Report No. 43075-AFR Lessons Learned from Mainstreaming HIV/AIDS in Transport Sector Projects in Sub-Saharan Africa June 30, 2008 Africa Transport Sector (AFTTR) Document of the World Bank TTL Task Team Leader TOR Terms of Reference SADC Southern African Development Community UNAIDS Joint United Nations Program on HIVIAIDS USAID United States Agency for International Development VCT Voluntary Counseling and Testing WB World Bank Vice President: Obiageli K. Ezekwesili Country Director : Mark D. Tomlinson Sector Manager: C. Sanjivi Rajasingham Task Team Leader: Jocelyne 0 . do Sacramento ACKNOWLEDGMENTS This work has been cofinanced by HDNGA (Human Development Network Global HIVIAIDS), AFTHV (ACTAfrica), and AFTTR (Africa Transport Sector Unit). It was led by Jocelyne 0 . do Sacramento (AFTTR), and supported by Ekong Emah, John Stephen Osika, and Marie Diop (consultants). The authors are grateful to the following for their availability to provide significant advice when needed throughout the process: Stephen Brushett, Lead Transport Specialist (LCSTR); Nadeem Moharnmad, Senior Operations Officer (AFTHV); and Andy Chi Tembon, Coordinator (AFTH2). This assessment of the Africa transport portfolio was made possible through the participation and assistance of numerous individuals: Alain Labeau, Sector Program Coordinator (AFTTR); Julie Babinard, Consultant (ETWTR); Pierre Pozzo di Borgo, Senior Transport Specialist (AFTTR); Elizabeth Ninan, Young Professional (AFTHV); Nilufar Egamberdi, Consultant (AFTHV): Carolyn Shelton, Consultant, (AFTHV), Vivien Foster, Lead Economist (AFTSN): Peter Nigel Freeman, Lead Evaluation Officer (IEGSG); Abdelmoula Ghzala, Lead Infrastructure Specialist (MNSSD); Gael Raballand, Transport Economist (AFTTR); Gylfi Palsson, Senior Transport Specialist (AFTTR); and Shalonda Robinson, Team Assistant (AETR). Table of Contents FORWARD EXECUTIVE:SUMMARY .....................................................................................................i SECTION I BACKGROUND INFORMATION . ...............................................................1 HTVIAIDS In Africa And Why African Governments Should Be Interested...............................................1 Background Informationon HIVIAIDS and the Transport Sector................................................................ 1 Why Does the Transport SectorNeed to Be Involved with HNIAIDS Prevention? ...................................2 What Is HIVIAIDS Mainstreaming?.............................................................................................................. 3 The Current Process of Mainstreaming..........................................................................................................4 SECTION I1 HIVIAIDSAND THE TRANSPORT SECTOR WITHIN THE . WORLD BANK ......................................................................................................................6 The Era of HIVIAIDS Treatment................................................................................................................... 7 The HIVIAIDS Project for the Abidjan-Lagos Transport Corridor ............................................................8 Support from Other DevelopmentPartners.................................................................................................... 8 SECTION I11 ASSESSMENT OF THE PROJECTS IN THE AFTTR . PORTFOLIOFOR HIVIAIDSMAINSTREAMING .......................................................10 Methodology.................................................................................................................................................10 Limitations....................................................................................................................................................10 HIVIAIDS-Related Interventionsin the Mainstreamed Projects................................................................14 SECTION IV LESSONS LEARNED. RECOMMENDATIONSAND . CONCLUSIONS ................................................................................................................... 21 Lessons Learned ...........................................................................................................................................21 Implementation Challenges.......................................................................................................................... 23 Recommendations for Action...................................................................................................................... 23 Conclusion ....................................................................................................................................................26 APPENDICES ..................................................................................................................27 REFERENCES ..............................................................................................................5 4 FOREWORD Transport, by its very nature of facilitating the mobility of people and goods, is a vector for the transmission of HIVIAIDS in Africa, as it is elsewhere. Those affected most by the disease include workforce, mobile populations, communities around the inkastructure development sites, and transport workers. Furthermore, the increased attention and investment in cross-border trade facilitation, although vital for Africa's economic growth, also encourage even longer travel routes, which in turn increase the reach of this disease. It is thus imperative that those of us who work in this sector, especially on the African continent, reflect appropriate responses in our operations policy actions. I am pleased to note that the transport sector has indeed drawn attention to the disease, mainstseamed HIVIAIDS prevention activities into its postfolio under the Multi-Country HIVIAIDS program (MAP), and helped stakeholders understand that HIV is a multisectoral problem affecting development goals. The World Bank's early support to the transpoi-t sector enabled key donors to come forward and finance HIVIAIDS initiatives in the sector. One easly project, the Abidjan-Lagos Transpost Corridor HIVIAIDS Pro-ject, provided a sub-regional platform for HIV care and prevention interventions, as well as a platform for the five member countries to address other epidemics in the sub-region. Ministers of Health from the five countries, as the members of the Board that provided guidance to the project, addressed standardization of testing and treatment protocols, as well as providing access to voluntary counseling and testing (VCT) services along the conidor. More broadly however, it is important that AIDS mitigation efforts are mainstreamed into all transport operations. The Bank has been successful in ensuring that our roads contracts cover the responsibilities of contractors to ensuring mitigatory measures. There is also much awareness among other donors, such as the European Union. However, more needs to be done to ensure that the Ministries of Transport have the tools and guidance available to enable them to apply those HIVIAIDS mitigation measures consistently across all operations and activities. With extended funding support (especially from MAP), draft policies have been developed to guide mainstreaming of HIV into the transport sector. At the institutional level in some countries, HIV workplace programs have been initiated in the road agencies and in the other subsectors. Sector-wide mainstreaming remains a challenge. Ministries of Transport are best placed to facilitate sector-wide mainstreaming, but sector policies integrating HIVIAIDS interventions of virtually all the countries are still in preparation, and some are awaiting finalization, approval, and adoption at the country level. This repost, on the mainstreaming of HIVIAIDS, is an effort to describe where we stand in this process and to suggest ways to further this effort. C. Sanjivi Rajasingham Sector Manager Africa Transport Sector (AFTTR) The World Bank June 2008 EXECUTIVE SUMMARY The HIVIAIDS pandemic burdens Sub-Saharan Africa (SSA) and continues to constrain its social and economic advancement. UNAIDS has estimated that in southern Africa alone, 930,000 adults and children died of AIDS in 2005. This represents about one-third of AIDS deaths recorded globally that year. In addition, about 12 million children below the age of 17in SSA are estimated to have lost one or both parents to AIDS. ' A working definition for mainstreaming AIDS has been provided by UNAIDS-"a process that enables development actors to address the causes and effects of AIDS in an effective and sustainable manner, both through their usual work and within their workplace" (UNAIDS 2004). This ESW was commissioned to review the process, results, and challenges of mainstreaming HIVIAIDS prevention activities into the transport sector. Major milestones achieved through HIVIAIDS activities initiated by Africa Transport Sector (AF;TTR), include the integration of HIVIAIDS prevention activities in ongoing projects through the retrofitting exercise, the incorporation of HIVIAIDS clauses in bidding and contract documents, and the development of HIVIAIDS policy in the workplace environment. One of AFTTR's flagships is the HIVIAIDS Project for the Abidjan-Lagos Transport Corridor; It was specifically designed to include both transport sector and HIVIAIDS interventions. Most of the other AFTTR operations did not have this unique design and had to be mainstreamed during project implementation for HIVIAIDS interventions. HIVIAIDS mainstreaming in the transport sector can be considered achieved once the transport sector has fully taken on HIVIAIDS interventions as part of its overall transport sector portfolio-meaning that there is a specific transport and HIVIAIDS program in place with institutional responsibility established and human and financial resources assigned. This concept was used to identify the projects that are deemed mainstreamed in the AFTTR portfolio. The top four interventions most widely implemented across projects before mainstreaming were: (a) Appointment of an HIVIAIDS focal point; (b) Hiring of a consultantlnongovernme~~tal organization (NGO) for technical implementation of HIVIAIDS activities; (c) Information, education, and communication/behavior change communication (IECIBCC) interventions; and (d) Distribution and promotion of condoms. "MAIDS Fact Sheet: Sub-Saharan Africa 2006. The least implemented interventions related to HIVIAIDS workplace policy implementation/development. A number of lessons stemmed from the assessment of the mainstreaming process. Four lessons deserve particular attention because they illustrate the very essence of the approach to mainstreaming: (a) The need to have HIVIAIDS as an integral element of the transport sector policy and development agenda, and not as an afterthought; (b) The need to support the development of simple (whenever possible) and clear monitoring-and-evaluation frameworks that address HIVIAIDS in the transport sector, (c) The need to generate the data needed to highlight progress; and (d) The need to ensure that the management of the HIVIAIDS interventions in the transport sector takes into consideration existing structures in the sector and that the support of the HIVIAIDS interventions by senior management and staff of the sector is actively encouraged. Other lessons and recommendations are outlined at the end of the document. Mainstreaming within the transport sector is facing a two-pronged challenge: First, the sector must ensure that its development gains are not lost as a result of HIVIAIDS and that its labor force is safe from HIVIAIDS and remains productive for the community. Second, the sector must ensure that it i s not creating a favorable environment that facilitates the spread of the epidemic. Transport sector workers (road, rail, air, and marine) and transport sector clients (passengers and communities who interact with transport workers) are particularly vulnerable because the mobility offered by the various modes of transportation creates opportunities for the various modes of transmission of the HIV epidemic. Transport sector workers may spend long periods of time away fronl their families, which may increase their vulnerability to HIVIAIDS. On the other hand, clients of the transport sector may either represent the vectorlmedium of vulnerability or be vulnerable to infection because of their association with the sector. This context led the Africa Transport Unit (AFTTR) to start incorporating HIVIAIDS prevention activities into its transport sector projects in 2000. This move was initiated to be consistent with the overall multi-sector approach championed in the Africa region, which aims at combating HIVIAIDS and which had been translated into the mainstreaming of HIVIAIDS mitigation across all sectors. HIVIAIDS mainstreaming in the transport sector was designed to complement, but not replace, the Multi-Country HIVIAIDS Program (MAP), which was being progressively rolled out across the region. Although it includes the provision to transport sector