HIV/AIDS in Africa- Getting Results These reports describe activities, challenges and lessons learned during the World Bank Global HIV/AIDS Program World Bank's HI/AIDS work with countries and other partners. Transporting HIV Prevention across Borders: 53323 The HIV/AIDS Project for the Abidjan-Lagos Corridor Carol Hooks and Siéle Silué Summary West Africa's main transport corridor and HIV How do you reduce HIV risk among some of the most In Africa, long-range ground transport is a major route vulnerable populations in West Africa? Along West Africa's for the spread of HIV. Drivers and their assistants main highway, the Abidjan­Lagos Transport Corridor joint overnight along their way and can spend days at border regional HIV/AIDS Project did it through careful planning crossings waiting to clear customs and border and effective monitoring, strong government commitment, formalities. These rest stops and delays provide multiple cooperation among local government authorities and the opportunities for sexual encounters that can transmit HIV health and transport sectors, community participation and and other STIs. This puts truck drivers, other mobile ownership, and targeted technical support. workers, sex workers, and the people who live along the Financed through the World Bank's Multi-country route at increased risk for HIV. HIV/AIDS Program (MAP), the Corridor Project achieved About 30 million people live along West Africa's main solid results: better knowledge of how to prevent HIV, east-west route, which stretches from Abidjan in Côte more diagnosis and treatment of sexually transmitted d'Ivoire to Lagos in Nigeria. Fourteen million people infections (STIs), greater condom availability and use, and travel along the corridor each year, and the route is greatly increased voluntary HIV counseling and testing. essential to the region's socioeconomic development. The Corridor project brought together five countries, working with different stakeholders in various locations to benefit truck drivers, sex workers, travelers, border communities, and military and customs officials. Abidjan-Lagos Corridor Project Quick Facts $16.6 million IDA grant $1.3 million Country contributions 1,022 km Corridor length 87 Implementing agencies 3,762 People trained 21 Organizations received support to care In 2001, estimated HIV prevalence rates among adults for PLHIV or vulnerable children in the five countries linked by the corridor were: 9.7% in 20 Automatic condom dispensers installed Cote d'Ivoire, 6.0% in Togo, 5.8% in Nigeria, 3.6% in 625 Condom sale points established Benin, and 3.0% in Ghana. Prevalence rates among 8.8 million Condoms distributed truck drivers and sex workers in large cities along the 16 VCT centers established corridor were multiples higher -- for example, surveys in 27,639 People used VCT centers 1992 had found that 33% of truck drivers and 80% of sex 14,202 Received STI services workers in Lomé, Togo, were HIV positive. 36 Health facilities refurbished 9 Incinerators installed 539 PLHIV accessing ART via project Seeing people in hospital with AIDS changed my view 30 million People sensitized of the world. When I was asked to develop this project, 2,978 Radio commercial airings I knew little about HIV/AIDS. Now I see just how 54 TV commercial airings important it is to the transport sector. Siélé Silué, World Bank Task Team Leader A turning point in STI/HIV/AIDS control along the female condoms. The project established 625 condom corridor ­ project rationale and goals sales points along the corridor, increasing the distribution network to 784 points of sale. HIV prevention can be especially effective when carried out in places where risky behavior occurs. So in 2001, The care and support component included voluntary development began on a joint regional HIV/AIDS Project in counseling and testing (VCT), diagnosis and treatment the Abidjan­Lagos Transport Corridor, the first sub- of STIs and opportunistic infections, community-based regional project under the World Bank Multi-country care and support, safe medical waste disposal, and HIV/AIDS Program (MAP). antiretroviral therapy (ART), added after the mid-term review. The project trained staff and renovated and The project aimed to increase access to HIV prevention, equipped eight health centers at border posts and eight basic treatment, support and care services by underserved reference hospitals to bring them up to standard in VCT. vulnerable groups, with particular attention to transport The project also trained health center staff to provide workers, migrants, sex workers, customs and immigration better medical diagnoses and treatment, contracted civil officials, and the local populations living and working along society and private sector organizations to provide the corridor--especially at the border towns. community-based care, and developed and implemented The project was expected to contribute to reducing the a medical waste management plan (including training, spread