Document of The World Bank FOR OFFICIAL USE ONLY Report No: PAD2380 INTERNATIONAL DEVELOPMENT ASSOCIATION PROJECT APPRAISAL DOCUMENT ON A PROPOSED CREDIT IN THE AMOUNT OF SDR 29.2 MILLION (US$40 MILLION EQUIVALENT) TO THE REPUBLIC OF UGANDA FOR A STRENGTHENING SOCIAL RISK MANAGEMENT AND GENDER-BASED VIOLENCE PREVENTION AND RESPONSE PROJECT May 24, 2017 Social, Urban, Rural And Resilience Global Practice Africa Region 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 disclosed without World Bank authorization. CURRENCY EQUIVALENTS Exchange Rate Effective April 30, 2017 Currency Unit = SDR 1 SDR= US$1,37102 US$1= 0,72938396SDR FISCAL YEAR June 1 - July 30 Regional Vice President: Makhtar Diop Country Director: Diarietou Gaye Senior Global Practice Director: Ede Jorge Ijjasz-Vasquez Practice Manager: Robin Mearns Co-Task Team Leaders: Patricia Fernandes; Peter Okwero ABBREVIATIONS AND ACRONYMS ACF Action Against Hunger BoU Bank of Uganda BRAC Bangladesh Rural Advancement Committee CEDOVIP Center for the Domestic Violence Prevention CAO Chief Administrative Officer CDFU Communication for Development Foundation CFO Chief Finance Officer CSO Civil Society Organizations CPF Country Partnership Framework DFID Department of International Development (UK) DA Designated Account DPP Directorate of Public Prosecution ECPR Emergency Child Protection Response ELA Empowerment and Livelihood for Adolescents EMF/P Environmental Management Framework/Plan FAO Food and Agriculture Organization FIDA Association of Ugandan Women Lawyers FM Financial Management GBV Gender-Based Violence GoU Government of Uganda GRM Grievance Redress Mechanism GRS Grievance Redress Service HCP Health Care Providers HMIS Health Management Information System IE Impact Evaluation ISR Implementation Status Report IPRs Independent Procurement Reviews IP Indigenous People IPP/F Indigenous People’s Plan/Policy Framework IPPF Indigenous People’s Policy Framework IFMS Integrated Financial Management System IFR Interim Financial Report IBRD International Bank for Reconstruction and Development IDA International Development Association ILO International Labor Organization IPV Intimate Partner Violence IPF Investment Project Financing JSI Judiciary Studies Institute JLOS Justice Law and Order Sector KPI Key Performance Indicators MTR Mid-Term Review MoFPED Ministry of Finance, Planning and Economic Development MOGLSD Ministry of Gender Labor and Social Development MoH Ministry of Health NGP National Gender Policy HCWM National Health Care Waste Management Plan NPEGBV National Policy on the Elimination of Gender-Based Violence NPF New Procurement Framework NGO Non-Governmental Organizations NPSV Non-Partner Sexual Violence NPV Non-Partner Violence NUSAF Northern Uganda Social Action Fund OHMIS Occupational Health Management Information System PS Permanent Secretary PEP Post-Exposure Prophylaxis PP Procurement Plan PRAMS Procurement Risk Assessment and Management System PC Project Coordinator PDU Procurement and Disposal Unit PIU Project Implementation Unit PMIS Project Management Information System POM Project Operations Manual PPSD Project Procurement Strategy for Development PST Project Support Team PSS Psychosocial Support PFM Public Financial Management PPDA Public Procurement and Disposal of Public Assets Act RCT Randomized Control Trial REAL Responsible, Engaged and Loving Fathers Initiative RSR Rapid Social Response NDP II Second National Development Plan SHARE Safe Homes and Respect for Everyone Program STI/D Sexually Transmitted Infection/Disease SDSP Social Development Sector Plan SOP Standard Operating Procedures SPDs Standard Procurement Documents SOE Statement of Expenditures STEP Systematic Tracking of Exchanges in Procurement ToRs Terms of Reference UBOS Uganda Bureau of Statistics UDHS Uganda Demographic and Health Survey UPF Uganda Police Force TSDP Uganda Transport Sector Development Project UNICEF United Nations Children’s Fund UNFPA United Nations Population Fund UNRA Uganda National Roads Authority USAID United States Agency for International Development UWONET Uganda Women’s Network VSLA Village Savings and Loans Associations VAC Violence Against Children WA Withdrawal Application WB World Bank WHO World Health Organization WINGS+ Enterprises for Ultra Poor Women and War Program The World Bank BASIC INFORMATION Is this a regionally tagged project? Country(ies) Financing Instrument No Investment Project Financing [ ] Situations of Urgent Need of Assistance or Capacity Constraints [ ] Financial Intermediaries [ ] Series of Projects Approval Date Closing Date Environmental Assessment Category 20-Jun-2017 30-Jun-2022 B - Partial Assessment Bank/IFC Collaboration No Proposed Development Objective(s) The Project Development Objectives are to increase: (i) participation in Gender-Based Violence (GBV) prevention programs; and (ii) utilization of multi-sectoral response services for survivors of GBV in targeted districts. Components Component Name Cost (US$, millions) Prevention of Social Risks and Gender-Based Violence 20.00 Gender-Based Violence Response in the context of