Page 1 PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No.: AB3146 Project Name Additional Financing for the HIV/AIDS II Project Region AFRICA Sector Health (60%);Other social services (20%);Central government administration (20%) Project ID P105724 Borrower(s) REPUBLIC OF CHAD Implementing Agency Environment Category [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) Date PID Prepared May 24, 2007 Estimated Date of Appraisal Authorization July 25, 2007 Estimated Date of Board Approval September 11, 2007 A. Key development issues and rationale for Bank involvement 1. The political instability experienced by Chad during the last three decades has severely compromised the country’s economic and social development, and the country’s most vulnerable groups (women and children) have witnessed a further deterioration of their already precarious living conditions. To date, an estimated 80% of the Chadian population live with less than $1/day and the country ranks 173 out of 177 on the UNDP Human Development Index scale (UNDP 2006). In addition to that, the continued turmoil and unrest in the neighboring countries has resulted in an influx of refugees. This situation, along with the particularly high fertility rate (6.3 in 2005), has inevitably contributed to a rapid population increase and considerably overstretched the capacity of health services across the country. A 2005 national HIV survey found adult HIV prevalence at 3.3%, with a peak at 8% in the capital N’Djamena. Incidence among women is higher than among men, even more so among young girls between the age of 15 and 25, with an estimated 200 000 people, including children, living with HIV in the whole country (WHO, 2007). The main factors contributing to vulnerability to HIV/AIDS include low condom use, multiple sexual partners, poverty, low education status of women and girls, socio political insecurity, conflict and limited access to AIDS services. 2. The Bank-financed Second Population and HIV/AIDS Prevention Project was approved on July 12, 2001 and became effective on April 11, 2002. The closing date is currently September 30, 2007. The total amount of the credit is SDR 19.6 million (US$24.56 million equivalent). As of May 24, 2007, SDR 18.8 million of the IDA Credit amount has been disbursed, which is around 96 percent of the total credit. Since the reorientation of project activities in accordance with the recommendations of the mid-term review and following the re- launching of activities in June 2006 after suspension of the portfolio, the project is achieving good results on the ground with respect to the decentralized local response approach for sexually transmitted infections (STIs) and HIV/AIDS. Achievement of the project development objective and implementation progress is currently satisfactory. An assessment on progress towards achieving the project development objectives indicates that these are likely to be achieved with Page 2 respect to the HIV/AIDS indicators. Knowledge about HIV/AIDS has increased in both men and women and the use of condoms has increased for both men and women (respectively in 1997 and 2004, for men from 1.8% to 24. 6%, for women 2.6% to 17%) and for military personnel, use during non-union sexual contacts, has greatly increased (67.6%). In addition, voluntary testing has increased from 6,000 tests in 2004 to more than 13,000 in the first 9 months of 2005. B. Proposed objective(s) 3. The objective of the project, which would remain unchanged, is to contribute to behavior change among the Chadian population in order to reduce the risk of both HIV infection and too closely spaced and/or unwanted pregnancies. The project finances five components: (1) support to a multisectoral response to HIV/AIDS through strengthening the capacities of key ministries; (2) support to the Social Fund (FOSAP) and community interventions; (3) social marketing of key health-related products; (4) support to the implementation of the National Population Policy; and (5) support to project implementation. C. Preliminary description 4. The proposed additional financing would permit consolidation of recent gains on the ground and allow for the scaling-up of the local integrated response to HIV/AIDS and other well-performing HIV prevention activities implemented under the other project components. The additional financing would also allow the strengthening of the quality of current interventions, the production of more solid results (which would also feed into a more thorough final evaluation exercise) and the identification of relevant lessons to build on during the preparation of a new MAP project. 5. In doing so, the additional financing will also help tackle the following emerging issues: (i) persistent stigma and discrimination against people living with HIV across the country; (ii) gender inequality in accessing health services; (iii) weak capacity; and (iv) insufficient funding to contribute to the achievement of the health-related Millennium Development Goals. The new approach is expected to be introduced into two new HIV/AIDS high-risk areas, most likely one of which would be in the conflict areas. To this end, partnerships will be strengthened with other donors, such as UNICEF, and civil society, such as Medecins Sans Frontiers , working in these areas to ensure a coordinated and harmonized approach to health services in these areas. Moreover, the capacity building element of the new approach would be expected to contribute to strengthened capacity of local levels of Government to manage health services. 6. The project objectives would remain the same. However, given that the new approach would be scaled up under the additional financing, the indicators used to measure process would be slightly modified, and new indicators introduced to reflect those activities that have become an integral part of the project over time and have significantly contributed to producing a positive impact on the targeted population. 7. The implementation arrangements under the additional financing would be the same as for the ongoing project, as they are working well. The Ministry of Finance, Economy, and Plan (MFEP) will be responsible for the planning, management and coordination of project activities Page 3 through a Steering Committee to be presided by the Secrétaire Générale of the MFEP. The day- to-day coordination of project activities will be carried out by the Project Coordination Team, headed by a Project Coordinator under the direct supervision of the Secrétaire Générale of the MFEP. The team also includes a senior administrator, a chief-accountant, an accountant, a procurement specialist and a monitoring and evaluation specialist. IDA activities of the FOSAP will continue to be managed by an administrator, with a team of a grant officer, a monitoring and evaluation specialist, an internal auditor and an accountant. Implementation arrangements, procurement, financial management and monitoring and evaluation are detailed in the Procedural Manual and the Administrative and Financial Manual of the project as well as the FOSAP Operational Manual. D. Safeguard policies that might apply 8. The only safeguard triggered is the environmental assessment, because a medical waste management plan (MWMP) is required. This plan will be prepared and disclosed prior to appraisal of the proposed project. E. Tentative financing Source: ($m.) BORROWER/RECIPIENT 0 International Development Association (IDA) 7 Total 7 F. Contact point Contact: Maryanne Sharp Title: Senior Operations Officer Tel: (202) 458-5560 Email: Msharp@worldbank.org