workers and clients of some HIVIAIDS-related health services, it complements the health sector's mandate for provision of health services to the general population. As the Africa region and the world as a whole are getting more experienced in tackling HIVIAIDS, it is becoming increasingly evident that HIVIAIDS interventions need to be tailored as much as possible to address the particular needs of the local epidemic. Task Teams therefore need to pay attention to HIVIAIDS during the preparation and supervision phases of the transport sector projects. The earlier the issues of HIVIAIDS mainstreaming are addressed, the better the mainstreaming process will progress. It is in the interest of the transport sector to know how much resource is allocated to HIVIAIDS interventions. Project teams need to keep record of these resources in a way that these financial resources can be monitored. The ideal stage that all countries should strive to reach is to have each Transport Ministry to be responsible for the design and implementation of its respective HIVIAIDS sector's response. This would be done using the National HIVIAIDS Strategic Framework as the base document upon which the sector's response would be developed. The transport sector at country level should be supported to develop simple (whenever possible) and clear monitoring-and-evaluation frameworks that address HIVIAIDS (see appendixes D & J for sample indicators and data collection forms). Capacity development in monitoring and evaluation, including the allocation of human and financial resources, should be a priority for HIVIAIDS interventions in the transport sector. The Africa region's transport framework for meeting the HIVIAIDS challenges is an important tool that project teams should use to guide their work in the field. This framework should be expanded to include simple "how to" tools like reporting forms, referral forms, and checklisls that can be adapted and used locally for quality assurance. In collaboration with the regional transport sector networks in Africa, the setting up of at least two regional transport sector HIVIAIDS support centers should be considered. These centers would facilitate capacity building and sharing of information across the client countries. To remain actively engaged, the transport sector needs to work with the Agenda for Action parameters. The hubs will consequently build on the "Three Ones principles" to disseminate and implement the four pillars of the Agenda for Action: (a) Focus the response through evidence-based and prioritized HIVIAIDS strategies; (b) Scale up targeted multi-sector and civil society responses; (c) Deliver more effective results through increased country monitoring and evaluation (M&E) capacity; and (d) Harmonize donor collaboration. AFTTR has made progress in mainstreaming HIVIAIDS in its portfolio. However, there is still more work ahead in ensuring that all projects are mainstreamed as needed. In this context, the Transport Sector Board needs to continue supporting such future mainstreaming efforts by establishing a Sector Board Strategy for HIVIAIDS activities on Bank-financed transport projects. The diverse nature of transportation activities implies that mainstreaming is both challenging and urgent. In 2000, the Africa Transport Team gave high priority to its contribution to the campaign against the HIVIAIDS pandemic and pledged to mainstream HIVIAIDS actions in the Bank's lending operations and at country level in the transport sector. The transport sector contributed significantly through integrating simple activities into its operations (such as HIVIAIDS contract clauses into bidding documents for road construction site workers). Similarly, the Bank financed a first-round workshop to prepare HIVIAIDS prevention policy in the workplace for Ministry employees. Its main objective is to develop and implement highly focused prevention interventions to reduce HIVIAIDS prevalence and slow down the spread of the disease in the transport sector. This document is subdivided in four sections. The first section gives background information on the transport sector and HIVIAIDS. The second section describes the Bank's transport sector activities, with particular focus on the Africa region and its achievements regarding HIVIAIDS. The third section presents the process and the results of the assessment of the Africa transport sector portfolio for HIVIAIDS mainstrearning. The fourth section enumerates the lessons learned as well as the recommendations made to the World Bank's Transport Sector Board and to stakeholders in the client countries. SECTION I. BACKGROUND INFORMATION HIVIAIDS in Africa and Why African GovernmentsShould Be Interested 1. Sub-Saharan Africa remains the most seriously affected region in the world with respect to HIVIAIDS. Based on UNAIDS published data (UNAIDS and WHO, 2007), 68 percent of the world's WIV-positive people lived in this region. This region also accounted for 76 percent of all global AIDS deaths in 2007. In terms of numbers of people living with HIVIADS, Sub-Saharan Africa had 22.5 million people, of whom 1.7 million were newly infected during 2007. The epicenter of the epidemic in Sub-Saharan Africa is in Southern Africa, where one third (35 percent) of the world's HIV-infected people live. National adult HIV-prevalence 2005 figures indicate that in no less than eight Southern African countries, prevalence exceeded 15 percent. Governments in Africa, therefore, have to be involved in the fight against HIVIAIDS because this is a development challenge for the whole continent, although some parts of the continent are clearly more affected than others. Background Information on HIV/AIDS and the Transport Sector 2. International research indicates that transport sector workers, particularly long- distance commercial drivers, have a relatively high vulnerability to HIVIAIDS and more generally to sexually transmitted infections (STIs). For example, studies carried out in East Africa found a relatively high prevalence of HIV (at least two times higher) among long-distance truck drivers from Kenya, Rwanda, and Uganda compared with that among the general urban populations of their respective countries (Bwayo et al. 1994; Carswell, Lloyd, and Howells 1989). Other studies elsewhere have produced results consistent with these findings (Ramjee and Gouws 2002; Lacerda et al. 1997). Transport workers, because of high mobility and long periods of time away from their homes, have a tendency to have multiple sexual partners, which increases their vulnerability to HIVIAIDS. In Nigeria, for example, 95 percent of commercial drivers had at least one other sexual partner in addition to their respective wives (Orubuloye, Caldwell, and Caldwell 1993). These Nigerian commercial drivers had an average of 6.4 regular girlfriends at different locations along their regular major transport routes. High-risk behavior among commercial drivers has been documented in other parts of the world, including Brazil, India, and the United States (Malta et al. 2006; Bal et al. 2007; Lichtenstein et al. 2008). 3. Populations associated with major transport hubs also display a high vulnerability to HNIAIDS and STIs. For example, in Kenya, along the Trans-Africa Highway, high-risk sexual behavior has been reported among girls and boys who frequently visited truck stops (Nzyuko et al. 1996). A history of STIs was reported in 50 percent of the girls and 30 percent of the boys in this case. Along the Abidjan-Lagos Transport Corridor, about 300,000 HIV-infected people travel along the corridor annually (Brushett and Osika 2005). In 2006, an estimated 47 million people traveled along the Abidjan-Lagos Transport Corridor, compared with 30 million in 20012. Information.on Abidjan-Lagos Corridor Organization (ALCO) Website. 1 Cross-border shopping centers, ports, and harbors are likely to be transport hubs with HIV high-risk behaviors. At the same time, however, these same transport hubs offer opportunities for provision of HIVIAIDS prevention and care services. 4. Transport workers (particularly truck drivers), regularly travel among and across populations with different HIV-prevalence levels. For example, they may regularly travel from urban areas with high HIV-prevalence levels to rural areas with relatively low HIV- prevalence levels, while having sexual partners in both types of communities. Cross- border travel may also involve travel from high-prevalence countries to low-prevalence countries, providing opportunities for HIV transmission from high-prevalence communities to low-prevalence communities. Transport sector workers can, therefore, act as a bridge between high-prevalence and low-prevalence communities. Why Does the Transport Sector Need to Be Involved with HIVIAIDS Prevention? 5. Apart from the human tragedy of the disease, a shortage of skilled human resources in Africa as a whole and in the transport sector in particular, it is in the interest of the transport sector to prevent new HIV infections among transport sector workers. The provision of support services for those transport workers and their families, who are already HIV-infected, also helps to sustain and prolong the productivity of those transport workers long after the infection has occurred. 6. Involvement of stakeholders in the sector in the prevention effort in the external domain (communities that interact with transport sector workers) is in the interest of the transport sector because of the commonality of HIV high-risk interactions between those communities and the transport sector worlters. The interactions increase with the increase in number of passengers and likewise the number of transport workers. For instance, interventions in communities that contribute to controlling the spread of HIV will also benefit the transport sector users and transport workers who interact with these communities. 7, Sector stakeholders also have detailed knowledge of the transport sector working environment and thus are well suited to design interventions to protect transport productivity and sector workers from HTV in the workplace. This internal knowledge of the sector is essential for the transport sector to place HIV/AIDS prevention and care services at the center of its core business. 8. For any HIVIAIDS interventions in the transport sector to be effective, the commitment and approval of the policymakers at the highest level are essential. Government ministries (and their sub-national agencies) responsible for transport, therefore, need to be engaged in HIVIADS prevention programs. In particular, they have to ensure that resources and organizational support are provided for the implementation of the HIVIAIDS interventions in the sector. Similarly, it is of importance for the success of HIVIAIDS programs in the transport sector that there is active participation of transport associations and unions, which can provide peer-level support critical in programs that might seek to modify behavior among sector employees. 9. Within the World Bank, the Africa region transport sector has appreciated the vulnerability of transport sector workers to HIVIAIDS and the role it can play in the fight against HIVIAIDS. The transport sector was one of the first non-health sectors in the region to give HIVIAJDS prevention prominence in its operations. The efforts toward mainstreaming, which started in 2000, are consistent with this deep understanding of its role in promoting prevention and care related to HIVIALDS. What Is HIVIAIDSMainstreaming? 10. A working definition for mainstreaming AIDS has been provided by UNALDS: "a process that enables development actors to address the causes and effects of ALDS in an effective and sustainable manner, both through their usual work and within their workplace" (UNAIDS 2004). "Development actors" in the transport sector would mean all public sector, civil society, and for-profit organizations, including transport sector unions. "Usual work for the transport sector is the mandate, mission, or business interests relating to transport sector infrastructure, services, and organization. Mainstreaming needs to be carried out in the "internal domain" (mainly transport sector employees, resources, and procedures) and the "external domain" (mainly the people in communities that interact with the transport sector). Depending on the nature of the environment in which mainstreaming is carried out, the relative balance between internal and external domains can vary with relative emphasis on one or the other or with equal attention to both domains. 11. Mainstreaming within the transport sector is faced by a two-pronged challenge: First, the sector has to ensure that its development gains are not lost as a result of HIVIAIDS and that its labor force is safe from HIVIAIDS and remains productive for the community. Second, the sector has to ensure that it is not creating an environment conducive to the spread of the epidemic. 