3 Designated Designated Account A Account B * COMMERCIAL BANK ,*** ******** p**+ AGF 1 1 2 1 3 1 4 / 5 / 6 the Ministries ..............+ - ReportslDocuments Resources 58 FinancialManagementActionsPlan 1Actionto be taken Expectedcompletion date Responsiblebody 'Transfer the PPLS FM March 31,2007 PPLS (Financial Specialist) system to the CNLS and SPICNLS Financial Unitand provide training Appoint a Chief Accountant, March 31,2007 Permanent Secretariat CNLS satisfactory to IDA Recruit the external auditor March 31,2007 for the MAP I1 Appoint an internal auditor, March 15,2007 satisfactory to IDA Update the Financial and May 31,2007 Accounting manual (already underway with Update the operational May 31,2007 Permanent Secretariat CNLS manual 59 Annex 8: ProcurementArrangements Benin: SecondMultisectoralHIV/AIDS ControlProject A. Background ProcurementReform - 1. A Country Procurement Assessment Report (CPAR) for Benin was preparedinApril 1999. In November 2002, an action plan for a procurement system reform was developed duringa national workshop and it integrates the CPAR's recommendations. This action plan supports the modernization o f the regulatory and institutional framework, and its objectives are to: (a) improve the management o f public contracts; (b) modeniize public procurement procedures; (c) strengthen capacities; (d) establish an independent control system, and (e) adopt anti-corruption measures. In addition, the plan provides for the gradual empowerment o f the decentralized procurement entities; the definition o f a strategic framework for capacity buildinginprocurement; and the updating of tools such as standard biddingdocuments and manual for procurement procedures to ensure effective use o f the procurement Code. 2. Implementation o f the new institutional framework has translated into the creation of: (a) a National Commission o f Public Procurement Regulation (CNRMP); (b) a National Directorate for Public Procurement (DNMP); and (c) Public Procurement Units (CPMP) at Ministries level. The government i s going to harmonize the legal and institutional procurement framework with the WAEMU ProcurementDirectives adoptedby its Council of Ministers inDecember 2005. B. Guidelines 3. Procurement for the proposed project would be carried out in accordance with the World Bank's "Guidelines: Procurement under IBRD Loans and IDA Credits" dated May 2004; and "Guidelines: Selection and Employment of Consultants by World Bank Borrowers" dated May 2004, and the provisions stipulated in the Credit Agreement. The general's descriptions o f various items under different expenditure category are described below. For each contract to be financed by the Credit, the different procurement methods or consultant selection methods, the need for prequalification, estimated costs, prior review requirements, and time-frame are agreed between the Recipient and the Bank project team in the Procurement Plan. The Procurement Planwill be updated at least annually or as required to reflect implementation progress and improvements ininstitutional capacity. 4. The NGOs, CSO and CBO will receive and manage small grants to implement the activities agreed on in their action plans. To that end, they will use, for procurement purposes, the Bank's SimpliJied Guidelines for Procurement and Disbursement for Investments with Community Participation (February 1998 or any other procedures and documents considered acceptable by the Bank and included in the Project Implementation Manual. C. ProcurementDocuments 5. The procurement will be carried out usingthe Bank's Standard BiddingDocuments or Standard Request for Proposal (RFP) respectively for all ICB for goods and works and recruitment o f consultants executed by SP/CNLS or PNLS. For National Competition Bidding(NCB), the biddingdocuments should be submitted to the Bank for prior review and will be used throughout the project once agreed upon. The Sample Form o f Evaluation Reports developedby the Bank, will be used. 60 D. Advertising procedure 6. The General Procurement Notice (GPN), Specific Procurement Notices (SPN), Requests for Expression o f Interest, the results o f the evaluation and the contract award should be published in accordance with advertising provisions in "Guidelines: Procurement under IBRD Loans and IDA Credits" dated May 2004; and "Guidelines: Selection and Employment of Consultants by WorldBank Borrowers dated May 2004. " E. Procurement methods 7. Procurement of Goods: The total cost o f contracts o f Goods to be financed by IDA, including drugs, i s estimated at US$11.80 million equivalent, not including contracts for goods to be procured at the community level. The items would include: office equipment, furniture and consumables, audio-visual and laboratory equipment; vehicles; HIV/AIDS- related health commodities, drugs, reagent, test, nutritional foods, condoms, IEC materials, and other project related supplies. Goods would be grouped inbidpackages estimated to cost at least US$200,000 per contract for equipment and US$350,000 per contract for reagent and drugs, and would be procured through International Competitive Bidding (ICB). Contracts estimated to cost less than US$350,000 equivalent for drugs and reagent, and less than US$200,000 equivalent for other goods may be procured through NCB. Goods estimated to cost less than US$20,000 equivalent per contract may be procured