of HIV and to mitigating adverse social and materials, equipment, and awareness-raising). economic impacts of HIV along the corridor. UNAIDS was the key technical support partner. The The third component was inter- implementation of the three-and-a-half Typical Profile of corridor travelers country coordination, training, year Abidjan-Lagos Corridor Project Young and policies. This work (February 2004 ­ July 2007) was a Mobile facilitated and harmonized work turning point in STI/HIV/AIDS control Poor across borders, creating along one of Africa's most important Frequents bars, pubs, drinking parlors effective public-private-civil highways. Alcohol abuser society groups and partnerships May smoke cigarettes or use illegal to implement and assess A simple and carefully considered drugs project activities. It also aimed design Knows how to prevent HIV, but has to reduce the amount of time limited access to HIV/AIDS spent at border crossings, by This was the first regional HIV/AIDS information undertaking checkpoint studies project aiming to reduce the impact of Main sources of STI/HIV/AIDS and observation to understand HIV on the transport sector and the information are radio and television the bottlenecks, and advocacy, transport sector's contribution to IEC, training and other spreading HIV. The project design relied Little exposure to health services or measures to address them. on a participatory process that engaged disease prevention information a variety of stakeholders. This approach Very little inclination to get STI The project development built strong stakeholder ownership, from treatment team comprised high-level the heads of state down to the Source: Project baseline survey country representatives from community level. The project objectives the health and transport sectors and design were realistic, simple, and based on known and national AIDS programs, World Bank and UNAIDS conditions in the target area and the desired outcomes. staff, PLHIV, transport union representatives, donors, The intended beneficiaries were clearly identified, and the and a private sector coalition. Stakeholders from all five project kept its focus on those target groups throughout countries, including civil society and public sector implementation. The project incorporated strong representatives, participated in a series of project design commitment to regional cooperation, objectives matching workshops. This built in ownership from the beginning regional capacity, clear delineation and coordination of the and incorporated a wide variety of needs, concerns, roles of national and regional institutions, accountable perspectives, and experiences. The project was governance arrangements, and planning for sustainable designed to complement national HIV/AIDS programs outcomes. and transport sector projects. The project design, planning and implementation The project had three components... reflected lessons learned from international experience The prevention component focused on condom social in responding to HIV/AIDS, specifically the need to: marketing, information, education and communication Address regional/cross-border determinants and (IEC) and behavioral change communication (BCC). implications of HIV Interventions were tailored by audience and included radio Seek strong political leadership and commitment at programs, forming support groups for people living with the highest levels HIV (PLHIV), peer education, improving service providers' interpersonal communication skills, distributing educational Focus on factors affecting risk and vulnerability materials, community outreach, and promoting male and Empower local communities 2 Work across and with several sectors of a condom at last encounter with a client or non- Acknowledge and plan for complexity implicit in cross- regular partner increased from less than 60% to over border endeavors 70% for sex workers and to 79% for truck drivers. By 2007, nearly 28,000 people along the corridor had Use participatory processes accessed VCT services, and 8.8 million condoms had Provide critical technical assistance been distributed. All of the process and output Sequence interventions to match implementation indicators were exceeded by large amounts. Very capacity substantial progress was made towards the ambitious Build a robust monitoring and evaluation (M&E) outcome targets. system. The project also had a contraception benefit ­ the condoms distributed through the social marketing Results worth the effort component over the two-and-a half years of the project were enough to provide 109,319 couple years of The investment in laying the foundations for success paid protection (CYP) ­ compared to 9,778 CYP for off. As shown in Table 1, knowledge of how to prevent HIV condoms distributed in 2003, prior to the project. increased in primary target populations from 50-68% pre- intervention to 83-88% post-intervention. Reported use Table 1: Select Project Indicators Indicator Baseline Target Value (2005) (2007) Outcome indicators Behavior change % of truck drivers who report using a condom in last act of sexual 59.3% 90% 78.8% intercourse with a non-regular partner in the previous 12 months % of sex workers along the corridor who report using condoms with their 58.8% 80% 70.5% clients of the previous week Prevalence of gonorrhea among sex workers along the corridor 8.9% 4.5% 3.8% Knowledge % of commercial vehicle drivers who can identify at least 2 ways to prevent 68% 90% 82.7% HIV % of 15- to 24-year olds residing along the corridor who can identify at 50.4% 90% 84.4% least 2 ways to prevent HIV % of sex workers along the corridor who can identify at least 2 ways to 59.5% 90% 87.9% prevent HIV Output Indicators Number of condoms distributed through social marketing along the corridor 0.97 million 1.46 million 8.8 million Number of people who use VCT centers along the corridor 1,000 1,500 27,639 % health facilities along the corridor that report adequate supply of 30% 90% 100% antibiotics for treating STIs over the previous six months Number of checkpoints per 100 km along the corridor 9 3 5 Average time (minutes) for trucks to clear border formalities 180 90 128 Process Indicators Train border town residents as key community HIV/AIDS IEC activists 37 500 1,460 % of total disbursements to sub-projects made through civil society 0% 40% 66% organizations Staff of health facilities along the transport corridor trained on basic 0 50 287 management of HIV Source: Abidjan-Lagos Corridor Organization (ALCO) 3 Five of the "best practices" in the project Results were impressive. In a single year (2005 to 2006), the number of people accessing VCT at center Best practices are defined as relevant, efficient, effective, along the corridor rose 50 percent. The total number of ethical, sustainable, reproducible, and well-documented people tested rose from around 1000 at project inception activities within a project. The Corridor project to 27,639 by 2007, with 90% returning for their test demonstrated best practice in a number of areas to results. Use of the health centers rose by up to 200% achieve the noted success. Five of those areas are over the life of the project. highlighted here. This best practice is also a good example of health 1. Bringing prevention and care to those who need it system strengthening for disease control. The health centers used a standardized reference document, Prior to the Corridor project, health facilities (public sector adopted a continuum of care approach, used community hospitals, clinics, or dispensaries) near border crossings members to educate and motivate members of the target and checkpoints provided few if any HIV/AIDS-related groups, had good financial management tools in place, services and generally had very limited capacity. The and received needed supplies and equipment. The project conducted facility assessments and substantially project helped improve national procurement systems to improved capacity at 36 public and private health facilities. reduce stock-outs, and through coordinating It financed staff training, equipment, furniture, supplies, mechanisms such as Inter-country Facilitation reagents and drugs to treat STIs, opportunistic infections Committees and Cross-Border AIDS Committees, and common ailments. A reference guide was developed created an enabling environment for dialogue between with the five countries to harmonize their approach to the public sector health centers and NGOs. continuum of prevention, treatment, care, and support services along the corridor. The guide used a consensus 2. Strong engagement of PLHIV technical framework and covered STI/HIV/AIDS prevention education, basic standards of practice, treatment The project partnered with the West African Network of protocols, and psychosocial support. Its purpose was to People Living with HIV/AIDS (NAP+WA) to provide help ensure equal access to quality care regardless of the psychosocial and nutritional care and support to people project country in which Corridor users found themselves. infected and affected by HIV, and to help reduce HIV stigma and discrimination along the corridor. The project Health center training focused on integrated care -- also supported five national PLHIV networks and 17 prevention interventions, VCT, follow-up, ART, PMTCT in local PLHIV associations. Counselors were trained, some centers, laboratory services, treatment of STIs and support groups were set up, ambassadors from the opportunistic infections, and medical waste management. national networks were named, and NAP+WA helped Health center staff received training to improve the quality develop the harmonized policy on STI/HIV/AIDS of service provision. In addition to the basics, training paid prevention, treatment, care, and support. particular attention to making sex workers feel welcome at the centers so that they would not avoid seeking According to project managers at the Project Secretariat treatment. To ensure continuity of care for