12. Attempts have been made to differentiate between "mainstreaming" and ~ntegration."While mainstreaming in HIVIAIDS is about adapting core business to cope b b ' with the reality of HIVIATDS, integration is limited and is seen as the introduction of HIVIAIDS into a project without necessarily affecting or interfering with the core business of the institution involved. Activities implemented through integration in an HIVIAiDS project are thus seen as add-on (UNAIDS 2002). 13. Following the lessons learned during the process of operations integration and the concept of mainstrearning in the context of development, there is growing consensus on what mainstreaming is, what mainstreaming is not, and the essential guiding principles of mainstreaming (as reflected in Table I). 14. The major thrust of the HIVIASDS initiative in the transport sector is mainstrearning, and in the road subsector where AFTTR's operations are most prominent, the mainstrearning objectives are twofold: (a) to prevent road construction projects from being vehicles of HIV infections; and (b) to help client countries better define their HIVIAIDS prevention strategies in the transport sector. The CurrentProcess of Mainstreaming 15. Within the AFTTR, mainstreaming is being done at two levels. The first level is when the project is being developed, and the second level is when the project is being implemented by the Ministry of Transport (MOT).The process of mainstreaming projects with the client countries involves the following actions: Identification of focal persons; Development of an action plan with the involvement of stakeholders; Inclusion of HIVIAIDS clauses in works contracts; Hiring consultants or NGOs to implement HIV prevention activities targeting both workers deployed on-site and communities around the project sites, including truck and bus drivers and their passengers; Bank team assisting client countries to request MAP funding; Bank team working with client to prepare concept paper; and Bank team prompting sector strategy development. Table 1.Mainstreaming HIVIAIDS: Definitionsand Principles IWhat Mainstreaming Is: /What Mainstreaming Is Not: (Essential Principles of Mainstreaming: All sectors, including the Mainstreaming is not about Identify a focal person or transport sector, determine: (SDC 2004): entry point. r How HIV is spread in the Pushing HIVIAIDS into Work within existing sector programs where it is not institutional structures- How the epidemic is likely relevant consistent with the Three to affect their sector's Changing core functions Ones. " goals, objectives and and responsibilities to turn Focus on advocacy, programs all sector activities into continuous education and Where their sector has a HIVIAIDS programs capacity building. comparative advantage to Simply introducing Mainstreaming cannot be respond to and limit the HIVIAIDS awareness expected to develop on its spread of HIV and raising in all our activities own. mitigate the impact of the All of us having to Focus on the domestic epidemic. become AIDS specialists domain as well as the Business as usual external domain. Identify strategic partnerships. Maintain exceptional action to ensure that HIV and AIDS responses remain relevant and effective as the epidemic evolves. b a. The Three Ones principles launched in Washington on April 25,2004, by UNAIDS are: One agreed HIVIAIDS action framework that provides the basis for coordinating the work of all partners One national AIDS coordinating authority. with a broad-based multisector mandate One agreed AIDS country-level monitoring-and-evaluation system b. bid. 16. When mainstreaming HIVIAIDS prevention activities in a project, the organization involved is likely to refocus its work, infusing HIVIATDS into every part of its management cycle. It will clarify how HIV affects its work, develop and implement policies that protect staff from infection, and support those who are living with HIV. In its planning, for example, the organization prioritizes HIVIAIDS interventions, taking into account likely disruption from an increase in morbidity and mortality. It will ensure that those infected and affected are taken care of, and at the sectoral level, it will contribute toward ensuring that "sector activities do not increase the vulnerability of the community it serves, or undermine their options for coping with the effects of the pandemic" (Elsey, Tolhurst, and Theobald 2005). SECTION 11. HIVIAIDS AND THE TRANSPORT SECTOR WITHIN THE WORLD BANK 17. The transport sector in the World Bank is one of the sectors contributing to a multi- sectoral approach to respond to HIVIAIDS. The transport sector has been a pioneering non-health-sector unit in the area of HIVIAIDS, having been one of the first such units to attempt to include HIVIAIDS into its core operations. 18. In the Africa Region, the Transport Unit (AFTTR) is implementing key initiatives aimed at strengthening the multi-sectoral response. The HIVIAIDS interventions supported by AFTTR aim to (a) prevent HIV transmission to transport sector personnel, clients, and communities; (b) provide care and support for those transport personnel and their family members already infected with HIV; and (c) mitigate the adverse social and economic impact of HIVIATDS in the transport sector (World Bank 2003). AFTTR addresses these objectives by: (a) tapping, for the transport sector, into the funding provided by the World Bank Multi-Country HIVIAIDS Program for Africa (MAP) and the Global Fund for HIVIAIDS, TB, and Malaria (GFATM); (b) working with Transport Ministries in client countries to retrofit transport sector projects to include HIVIAIDS interventions; (c) introducing HIVIAIDS clauses into project construction contracts; (d) working to put in place a transport and HIVIAIDS program with clear institutional responsibility and dedicated human and financial resources; and (e) initiating HIVIAIDS transport corridor projects that focus on transport workers and communities. 19. The South Asia Region has a multi-sectoral team assigned to work on transport and HIVIAIDS issues, including the full-tin~esupport of a coordinator and a designated Human Development counterpart. All new projects are screened for possible HIVIAIDS input and Task Team Leaders (TTLs) are involved in discussions on how best to address HIVIAIDS in their pro-jects. The positive experience in the region has been opportunistic and demand-driven, focusing first on contractors and their staff, and designed to complement other program interventions, often based on established needs and prevalence rates.3 20. The East Asia and Pacific Region adopted a regional strategy in 2004 of including HIVIAIDS education activities in all projects with major civil works components, in accordance with the requirements of the Bank's standard bidding documents (World Bank 2007). The focus of the strategy is on construction workers, commercial sex workers, and local residents affected by the projects. This strategy has been partially implemented, most successfully in Cambodia and China. With funding from the Global Minutes of the Transport World AIDS events, Nov. 28-29,2005, Washington, DC. 6 HIV Program, a toolkit for HIVIAIDS education was developed and will be pilot-tested starting in fiscal year (FY) 2009 in Cambodia, China, Indonesia, and Vietnam. 21. In the Latin America and Caribbean Region, recent strides have been made toward defining a program of selective interventions in the transport sector to combat the spread of HIVIAIDS. A strategy document was prepared in 2007, which called for a specific focus in three areas: road construction sites, road transport corridors, and city-port locations (these being generally perceived as the areas of highest risk). The regional portfolio and pipeline will be assessed to identify the countries and projects that should be prioritized for attention, in line with the strategy, initial efforts are now under way in Haiti (road corridors) and Honduras (road construction sites). In addition, support is being lent to a promising initiative in Argentina with the trucking industry (corporate social responsibility) to roll out, by priority road corridors, a program of HIV/AIDS prevention with vulnerable groups. 22. Launched in 2000, MAP is one of the major sources of financial support for the multi-sector response against HIV/AIDS in Africa region. MAP support is available to all countries eligible for International Development Association (IDA) and International Bank for Reconstruction and Development (IBRD) funding (Oornrnan 2006). Some key prerequisites for MAP funding are: the evidence of a strategic approach to HIVIAIDS, existence of a coordinating body with multi-sectoral representation, government willingness to use multiple implementation agencies (including NGOs and community- based organizations [CBOs]), and a willingness to channel funds to civil society and private sectors (Oomman 2006). 23. AFTTR started incorporating HIVIAIDS activities into its projects in 2000. This assessment was initiated to review its HIVIAIDS activities and the process, results, and challenges of mainstreaming HIVIAIDS prevention activities in the transport sector. The Era of HIVIAIDS Treatment 24. Following the introduction of new HIVIAIDS funding mechanisms into the HIVIAIDS program in Africa--especially through MAP; the U.S. President's Emergency Plan for AIDS Relief (PEPFAR); the Global Fund for HIVIAIDS, TB, and Malaria (GFATM); and private foundations-treatment. including the provision of antiretrovirals (ARVs), has become more accessible to low-income countries. In 2002, the World Bank Board approved MAP2 to extend support to scale up treatment programs as well. This development has provided the opportunity to the transport sector in client countries to refer project beneficiaries to the health sector for antiretroviral therapy (ART) services. Only Burkina Faso has used transport sector credit funds to directly procure and provide ARVs to project beneficiaries. This was a more challenging experience than referring transport sector staff to the health sector. 25. AFTTR has three priority objectives for HIVIAIDS prevention and care: (a) prevent transmission of HIV to transport sector workers and clients in the communities where the transport sector does business, (b) provide care and support for those transport personnel and their families that are already infected with HIV, and (c) mitigate the adverse social and economic impact of HIVIAIDS on the sector (World Bank 2003). In Sub-Saharan Africa, investments in HIVIAIDS in the transport sector have been most prominent in the roads subsector. AFTTR has supported a variety of projects in the roads subsector, including the Abidjan-Lagos Transport Corridor Project; the Road Sector Development Project in Ethiopia; the Zambia public-private partnership; and road construction projects in Burkina Faso, Cape Verde, the Democratic Republic of Congo, Kenya, Malawi, Mozambique, Niger, Nigeria, Senegal, Tanzania, and Uganda. The HIVIAIDSProject for the Abidjan-LagosTransport Corridor 26. This project, within the AFTTR portfolio, has so far been the only stand-alone transport sector HIVIAIDS project, designed with the ultimate objective of addressing transport sector HIVIAIDS prevention needs. The Cape Verde HIVIAIDS Project, which was also managed by AFTTR (it has since been transferred to Human Development), was also a stand-alone HIVIAIDS project, designed like most of the MAP projects in the region, with a multisectoral approach. 