through shopping procedures. Contract will be awarded on the basis o f written solicitation issued to several qualified suppliers (at least three), following evaluation o f bids received inwriting from such qualified suppliers. The award would be made, after comparing a minimum o f three quotations, to the supplier with the lowest price quotation for the required goods, provided it has the experience and resources to execute the contract successfully. For shopping, the procurement specialist will keep a register o f suppliers updated at least annually. Drugs and reagent for which there are a limited number o f suppliers would be procured under Limited International Bidding (LIB) procedures. The Direct Contracting (single source) may be used with prior agreement o f the Bank, for drugs and goods under the circumstance described in the paragraph 3.6 o f the Procurement Guidelines. Drugs including ARV, tests, reagents, and nutritional foods estimated to cost less than US$l million equivalent per contract may also be procured from the United Nations Agencies (WHO, UNICEF, UNFPA, WFP, etc.) in accordance with the Bank Guidelines with prior agreement o f the Bank. 8. Procurement of Works: The total cost o f contracts o f works to be financed by IDA i s estimated at US$1.OO million equivalent. The contracts will concern the rehabilitation and extension of the SP/CNLS office and the rehabilitation o f medical laboratories. Contracts with an estimated cost less than US$500,000 equivalent may be procured through NCB. Small civil works contracts estimated to cost less than US$50,000 per contract may be procured usingShopping procedures. 9. Selection of Consultants: The project will finance Consultant Services such as studies, surveys, financial audits, engineering, community development specialists, trainers and workshops facilitators; the total amount o f consultant services is estimated at US$5.50 million. Consultant firms will be selected through the following methods: (a) Quality and Cost Based Selection (QCBS); (b) Least Cost Selection (LCS) for financial audits and insurances; (c) Selection under a Fixed Budget (FBS) for recruitment o f facilitators (NGOs) to assist or advise the Communities; and (d) Single Source Selection (SSS), with prior agreement o f IDA, for services inaccordance with the paragraphs 3.10 to 3.12 o f Consultant Guidelines and for selecting o f Fiduciary Agency. The Government has proposed, and IDA has agreed that `'Agencede Gestion FinanciBre 2 la Base (AGeFIB)" will be selected as the Fiduciary Agency for the Component 2 of the Project, given that this agency had very 61 successfully managed the communities grant under the Local Response Component o f the M A P I. Individual Consultant (IC) will be hired in accordance with paragraph 5.1 to 5.4 of Bank Guidelines; sole source may be used only with prior review o f the Bank. Short lists o f consultants for services estimated to cost less than US$lOO,OOO equivalent per contract may be composed entirely o f national consultants in accordance with the provisions o f paragraph 2.7 of the Consultant Guidelines, provided that a sufficient number o f qualified individual or firms are available. However, if foreign firms have expressed interest, they would not be excluded from consideration. 10. Procurement of non-consulting services: Least Cost Selection (LCS) or Selection under a FixedBudget (FBS) could be used. 11. Training, Workshops, Study Tours, and Conferences: The training (including support for training activities), workshops, conference attendance and study tours and hiring consultants for developing training materials or conducting training will be carried out on the basis o f approved annual training programs that will identify the general framework o f training and similar activities for the year. A detailed training program giving categories o f training, number o f trainees, duration o f training, staff months, timingand estimatedcost will be submitted to IDA for review and approval prior to initiating the training process. The appropriate methods o f selectionwill be derived from the detailed schedule. 12. Operational Costs: Operating costs financed by the Project are incremental expenses, including office supplies, vehicles operation and maintenance, maintenance o f equipment, communication costs, rental expenses, utilities expenses, consumables, transport and accommodation, per diem, supervision costs and salaries o f locally contracted staff. They will be procured using the procurement procedures specified in the Project Implementation Manual. F. AssessmentoftheAgencies Capacityto ImplementProcurement 13. Procurement activities will be carried out by a recruited Procurement Specialist at SP/CNLS, and by the Ministry o f Health (MOH) Procurement Unit (CPMP) for drugs, reagent and medical material and equipment relevant to the PNLS activities. PNLS could also procure drugs and reagents through the National Drugs and Medical Supplies Administration (Centrale d 'Achat des Mkdicaments Essentiel et consommables Mkdicawc (CAME)) or UN Agencies. 0 SPKNLS:The mainrecommendation of the capacity assessmentis the recruitment of a Procurement Specialist. For Procurement activities, CNLS i s staffed by a Procurement Specialist, recruited for another project, and doesn't have any experience inBankprocurementprocedures. 