social risk management 10.60 Project Management and Monitoring and Evaluation 9.40 Organizations Borrower : Ministry of Finance, Planning and Economic Development Page 1 of 109 The World Bank Implementing Agency : Ministry of Gender, Labour and Social Development PROJECT FINANCING DATA (IN USD MILLION) [ ] [ ] IBRD [ ✔ ] IDA Credit [ ] IDA Grant [ ] Trust [ ] Counterpart Funds Parallel Funding [ ] Crisis Response [ ] Crisis Response Financing Window Window [ ] Regional Projects [ ] Regional Projects Window Window FIN_COST_OLD Total Project Cost: Total Financing: Financing Gap: 40.00 40.00 0.00 Of Which Bank Financing (IBRD/IDA): 40.00 Financing (in US$, millions) FIN_SUMM_OLD Financing Source Amount International Development Association (IDA) 40.00 Total 40.00 Expected Disbursements (in US$, millions) Fiscal Year 2017 2018 2019 2020 2021 2022 Annual 0.00 4.11 10.74 11.05 7.25 6.85 Cumulative 0.00 4.11 14.85 25.90 33.15 40.00 Page 2 of 109 The World Bank INSTITUTIONAL DATA Practice Area (Lead) Social, Urban, Rural and Resilience Global Practice Contributing Practice Areas Health, Nutrition & Population Climate Change and Disaster Screening This operation has been screened for short and long-term climate change and disaster risks Gender Tag Does the project plan to undertake any of the following? a. Analysis to identify Project-relevant gaps between males and females, especially in light of country gaps identified through SCD and CPF Yes b. Specific action(s) to address the gender gaps identified in (a) and/or to improve women or men's empowerment Yes c. Include Indicators in results framework to monitor outcomes from actions identified in (b) Yes SYSTEMATIC OPERATIONS RISK-RATING TOOL (SORT) Risk Category Rating 1. Political and Governance  Substantial 2. Macroeconomic  Moderate 3. Sector Strategies and Policies  Moderate 4. Technical Design of Project or Program  Substantial 5. Institutional Capacity for Implementation and Sustainability  Substantial 6. Fiduciary  High 7. Environment and Social  Moderate 8. Stakeholders  Moderate Page 3 of 109 The World Bank 9. Other 10. Overall  Substantial COMPLIANCE Policy Does the project depart from the CPF in content or in other significant respects? [ ] Yes [✔] No Does the project require any waivers of Bank policies? [ ] Yes [✔] No Safeguard Policies Triggered by the Project Yes No Environmental Assessment OP/BP 4.01 ✔ Natural Habitats OP/BP 4.04 ✔ Forests OP/BP 4.36 ✔ Pest Management OP 4.09 ✔ Physical Cultural Resources OP/BP 4.11 ✔ Indigenous Peoples OP/BP 4.10 ✔ Involuntary Resettlement OP/BP 4.12 ✔ Safety of Dams OP/BP 4.37 ✔ Projects on International Waterways OP/BP 7.50 ✔ Projects in Disputed Areas OP/BP 7.60 ✔ Legal Covenants Sections and Description The Recipient shall, by no later than six (6) months after the Effective Date, establish and thereafter maintain, throughout the Project implementation period, a Project Steering Committee. Sections and Description The Recipient shall, by no later than six (6) months after the Effective Date, establish and thereafter maintain, throughout the Project implementation period, a Project Technical Committee. Page 4 of 109 The World Bank Sections and Description The Recipient shall, by no later than six (6) months after the Effective Date, establish, and thereafter maintain, throughout the Project Implementation period, a Project Support Team, with terms of reference satisfactory to IDA. Sections and Description The Recipient shall, by no later than six (6) months after the Effective Date, establish, and thereafter maintain, throughout the Project Implementation period, a District Steering Committee in each of the targeted districts. Conditions Type Description Effectiveness The Recipient has nominated a Project Coordinator in accordance to Section I. A 4 of Schedule 2 of the Financing Agreement. Type Description Effectiveness The Recipient has prepared and adopted a Project Operations Manual referred to in Section I. D. of Schedule 2 of the Financing Agreement. PROJECT TEAM Bank Staff Name Role Specialization Unit Team Leader(ADM Patricia Maria Fernandes GSU07 Responsible) Peter Okwero Team Leader GBV - Health GHN01 Procurement Specialist(ADM Joel Buku Munyori Procurement GGO01 Responsible) Annet Tamale Katuramu Procurement Specialist Procurement GGO01 Grace Nakuya Musoke Procurement Specialist Procurement GGO01 Munanura Financial Management Paul Kato Kamuchwezi Financial Management GGO31 Specialist Annette Nabisere Team Member AFMUG Byansansa Targeting, Institutional Anton Karel George Baare Team Member GSU07 Arrangement, GBV response Page 5 of 109 The World Bank Catherine Asekenye Barasa Safeguards Specialist Gender-Based Violence GSU07 Christine Tina Musuya Team Member GBV Prevention and Response GSU07 Gender-Based Violence Diana Jimena Arango Peer Reviewer GCGDR Specialist Edwin Nyamasege Team Member Financial Management GGO25 Moguche George Ferreira Da Silva Team Member Disbursements WFALA Herbert Oule Safeguards Specialist Environmental Assessment GEN01 John Vedanayakam Team Member Procurement ITSDF Valaparla Kate Kanya Team Member GSU07 Lyndsay