Authorized Documentof The World Bank Disclosure FOROFFICIALUSEONLY Public ReportNo.: 39632-CF PROJECTPAPER Authorized ONA PROPOSEDRESTRUCTURING Disclosure OF THE Public MULTISECTORALHIV/AIDSPROJECT FORTHE CENTRALAFRICANREPUBLIC (CR.3584-CA) Authorized MULTISECTORALHIV/AIDS,HEALTH, AND EDUCATIONEMERGENCYSUPPORT PROJECT Disclosure FORTHE Public CENTRALAFRICANREPUBLIC May 10,2007 Authorized Africa Technical, Environment andSocial SustainableDevelopment 3 (AFTS3) Country Department Central Africa 1(AFCC1) Disclosure AfricaRegionalOffice Public This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosedwithout World Bank authorization. ABBREVIATIONS AND ACRONYMS AIDS Acquired Immune-deficiency Syndrome ARV Anti-retroviral CAR Central African Republic CDD Community-Driven Development CNLS TS CNLS Technical Support CNLS National HIV/AIDS Coordinating Committee cso Civil-Society Organization EFAP Education for All Program ESMF Environmental and Social Management Framework ESMP Environmental and Social Management Plan FBOs Faith-based Organizations FMPU Financial Management and Procurement Unit FTI Fast Track Initiative GDH General Directorate for Hydraulics, Ministry of Energy, MiningandHydraulic GDP Gross Domestic Product GF GlobalFund HIPC Heavily-Indebted Poor Country HN Human Immunodeficiency Virus ICIC Implementation Committee for IDA Credit 3485-CA IDA International Development Association I-PRSP InterimPoverty Reduction Strategy Paper ISN InterimStrategy Note ITBN Insecticide-treatedbednets K P I KeyPerformanceIndicator LICUS LowIncome Country under Stress M&E Monitoring and Evaluation M A P Multi-sectoral Aids Program MOE MinistryofEducation MOH MinistryofHealth M o U Memorandum of Understanding MTCT Mother-to-ChildTransmission MWMP MedicalWaste Mitigation Plan MWP Master Work Program NGOs Non-Governmental Organizations OMS Operational Manual Statement ovc Orphans andVulnerable Children PDO Project Development Objectives PLWHA People Living with HIV/AIDS PMTC Prevention o f Mother-to-ChildTransmission PPF Project PreparationFacility PTAs ParentdTeachersAssociations RESEN Education Country Status Report /Rapport d'Etat du Systeme EducatifNational TA Technical Assistance TPM TuberculosePulmonaire Mycobacteria (Microscopy inPulmonary Tuberculosis) UNAIDS Joint UnitedNations Programme on HIV/AIDS UNICEF UnitedNation's Children's Fund VCT Voluntary Counseling and Testing WHO World HealthOrganization .. 11 CENTRAL,AFRICAN REPUBLIC PROJECT PAPER FORA PROPOSEDRESTRUCTURING OF THE MULTISECTORAL HIV/AIDS PROJECT MULTISECTORAL HIV/AIDS. HEALTH. AND EDUCATION EMERGENCY SUPPORT PROJECT TABLE OFCONTENTS 1. DATA SHEET................................................................................................. iv 2. INTRODUCTORYSTATEMENT......................................................................... 1 3. BACKGROUNDAND REASONSFOR RESTRUCTURING....................................... 1 4. PROPOSEDCHANGES.................................................................................... 2 5. ANALYSIS................................................................................................... 7 6. EXPECTEDRESULTS..................................................................................... 9 7. REEVALUATIONOF CRITICAL RISKS............................................................ 10 ANNEXES: Annex 1: EpidemiologicalandEducation Situations inthe Central Afiican Republic Annex 2: Detailedchanges inproject design ....................................................... .........13 15 Annex 3 ResultsFramework. target values. data collection andreporting........................ . 18 Annex 4.Project Costs .................................................................................... 24 Annex 5.Analysis o f Economic. Financial. and Technical Issues ............................... 25 Annex 6. Summary of legal covenants ............................................................... 28 ... 111 1-DATASHEET Date: May 10,2007 Co-Task Team Leaders: Jean Delion& Country: Central African Republic Giuseppe Zampaglione Project Name: Restructuring of the Multisectoral H N / A I D S Project - Acting Sector Manager: Franqois G.L e Gall Acting Country Director: Marie- Franqoise Multisectoral HN/AIDS, Health, and Marie Nelly Education emergency support Project Project ID:PO73525 Environmental category: B -PartialAssessment Credit No3584 CA Borrower: Central African Republic (Ministry 0: Zconomy, Planningand International P Cooperation) Responsible agency: Implementation Committee IDA 3584 Credit, c/o Ministry o f Economy, PlannlngdInternational Cooperation Revised estimated disbursements (Bank FY/US$m) Current closing date: June 30, 2007 (original June 30,2006) Revised closing date (proposed): June 30,2010 Therestructuring will be: Board approved-X- RVP approved - Does the restructured project require any exceptions to Bank policies? oYes x N o Have these been approved by Bank management? oYes x N o I s approval for any policy exception sought fi-om the Board? oYes x N o Revisedproject development objectives: Contribution to meet (a) urgent needs inthe fight against HIVsuch as accessto prevention, treatment, andimpact mitigationservices and(b) urgent social needs such as prevention o f malaria, increased access to water supply and improvedprimary education. Does the restructured project trigger any new safeguard policies? Yes. OP 4.01 (Env. Assessment); OP 4.04 (Nat. Habitats); and OP 4.09 (Pest Mgmt): A Revised Environmental and Social Management Plan (ESMP) will be adopted no later than 3 months after the Restructuring Source Local Foreign Total Borrower IBRD/IDA Others iv 2. INTRODUCTORY STATEMENT 1. This Project Paper seeks the approval o f the Executive Directors to introduce the following changes in the Central African Republic Multisectoral HIV/AIDS Project, Credit 3584 CAR, (P07352.5) and subsequent amendments to the project's legal documents. The proposed changes would allow the project to better respond to the post- conflict situation in CAR. They would streamline resources for the original purpose o f fighting HIV/AIDS in CAR, taking into account existing and prospective support from other donors, and address emergency social needs identifiedwith the Government. 3. BACKGROUNDAND REASONSFORRESTRUCTURING 2. Project approval. The project was approved on December 14, 2001. CAR fell into non-accrual status in February 2002 before the project could become effective; the country cleared its arrears in November 2006. The original closing date was extended from June 30,2006 to June 30,2007 to allow for the restructuring o f the project. 3. Original objectives and design. The original objectives were to help the Government reduce HIV/AID,S prevalence in CAR, and to mitigate the impact of HIV/AIDS on persons infected with or affected by HIV/AIDS. The project included the following components besides coordination, financial management, monitoring and evaluation: (a) Strengthening of public-sector response, in policy development, planning, implementation, and monitoring o f HIV/AIDS actionplans; (b) Strengthening of civil-society response, in planning, implementation, and monitoring o f HIV-AIDSaction plans; and (c) Strengthening of community response, in capacity building, planning, and implementationo f HIV-AIDScommunity action plans. 4. Performance to date. Disbursements under the IDA Credit were suspended prior to effectiveness, as the country fell into arrears. Project preparation advances in the amount o f US$2.0 million were used to support: (a) the establishment and operation of the Technical Secretariat o f the National HIV/AIDS Coordinating Committee (Comite' national de lutte contre le SIDA, CNLS) and 16 Provincial HIV/AIDS Committees (b) capacity buildingo f various stakeholders inall sectors, (c) pilot activities inselected civil society organizations (CSO) and communities, and (d) mapping o f HIV/AIDSprevalence in at-risk areas. Many CSO, communities, and public sectors successfully completed their action plans, funded by PPF advances, by Low Income Country Under Stress (LICUS) grants or by other donors. CNLS carried out additional activities using US$500,000 with the aid of a LICUS grant, and i s currently implementing a second LICUS grant o f US$400,000. Supervision missions under the IDA Credit rated the overall project implementation unsatisfactory, due to the country situation. PPF and LICUS-funded activities were supervised and audited and their implementation was rated satisfactory. 1 Reasonsfor project restructuring 5. New emergencies resulting from civil disturbances and developments since original project approval. The CAR Interim Strategy Note (ISN) for FY07-08(paragraph 50) proposed to restructure the project to take into account developments since the project was approved in late 2001, including the availability o f new resources from the Global Fund, to also address emergency social needs, through the use of some o f the funds remaining under the HIV/AIDS Project. More than ten years o f civil unrest, chronic govemment policy mismanagement, and lack or misallocation o f resources have reduced both the coverage and quality o f essential services, such as primary education, provision o f basic health services, and access to water and sanitation. Human development indicators o f CAR are among the lowest in the world, well below sub- Saharan averages, and require an emergency response. In December 2006, an identificationmission agreed with the Government on priority emergency social needs in the health and education sectors. In the health sector, the project would support prevention against malaria transmission by supplies o f bed nets to pregnant women and children and by drainage o f marshlands in poor, highly infected areas, reduction o f transmission o f infectious diseases by construction o f village water systems, as well as provision o f health equipment for hospital emergency rooms. Inthe education sector, the project would support improving primary education in CAR by provision o f school suppliesandon-the-job training o fprimary school teachers. 6. HIV-AIDS remains a major problem in CAR. UNAIDS estimates HIV prevalence in CAR at about 6.2 percent among the population from 15 to 49 years o f age, well above the 3 to 5 percent rates in neighboring countries. To fight against HIV and AIDS, the Global Fund(GF) mobilizedUS$29 millionfor the period 2004-2008, and UN agencies and the World Bank contributed US$14 million. Some bilateral agencies and faith-based organizations (FBOs) made significant contributions; for example, the German cooperation supported the provision o f condoms, France provided technical assistance, and the Red Cross supported a pilot treatment center. Donor support mainly funded improved access to care and treatment for persons living with HN/AIDS (PLWHA), support to orphans andprevention(mainly provision o fcondoms), but only in the capital city. While more funding i s now available, little o f it has been allocated to prevention, leading to increasing infection rates. The epidemiological situation is described more fully inAnnex 1. 4. PROPOSED CHANGES 7. Changes in Project Development Objectives (PDO). The PDO related to the fight against HIV and AIDS have been adjusted in line with the country's updated National Strategy against HIV-AIDS (2006-2010). The revised PDO reflect today's understanding that MAP projects cannot use prevalence rates as impact indicators. The revised PDO would be to contribute to meeting(a) urgent needs inthe fight against HIV, such as access to prevention, treatment, and impact mitigation services (b) urgent social needs such as prevention o f malaria, increased access to water supply and improved primary education. 