0 PNLS: The recent capacity assessment made during the preparation o f BeninMalaria Control Support Project has showed that the ProcurementUnit o f MOH doesn't have experience inthe Bank's procurement procedures. A procurement Specialist has been recruited for this Procurement Unit; then, this Procurement Unit will be used for PNLS procurement activities. 0 CAME: The recent capacity assessment made during the preparation o f Benin Malaria Control Support Project has showed that CAME has qualified staff and experience in procurement o f drugs and reagent and it could help PNLS for this category o f procurement. 14. The main risk identified concerning procurement in this Project i s the lack o f experience in the Bank's procurement procedures at the SPKNLS level. The following corrective measures have been agreed upon: (a) a Procurement Specialist will be recruited for 62 the SP/CNLS according to Bank guidelines, the recruitment will be submitted to the Bank for non objection before the Credit effectiveness; (b) a civil servant qualified will be affected to CNLS as ProcurementAssistant and will receive procurement training and mentoring; and (c) the implementation manual of the SP/CNLS that will comprise simplified tender documents for the NGOs, CBOs, CSOs and others Ministries will be finalized and submitted for the Bank's reviewprior to Project effectiveness. 15. For CSO, CBO, and Private Sector Organizations, there i s no procurement capacity assessmentbecause the strategy is based on a demand-driven approach. 16. The table below summaries the project preparationactions plan: 1. Submitto the Bank the first Before Firstdraft shared with 18 monthprocurement plan negotiations IDAbyJanuary 15, CNLS 2006 2. Prepare the procurement the Before Firstdraft shared with Project Implementation effectiveness IDAby January 31, CNLS I 3. Manual. acceatable to IDA 2007 Recruitment o f procurement Before Selectionprocess ,cc,,+:.,,,,,, I begun before by 1CNLS January 31,2007 In view of experience gained under the predecessor project, the overall project risk for procurement is low. Procurement implementation arrangements 17. The Procurement Specialist recruited for SP/CNLS will be responsible for the coordination o f all procurement activities including: (a) programming and procurement progress report; (b)updating the procurement plan; (c) preparation, finalization and launching of the Proposal Requests and bidding documents; (d) drafting o f minutes o f opening and evaluation of the bids as well as preparation o f the bids evaluation reports; and (e) preparation and submission o f contracts for signing. All project procurement prior review documents should be submittedto IDA through SP/CNLS. The Procurement Specialist will oversee and manage the project's procurement activities; he will ensure these activities are proceeding ina timely manner and according to project objectives. 18. The M O H Procurement Unit will be responsible for procurement o f drugs and medical equipment and will provide to SP/CNLS quarterly report o f all procurement activities under PNLS. 19. For the implementation o f the action plan o f key line Ministries or Public-sector agencies, the procurement will be done by the respective HIV/AIDS Focal Points Units, if necessary, with the help o f the procurement units(CPMP) o f the concerned entities. 20. CSO, CBO and Private Sector Organizations will be responsible for the procurement o f goods or services necessary for the implementation o f actions plans agreed through signed conventions; these organizations will receive systematically the required basic training on the Simplified Guidelines for Procurement and Disbursement for Community-Based Investments before have the first grant. 63 21. The procurement responsibilities repartition i s summarized inthe following table: 1 I Type of activities Executingentity Itemsto be -1 Drocured Drocurement 1. NationalCoordination SP/CNLS Goods/works Procurement activities, Monitoringand Services Specialist of Evaluation, Project SP/CNLS Management 2. Medical equipment, drugs PNLS Goods/Services CPMP o f the MOH (including ARV) tests, and or CAME. reagents 3. Public and Private Sector Respective Ministries Goods/Services Respective Focal Response (implementation o f or Private-sector relative to grants Points Unit action plans) agencies I 14. 1- Non Governmental Sector CSOs/NGOs Goods/Services Respective II relative to grants 5. Support to community Community Goods/Services I Iinitiatives relative to mants G. Procurement Plan 22. The Government developed a draft Procurement Plan for project implementation, which provides the basis for the procurement methods; the plan covers the first eighteen months o f project implementation. This plan was agreed between the GOBand the Project Team during the negotiations and will be available at SP/CNLS and PNLS; it will also be available in the Project's database and in the Bank's external website. A draft procurement plan will be submitted to the Bank on January 15, 2007. The Procurement Plan will be updated in agreement with the Project Team annually inconjunction with preparation o f the sectoral action plan or as required to reflect the actual project implementation needs and improvements in institutional capacity. All procurement will be carried out in accordance with the formally agreedprocurementplans (original and formally up-dated) H. FrequencyofprocurementsupervisionmissionsandAudits 23. Inaddition to the prior review supervision to be carried out from Bank offices, the capacity assessment o f the Implementing Agency has recommendedbi-annual supervision to visit the field to carry at least an annual ProcurementPost Review. 