Claire McLean Team Member GBV Prevention GSU07 Hilker Margarita Puerto Gomez Team Member GBV Prevention GSU07 Maria Beatriz Orlando Team Member GSUGL Mariam Namwanje Team Member Costing GSU07 Lutakome Marjorie Mpundu Counsel Country Lawyer LEGAM Musonda Rosemary Peer Reviewer Health GHN01 Sunkutu Sexual and Gender-Based Pia Peeters Peer Reviewer GSU02 Violence Racheal Njeri Mwaura Team Member GBV - Health GHNDR Raymond Joseph Mbishi Team Member Procurement GGO01 Samhita Kumar Team Member Operational support GCFDR Extended Team Name Title Organization Location Consultant - GBV Service Gap Ishmael Nyanzi Analysis Consultant - GBV Service Gap Paul Bukuluki Analysis Page 6 of 109 The World Bank UG – STRENGTHENING SOCIAL RISK MANAGEMENT AND GENDER-BASED VIOLENCE PREVENTION AND RESPONSE PROJECT TABLE OF CONTENTS I. STRATEGIC CONTEXT ..................................................................................................................................... 8 A. Country Context ..............................................................................................................................................8 B. Sectoral and Institutional Context .................................................................................................................11 C. Higher Level Objectives to which the Project Contributes ............................................................................16 II. PROJECT DEVELOPMENT OBJECTIVES .......................................................................................................... 16 A. PDO ................................................................................................................................................................16 B. Project Beneficiaries .......................................................................................................................................... C. PDO-Level Results Indicators .........................................................................................................................17 III. PROJECT DESCRIPTION ................................................................................................................................ 18 A. Project Components ......................................................................................................................................18 B. Project Cost and Financing ............................................................................................................................25 C. Lessons Learned and Reflected in the Project Design ...................................................................................26 IV. IMPLEMENTATION .......................................................................................................................................... A. Institutional and Implementation Arrangements ..........................................................................................29 B. Results Monitoring and Evaluation ................................................................................................................31 C. Sustainability..................................................................................................................................................32 D. Role of Partners .............................................................................................................................................32 V. KEY RISKS .................................................................................................................................................... 33 A. Overall Risk Rating and Explanation of Key Risks ..........................................................................................33 VI. APPRAISAL SUMMARY ................................................................................................................................ 34 A. Economic and Financial (if applicable) Analysis................................................................................................. B. Technical ........................................................................................................................................................35 C. Financial Management ..................................................................................................................................36 D. Procurement..................................................................................................................................................37 E. Social (including Safeguards) .........................................................................................................................38 F. Environment (including Safeguards) ..............................................................................................................38 G. World Bank Grievance Redress .....................................................................................................................39 VII. RESULTS FRAMEWORK AND MONITORING ................................................................................................... 