2 8. Changes in project components and subcomponents. The project components and subcomponents would reflect the new objectives, addressing HN/AIDS, health and education emergency needs. The restructured project would include a component for each sector, plus a component for a small financial management and procurement unit. Each component would include subcomponents for specific activities. (Detailed changes in the project design are in Annex 2.) Component 1: Support to the National Program against HIV-AIDS (US$6.46 million) 9. Subcomponent 1 (a): Civil society responses against HIV/AIDS: The restructured project would focus on supporting 50 youth organizations, a federation of associations of people living with HIV/AIDS (PLWHA), and 30 PLWHA associations. 10. Subcomponent 1 (b): Ministry of Health responses against HIV/AIDS. The restructured project would support Ministry of Health activities by enhancing access to prevention, care, and treatment regarding HIV/AIDS, Project funding for the programs of the Ministry of Health would supplement the financing provided by the Global Fund and others, focusing in geographic areas not served by other donors. 11. Subcomponent 1 (e): Other public-sector responses against HIV/AIDS. The restructured project would follow the initial objectives of supporting public-sector responses in the following priority public sectors: Education, Defense, Social, and Public Services. 12. Subcomponent 1(d) Coordination, supervision, and monitoring and evaluation (M&E). The project would finance the operations of the CNLS Technical Secretariat and the decentralized coordinating committees at the prefecture level. The project would also support three studies for the monitoring and evaluation (M&E) of the National Program against HIV/AIDS. Component 2: Support to emergency Health needs (US$6.56 million) 13. Component 2 (a): Malaria prevention and improved access to emergency health services. This subcomponent would mainly procure and distribute: (i) about 300,000 insecticide-treated mosquito nets (ITMN) for pregnant women and children under age five and (ii)equipment for emergency health services. It would complement Global Fund support, following WHO guidelines. 14. Subcomponent 2 (b): Small emergency community subprojects. The project would finance small subprojects prepared with communities and civil-society organizations, addressing emergency health needs, such as small rural water supply systems and drainage of marshlands to reduce reproduction and spreading of mosquitoes. This subcomponent would support the contracting of an agency to channel funds to civil-society organizations (CSO) and community initiatives. It would also support engineers from "Direction Generale de L'Hydraulique" from Ministry of Energy, Mining 3 and Hydraulic, to provide the technical assistance to design and implement the civil works involved. 15. Subcomponent 2 (c): Coordination, supervision, and M&E. The project would support limited financing to assist the Ministry o f Health to supervise, monitor, and evaluate the above activities. Component3: Supportto emergencyEducation needs(US2.70 million) 16. Subcomponent 3 (a): Training of primavy schools teachers. The project would improve the quality o f teaching at the primary level and respond to urgent needs o f providing teaching services, by focusing on teachers' training and improving the student to teacher ratio. 17. Sub-component 3 (b): Access to educational materials in primary schools. The project would provide textbooks and other educational material inprimary schools. 18. Subcomponent3 (c): Coordination, supervision, and M&E. The project would support limited financing to assist the Ministry o f Education to supervise, monitor, and evaluate the above activities. Component 4: Supportto a FinancialManagementand ProcurementUnit (US$180,000) 19. The project would support a small Financial Management and Procurement Unit, to channel funds to the three implementing agencies. The unit would include an experienced financial management specialist and an experienced procurement specialist, both internationally hired. Financingplan 20. The project would finance 100 percent o f the specific project costs. The Government would contribute through the payment o f salaries to the staff o f the Technical Secretariat o f CNLS (CNLS TS), the Provincial AIDS coordinating units, the health-sector, as well as the HIV/AIDS teams in key ministries such as the Ministry o f Education and Defense. Furthermore, the Government would also provide offices for the various units implementing the activities of the restructured project. Details o f the project costs are presentedinAnnex 5 and contributions by other donors are inAnnex 7. Institutionalandimplementationarrangements 21. Coordination: Implementation arrangements would reflect the involvement o f concerned sectors, that is, CNLS (on HIV/AIDS related issues), Health, Education and Ministry o f Mining, Energy and Hydraulic (on water supply and drainage). To provide effective support to these sectors, the government would take, prior to the effectiveness o f Project restructuring, an inter-ministerial decision to create (a) an "Implementation Committee for IDA Credit 3485-CA" (ICIC) as a formal inter-ministerial committee to be chaired by a representative from the Ministry o f Planning, and (b) a financial 4 management and procurement unit (FMPU) attached to this committee, described below. The members o f this ICIC would be a representative o f Ministry o f Planning (Chair), a senior officer from each Ministry involved in implementation o f project activities and from CNLS, and one officer from the Ministry o f Finance. The ICIC would supervise the Financial Management and Procurement Unit (FMPU); it also would approve annual work plans and budgets, quarterly reports, and M&E reports o f the project. The members of the Committee would take part in regular supervision missions. The representative from the Ministry o f Planning in the ICIC would co-sign withdrawal requests with the project financial officer. 22. Central fiduciary services: The Committee would hire internationally an experienced financial management specialist and a procurement specialist to serve in FMPU, together with a locally hired administrative assistant. CNLS would host FMPU in its offices and support its daily activities. FMPUwould procure major supplies and make them available to the three concerned sectors concerned. It would advance funds to these three sectors to cover their operational costs and other expenditures to implement their activities and to an agency channeling funds to civil-society organizations (CSOs) and communities. FMPU would also manage the Designated Account and would be responsible for financial reporting, preparation o f statements o f expenses and annual financial reporting on the project. Furthermore, it would supervise the use o f funds advanced to implementing partners. Establishment o f the "Implementation Committee for IDA Credit 3485-CA", approval by IDA o f the revised project implementation manual and procurement plan, establishment o f the FMPU and hiring o f financial management and procurement staff with satisfactory qualifications, selection and appointment of financial management staff with satisfactory qualifications in CNLS TS, Ministry of Health and Education, to manage IDA credit funds would be conditions for effectiveness. 23. The conditions for effectiveness are presented in details in Annex 6. The Government has already started to prepare to meet the major conditions. Two missions are planned, in May and June 2007, to make sure that these conditions are met by early July 2007 so that the Project can proceed immediately after approval. 24. Small coordination, financial management and M&E units in the concerned Ministries: Under the restructured project, the FMPU would procure goods and channel funds to the implementingsectors and to supporting units such as GDH. Ineach sector a small financial management unit would manage advances. CNLS TS already established a small financial management unit which managed four project preparation advances and two LICUS grants. It also manages small grants from other donors including UN agencies. CNLS also built technical capacities inthe Ministryo f Health and coordination capacities at the provincial level, establishing task forces to coordinate various interventions. Experts trained during the last five years would scale up their activities, along project activities in CNLS TS, provinces, the Ministry o f Health, other public sectors, CSOs, and communities. 5 25. Supporting capacity building for implementing community-based projects by contracting an agency to channel funds to CSOs and communities . The Ministry of Planning expressed interest in contracting such an agency for the restructured IDA credit and for other funds intended for CSOs and communities. The Ministry of Health would support and use this agency to channel grants for small projects under subcomponent 2(b). The agency under would also channel grants to CSO and communities (youth organizations and the Federation of PLWHA) under component l(a). It would channel funds to CSOs as grants, with grant agreements to implement action plans (including output indicators). As soon as the agency would be contracted, the ICIC, and its FMPU could sign a contract as services providers with this agency to channel funds to CSO and communities. During project year 2, the two internationally recruited specialists mentioned above would transfer their responsibilities to the agency and would play an advisory and control role. During year 3 they would only do short technical assistance missions. Under a LICUS financed US$2.7 million operation, the Bank is supporting a Community-Driven Development (CDD) pilot in four prefectures in the East of the CAR, reaching more than 80 poor communities. This project will serve as a pilot and the TA specialists would work closely with the management unit of the on-going CDD pilot. This unit would be temporary, to provide services to the various sectors involved, it would be disbanded at the end of the project. 26. Implementation agreements with public sectors: The ICIC would sign agreements with public sector agencies and would fund their activities, using advances, as was done with PPF advances. 27. Monitoring and evaluation. The updated monitoring and evaluation arrangements will be presented in details in a revised M&E manual, under the overall implementation manual. A new Results Framework is in Annex 3. Expected results (see Section 7) will comprise key outputs across the three components to reflect the nature of activities supported and taking into account the lack of baseline values against which concrete targets can be set. Because there are very limited baseline data available the project would mainly use the output indicators presented in the Results Framework. In the education sector, the project would add a suitable outcome indicator during project implementation and make efforts to measure this indicator. 28. Financial management. As initially planned, the project's financial statements would be audited in accordance with International Standards of Auditing annually by independent and qualified auditors acceptable to IDA. The audit report would be submitted to IDA not later than six months after the end of each fiscal year. 29. Programmatic efforts on HIV/AIDS: During the project period, CAR would make efforts to progress toward a programmatic approach. Main donors would join and take the following concrete steps to contribute to one national program, starting in 2007: At least one joint supervision involving main donors each year; 6 Joint presentation of annual work plans and budgets inside one annual work plan and budget of the national program approved by CNLS each year; Financial and technical support to M&E studies; and Capacity building of the national drugs agency to become the main agency to procure tests and antiretroviral (ARV) drugs for all programs. 