27. The HIVIAIDS Project for the Abidjan-Lagos Transport Corridor is a regional project, being implemented along the road transport corridor covering five countries in West Africa (Benin, C6te d'lvoire, Ghana, Nigeria, and Togo). Interventions in this project involved both transport sector-specific interventions and HIVIAIDS-specific interventions. Among the transport sector interventions were interventions to reduce the time spent by truck drivers at border crossings; provision of information to truck drivers to accelerate the clearance of border control procedures: and education of customs, immigration, and police authorities on the need to accelerate the flow of traffic across the borders. HIVIAIDS-specific interventions included provision of condoms at border- crossing points; upgrade of health facilities along the border-crossing points to provide HWAIDS-specific services; and provision of HIVIAIDS information and training to truck drivers, border control officials, and commercial sex workers along the corridor. Resident populations along the corridor were also beneficiaries of the project. The project also involved institutional interventions that included formation of border HIVIAIDS committees and the formation of a corridor-wide coordination body, with a secretariat based in Cotonou (Benin). It is also important to note that both Togo and C8te d'Ivoire were in non-accrual status and the latter was also in conflict. Regardless of the above situation, the project succeeded in bringing these countries together and addressing HIVIAIDS as a global public benefit in the most important trade route in West Africa (over 65 percent of trade takes place on this route). Supportfrom Other DevelopmentPartners 28. Several development partners working in transport projects in Africa-especially bilateral donors through such institutions as the United States Agency for International Development (USAID), the U.K. Department for International Development (Dm), the Canadian International Development Agency (CIDA), and the Swedish International Development Cooperation Agency (SJDA)-target high-risk groups like truck drivers and sex workers in their HIV-prevention interventions. Donor support has often been channeled directly to the private sector, especially nongovernmental organizations, whose capacities were built on experience gained working with the truck drivers and sex workers. While capacities grew in the private sector, the public sector, including the Ministries of Transport, lagged behind in response. Unfortunately, many Transport Ministries had no sustained support from their respective National A D S Commissions (NAC). Development partners often left out some critical areas including: (a) engagement of communities in border areas and trucking routes and (b) integration of donor-led HIVIAIDS prevention activities within national transport sector programs. SECTION 111.ASSESSMENT OF THE PROJECTS IN THE AFTTR PORTFOLIO FOR HIVIAIDS MAINSTREAMING 29. An assessment was carried out of the experience of the Africa transport sector in mainstreaming HIVIAIDS into transport sector projects. The assessment had three principal objectives: (a) to document the HIVIAIDS mainstreaming experience in the transport sector, (b) to use this experience to develop a learning tool for future projects, and (c) to determine the linkages between the transport projects and the national HIVIAIDS strategy of each client country. Methodology 30. The methodology for the assessment included a blend of instruments for collecting information, including a questionnaire, desk review of various project reports, and interviews of Task Team Leaders. The desk review included a wide range of documents that varied in length and areas covered. They included activity reports (appendix G), project review reports, quarterly project implementation reports, Powerpoint presentations, and briefing notes. In all, 54 documents were reviewed. 31. Feedback from HIV1AIIL)S focal persons in the transport sector of selected client countries using a key informant interview questionnaire (Key Informant Interview Questionnaire [KIIQ] in appendix E) was also obtained. The KIIQ was sent to 22 focal persons and had a response rate of 59 percent (13 respondents; see appendix F). Questions were asked in the following thematic areas: Mainstreaming HIVIAIDS prevention Care, support, and treatment Coordination and capacity building Management Monitoring and evaluation Quality assurance of data Sustainability The questionnaire was designed and used to gain an insight into the HIVIAIDS response by the transport sector, rather than generate quantitative data. Follow-up interviews were conducted and e-mails sent to seek clarification, obtain more information, or strengthen existing information. Limitations 32. The relative quality of content of the information collected through these various sources of information varied. Initially, most of the projects were designed as transport sector projects, and HIVIAIDS was not originally the focus of the projects. Furthermore, HIVIAIDS was not considered as a development issue. Many of the key informants who responded to the questionnaire did not provide answers to some of the questiuns. This limited the possibility of undertaking comparative analysis or determining mnds. Financial information regarding disbursements on HIV/AIDS interventions was not easily identifiable because HIVIADS interventions are disbund under the broad "social" component, which includa mare than just HIV/AIDS interventions. On monitoring and evaluation, baseline data on HNIAIDS intewentians were not collected in many of theprojects, which limited the potential to measuremults of bHIV/AIDS interventions. Notwithstanding the abovbmentionedlimitations, the assessment provides broad insights into the experience of the emsport sector in, mainstreaming HNlAIDS into its operations. 33. The infomation obtained through the different sources idmtified above was analyzed and collated to address the key questions that the ESW sought to answer:(a) to documentthe HIV/AIDS mainstreaming experiencein the transport sector,(b) to usethis experienceta develop a l m h g tool for futureprojects, and (c) to determine the W g e s txtween the transportprojects and the national HIV/AlDS strategyof each client country. (A summary of these findings and some of AF'TTR' s accomplishments are highlightedin the followingBoxes 1-5). Ekprienceofthe transportsector,inrnahhedagHIVIAIDS 24. HIVIAIDS mainstreaming in the transport sector can be consideredachieved once the mspott sector has fully taken on HIVIAIDS interventions as part of its Bwr 1 Uganda: A m n w Campaign at overdl transport sector interventions. It is Road ConstructionSite this concept that was used, as far as The Phach-Olwiyo road construction project was fundedby the World B d through possible, to identify tho= pmjects in the the Road Agaacy F d o n Unit (ICAFU). AFITR portfolio that are considered This road construction project passes through mainstreamed.Tbislist of projectsincludes cornmities referred to as "Project-Affected projects that had m a r k e d resources fopulations (F'APS)." These includc seven (financial and human) and were addressing Internally Displaced People's Camps (IDPCs). the specific HIV/AIDS needs of the During awareness cmpaigns, thc facilitators transport sector. Out of the 38 projects emphasize the power of knowledge in under supervision in the AFMR portfolio, HIV/AIDS prevention. When one acquires as of February 2007, 22 projects had adequate knowldge about HWIAIDS, he or ea~&ed resources, were adbssing the she will know the right actionsto take toavoid specific W / A D S needs of the transport HIVIAIDS, The facilitators explain the benefits of getting tested and encourage all smr, and were consideredrnainstreamed. pmidpautsthat have nottaken an HIV test to This amounts to 58 percent of the projects seek VCT services. Knowing one's status in the A . supervision portfolio as of early enough is very important beawe one February 2007;however, the^ is stillroom can get early HIVIAIDS treatment (which for improvementin theremaining projects. means longer life) if one is found to be This also appliis to the new projects that infected. are being prepared. A review of the four new AFITR projects that were approved by the Board during the first half of FY 2008 shows that two of them were HIVIAIDS-mainstrezuned by design, while the other two were not, Because mainstreamhg has not yet been institutionalid at the Bank operations level, no budget line for it appears in the project allocation.(See appendix H1, which lists all the projectsinthe portfolioandtheir mi11streamiagstatus. With more than half of the projects in the portfolio having been mainstred, it is evident that there has been significant progress in the mainstreaming process; however, Figures lb and lc give the mainstreaming s t a s by project type and by subsector, and they sum up the table in Appendix HI). 35, The Bank-financed projects had HNIAiDS focal persons in the MOT, and the projects estimated to cost at least US$lO million had EITVIAI1DS-prevention contract clauses. HIVIAIDS interve~tionswere being implemented for both in'krnd clients (transport sector employees) and externalclients (outreach clients in the areas of project operation).The cost of specificintewentionsby the civii works contractorsis includedin the overallcontract price; hence, did financeHNIAIDS initiatives Erom its own IDA allocations. Unfortunately, the information cannot be easily tracked in the Bank system because it is embedded in the Civil Works component. A "laming by doing" approach is being utilized by most of the projects to address unforatm challeng~as theirrespectiveexperience with HW/AIDS increases, Figure la, Znustration of the Mainstreaming Achieved in AIFTTR's Supervision Portfolio r - -- - - ! 40% l LEN AFHR C AFITR SPNnot yet malnPrrrwmcd -- - - - - #MI1HSpNrna~nstrcarnd 36, Figwe la illustrates the proportion of projects under supervision in the AFITR portfolio that wem HXVlAIDS mainstreamed as of February 2007. It shows that the majority of projects (22 out of 38, amounting to 58 percent of projects) had been mainstrearned. The chart indicates significant progress in rnainsmming majority of the projects in the AFITR portfolio. The 2008 fiscal year shows a lesser number of mainstreamed projects because some of the mainstreamed projects have been completed and therefore cannotbe counted, Figme lb. Mah&amhg Status of Projects h the AFlTR Portfob by Project TvDe 37. Pip= lb is self-explanatory in the sense that emergency projects (for example) were not mainsbeamed at first, but new ones were. Corridor projects reflect a large percentage of mainsirearning, but there were no new projects for thie sector, As for regular transport projects, they illustrate an important percentage of mainstreamed proj-, followed by a large number of non-mainstreand ones as well. Only one new project was &streamed (out of three), Rmd Rall Subsector AIr Subseetor Port SubreEtor subrector ; 38. Rgure lc illustrm the dichotomy between the road and rail sub-secton and the other sub-sectors (air and port). With three projects in the latter two sub-satmi, none was mainstreamed, which explains the zero percentages on the figure. The road sub- sector shows an important percentage of mainstreamed projects which is much mare labor-intensivecompared with other sub-sectors,The rail subsector shews an important percentage of non-mainstreamed projects, although the mainstreamedpercentagehere is not negligible and operators (especially private concessionaires)are carrying prevention activitieswithout IDA support. HIV/AIDS-Related Interventionsin theMahstremedFkjects 39. Appendix H2 shows the nature of HN/AIDS interventions that wwere carriedout in the mainstreamed projects. The top four interventions that were more widely being implemented acrossprojects were (a) appointment of an NLV/AIDS focalpoint; (b) hiring of a consultant or NGO for technical implementation of HIV/AIDS activities; (c) information,education, and communication/behaviorchange communication (JEC/BCC) inteweations; and (d) condom distribution and promotion. The least implemented interventions were related to HlV/AIDS worlcplace policy development1implementation. The issue of HIVlAIDS workplace policy development is a criticaI intervention in secloral HTVIAIDS programs and therefore needs to be more aglpessively addressed in transport sector projects, The development and implementation of such policies requires high commitment by the leadership of the transport sector. Pocd points of the government transport sector ministries need the support of the top management of these ministries in ensuring that resources are allocated for this very important HlVlADS intervention. Comparison of mainstreamed and non-mainstreamedprojects 40. To identify any differences between the mainstreamed and non-mainstreamed projects, a comparison was made of the two types of projects (as shown in appendix HI). Both mainstreamed and Box 2: Ethiopia - ERA Commitment non-mainstreamed projects included a The GTZ (contracted international NGO) together with combination of older and younger the ERA introduced one condom dispenser at the ERA headquasters in Addis Ababa and some offices of the projects. The size of the Rank credit ERA districts in the regions. A comprehensive did not influence the status of a project HIV/AIDS prevention and control strategy, including being mainstreamed because both policy, IEC, condom distribution at workplaces, VCT and small- and large-sized projects were treatment, was developed and successfully implemented represented among the mainstreamed by ERA at the headquarters in Addis Ababa. As a result, and non-mainstreamed projects. The the program received wide recognition in the country and regional location in the African was later adopted by the Ethiopian Parliament as its continent also did not appear to have workplace strategy. Strong commitment to HIVIAIDS by an effect because projects in West the management of ERA played a significant role in the Africa and those in East and Southern mainstreaming. Africa were well represented in the mainstreamed and non-mainstreamed projects. Overall country HIV Box 3. TanzanidZambia: Building a Public-Private prevalence did not account for the Partnership differences in the mainstreamed and Partnership and coordination are perhaps the strongest points of the Zambia program. Through the Ministry of non-mainstreamed projects because Transport and Communication, the World Bank's projects in relatively low-HIV- assistance to the sector has helped to build a strong public- prevalence countries (like Cape Verde, private partnership that is driving the response in the sector. Madagascar, and Senegal) were The Tanzania-Zambia Railway (TAZARA), the National mainstreamed