41 ANNEX 1: DETAILED PROJECT DESCRIPTION ......................................................................................................... 52 ANNEX 2: IMPLEMENTATION ARRANGEMENTS ................................................................................................... 63 ANNEX 3: IMPLEMENTATION SUPPORT PLAN ...................................................................................................... 77 ANNEX 4: TARGETTING APPROACH…………………………………………………………………………………………………………………. 83 ANNEX 5: FINANCIAL MANAGEMENT AND DISBURSEMENT ARRANGEMENTS…………………………………………………. 89 ANNEX 6: ECONOMIC AND FINANCIAL ANALYSIS………………………………………………………………………………………………98 ANNEX 7: SUMMARY OF GENDER-BASED VIOLENCE DIAGNOSTIC……………………………………………………………………..103 ANNEX 8: OVERVIEW OF CONSULTATIONS WITH PARTNERS……………………………………………………………………………107 Page 7 of 109 The World Bank I. STRATEGIC CONTEXT A. Country Context High levels of Gender-Based Violence (GBV) and of acceptability of such violence particularly among youth 1. Uganda has experienced steady macro-economic growth, poverty reduction, and relative political stability over the last few decades. The country has been successful in reducing poverty, but a third of the population still lives below the international extreme poverty line. According to the Uganda Country Partnership Framework ( CPF FY16-21), the proportion of households living in poverty more than halved from 1993 to 2013, with poverty reducing from 68 percent to 33 percent. However, a large proportion of the population remains vulnerable to falling back into poverty. Overall, 43 percent of Ugandans live in non-poor (but vulnerable) households, illustrating the fragility of the gains realized. 2. Uganda ranked 88th out of 142 countries 1and lowest in the East African region, in the 2014 Gender Inequality Index. This index benchmarks national gender gaps using economic, political, education, and health criteria. Three of the areas where gender inequality persists are economic participation, access to education and access to health services. Attitudes, beliefs, and practices that exclude women from social and economic life are deeply entrenched in society. Discriminatory attitudes towards women as well as high fertility rates may limit the extent to which women are able to benefit from poverty reduction gains2. Perceptions of what are gender appropriate economic roles may contribute to lower female earnings, partly causing women to go into lower productive sectors3. 3. Prevalence rates of GBV in Uganda are high compared to both global and regional averages. 4 Overall, 62.2 percent of all women and 58.8 percent of all men aged 15-49 in Uganda reported experiencing physical or sexual violence (by any perpetrator) at least once since the age of 15 (according to the 2011 Uganda Demographic and Health Survey).5 By comparison the global average prevalence rates for violence against women (physical or sexual) aged 15-49 is estimated by the World Health Organization (WHO) at 35.6 percent and the regional (Africa) average is 37.7 percent.6 In most cases (60 percent), perpetrators were intimate partners. Furthermore, the 2011 Uganda Demographic and Health Survey (UDHS) data indicates that beyond Intimate Partner Violence (IPV) Non-Partner Sexual Violence (NPSV) and child sexual abuse are the two most prevalent forms of GBV. 4. Overall, acceptance of IPV is also high in the Africa Region, on average around 30 percent, which is more than twice the average of the rest of the developing world (at 14 percent). Such accepting attitudes towards IPV are high in Uganda even when compared to other countries in the region (please see Figure 1 below). The 1 With a score of .6821 2 World Bank Uganda Poverty Assessment, 2016 3 World Bank Uganda Poverty Assessment, 2016 4 Preliminary results from the 2016 DHS were made available on March 18, 2017. The information currently released is limited to key indicators on sexual violence. Micro-data from the 2016 DHS will not be available before project approval, expected in June 2017. The background analysis for the project uses the most complete available DHS data, which is currently from 2011. Further analysis of the 2016 DHS data will be carried out by the team before project effectiveness 5 Figures are for men and women aged 15-49 whether never married, married /living together or divorced /separated / widowed. 6 World Health Organization (2013). Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva, World Health Organization. Page 8 of 109 The World Bank 2011 UDHS found that 58 percent of all Ugandan women aged 15-49 believe that wife beating is justified for at least one specified reason. Acceptance varies with age and location and worryingly, women from younger age groups and rural areas appear to be more accepting of abuse. Among men, the acceptability of wife beating is still high but lower than for women. The 2011 UDHS found that 44 percent of all Ugandan men aged 15-49 believe that wife beating is justified for at least one specified reason with figures being higher for rural men (47 percent) compared to urban men (29 percent). 