64 Attachment 1 DETAILSOFTHE PROCUREMENTARRANGEMENTINVOLVINGINTERNATIONAL COMPETITION 1. Goods and nonconsulting services. (a) List of contract Packages which will beprocuredfollowing ICB and Direct contracting: 1 1 2 3 4 1 5 1 6 1 7 8 9 Ref. Contract Estimated Procurement P Q Domest Revlew Expected Comments No. (Descrlptlon) Cost (`000) Method Pref by Bank Bid- 11 (yeslno) (Prior I Opening Post) Date 1 -WORKS ;`I No InternationalCompetitionBidding is expectedfor works I 2 - G 3DS 2.1 Acquisitionof Acquisition during vehicles for CNLS, I the first year of CDLS, M&E a 470,874 ICB May2007 Proiect - FMA implementation 2.2 Acquisitionof 1;; Acquisition during vehicles for CNLS, the secondyear CDLS, M&E a 714,563 ICB March 2008 - of Project FMA implementation 2.3 Acquisitionof 200,608 ICB __ computersand office equipment May2007 for CNLS and its - decentralizedunits 2.4 Acquisitionof ARV 1,553,398 ICB Uniquecontract June 2007 with semester - delivery 2.5 Acquisitionof 234,951 ICB Uniaueorder with other drugs for the 1 semesterdelivery 1 treatment of IST Yes June2007 - and 01 2.6 Acquisitionof 1,590,291 ICB No Uniquecontract tests, reagents for with semester HIV infectionand delivery biological 1;: monitoring(Elisa, No Yes June2007 rapid tests, hematology, biochemistrv. - CD4, hepath) 2.7 Acquisitionof bio- II 629,126 I ICB security equipment (incinerator,small clinicalwaste May2007 management - equipment) 2.7 Acquisitionof 350,485 ICB laboratory I equipment (cytometerand May 2007 printing - equipment) No (b) Prior review: all contracts estimated to cost above US$200,000, and the first two (2) contracts o f each procurement method, irrespective o f the amount, will be subject to IDA prior review as determined mandatory in paragraphs 2 and 3 o f Annex 1 o f the Bank's procurement Guidelines. (c) Post review: for each contract for works and goods not submitted to the prior review, the procurement documents will be submitted to IDA post review in accordance with the provisions o f paragraph 4 o fAnnex 1o f the Bank's procurement Guidelines. The post review will be basedona ratio of at least 1to 5 contracts. 65 2. Consulting Services. (a) List of ConsultingAssignments with short-list of internationalfirms. - 1 2 3 4 1 5 1 6 7 Ref. Description of Estimated Selection Review Expected Comments No. Assignment cost Method by Proposals (`000) Bank Submission (Prior Date - I Post) 1 Financial Management 879,905 Single Yes May2007 The selected Agency for the Source Financial implementationof the Selection Management community component Agency is - AGeFIB 2 Behavioral Surveillance 215,000 QCBS Yes April2007 Surveyat the high-risk groupslevel (b)Prior review: (a) each contract estimated to cost more than US$lOO,OOO per contract for Firms and US$50,000 per contract for individuals consultants; (b) all single source selection; (c) all training; (d) the first two (2) contracts o f each selection method irrespective o f the amount; (e) all terms o f reference o f contracts that estimate cost i s greater than US$5,000; and (f)all amendments o f contracts raising the initial contract value by more than 15 percent o f original amount or above the prior review thresholds will be subject to IDA prior review mandatory inparagraphs 2 and 3 o f Annex 1o f the Bank's Consultants selection Guidelines. (c) Short lists composed entirely of national consultants: Short lists o f consultants for services estimated to cost less than US$lOO,OOO equivalent per contract may be composed entirely o f national consultants in accordance with the provisions o f paragraph 2.7 o f the Consultant Guidelines. (d) Post review: For each contracts for services not submitted to the prior review, the procurement documents will be submitted to IDA post review in accordance with the provisions o f paragraph4 o f Annex 1of the Bank's Consultant selection Guidelines. The post review will be based on a ratio o f at least 1to 5 contracts. 66 Annex 9: EconomicandFinancialAnalysis Benin: SecondMultisectoralHIV/AIDS ControlProject The EconomicImpactsof HIV/AIDS 1. HIV/AIDS affects economic activity in several ways. It leads to decreases in productivity, increased absenteeism o f the economic work force, and increased turn-over with its associated costs (Haacker, 2004a). Moreover, HIV/AIDS depletes the stock o f human capital as skilled workers die prematurely. Furthermore, increased out-of pocket expenditures for health reduce household's savings. Studies for South Africa reveal that HIV/AIDS related expenditures amount to 25 percent o f the income o f a household worker inurban areas and up to 50 percent inrural areas (Salinas & Haacker, 2006). Social capital i s also eroded specially due to the stigma associated with the disease (Gaffeo, 2003). At the same time that the epidemic causes an increase inthe demand for govemment services (particularly inhealth), it can also lead to reductions in public revenues. This occurs essentially as the tax base decreases and possibly on long-run output through the negative effects o f the epidemic (Hacker, 2004b). Hence, HIV/AIDS puts enormous strains onpublic finances. 