Document of The World Bank Report No: 23881-GUI PROJECT APPRAISAL DOCUMENT ONA PROPOSED GRANT IN THE AMOUNT OF SDR15.4 MILLION(US$ 20.30 MILLION EQUIVALENT) TO THE REPUBLIC OF GUINEA FOR A MULTI-SECTORAL AIDS PROJECT (MAP) November 13, 2002 Human Development 2 Country Department 11 Africa Regional Office CURRENCY EQUIVALENTS (Exchange Rate Effective March 21, 2002) Currency Unit = GNF GNF 100 = US$.05 (or 5 cents) US$1 = 1978 GNF FISCAL YEAR ABBREVIATIONS AND ACRONYMS ACTafrica AIDS Campaign Team for Africa AGBEF Guinean Association for Family Well-Being ARV (T) Anti-retroviral (Therapy) CAS Country Assistance Strategy CBO Community-based Organization CCC Communication for Changing Behavior CDF Comprehensive Development Framework CIDA Canadian International Development Agency CNLS National Comittee for the fight against AIDS CPLS Prefectoral Committee for the fight against AIDS CRLS Regional Committee for the fight againt AIDS CRD Communaute Rurale de Developpement (rural development communities) DHS Demographic and Health Survey EA Environmental Assessment EDS Enquete Demographie et Sante EMP Environment Management Plan FMA Financial Management Agent GNF Guinean Francs GTZ German Technical Assistance Organization HCR Haut Commissariat aux RefugiJs HIPC Highly Indebted Poor Country HIV-OI/STI Human Immunodeficiency Virus-Opportunistic Infection/Sexually transmitted infection LkPSO Inter-Agency Procurement Services Office IDP Internally displaced persons KAP Knowledge, Attitudes and Practices MAP Multi-sectoral AIDS Project PACV Projet d'Appui aux Communautes Villageoises PMTCT Prevention of Mother-to-Child Transmission PLWHA/PWS Person living with HIVIAIDS/Personnes vivant avec VIHISIDA PNLS Plan National de lutte contre le SIDA PNPCSP Programme national de la prise en charge sanitaire et de la prevention PPSG Projet Population et Sante Gdndsique PRSP Poverty Reduction Strategy Paper PSI Population Services International, NGO UNIPAC United Nations Children's Fund Procurement and Assembly Center URD Unite Regional de De'veloppement (Regional Development Unit) VCT Voluntary Counseling and Testing Vice President: Callisto E. Madavo Country Manager: Mamadou Dia Sector Manager: Alexandre V. Abrantes Task Team Leader: Tonia Marek GUINEA MULTI-SECTORAL AIDS PROJECT (MAP) CONTENTS A. Project Development Objective Page 1. Project development objective 2 2. Key performance indicators 2 B. Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported by the project 3 2. Main sector issues and Government strategy 3 3. Sector issues to be addressed by the project and strategic choices 6 C. Project Description Summary 1. Project components 8 2. Key policy and institutional reforms supported by the project 11 3. Benefits and target population 11 4. Institutional and implementation arrangements 12 D. Project Rationale 1. Project alternatives considered and reasons for rejection 13 2. Major related projects financed by the Bank and other development agencies 14 3. Lessons learned and reflected in the project design 15 4. Indications of borrower commitment and ownership 15 5. Value added of Bank support in this project 16 E. Summary Project Analysis 1. Economic 16 2. Financial 16 3. Technical 16 4. Institutional 17 5. Environmental 20 6. Social 20 7. Safeguard Policies 22 F. Sustainability and Risks 1. Sustainability 22 2. Critical risks 22 3. Possible controversial aspects 23 G. Main Grant Conditions 1. Effectiveness Condition 23 2. Other 23 H. Readiness for Implementation 24 I. Compliance with Bank Policies 24 Annexes Annex 1: Project Design Summary 25 Annex 2: Detailed Project Description 28 Annex 3: Estimated Project Costs 39 Annex 4: Guinea Multi-Sectoral AIDS Project 40 Annex 5: Financial Summary for Revenue-Earning Project Entities, or Financial Summary 41 Annex 6: (A) Procurement Arrangements 42 (B) Financial Management and Disbursement Arrangements 50 Annex 7: Project Processing Schedule 54 Annex 8: Documents in the Project File 56 Annex 9: Statement of Loans and Credits 58 Annex 10: Country at a Glance 59 Annex 11: Supervision Arrangements 61 MAP(S) IBRD 31718 GUINEA MULTI-SECTORAL AIDS PROJECT (MAP) Project Appraisal Document Africa Regional Office AFTH2 Date: November 13, 2002 Team Leader: Tonia Marek Sector Manager: Alexandre V. Abrantes Sector(s): Agricultural extension and research (40%), Country Director: Mamadou Dia General information and communications sector (25%), Project ID: P073378 Health (15%), Other social services (10%), Secondary Lending Instrument: Specific Investment Loan (SIL) education (10%) Theme(s): Fighting communicable diseases (P) Project Financing Data- [ ] Loan [ Credit [X] Grant [ Guarantee [ Other: For Loans/Credits/Others: Amount (US$m): $20.3 Financing Plan-(USm): Source - Local - - - Foreign Total BORROWERIRECIPIENT 2.00 0.00 2.00 IDA GRANT FOR HIV/AIDS 14.80 5.50 20.30 Total: 16.80 5.50 22.30 Borrower/Recipient: GOVERNMENT OF GUINEA Responsible agency: National Committee for the Fight against AIDS (CNLS) Contact Person: Dr Hadja Mariama Dielo Barry Tel: 224-29-46-87/21-62-88/25-01-93/46-46-00 Fax: Email: cnlsidaO2@yahoo.fr Estimated Disbursements ( Bank FY/US$m): i-~.IFY NO 2006 2007 _ Annual 3.00 3.36 | 4.41 5.21 4.32 Cumulative 3.00 6.36 10.77 15.98 20.30 Project Implementation period: Five years (Year 1 amount includes PPF of $700,000) Expected effectiveness date: 04/03/2003 Expected closing date: 07/31/2008 A. Project Development Objective 1. Project development objective: (see Annex 1) The proposed project is part of the World Bank's Multi-country BIV/AIDS Program for the Africa Region (MAP2, report P7497 AFR*) approved on February 7, 2002. In accordance with the main goal of MAP2, the overall objective of the project is to limit and reverse the trend of the epidemic, by preventing new infections. The project will support the implementation of the National Plan against HIV/AIDS (Plan National de Lutte contre le SIDA - PNLS) for the period FY03-06 and promote civil society and community initiatives for prevention and care put forward by beneficiary groups. The project will also contribute to building capacity for HIV/AIDS prevention, care and treatment, and mitigation activities. *Up to present, 16 MAPs have been approved for Africa, 13 are effective, and all are rated Satisfactory on their Development Objectives and Implementation Progress. 2. Key performance indicators: (see Annex 1) Based on the nature of the HIV/AIDS epidemic and the experience of other countries, the impact of project-supported activities would be difficult to assess in terms of a reduction of HlV/AIDS prevalence in the overall population or of increased life expectancy within the five-year implementation period. However, a measurable impact can be expected among key target groups as set out in the outcome indicators of the logical framework (Annex 1). The project's development objective is to limit and reverse the trend of the epidemic by preventing new infections, to be measured by the following main indicators, complemented by those of Annex 1: Outcome Indicators * at least 55% of high risk groups (men in uniform, miners and commercial sex workers) used condoms during their last sexual encounter in 2007 (the figure for formal sector miners was 19% in 2001); * at least 50% of men and women who are aware of AIDS have used a condom with a partner other than their regular partner in the last twelve months (the numbers in 1999 were 27% for men and 18% for women), by 2007; * keep the HIV prevalence rate among 15-24 year old urban pregnant women below 5% by 2006 (it was at 4.4% in 2001 among all urban pregnant women); * increase by at least 1,500 the number of orphans who attend school regularly as of 2004. Output Indicators * No cases of HIV/AIDS traceable to a hospital blood transfusion by 2007. Process Indicators * 80% of 303 CRDs to be implementing 80% of their annual FHV/AIDS plans by 2007; Input Indicators * fund 42 urban projects (supporting prostitutes, truckers, and orphans for example) by 2005; and - 2 - about 100 by 2007; * fund about 300 rural projects (supporting PLWH, vulnerable groups and high-risk groups) by 2005 and about 1000 by year 2007; B. Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported by the project: (see Annex 1) Document number: 7183 GUI, dated 11/21/1997 Date of latest CAS discussion: November 1997 The 1997 CAS acknowledged Guinea's weak administration and poor governance and emphasized the progress the Government had made in the recent past to strengthen human and institutional capacity and improve governance. The CAS focused on helping to reduce poverty in Guinea through; (i) improving access to basic services; (ii) increasing economic growth and creating income-earning and employment opportunities, particularly for the rural poor; and (iii) improving governance and strengthening institutional and human capacity. AIDS was first mentioned as a problem in the July 2001 "CAS Progress Report". The Executive Directors discussed Guinea's interim Poverty Reduction Strategy Paper (PRSP) in December 2000 and a CAS Progress Report in July 2001. A new CAS will be prepared on the basis of the priorities set in the full PRSP, a first draft of which was written in January 2002. The objectives of the interim PRSP are fully aligned with those of the 1997 CAS and it supplements it by dealing with AIDS. It emphasizes the need to take up the challenge of dealing with the emerging AIDS threat and set forth two objectives in that area: (i) stabilize or reduce the incidence of HIV/AIDS and (ii) control its socioeconomic impact. The CAS progress report indicates that Guinea has made advances in reducing macroeconomic imbalances, despite increased military expenditures due to worsening security conditions in three neighboring countries, in restructuring its economy, and in increasing primary enrollment rates, including for girls. It also indicates that, before discussion of a full CAS, Bank activities would address two urgent emerging issues: the HIV/AI)S epidemic, in response to a request of the President of Guinea, and the reconstruction needs arising from the refugee/internally displaced persons (IDP) issue. It is in this context that a project is proposed for Bank assistance in the framework of MAP2. 2. Main sector issues and Government strategy: Past failures and challenges from an unsettled envirovment. Guinea is recovering from the failure of a centrally planned economy, which prevailed until the mid-1980s. The introduction of multi-party democracy in 1994 improved political accountability, even if elections have been plagued with widespread irregularities. For much of the past decade, Guinea has been home to nearly half a million of refugees from its two southern neighbors, Liberia and Sierra Leone. In September 2000, it suffered from cross-border incursions, which have caused the displacement of populations and damage to infrastructure. Since 2001 the security situation improved in Sierra Leone, but has remained fragile in Liberia. Poor social indicators. In the 1990s, Guinea made significant strides in human development, particularly in education, and managed to reduce the gap relative to averages for sub-Saharan Africa (SSA). School enrollments increased from under 30 percent in the 1980s to 56 percent by the end of the 1990s. Girl enrollment rates doubled from 20 to 40 percent. Important achievements were made in the health sector during the past decade to develop a basic health care system. Vaccination rates for Polio3 increased from 15% in 1982, to 17% in 1990, and reached 54% in 1995. However, Guinea continues to compare poorly with other SSA countries. In 1999, for instance, one child out of four suffered from chronic malnutrition and one woman out of ten suffered from acute malnutrition. - 3 - Successes to build upon. Guinea was a pioneer in implementing a decentralized cost-recovery system for primary health care. The success of this system might be in great part responsible for the higher decrease in infant mortality among the poor than among the non-poor in the 90's, a result in equity that no other country of Africa has achieved. In the last few years however, it seems that local health committees started mismanaging the committee's funds due to lack of proper supervision. In addition, the bankruptcy of the Bank where all the committees' revolving funds were held also contributed to the problem. Another success in Guinea is its tuberculosis control program which covers the whole country with the DOTS system which was established in 1990. Since its inception, the program has never experienced a drug stock-out. All donors, under the leadership of the national TB program, plan drug supply needs, drug procurement, and drug distribution in a collaborative manner. The program detected 66% of the estimated new infectious TB cases in 2000, while the global target for case detection is 70%. It is estimated that approximately 17% of new TB patients are infected with HIV. Epidemiological Situation of HIV/AIDS. The low HIV prevalence rate reported in official records in the past few years is more a reflection of poor reporting and monitoring than of the true epidemiological situation in Guinea. The sentinel sites established to monitor sexually transmitted infections (STIs) and HIUV/AIDS prevalence have been nonfunctional since 1996. In the absence of data, the Guinean HIV prevalence rates were likened to those of Senegal, its neighbor, where the population of reproductive age, for example, had a prevalence rate of approximately 3 % in 2000. However, the national prevalence survey undertaken in July 2001 showed that the HIV prevalence rate was much higher than estimated. The prevalence rate among pregnant women had reached the critical point of 4.4 % in the urban areas throughout the country, with even higher rates in Conakry (5%) and Guin&e Forestnre (7%). The higher rates in Guinee Forestiere are probably due to the state of conflict in that region, the large military presence, increased migration, and the heavily traveled roads leading to and from neighboring countries such as the Cote d'lvoire. In the late 1980s, the gender ratio of HIV-infected patients reporting to health facilities was 8 men for 1 woman. In 2000, the ratio shifted to 2 women for one man, clearly showing that HIV/AIDS had spread to the general population, mainly through heterosexual relations. The average age of AIDS cases has decreased from 39 years old in 1989 to 26 years old in 1999. These rates show that the epidemic is clearly picking up speed and must be halted through rapid and effective actions to prevent the devastation which occurred in Central African Republic. CAR also had a prevalence rate of 4.7% among urban pregnant women in 1986; three years later the rate reached 8%; and ten years later it had climbed to 11.6%. The progression of the epidemic was similar in Cote d'lvoire where 3% of urban pregnant women were infected in 1986, increasing to 8% two years later, and climbing to 15% in 1991. In Guinea, studies have shown some groups to have extremely high rates: 42% of commercial sex workers, 7.3% of truck drivers, 6.7% of military, and 4.7% of miners. EpiModel estimates indicate that in 2002 about 70 Guineans would be infected per day, resulting in 6500 AIDS cases by 2007. A number of factors contribute to the spread of HIV/AIDS: inadequate knowledge and inappropriate attitudes, sexuality at an early age, high prevalence of risky behavior, subordinate status and lack of empowerment among women, importance of mining and trucking activities, and large numbers of refugees and displaced people. In addition, the high prevalence of STIs (between 7 to 13% of adults declared having had a STI during the last twelve months, with variations depending on matrimonial status, age, and domicile, according to an EDS survey in 1999) is a major factor in the spread of HIV/AIDS. Finally, Guinea's high incidence of poverty -- about 40 percent of households below the poverty line - underlies the epidemic, leaving an extremely vulnerable population. Government response to the HIV/AIDS challenge -4 - Although the Government response was slow and uncoordinated following the notification of the first AIDS case in 1987, some steps were taken. The PNLS was coordinated by a National Commnission created in November 2000 and chaired by the Minister of Health. In early 2002 the PNLS was abolished to be replaced by a multi-sectoral National AIDS Commnission under the leadership of the Prime Minister. The Commission's Executive Secretary was selected in May 2002. Focal points for AIDS exist in most central ministries, and both Regional and Prefectoral committees have been established under the chairmanship of the health director in each Region and of the Medical officer in each District. The prefectoral committee includes a representative of youth organizations, a teacher, and a prominent person at the local level. The Government's National Budget has included a line item for AIDS since 1998, which reached 138 million Guinean Francs (US$72,000) in 2001. The following AIDS prevention activities were underway by project preparation and financed from multiple sources: the Ministry of Agriculture trained 128 trainers, 1500 monitors, and 1000 auxiliary agents in AIDS prevention who have reached more than 700,000 agriculture workers and 110,000 cattle raisers. The Bank-financed PACV project trained 50 persons in 33 districts. The Bank-funded PPSG project financed several micro-projects related to AIDS prevention. USAID and KfW financed a social marketing of condoms program which is managed by a national NGO and covers the whole country (although the condoms are not widely used in spite of their low price of GF 25 per unit (US$0.02)). USAID provided technical assistance for drug stock management. GTZ was active in peer education. Canada financed its second AIDS/STI prevention project in two Regions and could increase its coverage if further financing were available. WHO has been involved in training. UNICEF has been active in helping set up 22 anti-AIDS clubs in secondary and technical schools. UNFPA has been involved in condom provision among other activities. The major mining company has started an AIDS prevention campaign for its personnel. An HIV/AIDS network of NGOs called