30. Procurement. Procurement under the PPF advances and under LICUS grants moved from moderately unsatisfactory during the first years to satisfactory in 2006. Procurement reviewers and auditors advised changes, which were satisfactorily implemented. The restructured credit would be implemented on the basis of the same procurement arrangements, under the responsibility of the FMPU and detailed in the Operations Manual, but it would be subject to the revised General Conditions, and anti- corruption guidelines. Approval of this revised procurement plan would be a condition for effectiveness. 31. Revision of the operational manual: The Borrower plans to revise the implementation manual, incorporating the above changes. The CDD LICUS financed pilot has prepared a full manual on CDD operations, with detailed procedures and forms to implement the project in collaboration with all partners such as international and local NGOs, national and local government authorities, and the communities. An adapted version of this manual could be the basis for the operations of the newly contracted agency. Approval of the revised manual would be a condition for effectiveness. A consolidated Environment Management Plan would need to be prepared within three months of restructuring effectiveness. Closing date 32. The project closing date was extended from June 30, 2006 to June 30, 2007. The new closing date would be September 30, 2010, leaving three years for project implementation. 5. ANALYSIS Economic and financial analysis. 33. In the HIV-AIDS sector, the economic analysis of the concerned activities is supported by the recent work under the Second Multi-Country HIV/AIDS Program for the Africa Region (Report No. P7497). The report provides an assessment of the impact of prevention, access to testing, care and treatment, and a cost-benefit analysis of HIV/AIDS interventions; it shows that a reduction in AIDS-related deaths would increase the growth of GDP. It also concludes that HIV/AIDS reduces the value of physical, human, and social capital. The project activities would not carry additional financial charges for the government. Major donors took part in a CNLS general assembly in July 2006 that approved the National Strategy 2006-2010 and pledged support to implement this strategy. The government also envisages using part of HIPC resources, after 2009, to support the fight against HIV-AIDS. 7 34. In the health sector, a least-cost approach would be used, because it would be hard to measure financial and economic benefits. Malaria prevention with insecticide- treated bed nets would reduce malaria transmission for young children, improving health and saving lives at a low cost. Evidence from other African countries show that investments in mosquito nets, if accompanied by adequate distribution and training on how to use them, have a highreturn interms o f reduction o f prevalence, and reduction o f morbidity and mortality rates. Improved equipment in emergency health services has direct effects in lives saved. Community-based projects would have specific economic and financial impacts. For example, drainage o f swamps would reduce transmission o f malaria and small rural water supplies decreases morbidity. All these activities are low cost and have a large impact. 35. In the education sector, provision o f school supplies would entail a small cost per pupil, and together with support to on-the-job training o f teachers, would improve the quality o fprimary education inCAR, which has considerably deteriorated inrecent years. The Country Status Report in Education (RESEN) shows investment in school material and in teachers (preparedness and willingness to teach) have the highest returns in improving quality o f education (see Annex 5). 36. For all three sectors, the project would document the economic and financial impact of the specific activities on a retroactive basis at project end. 37. From a social analysis perspective, the restructuring would not have negative social consequences. It would pay specific attention to gender issues in prevention activities (both on HIV/AIDS andmalaria, with an emphasis on sex workers andpregnant women). 38. From an environmental perspective, the restructuring would not change the environmental category o f the project. The effects and mitigation measures would be the following: 0 On HIV/AIDS, the project would review the effectiveness o f the existing Medical Waste Mitigation Plan (MWMP), adjust it to the present context and re-disclose the final plan, and would fund it with a provision o f US$200,000. The MWMP would also serve the health sector at large. 0 Inthe healthsector, under Component 2, Subcomponent (b), smallprojects would involve the drainage o f small marshlands and rural water supplies at the community level. These small projects would not involve land acquisition or resettlement. However, they would trigger OP 4.01 and OP 4.04. Before the start o f any drainage o f marshlands or construction o f water supply subprojects, the Ministry of Health will be required to produce an Environmental and Social Management Framework (ESMF) that needs to be acceptable to the Bank, with a framework and guidelines for conducting impact assessments and preparing Environmental and Social Management Plans (ESMP) against specific subprojects. The ESMF will discuss issues regarding OP. 4.37, if it was 8 determined that the project will engage in dam construction; in regard with OP 4.07, the project would consult broadly project stakeholders on issues related to drainage o f marshlands and small water supply activities. The ESMF will designate the authority that would approve each specific ESMP. The use o f insecticide-treated bed nets would comply with the requirements of OP 4.09. Under the ESMF, M O H will provide the list o fpesticides involved intreatment o f bed nets. Under approval of the ESMF, MOH will confirm that it complies with WHO guidelines (class 3 pesticides) and would control strict adherence to it during project implementation. Under these conditions, the use o f impregnated bed nets and class I11 insecticide for malaria would trigger OP4.09 on pest management, but would not require a pest management plan, in accordance with 4.01 Annex C. 39. Therefore, the project would remain as category B. The financing agreement would plan for submission and approval o f a revised MWMP and ESMF within three months after signing o f the revised credit agreement. Approval o f the ESMF would be a condition for disbursement for the concerned small projects under Subcomponent 1(a) and 2(b). The restructuring would not involve exception to the Bank's environmental policies. 6. EXPECTEDRESULTS 40. I n the HIV/AIDS sector, the envisaged results as to increased adoption o f HIV/AIDS prevention measures and increased access to treatment will be measures by 3 outcome indicators: (i) number o f men and women who accepted VCT and received test results intargeted health centers; (ii) o f PLWA receiving ARV in targeted health number centers; and (iii)number ofPLWHA receiving support through their associations or their national federation o f associations. All activities would complement activities already carried-out by other donors. The project would provide: (a) PMTCT services to pregnant women intargeted Health centers; (b) access to voluntary testing and counseling services to youth and adults in selected health centers; and (c) access to treatment to additional patients in selected health centers; in addition, the project would support (d) PLWHA in their national federation o f associations o f PLWHA and intheir associations; (e) support action plans o f youth associations and selected public sectors; (0 test 110,000 blood transfusion pockets in selected health centers; and (g) implement a medical waste mitigation plan in selected healthcenters. 41. I n the health sector, the main results as to increased adoption o f preventive measures against malaria and increased access to water supply would be measured through using outputs indicators, such as distribution of impregnated bed nets, establishment o f additional rural water points, drainage o f marshlands, installation o f new emergency equipment inselectedhealth centers. The target project values for the number o f people to benefit from water points and surfaces o f marshlands to drain would be decided during preparation o f the baseline survey. The target communities would be severely underserved populations, with no access to clean water or having major infestations o f mosquitoes reproducing inmarshlands. 9 42. In the Education sector, the main result as to improved primary education would be measured against two output targets to be set: the number of teachers meeting minimum teaching qualifications in targeted areas and the student hooks ratio in the targeted areas. "The minimum teaching skills" for the qualitative indicator would be defined during preparation of the baseline survey and target values would be entered accordingly. Outcome indicators of quality of education would be hard to measure over a very short period. 43. On the institutional side, the project would develop management capacities in all three sectors; it would also contract an agency to channel fund to CSOs and communities, which would become the entry point for CDD funds from various sources. 7. REEVALUATION OF CRITICAL RISKS. 44. The main risks include: (a) political instability and civil unrest, which can be mitigated through French and other international assistance to the security situation as well as through economic recovery and development programs; (b) shortage of institutional capacity to carry out the operations of the restructured project; and (c) limited use or misuse of goods and services provided under the health and education emergency components by the project management unit, local elites and/or community members. These risks would be mitigated by the planned institutional arrangements and by training of potential beneficiaries in the use of goods and services provided by the project. In the case of anti-malaria strategies, mosquito nets would be distributed in the context of the massive immunization campaigns that the Government, with support from WHO and UNICEF, has launched in recent months. Distribution would be accompanied by short training. Teachers benefiting from on-the-job training would receive school supplies and teaching materials, and would be trained to teach students, parents, and Parents Teachers Associations (PTAs) on how to best manage school supplies. CDD approaches and an adapted version of the existing manual of the pilot CDD operation will ensure that elite capture is negligible and that procedures and targeting approaches are transparent and equitable. Other risks include low utilization of bed nets and poor management of school supplies. The concerned ministries would monitor these risks together with supervision missions. The project would undertake a study at mid-course to assess use and management of supplies and take corrective actions as needed. The risks are reevaluated in Annex 6. 