as were those in Drivers Association of Zambia (NDAZ), the Truck Drivers relatively high-prevalence countries Association of Zambia (TDAZ), the National Council for (like Lesotho, Malawi, and Zambia). A Constsuction, the Road Development Agency, and Zambia possible factor that may account for Railways are institutions partnering in the response to whether a project is likely to be HIV/AIDS in the road subsector in Zambia. Workplace mainstreamed may lie with the project policies have been developed, and peer educators have preparation and supervision team. In been trained in all the institutions to facilitate HIV risk- reduction education and promote referral to treatment and particular, the team's perception of the care services, including VCT services. The partners use relative significance of HIVIAIDS their comparative advantage to intensify local campaigns mainstrearning in the transport sector against HIVIAIDS. For example, the NDAZ conducts project may influence the likelihood sensitization sessions in bus stops, reaching their members that HIVIAIDS is mainstreamed in the and passengers. TAZARA on its part distributed condoms project. and conducted outreach to the workers and communities around the rail line, while TDAZ reached out to the truck 41. The level of maturity in drivers. As the Zambia initiative matured, the government mainstreaming differed from country of Zambia, the Global Fund, and the HIPC Program have to country. While a country like Kenya provided additional funds. Quarterly reports submitted by is at an early stage of the HIVIAIDS the HIVIAIDS Coordinator specify activities supported by each funding agency. mainstreaming exercise, Ethiopia- through the Ethiopia Roads Authority (ERA)-is at an advanced stage, having succeeded in getting management and staff to own the process (Box 2). ERA has a management that is co~nnlittedto HIVIAIDS at the central level and in the regions. All staff (professional and support) are given training on HIVIAIDS, and condoms are made available to the staff at both the ERA offices and construction sites. HIVIAIDS clauses are included in contracis with the contractors, who can either provide the services themselves or subcontract the HIVIAIDS activities to third parties (NGOShave been the most successful subcontractors). 42. ERA developed its HIVIAIDS workplace policy, which served as a road map for Kenya, Lesotho, Malawi, Uganda, and Zambia. Malawi and Zambia are now implementing their workplace policies. ERA'S employees went further in their commitment and volunteered to create-in addition to management's response-a collective HIVIAIDS account to which each staff member provides one percent of his or her monthly salary for a duration of two years for assistance to affected and infected workers. Linkage with the National StrategicFramework 43. All responses received from the Ministries of Transport indicated that the project HIVIAIDS activities were in line with the expectations in the National HIVIAIDS Box 4. ZambiaMalawi: Promotinga Strategic Framework. Some of the ministries, Workplace Policy particularly those in English-speaking countries, The World Bank financed a workshop have developed sector-level HIVIAIDS policies for participants from five countries to and strategies that draw from and complement prepare the HIVIAIDS prevention the National Strategic Framework. The sector policies for their respective workplaces. Although the road policies further clarify the priorities in the subsector is the predominant mode of transport sector. These sector HIVIALDS transport Eor the majority of Africans, policies and strategies offer opportunity for a the other subsectors should not be long-term sector response to HIVIAIDS. More neglected. The road subsector, specifically, higher and consistent priority needs however, took the lead in getting the to be given to the development of workplace other transport subsectors (railways, policies in the mainstreaming process. The marine, and air) on board the French-speaking countries will now learn from HIVIAIDS prevention effort. Today, this experience and launch their workplace Zambia and Malawi are implementing policy program. However, apart from the legal their policies and have mainstreamed framework, the condition of service, the HIVIAIDS prevention activities into their Human Resource Management grievance procedures, and a good workplace Departments. policy program should reflect the following: specific objectives of the HIVIAIDS policy; awareness raising; promotion of VCT services in the workplaces; stigma and discrimination and the strategies; confidentiality and the strategies; care and support for infected workers; and monitoring and evaluation. Contributing to the National Uptake of HIV Voluntary Cornling and Testing (VCT) 44. In some countries, the transport sector has been an effective partner in increasing the uptake of VCT. For example, in Zambia, 43 percent of members of the population targeted by the bansport sector took the HTV test in 2005. This was above the national uptake for VCT of 37percent (Appendix G).Increased knowledge of their HXV status is a major step in empowering project beneficiariesto furtherprevent HIV infection or moll in treatment. Monitodng and Evaluation (Maswing Results) and Uther Implementation Challenges 45. A number of challenges were identified during the assessment (see Appendix A for summary), Most of these -5. RqionalHIVIAIDS challenges to mainstreaming stem from the limited capacity to RojdfortheAbum-Lagm collect and disseminate HIVIAIDS-related information, Tramport Corridor particularly monitoring-andevaluation information. For Thisproject was designed example, such challenges in collecting and dissemination of specificallytoaddresstransport sector W/AIDS prevention HIVjAIDS-related information b e been idenad in Ethiopia, Senegal, and Zambia. Lack of baseline information was a needs alongthe road corridor covering five cowtries (Benin, common challenge. In some of the client countries (such as Coted'Ivoire, Ghana, Nigeria, Ethiopiaand Zambia) wherebaselint studieswere commissioned andTogo).Transportwtor at some point, delays in the completion of assessment reports by interventionsinclude consultants denied the projects the benefit of allowing the interventionstoreduce the time fmdings to guide implementation. In cases in which the reports spent by muck driversand h v e d , they did so after the first phase of the project had been passengers atborder-crossing completed. points. Targetpopulations include truckdrivers,customs, 46. Because W A D S interventions were introduced into police,and transpoa and immigrationofficials atthe many of these transport projects after the whole project had been borde~mssingpoints. designed,the project monitoring-and-evaluation framework did Passengers,commercial,sex not initially include HIVIAIDhpecific monitoring-and- workers, and residents dong the evaluation indicators. The project development objectives did transportconidor are also not aZso include specific HIV/AlDS objectives. Reporting on targeted. HIV/AIDS-spcik HIVIAIDS interventions was therefore not dways consistent in inmentions forthe target most of the projects. Also, no linkage was made to the National group include provision of HIVIAIDS Monitoring-and-EvaIuation Framework, and many condoms,HIV/AIDS focal points were not aware of the existence of such a information,upgradmgof border framework. Moreover, =sources were not allocated to support HIVIAIDS healthfacilities,and the need for developing system for monitoring and evaluation formation of borderHIVIAIDS c o m m i ~onboth sidesof s of the transport sector HIV/AIDS response. Measuring the Wrs, results of theHIVlADS interventions without a monitoring-and- evaluation framework that is designed to address these interventionsis therefore a challengeforthese projects. Sourcesof ResourcesUsed inMainstreaming 47. Client countriesusedthe bansport project credits, MAP funds,or combined both to retrofit and mainstream In the absence of MAP funds, some countries have had to rely on funding support from other donors such as the Global Fund for AIDS, TB,and Malaria (GFCAM) andlorleveraged funds fromthe private sectorto support the work (as indicated in figure 2). Flgure 2, Sourcesof FundingforE3[IV/Arr)ShMTTR Portfolio 48, As shown in Figure 2, projects in the AFITR portfolio used different sources of funds to finance HIVIAIDS intewentions within the transport sector with majority of projects in the portfolio using moms from their own transport projects to finance HlVlAIDS intenentiom. The second group of projects in the AFTTR portfolio tapped into the MAP projects while others used a combination of financing, but invariably transport sector resources were used in the various combinations of Fxnancing, This indicates that within the A m portfolio, the transport sector and MAP were the more likely sources of financing for HIVlAIDS interventions. What Dms It CosttoMainstreamHIV/AIDS into TransportM o xProjects? 49, On review of the projects in the AFTIR portfolio, it was evident that it was not always possible to quantify the actual financial resources that were utilized for W/AEDS mainstreaming of each of the projects, Records of mources utilized for KIVIAIDS mainstreaming indicate that WIAIDS-specific fmmcial resources were lumped with financial resources that addressed all "social"interventions in the projects. The relative proportion of the HlVlAlDS component of the social expenditures in many projects could not be separated from the overall expenditures for socia1 interveations. Attempting to estimate the WIAIDS-specific resources, without representative empirical data to indicate the relative proporlions ofthe HIVIAIDS element of the social expenditures, would not give a redistic estimate of the resources utiIizd for HIVIAIDS main~treaming,particularly beawethe pattern of expendituresacross projects may not be similar. EIV/AIDS Financing,Basedon ReportingProvidedby TaskTeamM r s 50. An attempt was made to estimate the project resourcm allocated for HIVIAIDS in three projects whose data were available (Table 2). Data were obtained from document review and interviews with Task Team hadem. Allocation of project resources for HIV/ADS ranged from 0.1 pemnt of the total commitment amount in Malawi to 2.9 percent in Lesotho, Both Lesotho and Malawi are in the high-HIV-prevalence region of the continent. Based oa this, it would appear that relative allocations for HIWADS interventions in these tramport projects are not related to the country's HIV-prevalence rates, Table2. ProjectRwwrcesAIlocated forHIVIAIDS inThreeProjects 1 IDA commitment HIVIAIDS I I percentage of1 amolmts allocation project resouras Transportproject (US$millions) (us$) allmted for ~ f A I l ) c S Lesotho Integrated - 23.5 675,000 2.87 Transport Malawi Infhstruchlre 40.0 45,000 0.11 Services SenegalTransportSIL2 90,O 684,000 0.76 TramportSector and Other Non-HealthSectorHIVIAIDS All0~8ti0n~ 51. Using the Bank's internal databast, an attempt was made to compm HTVfAIDS thematic alImtimsfor the transport sector with other non-health sectors(Figure 3)- As an illustriltive example, the education sector had the MOB^ identified projects with HIV/AIDS codes (12 projects), and the Wan developmentsectorhad the least identified projects (only one project). The a g r i c u l w d development sector had the highest average HIVIAIDS comtnitmeat per project at US$20.0 million, while the education sectorhad the lowest averageHIV/AIDS commitment per project at US$7.8 million, and the transport =tor had an average allocation of US$ll,6 million according ta the methodologyusedfor calculating the allocationof projectcost by theme. 52. The process of assigning a particular sectoral or thematic code to a project is relatively subjective; hen=, the number of projects assigning codes for HIVlAIDS is likely to be a poor indicatorof the number of projects with an HIVIAIDS component or set of activities. The propdim of tramport projsct cost directly allocatedto HIVIAIDS is usually quite small. Resources are allocated to components and specific activities within the components. An d t h m such as HIWADS may cut across several components. For example, the mast significant spending on HIVIAIDS will often be included in the cost of constructionof a transport projec~Thus,there will not be a direct relationship between the assigned codes and the mources allocated to any given themelarea. 