ROSEGUI has been established, within which such NGOs as SIDALERTE and MST UNIVERSITE work with truck drivers and commercial sex workers. The UNHCR and MSF, along with the International Red Cross, have been fighting AIDS in refugee camps. At the time of project preparation only the blood provided by donors was being tested for HIV, although a National Blood Transfusion Policy existed which included the prevention of HIV/AIDS. The European Union is planning to help set up a modern national transfusion center. Prior to project start there was no program dealing with mother-to-child transmission. UNAIDS set up an extended national committee including bilateral donors. This Committee was meeting on a regular basis for coordination purposes. With the creation of the National AIDS Commission, the UNAIDS Committee will work in even closer collaboration with Government. Assessment of results and shortcomings: In January 2002, the MOH undertook a critical analysis of the Government's response to the AIDS epidemic. It noted the following weaknesses: no activity in some of the committees, poor coordination, poor inter-sectoral collaboration, lack of political commitment by Ministries, lack of information and training. Indeed, while the initiatives taken thus far are steps in the right direction, their efficiency has been sorely limited by lack of resources and the narrow focus on the health sector. The Government therefore decided to adopt a multi-sectoral approach in the fight against HIV/AIDS. A National AIDS Commission was created, placed in the Prime Minister's office, and its membership has been broadened. Twelve of 22 Ministries prepared action plans, and the Government finalized its national strategy for the fight against AIDS. Religious groups are increasingly involved in the fight against HIV/AIDS and are expected to participate actively in the implementation of the strategy. PLWHA associations are established and will be represented in the new institutional framework. Several studies were undertaken to identify high-risk groups and their behaviors. A capacity assessment of NGOs was undertaken by a large international NGO, and a NGO roster was established during project preparation, which will be updated regularly, as NGOs get training and can therefore satisfy the criteria -5 - to enter into this roster. Government strategy The Government's inter-sectoral strategy for the fight against AIDS covers the period 2002-2006 and emphasizes seven areas for action: (i) activities covering the whole population, namely community mobilization for HIV prevention; (ii) improving communication for behavior change through local radios, religious leaders, and advocacy at various levels; (iii) targeted interventions especially for youth, commercial sex workers, refugees, miners, prisoners, military, and police; (iv) health sector response emphasizing epidemiological surveillance, STI control, blood safety, mother to child transmission, and general testing and counseling; (v) care and psycho-social support to HIV infected people and affected families; (vi) research on H[V/AIDS; and (vii) strengthening the institutional framework, where the national, regional and local AIDS committees will be reinforced. Their membership will be broadened to include representatives of institutions and groups active in the fight against AIDS. Their operations will be strengthened through training and allocation of additional resources. At the local level their role will be to support initiatives by NGOs, local groups, and the civil society at large. The National Commission will review action plans prepared by line ministries and large enterprises and provide support as needed. Some of these areas for action -- such as refugee work and basic research -- will be managed by donors other than the World Bank. Some donors are already financing activities such as targeted interventions for youth and STI control on a small scale, which will be expanded with Bank financing. The Bank will intervene as a donor of last resort following the first annual review, thereby assisting Government to finance the program. Furthermore, Government has committed some HIPC resources to the fight against AIDS, and a request for funding has been made to the Global Fund for Malaria, AIDS and TB control in 2002 to complement the IDA financed project and other activities. The new Director of the National AIDS Commission has taken the lead in donor coordination, effectively using the Guinea extended UNAIDS group. The annual reviews of the national HIV/AIDS program will be led by Govemment and greatly contribute to donor coordination. 3. Sector issues to be addressed by the project and strategic choices: Eligibility of Guinea for MAP. The Government requested Bank support for its H[V/AIDS program in the framework of MAP 2, rendering Guinea eligible for MAP funding, having satisfied the four criteria: * Satisfactory evidence of a strategic approach to HIV/AIDS. A comprehensive and broad-based HIV/AIDS national strategy for 2002 to 2006, including adequate strategies for prevention, and for care and support, was finalized through a consultative process. The President and Prime Minister are strongly involved in the fight against HIV/AIDS, and key cabinet members are active in the sensitization on HIV/AIDS issues. * A high-level HIV/AIDS coordinating body. The National HIV/AIDS Committee was established under the supervision of the Prime Minister by a Decree signed by the President of the Republic on March 5, 2002. A Secretariat was established as its Executive Secretary was selected in May 2002. All Secretariat members were recruited through a competitive process. * Government agreement to use exceptional implementation arrangements. The Government established a Secretariat to coordinate implementation of the HIV/AIDS program under the supervision of the new CNLS. The Government agreed to contract out financial management activities. A contract management firm will be hired to help set up a monitoring and early warning system for the various contracts which the Secretariat will finance. Selection of a Financial - 6 - Management Agent will be a condition for effectiveness. * Government agreement to use and fund multiple implementation agencies. The Government has requested all ministries and public enterprises to prepare HIV/AIDS programs. It has agreed to fund activities undertaken by the private sector, civil society organizations, including religious groups, local associations, and conununities. It has agreed to enlist the support of traditional healers and birth attendants. It was also agreed that existing institutions which are performing well will be contracted to expand coverage more rapidly. For example, GTZ will be contracted to improve coverage among youth, and the University of Montreal (the SIDA3 project)will be contracted to continue their STI/HIV/A1DS activities in selected regions. Other Sector issues to be addressed by the project and strategic choices Weak institutional capacity and limited partnership with civil society. The intensification of the prevention effort and the introduction of orphan-support will require significant strengthening and coordination of the concerned institutions, services, and systems, notably: * systems and procedures for channeling funds more efficiently to the grassroots on a large scale; * developing capacity at the regional and prefectoral levels through accelerated training of technicians in the areas of VCT (especially for pregnant women), ART, treatment of OIs and STIs, procedures to ensure safe blood supplies and the safe handling of medical waste; * partnerships within the civil society to strengthen and develop local capacity to deliver prevention and care at a decentralized level; * monitoring and evaluation, which becomes more complex as a result of greater grassroots involvement; * research and dissemination activities: consolidation of existing, successful collaborative operational research arrangements and enhancement of Guinea's role in disseminating best practices to other countries in the Region; * procurement of drugs, testing kits, and related services to ensure that regional and district services are supplied efficiently and on time. The project will begin with core activities that are ready for implementation. Support to capacity building will help galvanize the fight against EHV/AIDS and STIs, as well as organize prevention and care activities in sectors and communities not yet engaged. Civil servants in all ministries will be trained in FHV/AIDS prevention and care activities, and a pool of trainers in each ministry will be able to replicate training as needed. Prevention at the grassroots level. Although there is now broad agreement on prevention as a national priority, much work is still to be done, particularly with regards to: * Non-schooled youth, aged 20 to 24, who have an lIV prevalence of 4.9%, must be educated about disease transmission and protection, and encouraged to postpone first sexual encounters. To be effective, this group must be reached in the last years of primary school, before sexual activity begins. * Truck drivers, who have an HJV prevalence of 7.3%, are major carriers and spreaders of the disease. Specific activities need to be set up at all major truck stops. * Miners, who have an HIV prevalence of 4.7%, will be reached through the private firms who employ them, while self-employed miners will be reached through NGOs. - 7 - * Commercial sex workers, who have an HIV prevalence of 42%, will be provided with peer education and special STIIBIV prevention measures. * Men/Women in uniform, who have an HIV prevalence of 7%, need to be informed about prevention and have condoms available at all times. The project will finance NGOs and institutions which are already working with those groups, and will add a quality enhancement dimension as some institutions in Guinea are specialized in certain areas such as youth counselling, STI control, social marketing of condoms, and so on. Those institutions will be financed by the project to ensure that activities are expanded rapidly and that quality of services remain at a standard. Health sector issues. Although Guinea was a pioneer in implementing a decentralized cost-recovery system, the present-day health services need significant resources to prevent the system from collapsing. It is hoped that HIPC funds can be used to reconstitute the drug supply which has suffered in great part from the bankruptcy of the commercial bank where all the revolving funds were held. A biannual monitoring system of the health services is still carried out in a very professional manner, but the lack of vaccines and drugs is having a detrimental effect on attendance. Government has requested IDA resources for a health sector program, which should help revive service delivery. Their request is being met by a loan to be channelled through the upcoming programmatic lending through PRSC which should be available in early 2003. The private sector will also need to be mobilized in order to improve coverage of HiV/AIDS/STI prevention, and the HIV/AIDS project will initiate such partnership. Although there is a network of more than 500 private pharmacies, medical, and para-medical offices, the Government has not worked with them to date. In addition, traditional healers will be mobilized and trained in HIV/AIDS prevention and care. C. Project Description Summary 1. Project components (see Annex 2 for a detailed description and Annex 3 for a detailed cost breakdown): The project will support implementation of Guinea's strategic plan through a wide variety of public sector agencies, private and non-governmental organizations, and community-based organizations. It will be implemented over a five-year period. The project includes four major components as described below. The content of those components were extensively discussed with the different stakeholders during preparation, through national and local workshops, and agreed upon with the Government at negotiations: Support to community-based initiatives. The main objective of this component is to empower communities to address HIV/AIDS prevention, care, mitigation, and support. Grant resources will be provided to support a broad range of community, civil society and private sector initiatives. The notion of community is very broad. It can be any small group of less than 10,000 people who form an association, including different categories, such as youth groups, groups of prostitutes, of miners, of orphans, of villagers, of PLWAs; or it can be a larger group of 10,000 people or more, encompassing populations from across communities, such as large workers unions, large mining companies. This component will provide the resources for a wide spectrum of preventive and care-giving activities at the local level. At this time, ART, with its consequent and difficult management, is not expected to be undertaken at the local level. For a community to be eligible for financing by the MAP, it will have to meet some criteria such as (a) having designed its HIV/AIDS prevention plan based on a participatory approach; (b) co-financing those activities for at least 10%, in cash or kind (more if the community is a "for profit" private sector); (c) the activities cannot be those of the negative list as it appears in the Operational - 8 - Manual. Since HIV/AIDS is not a subject about which many communities have strong felt needs, the MAP will finance participatory diagnosis to stimulate demand through NGOs who will work with the communities. This component will build upon the instruments developed in the Health Project's (PPSG) Social Fund component (FAP), and the participatory approach used by the PACV project, both financed by IDA. Communities will be asked to set up a revolving fund in order to sustain their efforts. There are two main types of NGOs: those that will help local communities carry out their participatory diagnosis, and those that are specialized and will be hired to provide certain services. The latter type is considered under the "Capacity Building" component. For both types of NGOs, the ones which will be contracted will be those which are part of the register set up by the CNLS. This is an open register which identifies the capacities and specialty of NGOs and was set up during the NGO assessment undertaken during project preparation. This roster will be updated with new NGOs who want to be part of it, and an assessment of the capacity of that NGO will be carried out at that time. No contract with a local NGO will be more than 9 million FG (US$4,500) at a time, increases may be considered based on a performance review at the time of the Mid-Term Review. With support from NGOs specialized in participatory process, each local community will identify its activities, prepare and submit an action plan to its governing CRD or urban commune, which will judge the pertinence and content of the activities proposed using a checklist attached in the operational manual. Among other things, the checklist will ensure that proposed activities are not part of the negative list of the project. It will also ensure that the action plans proposed result from a participatory diagnosis process, fit into the CRD's (or the urban commune's) overall strategy for fighting HIV/AIDS and that benefiting communities are not receiving funding from other sources for the same activities. Moreover, it will ensure that the action plans follow the main axes of activities supported by the project. After evaluation and approval of the action plans submitted by local communities, the CRD or urban commune will submit a package of action plans to the project for financing. The project will sign a financing agreement with, and deposit the grant amount into the treasury of the CRD/urban commune. The CRD/urban commune in turn will sign an implementation agreement with, and disburse the grant to benefiting communities. In both cases, the disbursement procedures will be detailed in the financial manual of the project. The CRD will supervise implementation of the action plans, along with the District and the Regional MAP Coordinators, and provide progress reports to the CNLS on a timely basis. One community can receive several such grants if it has successfully completed the previous ones. An evaluation will be carried out at the end of year 1 on a sample of communities to assess the impact and the extent to which the objectives were met, and if the amount of the grant limit should be revised. Coverage will start in the communities already covered by the PACV, and will continue in communities covered by PACV-like projects financed by other donors, to reach all 303 rural communities and all 38 urban communes by the year 2007. The size of a grant for most community-based activities is expected to be small, not exceeding US$1,000 for a community of 10,000 people. One community can receive several such grants if it has successfully completed the previous ones. However, larger organizations will receive more funding and will be awarded multi-year commitments. Quality will be checked by the Ministry of Rural Development which will be helped in this task by specialized institutions such as qualified NGOs. This component is expected to receive about 45 % of project funds. Support to the Public Sector. Under this component, the project will support annual action plans prepared by ministries, at the central and regional levels, and by other public agencies. Several ministries have prepared action plans: the Ministries of Health, Education, Interior, Mining, Social Affairs, Youth, and Communications, and Commerce and Industry have already made concrete proposals. These -9- proposals will be formalized in Annual Agreements to be signed by the CNLS Secretariat and the Central Ministry concerned. Those Agreements will also include each Ministry's Regional plans with their separate lists of activities and budgets. The proposal made by the Ministry of Health covers the full spectrum of prevention and care activities, in particular blood safety, voluntary testing, prevention of mother-to-child transmission, sentinel sites, and a pilot antiretroviral therapy for around 150 patients as of January 2004. It is expected that about half