2. Inaddition, HIV/AIDScontributes to the persistence of poverty as it affects not only the stock, but also the accumulation of human capital. Infact, when parents die orphans are threatened by financial distress and lack o f care, which may lead to increases inthe incidence o f child labor and/or reduce school enrollment/attendance. Therefore, the potential negative long-run impact o f HIV/AIDS on economic development can be quite substantial (Bell et al., 2006). Results on the empirical link between the epidemic and economic growth seem to be mixed. It appears that a majority o f papers finds a negative effect, whilst others fail to find any effect at all and some even report positive impacts on growth (see Corrigan et al, 2005 among others). Nevertheless, there is substantial evidence that the epidemic reduces investment inhuman capital (Kalemli-Ozcan, 2006). HIV/AIDSinBeninand FinancingGaps 3. Benin represents a generalized HIV/AIDS epidemic with a low prevalence rate, estimatedby UNAIDS to be around 2 percent o f the population in2006. Differences between urban and rural areas are not large (2.4% versus 1.6%) and the epidemic i s already present even in remote rural areas. The high prevalence rates among commercial sex workers (25.5%) and people with tuberculosis (16.7%) indicate some concentration incertain groups, but those groups are small relative to the entire population. Even inthis context, HIV/AIDS can have perceptible demographic impacts. According to the WHO core health indicators, Benin presented 5,800 deaths due to HIV/AIDS per 100,000 people in the population in 2003. 4. UNAIDS estimates that the amount spent by the Govemment o f Benin from domestic resources on HIV/AIDSwas approximately US$10.6 millionin2004. Nonetheless, programs to combat the epidemic in the country still depend heavily on external finance. For instance, in2005 91 percent of the National AIDS Council (CNLS) financing originated from foreign sources. Financing for the previous HIV/AIDS program that covered the period from 2001 to 2005 was based on the first US$23 million MAP project, a US$17.8 million Global Fund project, a US$4.5 million project by USAID, US$3 million fiom the World Bank's Abidjan- Lagos Corridor Project, and a number o f technical assistance cooperation projects from bilateral donors. The table below presents estimates o f the total amount o f international financial resources mobilized by the Government to fund the 2006-2010 HIV/AIDS programs. It includes funds approved in the 5th round o f the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), as well as funds provided by Bilateral and Multilateral 67 agencies, such as the African Development Bank (AfDB), and the Corridor project, which will continue until2007. 2006 2007 2008 2009 2010 Total GFATM 10,458 9,714 10,130 11,538 12,846 54,686 AfDB 1,552 1,552 1,552 0 0 4,655 WB(Corrid 600 600 0 0 0 1,200 or) DANIDA 0 221.5 221.5 221.5 221.5 886.2 (PALBIDA) USAID(*) 0 2,800 2,800 2,800 2,800 11,200 (IMPACT) TOTAL 12,610 14,887 14,704 14,560 15,867 72,627 5. Furthermore, CNLS undertook a costing exercise, detailed in the table below, that estimated the total resource needs for the implementation o f its Cadre Stratbgique from 2006 to 2010, taking current commitments o f the government in terms o f prevention efforts and coverage rates regarding treatment and care. The total estimated resource needs would amount to FCFA 125 billion, which i s equivalent to approximately US$240 million. The bulk o f the costs would be concentrated inthe areas o f prevention and testing, as well as treatment and care, which account respectively for 50.4 percent and 34.3 percent o f the total costs over the period. 6. It is crucial to note that those figures refer to the National AIDS Commission's own calculations and are likely to overestimate the real resource needs. As mentioned previously, the epidemic inBeninis generalized, butdrivenby some specific groups (such as commercial sex workers), hence there i s a strong rationale for increasing the focus o f interventions. This means that there might be scope to reduce resource needs by increasing the targeting o f StratigiquelCNLS) . interventions when compared with what is planned under the National AIDS strategy (Cadre Source: CNLS 7. Hence, by comparing the two tables one can easily note that there still i s a considerable gap between resources mobilized and estimated costs. The table below presents estimates o f the financing gap for each year from 2006 to 2010, as well as the total for the period. When performing the calculations an exchange rate o f FCFA 515 per US$ was used. The total gap over the five years would amount to over US$164 million on the basis o f the resource needs estimated by the CNLS. The US$35 millionM A P I1project would contribute towards filling this funding gap and the remaining amount would need to be obtained from Benin's own resources or other donors. Hence, if government expenditures on HIV/AIDS 68 remain at 2004 levels, the total gap taking account o f the resources from the MAP I1project would amount to approximately US$76 million.One needs to bear inmindthat commitments such as ARV treatment imply recurrent costs for extendedperiods o f time, therefore resource mobilizationefforts will have to continue to be strong beyond 2010. 