mobile people, and the World Bank, engaging PLHIV in the project to the project adopted a single medical file for following up the point where they felt it belonged to them contributed drivers and other patients who accessed services in more h to the project's success in many ways. Tey feel they than one center. Mobile clients carried their medical record are in the driver's seat, noted Abidjan-Lagos Corridor with them as they traveled. The project gave funds and Organization (ALCO) Project Manager Justin Koffi. capacity building support to associations of PLHIV to PLHIV held workshops to sensitize uniformed service provide community-based care. personnel on the rights of PLHIV and worked in other ways to educate and motivate their communities regarding HIV prevention, testing, treatment, and care. Providing treatment, care, and support to PLHIV showed others that there is life with HIV/AIDS and gave them a reason to be tested. It also promoted long-term vision. Mrs. Gouna Yawo, Coordinator, ALCO/NAP+ Project The remarked that coordination of the care and support for people living with HIV/AIDS--and orphans and vulnerable children--has contributed greatly to the setting up of self-support groups that are a guarantee of sustainability. 3. Loving Life - IEC In 2004 and 2006, the Corridor project mounted the month-long Love Life Caravan with support from the Hillacondji border ­ some of the target beneficiaries of World Bank project, UNAIDS, and the Coca Cola Africa the project's services and information Foundation. A convoy centered on a large truck outfitted 4 with a sound stage and movie screen, the Caravan that we can eat with someone infected with HIV without stopped at sites from Lagos to Abidjan, attracting over any risk. 160,000 participants along the corridor in 2004 and nearly The Love Life Caravan has become a recognized brand. three million in 2006. Broad regional and international Information kiosks at project sites sport the Caravan media coverage extended its reach even further. The logo, and the Caravan continues annually with Global Caravan used celebrities, politicians, and entertainment to Fund and other support. draw large crowds at each stop. It raised awareness of the Corridor project, educated about HIV/AIDS, fought stigma, demonstrated male and female condom use, and spread positive messages about avoiding HIV and living positively with it. It even fostered greater community engagement and interagency collaboration. Importantly, the Caravan educated and motivated young people to get involved in the battle for life. Powerful testimony by PLHIV and others affected by HIV/AIDS helped put a human face on the epidemic. PLHIV associations helped prepare speakers to tell their stories, and provided support to help them handle any negative reaction to going public. They also created support groups at each border, and people testing positive at VCT centers were referred to those support groups. These activities seem to have contributed to a gradual reduction in stigma and discrimination against PLHIV. Remarked one truck driver in Ghana who participated in the Caravan, Tanks to this Caravan, I have understood h A Love Life Caravan stop in Badagri attracts a huge crowd (2006) 2004 and 2006 Love Life Caravan in Brief 2004 2006 Number of people reached 165,209 2,991,000 Number of condoms distributed 345,300 527,000 Number of people tested for HIV 0 1,885 Number of CD4 cell counts conducted for PLHIV 0 249 Number of HIV+ referred 0 94 Estimated people reached through the media 50,000,000 882,220,000 National and local TV and radio stations, and newspaper coverage 2 TV: ORTB & LC2; 3 Radios; Benin 8 Newspapers 1 TV: ORTB; 5 Radios; 2 Newspapers 1 TV station: RTI La Première; 2 TV stations: RTI La Première, TV2 ; Cote d'Ivoire 3 Radios ; 3 Newspapers 6 Radios; 12 Newspapers 1 TV station: TV3; 3 Radios; 3 TV stations: GTV, TV3, Metro TV ; Ghana 1 Newspaper 8 Radios; 4 Newspapers Nigeria - 1 TV; 4 Radios; 3 Newspapers 1 TV station: TVT; 5 Radios; 9 2 TV stations: TVT, RTDS; 6 Radios; 13 Togo Newspapers Newspapers International media coverage BBC, Reuters, IPS IRIN, CNN+, itélé (Canal+), TV5, Al Jazeera International, 3A Télé Sud, Africable, Raina, RTBF, Quatro, Associated Press, AITV, Africa n°1, RFI, VOA, Ouest TV, ONUCI FM 5 4. Harmonized communications strategy Implementing agencies were trained in M&E and produced monthly reports on their activities. The type of The project successfully developed and implemented a data routinely collected was tied to the implementing unified sub-regional communications strategy to enable agencies' contractual obligations, for example: HIV- those involved (public sector and civil society partners, related knowledge/attitude/practice, STI incidence, VCT community groups, technical assistance partners, and visits and test results, medical supplies on hand, others) to address the HIV-related needs of border condoms distributed, number of people trained and on communities and mobile populations