of the funds for this component will go to the Ministry of Health. This is justified by the fact that the Ministry of Health has a large role to play in terms of testing, counseling, caring as well as in prevention through STI prevention programs. The proposal made by the Ministry of Education also includes school-based AIDS education. The proposal by the Ministry of Communication includes mainly reinforcing AIDS programs of rural radios as well as advocacy campaigns. Proposals made by other ministries focus mainly on staff training and sensitization of the segment of population they serve. Four national reference training guides will be designed by different ministries, and the guides will be used by all involved personnel in the country. The four guides are: (a) Guide for Peer Sexual Education, by the Ministry of Education, but in collaboration with other ministries; (b) Guide for counseling for testing, to be designed by the Ministry of Health; (c) Guide for social mobilization, to be done by the Ministry of Youth; and (d) Guide for advocacy and social communication to be designed by the Ministry of Communication. This component is expected to receive about 30% of project funds. Capacity building. The component will strengthen the capacity of government agencies, civil society, rural organizations and private sector to prepare and implement HIV/AIDS prevention and care projects. It will reinforce the resource management, monitoring and evaluation capacity of the HIV/AIDS committees. It was agreed during negotiations that the Recipient shall carry out data collection surveys during thefirst year of the Project, prior to the midterm review and at the completion of the Project. It will finance cross-sectoral activities that need to be pooled, such as training, advocacy, as well as technical assistance to sectors. It will provide support and training to the HIV/AIDS units of line ministries, to the CNLS Secretariat, and to other sectors. It will include a comprehensive on-the-job training for health personnel in all activities related to prevention and care. It will help NGOs provide support to local groups in the formulation and execution of proposals. Most of the activities will be contracted out to local or international institutions specialized in communication or training. Some entities who have shown success in executing HIV/AIDS/STI programs, will also be contracted to rapidly expand their services and to also serve as technical support to the CNLS and Ministries in terms of building capacity in the different sectors they work with mainly through training and supervision. In this regard contracts can be established with GTZ, University of Montreal, and AGBEF, which are agencies that have been in operation in Guinea for several years, have demonstrated their capacity, and can increase their activities if further financing is available to them Other specialized NGOs will be identified through a selection process after the first year of implementation. Considering the importance of adequately trained personnel for the implementation of this project, it was agreed during negotiations that the Recipient shall, no later than March 15, 2003, adopt training modules for training of traine;s program for thefirst project year, inform and substance satisfactory to the Association. This component is expected to receive about 12% of project funds. Project coordination and facilitation. This component will provide support to facilitate the programming, coordination and monitoring of project operations, including support to the HIV/AIDS committees. The project management component will support the incremental cost of the executive secretariat, and the local units. The secretariat will include a monitoring and evaluation unit where a contract monitoring system will be installed. It was agreed during negotiations that the Recipient shall, by March 15, 2003, develop and establish a computerized contract tracking and monitoring system. Funds will be available for financing services provided by consultants. This component is expected to - 10 - receive about 12% of project funds. -- ~-. -. - - . . . ndicative - : Bank-7: 96 0?of: - '---I--~Component'--- ---- -Costs- :%of financing . Bank- -- -. - - (US$M) 'Total . (US$M) financing Support to community based initiatives 10.00 44.8 10.00 49.3 Support to public sectors 6.94 31.1 5.94 29.3 Capacity Building 2.66 11.9 1.66 8.2 Project Coordination 2.70 12.1 2.70 13.3 Total Project Costs 22.30 100.0 20.30 100.0 Total Financing Required 22.30 100.0 20.30 100.0 2. Key policy and institutional reforms supported by the project: Although the project is not designed to support policy reform in any sector, it will have a major impact on how the government carries out certain responsibilities: (i) the project will support the decentralization policy initiated by the Government to build up the capacity of local communities and make them better able to address their development challenges. The capacity of local communities, associations, local clubs, NGOs and more generally civil society organizations to prepare and implement projects will be enhanced; (ii) the project will also strengthen the capacity of public institutions, including the HIV/AJDS committees and secretariat at the national, regional, and prefectoral levels. It will enhance inter-ministerial coordination and establish a strong monitoring and evaluation system; and finally, (iii) the project will improve public-private partnership through support to civil society and community-led initiatives, through the support to the private sector delivering health services via a type of accreditation system, through the co-financing of activities for miners with large mining companies, and through collaboration with the traditional healers to improve management of opportunistic infections and counselling. 3. Benefits and target population: The project will contribute to lowering Guinea's burden of diseases due to such infections as STIs and tuberculosis through targeting these and other opportunistic infections. The risk of an even higher child mortality rate will be lowered by reducing the number of HlV-infected newborns. Project interventions targeted to orphans, widows, rural poor, miners, and transporters will rnitigate the econormic and social impact of AIDS. Cost savings are expected from the decrease in future needs for treatment, care and support. The slowing of the spread of HIV will have a positive impact on economic growth as demonstrated by international experience. The project will contribute to extending the productive life of people living with FHV/AIDS through provision of care and assistance. It will strengthen the capacity of local communities to provide support to groups affected by HIV/AI)S, including orphans, and will streamline the procedures for transferring resources to local communities. The entire population of Guinea will benefit from the project. Care will be taken during project implementation that communities are not left behind, and, on the other hand, high-powered groups do not get disproportionate support from the project. Youth, women, and high-risk groups (sex workers, truck drivers, military, and miners) will be specifically targeted by the prevention programs supported by the project. The people currently HIV infected will receive improved care. This will benefit their immediate families. Orphans and families headed by children will be specifically targeted for support. It is estimated that the grant will help reach about 50% of the country's population through one or several of the following means: information on EHV/AIDS, voluntary testing and counseling, STI diagnosis and -11 - treatment, blood safety, condom access, ARV treatment, management of opportunistic infections. Coverage of some target groups will be higher, for example 100% of miners in the formal sector, two-third of youth 15-19 years old, half of the commercial sex workers, of the truck drivers and of the military will be reached. Other financing from other donors will help reach the remaining population. For example, the HCR and NGOs such as Medecins Sans Frontires which are working with refugees. 4. Institutional and implementation arrangements: The project will be implemented by a large number of public agencies and civil society organizations. The CNLS secretariat will coordinate implementation of the project at the national level and will operate on the principle of "fairefaire". The secretariat will include a maximum of seven professional staff: an executive secretary, a deputy officer, a procurement specialist, a financial and adrninistrative specialist, a community initiatives/private sector coordinator, a public sectorial response coordinator, and a monitoring and evaluation specialist. Staff will be hired through a competitive process. A number of tasks will be contracted out such as financial management and contract monitoring. The CNLS will supervise implementation of the project. Review groups will be established to approve proposals made by public sector agencies and civil sector organizations. Each review group will include about 7 representatives of the public sector and of the civil society. Regional, prefectoral and sub-prefectoral committees will supervise implementation of action plans and proposals at local levels. The CNLS will recruit four regional supervisors, one for each natural region, who will work within and with existing decentralized units of the PACV to help with certain administrative, and technical aspects, including monitoring and evaluation. The procedures for preparation, appraisal, approval, implementation and supervision of action plans and proposals will be detailed in an operational manual. The procedures manual will include a project implementation plan, a financial management manual, and a procurement plan along with technical procedures for implementation as well as description on how to carry out the monitoring and evaluation. The manual will befinalized before Grant Effectiveness. To provide assistance to local groups, several specialized NGOs will be identified and selected to train local groups to design AIDS prevention and care activities which can be financed by the project. Such NGOs already exist and are working with local communities, doing participatory diagnosis and identifying relevant activities. An NGO assessment is being undertaken in order to set up an open roster of NGOs from which Government will select those to be contracted for different services. Technical support will be made available from a Financial Management Agency whose responsibilities will include: (a) the establishment of a financial accounting management system including installation of appropriate financial management software that will meet GOG and IDA reporting requirements; (b) the overall responsibility of the project's financial management by placing (seconding): a full-time Financial Management Specialist in the CNLS Secretariat. In addition, a Contract Management Agency may be hired whose responsibilities will include: (a) the establishment of a computerized contract tracking and monitoring system for the Secretariat of the CNLS. Such system could be decentralized to the regional level. This system should allow the early identification of problem contracts and should provide the necessary checkpoints to trigger subsequent actions. It should be linked to the financial and administrative procedures; (b) the overall responsibility of technical contract management by placing the necessary personnel in the CNLS Secretariat. - 12 - D. Project Rationale 1. Project alternatives considered and reasons for rejection: The project preparation team was guided by the work done under the first phase of the Multi-country HIV/AIDS Program for the Africa Region (MAP I) and the lessons learned from those projects and contained in the Memorandum and Recommendation of the President for MAP2 (Report No. P 7497 AFR of December 20, 2001). In addition, the team drew upon field experience from Guinea and from other African countries (particularly Cameroon, Sierra Leone, and Senegal) to ensure that the program would be truly multi-sectoral and would focus heavily on the empowerment of communities in the fight against HIV/AIDS. The project will not specifically target refugees since there are other donors and organizations already working with this group of people, such as the HCR and Medecins Sans FrontiAres. In addition, the number of refugees in Guinea is on the decrease. - 13 - 2. Major related projects financed by the Bank and/or other development agencies (completed, ongoing and planned). Latest Supervision Sector Issue Project (PSR) Ratings (Bank-financed-projects only) Implementatlon Development Bank-financed Progress (IP) Objective (DO) Health Guinea Health/Nutrition S S Guinea Pop & Repro Health S S Education Guinea Equity and School S S Improvement Guinea Education for All S S Guinea Higher Education S S Guinea Pre-Service Teacher Ed S S Rural Development PACV S S Other development agencies AFRICARE Rural Youth Behavioral Change Canada STIVHIV/AIDS Prevention Program GTZ Peer Education Activities; Refugee Activities (KAP); Project in Moyenne Guinea Medecins Sans Frontieres Refugee Camp Programs PSI Mining Company Employees; Marketing study - condoms PRISM Adolescents and Youth; Socio-cultural study, Haute Guinea SONGES SIDA-3 Commercial Sex Workers Plan International Project in Guinee Forestiere SIDALERTE Commercial Sex Workers UNCDF Community Devp Project in 22 CRDs, Haute Guin6e UNHCR Refugees - 14 - UNDP UNICEF Anti-AIDS Clubs in Schools Program USAID/KfW Social Marketing of Condoms Program WHO Training Program IP/DO Ratings: HS (Highly Satisfactory), S (Satisfactory), U (Unsatisfactory), HU (Highly Unsatisfactory) 3. Lessons learned and reflected in the project design: Project design takes into account the lessons learned from international experience with HIV/AIDS programs, and from the implementation of Bank-financed projects in Guinea. Key lessons learned from the experience under MAPI include: * Importance of political leadership and commitment. Experience shows that strong commitment from the top political and religious leadership in the country is important for the success of HIV/AIDS efforts. In recent months the President of the Republic of Guinea, the Government and the leaders of the major religious groups have demonstrated strong support for the program. * Need for a multi-sectoral approach. Experience in Guinea and in other countries has shown that HIV/AIDS control activities start in the health sector, but need to be expanded to other sectors rapidly. * Need for community participation. Local communities have a key role to play in the prevention of HIV/AIDS, the care of infected people and the support to affected groups. The spread of HIV/AIDS results in a heavy burden to local communities. They need support to cope with the IH1V/AIDS epidemic. They are able to express their requirements. Appropriate mechanisms must be put in place to facilitate the provision of support. * MAP projects tended to lose momentum after Board approval. Funds available under a PHRD grant are being used to sensitize representatives of public sector and civil society organizations, to establish program coordination and implementation mechanisms and to train community development agents.A PPF was requested by Govemment and approved by IDA in April 2002. * Importance of partnerships: some MAPs have been prepared very fast and other development partners were not involved enough. In Guinea the MAP worked through the UNAIDS group which was extended to other non-UN partners. * The tendency for some National AIDS Commission to become bureaucracies: this was taken into account in Guinea by limiting the CNLS to six professionals, and by not creating decentralized Units. * Importance of monitoring and evaluation. The design of the monitoring and evaluation system should focus on who will use the indicators and how they will influence the decision-making process. Baseline data are essential for proper monitoring. 4. Indications of recipient commitment and ownership The Recipient's previous strategy to fight IIV/AIDS was revised using a multi-sectoral approach, which the Recipient recognizes as the only viable approach. Some important initiatives have already been taken both by various ministries and by development partners, civil society, NGOs, and within the private sector. Government created the National Committee for the Fight against IV/AIDS in March 2002, and selected the Executive Secretary of its Secretariat in May 2002. Concrete evidence of Recipient commitment will be manifested by the rate at which implementation will take place and by the adequate monitoring of the situation at the highest government levels. - 15- 5. Value added of Bank support in this project: The Multi-country HIV/AIDS Program for the Africa Region places the epidemic at the center of the development agenda. Curtailing the spread of HIV is pivotal if human development and overall development goals in the region and in countries such as Guinea are to be achieved. The Bank has provided leadership to the donor community in assisting Guinea move from a state-controlled economy to a market-based economy. It has helped Guinea focus on poverty issues and strategies for improving the delivery of basic services to the population. Considerable progress has been made in past years. This progress is not sustainable, however, if strong efforts backed by the international community are not made to help Guinea implement its HIV/AIDS program. Donors have expressed interest in supporting the program and indicated that Bank involvement was essential for its success. E. Summary Project Analysis (Detailed assessments are in the project file, see Annex 8) 1. Economnic (see Annex 4): O Cost benefit NPV=US$ million; ERR = % (see Annex 4) 0 Cost effectiveness * Other (specify) The Economic Analysis of HIV/AIDS contained in the Multi-Country HIV/AIDS Program for the Africa Region (MAP) Project Appraisal Document (Report No. 20727 AFT, Annex 5), provides the econornic justification for the project. As it indicates, HIV/AIDS undermines the three major determinants of economic growth, namely physical, human, and social capital. Due to its long incubation period (7-10 years), the impact of the IlV/AIDS epidemic is likely to be drawn over time with the rate of growth of physical and human capital and the efficiency of social capital declining slowly in parallel with the maturing of the HiV/AIDS epidemic. Over time, the behavior of GDP would reflect a similar gradual downward reduction of the rate of growth (or increased rate of contraction), rather than a sudden fall in GDP per capita. 