5. Both the prevalence of and accepting attitudes towards specific forms of GBV 7 have decreased in Uganda between 2006 and 2011, according to the UDHS data. These gains have, however, been relatively limited and are not shared by all cohorts of women. The proportion of women who have ever experienced physical violence (age 15-49) declined only by 4 percentage points—from nearly 60 percent in 2006 to 56 percent in 2011. The recent 2016 UDHS is currently being analyzed and was not available to inform project preparation. Initial data released focuses only on the prevalence of sexual violence. It shows a further modest decline in prevalence rates between 2011 and 2016. Preliminary findings from the 2016 UDHS show that the probability of experiencing sexual violence at some point in one’s life was at 22 percent in 2016 for women aged 15 -49 (reduced from 28 percent in 2011). Sexual violence was only reported by approximately 8 percent of men in 2016. Based on the initial data available, sexual violence prevalence patterns in 2016 were similar to those observed in 20118. 6. Key vulnerable groups include adolescent girls. Early marriages and pregnancy are leading contributors to vulnerability accounting for more than half of all reasons for girls leaving school. The national teenage pregnancy rate was 24.8 percent among girls aged 15-19 in 2011. On average, 40 percent of women aged 20-40 were married before the age of 18 and 15 percent before the age 15. Prevalence of physical and sexual violence remains high among younger cohorts of women (Figure 2 and 3 below). Physical violence declined for most age groups, except for women aged 20-24 and 40-49. The highest drop was for those age 30-39. Violence prevalence declined for women with primary and secondary or higher education, but increased for those with no education by one percentage point. Importantly, high levels of acceptability of wife beating remain among women in younger cohorts (61.8 percent for women aged between 15 and 19). 7 Specifically, wife beating which is monitored by the UDHS 8 Namely higher rates in rural areas, and among women with an education level lower than secondary education Page 9 of 109 The World Bank Social acceptability of GBV creates high risk conditions for violence, which can be further exacerbated by infrastructure investments 7. In a context where both rates of GBV and levels of social acceptability of GBV are high, the risk of such violence can be exacerbated by development interventions, including infrastructure investments. Research has shown that while these investments - roads, dams, and railways – can be key for economic development at a macro level, they can also negatively impact communities. For instance, labor influx associated with large investment projects, taking place in a context where social norms and values may include high levels of acceptability of GBV can further expose vulnerable groups living around construction sites to sexual assault, transactional sex, rape, and forced or early marriage. Furthermore, labor influx also has the potential to exacerbate chronic vulnerability of children and adolescent girls. It increases their risk of experiencing multiple forms of violence at community level. 8. The Uganda World Bank Country Portfolio has recently faced numerous challenges in managing and mitigating social risks associated with the influx of labor in infrastructure projects, particularly in Kamwenge and Kabarole districts. Adverse social impacts experienced during the implementation of the Uganda Transport Sector Development Project (TSDP, P092837), included the sexual abuse of minors in communities. The Government of Uganda (GoU) with the support of the World Bank (WB) has subsequently put in place a series of measures to respond to the emergency needs of child survivors of sexual violence in the project area, through the Emergency Child Protection Response (ECPR) intervention. The ECPR provided emergency support to the survivors and their families in accessing health care, legal aid, as well as livelihoods and education opportunities. Further acknowledging the need to develop a more sustainable and comprehensive approach to addressing the risk of GBV as part of infrastructure investments, GoU is currently implementing a project supported by the Rapid Social Response (RSR) Grant in the two above mentioned districts. The Grant will enable GoU to test out mechanisms to: (i) raise awareness among project affected communities of the potential risks of GBV; and (ii) establish response services in these same communities that can address instances of GBV (particularly those related to issues of labor influx). The RSR supported intervention (US$1 million) 9 will be completed by January 2019. It has generated lessons-learned for the current operation and is expected to further inform future 9 The RSR supports interventions directly implemented by Government of Uganda (US$700,000) as well as activities implemented by the World Bank in coordination with Government of Uganda (US$300,000). The latter focus on supporting the development of Grievance Redress Mechanisms (GRM) Page 10 of 109 The World Bank interventions by GoU to manage the risk of GBV associated with infrastructure interventions. Managing social risks and addressing GBV in a comprehensive manner 9. The Government of Uganda is strengthening its systems for managing social risk in development projects. Beyond the ongoing interventions mentioned above, which contribute directly to addressing the risk of GBV linked to infrastructure interventions, there are discussions to support the GoU in this reform agenda, including, but not necessarily limited to: (i) land acquisition and resettlement, and; (ii) national systems for Social Impact Assessment in development investments. 