through a coherent, what topics, IEC/BCC materials distributed, client coordinated, and harmonized approach. Consistent satisfaction, time required to clear borders, and number messaging was crucial to the project's recognition, of informal checkpoints along the corridor. Implementing acceptance, and success in facilitating and supporting agencies in each country submitted reports to the behavior change. experienced NGO in their country (one per country, each The project supported training for more than 2,000 peer linked to the national M&E program) contracted to educators, border committee members, journalists, health monitor local activities. The five M&E NGOs compiled workers, and uniformed service members to raise and analyzed information from the local organizations, awareness, educate, and support behavior change related submitting monthly and annual reports to the Executive to HIV/AIDS, human rights, and customs regulations. Secretariat. After the project's mid-term review, M&E Advocacy efforts sought to empower communities, specialists in each of the national HIV/AIDS programs resulting in the creation of activist groups: PLHIV began supporting the collection and analysis of data--a associations, an association of transport unions, and a very positive expression of ownership and a step toward committee of religious leaders engaged in HIV/AIDS integration. education and support--including stigma reduction. Along The project developed and disseminated (with training) the corridor, kiosks were established, stocked with an M&E handbook designed to be an easy reference information and condoms, and staffed. The communication manual. It listed the procedures, tools, and information strategy held to ten guiding principles: needed to implement the system. It also helped to Engage PLHIV standardize M&E methodologies and tools across the Harmonize messages and materials based on various actors, and to facilitate course corrections as behavior change objectives needed. Emphasize community participation Well-planned and timely M&E allowed the project to Build IEC/BCC capacity of both traditional and non- identify problems early. For example, locations where traditional service providers condom sales outpaced re-supply were restocked more frequently or in higher quantities to avoid future Fight stigma and discrimination disruptions, and reported difficulties with ART referrals Use a multi-media approach to reach and affect varied led the project to add antiretroviral drug supply to the audiences services provided. The project responded to low uptake Base IEC/BCC interventions on research of female condoms (3,500 per month on average versus Pay specific attention to gender issues, and 500,000 male condoms per month) by commissioning a study to identify factors influencing female condom Engage authorities with the power to help or hinder acceptance. Completed in 2007, the study included IEC/BCC efforts. recommendations for The project results noted above speak to the effectiveness increasing use of of the IEC/BCC efforts. female condoms. Partners' willingness 5. Monitoring for impact, acting on the data to address problems identified through M&E In addition to documenting project results, the Secretariat contributed to the and partner agencies at all levels relied heavily on good- project's success. The quality M&E data to regularly assess the project and make project's ability to adjustments as it progressed. This was especially critical ensure data flow, because the project was charting new territory as the first synthesis and cross-border project of its kind. The regional and cross- utilization in sectoral nature of the project made setting up an effective stakeholder and coherent M&E system a true challenge. M&E had to consultations and cover five countries, two major languages, 87 action planning has implementing agencies, and multiple diverse target groups been impressive. spread over many locations. Despite a slow start, the M&E system was built and managed by the financial management firm contracted to support the Secretariat. ALCO shared messages on HIV in all sorts of places! 6 Transport Sector Meets HIV/AIDS Head-On the national average. Changing HIV-related behavior and monitoring progress in mobile populations is more By engaging the transport sector on issues already difficult than in settled populations. It required special important to them--such as reducing the time wasted at strategies and approaches such as creating checkpoints and border crossings--the Corridor Project community-based Border HIV/AIDS Committees and created an opening for transport workers to understand Inter-Country Facilitation Committees. M&E in their risk of contracting and spreading HIV. Now the particular requires long-term investment and vision. sector--including unions and ECOWAS--has workplace The project built solid links with country M&E systems HIV/AIDS programs that provide information and to minimize risk of duplication, and fed data into