2. Financial (see Annex 4 and Annex 5): NPV=US$ mnillion; FRR = % (see Annex 4) A large number of resources will be directed at community interventions. The project will rely on civil society organizations. The fiscal burden of the program is expected to be low. The recurrent costs are limited. They consist mainly of costs related to the coordination of program implementation, financial management and monitoring and evaluation. There will be efforts to track the cost-effectiveness of the different interventions planned, as well as monitor the longer term economic impact of the program through analysis of employment and income of HIV positive individuals and their dependents. Fiscal Impact: With the large amount of resources directed at community and civil society interventions, reliance on NGOs and CBOs and the private sector, the permanent recurrent costs of the program should be manageable. Civil works (for example, works related to medical waste management), will be limited and therefore not generate significant operating and maintenance costs. There will be, however, coverage of operating expenses for the CNLS's Secretariat operations. 3. Technical: The design of the program has taken into account lessons from experience in other African countries. It includes a diversity of activities, which are mutually reinforcing. Effective care for STIs will contribute to prevention, for instance. Messages will be tailored to their respective audiences. - 16 - Target groups have been identified. Line ministries will prepare their annual action plans in keeping with national as well as international technical standards. Technical teams at the national and provincial levels will receive adequate training and will ensure that proposals are technically sound and cost effective. Most components will include training programs to ensure that staff involved in implementation have the capacity to deliver services as expected. Quality will be ensured by hiring certain specialized institutions which will work with line Ministries on specific areas such as STI, peer youth education, sentinel sites. Delivery of ARV drugs will be integrated in the prevention of mother-to-child transmission, but the drugs for other groups will only be bought and delivered when certain criteria are met, namely, that the technical personnel be trained and equipment be available to monitor how the patient is reacting to those drugs, that Government continue negotiating the prices of ART with pharmaceutical companies, and that the system designed by Government to control access to ART, as described in its August 2001 report entitled "Accelerer l'acces a la prise en charge des PVVS en Republique de Guinee", be operational. The IDA financing will only buy drugs for around 150 PVVS. 4. Institutional: Success will depend on the effective collaboration between the National Commission, line ministries, NGOs, private sector and other partners at national, regional, and prefectoral levels. This will require sound financial management and clear accountability as well as technically sound outreach strategies. It is believed that the recruitment of a financial management agent and a clear understanding of the role of policy coordination and monitoring by the National Commission under the chairmanship of the Prime Minister will facilitate project implementation and timely resolution of problems which might arise in execution of activities by multiple ministries and the civil society. 4.1 Executing agencies: The Secretariat of the National Commission will be responsible for overall project management and coordination. Ministries, public agencies and civil society organizations will implement the program with support from the national secretariat and local teams. The national, regional, prefectoral and local HIV/AIDS committees will coordinate efforts in their respective areas of responsibilities. As a condition of effectiveness, an implementation manual will be finalized to define the roles of each category of participants and the procedures for preparing, approving, implementing and supervising proposals and action plans. It will take into account lessons from experience in other countries, which are already in the process of implementing a MAP program. Contracts will be signed for delivering certain specific services such as training, participative diagnoses, or service delivery to certain target groups or areas. 4.2 Project management: Project supervision will be regularly conducted by the Secretariat of the National Comrnission which will organize annual program reviews involving all parties in the partnership against HIV/AIDS in Guinea. These reviews will focus on progress made in achieving the PNLS objectives and on constraints faced in its implementation. In addition, the CNLS will meet every three months to assess progress. The CNLS Secretariat will maintain a monthly monitoring "tableau de bord" containing some of the indicators mentioned in Annex 1 of the present document, as well as some more detailed indicators. Supervision by the CNLS Secretariat will be mainly selective, based on the triggers highlighted by the technical contract management system, which will identify outlier, or problem, projects which need supervision. In addition, the FMIA will supervise the use of resources at the decentralized level. Consolidated yearly financial and progress report will be prepared by the Secretariat and the financial management firm for the National Commission's annual review meetings.World Bank implementation support and supervision activities will be more intensive than customary, at least in the first two years. 4.3 Procurement issues: Procurement for all IDA-financed activities will be carried out in accordance with the Bank's - 17 - Guidelines for procurement under EBRD loans and IDA credits (January 1995 and revised in January and August 1996, September 1997, and January 1999), in particular, Section 3.15, "Community participation in procurement." Consulting services will be awarded in accordance with the Bank's Guidelines: Selection and employment of consultants by World Bank borrowers (January 1997, revised in September 1997 and January 1999). Procurement performance will be assessed on an annual basis, in the form of random audits by an external agency. A procurement specialist was hired prior to negotiations. In order to manage the large number of contracts, the Secretariat will hire a firm to set up a technical contract monitoring system. 4.4 Financial management issues: A key decision by the Government during appraisal was that financial management of this project will be contracted out to a Financial Management Agency (FMA). While the CNLS will retain the authority to approve all programs and project activities proposed by NGOs, Government departments and other implementing entities. Once approved and corresponding contracts are signed, the FMA will take over the key functions of disbursing funds to the implementing entities in a timely and systematic fashion and establish adequate procedures to ensure that funds are utilized in accordance with the programs and approved contracts and that the entities account for the use of funds on a regular basis. FMA will also be responsible for periodic, internal audits of beneficiary entities utilizing project funds. Other key tasks for the FMA will include, operations of the Special Accounts, timely submission of withdrawal applications for replenishment of funds in SA, as well for direct payments to suppliers, establishment of adequate accounting and internal procedures and incorporating these in a manual of financial and accounting procedures, preparing quarterly Financial Monitoring Reports (FMRs) in accordance with the IDA's guidelines in this regard, assessing the financial management capacity of civil society organizations that require one per the Manual of Operations, monitoring the appropriate use of project resources by recipients and link it the disbursement of funds, preparing six monthly financial statements of all project expenditures and in close consultation with IDA, make the necessary arrangements for external audits of these by independent external auditors acceptable to IDA. The FMA which is likely to be one of the international audit firms represented in Conakry, will be recruited via competitive bidding procedures under TORs acceptable to IDA. Recruitment of the FMA with adequately qualified financial staff to undertake the financial managementfunctions of the project will be a condition of effectiveness. In addition, the core staff of CNLS will include a Finance Officer (FO) who will work closely with FMA on all aspects of financial management of the project. The CNLS Secretariat may conclude a memorandum of understanding with each ministry, in form and substance satisfactory to the Association, which shall specify, inter alia: (i) the activities to be implemented at both the central and regional levels; and (ii) the modalities of transfers of funds by the CNLS Secretariat to the relevant ministry for the financing of its action plan at the central and regional levels, it being understood that, in order to facilitate the carrying out of activities at the regional level, the CNLS Secretariat may directly transfer funds to the regional directorates of a ministry, through a monthly advance mechanism, provided that such directorates furnish on time to CNLS adequate statements of expenditures to justify expenses paid with such funds. As soon as the FMA is recruited, Bank FMS will undertake further missions as necessary to discuss the Bank's procedures for disbursements, requirements of FMRs and the Bank's overall requirements for adequate financial management of project resources. External Audits As indicated above, the FMA will prepare, every six months, financial statements of all project expenditures in the same format as the quarterly FMRs. These will be audited by independent external - 18 - firm of auditors and under audit TORs acceptable to IDA. In case the volume of operations in the initial months does not justify a six-month audit, the first audit will be undertaken twelve months after effectiveness. In any case, the project will employ independent auditors, before project effectiveness. 4.5 Disbursement Issues The project is expected to be completed over a five-year period according to the categories shown in Table C above. Government counterpart funds needed for each fiscal year to cover the share of recurrent costs not financed by IDA will be deposited by the Government in a Project Account managed by the CNLS. Use of Statement of Expenditures (SOEs): Disbursements for all expenditures would be made against full documentation, except for items of expenditures for: (a) contracts for consulting finms in an amount inferior to $100,000 equivalent, (b) contracts for individual consultants in an amount inferior to $50,000 equivalent, (c) contracts for works and goods in an amount inferior to $50,000, and (d) community sub-projects, training and operating costs, which would be claimed on the basis of Statement of Expenditures (SOEs). All supporting documentation for SOEs would be retained at a suitable location at the CNLS, the region, and/or the CRD level and readily accessible for review by periodic IDA supervision missions and external auditors. Special Account: To facilitate project implementation and reduce the volume of withdrawal applications, the CNLS would open two Special Accounts in US dollars in a commercial bank on terms and conditions acceptable to IDA. Special Account A would finance all project expenditures including those related to line ministries and to the regions, except for the expenditures related to the "Community-based Initiatives" component, which would be financed from Special Account B. The authorized allocation would be for US dollars 1 million for Special Account A and US dollars 1 million for Special Account B, and would cover about six months of eligible expenditures. Upon grant effectiveness, IDA would deposit the amount of $500,000 into Special Account A and US dollars $500,000 into Special Account B representing fifty percent of the authorized allocations. The remaining balance would be made available when the aggregate amount of withdrawals from the grant account plus the total amount of all outstanding special commitments entered into by the Association shall be equal or exceed the equivalent of $4 million for Special Account A and $4 for Special Account B. The Special Account would be used for all payments inferior to twenty percent of the authorized allocation and replenishment applications would be submitted monthly. Further deposits by IDA into the Special Accounts would be made against withdrawal applications supported by appropriate documents. 90-day advances: 90-day advances will be authorized for the main line Ministries i.e. Education, Health, Youth, Social Affairs, Communication, and Agriculture. For all other line Ministries, CNLS will effect directly all payments of beneficiaries. At the regional level, payments for training and operating costs will also be made directly by CNLS. Non-objection by IDA on annual work programs will be required. The CNLS Secretariat will prepare at the end of every year, an assessment of the progress as well as the annual work program and budget which translate into activities agreed-upon objectives. Work programs and budgets will be validated during workshops where representatives of the different stakeholders will be discussing with the Secretariat. Work programs and budgets will then be approved by the National Commission and submitted to IDA. Work programs will include agreed upon annual objectives, against which progress will be measured. If a Ministry, or entity, failed to implement at least 80% of the agreed-upon activities 19 - and to reach at least 80% of its objectives, this could trigger no further financing for that entity till the next year, if it then implemented all its activities and reached its objectives. Greater level of investments could reward successful outcomes. 5. Environmental: Environmental Category: B (Partial Assessment) 5.1 Summarize the steps undertaken for environmental assessment and EMP preparation (including consultation and disclosure) and the significant issues and their treatment emerging from this analysis. The program is not expected to have major environmental impacts. The handling and disposal of HIV/AIDS-infected materials is the most significant issue. An assessment of current practices was carried out by a consultant. A long term comprehensive national health waste management plan was designed and accepted by Govemment. This plan will be partly financed by the project, other activities are being financed by other donors, in particular the European Union, and activities not yet financed will be submitted to donors. This project will mainly finance incineration equipment as well as waste collection equipment, training on how to safely dispose of contaminated blood and other materials, and information on the hazards of contamination. Health organizations benefiting from proceeds to the grant will be required to demonstrate that they have safe methods of waste disposal and that the training provided to their staff includes precautions in handling sensitive materials. This training program will include instruction on the triage, transport and disposal of such waste material.As a condition of effectiveness, the Recipient will adopt the waste management plan which was accepted by IDA (note that it was already accepted by the Ministry of Health but the Association asked that another Ministry be officially involved in this acceptance). 5.2 What are the main features of the EMP and are they adequate? See above. 5.3 For Category A and B projects, timeline and status of EA: Date of receipt of final draft: 5/5/2002 5.4 How have stakeholders been consulted at the stage of (a) environmental screening and (b) draft EA report on the environmental impacts and proposed environment management plan? Describe mechanisms of consultation that were used and which groups were consulted? The Directorate of Hospitals in the Ministry of Health is responsible for waste management of all infrastructures. It has approved the Master Plan which will be financed by this project. The Master Plan was made available to a consortium of NGOs. 5.5 What mechanisms have been established to monitor and evaluate the impact of the project on the environment? Do the indicators reflect the objectives and results of the EMP? Impact of the project on the environment and the recommendations of the EA will be monitored during supervision missions. 6. Social: 6.1 Summarize key social issues relevant to the project objectives, and specify the project's social development outcomes. The project is expected to have a positive social impact by raising the awareness of high-risk groups (e.g., commercial sex workers, truckers, miners, youth, the military) and encouraging safe sex behavior among the population at large. The civil society component of the project should have beneficial effects in assisting and empowering individuals, communities, and institutions to deal more effectively with the disease by (i) increasing community awareness and accountability surrounding HIV/AIDS; (ii) addressing the critical needs of PLWHA in terms of psycho-social and medical support; and (iii) addressing economic needs of HIV/AIDS affected/infected households. -20 - One key social issue that needs to be flagged is the difficulty in recruiting women as peer trainers. Not only is it difficult to persuade women (via their father's permission) to be part of a team of trainers, it is equally challenging to retain them since they get married at a relatively young age, especially in the rural communities. 