10 Annex 1:EpidemiologicalandEducationSituationsin the CentralAfrican Republic 1, The increasing poverty and disintegration of social structures have contributed to the growing incidence o f communicable diseases, including malaria, diarrhea, HIV, and AIDS. Only 37 percent o f the rural population lives less than 10 km from a sanitary service. With on an average one health center for 6,000 and one bed for 1,095 inhabitants, and health centers having little equipment and sanitary material and often operating without tap water, latrines, and adequate management o f biomedical waste, the current health-sector infrastructurei s grossly inadequate. 2. HIV/AIDS epidemiology. HIV/AIDS and its "opportunistic diseases" have become a substantial threat to the economic and social development o f the country. The number ofpeople infectedwith HIV has increased steadily since the identification of the first cases o f AIDS in the mid-eighties. UNAIDS estimated that at the start o f the original project in 2001, 10.7 percent of the population aged 15 to 49 was infected with HIV. UNAIDS used a methodbased on measuring the HIV/AIDS infectionrate among pregnant women and extrapolatingthe results to the whole population. This placed CAR as the 10thmost HIV-infected country insub-Saharan Africa. 3. In2006, CNLS conducted a seroprevalence study on 11samples (including 5,413 women and 5,179 men from 15 to 49 years o f age) all over the country, with assistance supported by many donors, including IDA under PPA advances. CAR has a generalized epidemic with highregional variations however. e OverallHIV prevalence rate inCAR i s 6.2 percent e Gender: The HIV prevalence rate for women i s 7.8 percent and for men 4.3 percent e Age: The highest prevalence rate for women i s inthe age group 30 to 35 years (12 percent) and for men inthe age group 35 to 39 years (10percent) e Type o f society: Inurban areas the HIV prevalence rate is 8.3 percent and inrural areas 4.7 percent e Administrative regions: There are substantial differences between prefectures, the prevalence rate ranging from 1percent to 15 percent, with 7.8 percent inBangui the capital city. e Religion: The prevalence rate for the Catholics i s almost the same as for Protestants (3.4 percent for menand 7.4 for women vs. 4.3 percent for men and 7.4 for women). Muslimshave higher rates at 9.7 percent and 10.7 percent, respectively, and animists the highest (11.O overall) e Education level: The highestprevalence rate among men i s for those with high school and university education (10.4 percent) and for women for those with secondary education (13.O percent) e Profession: The far highest prevalence rate i s among the uniformed personnel (military, police) at 21.1 percent. The second highest is among service occupations and non-skilledworkers at 8.5 percent 11 Standard o f living: The highest prevalence rates are in the richest group (4.9 percent for men and 10.9 for women) and the lowest for the poorest people (3.4 percent for menand 4.7 percent for women). 4. The former UNAIDS estimates were based on few antenatal clinics. New estimates are based on a wider national sample. Similar differences have been observed in many other countries, including in neighboring countries Cameroon and Benin. The lower estimate in2006 may also be affected bythe highmortality of PLWHA since 2001. Based on the recent study, the total number o f seropositive people would be about 200,000, most o f whom are not aware o f their infection status and contribute to spreading the infection. Among the infected persons, 54 percent are estimated to be women, 42 percent men, and 4 percent childreno f 0-14. Currently only 2,000 AIDS patients receive ARV treatment. The number oforphan childrenis estimated at about 110,000. 5. Malaria. Malaria is one o f the most important causes of death in CAR. There were 2,210 malaria cases per 100,000 people in2000. In2003, the mortality rate due to malaria was 650/100,000 inhabitants, but amounted to 777/100,000 in the 0-4 year category. The available indicators confirm the severity o f the health crisis, o f which malaria ranks as one o f the key causes. From 1988 to 2003 life expectancy went from 48.9 to 42.7 years. From 1995 to 2003 the maternal mortality ratio increased from 986 to 1355 per 100,000 and the under five mortality from 157 to 220/1000. 6. CNLS TS reports the following contributions from the Global Fund and other donors. Global Fundcontributions Programs Period Budget Budget Amount Balance budget phase 1 phase2 spent (2 years) (3 years) access to global treatment for 25,0903 94 2004-2009 8,198,921 16,811,673 12446735 12,643,859 Strengthening support to orphans 16,265,930 2005-2010 4,695,012 11.570.918 3347750 12.918.180 Strengthening the fight against 4,808,885 Tuberculosis 2005-2010 1,939,529 2,953,483 Reducing malaria inCAR 17,857,068 2005-2010 10,592,8 16 12,574,320 12 Targets for phase 1 Programs Global Fundindicators (2 years) Strengthening Nb ofpatients underARV 3,961 access to global 1,400 treatment for Nb ofpatients accessing I PLWHA Voluntary Counseling and 106,000 58,645 Testing(VCT) 31,000 Number o f foster families supported with food and I 4,603 supplies 2,250 Strengthening Number o f Orphans and support to orphans Vulnerable Children (OVC) reintegrated into 4,500 7,676 "foster families" Number o f O V C I sponsored inschool 6,000 11,080 Number o f new TPM+ Strengthening the cases identified 6,050 7,700 6,159 fight against tuberculosis Number o f new TPM+ cases treated with success 2,723 Number o f households I with long term ITBN 280,000 125,828 Reducingmalaria inCAR Number o f children <5 years accessing to malaria 206,430 treatment inhealth centers 51,609 Main contributionsfrom other donors 2004 2005 2006 Total 2004-06 % of (US$) (US$) (US$) (US$) contributions WORLD FOOD 730,234 1,185,843 2,338,851 4,254,928 27.88 I PROGRAM I I I I I I Source:Dataassembled by UNAIDS,December2006 13 7. Education: The recent deterioration of the education system i s a major challenge. School attendance tripled between 1960 and 1970 and increased by a further 40 percent duringthe 1970s. However, since the late 1980s, the education systemhas been avictim of civil strife: (a) the completionrate inthe primary cycle stagnated at around 30 percent duringthe period 1988-2005; (b) the teachedpupil ratio fell from 1/63 in 1987 to 1/87 in 2003 and 1/79 in 2004 and 1/92 in2005/2006 period, reaching as low as 1/160 incertain schools); the girlshoys ratio has stayed at about 7 to 10. Furthermore, the quality o f education is low; the rate of success inthe final examinationo f the primary school is only about 34 percent. The results o f the report on the national situation by the recent Country Status Report (Rapport d 'Etat d'un Systkme Educatif National -RESEN) assessment show that actual learning inmathematics and French i s among the lowest inFrancophone countries. The repetitionrate i s high at more than 30 percent o f pupils versus an average o f 10 percent in Africa, and 40 o f pupils drop out before completing primary school. Almost half o f the teachers inthe primary schools are "parent-teachers," poorly paid, and livinginthepoorest villages. 14 Annex 2: Detailedchanges in Project design Component 1: Support to the NationalProgram againstHIV/AIDS 1. Subcomponent 1 (a): Civil society responses against HIV and AIDS: The restructured project would focus on supporting action plans against HIVIAIDS prepared by two main categories of CSO: around 50 youth organizations, a federation o f associations o f people living with HIV-AIDS (PLWHA) and 30 PLWHA associations in areas not yet supported by other donors. These CSO would focus on behavioral changes and support to infected and affected people. Both youth organizations and associations o f PLWHA would make special efforts to reach sex workers, following training o f trainers provided with PPF support to 10youth organizations and to the federation o f PLWHA. In 2004, similar training involved four young sex workers organizations and two branches o f the federation of PLWHA (young sex workers and adult sex workers). The project would select beneficiary organizations on the basis of criteria defined in the Operational Manual o f the project. Financing would be based on annual contracts with an obligation to report against key project indicators. 2. Subcomponent 1 (b): Ministry of Health responses against HIV/AIDS. The restructured project would support M o H in its efforts to enhance access to HIVIAIDS prevention, care, and treatment. Project funding for the programs o f M o H would supplement the financing providedby the Global Fundand others, focusing in geographic areas and activities not served by these other donors to increase use o f PMTCT services bypregnantwomen incenters: Increase use o f VCT services; 0 Increase access to ARV by PLWA; and 0 Improve compliance with national blood testing guidelines and with a medicalwaste mitigationplan. Financing would be based on annual contracts with an obligation to report against key project indicators. 3. Subcomponent 1 (c): Other public-sector responses against HIV/AIDS. The restructured project would keep the initial objectives o f supporting public sector responses but would reduce this support to four priority public sectors, that is, the Ministries o f Education, Defense, Social and Public Services. The project would support priority activities identified inthese ministries and contributing to prevention and support to affected and infected people, using annual agreements with outputs and results indicators. CNLS successfully funded such action plans between 2002 and 2006, under PPFs advances. Bed nets would be distributed as part o f the on-going comprehensive under 5 immunization campaigns. 4. Subcomponent 1(d) Coordination, supervision, and monitoring and evaluation. The project would finance the operation o f the CNLS Technical Secretariat and provide limited support to the decentralized coordinating committees at the prefecture level. 15 CNLS Technical Secretariat would assist the various actors implementing the national strategy against HIV/AIDS to prepare their annual action plans and budgets in line with the framework of a national program against HIV/AIDS. The project would also support three key steps in monitoring and evaluation: a national Health and HIV-AIDS study, a second generation sero- surveillance study, and quarterly reports of health centers against the National HIV-AIDS Strategy indicators. Component 2: Support to emergency needs in the Health Sector 5. Component 2 (a): Malaria prevention and improved access to emergency health services. This subcomponent would mainly procure and distribute: (i) insecticide-treated bed nets (ITBN) for pregnant women and children under age five and (ii)equipment for emergency health services. It would complement the limited provision of ITMN under the Global Fund program, and follow WHO guidelines and existing arrangements for distribution. 6. Subcomponent 2 (b): Small emergency community subprojects. The project would finance small subprojects prepared with communities and civil-society organizations, addressing emergency health needs. These would include mainly (i) small rural water supply systems contributing to improve health and to reduce of transmission of infectious disease (ii)drainage of marshlands to reduce reproduction and spreading of mosquitoes and (iii)other works, supplies and services of an emergency nature as identified by communities as priorities (small medical supplies, limited rehabilitation, training of health workers and of community members in basic preventive care). This subcomponent would support contracting of an agency to channel funds to CSOs and communities initiatives. It would also support engineers from General Directorate from Hydraulics (GDH), from Ministry of Energy, Mining and Hydraulic, to provide the technical assistance to design and implement the civil works involved. 