services to their constituents. national systems. Stakeholders in the target areas validated findings. The project faced many challenges Success required overcoming many and varied hurdles, often with quite innovative solutions. Creating something special from almost nothing: Border areas and checkpoints along the Corridor had almost no HIV interventions when the project started. The need for training, materials, supplies, systems, relationship development (across the various types and levels of groups that needed to be involved) and virtually everything else was staggering. The project invested heavily from the beginning to improve the odds for success. Building grassroots capacity from the ground up: The sheer number of different groups involved and the previous lack of engagement on HIV in the targeted areas made capacity building extremely difficult, time consuming, and costly. Project coordination across borders, languages, cultures, traditions, and ministries: Coordination was highly labor intensive and required considerable diplomatic and political skill. In addition to working in The project posted Information on documents required English and French, to reach large numbers of the at border crossings to help speed the process affected communities, materials and activities often had to be available in local languages as well and adapted to reflect local culture and tradition--very important Easing the flow of persons and goods across considerations in addressing the intimate behaviors and borders by simplifying border and checkpoint health practices that affect HIV. The project also policies across the five countries: The border required ministries of health, transport, and uniformed security agencies resisted changes that they feared services to work together--ministries that do not would compromise national security. This was normally do so. especially contentious during Côte d'Ivoire's political unrest. Nevertheless, the time to get through border Developing synergy among five national AIDS and checkpoints decreased from three hours to just programs and a sub-regional program: Although the over two hours. The border agencies fully cooperated project's Governing Board facilitated the process, in the IEC activities. While the project is an excellent operational-level harmonization of clinical aspects, a example of mainstreaming HIV in the transport sector, referral system, and the communications strategy was border clearing formalities have not been streamlined difficult. Subcontracting financial management and M&E enough to reduce significantly the time spent by trucks allowed the Secretariat to focus on programmatic and in front of a border. Addressing the root causes of the thematic harmonization. chaotic conditions prevailing at some borders requires Developing a sub-regional M&E system: Only a few a comprehensive program combining physical countries had a national M&E system when the project investment and regulatory and behavior change. started. Getting agreement on the M&E standards, Ministries with relevant responsibilities such as software, data collection, and reporting took much time customs duties and security concerns need to be and negotiation. engaged in solution-finding, and the Economic Community of West African States (ECOWAS) could Keeping track of highly mobile constituents: Border play a more active role in pushing the regional areas are estimated to have HIV prevalence up to twice integration agenda. 7 Other challenges included reducing truck drivers' were consolidated monthly, and ALCO reimbursed resistance to condom use, improving knowledge of how countries that provided ART to non-citizens along the HIV is transmitted and risk factors, reducing stigma corridor. The system also helped Ministries of Health (especially stigmatization of women living with HIV), and harmonize ART for mobile populations and non- addressing the nutritional needs of PLHIV. citizens and helped national AIDS programs better plan for ART services. Additional factors crucial to the project's success Waste management. To address environmental As would be expected, a host of factors had to come concerns that accompanied the massive influx of together in order for the project to achieve the desired medical supplies, the project developed a corridor outcomes. waste management strategy and plan. A full-time environment and waste management officer was Being flexible enough to innovate during hired, and WHO-compliant incinerators were installed implementation at all border posts. IEC programs also integrated As this was the first project of its kind and learning while waste management content. doing was a key principle of the MAP, the Corridor project adopted several innovative approaches not envisaged Commitment was crucial during project design. Listening to the main beneficiaries The five Governments showed strong commitment to the spawned many of the innovations. Among them: project. The presidents of the five countries signed