6.2 Participatory Approach: How are key stakeholders participating in the project? The preparation process of the Guinea MAP was highly participatory with extensive consultations with PLWHA, representatives of intemational and national NGOs, multilateral and bilateral donors, and various other stakeholders. Both NGOs specializing in participatory planning and H1V/AIDS were invited to prepare the Operational Manual for the Civil Society component. More specifically PLWHA will participate through representation in HIV/AIDS committees at all levels. Rural communities will develop their own priority HIV/AIDS action plans through a participatory diagnosis undertaken with the assistance of a community mobilization agent. Communities will design their own HIV/AIDS prevention activities based on a negative list as well as a nonrestrictive list of possible HIV/AIDS activities which the community mobilization agent will talk about with them.Some NGOs, associations, and the private sector will participate by implementing their own action plans targeting specific groups. They will also be sub-contracted to carry out specific monitoring and evaluation studies, including supervision of field activities and random control on the use of funds. The large bauxite mining companies were consulted and will ask for cofinancing to help them implement an action plan to be put forward by the Chamber of Mines. 6.3 How does the project involve consultations or collaboration with NGOs or other civil society organizations? NGOs and other civil society organizations were involved in project design and are expected to play an active role in project implementation. They will be provided with capacity building support and will assist communities in the design, implementation, and monitoring of community-led initiatives. NGOs are also likely to be involved in KAP surveys, training of trainers, and monitoring and evaluation. 6.4 What institutional arrangements have been provided to ensure the project achieves its social development outcomes? The participatory approach used in project preparation will be continued and expanded during project implementation. In fact, all community HIV/AIDS action plans will be developed with the assistance of a community facilitator and by using participatory planning methods. In addition, NGOs, PLWHA, and private sector representatives will be members of H/V/ASDS commnittees and will be systematically included in the steering and supervision of the project. 6.5 How will the project monitor performance in terms of social development outcomes? An NGO capacity assessment was conducted with PHRD grant resources. In addition, KAP studies for the major high risk groups have been/will be carried out. These reports will provide a baseline for the Guinea MAP. Technical reviews will be conducted under contractual arrangements to assess NGO and CBO performance and take corrective action. Since the MAP will use the PACV as a channel to fund activities in the rural areas, H[V/AIDS situation analysis and social development indicators have been added to the TORs of the NGOs who carry put social mobilization in the rural communities for PACV now. Indicators of beneficiaries' satisfaction will be regularly monitored during project implementation. Moreover, technical reviews will be conducted under contractual arrangements with selected private sector firms to assess NGO and CBO performance and take corrective action. Finally, an NGO capacity assessment was undertaken during preparation, with PHRD grant resources. This report - 21 - provides a baseline for the MAP. Thereafter, the roster of NGOs which was set up at preparation time will be regularly updated and new NGOs might be included, turning this management tool into a data base for monitoring of NGO capacity. 7. Safeguard Policies: 7.1 Do any of the following safeguard policies apply to the project? Policy - _ Applicabil_ty Environmental Assessment (OP 4.01, BP 4.01, GP 4.01) * Yes CD No Natural Habitats (OP 4.04, BP 4.04, GP 4.04) U Yes * No Forestry (OP 4.36, GP 4.36) Y No Pest Management (OP 4.09) ( Yes *_ No Cultural Property (OPN 11.03) U Yes * No Indigenous Peoples (OD 4.20) (9 )Yes * No Involuntary Resettlement (OP/BP 4.12) (9 Yes * No Safety of Dams (OP 4.37, BP 4.37) 9 Yes w No Projects in International Waters (OP 7.50, BP 7.50, GP 7.50) 9 Yes * No Projects in Disputed Areas (OP 7.60, BP 7.60, GP 7.60)* ( Yes * No 7.2 Describe provisions made by the project to ensure compliance with applicable safeguard policies. A medical waste management plan has been prepared in compliance with OP 4.01. F. Sustainability and Risks 1. Sustainability: The sustainability of the program will depend on the degree to which the strategy and activities become fully owned by the various partners at national, regional, prefectoral, and local levels. It will hinge on improved capacity at all levels to develop and implement action plans and proposals that are effective in changing behaviors and providing care and support to affected groups. 2. Critical Risks (reflecting the failure of critical assumptions found in the fourth column of Annex 1): Risk . Risk-Rating Risk Mitigation Measure From Outputs to Objective Continued political support by ministers M Organize workshops to share experiences, and religious groups not forthcoming encourage innovation and stimulate interest. Contracted agency(ies) unable to provide M CNLS to maintain good monitoring and suggest the relevant service. needed changes CNLS personnel lacks full understanding M Review M&E activities during each SPN of M&E aspects of its mandate mission and ensure any necessary TRG. Health services are not available and M Continue sector support improving From Components to Outputs Capacity of Ministry of Rural H Review implementation arrangements regularly Development to respond to NGOs and CBOs is slow Capacity of NGOs and local associations S Intensify local training - 22 - does not improve CNLS Secretariat is not rapid and does S Review procedures in light of experience and not solve problems. modify if necessary Transfer of funds to local organizations is S Do random checks during each SPN mission at not smooth nor efficient LOCAL level to ensure arrival of funds Overall Risk Rating Risk Rating - H (High Risk), S (Substantial Risk), M (Modest Risk), N(Negligible or Low Risk) 3. Possible Controversial Aspects: None G. Main Grant Conditions 1. Effectiveness Condition The conditions of effectiveness are: a) The Recipient has established an adequate financial management system for the Project, satisfactory to the Association, including entering into a Financial Management Services Agreement with a financial management services agency under terms and conditions satisfactory to the Association for the purposes of assisting the Recipient in the financial management of the project; b) The Recipient has adopted the Project Operations Manual, which will include the first calendar year Project Implementation Plan, a final Administrative/Financial Management/Procurement section with the first year's procurement plan, and a Technical section, all satisfactory to IDA. c) The Recipient has deposited in the project's account 300,000,000 FGN. d) The Recipient has employed the independent auditors. e) The Recipient has adopted the waste management plan, in form and substance satisfactory to the Association. 2. Other [classify according to covenant types used in the Legal Agreements.] The condition for financing an Annual Project Work Program submitted by the CNLS, is to have obtained IDA's non-objection. Dated Covenants (as written in Schedule 4 of the Grant Agreement): a) The Recipient shall, no later than March 13, 2003, adopt training modules for training of trainers program for the First Project Year, in form and substance satisfactory to the Association; b) The Recipient shall, by March 13, 2003, develop and establish a computerized contract tracking and monitoring system; c) The Recipient shall carry out data collection surveys during the first year of the project, prior to the mid-term review and at the completion of the Project. - 23 - H. Readiness for Implementation 0 1. a) The engineering design documents for the first year's activities are complete and ready for the start of project implementation. 1. b) Not applicable. 2. The procurement documents for the first year's activities are complete and ready for the start of project implementation. 3 3. The Project Implementation Plan has been appraised and found to be realistic and of satisfactory quality. [ 4. The following items are lacking and are discussed under loan conditions (Section G): 1. Compliance with Bank Policies Z 1. This project complies with all applicable Bank policies. a 2. The following exceptions to Bank policies are recommended for approval. The project complies with all other applicable Bank policies. ^,nia~arek Alexandre V. A rantes Mamadou Dia eam L ader Sector Manager Country Director -24- Annex 1: Project Design Summary GUINEA: MULTI-SECTORAL AIDS PROJECT (MAP) -'- ,,t_ -- , -9* '- .F .-~-'. Key Performance ' - Data Collectlon Strategy . - ; Hierarchiy of Objectives -. -Indicato'r8 . :9rCriticalAssumptionss Sector-related CAS Goal: Sector Indicators: Sector/ country reports: (from Goal to Bank Mission) Mitigate socioeconomic Human Development UTNDP annual report Political commitment to impact of HIV/AIDS within indicators, including poverty Epidemiological reports ad effectively address the framework of poverty profiles surveys HIV/AIDS epidernic, and reduction strategy sufficient financing of the national HTV/AIDS campaign PRSP implementation An effective and progress reports well-coordinated multi-sector program, fully involving the public and private sectors, NGOs, civil society, and donors. Project Development Outcome / Impact Project reports: (from Objective to Goal) Objective: Indicators: Limiting and reversing the - At least 55% of high risk KAP studies Continued political support by trend of the epidemic by population (youth, army, sex ministers and religious groups preventing new infections workers, truck drivers, miners) used a condom in their last sexual encounter. - at least 50% of people who Baseline is the 1999 DHS are aware of AIDS have used a which showed 27% for men condom with a partner other and 18% for women. than their regular partner in the last 12 months - Keep the HIV prevalence Data from sentinel sites, and armong 15 to 24 year old sero-prevalence surveys in urban pregnant women below 2002 and in 2006 5% by 2006. Output from each Output Indicators: Project reports: (from Outputs to Objective) Component: Support to Commrunity based initiatives A social support system is - Increase by at least 1,500 the Surveys Contracted agency(ies) able to developed in which CCC number of orphans who attend provide the relevant service. activities are strengthened in school regularly as of 2004. the communities for all groups affected by HIV/AIDS (orphans, PLWHA, high risk groups) - Decrease by at least 20% the Baseline is the 1999 DHS; % of women and men who KAP Surveys don't know any mean to CNLS progress reports - 25 - prevent transmission of the HIV or who have erroneous knowledge of it from its 1999 level of 30%. - 100% of truck stops (total of CNLS Progress Reports 10 in country) offer an HIV/AIDS prevention program to drivers Support to Sectors Sectors have developed -100% of ministries and 2 CNLS progress reports Capacity of CNLS to customized AIDS plans and main Unions have HIV/AIDS coordinate implemented them work plans by end 2003. - 80% of 303 CRDs are idem Smooth financial flow implementing 80% of their annual HIV/AIDS plans by Good monitoring data 2007. - 100% of blood units in CNLS Progress Reports Health services are available hospitals are regularly and and improving adequately screened by 2005 -100% of health personnel Analysis of MOH Reports involved with SlTs and opportunistic infections fully trained by 2006. -70% of PLWAs benefit from Analysis of MOH Reports treatment of STIs and 70% of those with TB treated by 2006. - All national and regional hospitals have facilities to Surveys dispose of hospital waste and use them regularly - 85% of youth between 15-24 Surveys years have knowledge of symptoms for STDs and of ways to prevent HIV/AIDS Project Coordination (M&E) Coordination and evaluation mechanisis are in place and Data for outcome and impact CNLS Progress reports and Good quality of CNLS operate satisfactorily dicators are collected surveys personnel with full regularly from all line understanding of M&E aspects rninistries, from regions, from of its mandate NGOs and community projects. Capacity Building he effective participation of 90% of all sale points didn't Report from social marketing NGOs is strengthened, and the have lack of condoms in last program capacity of NGOs and private month by 2004 and thereafter. and public sector to improve coverage and quality of services s reinforced. -5 new private service delivery NLS Progress Reports Capacity of contracted agencies -26 - points receive yearly quality logo each year. - 250 traditional healers have CNLS Progress Reports Capacity of CNLS been trained in HIV/AIDS prevention and counseling by 2006 Project Components / Inputs: (budget for each Project reports: (from Components to Sub-components: component) Outputs) Support to conmunity-based US$10.0 million Project data Strong government and initiatives religious groups comnmitment to program continues Support to Sectors US$5.94 million* Project data Capacity of MOH to respond to NGOs and CBOs Capacity building US$1.66 million Project data Drug supply system works in a cost effective way Project Management and US$ 2.58 million Project data Capacity of NGOs and local Administration associations improves (including contingencies) Transfer of funds to local organizations is smooth and efficient CNLS Secretariat is efficient, rapid and solves problems. -27- Annex 2: Detailed Project Description GUINEA: MULTI-SECTORAL AIDS PROJECT (MAP) The proposed project will finance the full spectrum of HIV/AIDS activities including prevention, care, support, and impact mitigation. A US$20 million, 5 year project is contemplated. It will have four components: (1) Support to community-based initiatives; (2) Support to sectors; (3) Capacity building; and (4) Project coordination. These activities will build on existing successful activities, and will take into account the existing level of capacity at each administrative structure. The project will concentrate the majority of its activities in two of the most affected Regions during the first year, namely in Conakry and the Region ForestiMre. The expansion thereafter will follow the MOH expansion of VCT and STI services. By Component: Project Component 1 - US$10.00 million Support to community-based initiatives 1. The main objective of this component is to empower communities to address H[V/AIDS prevention, care, mitigation, and support. Grant resources will be provided to support a broad range of community, civil society and private sector initiatives. The notion of community is very broad. It can be any small group of less than 10,000 people who form an association, including different categories, such as youth groups, groups of prostitutes, of miners, of orphans, of villagers, of PLWAs; or it can be a larger group of 10,000 people or more, encompassing populations from across communities, such as large workers unions, large mining companies. This component will provide the resources for a wide spectrum of preventive and care-giving activities at the local level. At this time, ART, with its consequent and difficult management, is not expected to be undertaken at the local level. For a community to be eligible for financing by the MAP, it will have to meet some criteria such as (a) having designed its iHIV/AIDS prevention plan based on a participatory approach; (b) cofinancing those activities for at least 10%, in cash or kind (more if the community is a "for profit" private sector); (c) the activities cannot be those of the negative list as it appears in the Operational Manual. 2. Since HIVIAIDS is not a subject about which many communities have strong felt needs, the MAP will finance awareness raising to stimulate demand through NGOs who will work with the communities and help them in their participatory diagnosis. This component will build upon the instruments developed in the Health Project's (PPSG) Social Fund component (FAP), and the participatory approach used by the PACV project, both financed by IDA. Communities will be asked to set up a revolving fund in order to sustain their efforts. 3. There are two main types of NGOs: those that will help local communities carry out their participatory diagnosis, and those that are specialized and will be hired to provide certain services. The latter type is considered under the "Capacity Building" component. For both types of NGOs, the ones which will be contracted will be those which are part of the register set up by the CNLS. This is an open register which identifies the capacities and specialty of NGOs and was set up during the NGO assessment undertaken during project preparation. This roster will be updated with new NGOs who want to be part of it, and an assessment of the capacity of that NGO will be carried out at that time. No contract with a local NGO will be more than 9 million FGN (US$4,500) at a time. This amount may be revised at the time of the Mid-Term Review based on a performance review. 