53, Given that the transport sector is hampered by gross under reporting of the number of projects with HIVIAIDS activities according to the thematic coding system, this data may not necessarilybe representativeof the overallHIVIAIDS allocations in the respective sectors. However, at the very least, they are an indication of the degree to which the various non-health saturs, in tmns of allocations for W/AIDS, have mainstreadHIV/AIDS interventions. Figure3. Active Non-HealthSectorProgects with IETY/AIDS Cdes Assigned during RojectPreparation Actlve HlVlAlDSThematic Allocationsby Sector Board 100 '4 8 DO 80 i 10 l2 1: l! a 8: : 20 f' 10 P * 0 0 Agriculane/rurtrr Ttanspol E h t l o dmlopn)ent n rnTotalnetcommitments Aw. rieleommlt, =t actlvepmlects codedto HIVIAID9 coded to HlWAIDS coded to HlVlAlDS Sou## WaM Bulk BurinmsWarehouse,January27, W. SECTIONIV. LESSONS LEARNED, RECOMMENDATIONS AND CONCLUSIONS LessonsLearned 54. HIV/AIDS ShouldBe an Integral Element in the TransportAgenda: Because of the role that transport plays in a country's development, it is paramount to preserve the health of the labor force working in, and the communities interacting with, the sector. Transport by its very essence of helping to facilitate the mobility of goods and services should not be a vector for the transmission of HIVIAIDS. Therefore, HIVIAIDS should be on the agenda at the early stages of project design. This is absolutely necessary to avoid loss of development gains by protecting the labor force and mobile population, as well as preventing the spread of the epidemic through sector initiatives. 55. HIVIAIDS Workplace Policies Is an Important Tool to Implement Prevention Activities: The urgency and magnitude of the HIVIAIDS epidemic call for significant, appropriate, and intensive responses. To help reduce the spread of the disease and its negative consequences, the transport sector has to develop multilevel interventions enforcing prevention, care, and mitigation of social and economic effects (Box 2 and Box 4). 56. Monitoring and Evaluation(M & E) of HIVIAIDS ShouldBe Part of Projects in the Transport Sector (Measurement of Results): Building an M & E system prevents deviation from the main objective. Monitoring gives information on where the project is at any given time, and evaluation gives evidence of why a goal has not been met. However, there is no standardized way of doing so. The real challenge comes from the fact that it takes commitment, time, and resources. Conversely, failure to implement the M & E system leads to the possibility of jeopardizing good results. 57. M & E was a significant challenge to many of the countries that were mainstreaming HIVIALDS because it was perceived as a judging tool instead of a learning tool. Measuring results as part of a monitoring-and-evaluation framework becomes a challenge because the sector has to decide what to measure and how to measure it to determine the results of the HIVIAIDS interventions. It is a challenge even for the health sector-managed projects, which have been working on HIV/AIDS interventions for much longer than the transport sector. It is understandable that the transport sector is grappling with the concepts of what should be done in this relatively new domain for the sector. A starting point is the determination of which HIVIAIDS development objectives thc project intends to achieve. Based on clear and realistic HIVIAIDS development objectives, the type of measurement and the frequency of the measurement of the indicators can be determined. 58. It is important that the monitoring-and-evaluation framework, with all the indicators, baselines, and targets, are prepared at the preparation phase of the project, before the interventions are implemented. Appendix D of this document provides some illustrative indicators that can be adapted to suit the specific project's monitoring-and- evaluation framework. A matter of importance, based on the projects assessed, is the need to allocate financial resources as early as possible to ensure that baselines can be collected to help measure results. The unavailability of allocated financial resources for these key monitoring-and-evaluation interventions in the assessed projects greatly hampered the ability of the projects to measure results of the interventions. Appendix I provides an illustrative chart of how monitoring-and-evaluation information can flow from the communities to the higher levels of project management. 59. Evidence on Impact and Effect of HIVIAIDS on Sector Is a Necessity Going Forward: Without evidence, it is very difficult for a country to evaluate the HIVIAIDS needs within the transport sector. In Ethiopia, Senegal, Tanzania, Uganda, and Zambia, where baseline studies or situation assessments were done, HIV awareness was extremely high (above 80 percent). This suggests that, in such countries, projects should focus more on behavior change instead of committing huge resources to awareness creation. Emphasis on behavior change would be the next step in such environments. 60. Transport Should Use HIVIAIDS Care and Support Facilities outside the Sector to Accelerate Programs: Among the mainstreamed projects that provided information on the type of services, one of the transport sector ministries (in Burkina Faso) actually attempted to set up facilities to provide antiretroviral treatment within the transport sector. The capacity-building requirements for this intervention were huge, and big delays were experienced in this attempt. In other countries, however, the projects preferred to link with the nearby health care facilities and piggyback on their services for antiretroviral treatment. This second approach was more effective and took a shorter time to actually start functioning. Hence, where capacity exists outside of the transport sector, particularly in a specialized area of HIV/ADS care, it may be preferable to link up with the non-transport sector agency to provide the needed service. Building and strengthening collaboration with other stakeholders (for example, in care and treatment) can have benefits for the transport sector. 61. Specific Management Structures within the Transport Sector Need to Be Developed to Combat HIVIAIDS: In many of the projects, the use of existing sector management structures to manage HJVIAIDS, as opposed to creating new ones, was found to be beneficial because the top management already recognized such structures. Focal points implementing the HIVIAIDS program with a team of workers also avoided the situation in which one person is overburdened by the management of the HIVIAIDS program. The sharing of responsibility within the team also ensured dissemination of institutional memory among team members. The first lesson here is that the use of existing transport sector structures facilitate mainstreaming of HIVIAIDS in the sector. The second lesson is that focal persons working in teams ensure better team ownership and continuity, compared with focal persons working alone. 62. Country-Level Ownership Is a Good Indicator of Likely Success: In those projects where ownership of the HIVIAIDS mainstreaming was high at the top levels of management (for example, Ethiopia transport projects), the process of mainstrearning was relatively smooth and with a diverse number of HIVIAIDS interventions implemented (appendix H2). This strengthens the argument for strong management commitment in the transport sector, at country level, to ensure that HIVIAIDS mainstreaming becomes a reality. Implementation Challenges 63. The projects had a number of implementation challenges, many of which are summarized in Appendix A. The lack of baseline data and inadequate support by management to focal points were the two most critical challenges. The need to have top management committed to HIVIAIDS mainstreaming cannot be overemphasized. The collection of baseline data is critical in the measurement of results of the HIVIAIDS interventions in the transport sector. 64. CapacityBuilding Is an Important Ingredient for Successful Implementation of a Project in the Sector: At the level of the Bank, the project preparation teams need to be able to depend on capacity in the teams, during project preparation and project implementation, to design and supervise HIVIAIDS interventions. Many of the project teams that were able to address HIVIAIDS at the design and implementation stages were able to do so because of the knowledge of HIVIAIDS that they were able to bring into the project. Decisions need to be made by a team with a strong HIVIAIDS focus on what interventions need to be included in the project activities, as well as which HIVIAIDS indicators are to be included in the monitoring-and-evaluation framework. Finally, additional resources and HIVIAIDS networks need to be considered as part of a multidisciplinary project preparation and project supervision team. 65. At the country level, a number of stakeholders were identified as likely to benefitfrom capacity building: Capacity building among transport sector workers in being able to talk freely about HIVIAIDS Ongoing capacity building among new focal points and the team members who work with these focal points to ensure that they are comfortable talking to transport sector workers about HIVIAIDS Capacity building in monitoring and evaluation of HIVIAIDS interventions is another critical domain that needs to be strengthened because it was one of the weakest in the mainstreaming process. RecommendationsforAction 66. HIVIAIDS in the Transport Sector: The findings of this document indicate that many of the projects in AFTTR are mainstreamed; however, a significant portion of projects still needs to be mainstreamed. Indications from the four AFTTR projects that were approved by the Board during the first half of FY 2008 show that not all of them have designs with HIVIAIDS mainstrearning in mind. There is still work to be done by AFTTR in the mainstreaming of HIVIAIDS in the projects in its portfolio. The management of the Task Teams and the overall management of AFTTR need to keep focus on those projects that are not yet mainstreamed and identify mechanisms to motivate the teams to mainstream these projects. One example of incentive measures would be to use the incentive funds to conduct an analytical study on HIVIAIDS activities during project preparation phase. Appendix C presents a sample of some key questions that can be used during mainstreaming HIVIAIDS into the transport sector. Appendix B provides additional information on elements in slart-up, service delivery, and management of HIVIAIDS, as demonstrated in the transport sector in the Africa region. Recommendationsto Task Teams 67. Tailor the HIVIAIDS Interventions to Local Needs (High-/Low-Prevalence Settings):As the Africa region and the world as a whole are getting more experienced in addressing HIVIAIDS, it is increasingly becoming evident that HIVIAIDS interventions need to be tailored, as much as possible, to address the particular local epidemic. No approach fits "all" local epidemics. HIVIAIDS epidemics vary from country to country or even within the same country. Project teams need to determine the "drivers" of the respective local epidemics and tailor the HIVIAIDS interventions to address them. The specific nature of the transport project also needs to be considered, so that the HIVIAIDS interventions are adequately tailored to respond to the risks associated with the project. However, in high-prevalence countries (and in particular, in those with population prevalence of 5 percent or higher), tailoring the interventions should be carried out with care to avoid creating disincentives to act and undermining previous HIVIAIDS mobilization efforts. To ensure coherence in the design of the project and an efficient implementation, a particular effort is asked of the Task Team Leader to be in touch with the HIVIAIDS focal point for his or her respective country (for instance, by assuring that the recording of HIVIAIDS prevention activities are included in the project quarterly report). 68. Keep Focus on HIVIAIDS: Task Teams need to pay attention to HIVIAIDS during the preparation and supervision phases of the transport sector projects. The earlier that the issues regarding mainstreaming of HIVIAIDS arc addressed, the better the mainstreaming process will progress. When projects have HIVIAIDS on the agenda during the early project preparation stage, it is vital that the project team keeps the issue on the agenda so that it does not drop off the radar during the project implementation stage. 69. Code HIVIAIDS during Project Preparation: Many of the projects with HIVIAIDS interventions did not include the HIVIALDS code in the Business Warehouse system. This limits the value of the codes in enhancing the monitoring of projects with HIVIAIDS interventions. Task Teams need to ensure that the HIVIAIDS codes are selected in the Business Warehouse system during the project preparation stage because it is not possible to include these codes after the project has been approved by the Board. 70. Create Dissemination Plan :To share the present findings, this document needs to be disseminated to as wide an audience as possible. The targeted audience should include transport sector workers at country level. Transport sector and HIVIAIDS Websites where this document can be posted already exist: the SSATP. the World Bank Global HIVIALDS, and the other transporl sector and HIVIAIDS Websites. Hard copies of the document can also be made available, particularly to project teams at country level. 