2006 2007 I 2008 2009 2010 I TOTAL The ExpectedImpactsof the MAP I1Project 8. As one can see from the previous sections, precise quantification of the economic effects o f HIVIAIDS i s a complex process. The benefits o f the project will be estimated in terms o f the number o f deaths averted, as suggested by World Bank (1996). The estimation will consider a number o f alternative scenarios and will attempt to assess whether the project i s likely to contribute towards a significant improvement in welfare for a given budget. In particular, the analysis will concentrate on the cost-effectiveness ratio defined as the cost o f the project divided by the number o f premature deaths prevented if the project i s implemented, when compared to the counterfactual that no action i s taken. According to World Bank (ibid.), a conservative estimate o f the value o f a year o f life saved is annual per capita income. The number o f deaths averted will cover the effects of the project interms o f mortality, but one should also consider the benefits o f other direct impacts such as avoided treatment costs, as well as indirect benefits, such as the reduced number o f HIV/AIDS orphans and the implications interms of human capital accumulation andneed for support. 9. The demographic projections used in this analysis were obtained from the SPECTRUM and the AIDS impact model (AIM) software packages3. The first package was usedto make general demographic projections based on data from the UNstatistical division. The latter package allows to estimate future numbers o f infections, AIDS cases and AIDS deaths, as well as other impacts o f the epidemic, given assumptions about the hture course o f adult HIV prevalence. Inthe analysis a number o f different scenarios are considered based on Benin's Cadre Stratbgique National de Lutte Contre le VIH/SIDA/IST 2006-2010 and different assumptions about future prevalence rates. The Cadre Stratkgique sets targets in terms o f coverage rates for a number o f prevention and treatment services that were incorporatedto the scenarios when necessary. 10. The baseline scenario assumesthat the country will continue with the current levels of coverage o f prevention and treatment services and would constitute the case were the M A P I1 project i s not implemented, i.e., assuming that the status quo remains for the period o f the projection until 2015. The prevalence rate i s also assumed to remain constant at 2 percent during the projection period. Furthermore, in the high prevalence scenario, the levels of coverage o f services remain constant at current levels, but the prevalence rate increases to 3 percent by 2015. Inorder to obtain estimates o f the number o f HIV/AIDS orphans data from the Benin DHS survey on the percentage o f women aged 15-19 that never married was used. ART started in Benin in 2002 with a coverage rate of 3 percent o f those in need (CNLS, 2006). For those two scenarios, coverage rates for ARV treatment for both adults and children were set at the current levels from 2005 onwards. The softwarepackagesandmanuals giving further technical details are available to downloadat www.futuresmoup.com 69 11. The M A P I1scenario considers what would occur if the project i s implemented and contributes to achieving the target coverage rates set by the Cadre National Stratkgique. Nonetheless, this scenario considers that HIV prevalence rates remain at 2 percent. One should note that increased efforts in terms o f treatment and prevention may not lead to decreases in the prevalence rate in the short run, as more people infected with the virus survive for extended periods o f time. Finally, the low prevalence scenario assumes that project is implemented and the prevalence rate declines to 1.8 percent by 2010 in line with the target set in the Cadre Stratkgique, i.e., this is the prevalence figure used for the national strategy. 12. The figure below illustrates the number o f deaths due to AIDS under the different scenarios. One can estimate the number o f deaths averted simply by subtracting the number o f deaths that would occur if the program i s not implemented, i.e. Baseline and High Prevalence Scenario, from the estimated number o f deaths in case the program i s adopted. The figure provides a glance on the large welfare implications o f HIV/AIDS interventions, even when one only considers the relatively short 5-year project period. One should also bear inmindthat ifefforts to avert new infections are effective, the benefits ofthe project will still accrue well beyond 2010. A cursory comparison between the High and Low Prevalence Scenarios until 2015 gives us a rough quantification o f the potential benefits in terms o f deaths avertedo f reductions inthe incidence rate over the project period. NumberofDeathsDueto AIDS inBenin(2000-2015) 16,000 15,000 14,000 13,000 12,000 +Baseline -MAP 2 +High Prev 11,000 -Low Prev 10,000 9,000 8,000 7,000 I 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 201: 13. The table below presents estimates o f the cost per death averted for each year as well as the cumulative total over the period from 2006 to 2010. Each column considers the cost per death averted when comparing an intervention scenario with a no-intervention counterfactual. Firstly, the M A P I1 scenario i s compared to the Baseline scenario. Subsequently, the second column compares the M A P I1with the High Prevalence scenario, then the Low Prevalence with the Baseline