4. With support from NGOs specialized in the participatory process, each local community will identify its activities and prepare and submit an action plan to its governing CRD or urban commune, - 28 - which will judge the pertinence and content of the proposed activities using a checklist found in the operational manual. Among other things, the checklist will ensure that proposed activities are not part of the negative list of the project. It will also ensure that the proposed action plans result from a participatory diagnosis process, fit into the CRD (or the urban commune) overall strategy for fighting HIV/AIDS and that benefiting communities are not receiving funding from other sources for the same activities. Moreover, it will ensure that the action plans follow the main axes of activities supported by the project. After evaluation and approval of the action plans submitted by local communities, the CRD or urban commune will submit a package of action plans to the project for financing. The project will sign a financing agreement with, and deposit the grant amount into the treasury of the CRD/urban commune. The CRD/urban commune in turn will sign an implementation agreement with, and disburse the grant to benefiting communities. In both cases, the disbursement procedures will be detailed in the financial manual of the project. The CRD will supervise implementation of the action plans, along with the District and the Regional MAP Coordinators, and provide progress reports to the CNLS on a timely basis. One community can receive several such grants if it has successfully completed the previous ones. An evaluation will be carried out at the end of year 1 on a sample of communities to assess the impact and the extent to which the objectives were met, and if the amount of the grant limit should be revised. Coverage will start in the communities already covered by the PACV, and will continue in communities covered by PACV-like projects financed by other donors, to reach all 303 rural communities and all 38 urban communes by the year 2007. The size of a grant for most community-based activities is expected to be small, not exceeding US$1,000 for a community of 10,000 people. One community can receive several such grants if it has successfully completed the previous ones. However, larger organizations will receive more funding and will be awarded multi-year commitments. Quality will be checked by the Ministry of Rural Development which will be helped in this task by specialized institutions such as qualified NGOs. 5. The IDA Grant will finance the following, among other activities, during the five years of project implementation: * training of PACV and other projects' rural development workers; * pilot activities; * contracts for participative diagnosis for AIDS in CRDs * contracts for participate diagnosis for AIDS in urban communes; * training of NGOs on sex education by peers; * training of NGOs on social mobilization for AIDS; * training of NGOs on advocacy and social communication; * training of NGOs on counselling; * training of NGOs on project management and monitoring; * contract with the Chamber of Mines for HIV/AIDS activities with its members; * contract for specialized NGOs; * contract with traditional healers associations; * contracts with the largest two workers unions and with truck drivers union (activities centered around the major truck stops: Coyah; Tamagaly; Luna Bar, Mamou; Mardla, Faranah; Tokounou; Bola; N'Zerekore ville; Sinko; Kolaboundji; Labe ville; Boffa; Lola; Kankan ville; Dabola ville; Kissidougou. * contracts with the private health sector; * agreements to finance activities with urban communes; * agreements to finance activities with rural communes. -29 - Project Component 2 - US$5.94 million Support to the public sector This component will improve the capacity of all line ministries -- both central and regional -- to respond to the HIV/AIDS epidemic, emphasizing prevention and care. HIV/AIDS related activities will be integrated into the ongoing operations, based on revised ministerial policies coupled with specific AIDS-related activities. The plans will not only provide ministerial staff and their dependents with HIV/AIDS and STI education, training, and care-related support, but also develop AIDS-related activities in every realm of their mandate through which information on effective HIV/AIDS and STI prevention and ways to access such prevention and care will be made available to their constituencies (parent-teachers associations for the Ministry of Education, farmers' associations for the Ministry of Rural Development, orphan support for the Ministry of Social Affairs). Local ministries have HIV/AIDS focal persons designated to design and coordinate the implementation of their action plans. Yearly contracts or agreement will be signed between each ministry and the CNLS, which will include each ministry's regional plans with their own lists of activities and budgets. For an action plan to be financed by the MAP it will need to include all its H1V/AIDS/STI prevention and care activities, as well as the different sources of financing. There are 22 ministries. At appraisal already 12 of those provided an action plan.The CNLS will provide help to other interested ministries in developing their action plan. Each action plan will be annual. At the end of the year, a review will be undertaken and those entities which were able to implement their action plan at 80% or more, will see their financing continued for another annual action plan, the others will need to complete their action plan before another one is financed. The Ministry of Health will receive the most financing because a strong health system is a foundation for success in the fight against HIV/AIDS. This ministry plays a pivotal role in many preventive activities and it also carries special responsibilities for treatment and care of AIDS, STI and other opportunistic infections, including tuberculosis. The Health Sector Response sub-component will provide the resources to the health sector to build on and complement the work done by the MOPH under the Reproductive Health Project, as well as other reproductive and communicable disease activities currently performed by or to be financed by the MOPH and its health sector partners. Under the MAP the MOPH will assist other line ministries. MOPH will determine which aspects, where, when and how quickly it can implement and scale up its HIV/AIDS, Sn, and TB services in the context of its Health Sector Action Plan, with a view to a more aggressive effort against HIV/AIDS, and enhance its reproductive health. The health sub-component activities will be geared to: (i) improving performance in the national blood transfusion center; (ii) scaling-up the national blood screening and supply program; (iii) increasing the number of health centers using the syndromic approach for diagnostic and case management of sexually transmitted infections (STIs); (iv) scaling-up the national sentinel surveillance system and voluntary counseling and testing (VCT) protocols as well as carrying out VCT activities and follow-up; (v) strengthening the national and other referral hospitals for dealing with HIV/AIDS, STI, and other opportunistic infections including TB; (vi) procuring condoms beyond those provided by OSFAM/PSI, supporting a social marketing program, and playing a significant role in the distribution of condoms; (vii) scaling up activities geared to potentially high risk/high transmitter groups in collaboration with other sector partners; (viii) establishing at the primary level a care (and possibly -30 - treatment) program for people infected and affected by HIV/AIDS; (ix) improving services to prevent mother-to-child-transmission (PMTCT), including counseling, maternal support, and drug therapy in tandem with VCT, and care for HIV positive pregnant women and children. The stated policy goal of Guinea is that the national blood supply be controlled and safe. Donor mobilization, the construction and equipment of a new center, and the development of a plan for national blood transfusion services will be financed by the European Union. Health workers require specialized training in both the handling of hazardous materials connected with HIV/AIDS and in the use of the particular medical supplies that prevent STI and H[V transmission. To promote testing of patients and to provide caring support for PLWHA, health workers need to be confident of their own personal safety. For this, norms and standards for hazardous waste disposal appropriate to Guinea are being developed, and training of health personnel will be carried out. Incinerators as well as burial of medical waste will be bought/built in selected health centers for proper disposal. IDA will support the PMTCT program. When combined with voluntary counseling and testing (VCT), PMTCT can be dramatically reduced through short, inexpensive treatment plans of pregnant women and newborns. Guinea will volunteer to be part of a pilot program to receive Nevirapine for five years free of charge under a program run by the Boehringer-Ingelheim firm. An expanded program will then be pursued with IDA financing under WHO/UNAIDS protocol. Complementary staff training, facilities, and equipment will be financed by IDA. The establishment of VCT sites at antenatal (ANC) centers will reduce the impact of HIV/AIDS and STI at pregnancy, both in terms of primary prevention of infection and care of the pregnant woman and her child. Anti-Retroviral Therapy (ART), on the other hand, must be considered separately. While such therapy has the potential of prolonging, improving, and saving lives, its financing on a large scale in Guinea at this time is not judicious, except in a pilot effort for 150 patients as of January 2004, after the conditions for buying ARV drugs are in place. For this, technical personnel must be trained and equipment must be available to monitor how the patient is reacting to ARV drugs; Government must continue to negotiate the prices of ARVs with pharmaceutical companies; the system designed by Government to control access to ART, as described in its August 2001 report entitled "Accelerer l'acces a la prise en charge des PVVH en Republique de Guinee," must be operational. Although drug prices have fallen, serious challenges of sensitivity, toxicity, resistance, sustainability, access, ethics, and equity must also be addressed. At present, Guinea has just one health system infrastructure -in Conakry -- capable of delivering such drugs with the necessary long-term patient management. Any program dealing with ART must be developed with the participation of PLWHA and must include ethical and equitable guidelines for deciding who is to benefit in the initial stages. The project would finance generic drugs only. At the project's mid-term review, the number of patients to benefit from ART will be re-evaluated, if necessary. ART will be supplied through the UNIPAC unless direct purchase prices with pharmaceutical companies in Guinea become cheaper, in which case direct buying will be allowed. Guinea may continue to buy drugs with funds other than IDA's from others Pharmaceuticals companies like Merck, Glaxowellcome or others, for those who started already on those molecules and who cannot be changed. Those companies already have an agreement with the MOH to provide drugs for patient who are treated now. IDA support for ART will therefore adhere to the technical conditions established by the relevant - 31 - technical agencies. WHO, UNAIDS, and the International AIDS Society have developed the following conditions as essential for the introduction of Anti-Retroviral Therapy in resource-poor settings: * Assured access to voluntary HIV counseling and testing, and institutional follow-up and counseling services for ART to ensure continued psychological support and to enhance adherence to treatment; * Capacity to recognize and appropriately manage common HIV-related illnesses and opportunistic infections; * Reliable laboratory monitoring services including routine hematological and biochemical tests for the detection of drug toxicity as well as access to facilities for monitoring the immunologic and virologic parameters of HIV infection; * Assurance of an adequate supply of quality drugs, including drugs for the treatment of opportunistic infections and other HIV-related illnesses; * Identification of sufficient resources to pay for treatments on a long term basis; * Information and training on safe and effective use of anti-retroviral drugs for health professionals in a position to prescribe therapy; and * Establishment of reliable regulatory mechanisms against misuse and misappropriation of anti-retroviral drugs. The health-sector response component will be managed by a unit of MOH called "Programme National de Prise en Charge Sanitaire" ( PNPCS), which will prepare and subrmit to CNLS a detailed annual work plan with specific targets. CNLS will provide necessary support, including technical assistance, to strengthen the management capacity of PNPCS. The CNLS will set up a project monitoring and evaluation system to assess the benefits of the project to beneficiaries through supervision, surveillance, and surveys. The first type of monitoring will be through periodic progress reports received from MOH. The second and third types will be based on behavioral and biological survey(s) of beneficiaries. Surveillance will be coordinated by the health sector technical unit, with external technical assistance from WHO, USAID or an UNAIDS partner. A contract with the GTZ and the University of Montreal will provide quality control for the CNLS in terms of IST management and control, surveillance, peer education. Behavioral surveillance will also be coordinated by the health sector HIV/AIDS response group (in close collaboration with CNLS) and contracted to an academic or consulting organization. The IDA Grant will help finance the main following activities: * support to the MOH focal point for coordination and monitoring; * the Reference Guides for STI diagnosis, for treatment and for Counselling and Testing; * training of health personnel in the public sector and some in the private sector on STI/HIV/AIDS; * STI drugs; * reagents and other material needed for HIV testing; * lab equipment, drugs and other material needed to treat opportunistic infections * ARV drugs for PMTCT, and for treatment of 150 patients; * equipment for CD4 counts in two central hospitals and for viral load counting; * HIV sentinel sites; * quality control and decentralized supervision of the HIV/AIDS activities; * strengthening of central and regional level capacities for monitoring and evaluation. -32 - The Ministry of Education will also undertake more activities than most mninistries as it has to develop and implement 1IV/AIDS modules for different grades. The IDA Grant will help finance the main following activities: * support to the Ministry's focal point for coordination and monitoring; * the Reference Guide for Peer Sexual Education, with technical assistance from GTZ; * support to 100 Anti-AIDS Clubs per year in schools; * training and support to peer educators; * support to students and teachers living with H1V/AIDS and their families; * support to the Radio Scolaire for advocacy. The Ministry of Youth, Sports and Culture will especially concentrate on children who don't go to school. The IDA Grant will help finance the main following activities: * support to the Ministry's focal point for coordination and monitoring; * the Reference Guide for Social Mobilization of kids out of school; * communication material for social mobilization; * training of 150 peer educators/year, and support to their program for young girls in youth clubs or in sports clubs; * training of regional personnel on youth mobilization; * social events for youth mobilization; * organization of regional and prefectoral days "Partners without AIDS" with youth associations; * monitoring and coordination of those activities. The Ministry of Communication: the IDA Grant will provide support for a) advocacy for the multi-sectoral fight against AIIDS; b) radio information targeted to both vulnerable and high risk groups in each region; and c) marketing for people to use the health and social services made available to them to combat HIV/AIDS. Concretely, the IDA Grant will finance the main following activities: * support to the Ministry's focal point for coordination and monitoring; * the Reference Guide for advocacy and social communication; * training of journalists and other professional communicators; * local production of audiovisual advocacy kits in national languages; * equipment to complement what's missing for 3 rural radios; * support to produce magazines, round tables and short programs on radio, to cover the whole country; * support to artists such as traditional griots, AIDS theater plays, AIDS circus acts. The Ministry of Transports and Public Works will focus on transporters, a high risk group. The IDA Grant will help finance the main following activities: * support to the Ministry's focal point for coordination and monitoring; * training, by a central PPSG team, of training and peer educators in the Ministry and among transporters; * peer education in public enterprises; * decentralized meetings for advocacy and mobilization in order to result in partnership between transport industries and NGOs specialized on AIDS which could help them. -33- The Ministry of Mines, Geology and Environment will focus on miners, another high risk group. The IDA support will focus on two aspects: a) direct support to the Ministry to work with the informal gold and diamond miners; b) partial support to large private bauxite companies in order to help them cover population living around their mines. The IDA Grant will finance the main following activities: * support to the Ministry's focal point for coordination and monitoring; * training of trainers in social communication and in sexual education; * training of peer educators; * support to decentralized advocacy activities especially to promote the use of available services to fight HIV/AIDS. The Ministry of Social Affairs will focus on a social package for PLWHAs and their families, especially for people who don't benefit from a social safety net. The IDA Grant will finance the main following activities: * support to the Ministry's focal point for coordination and monitoring; * training of personnel in coordination positions; * training module on social assistance to PLWHAs and their families; * workshops on social communication at the prefectoral level; * training of 100 peer educators/year, with the technical assistance of GTZ; * organization of Caravans during the Day of the Woman; * support to social help for PLWHAs and orphans; * training of social workers to help PLWHAs and orphans. The Ministry of Interior will focus on a) personnel of its decentralized and central units; b) policemen. The IDA Grant will finance the main following activities: * support to the Ministry's focal