71. Monitor Clearly the Financial Resources Allocated to HIVIAIDS: It is in the interest of the transport sector to know the resources that are allocated to HIVIAIDS interventions. Project teams need to keep a record of these resources in such a way that these financial resources can be monitored. The practice of combining HIVIAIDS financial resources with resources for other social interventions does not allow for the HIVIAIDS resources to be clearly monitored. Recommendationsto Country Partners 72. Based on the assets of the past experience and looking forward to the future, these recommendations are in line with the Africa Region HIVIAIDS Agenda for Action 2007- 11 (AFA). They recoup the four strategic pillars mentioned in the document. 73. Continue Funding Support for HIVIAIDS Progra~nsin the Transport Sector: Countries should strive to reach the stage where all Transport Ministries are responsible for the design and implementation of their respective sector's HIVIAIDS response. This would be done using the National HIVIAIDS Strategic Framework as the base document upon which the sector response would be developed. The transport sector would need to allocate resources for the HIVIAIDS response in its annual budgeting process, as it does for its transport mandate. The inclusion of HIVIAIDS in contracts would also be a regular occurrence in the transport sector. Many countries have already started moving in this direction. In countries where this process has not yet been developed, national HIVIAIDS programs (with or without MAP-like resources) should continue to support the transport sector with both financial and technical resources to develop its own sector HIVIAIDS capacity. 74. Conduct Monitoring-and-Evaluation and Operational Research: The transport sector at country level should be supported to develop simple (whenever possible) and clear monitoring-and-evaluation frameworks that address HIVIAIDS (see appendixes D & J for sample indicators and data collection forms). Capacity development in monitoring and evaluation, including the allocation of human and financial resources, should be a priority in HIVIAIDS interventions in the transport sector. Project development objectives need to reflect HIVIAIDS objectives because this will enhance the measuring of results of the HIVIAIDS interventions. In terms of operational research, a better understanding is needed of the impact of HIV/AIDS, levels of risk and vulnerabilities of the mobile populations, and behaviors that predispose people to HIVIAIDS in the transport sector. Sexual transmission is understood to be the major mode of HIV transmission in Sub-Saharan Africa, but understanding the specific determinants and settings for the transport sector in different countries would be very valuable to target the intervention. 75. Encourage Projects to Use the AFTTR Framework as a Guide: The Africa region's transport framework for meeting the HIVIAIDS challenges is an important tool that projects need for guidance. The Task Team should encourage the Ministry of Transport and partners to harmonize a framework that will benefit all concerned parties (for example, the AFTTR framework, which includes tools such as reporting forms, referral forms, checklists, and a pamphlet on how to implement the HIVIAIDS contract clauses that can be adapted and used locally for quality assurance). 76. Create HIVIAIDS Regional Hubs: In collaboration with the regional transport sector networks in Africa, the establishment of at least two regional HIVIAIDS support centers should be considered. The hubs would be responsible for capacity building and facilitating regular information exchange among focal persons across the continent. Transport sector unions, particularly those with cross-country mandates, have an important role to play in these hubs. These centers would facilitate the delivery of capacity building and information sharing across the client countries, as advocated in the AFA. A short assessment could be done to determine the two countries best positioned to host the hubs. Once operational, the hubs would become a platform for facilitating south- south exchange and networking and conducting capacity assessment to meet the training needs of a variety of groups in the geographically contiguous client countries. To minimize the cost of such a hub and ensure sustainability of the functions above, piggybacking on existing transport sector regional networks is a preferred option to starting a brand-new hub. SSATP, the Ii~tergovernmentalAuthority on Development (IGAD), and other regional networks should be considered as options. Recommendationsto the TransportSectorBoard 77. Continue HIVIAIDS Work in the Transport Sector: AFTTR has made progress in mainstreaming HIV/AIDS in its portfolio. However, there is still more work to be done in ensuring that those projects that need mainstreaming have been mainstreamed. In that context, the Transport Sector Board needs to continue supporting such future mainstreaming efforts by establishing a Sector Board Strategy for HIVIAIDS activities on Bank-financed transport projects. 78. Support Knowledge Management: The Transport Sector Board has been instrumental in identifying resources for collection and dissemination of knowledge on HIVIAIDS in the transport sector. Such support needs to continue as the sector amasses experience and knowledge on HIVIAIDS in the transport sector. Sharing of such knowledge across regions will be a value added in the mainstreaming process. Conclusion 79. AFTTR will be preparing separate costed policy proposals for each of those recommendations. APPENDICES Appendix A. Key Challenges and Limitations - ---- --.---.-------- Remarks Situation analysis Baseline data were not collected in 13of the information or start- projects that returned the questionnaire. Only up assessment to Ethiopia and Zambia did baseline study. Delay in inform project the completion of assessment reports by consultants design and respond denied the pro-jectsthe benefit of allowing the to the needs of the findings to appropriately guide implementation. beneficiary Sometimes the reports arrived almost after the population completion of the first phase of the project. In countries where situational assessment or baseline was not done, lack of funds was mostly responsible for not undertaking the activity. Project management Inadequate support Focal persons get minimal support from top for focal persons management. They are allowed little time and lack necessary finances and moral support. Most focal persons have HIVIAIDS as an added responsibility. They are expected to pay more attention to their primary assignments. Public sector in Sub-Saharan Africa is very hierarchical; hence, midlevel and junior focal persons are not likely to be in a position to dialogue with and influence the top-level policy makers on their own. Focal persons require training in HIVIAIDS project management in the context of the peculiarities of the types of organizations or agencies in which they work. Key challenges and limitations: Training workshops meant to empower focal persons to do their jobs are often too general and have no direct relationship with project management. Such workshops are often designed to help focal persons "gain an understanding of the HIVIAIDS epidemic, the importance of HIVIAIDS mainstrearning, and the concept of behavior change." " Absence of committed leaders hi^ ------. , , v-- Categarjes Issues I Rema;&s , Increasein program Most programs grew from providing sensitization portfolio not and condomsto providing care and support. matched with Despite this growth, some client nations have increase in maintained one focal person who is part time on the management staff program. NGOs engaged Project implementation sometimessuffered a lull or sometimes withdraw came to a complete stop when implementingNGOs from the project were not paid. NGOs engaged lack monitoring-and-evaluation system. Contractorsdelay payment to NGOs. Reports of activities were not submitted on time. Priority not placed Lack of a detailed capacity and situation on supporting NGO assessmentoften led to the assumptionthat NGOs capacity building had all the capacity required to implement projects. Program design omitted NGO capacity building as part of sustainability plan. No standardized M Monitoring-and-evaluationprocedures not &E procedures developed before project implementation Inconsistentreporting No clear reporting requirements No budget allocated for M & E Project management and NGO staff lack M & E skills No guidelines on how to implement the contract clauses Indicators for mainstreaming not clear Policy Policies still in draft Development, approval, and adoption of sector policy require time. In virtually all countries where they have been developed, sector policies meant to guide the mainstrearning of HIVIAIDS are still in draft. Gender Inadequategender From all the project reports and documents consideration in reviewed, it was apparent that gender inequities L- - .. .-.. --.-- . . Categories Issues Remarks I I programming may have been ignored in both design and I-- I IIimplementation of project activities in the transport II sector. Role of sector focal Under the principle of "Three Ones," each country Coordination teams or persons has one nationalcoordinating authority with a unclear in the broad-based multi-sectoral mandate for HIVIAIDS. national The roles of the focal persons or teams in the coordinating transport sector have not been properly defined in structure the national coordina.tingstructure. Care and support Weak referral Often there is 110 specific system in place for system treatment of opportunistic infections and little or no money available to support persons living with HIV and AIDS (PLHAs). In virtually all the projects, however, the referral system has remained weak because not enough project time and financial resources have been devoted to building referral systems for effective linkages. Stigma and Minimal attention Stigma and discrimination are yet to be properly discrimination paid to stigma and addressed. Activities are often not clearly defined. discrimination They are folded into the sensitization activities imulemented bv the uroiects. Knowledge No system of Multiple lessons learned in countries are not management information sharing commonly shared and used. in place a. Road maintenance and rehabilitation project (ROMARP) completion training and HIVIAIDS mainstreaming report. Appendix B. Elements in Start-up, Service Delivery, and Management Phases of AFTTR HIVIAIDS Project Implementation in Client Countries ---------- .------ .- -- Start-up Servicedelivery Management I Definition of Prevention Human resource objectives Advocacy with management Appointment of focal management (client Project management person country transport Monitoring and evaluation Identification of an sector, contractor Documentation implementing partner, company, and Institutional capacity usually an NGO community leaders in building Development of an neighboring Partnerships and networking action plan for communities) Sustainability mainstrearning with HIV risk reduction Other sources of finance the involvement of education and obtained by the transport stakeholders communication sector, apart from MAP Stakeholder analysis to Referral to HIV identify strategic counseling and testing partners services Linkage with the Quality assurance national HIVIAIDS Condom distribution coordinating institution or structure Care and support Linkage with the Client recruitment National HIVIAIDS Provision of, or referral Strategic Framework to, HIV counseling and Linkage with the testing services National h4 & E Laboratory support Framework Provision of, or referral Training of personnel to, ST1services Procurement of Provision of, or linkage equipment and to, services for supplies opportunistic infections Referral to antiretroviral therapy services Quality assurance Condoin distribution Appendix C. Illustrative Checklist for Mainstreaming HIV into the Transport Sector The following are some key actions to ensure mainstreaming of HIVIAIDS into the transport sector in countries implementing the multi-sectoral HIVIAIDS program: where HIVIAIDS mainstreaming needs to be addressed in Have activities been clearly outlined in the mainstreaming IVIAIDS (PLWHA), involved National M & E Framework? 15 Have resources (materials, human, and financial) been allocated for supporting the maillstreaming process? 16 Has a sector policy and strategy been developed? 17 Has the sector's comparative advantage been taken into consideration in designing and implementing project activities? 