10. As part of this broader agenda on the overall management of social risk, the present operation aims to address the underlying causes of GBV and develop a scalable model for prevention and response beyond the potential negative impacts that are directly linked to investment projects. International evidence indicates that norms around gender relations, strictly enforced gender roles and negative constructions of masculinity can create an environment conducive to violence in which men may be expected to control women’s behaviour. In fact, social norms condoning IPV and male control of female behaviour are one of the strongest drivers of GBV.10 Such norms and accepting attitudes towards GBV contribute to greater levels of both IPV and Non-Partner Violence (NPV). Building on the lessons learned from the ECPR, RSR as well as rigorously evaluated interventions in Uganda11 the proposed project will aim to support the overall operationalization of the newly approved Policy on the Elimination of Gender-Based Violence (October 2016) by rolling out a set of comprehensive prevention and response interventions to tackle GBV. B. Sectoral and Institutional Context Solid legal and policy framework but significant gaps in terms of its implementation 11. A Diagnostic of GBV in Uganda was carried out to inform project preparation (a summary of key findings is included in Annex 7). The objectives of the Diagnostic were to (i) assess the prevalence, and risk factors for GBV in Uganda and the impact of GBV on key development outcomes; (ii) assess the roles, responsibilities and capacities of existing formal and informal institutions in addressing GBV; and (iii) summarize the evidence base on GBV prevention and response programs to identify interventions that could be scaled up in Uganda. This comprised an analysis of national datasets, smaller surveys and qualitative studies, a geographical mapping and a logit analysis of risk factors based on the 2011 UDHS. An assessment was also undertaken of the institutional landscape related to GBV in the country, drawing on a review of policy and strategy documents, a legal review, and interviews with key stakeholders. Finally, the diagnostic included a review of both the international evidence base on GBV interventions as well as available documentation and evaluations of interventions designed to prevent and/or respond to GBV in Uganda. Data collected through the Diagnostic informed the overview of the sectoral and institutional context presented in this section. 12. The Government of Uganda recognizes the burden that gender inequality, including GBV, places on social and 10 Arango et al (2014), Interventions to prevent or reduce violence against women and girls: a systematic review of reviews 11 Particularly the SASA! (Sasa is a Kiswahili word that means “now”) and Empowerment and Livelihoods for Adolescents programs w hose results are presented respectively in: (i) Abramsky et al (2014), Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduced HIV risk in Kampala, Uganda. SASA! and; (ii) Bandiera et al (2012) Empowering Adolescent Girls: Evidence from a Randomized Control Trial in Uganda. Page 11 of 109 The World Bank economic development. This realization is reflected by the consistent progress made by GoU in strengthening the policy and legal framework to address GBV as follows: i. The National Policy on the Elimination of Gender-Based Violence (NPEGBV, October 2016). The NPEGBV provides a framework for the implementation of comprehensive GBV prevention measures and provision of multi-sectoral support services for survivors. It also outlines the role of various line agencies and civil society organizations at local and national levels, strategic actions, and milestones for measuring progress. (Please see Table 1 below). The new policy plays a key role in addressing critical gaps in GBV response, such as the lack of functioning referral systems that coordinate health, social, law enforcement, and judicial sectors. ii. The Second National Development Plan II (2015/16-2019/20), focuses on the promotion of decent employment and labor productivity; enhancement of community mobilization and empowerment and promotion of gender equality and female empowerment. iii. The National Gender Policy (2007) and associated National Action Plan on Women (2007) which encourages Government, civil society, and