7. Subcomponent 2 (c): Coordination, supervision, and M&E. The project would support limited financing to assist the Ministry of Health to supervise, monitor, and evaluate the above activities. Component 3: Support to emergency needs in the Education Sector 8. Subcomponent 3 (a): Training of primary schools teachers. The project would improve the quality of teaching at the primary level and respond to urgent needs in providing teaching services, by focusing on teachers' training and improving the student to teacher ratio; US$1.5 million would be used to finance twenty months of on-the-job training for student-teachers. This activity would involve around 750 new apprentice teachers in the classrooms to help them get acquainted with on-the-job educational challenges. The proposed student-teachers system would help make the transition towards increased and better prepared educational staff, 9. Subcomponent 3 (b): Access to educational materials in primary schools. Increase the number of textbooks, small furniture, teaching kits, and other educational material in primary schools in underserved areas. 16 10. The two above activities would address urgent needs in the education sector, as part o f the Government strategy to address the systemic weakness o f the sector. This strategy i s centered inthe preparation o f a plan, which would then allow CAR to access the Education for All Program (EFAP) under the Fast Track Initiative (FTI). EFAP i s a major global multi-donor partnership initiative to enable more low-income countries to access donor resources and accelerate progress towards quality universal primary education. The FTI i s a special funding mechanism o f the EFAP, administered by the World Bank in support o f the poorest performers inprimary education, to enable them to have access to the EFAP funding, also by finalizing an education strategic plan, which in the case o f CAR i s currently under preparation following the diagnostic o f the sector (RESEN). There would be a clear continuity between the actions proposed under this component and a full Educationfor All program. 11, Subcomponent3 (c): Coordination, supervision, and M&E. The project would support limited financing to assist the Ministry o f Education to supervise, monitor and evaluate the above activities. Component4: Supportto a FinancialManagementand ProcurementUnit 12. The project would support a small Financial Management and Procurement Unit whose primary purpose i s to channel funds to the three implementing agencies. The unit would include a financial management specialist and a procurement specialist, both internationally hired and experienced in similar projects. The unit would be placed under the authority o f the ICIC. The unit could be hosted in one office in CNLS and use the facilities put inplace with IDA funds inCNLS. 17 Annex 3: ResultsFramework,target values, data collection and reporting Table a. Resultsframework 1. Expectedresults will comprise key outputs across the three components to reflect the nature o f activities supported and taking into account the lack o fbaseline values against which concrete targets can be set PDO Key Outcome Indicators Use of Outcome Information Increased adoption o f HIV/AIDS mevention Contribution to meet (a) urgent needs measures and increased access to treatment: inthe fight againstHIV suchas (i)Number of men and women who Informationwould demonstrate access to prevention, treatment, and accepted V C T and received test results effectiveness ofboth HIV/AIDS impact mitigation services, and (b) intargetedhealthcenters. awareness1sensitization campaign urgent social needs such as (ii)NumberofPLWAreceivingARVin as well as availability and use o f prevention o f malaria, increased targeted health centers. testing material. Access to VCT access to water supply and improved (iii)NumberofPLWHAreceivingsupport was chosen as K P I since testing i s primary education. through their associations or their entrypoint for other measures national federation o f associations. aiming at prevention and treatment. Increased adoption o f preventive measures against malaria (vi) Additional number o f households using Information would demonstrate ITBNs. adoption very important preventionmeasure, which has a Increasedaccess to water supplv: highimpactyonmalaria (v) Number o f people having access to water prevalence, as experience shows. points provided by the project. Informationwould show Improved primary education: qualitative impact o f project (vi) Number o f teachers meeting minimum outputs oneducation quality. teaching qualifications' intargeted areas. Information would also support preparation o f future investments o f the World Bank inthe Educationsector. 'listof minimum aualifications is to be determined along preparation of baseline study 18 Intermediate Results ResultsIndicators and Key Outputs for Each Use of Results Component Monitoring Component 1: Support to the 0 (i)Number of pregnant women reached by To monitor to which National Program avainst HIV- PMTCT during the last 12 months in targeted degree and AIDS Healthcenters immediate effects 0 (ii) ofbloodtransfusionpocketstestedfor Number key activities o f the HIVand other bloodborne infections intargeted nationalprogram health centers have beencarried 0 (iii) ofhealthcentersimplementing Number out. measures planned inthe MedicalWaste Mitigation Plan 0 (iv) Number o fpublic-sector HIV actionplans developed and implemented (v) Number o f youth HIV action plans developed and implemented Component 2: 0 (i) Number o f ITBNdistributedthrough project. To monitor Support to Emergency health 0 (ii) ofnewruralcommunitywaterpoints Number implementationo f Needs established through project. key activities from 0 (iii) areadrained(throughproject)of(previous) m2 National Program standing water and marshlands identified by against Malaria with population as major cause o f malaria transmission high probability o f in communities expected impact on malaria prevalence (on the basis of proven experience made inother malaria infested areas). Component 3: To increase quality Support to Emergency Education 0 (i)Studentbooks ratio intargeted areas and results o f primary Needs education 2. Arrangements for results monitoring. FMPU would have the main responsibility for collecting and transmitting the M&E reports form each sector. Quarterly and annual reports would come from benefitinghealth centers, youth, PLWHA associations, public sectors, and communities; these reports would be a condition for follow-up support as detailed in the implementation manual. FMPU would contract a study to collect baseline data within six months o f effectiveness and another study at project end. Each implementing sector (or agency in the case o f grants to CSO and communities) would have the responsibility to collect and present data against the above indicators. At the end o f each year, each sector would document the status o f the above indicators in annual reports, to be produced no later than 3 months after the end o f each year. Each sector would also document indicators in its sector in general. For example, CNLS would document generic MAP indicators. CNLS provided a table o f these indicators; it is available as a supporting document. As described in the main text, the project would also contribute to data collection to monitor and evaluate implementation o f the National AIDS strategy, on a quarterly basis, against the indicators of this strategy. 19 w rr 0 0 U 0- 5 8 CY -4 w U 5 4 w 0 0 0 0 5 8 P d E z 0 0 3 -+----- 2 0 0 W 0 vl 9 s U M E 0 3 0 0 0 d d K) 3 z- 0 m d- z* 3 3 0 r4 N 3 0 m hl 3 ci .% B a 0 0 8 v, 3 0 0 8 v, 0 0 0 .E 0 .r( YE Annex 4: Project Costs The table below present the project costs for the remaining SDR13,300,000 after deduction o f PPF advances already consumed (SDR 1,350,000). The table i s only an estimation inUSD basedon equivalency o f SDR13,300,000 at time of project preparation Project Cost by Component andor Activity Total (US$ million) Component 1:Support to the National Program against HIV-AIDS Subcomponent1(a): Civil -society responses against HIV-AIDS 720 Subcomponent I (b): Ministry of Health responses against H I V M D S 4,599 Subcomponent I (c): Otherpublic-sector responses against HIV/AIDS 180 Subcomponent 1(d): Coordination, supervision, and M&E 970 Total component 1: 6,469 Component 2 :Support to emergency health needs Subcomponent 2(a): Malaria prevention and improved access to emergency health services 2,700 Subcomponent 2(b): Support to emergency community subprojects 3,680 Subcomponent 2 c): Coordination, supervision, and M&E I80 Total component2 : 6,560 Component 3 :Support to emergency educationneeds Subcomponent 3(a): Training of primary schools teachers 1,260 Subcomponent 3(b): Provision of educational material inprimary schools 1,260 Subcomponent 3(c): Coordination, supervision, and M&E I80 Total component3 : 2,700 Component 4: Support to a Financial Management and Procurement Unit (FMPU) Consultant and operational costs of the FMPU I80 Total component4 : 180 Unallocated 1,591 Total of the four componentsand unallocated 17,500 IThe total project cost, net of taxes, i s US$17.5 million. IDA will finance 100percent of project costs net o f taxes. Details are provided under the financing plan. 24 Annex 5: Analysis ofEconomic,Financial,andTechnicalIssues 1. The proposed changes would affect the original social, economic, financial, technical, institutional, and social aspects o f the project design. The main results o f the economical, financial, andtechnical issues are as described below. 2. Economic and Financial analysis. The economic analysis on HIV/AIDS has been carried out under the Second Multi-Country HIV/AIDS Program for the Africa Region (Report No. P7497). It provides the economic justification for the second- generation MAPS. The report concludes that HIV/AIDS reduces the value o f three important factors o f economic growth: physical, human, and social capital. The analysis in the report includes an overall assessment of the impact of HIV/AIDS on economic development and the cost-benefit o f HIV/AIDS interventions, showing that a reduction in AIDS-related deaths would increase the growth o f GDP. As elsewhere in Africa, HIV/AIDS inCAR intensifies poverty because infectedpeople have shorter economically productive lives. The fiscal impact of the project is expected to be modest. No counterpart funds would be required and the project would therefore not impose a financial burden on the Government. Since 2002, the Government i s supporting salaries and basic operations of TWCNLS, to coordinate implementation o f the national strategy against HIV-AIDS. 3. The economic analysis on malaria has been made in the context of regional and sub-regional studies. Macroeconomic projections show that the impact o f malaria on productivity o f workers and on external investments into endemic countries i s major and has a deleterious impact on growth and poverty reduction strategies. It i s estimated that malaria reduces GDP growth by approximately 1 full percentage point per year. The poor are affected most as they have less access to medical services, information and protective measures, and less opportunity to avoid living or working in malaria-affected areas. Infact, poor populations are at greatest risk; 58 percent o f the cases occur inthe poorest 20 percent o f the world's population, and these patients receive the worst care and have catastrophic economic consequencesfrom their illness2 4. Ineducation, the Country Status Report on education (RESEN) shows that most cost effective investments in the context o f CAR are those related to the supply o f schooling materials (textbooks and pens) and increase in availability o f teachers and o f their services, as well as reduction o f their in-class training period in favor o f on-the-job training. The current restructuringbuilds on the main findings o f the RESEN. 