scenario in the third column and finally the Low Prevalence with the High Prevalence scenario inthe forth column. Once again, one needs to bear inmind that those measures are only indicative and probably understate the benefits in terms of deaths averted, since the impact o f prevention efforts persists for a number o f years beyond the project period. This implies that a certain percentage o f deaths averted from 2011 70 onwards will be related to expenditures financed by the M A P I1project, the costs were only spread over the deaths averted inthe period2006-2010. Ratioof Cost to PrematureDeathPreventedinThousandsof FCFA (2006-2010) 14. The analysis o f the ratio o f the cost o f the program to number o f premature deaths averted reveals that this cost decreases substantially over the period o f the project under all scenarios. When one considers the M A P I1scenario usingthe Baseline as the counterfactual, one can observe that the ratio goes from FCFA 10.2 million per death averted in 2007 (around US$19,500) to FCFA 3 million per death averted in 2010 (around US$5,800). Estimates o f the cost per death averted seem to be fairly robust, as significant differences do not emerge between the distinct scenarios and counterfactuals. Overall the estimates for the whole period from 2006-2010 range from an upper bound o f FCFA 6.43 million (approximately US$12,200) to a lower limit o f FCFA 6.27 million (approximately US$ll,900). Iti s crucial to emphasize that one needs to contrast those costs with the possible financial and economic benefits discussed previously, such as a substantial reduction in hospitalization costs, the reduced negative fiscal impact of HIV/AIDS, as well as the reduced negative impact on the stock and accumulation of human capital among other issues. 71 Annex 10: SafeguardPolicyIssues Benin: SecondMultisectoralHIV/AIDS ControlProject PotentialLong-TermImpacts 1. This project falls into Environmental category B because no adverse long-term impacts are anticipated. No long-term adverse impacts were identified in the Environmental Assessment instrument, that is, the Medical Waste Management Plan (MWMP). This project will not fundactivities that would cause an adverse effect onthe environment. 2. The M W M P focuses on the reduction o f medical wastes and would involve a lot o f sensitization and training, including those pertaining to appropriate separation, transport, and disposal o f hazardous medical waste. ProjectLocationand Salient PhysicalCharacteristicsRelevantto the Safeguard Analysis 3. The proposed project i s expected to take place in the whole territory o f Republic of Benin. MeasuresTakenbythe Borrowerto Address SafeguardIssues 4. The Medical Waste Management Plan o f M A P Iproject was revised to be applicable for this project. 5. An environmental health specialist at the Sanitation Department of the Ministry o f Health will be responsible for following up on the M W M P recommendations during project implementation. The Project Administration (PA) will have a database o f consultants that will be required to prepare studies and training based on the recommendationso f the M W M P as and when necessary. Assessing and buildingenvironmental health capacity at the state and local levels would be an added responsibility for the environmental health specialist, and he will be complemented with short-term national environmental safeguards consultants as and when the need arises. 72 Annex 11:ProjectPreparationand Supervision Benin: SecondMultisectoralHIV/AIDS ControlProject (a) Projecttimetable @) Key InstitutionsResponsiblefor ProjectPreparation: CNLS, 0 UNAIDS 0 PAIMAPI (c) Team Composition Cassandrade Souza I Operations Analyst AFTHV Antonio C. David I Economist II AFTHV Anne-MarieBodo Pharmacist, Consultant AFTHV Turto Turtiainen RuralDevelopmentSpec. Consultant Soulemane Fofana OperationsAnalyst AFTS3 LydieAhodehou ProgramAssistant AFMBJ Sylviedo Rego TeamAssistant AFMBJ Marie-ClaudineFundi LanguageProgramAssistant AFTS3 Sheela Reddi LanguageProgramAssistant AFTS3 73 (d) EstimatedProject Preparation and SupervisionCosts 0 Bank funds expended to date on project preparation: PHRD Grant:O Gender Trust Fund:O Bank Resources: US$166,565 Total: US$166,565 0 EstimatedApproval and Supervision costs:US$150,000 a. Remaining costs to approva1:O 0 Estimatedannual supervision cost:US$150,000 74 Annex 12: Documentsinthe ProjectFile Benin:SecondMultisectoralHIV/AIDS ControlProject Bell, C. et al. (2006) "Economic Growth, Education and AIDS in Kenya: A Long-Run Analysis" World Bank Policy ResearchWorking Paper4025, October, Washington: DC. CNLS (2006) "Cadre Strategique National de Lutte contre le VIWSIDA 2006-2010", CNLS Benin, Cotonou. CNLS: Draft Annual WorkPlanfor theFirst Project Year Corrigan, P. et al. (2005) "AIDS Crisis and Growth" Journal o f Development Economics, 77. Gaffeo, E. (2003) "The Economics o f HIV/AIDS: a Survey" Development Policy Review, 21 (l), pp.2749. Haacker, M. (2004a) "HIV/AIDS: The impact on the Social Fabric and the Economy" inHaacker, M (ed.) "The Macroeconomics o fHIV/AIDS" InternationalMonetaryFund, Washington: DC. Haacker, M. (2004b) "The impact o f HIV/AIDS on Government Finances and Public Services" in Haacker, M (ed.) "The Macroeconomics o f HIV/AIDS" International Monetary Fund, Washington: DC. Kalemli-Ozcan, S. (2006) "AIDS, Reversal o f the Demographic Transition and Economic Development: Evidence for Africa" NBER Working Paper 12181April, Cambridge:MA. Salinas, G. & Haacker, M.