18 Are the activities related to the core business of the sector? Appendix D. Illustrative Indicators for Tracking Progress at the Project Level Activities Iflustratiyeindimtors Data saurce Frequencyof data Responsible collection Behavior change Number of Sessions Monthly Report Monthly 1NGO communication through peer education and outreach activities Strengthening # of peer educators trained /Monthly reports peer education I # of group meetings conducted Peer educator reporting forms Monthly NGO by trained peer educators Monthly reports Quarterly Quarterly narrative reports # of persons participating in Peer educator reporting forms Monthly NGO group meetings Monthly reports Quarterly Quarterly narrative reports # of one-to-one mcetings held Peer educator reporting forms Monthly NGO Monthly reports Quarterly Quarterly narrative reports # of persons reached by trained Peer educator reporting forms Monthly NGO peer educators Monthly reports Quarterly Quarterly narrative reports Strengthening # of training sessions held Monthly reports Monthly NGO outreach activities # of outreach workers trained Training workshop reports As the activity is NGO performed # of monthly meetings Monthly reports Monthly NGO conducted by trained outreach Quarterly reports Quarterly workers # of persons reached by trained NGO Quarterly NGO ] outreach workers Appendix E. Key Informant Interview Questionnaire (HIVIAIDS Focal Persons) Mainstreaming What was the process of mainstreaming? How and who were the stakeholders involved in the mainstreaming process? How were PLWHA involved in the mainstrearning process? Was there a mainstreaming action plan? .Howwas this developed? What has been the scope and target of mainstrearning so far (internal mainstreaming of HIVIAIDS, sector wide mainstreaming of HIVIAIDS, or mainstreaming of components of the HIVIAIDS program). Please explain; To the best of your knowledge, what challenges did you face in mainstreaming HIVIAIDS into the transport sector? What do you consider as gaps in the mainstreaming effort? HIVIAIDSPrevention How did baseline or pre assessment findings inform the mix of interventions? How were stakeholders involved in the development and implementation of the project? Did the interventions borrow from the National Strategy Framework? Were the target populations properly segmented, and interventions tailored to meet the specific needs of each segment? (for example, transport workers who are MSM, transport workers who consume alcohol, or transport workers who consume drugs) Key Informant Interview Questionnaire (HIVIAIDS Focal Persons) continuation - from previous page How is the project reaching other populatjons associated with transport workers? (for example, sex workers) How was stigma addressed? How were stakeholders involved? What were the major challenges encountered implementing the prevention program? How can the prevention program be improved? How will the prevention program be sustained? Care, Support,and Treatment What are the care, support, and treatment components/activities in your program? Describe the referral system into which target population is linked. What is the percentage of those receiving ARV in the transport sector, compared with that of the general population? What is the percentage of those who know their sero status in the transport sector, compared with that of the general population? How have the health centers in the projects been linked to the national system of data collection? Coordinationand CapacityBuilding How have the MAP-supported HIVIAIDS activities been linked to the National Strategic Framework? How have the MAP-supported HIVIAIDS activities been linked to the National M&E Framework? Describe the extent of collaboration and strategic partnerships with other partnerslsectors, including the private sector. Is there a policylstrategic framework of action for the transport sector? What specific capacity-building activities were implemented? (organizational capacity, technical capacity, and administrative capacity) Management Is there an HIVIAIDS team or an HIVIAIDS focal person in the transport sector? What percentage of time does the focal person dedicate to HIVIAIDS work? Is HIVIAIDS mainstreaming the primary assignment of the focal person, or is it an add-on responsibility to existing workload for the focal point? Is there involvement of the Ministry of Transport in activities? Is there a project document and implementation plan? Is there a mechanism for the involvement of stakeholders in the implementation of the project? M & E How are activities currently being monitored? What is the frequency of data collection? How does the reporting system operate? QualityAssurance of Data What indicators do you track? Are these indicators similar to those envisaged for the target population in the National M & E Framework? Key Informant Interview Questionnaire (HIVIAIDS Focal Persons) -continuation from previous page How do stakeholders receive feedback? How are the M & E results used to refine and improve program? What reporting tools are being used? Describe the dissemination plan in place. Sustainability What funding was available for activities in the transport sector before MAP? Apart from MAP money, what are the other sources of funding for the HIVIAIDS program in the transport sector? Are there specific budget lines in the Ministry of Transport and the other tiers (statelprovincial and local councils) to support the HIVIAIDS program in the transport sector? What additional funds will be required to scale up the existing program? What are the sustainability plans? Appendix F. Contact List for HIVIAIDS Activities and Questionnaire Responses Gournttrfw Facat pa6ats Burkina Faso Ernest Kologo E-mail: ernestkologo@yahoo.fr Telephone: 226-70-27-36-01 Cape Verde Lucio Spencer E-mail: rssp@cvtelecom.cv Telephone:238-261-48-20 Camel-oon Tarcicius Manga E-mail: Tarcisius.Manga@camrail.net Telephone: 237-340-61-19 Cell: 237-985-44-78 Ghana Rita Ohene Sarfoh Focal Person at Ghana Highway Authority E-mail: I-osarfoh@highways.mrt.gov.gh Telephone: (233-20)-812799 Lesotho MaselomoPama E-mail: itppm@mopwt.gov.ls Telephone: 266-22-32-6973 Madagascar Paul-Jean Feno E-mail: pfeno@wor1dbank.01-g Telephone: 261-20-22-516-92 Cell: 261-32-050-01-39 Malawi Rose Ligomeka E-mail: rligomeka@NRAMW.corn; also roseligomeka@yahoo.com Telephone:265-884-3597 E-mail: vzuca@ane.gov.mz Niger Sina Moumouni E-mail: pii@intnet.ne Tel: 227-73-54-38 Senegal Birahim Fall E-mail: transrur@sentoo.sn Telephone: (221-33)-869-02-50 Tanzania JosephineMwankusye E-mail: josephinernwankusye@yahoo.com Telephone: 255-754-266147;also 255-787-266146 Uganda Francis Bya-uhanga (acting) E-mail: FMByaruhanga@raf~~.or.ug Telephone: 256-754-266-147 Zambia Raphael Mabenga E-mail: mabenga@nrfa.org.zn~ Telephone: 260-1-253145 Appendix G. List of Documents Reviewed - - --- ---+--- ---?." Caunfxy D o m m t Date Burundi Rdpublique du Burundi, Projet de Ddveloppement N/A du Secteur Routier Mission de Suivi des Activitds du Projet (du ler au 8 octobre 2005), Aide-Mkmoire Rdpublique du Burundi, Projet de Ddveloppement N/A du Secteur Routier Mission de Suivi des Activitds du Projet (du 26juin au ler juillet 2006), Aide- Mdmoire Cameroon CAMRAILICNLS, Programme de lutte contre le June 2005 VIHISIDA, Rapport 2eme semestre 2005 CAMRAIL/CNLS Programme de lutte contre le June 2005 VWSIDA rapport MI parcours Campagne de lutte contre le VIWSIDA A March-April, 2005 CAMRAIL, Programme de facilitation des transports en zone June 5-1 7,2006 CEMEC, Mission en Rdpublique du Cameroun et en Rdpublique Centrafricaine Chad Republique du Tchad, Projet D'Appui au June 16-30,2005 Programme National des Transports (PAProNaT), Aide-Mdmoire, Mission de supervision du PAProNaT et suivi du secteur des transports - Ethiopia Africa Transport Technical note: Worlting with - N/A road contractors on HIVIAIDS prevention HIV/AIDS Implementation Report (2003-April N/A 2006) Malawi ROMARP project: Completion Training and N/A HIVIAIDS Mainstreaming Mozambique Implementation Strategy for the HIV/ADS July 2003 subcomponent of the social unit's action plan (2003- 2005), final report Senegal Second Programmed Sector of Transportation N/A (PST2) Second Sector Program of Transportation (PST2) N/A (Powerpoint) Tanzania Republic of Tanzania, Second Integrated Roads NIA Project, TANROADS Initiative on HIVIAIDS Uganda A report on STDs/HIV/AIDS sub-county September 2005 sensitization workshops in Katunguru-Kikorongo Mpondwe Road construction project No. RDP/HIV/C009 A report on STDs/HIV/ATDSsensitization workshop August 2005 in Fortportal-HIMA Road construction project No. RDP/HIV/C007 Activities conducted during the last two months, N/A ------- --- -+..-------- Country Dmment Date ,, November-December 2005, under C003, Pakwach- Olwiyo Road project Progress report on HIVIAIDS sensitization May 2005 workshop in Katunguru-Kikorongo, Mpondwe Road construction project A report of STDMIVIAIDS needs assessment under NIA road construction project No. RDPMIVlC007, Fortportal-HIMA A second report on STDMIVIAIDS needs NIA assessment under road construction project No. RDPMIVlC009, Katunguru-Kikorongo A report on STDMIVIAIDS needs assessment, NIA 1 A report on STDMIVIAIDS needs assessment, NIA Pakwach-Olwiyo Road construction project A report on the launch of Pakwach-Olwiyo HIV N/A clinicNCT Report on HIVIAIDS sensitization campaign in July 16,2005 Puringo Internally Displaced People's Camp (IDPC), July 16,2005 Progress report on HIVIAIDS for the month of NIA February 2006, under C003, Pakwach-Olwiyo Road construction project Progress report on HIV/AIDS for the month of N/A February 2006, under C009, Katunguru-Kikorongo Road construction project A report on STDMIVIAIDS sub-county January 2006 sensitization workshops in Fortportal-HIMA Road construction project RDPIHIVlC007 A report on STDsMIVIAIDS IDPCs sensitization February 2006 workshops in Pakwach-Olwiyo Road construction project Progress report on HIVIAIDS for the month of N/A February 2006, under C003, Pakwach-Olwiyo Road construction project Progress report on HIVIAIDS for the month of N/A January 2006, under C004, Karuma-Olwiyo Road construction project Progress report on HIVIAIDS for the month of NIA January 2006, under C009, Katunguru-Kikorongo Road construction project A reporl on STDsMIVIAIDS teachers sensitization February 2006 workshop, under C004, Karuma-Olwiyo Road construction project Progress report for Karuma-Olwiyo Road sector May 2005 Sector,fourth quarter, 2005,by Edna Stake; Transportation Social Responsibility; Thematic Group by Julie Babinard (TUDTR) and (TUDTR), May 5,2004 (Powerpoint . . ..-.- ..- . -. ---. . . --.-.-.--. ---.-- ---.--..-- --.--. . -- - --- -. ....... -.-.- .--.. .. .. . ? Country Document Date HIVIAIDS and Transport Retrofitting Exercise, N/A Africa Transport, World Bank Africa Region (PowerPoint presentation) Interview with Jocelyne Do Sacramento: World NIA Bank HIVIAIDS Partnership with Air France Transport Against AIDS: Minutes of the 2005 November 28 -29, Transport World A D S Events, November 28-29, 2005 2005, Washington, DC Multi-Country HIVIAIDS Program (MAP) for NIA Africa, world Bank (a Power~ointpresentation) Programme Regional de Facilitation des Transports: June 2005 Ghana-Burkina Faso-Mali by Violet Sida, Ouagadougou, May 30-June 3,2005 (PowerPoint) Concept Note: HIVIAIDS Agenda for Action in NIA Sub-Saharan Africa Proposed Abidjan-Lagos Transport and Transit N/A Facilitation Project (ALTTFP) Project Identification Mission to Benin, Togo, and Ghana (May 31-June 9,20061, Aide-Mkmoire AIDS and Transport in Africa: A Framework for July 2003 Meeting the Challenge, Africa Technical Transport Sector Unit (AFTTR), World Bank Note: N/A = Not appl able Appendix H-1. MainstreamingStatus of Projects in the AFTTR Portfolio AFRR PQRTFFOtOSTPITUS[as a1February6,2007) Country New projects [approvadinfirst halfof FYWJ Amount Mainstreaming (US$millions) Country] status Project name Board approval date (YIN) 1. Africa 3A APL2 West 1010212007 46.7 N *' Dern* ZR-EMRRP Supp 2 12/18/2007 12.0 Y Rep. of 3. Liberia I LR-Agric. 07/31/2007 37.0 N 4, Rwanda 1RW- Trnsp Sector Development 0812812007 11-0 Y Note: DO = DevelopmentObjectives. S = Satisfactory. MS =Moderately Satisfactory... U = Unsatisfactory. MU = Moderately Unsatisfactory. TBD = To be determined. Appendix H-2. HIVIAIDS-Related Interventions in the Mainstreamed Projects 6. Cameroon CM-Ralway No Y Y Y Y Y IECBCC. condoms; VCT Concession SIL (FY03) 7. Cameroon CM-Douala N/A N/A N/A N/A N/A N/A N/A Infrastructure (FY03) 8. Cape CV-Road Sec Support Y Y Y Y N/A NIA IECBCC: condoms Verde Project (FYOS) 9. Chad TD-Natl Trnsp Prgm Y Y Y Y N/A NIA IECBCC; condoms Supt SIL (FYOI) 10. Congo, CD-EmergMS Rehab Y Y Y Y N/A N/A IEC/BCC; condoms; VCT Dem. Rep. of & Recovery ERL (FY03) Rehabilitation (FY07) 1 19. Lesotho LS-Integr Trnsp SIL Y Y Y Y Y N/A IECIBCC;condoms; VCT (FY07) 20. MG-Rural Trnsp APL Y Y Y Y NIA N/A IECIBCC;condoms Madagascar 2 (FY03) 21. MG- Trnsp Infrastr Y Y Y Y N/A N/A IECBCC: condoms Madagascar Invest Prj (FY04) 22.Mali ML- Trnsp Corridors Y Y Y Y N/A NIA IECBCC; condoms Improv (FY04)- (PACT) Dev Prgm (FY06) 32. Sudan SD-National Emerg N/A N/A N/A N/A N/A N/A N/A Trnsp Rehab (FYITBD) 33. Tanzania TZ-Central Trnsp Y Y Y Y Y N/A IECIBCC; condoms; VCT Corridor Prj (FY04) 34. Uganda UG-Roads Dev APL Y Y Y Y Y N/A IEC/BCC; condoms; VCT (FY99) 35. Uganda UG-Road S e c & Inst N/A N/A N/A N/A N/A NIA N/A Supt (FY98) Sample Quarterly HIV/AmS Reporting Form (continued) CondomDistributionPoints Data collected by: Date: REFERENCES Bal, B., S. I. Ahmed, R. Mukherjee, S. Chakraborty, S. K. Niyoqi, A. Talukder, N. Chakraborty, and K. Sarkar. 2007. 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