2Conqueringthe intolerableburdenof malaria: what's new, what's needed, BremanJG, Alilio MS, MillsA. Am J 1rop \led 1111. 2003 25 Table 1:Cost-effectiveness of different options of educational policy - CAR Impact :- negativeimpact, 0 :no impact, * : significant impact, ** :highimpact, ***: veryhigh impact; Cost : +++ : major savings, 0 : no cost, $ : low cost, $$ :high cost, $$$ :very highcost Source: RESEN-CentralAfrican Republic-Draft February2007. 5. Technical issues. The actual approaches o f the restructured project follow the MAP principles and the draft national strategy against HIV/AIDS, which reflects a consensus among all stakeholders. The technical design o f the project i s in line with the goals o f the original project: a To stimulate changes in behavior and attitude o f the population by helping communities to carry out their own responses, both directly and through social and voluntary organizations that have extensive networks inthe country. a To assign highpriority to proven and cost-effective interventions for the groups at highest risk o f acquiring and transmitting HIV by improving testing, counseling and care and support inorder to create a positive environment. a To make special efforts to reduce new infections inprofessional and other groups that have proven to be at increased risk for the infection, while also increasing the provision o f information and preventive services to the general population or groups that still are at lower risk. a To monitor the progress o f HIV/AIDS and evaluate the effectiveness o f the actions taken by the project, including carrying out a baseline survey in order to facilitate the tracking o f trends over time. 6. Because many lessons inHIV/AIDS prevention and care have been learned since the original project design, the restructured project would incorporate the current internationally accepted practices for HN/AIDS responses, as set forth in UNAIDS guidance on HIV/AIDS and inMAP guidelines o f the World Bank's Africa Region, inits annual implementation plans. In particular, the restructured project would support strengthening the implementation o f the "three ones" approach. The UNAIDS Thematic Group would continue to advise CNLS and the Project duringproject implementation. 26 7. The activities under the Health and Education components follow a two-pronged approach. (i) First, the project will take into account the emergency nature o f some o f these interventions, in particular in the areas o f supply o f bed nets, teachers on-the-job training support, and provision o f learning materials. These activities would be managed directly by the Ministries o f Health and Education, respectively; they would complement other donors interventions (the Global Fundinparticular), are part o f the Government strategy as described in the I-PRSP, and are built on sector strategies, ineducation inparticular. (ii) Second, the development o f a community-based approach to deliver selected basic services will contribute in addressing the issues of governance and social cohesion, which have been major victims o f the long conflict inCAR. Due to the quasi-abandonment o f local communities by the central Government, the population o f CAR-in rural areas especially-remains deeply distrustful o f Government, its officials, and its ability to deliver basic social services. The proposed approach will ensure the involvement o f communities in project identification, implementation, and evaluation. The World Bank has a clear comparative advantage in supporting this approach, given its extensive involvement in community based and CDD projects in other post-conflict, crisis affected LICUS countries (Liberia, Sierra Leone, and Togo for example). As discussed in a recent Bank paper (Conflict and Development in Africa: A proposed Regional Approach, August 2006), in countries such as CAR, IDA assistance should focus on (a) laying the ground o f improved economic governance; (b) delivering early "peace dividends", typically a few pieces o f important infrastructure; and (c) supporting small-scale, community-level activities in key areas where such actions can have a tangible impact in a relatively short period o f time. 8. The activities under these two approaches will build on experiences o f other donors (inthe health sector inparticular) and on activities financed under the LICUS TF (first round in 2004-2005 to support emergency basic services in the Northern regions, which was implemented byUNagencies and InternationalNGOs; and second roundwith an on-going operation in the social sectors which supports community development activities infour prefectures). 27 Annex 6. Summary of legal covenants Additional Conditions o f Effectiveness: the Recipient has established the ImplementationCommittee ina form andwith functions, staffing andresources satisfactory to the Association; the Recipient has established the FMPUwithinthe ImplementationCommitteein a form andwith functions, staffing andresources satisfactory to the Association, includinga financial management specialist andaprocurement specialist; the Recipient has adopted: (i) amendedProjectImplementationManual; (ii) the the amendedFinancialandAccountingManual; (iii) amended Monitoring and the EvaluationManua1;and (iv) an amended procurement plan; all inform and substance satisfactory to the Association; the Recipient has appointed financial management staff with satisfactory qualifications inCNLS TS, Ministryof health and Education, to manage Credit funds; and that the executionand delivery of the Amended and Restated Development Credit Agreement has beenduly authorized or ratified by all necessary governmental action. WithdrawalConditions; WithdrawalPeriod No withdrawal shall be made: (i) under sub-components 1(a) and2(b), prior to the express satisfaction ofthe Associationthat the Recipient shall appointed within the FMPUtwo technical assistants specialized inchanneling funds to CSOs and Communities, and (ii) under sub-components 2(b) with respect to any drainage o fmarshlands or construction o f water supply Sub-projects, prior to the express satisfaction o f the Associationthat the RevisedESMP hasbeen adopted inform and substance satisfactory to the Association. Datedcovenants (i) No later than 3 months after the RestructuringEffectiveDate, the Recipient shall have appointed within the FMPUtwo technical assistants specialized inthe channeling o f funds to CSO and communities, with satisfactory qualifications (ii) No later than 3 months after the RestructuringEffectiveDate, the Recipient throughthe Ministry o fPlanning shall have adopted the RevisedESMP, inform and substance satisfactory to the Association. 28 ProjectName Restructuring o f the MultisectoralHIV/AIDS Project Region AFRICA Sector Health (47%); Other social services (33%); Central government administration(15%); Sub-national government administration (5%) Proiect ID " PO73525 Borrower(s) CENTRAL AFRICAN REPUBLIC ImplementingAgency MinistryofPlanning, Economy and InternationalCooperation Po Box 696, Bangui, Central African Republic Phone number: +(236) 61 38 00 or +(236) 61 38 05 Fax number i s : +(236) 61 73 87 EnvironmentCategory [ ] A [XIB [ ] C [ 3 FI [ ] TBD (to be determined) IDate PID PreDared A ~ r i18.2007 l Date of Appraisal I April 23,2001 I Authorization Dateof BoardApproval December 14,2001 (Board date for restructuringMay 24,2007) 1. Country and Sector Background Despite the country's tense political situation, the Government, with assistance from donors has made an effort to improve prospects for sustained civil peace and lay the foundations for economic recovery and poverty alleviation. These actions, combinedwith budget support and technical assistance from the Bretton Woods institutions allowed a return to an average 4 percent rate o f growth between 1997 and 1999. This upward trend was interruptedby two exogenous shocks in2000; first, a sharp rise ininternationaloil prices, then an unexpected interruptionin the national supply ofpetroleumproducts via the OubanguiRiver. The Government has expressedits commitment to halt the degradation o fthe country's humanandphysical capital and to develop the nation's natural potential. To improve access to social services, the Government intends, among other things, to decentralize decision-makingprocesses andto involve communities inplanning, managing, and financing o f social sector programs, including health services. Epidemiological Situationo f HIV/AIDSIncreasingpoverty and disintegration o f social structures have contributedto an increase inthe incidence of communicable diseases, including malaria, diarrhea, and HIV/AIDS. HIV/AIDS and its relatedopportunistic infectionshave become a substantial threat to the economic and social development o fthe country. The number o fpeople infectedwith HIVhas been increasing steadily since the identificationo fthe first cases o f AIDS inthe mid-eighties. According to 1999UNAIDS estimates 13.84 percent o f the adult population (15 to 49 years o f age) were infectedwith HIV.Estimates indicate a total number o f people infectedwith HIV o f 240,000 (with 54 percent women, 42 percent men, and 4 percent children ages zero to fourteen), a total number o f deaths due to AIDS between 13,000 and 23,000, and the number o f living maternal and double orphans exceeding 70,000. These results place the CAR as the tenthmost HIV-infected country insub-Saharan Africa. Despitethe efforts o fthe Government and various donor andother agencies, the epidemic has shown no signs o f abating. The Government has approached the World Bank for resources inthe context o fthe MAP'Sfirst phase. The CARis eligible for MAPfundinginthat it satisfiesthe four MAP eligibility criteria: Satisfactory evidence o f a strategic approach to HIV/AIDS. A Government- appointed working group i s preparing a multi-sectoral strategy against HIVIAIDS andhas prepared a situational analysis and a positionpaper. 2. Objectives The objectives related to the fight against HIV and AIDS have been adjusted in line with the country's updated National Strategy against HIV-AIDS (2006-2010). The revised objectives reflect today's understanding that MAPprojects cannot use prevalence rates as impact indicators. The revised objectives would be to contribute to meeting (a) urgent needs in the fight against HIV, such as access to prevention, treatment, and impact mitigation services (b) urgent social needs such as prevention o f malaria, increased access to water supply and improved primary education. 3. Rationale for Bank Involvement New emergencies resultingfrom civil disturbances. The CAR Intermediate Strategy Note (ISN) proposed addressing emergency social needs, through the use o f some o f the funds remaining under the HIV/AIDS Project. More than ten years of civil unrest, chronic government policy mismanagement, and lack or misallocation o f resources have reduced both the coverage and quality o f essential services, such as primary education, provision o f basic health services, and access to water and sanitation. In December 2006, an identification mission agreed with the Government on priority emergency social needs inthe health and education sectors. HIV-AIDSremains amajor probleminCAR. UNAIDS estimates HIVprevalence inCARat about 6,2 percent among the population from 15 to 49 years o f age, well above the 3 to 5 percent rates inneighboring countries. To fight against HIV and AIDS, the Global Fundmobilized US$29 million for the period 2004-2008, andUNagencies andthe World Bank contributed US$14 million. Somebilateral agencies and faith-based organizations (FBOs) made significant contributions; for example, the Germancooperationsupported the provision o f condoms, France provided technical assistance, andthe RedCross supported a pilot treatment center. Donor support mainly fundedimproved access to care and treatment for persons livingwith HIV/AIDS (PLWHA), support to orphans andprevention(mainly provisionof condoms), but only inthe capital city. More fundingi s now available, but little fundingi s available for prevention, leading to increasing infectionrates. 