UN agencies to put gender equality at the heart of their strategies and interventions, including those that address GBV. iv. The Social Development Sector Plan 2015/16-2019/20, underlines the expansion of GBV prevention and response programs as a priority area of action. Table 1 - Mandates of key GoU institutions and other stakeholders in the implementation of the NPEGBV Institution Mandate Ministry of Gender Leads a coordinated prevention and response approach to GBV, establishes Labor and Social coordination mechanisms, sets standards and develops guidelines, and holds the Development overall mandate for building capacity of district staff. MOGLSD is also responsible for (MOGLSD) raising awareness of social norms that perpetuate GBV. Ministry of Health Provides appropriate medical services (including emergency services), builds capacity (MoH) of health sector staff and establishes forensic services. Directorate of Public Responsible for timely court processes and the provision of legal assistance. Prosecution (DPP) Judiciary Establishes procedures for procuring justice for survivors of GBV, builds capacity of judicial officers to handle GBV cases. Uganda Police Force Provides security, establishes mechanisms to ensure perpetrators are apprehended, (UPF) builds capacity of police staff. Local Governments Monitor response and management of GBV cases and establish coordination mechanisms for GBV prevention and response at district and sub-county level. Civil Society Advocate for policy implementation, and support government in implementing Organizations programs that address key NPEGBV policy areas, raise awareness at community level on the elimination of GBV. 13. These policies are complemented by a robust legal framework which includes the ratification of major international and regional agreements12 to promote gender equality. In addition, comprehensive domestic 12 Uganda is party to: (i) The UN Convention on the Elimination of all Forms of Discrimination Against Women; (ii) The UN Convention of the Page 12 of 109 The World Bank legislation addresses the issue of GBV. This includes the Constitution (1995), Penal Code Act (2007), Domestic Violence Act (2011), Equal Opportunities Commission Act (2007), and the Prohibition of Female Genital Mutilation Act (2010). However, this legal framework co-exists uneasily with customary laws and practices. These remain the primary determinant of outcomes for most women due to Uganda’s dual legal system, especially in domains related to marriage and successions.13 14. In terms of social risk management and GBV in the workplace, the overall legal framework is provided by the following pieces of legislation: the Occupational Safety and Health Act (2006); the Labor Disputes and Arbitration Act (2006); the Workers’ Compensation Act (2000); the Magistrate Courts Act, Employment Act (2006) and its attendant regulations like the Employment (Sexual Harassment) Regulations No. 15 (2012) among others. The implementation of these acts and regulations has faced a number of challenges. The gaps noted in the existing legal and policy framework result largely from a lack of clear procedures to address issues of GBV in the workplace. 15. National coordination mechanisms have been put in place by the above mentioned policy framework. However, these platforms lack financial resources as well as strategic planning aligned with the goals of the National Policy on the Elimination of Gender-Based Violence. They include: (i) the National GBV Reference Group coordinated by the Ministry of Gender Labor and Social Development (MOGLSD) and comprised of government, Civil Society Organizations (CSOs), development partners, and the private sector; and (ii) the Gender and Rights Sector Working Group bringing together Gender Focal points from the different Government Ministries and departments. In addition, Uganda has a vibrant community of civil society organizations that contribute significantly to innovative and quality service provision for survivors and those at risk of GBV. Currently, civil society organizations active in this field lack a national coordination platform and depend primarily on the regional African GBV Prevention Network14, as a platform for knowledge exchange on effective approaches. 16. While Uganda’s legal and policy framework is comprehensive, critical gaps in terms of policy implementation remain. Government agencies at national and local levels experience challenges particularly with the provision of integrated services for survivors of GBV. Specifically, barriers include: (i) insufficient resource allocation to fund prevention and response programs across sectors; (ii) limitations in terms of staffing numbers and technical knowledge on the management of GBV cases, (iii) weak law enforcement, and; (iv) limited availability of gender- disaggregated data to inform GBV programming. Regarding GBV in the workplace, MOGLSD’s oversight capacity is limited. Currently there are 84 labor inspectors nationwide, who have not had sufficient training to address issues of GBV in the workplace. Rights of Child and African