point for coordination and monitoring; * training of local "animators" for HIV/AIDS project design and for improved partnerships; * advocacy sessions for central and prefectoral personnel; * advocacy sessions for elected members of Government; * production of written material for advocacy; * training of peer educators among policemen; * informal education sessions for policemen; * monitoring and coordination of activities. The Ministry of Tourism will focus on sex workers. The IDA Grant will finance the main following activities: * support to the Ministry's focal point for coordination and monitoring; * legal texts related to prostitution; * training of 20 trainers in social communication and advocacy; * training Ministry personnel; * advocacy sessions to be held with hotel owners. The Presidency, will focus on the men in uniform working there. The IDA Grant will finance the main following activities: * support to the Ministry's focal point for coordination and monitoring; * training of peer educators at the Presidency; - 34 - * inforration sessions for personnel * support to their health center for testing, counselling, treatment of STIs and OI and HIV. Project Component 3 - US$ 1.66 million Capacity Building This component would strengthen Guinea's capacity to cope with the spread of HIV/AIDS by supporting: (i) the update of the national HIV/AIDS Strategy and Action Plan; (ii) the strengthening of public and private institutions in HIV/AIDS prevention and care through technical assistance; (iii) the implementation of the necessary cross- sectional training, communication, and large pooled procurement needs of the "Support to Communities" and "Support to Sectors" components. The National Strategy will need to be made known to all kinds of groups, feedback will need to be integrated, and yearly plans of actions designed. This will involve hiring of people who can do the work, and holding of meetings. The strengthening of public and private institutions in HIV/AIDS prevention and care will mostly consist in contracts to private entities who can expand rapidly HIV/AIDS prevention or care services to regions not yet covered. A few study tours to other countries with successful HIV/AlDS prevention or care programs will be provided to public as well as private entities. Procurement needs in terms of goods, drugs, condoms will be all assessed together in order to group purchases as much as possible. Those purchases will be done by UNICEF and UNDP to UNIPAC and IAPSO. Communication needs will mainly consist in contracting media and publishers. Drugs and condoms will be distributed via the National Immunization Program, which already does that. The Secretariat will contract out the evaluation of the project, which involves a base-line as well as a mid-term and end of project survey. It will also contract specific operational research as need arises. Technical assistance by some specialized NGOs already working in Guinea and whose services are satisfactory, will permit a certain quality control, a rapid expansion of some activities, and capacity building. This professionalization of the fight against AIDS is important for its sustainability. It's anticipated that five such contracts will be signed on a sole-source basis: with GTZ, University of Montreal, and AGBEF. The contract with GTZ will include the main following activities: Working with the MOH to: * support laboratories for HIV/AIDS; * support sentinel surveillance for HIV/AIDS; * give technical assistance on the Reference Guides for Counselling for Testing and for Treatment of pediatric cases of HIV/AIDS; * support to develop a training curriculum for psychological support; * give technical assistance to design quality control protocols for counselling, psychological support, testing, care of pediatric cases; * give technical assistance for training of trainers in counselling, testing, PMTCT, care of pediatric cases. Working with the Ministry of Social Affairs to: - 35 - * give technical assistance to design the strategy of support to PLWHAs and their families, including orphans, and the development of community health and social security mutuals; * give technical assistance to design a National Guide for social workers for PLWHAs and orphans; * give technical assistance for training of trainers for social and psychological support to PLWHAs and orphans. Working in the Regions of Mamou, Labe and Faranah: * strengthen the STI components of the public and private sectors; * support to the local branches of the ministries of Education, Interior, Agriculture and to local NGOs; * support to sexual education by peers; * support to the introduction of ART according to the plan by the MOH. The contract with University of Montreal/SIDA3 will include the main following activities: Working with the MOH to give technical assistance for: * revising and updating the national guide for STI control, and designing a national protocol for quality control of STI management; * training of trainers in STI management; * training of trainers for quality control of STI management. Working with the ministry of Education, Health, Youth and with other NGOs such as AGBEF to: * give technical assistance to develop a Reference Guide for Sexual Education by Peers; * give technical assistance for training of trainers on informal sexual education. In the regions of Kindia, Mamou and Labe, not already covered by other donors: * support to STI control in public and private health centers; * training, monitoring supervision of health personnel; * support to the local response component for community initiatives; * support to implementation of health services for sex workers and their clients in Labe. The contract with AGBEF will include the main following activities: Working with the Ministries of Education, Health, Youth and with GTZ and SIDA3: * technical assistance to revise and validate the Reference Guide on Sexual Education by Peers and the quality control protocol; * technical assistance to train trainers in the ministries in sex education; * technical assistance to define and implement the quality control for sex education in public and private entities. At the local level: * ensure the quality control of sex education put in place by the local response and the other local actors; - 36 - * participate in the studies on the impact of peer sexual education. Project Component 4 - US$2.70 million Project Coordination and facilitation The project will be placed under the authority of the National Commission against H[V/AIDS (CNLS) located in the Prime Minister's Office, which will be in charge of the National HIV/AIDS Strategy and Plan of Action, and will define broad priorities of action, approve the key staff of the CNLS Secretariat, and monitor both the performance of the project, as well as national performance in responding to the HIV/AIDS epidemic. The CNLS will include high level representatives of both the public and non-public sectors, including NGOs, the private sector, and PLWHA. The CNLS will be supported by a Secretariat. The Secretariat will be the administrative, coordinating and facilitating mechanism for the project. The Secretariat will be involved in advocacy and policy coordination, assist in the review of line ministries and other entities' annual plans, coordinate training, oversee operational research and studies, provide monitoring and evaluation for the entire program, convene meetings of the CNLS, and provide information to it. The Secretariat will organize the annual review meetings of the national HIV/AIDS program with all interested donors, and will subsequently help plan the next year's program. Regional, prefectoral and sub-prefectoral committees will supervise implementation of action plans and proposals at local levels. The CNLS will recruit four regional supervisors, one for each natural region, who will work within and with existing decentralized units of the PACV to help with certain administrative, and technical aspects, including monitoring and evaluation. A firm will be contracted to monitor all the contracts. A financial and procurement management agent will be hired to help on those aspects. This component will provide support to facilitate the programming, coordination and monitoring/evaluation of project operations, including support to the HIV/AIDS committees It will also support the incremental cost of the Executive Secretariat, and the local units. -37 - INSTMTUTIONAL FRAMEWORK OF HIV/AIDS PROJECT LOCAL RESPONSE SECTORAL RESPONSE CNLS (Tech. Sec.) I Workers I Unions of //$ more than /\/IV 10,000 people Service Contracts Pofessional U Chambers of \\ / ~ ~ ~~~~~~~~~~$\ CRLS/URD Central Ministries NGOs\ CPLS CRD H Regional Ministerial / $ Departnents Communities -38 - Annex 3: Estimated Project Costs GUINEA: MULTI-SECTORAL AIDS PROJECT (MAP) - ,. - *-.,-. _.LocaI~--~--~ .F_ TTotiff --;-= r-' Project.CostBi y Component '. ,:US$million* US Iion, 2US $millio-o - Support to Community-based Initiatives 10.00 0.00 10.00 Support to the Public Sector HIV/AIDS plans 2.44 2.92 5.36 Capacity Building 0.31 1.50 1.81 Project Coordination, Facilitation, and Monitoring 1.90 0.68 2.58 Total Baseline Cost 14.65 5.10 19.75 Physical Contingencies 0.02 0.00 0.02 Price Contingencies 0.24 0.29 0.53 Total Project Costs' 14.91 5.39 20.30 Total Financing Required 14.91 5.39 20.30 ;;;~~s~~; ~ ar_.* - C a FS $*nil io Goods 1.36 2.12 3.48 Works 0.00 0.08 0.08 Services 2.03 2.83 4.86 Training 0.22 0.24 0.46 Grants for Sub-projects 9.90 0.00 9.90 PPF 0.00 0.70 0.70 Operating Costs 0.29 0.00 0.29 Unallocated 0.53 0.00 0.53 Total Project CostsI 14.33 5.97 20.30 Total Financing Required 14.33 5.97 20.30 Identifiable taxes and duties are 0 (US$m) and the total project cost, net of taxes, is 22.3 (US$mn). Therefore, the project cost sharing ratio is 0% of total project cost net of taxes. - 39 - Annex 4 GUINEA: MULTI-SECTORAL AIDS PROJECT (MAP) The "Economic Analysis of liV/AIDS" contained in the Multi-Country HiV/AIDS Program for the Second Multi-Country HIV/AIDS Program (MAP2) (APL) for the Africa Region (Report No. P7497-AFR), provides the economic justification for the Guinea Multi-Sectoral AIDS Project. As it indicates, HIV/AIDS undermines the three major determinants of economic growth, namely physical, human, and social capital. Due to its long incubation period (7-10 years), the impact of the HIV/AIDS epidemic is likely to be drawn over time with the rate of growth of physical and human capital and the efficiency of social capital declining slowly in parallel with the maturing of the HIV/AIDS epidemic. Over time, the behavior of GDP would reflect a similar gradual downward reduction of the rate of growth (or increased rate of contraction), rather than a sudden fall in GDP per capita. Available data indicate that Guinea represents the classic case of a country in which the rapid spread of the virus is likely. Poverty, refugees, high levels of sexually transmitted infections and opportunistic infections, inequality, gender inequality, are all part of the mosaic. Once HIV levels reach around 5%, the infection spreads exponentially with the prevalence rate sometimes increasing by 50% every year. Should the epidemic not be checked it will prevent an increasing share of the population from participating in the economy, resulting in reduction in economic growth and an increase in poverty, thereby accelerating the vicious cycle. -40 - Annex 5: Financial Summary GUINEA: MULTI-SECTORAL AIDS PROJECT (MAP) Years Ending thousands IMPLEMEN1J Al ION PFlRIOl I Year I Year 2 I Year 3 1 Year 4 1 Year 5 Year 6 I Year 7 Total Financing Required Project Costs Investment Costs 2942.0 3301.0 4349.0 5147.0 4256.0 0.0 0.0 Recurrent Costs 58.0 59.0 61.0 63.0 64.0 0.0 0.0 Total Project Costs 3000.0 3360.0 4410.0 5210.0 4320.0 0.0 0.0 .Total Financing 3000.0 3360.0 4410.0 5210.0 4320.0 0.0 0.0 Financing IBRD/IDA 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Govemrnment 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Central 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Provincial 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Co-financiers 0.0 0.0 0.0 0.0 0.0 0.0 0.0 User Fees/BeneficIarIes 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total Project Financing 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Main assumptions: -41 - Annex 6(A): Procurement Arrangements GUINEA: MULTI-SECTORAL AIDS PROJECT (MAP) Procurement General 1. A public procurement assessment in Guinea was first carried out in FY97. These activities were followed up under the IDF grant for Public Procurement Reform. As a result of the Bank's support for reforms in public procurement, a Procurement Code was adopted by the National Assembly in June 1997. .It is considered that although the Procurement Code is comparatively acceptable, it still has numerous articles that were left out in the 1997 amendments and required addressing. A new CPAR was carried out in June 2002. In general, Guinea's Laws and regulations do not conflict with IDA Guidelines and allow IDA procedures to take precedence over any contrary provisions in national laws and provisions. Use of the Bank's Guidelines 2. Goods and works financed by IDA would be procured in accordance with World Bank's Guidelines for Procurement under IBRD Loans and IDA Credits (January 1995, revised in January and August 1996, September 1997, and January 1999). The Bank's Standard Bidding Documents and Standard Evaluation Report would be used for ICB. National Competitive Bidding (NCB), advertised locally, would be carried out in accordance with the Republic of Guinea's procurement laws and regulations, acceptable to IDA, provided that the principles of economy, efficiency, transparency, and fair competition in line with the Bank Guidelines are respected. For NCB procedures, the following conditions have to be met: (a) bids would be advertised in national newspapers with wide circulation; (b) any bidder is given adequate response time (4 weeks) for preparation and submission of bids; (c) bid evaluation and bidder qualification are clearly specified in the bidding documents and applied without discrimination; (d) no preference margin is granted to domestic manufacturers; (e) eligible firms, including foreign firms, are not precluded from participation; (f) award would be made to the lowest evaluated bidder in accordance with the criteria specified in the bidding documents; and (g) bid evaluation reports would clearly state the reasons to reject any non-responsive bid. The Standard Bidding Documents to be used for NCB would be reviewed by IDA before Grant effectiveness. 3. Consultant Services contracts financed by IDA would be procured in accordance with the Bank's Guidelines for the Selection of Consultants by World Bank Borrowers (January 1997, revised in September 1997, and January 1999). The standard Request for Proposal, as developed by the Bank, would be used for appointment of consultants and the Sample Form of Evaluation Report for the Selection of Consultants. Simplified contracts would be used for short-term assignments, that is, those not exceeding 6 months, and carried out by firms or individual consultants. The government will be briefed during the negotiations about the features of the new Consultant Guidelines, in particular with regard to advertisement, bid opening, and steps of IDA reviews. Essentially, communities would receive and manage small grants. Participation by communities in procurement would be based on Simplified Procurement and Disbursement Procedures for Community-Based Projects (February 1998). -42 - Advertising 4. A General Procurement Notice (GPN) would be prepared and issued in the United Nations Development Business (UNDB) as well as in the local newspapers to advertise for major consulting assignments (above US$200,000 equivalent) and ICB. It would be updated annually as long as there are ICB and major consulting assignments. Specific procurement notices for goods and works would be advertised in the national press with wide distribution and internationally for ICB contracts. Request for expression of interest in supplying the requested services would be issued before each procurement, in accordance with the Bank's guidelines. Answers to these expressions would be used to establish list of NGOs and service providers that would help communities. Sufficient time would be allowed (minimum of 15 days) for preparing the short list. The related bidding documents, as applicable, would not be released -- or the short list for consultant services would not be prepared - until 8 weeks after the GPN had been published. Procurement Capacity Assessment 5. A formal capacity assessment of the project management unit to verify whether it will be able to handle the procurement work load during project implementation was carried out during the appraisal mission. The summary of findings of the assessment report indicates "a high risk" for this project. It outlines the main issues and recommendations and is in the project files. Based on these recommendations, the following actions were discussed with the Borrower during the negotiations: (i) the CNLS Secretariat procurement specialist will be sent for training on Bank procurement procedures and the project will hire a short-term consultant with extensive Bank experience during the first year; (iii) proper logistics support for proper filing of procurement documentation will be sought from the Bank's Resident Mission during the first year. 6. For community sub-project, the communities, through their representatives committees, would be responsible for the procurement process using the simplified procurement procedures as described in the project Implementation Manuel. The adoption of the manual satisfactory to IDA is a condition of effectiveness. Sub-projects from communities would indicate how procurement would be organized. 