4. Description The project components and subcomponents would reflect the new objectives, addressing HIV/AIDS, health and education emergency needs. The restructured project would include a component for each sector, plus a component for a small financial management and procurement unit.Eachcomponent would include subcomponents for specific activities. Component 1:Support to the National Program against HIV-AIDS Subcomponent 1 (a): Civil society responses against HIV/AIDS: The restructured project would focus on supporting 50 youth organizations, a federation o f associations o f PLWHA, and 30 PLWHA associations. Subcomponent 1 (b): Ministry of Health responses against HIPZAIDS. The restructured project would support Ministry o f Health activities by enhancing access to prevention, care, and treatment regarding HIV/AIDS. Project funding for the programs o f the Ministry o f Health would supplement the financing providedby the Global Fund and others, focusing ingeographic areas not servedby other donors. Subcomponent 1 (c): Other public-sector responses against HIV/AIDS. The restructuredproject would follow the initial objectives o f supporting public-sector responses inthe following priority public sectors: Education, Defense, Social, and Public Services. Subcomponent 1(d) Coordination, supervision, and monitoring and evaluation (M&E). The project would finance the operations o f the CNLS Technical Secretariat and the decentralized coordinatingcommittees at the prefecture level. The project would also support three studies for the monitoring and evaluation (M&E) o f the National Programagainst HIV/AIDS. Component2: Support to emergencyHealthneeds Component 2 (a): Malaria prevention and improved access to emergency health services. This subcomponent would mainly procure and distribute: (i)about 300,000 insecticide-treated mosquito nets (ITMN) for pregnant women and children under age five and (ii) equipment for emergency health services. It would complement Global Fund support, following WHO guidelines. Subcomponent 2 (b): Small emergency community subprojects. The project would finance small subprojects prepared with communities and civil-society organizations, addressing emergency health needs, such as small rural water supply systems and drainage o f marshlands to reduce reproduction and spreading o f mosquitoes. This subcomponent would support the establishment o f an agency to channel funds to civil-society organizations (CSO) and community initiatives. It would also support engineers from "Direction Generale de 1'Hydraulique" (DGH) from Ministry of Energy, Mining and Hydraulic, to provide the technical assistance to design and implement the civil works involved. Subcomponent 2 (c): Coordination, supervision, and M&E. The project would support limited financing to assist the Ministry o f Healthto supervise, monitor, and evaluate the above activities. Component3: Supportto emergencyEducationneeds Subcomponent 3 (a): Training of primary schools teachers. The project would improve the quality o f teaching at the primary level and respond to urgent needs o f providing teaching services, by focusing on teachers' training and improving the student to teacher ratio. Sub-component 3 (b): Access to educational materials in primary schools. The project would provide textbooks and other educational materialinprimary schools. Subcomponent3 (c): Coordination, supervision, and M&E. The project would support limited financing to assist the Ministry o f Education to supervise, monitor, and evaluate the above activities. Component 4: Supportto a FinancialManagementandProcurementUnit Theprojectwould support a small FinancialManagement andProcurement Unit, to channel funds to the three implementingagencies. The unitwould include an experienced financial management specialist and an experienced procurement specialist, bothinternationallyhired. 5. Financing Source: ($mJ BORROWERRECIPIENT 0.5 InternationalDevelopment Association (IDA) 17 Total 17.5 6. Implementation Implementationarrangements would reflect the involvement o f concerned sectors, that is, CNLS (on HIV/AIDS related issues), Health, Education and Ministryo f Mining, Energy and Hydraulic (on water supply and drainage). To provide effective support to these sectors, the government would take, prior to the effectiveness o f the restructuring o f the Project, an inter-ministerial decision to create (a) an "Implementation Committee for IDA Credit 3485-CA" (ICIC) as a formal inter-ministerial committee to be chaired by a representative from the Ministry o f Planning, and (b) a financial management and procurement unit (FMPU) attached to this committee, described below. The members o f this Implementation Committee would be a representative o f Ministry o f Planning (Chair), a senior officer from each Ministryinvolved in implementation o f project activities and from CNLS, and one officer from the Ministry o f Finance. The Implementation Committee would supervise the Financial Management and Procurement Unit (FMPU); it also would approve annual work plans and budgets, quarterly reports, and M&E reports o f the project. The members o f the Committee would take part in regular supervision missions. The Implementation Committee for IDA Credit (ICIC) would co- sign withdrawal requests with the project financial officer. 7. Sustainability Giventhe very low probabilitythat anHIV/AIDSvaccine would be developed inthe near future to stop the devastating spread o f HIVIAIDSinthe CAR, the Government i s dedicated to mobilize additional funding requiredfor addressing the HIV/AIDScrisis over the next 10to 15 years. A conscious effort has beenmade to design the project so that the direct costs for the Government are low andthat the project can be usedas a leverage to mobilize additional resources. It i s nevertheless important to recognize the existence o frisk factors that may affect sustainability. Inparticular, despite the flexible design allowing the project to adjust to various levels o f insecurity &e., multi-yearperformance-based contracts for annual action plans o f CSOs andNGOs, reliance on CSOs,NGOs, religious organizations, traditional healers, communities, and other stakeholders who are likelyto ensure continuity o f project activities), high levels o f political uncertainty, possible delays inpayments o f counterpart funds or o f staff salaries could still disrupt the continuity required for sustainability. Aside from these areas o f concern, the project i s expected to be sustainable because it is built on strong government ownership involving all key ministries, and on broadpartnership at all levels o f the project cycle. It would scale up existing activities andprogressivelymainstream HN/AIDS operations into major government ministries and civil society. The focus on scaling up through CSOs i s expected to produce early successes that would help generate sustained support andprovide useful lessons for replication. 8. LessonsLearnedfrom PastOperations in the Country/Sector Lessons learned from past operations inthe country/sector Project design reflects key lessons learned from international experience with HIV/ADS, from HIV prevention and control efforts inthe CARandother countries inAfrica, andfromthe implementationofpreviousBank- financed projects inthe CAR.Key lessons learned from the global experience highlightthe importance o f the following elements: Although the process is difficult, scalingup from several small efforts to nationalcoverage is essential. Because implementationcapacity, particularly in the field, is weak, project components must involve a substantial capacity buildingefforts. Hence, an important part o fproject support would go to capacity building. To ensure a multi- sectoral approach to prevention and care, programs must take specific measures (e.g. mobilize CSOs,empower communities to design andimplement their own responsesto the epidemic) to involve non-health sectors. Because HIV infectioni s associatedto other diseases, such as STIs and tuberculosis, it i s essential for HIV/AIDSprograms to also prevent andtreat these associated diseases. To be effective, interventions must be made on a sufficiently large and sustainable scale, andinterventions aimed at the general population should be combinedwith interventions targeted to groups at an increased risk o f HIV infection. Mucho f the work can be contracted out to a variety o f organizations, includingpublic agencies andNGOs. Inthe CAR, the project plans to allocate most o f its resources to CSOs and communities. To improvepolicies and sustain awareness, it i s important to effectively monitor the epidemic andrisk behaviors and to disseminate findings. Giventhat several other agencies are already involved inthe fight against HIV/ADS inthe CAR,IDA-financedactivities would needto becomplementary to these efforts and to those undertaken by the Government. Another lesson that was incorporated inproject design was one learned from previous IDA-financedprojects, which highlighted the necessity to incorporate additional mechanisms to ensure compliance with the Bank'sprocurement guidelines. 9. Safeguard Policies (includingpublic consultation) SafeguardPoliciesTriggered Yes No EnvironmentalAssessment (OP/BP4.01) X NaturalHabitats(OP/BP4.04) X Forests(OP/BP 4.36) X Pest Management(OP 4.09) X PhysicalCulturalResources(OP/BP4.11) X IndigenousPeoples(OP/BP4.10) X InvoluntaryResettlement(OP/BP 4.12) X Safety of Dams(OP/BP4.37) X Proiects on InternationalWaterwavs (OP/BP 7.50) X 10. Contactpoint Contacts: Jean J. Delion Title: Senior SocialDevelopment Specialist Tel: (202) 473-5010 Email:Jdelion@worldbank.org Giuseppe Zampaglione Title: Senior OperationsOfficer Tel: (202) 473-0955 Email: Gzampaglione@worldbank.org 11. For moreinformationcontact: The InfoShop The World Bank 1818 HStreet, NW Washington, D.C. 20433 Telephone: (202) 458-4500 Fax: (202) 522-1500 Email:pic@worldbank.org Web: http://www.worldbank.org/infoshop INTEGRATED SAFEGUARDSDATASHEET APPRAISAL STAGE I.BasicInformation Datepreparedhpdated: 04/26/2007 Report No.: AC2906 Estimated Appraisal Date: April 23, 2001 Estimated Board Date: December 14, 2001 Managing Unit: AFTS3 LendingInstrument: Adaptable Program Loan 2. ProjectObjectives The Multisectoral HIV/AIDS Project i s beingrestructured. The revised objectives would be to contribute (i) to emergency HIV-AIDS needs such as prevention & treatment, (ii)to prevention o f malaria and access to water supply and (iii) toprimaryeducation. access 3. ProjectDescription Changes inProject Development Objectives (PDO). The PDO related to the fight against HIV-AIDS have been adjustedin line with the country?s updated National Strategy against HIV-AIDS (2006-2010). The revised PDOreflect today?s understanding that MAP projects cannot use prevalencerates as impact indicators. The revised PDOwould be to contribute to (i) needs inthe fight against HIV-AIDS such as access to tests urgent and treatment (ii)urgent social needs such as prevention o f malaria, increased access to water supply and improvedprimary