a A "corridor" condom brand. The project created a joint declaration confirming their commitment to joint special brand of male and female condoms--Migrant action to fight HIV/AIDS along the corridor and to put in and Femigrant--that could be sold all along the corridor place the necessary institutional framework. Each (instead of a different brand being sold on each side of country agreed to contribute $50,000 per year to the the border as required by national licensing regulations), project, and consensus was reached on the project's often by sex workers as an alternate income source. basic principles and detailed institutional arrangements. This is the only project so far to develop a single condom The Bank and UNAIDS also committed fully to the brand across countries, and it greatly simplified condom project, ensuring adequate financial, policy, and messaging, procurement, and tracking distribution. technical support, including strong continuity of the World Bank task team. Training border committees for peer-to-peer learning. In addition to training border committee A streamlined framework to accommodate a members to coordinate the local response to HIV, the multitude of actors project trained them in community mobilization and peer- Making this project work required an enormous number to-peer learning. This approach was cost efficient in of people and a clear organizational framework. The better enabling the members to play their multiple roles inherent complexity of a multiple-country cross-border in the project, and it gave committees clear mandates HIV/AIDS project demanded that institutional and operational objectives. arrangements be as straightforward as possible. 1 Localized radio channels. Through IRIN Radio , the A Governing Body of heads of national HIV/AIDS project established partnerships with 32 local and programs and Transport Directors from each country national radio stations in the five countries. These adopted annual action plans, supervised their stations produced and broadcast programs in 17 local implementation, and liaised with the national HIV/AIDS languages. Over 15 months, more than 30 million radio programs. The Executive Secretariat coordinated project listeners were sensitized on HIV, generating significant implementation by civil society organizations (CSOs) demand for VCT in particular. and public sector organizations. An Advisory Body, with Border observatories to monitor behavior and traffic half of its members from private sector organizations, flow time. Installed at all borders, observatories staffed provided technical and policy advice to the Governing by trained observer were critical in obtaining a constant Body. Community-based border HIV/AIDS committees flow of data that allowed the project to identify and focus coordinated the local response to HIV/AIDS. Inter- on areas requiring special attention. country Facilitation Committees, with representatives from all stakeholders, helped provide training on HIV ART referral system. Access to ART for mobile people prevention and implementation of ECOWAS regulations when outside their own country was a challenge. ALCO on the free movement of people and goods, and negotiated a referral system with all countries. Patients oversaw or implemented IEC activities. An operational were issued a referral slip through which they could manual spelled out roles and responsibilities and guided access ART in any member country. Referral records project implementation. 1 The five participating governments agreed on shared IRIN (Integrated Regional Information Networks) is a project responsibilities, including which country housed unique humanitarian news and analysis service of the UN the headquarters and how it would be staffed to ensure Office for the Coordination of Humanitarian Affairs. openness, transparency, and equal opportunity to all 8 nationalities. Countries led different aspects of project Planning for Sustainability management: Planning and implementation must take place with Nigeria: Presidency of the Governing Board sustainability in mind. Key to this was intense involvement of a broad cross-section of stakeholders in Ghana: Vice-Presidency of the Governing Board project design so that their ideas were implemented. Benin: Host of the Secretariat headquarters and grant Project partners then worked quickly to demonstrate the recipient on behalf of the other countries value of the approach and begin to identify potential new Cote d'Ivoire: Executive Secretariat partners and donors. Based on the project's Mid-Term Review, the Global Fund awarded ALCO $45 million for Togo: Advisory Body Chair a five-year follow-on project, allowing the work to continue and to expand. The Abidjan-Lagos Trade and Corridor Project Organization Chart Transport Facilitation Project being prepared for Bank support will include an HIV/AIDS component. This project will combine physical investment to improve roads with policy and programmatic efforts to reduce impediments