7. In order to ensure that participating agencies (line ministries, provinces, communities) are familiar with Bank's procurement guidelines in general and the procurement procedures in this project in particular, the CNLS with the assistance of IDA, would provide a series of workshops, with the first workshop organized at effectiveness. The subsequent workshops would be organized so as to coincide with IDA supervision missions when the procurement specialist would conduct the workshop as part of the supervision mission. The costs of these workshops would be included in the project. These workshops would also act as forums to review procurement problems experienced during project implementation with a view to identify measures that would address these problems. The CNLS as well as annual external technical audits will also play a critical role in providing assistance to line ministries and other participating agencies in carrying out their activities in accordance with the project Implementation Manual. Procurement Planning 8. Draft procurement plans have been prepared during appraisal for all procurement to be carried out during the first year activities. The final plan will be submitted to IDA before effectiveness. The exact mix of procurement will be determined on annual joint reviews between CNLS, lines ministries, IDA and other partners, where the draft procurement plan for the following financial year will be presented and agreed upon. The detailed procurement plan for subsequent years will be -43 - developed and submitted to IDA for review and approval. The plan will include relevant information on goods, works, and consulting services under the project. As well as the timing of each milestone in the procurement process. These plans will be reviewed by IDA supervision missions and by the external audits. This being a multi-sector project, the respective annual plans would also need to be closely coordinated with other operations in the various sectors such as PACV and PPSG. To that end, one of the key responsibility of the focal point for fight against HIV/AIDS named in each of the line ministry will be to ensure that risks of overlapping and coordinated efforts are minimized as much as possible by keeping track of activities financed under ongoing IDA operations and or sources of financing in the area of HIV/AIDS. Procurement Implementation Arrangements 9. The overall coordination of the program implementation would be carried out by the CNLS, with each line ministry, and Regional Ministry Representative, CRD, and community responsible for implementation of their relevant works programs or sub-projects. Procurement would be done at three levels: national (CNLS, line ministries), regional (by the Directorate of each Ministry), and local (CRD and community). The procurement arrangements are as described below. 10. At the national level, the CNLS would be responsible for procuring all major items under ICB and NCB procedures and all consulting services. Procurement by line ministries and their regional representatives would be limited to expenditures in support of their respective approved work program at an estimated cost of less than US$ 22,000 per contract (IEC materials, workshops, training and operations). Procurement at the CRD level will be limited to less that US$1,000 per year per CRD through petty cash arrangements and will include small supplies, per diem and transportation in support of training and sub-project selection. Procurement for community sub-projects would be carried out by communities themselves and could include: minor repair works, purchase of drugs and supplies in small quantities, care and support for AIDS patients and orphans, AIDS prevention and care activities. Assessment and approval of community sub-projects would be based on application received from respective committees and communities against a standard menu of activities. A project Implementation Manual, including a description of sub-project procedures satisfactory to IDA is a condition of effectiveness. Procurement Methods 11. Civil Works. With the exception of civil works for office rehabilitation and for medical waste management, all other works are included in sub-projects. As part of the community sub-projects, small works will mostly consist of works related to small community structures such as care centers, youth facilities and community meeting facilities. These small works are estimated to cost less than US$ 20,000 per contract, up to an aggregate amount of US$ 80,000 equivalent. They may be procured under lump-sum, fixed price contracts awarded on the basis of quotations obtained from three qualified domestic contractors invited in writing to bid. The invitation shall include a detailed description of the works, including basic specifications, the required completion data, a basic form of agreement acceptable to IDA, and relevant drawings where applicable. The award will be made to the contractor who offers the lowest price quotation and satisfies the technical quality standards for the required work, provided they demonstrated they have the experience and resources to complete the contract successfully. 12. Goods. The total cost of goods estimated at US$ 3.5 million equivalent for the project, not including contracts for goods under the community sub-projects. The items would include: office, - 44 - audio-visual, and laboratory equipment, vehicles, pharmaceutical products (e. reagents), condoms, diagnostic kits, pharmaceuticals for the clinical management of HIV/AIDS and opportunistic infections, including TB; EEC materials, and other project related supplies. Procurement of goods will be bulked where feasible into packages valued at US$ 100,000 equivalent or more per package and will be procured through ICB. Preference for domestically manufactured goods will apply in accordance with the World Bank Guidelines. (a) Goods estimated to cost less than US$ 100,000 up to an aggregate amount of 0.6 million equivalent would be procured through national competitive bidding. The Bank's standard bidding documents for the procurement of goods suitably modified will be submitted to IDA by the CNLS for prior review. The approved document would form the basis of all national competitive bidding procurement under this project. (b) Goods that are estimated to cost less than US$ 20,000 equivalent per contract may be procured by line ministries, Regional Ministry Representatives, and CRDs (as part of approved work program agreements, and up to an aggregate of $1.8 million equivalent) through national shopping procedures. In the case when a contract for goods cost the equivalent or more than US$ 20,000, the CNLS will carry out such procurement on behalf of these entities. The CNLS may procure goods to cost less that $ 25,000 through National shopping procedures and/or international shopping procedures (for those goods to be procured under Parts A, B and D of the Project), and/or through the United Nations Agencies (LAPSO, UNIPAC, UNFPA, WHO), all up to an aggregate of US$ 2.0 millions in accordance with the Bank Guidelines. (c)The procedures followed and the total aggregate amounts for all shopping methods under the project, will be reviewed after six months of project implementation. Depending on performance and the result of the review, the total aggregate amount may be adjusted where necessary. Standard request forms and establishment of guidelines for conducting the shopping methods will be discussed during the negotiations as per the Bank's memorandum of June 8, 2000 on " Guidance Procurement note on Handling Procurement under shopping method" and will be included in the project Implementation Manual. (d) Procurement of reagents for H[V/AIDS considered as proprietary items costing less than US$ 50,000 equivalent per contract up to an aggregate of US$ 0.12 million equivalent, may be procured directly from manufacturers and authorized local distributors in view of the requirements of existing laboratory/testing equipment in Guinea. 13. Grant for community sub-projects. The project will finance community sub-projects related to HIV/AIDS activities (total is estimated at US$10.00 million equivalent), such as IEC-related activities and materials, minor repairs or works, care and support for AIDS patients and orphans, awareness campaigns, income generating activities for person living with HIV/AIDS and their dependants. Funding these activities will be in form of grants. 14. Financing will depend on applications received from conmmunities and NGO and private organizations against positive lists of activities. It is not possible to determine the exact mix of goods, small works, and services to be procured under these activities due to their demand driven nature. Therefore, the type of activities to be financed and their procurement details will depend on the needs identified by the communities. Procurement of items for the implementation of sub-projects would be carried out in accordance with simplified procurement procedures referred to in section 3.15 of the guidelines and in accordance with the project Implementation Manual. The manual will contain a special chapter describing the procedures and tools in accordance with those found in the Bank's -45 - Guidelines for simplified Procurement and Disbursement for Community-based Investments (February 1998). The CNLS will be responsible for ensuring compliance with these guidelines. Ex-post reviews of random sub-projects will be conducted periodically by the Bank and independent technical audits. 15. Aggregate amounts are limitative, therefore, the CNLS will maintain a tracking system to ensure that they are not exceeded the specified amounts, and that IDA is advised in a timely fashion when it is likely to happen. Consulting Services, Studies, and Training 16. The consultant services, studies and training financed by IDA would be for the following type of activities: studies and surveys related to the monitoring and evaluation activities, trainers, community developments specialists, public relations firms (IEC campaigns), specific HAIV/STI prevention services, procurement, financial management, monitoring and evaluation, audit, and accounting specialists. The CNLS would ensure that the procurement notices are widely publicized to get candidacies from consultants (firms and individuals). Based on agreed upon criteria, the CNLS will maintain and update a list of consultants which will be used to establish short lists. The following selection procedures would be used. (a) Ouality -and -Cost-based selection: All consulting service contracts for firms would be awarded through Quality and Cost Based Selection (QCBS) method. To ensure that priority is given to the identification of suitable and qualified national consultants, short-lists for contract estimated to cost at or less than US$100,000 equivalent may be comprised entirely of national consultants (in accordance with the provisions of paragraph 2.7 of the consultant Guidelines), provided that a sufficient number of qualified individuals or firms (at least three) are available. However, if foreign firms have expressed interest, they should not be excluded from consideration. (b) Consultant's Oualification selection may be used for consulting services for research, and targeted intervention for which organizations with specialized expertise, strong capacities to work with vulnerable groups and proven track records would be recruited. The amount of the contract is estimated to cost less than US$ 50,000. This method may also be used for the selection of training institutions when training cost exceed US$ 50,000 equivalent per contract. (c) Single Source Selection may be used for consulting assignments such as those provided by NGOs or other organizations to assist province and community sub-projects costing less than US$ 5,000 up to an aggregate of US$ 28,700 equivalent, and for beneficiary assessments in view of the specific nature and requirements of the methodology. Technical assistance contracts with GTZ, University of MontrealJSIDA3, and AGBEF can be done through single source up to a maximum amount of US$300,000/firm/year and if unit costs are satisfactory to IDA. Those three firms have been in operation in Guinea for several years with positive results, they also have the technical staff which can provide the necessary quality control for rapid expansion of the firms' activities, also, they can expand rapidly their activities if further financing is made available to them. (d) Consultants for services meeting the requirements of section V of the consultants Guidelines will be selected under the provisions for "Selection of Individual Consultants" method. Individual Consultants (IC) will be selected through comparison of curriculum vitae against job description requirements of those expressing interest in the assignment, or those having been identified directly by the Borrower. Consultants hired under the project cannot be civil servants. -46 - 17. Training, workshops, and conferences. The total cost of these activities is estimated at US$ 1.4 million equivalent for the project. Training, workshops, conference attendance and study tours will be carried out on the basis of annual approved programs that will identify the general framework of training and similar activities for the year, including the nature of training/study tours/workshops, the number of participants, and cost estimates. Prior Review 18. All ICB, the first three NCB contracts, and direct contracting for works and goods would be subject to prior review as per paragraph 2 Appendix 1 of the Guidelines. All other contracts would be subject to post review in accordance with paragraph 4 Appendix I of the Guidelines. All consultant contracts costing US$ 100,000 equivalent or more for firms would be subject to IDA prior review. For consulting contracts costing less than US$ 100,000, but more than US$ 50,000, the Borrower will notify the Bank of the results of the technical evaluation prior to opening the financial offers. With respect to each contract for employment of individual consultants estimated to cost the equivalent of US$50,000 or more, the qualifications, experience, terms of reference and terms of employments of the consultants shall be fumished to IDA for its prior review. Any amendment to existing contracts raising their values to levels equivalent or above the prior review threshold are subject to IDA review. The first ten contracts with communities will be submitted to prior review by IDA. 19. All terms of reference and all single selection of consultants would be subject to IDA prior review. Other procurement subject to IDA review would include: annual training plans for, local and overseas training and workshops, including terms of reference and estimated budgets. All out of country training will be subject to IDA approval. Post Review 20. Monitoring and evaluation of procurement performance at all levels (national and community) would be carried out for procurement under the prior review thresholds during IDA supervision missions and through annual ex-post procurement audits. At minimum, 1 out of 10 contracts would be managed by CNLS, and 1 out of 3 contracts managed by line ministries for goods will be subject to post review. Post-review of in-country training will be conducted from time to time to review the selection of institutions /courses contents/trainees and justifications thereof, and cost incurred. Annual independent technical audits (ex-post procurement audits) would (a) verify that the procurement and contracting procedure s and processes followed for the projects were in accordance with the Grant Agreement (GA); (b) verify technical compliance, physical completion and price competitiveness of each contract in the selected representative sample; (c) review and comments on contract administration and managements issues as dealt with by the participating agencies; (d) review capacity of participating agencies in handling procurement efficiently; and (e) identify improvements in the procurement process in light of the any identified deficiencies. All thresholds stated in this section will be reviewed by the Borrower and IDA on an annul basis. Amendments may be agreed upon based on performance and actual values of procurement implemented. Amendments to the Grant Agreement (GA) may be proposed accordingly. -47 - Procurement methods (Table A) Table A: Project Costs by Procurement Arrangements (US$ million equivalent) ~ r =:#.- + . Y - _ - - Procurement Method . : -,. _.'Expenditure Category - - IB NCB Other. 'NB.F.; Total (est 1. Works 0.00 0.00 0.08 0.00 0.08 (0.00) (0.00) (0.08) (0.00) (0.08) 2. Goods 1.10 0.58 1.80 0.00 3.48 (1.10) (0.58) (1.80) (0.00) (3.48) 3. Services 0.00 0.00 5.57 0.00 5.57 Consultants and Training (0.00) (0.00) (5.57) (0.00) (5.57) 4. Grants for subprojects 0.00 0.00 9.15 0.00 9.15 (0.00) (0.00) (9.15) (0.00) (9.15) 5. Operating costs 0.00 0.00 0.31 0.00 0.31 (0.00) (0.00) (0.31) (0.00) (0.31) 6. Unallocated 0.00 0.00 1.71 0.00 1.71 (0.00) (0.00) (1.71) (0.00) (1.71) Total 1.10 0.58 18.62 0.00 20.30 0(1.10) (0.58) (18.62) (0.00) (20.30) " Figures in parenthesis are the amounts to be financed by the Bank Grant. All costs include contingencies. 21 Includes civil works and goods to be procured through national shopping, consulting services, services of contracted staff of the project management office, training, technical assistance services, and incremental operating costs related to (i) managing the project, and (ii) re-lending project funds to local government units. PPF amount of $700,000, is included in Unallocated. -48 - Prior review thresholds (Table B) Table B: Thresholds for Procurement Methods and Prior Review' - - _ - - -- Contract.Value-. -: u - Contracts Subject'to Threshold- . - -, Procurmet lor Review Expenditure Category '(USS thousands) - -' -Method - (US$ millions); , 1. Works > or = US$20,000 eq. NCB = or > US$20,000 > US$20,000 Price quotation 3 The first 2 contracts contractors 2. Goods > or = US$100,000 eq. ICB All or = US$ 100,000 QCBS All firm s _____________________ SSS A ll 4. Services - Auditors US$50,000 eq; first 2 contracts and all TOR regardless of the cost 5. Services - Individuals > or = US$50,000 eq. All t < EFER I '7 A t a n cMAURITANIA i AERODROMES LEN/ G uE c 'RSIR -' . ..-; BISSA GUKINEA 8-0uRaA - PREFECTURE BOUNDARIES r C b)AOTE 80- Conralrr* -. r, iF_ OIMItOTES DES PREEC / L I D 1 R ADMINISTATIVER REGONA ONDRESSrk SIERPAFLE0-NE~"'. ~ COE INTE PRNATIONAL BOUNDARIES / xn' 0 Guel ol '-KL E or acceptance of such boundaries, or any *0~~~~~~~~~~~~~~ N~~~~~RV R - Cult ol ~ ~ ~ ~ ~ ~~FEUE Report No.: 23881 GUI Type: PAD