(2006) "HIV/AIDS: The impact on Poverty and Inequality" IMFWorking Paper 126, May, Washington: DC. Projet multisectoriel de lutte contre les VIH/SIDA (Benin): OperationsManual, French Version Projetmultisectoriel de lutte contre les VIWSIDA (Benin): Operations Manual Annex 11 Rkpublique duBenin, Ministbre Chargk de laPlanification et duDkveloppement, CNLS: Monitoring and Evaluation Manual (national M&E system) Rkpublique duBenin, Ministbre du dkveloppement, de l'kconomie et des finances, CNLS : Cadre Stratigique National deLutte contre le VIH/SIDA/IST 2006-2010. Rkpublique duBenin, Ministkre dudkveloppement, de l'kconomie et des finances, CNLS :Plan Opdrationnel pour CadreStratigique National de Lutte contre le VIH/SIDA/IST 2006 -2010. Rkpublique duBenin, Ministkre du dkveloppement, de l'kconomie et des finances, CNLS :Rapport de la Prdparation de laphase 11du MAP (Project Plurisectoriel de Lutte contre les ISTNIH/SIDA II) du Benin The World Bank: Implementation Completion and Results Report (ICR) of PPLS The World Bank: TurningBureaucrats to Warriors.Preparing and Implementing Multi-Sector HIV/AIDS Programs in Afizca World Bank (1996) "Handbook on Economic Analysis of Investment Operations Operation " Policy Department, May, Washington: DC. 75 Annex 13: Statementof LoanandCredits Benin:SecondMultisectoralHIV/AIDSControlProject Difference between expected and actual Original Amount inUS$Millions disbursements ProjectID FY Purpose IBRD IDA SF GEF Cancel. Undisb. Orig. Frm. Rev'd PO82725 2006 BJ-DecentralCity Mgmt 2 (FY06) 0.00 35.00 0.00 0.00 0.00 27.36 -2.39 0.00 PO96482 2006 BJ-MalariaCntrl BoosterPrgmSIL (FY06) 0.00 0.00 0.00 0.00 0.00 32.03 0.85 0.00 PO79633 2005 BJ-EnergySNC Delivery APL (FY05) 0.00 45.00 0.00 0.00 0.00 42.19 31.95 0.00 PO81484 2005 BJ-NatlCDD SIL (FY05) 0.00 37.70 0.00 0.00 0.00 41.51 10.78 0.00 PO72503 2002 BJ-Cotton Sec ReformSIL (FY02) 0.00 18.00 0.00 0.00 0.00 4.53 1.73 1.73 PO39882 2000 BJ-Priv Sec (FYOO) 0.00 30.40 0.00 0.00 0.00 4.29 4.07 0.98 Total: 0.00 166.10 0.00 0.00 0.00 151.91 46.99 2.71 BENIN STATEMENT OF IFC's HeldandDisbursedPortfolio InMillions ofUSDollars Committed Disbursed IFC IFC FY Approval Company Loan Equity Quasi Partic. Loan Equity Quasi Partic. 2000 FMADEV 0.00 0.34 0.00 0.00 0.00 0.34 0.00 0.00 Totalportfolio: 0.00 0.34 0.00 0.00 0.00 0.34 0.00 0.00 Approvals PendingCommitment FY Approval Company Loan Equity Quasi Partic. Totalpendingcommitment: 0.00 0.00 0.00 0.00 76 Annex 14: Country at a Glance Benin:Second MultisectoralHIV/AIDS ControlProject - - Beninat a glance 8/12lW. -9 Sub- S r h m LOW- Benin Africa Developmentdiamond 8 4 741 510 745 4 3 552 3 2 2.3 3 2 2.3 29 40 35 55 46 1 90 100 23 29 67 56 35 99 93 111 99 86 87 1995 2004 2005 Economioratios' GDP (USSt M h s ) 1a 2 0 4.O 4.3 GrosscapitalfamationloDP 8.9 196 182 19.6 Expects of pxdaand servioeslGDP 23.7 202 13.3 13.5 Trade GrassdomesticsavingffiDP 4.1 6 7 5 5 6.9 GrosanatbndsavInpdGDP -02 a 2 10 3 10.6 Curtnt acowntbatmceloDP -42 4 7 -8.0 8.5 InterestpsymentSKiDP 13 1.1 0.4 Domestic CapW TotrrlaMlGoP 816 803 47.3 ssvinps fwmaihm TotaldeMsavralcxp&a 115 110 s 4 P m n td u e ddeW/GDP 19.9 Resentvsluedd&kpoits 119.7 1985-95 1995-05 2004 2005 2005-09 ( a m annualgrowth) GDP 25 4 7 3 1 3.9 GDPperq t a -10 16 4 2 0.7 Expubolgooc$andsewlees 0 5 24 0 4 5.0 1985 1995 2004 Mo5 315 340 321 322 167 146 133 134 7 9 86 7 6 75 tO 518 514 546 544 5 0 007 a20 809 781 a 154 112 136 250 366 330 261 261 1985-95 199505 2004 Mo5 Growth of cxprts and imparts(W) I 4.8 5.3 5.7 4.4 I 3.9 4.6 -0.6 4.6 6.0 4.8 -2.1 4.5 0.5 4.3 2.0 3.2 5 2.2 1.6 4.0 -1.7 0 -1.5 8.2 5.5 14.5 -5 6.2 13.5 4.1 11.5 0.0 2.9 1.3 4.1 Note 2005 data are prelmnarl.estimales `Thediamonds show fap keyirdicatarsini k counbyrrnbold]anparedwth Itsicomegrarpaverape Ifdataare missmng. thedmmwwlwll Lxr incomplete 77 IBRD 33372 0 1E 2E 3E 4E To To Dosso Sokoto NIGER NIGER RIVER NIGER RIVER BURKINA 12N BENIN FASO MékrouMékrou Malanville Malanville Pendjari AliboriAlibori s a i n To n t KandiKandi Dapaong 11N PanjariPanjari o u SotaSota M 11N MékrouMékrou A L I B O R I a k or ATA K O R A ta A Lake Lake NatitingouNatitingou KainjiKainji Bembéréké Bembéréké Tassiné ssiné Koumongou 10N 10N DjougouDjougou OuéméOuémé B O R G O U NIGERIA To To Kabou AlpouroAlpouro OkparaOkpara Kaiama D O N G A ParakouParakou 9N 9N TOGO 0 20 40 60 80 100 Kilometers 0 20 40 60 Miles GHANA C O L L I N E S This map was produced by the Map Design Unit of The World Bank. 8N SavalouSavalou The boundaries, colors, denominations and any other information 8N shown on this map do not imply, on the part of The World Bank Group, any judgment on the legal status of any territory, or any endorsement or acceptance of such boundaries. ZouZou Dassa- Dassa- 1E Zoumé Zoumé Ouémé Couf Couffo PLATEAUPLATEAU BENIN Z O U AbomeyAbomey Cové Cové COUFFOCOUFFO SELECTED CITIES AND TOWNS Bohicon Bohicon DEPARTMENT CAPITALS 7N PobéPobé 7N To NATIONAL CAPITAL Notsé Aplahoué Aplahoué DogboDogbo RIVERS LakeLake OUEMEOUEM Vo ta Vol To M O N O E SakétéSakété Ibadan MAIN ROADS LokossaLokossa ATLANTIQUE TLANTIQUE RAILROADS MonoMono PORTO NOVO PORTO NOVO DEPARTMENT BOUNDARIES To Lomé OuidahOuidah CotonouCotonou LITTORALLITTORAL INTERNATIONAL BOUNDARIES BIGHT OF BENIN BIGHT OF BENIN 0 1E 2E Gulf of Guinea 3E DECEMBER 2005