to cross-border trade and travel, and continued support for ALCO's HIV focus. Are cross-border projects worth doing? The Bank catalyzed innovation and positive results by taking high risks with this project. Development partners did not show much interest in joining the project in the beginning--it was clear that it would be politically, logistically, and culturally complex. The main exception was UNAIDS, whose solid technical and financial support to design and deliver the project was critical to developing the project concept and bringing it to fruition. The Corridor project confirms that the World Bank can ALCO play a catalytic role, take risks, help build effective institutions, and work with countries and other partners The Abidjan-Lagos Corridor Organization (ALCO) was to deliver results in HIV prevention, care, and support. established to implement the project. Creating a new organization helped ensure shared ownership among the Perhaps the most important contributions of the Abidjan- five countries. It also made the project easier to manage. Lagos Corridor Project have been bringing HIV No single country owned it, and working through ALCO prevention interventions to very hard-to-reach and avoided conflicts of interest that might have arisen if an vulnerable people and establishing a platform for existing local, national, or regional organization had taken regional integration beyond HIV/AIDS and on the role. ALCO was supported by an experienced transportation. The project added value to national AIDS management firm that dealt with fiscal management, programs by focusing on people who national programs procurement, and M&E, enabling the Secretariat to focus were not yet reaching. It generated strategic data that on coordination, collaboration, and capacity building. countries could use in their planning, such as real-time Contracting selected management responsibilities to a information on emerging behaviors in specific lean management group with routine account and populations (intravenous drug use among sex workers procurement management experience and M&E system and drug use by youth, for example). By putting in place development expertise proved to be cost efficient and facilitation mechanisms and learning how to work across effective. Expenditure categories were kept to a minimum, borders, it encouraged collaboration on issues as allowing the project considerable flexibility to allocate diverse as childhood immunization and fighting illegal resources each year. The firm' operated on a build- drugs. The challenge now is to maintain and improve on operate-transfer basis, and ALCO successfully took over the gains made. the fiduciary and M&E roles by the end of the Bank-funded Now that we have started working as a team, we are project. finding solutions to some problems, observed Iguo Afelokhe, President, Inter-Border Facilitation Committee, Complementing national AIDS programs Kraké-Plage/Seme (Benin-Nigeria). Regional HIV/AIDS programs are most useful when they complement national programs, focus on border areas, and target vulnerable groups associated with the trucking industry. The Governing Board greatly facilitated the process of developing synergies between the regional program and the five national AIDS programs. 9 Abidjan-Lagos Corridor HIV/AIDS Project Innovations Crossed five different countries Engaged stakeholders at multiple levels In many different languages In different fields With different concerns and priorities Tackled HIV risks related to international ground transport For the benefit of the mobile and local populations ALCO Partners: Good project collaboration with uniformed personnel About the authors: Carol Hooks is a communications consultant and Principal of Carol Hooks Communications. She has provided strategic communications support to the World Bank and other international organizations making a difference. Sielé Silué is a Senior Transport Specialist and worked on the project throughout - from initial planning through project closing and the Project Completion Report. He received the Africa Award for Excellence in 2008 for his work as Task Team Leader for the project. References, further information Implementation Completion and Results Report, ICR615, June 2008, World Bank. Acknowledgements On line, with other project documents at The World Bank Africa Region Transport Sector (AFTTR) www.worldbank.org, search for: P074850 demonstrated exemplary dedication and co-ownership of the project. The project greatly benefited from significant technical and financial support of UNAIDS, ACTAfrica Related Links: (AFTHV), HDNGA and AFTTR. corridor-sida.org, www.worldbank.org/aids www.worldbank.org/afr/aids, Transport and HIV/AIDS (http://go.worldbank.org/OT9S9XA140), www.unaids.org The "HIV/AIDS Getting Results" series is published by the World Bank's Global HIV/AIDS Program For more topics in the "HIV//AIDS - Getting Results" series, please go to www.worldbank.org > Getting Results December 2009 10