education. Changes inproject components and sub-components. The project components and sub- components would reflect the new objectives, addressing H I V - A D S , health and education emergency needs. The restructuredproject would include a component for eachsector, plus a component for a small financial management andprocurement unit. Each component would include sub-components for specific activities. (Detailed changes inthe project design are inAnnex 2.) Component 1: Support to the NationalProgram against HN-AIDS Subcomponent 1(a): Civil society responses against HIV/AIDS: The restructured project would focus on supporting 50 youth organizations, a federation of associations o f people living with HN/AIDS (PLWHA) and 30 PLWHA associations. Subcomponent 1(b): Ministry o fHealth responses against HIV-AIDS.The restructured project would support Ministry o f Health activities by enhancing access to prevention, care andtreatment regarding HIV/ALDS. Project fhnding for the programs o f the Ministry of Healthwould supplement the financing provided by the Global Fundand others, focusing ingeographic areas not servedby other donors. Subcomponent 1(c): Other public-sector responses against HIV-AIDS.The restructured project would follow the initial objectives o f supportingpublic sector responses inthe following priority public sectors: Education, Defense, Social and Public Services. Subcomponent 1(d) Coordination, supervision, M&E. The project would finance the operations o f the CNLS Technical Secretariat and the decentralized coordinating committees at the prefecture level. The project would also support three studies for the monitoring and evaluation (M&E) o f the National Program against HIV/AIDS. Component 2: Support to emergency Healthneeds Component 2 (a): Malaria prevention and improved access to emergency health services This subcomponent would mainly procure and distribute: (i) 300,000 insecticide- about treated mosquito nets (ITMN) for pregnant women and children under age five and (ii) equipment for emergency healthservices. Itwould complement Global Fundsupport, following WHO guidelines. Subcomponent 2 (b): Small emergency health subprojects. The project would finance small subprojects prepared with communities and civil-society organizations, addressing emergency healthneeds, such as small rural water supply systems and drainage o f marshlands to reduce reproduction and spreading o f mosquitoes. This subcomponent would support the establishment of an agency to channel funds to civil-society organizations (CSO) and community initiatives. Subcomponent 2 (c): coordination, supervision, M&E. The project would support limited financing to assist the Ministryo f Health to supervise, monitor, and evaluate the above activities. Component 3: Support to emergency Educationneeds Sub-component 3 (a): Training o f primary schools teachers. The project would improve the quality o f teaching at the primary level and respond to urgent needs o f providing teaching services, by focusing on teachers? training and improvingthe student to teacher ratio. Sub-component 3 (b): Access to educational materials inprimary schools. The project wouldprovidetextbooks and other educational material inprimary schools. Subcomponent3 (c): Coordination, supervision, M&E. The project would support limited financing to assist Ministry o f Educationto supervise, monitor and evaluate the above activities. Component 4: Support to a financial management and procurement Unit The projectwould support a smallFinancialManagement andProcurement Unit,to channel funds to the three implementing agencies. The unit would include an experienced financial management specialist and an experienced procurement specialist, both internationallyhired. 4. ProjectLocationand salientphysicalcharacteristicsrelevantto the safeguard analysis Country-wide inareas not already served. Subcomponent 2(b) would include small rural water supply systems and drainage o f marshlands to reduce reproduction and spreading o f mosquitoes. 5. Environmentaland Social SafeguardsSpecialists MrAmadouKonare (AFTS1) 6. SafeguardPoliciesTripgered Yes N o EnvironmentalAssessment (OP/BP 4.01) X Natural Habitats(OP/BP4.04) X Forests(OP/BP4.36) X ~- X PhysicalCulturalResources(OP/BP 4.11) X IndigenousPeoples(OP/BP4.10) X InvoluntaryResettlement(OP/BP4.12) X Safety of Dams(OP/BP 4.37) X Projectson InternationalWaterways (OP/BP 7.50) X ProjectsinDisputedAreas (OP/BP 7.60) X 11. Key SafeguardPolicyIssues and Their Management A. Sunimary of Key Safeguard Issues 1.Describe any safeguard issues and impacts associatedwith the proposed project. Identify and describe any potential large scale, significant and/or irreversible impacts: The restructuring would not change the environmentalcategory o f the project. The effects and mitigationmeasures would be the following: - OnHIV/AIDS, the project would review the effectiveness o f the existing Medical Waste MitigationPlan (MWMP), adjust it to the present context and re-disclose the final plan, and would fund it with a provision o f US$200,000. The MWMP would also serve the health sector at large. - Inthe health sector, under component 2, subcomponent bysmall projects would involve the drainage of small marshlands and rural water supplies at the community level. These small projects would not involve land acquisition or resettlement. These small projects would trigger OP 4.01 and OP 4.04. Due to the lack o f detailed information on the number, scale and environmental characteristics o f sub-projects, at this time, the Ministry o f Health will prepare an Environmental and Social Management Framework (ESMF)acceptable to the Bank, withprocedures, guidelines and institutional arrangements for screening, review, approval, implementation and monitoring sub- project specific environmental measures. Before the start o f any drainage o f marshlands or construction o f water supply sub-projects, the Borrower will prepare specific sub- projects Environmental Management Plan. The ESMP would discuss issues regarding OP.4.37 ifit i s determined that the project will engage indam construction. Inthe context o f the EMP, the project would consult broadly project stakeholders on issues related to OP 4.07, inparticular, the drainage o fmarshlands and small water supply activities, and implement mitigationmeasures as required. The ESMP would designate the authority that would approve each specific ESMP. The use o f insecticide-treated bed nets would comply with the requirements o f OP 4.09. Under the ESMP, MOHwould provide the list o f pesticides involvedintreatment of bednets. Under approval o f the ESMP, the MOHwould confirm that it complies with WHO guidelines (class 3 pesticides) and would control strict adherence to it duringproject implementation. Under these conditions, the use of impregnated bednets and class I11insecticide for malaria would trigger OP4.09 onpest management, but would not require apest management plan, inaccordance with 4.01 Annex C. 2. Describe any potential indirect and/or longterm impacts due to anticipated future activities inthe project area: The Project environmental category remains unchanged, as Byeven with the revision o f the existing MWMP and preparation o f an ESMF, as it is expected that the impacts would be minimal, site-specific and manageable to an accepted level.. The financing agreement would plan for submission and approval o f a revised MWMP and ESMF within three months after signing of the revised credit agreement. Approval o f the ESMF would be a condition for disbursement for the concerned small projects under sub-component 2(a). The restructuring would not involve exception to the Bank?s environmental policies. 3. Describe any project alternatives (ifrelevant) considered to help avoid or minimize adverse impacts. The Borrower did not envisage alternatives: water supply i s a priority inrural areas. The Borrower i s used to address proliferation o f mosquitoes by drainage o f marshlands as it is a long-term sustainable option. 4. Describe measures taken by the borrower to address safeguard policy issues. Provide an assessment o fborrower capacity to plan and implement the measures described. CAR is a post-conflict country, the Bank has limited recent experience. Still, Ministry o f Environment i s willing to apply the planned measures. It will prepare a detailed ESMP with assistance from an international consultant inJune 2007. 5. Identifythe key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis onpotentially affected people. Ministry o f Planning and Ministryo f Environment plan to organize areview o f the proposedESMFwith Ministry o f Health, Ministry o f Energy, Mining and Hydraulic, private firms and NGOsinvolved inthe field o f the envisaged project activities. B. Disclosure Requirements Date EnvironmentalAssessment/Audit/ManagementPlan/Other: Date of receipt by the Bank 10/31/2007 Date of "in-country" disclosure 11/15/2007 Date of submission to InfoShop 11/20/2007 For category A projects, date o f distributingthe Executive Summary of the EA to the Executive Directors Pest ManagementProcess: Date of receipt by the Bank 10/31/2007 Date of "in-country" disclosure 11/15/2007 Date of submission to InfoShop 11/20/2007 * Ifthe projecttriggers the PestManagementand/or PhysicalCulturalResources, the respectiveissues are to be addressedand disclosedas part of the Environmental Assessment/Audit/orEMP. Ifin-countrydisclosureof any ofthe abovedocumentsis notexpected, please explainwhy: C. Conipliaizce Moizitoring Indicators at the Corporate Level (to befilled in when the ISDS isfiiialized by theproject decision meeting) OP/BP/GP4.01 EnvironmentAssessment - Does the project require a stand-alone EA (including EMP) report? Yes Ifyes, then didthe RegionalEnvironment Unitor SectorManager (SM) No review and approve the EAreport? Are the cost and the accountabilities for the EMP incorporated inthe Yes credit/loan? OP/BP4.04 Natural Habitats - Would the project result inany significant conversion or degradation o f N o critical natural habitats? Iftheprojectwouldresultinsignificant conversionor degradation ofother No (non-critical) natural habitats, does the project include mitigation measures acceptable to the Bank? OP4.09 PestManagement - Does the EA adequately address the pest management issues? Yes I s a separate PMP required? N o Ifyes, hasthePMPbeenreviewed andapprovedby asafeguards specialist or N/A SM? Are PMPrequirements included inproject design? Ifyes, does the project team include a Pest Management Specialist? The World BankPolicyon Disclosureof Information Have relevant safeguard policies documents been sent to the World Bank's N o Infoshop? Have relevant documents been disclosed in-country ina public place in a N o form and language that are understandable and accessible to project-affected groups and local NGOs? All SafeguardPolicies Have satisfactory calendar, budget and clear institutional responsibilities Yes been prepared for the implementation o f measures related to safeguard policies? Have costs related to safeguard policy measures been included inthe project Yes cost? Does the Monitoring and Evaluation system o f the project include the Yes monitoring o f safeguard impacts and measures related to safeguard policies? Have satisfactory implementation arrangements been agreed with the Yes borrower and the same been adequately reflected inthe project legal documents? D.Approvals Signed and submitted by: Name Date Co-Task Team Leaders: Messrs. Jean J. Delion & Giuseppe 0411912007 Zampaglione Environmental Specialist: MrAmadouKonare 0411912007 Social Development Specialist Additional Environmental andor Social DevelopmentSpecialist(s): MrFrancoisG. LeGall