Charter on the Rights and Welfare of the Child; (iii) The Optional Protocol to the Convention on the Rights of the Child on the Sale of Children, Child Prostitution and Child Pornography; (iv) the Beijing Platform for Action (1995); (v) The Declaration on Elimination of Violence Against Women (1993); (vi) UN Security Council Resolution 1325 on Women, Peace and Security (2000) and UN Security Council Resolution 1820 on sexual violence in situations of armed conflict (2008), (vii) The UN Resolution on FGM - Zero tolerance (2012); (viii) the African Charter on Human and Peoples’ Rights and The Protocol to the African Charter on the Rights of Women in Africa (Maputo Protocol) (2003); (ix) The Protocol on the Prevention and Suppression of Sexual Violence against Women and Children of the International Conference on the Great Lakes Region (2006); (x) the Goma Declaration on Eradicating Sexual violence & ending impunity in the Great Lakes Region (2008); and (xi) the Kampala Declaration on ending impunity (2003). 13 Diagnostic on Gender-Based Violence carried out during project preparation in collaboration with MOGLSD (World Bank 2016), please see summary findings in Annex 7. 14 http://preventgbvafrica.org/about-the-network/ Is a civil society network focusing specifically on the prevention of Violence Against Women. It currently has approximately 500 members, across 18 countries in the Horn, East and Southern Africa. Page 13 of 109 The World Bank 17. An analysis of the gaps in service provision for GBV survivors at district level was conducted as part of the project preparation process in four purposefully selected sites in both Western (Hoima and Kibaale districts) and Eastern (Kamuli and Bugiri districts) regions of the country. The analysis, conducted between December 2016 and February 2017, using primarily qualitative research methodologies, provided important insights in terms of both availability of services and their quality as follows: i. Access to health services - The majority of the facilities did not have protocols or guidelines for the clinical management of GBV and no comprehensive training program had been rolled out by the MoH on its guidelines for the management of the GBV cases. Overall, lower level health facilities lacked sufficient equipment and staff to provide the necessary basic services. The analysis conducted indicated gaps in: (a) the availability of Post Exposure Prophylaxis (PEP) treatment; (b) sufficiently trained staff to manage GBV cases; (c) gaps in the routine screening for Sexually Transmitted Infections (STIs) beyond HIV; and (d) access to emergency contraception. The vast majority of facilities lacked appropriate space to conduct consultations in a private setting. ii. Counselling services and psycho-social support at community level – While the analysis highlighted gaps in terms of access to counselling at health facility level, it also noted that survivors often seek informal community-based counselling. The latter was provided by a range of entities such as para-social workers, members of child-protection committees, community activists as well as MOGLSD staff at district and sub-county level and local council authorities. While these groups play a critical role as first responders to GBV, they may not always have the required training to provide such services, which may result in further harm to GBV survivors. iii. Livelihoods and economic empowerment – While the analysis highlighted the strong presence of Village Savings and Loans Association (VSLAs) in the targeted districts, the overall absence of structured referral systems and of psycho-social support or counselling meant that among respondents there were no instances of referrals of GBV survivors to existing livelihoods programs. In addition, existing programs reviewed did not include an element of gender transformative training and/or engagement of men and boys in the community. In line with international evidence, this may lead to increased tensions at household level over the additional income earned by women (which in some instances was found to result in increased levels of GBV). iv. Security – The analysis noted a lack of Standard Operating Procedures (SOPs) to deal with cases of GBV. While the research team observed efforts to train police officers and establish Gender Desks in some stations, there were a number of significant operational limitations in the ability of police to respond adequately to cases of GBV. This included a lack of trained personnel, and funding to cover basic operational costs (including transport). Significantly, respondents indicated a relatively high level of mistrust regarding the soundness of police investigations into instances of GBV. An important lack of coordination between the health system and the police on the collection of forensic evidence and medico-legal information was also observed. v. Access to justice - Given the significant gaps in access to health and security services noted earlier (particularly in what concerns medico-legal support), only a small proportion of reported GBV cases are ever prosecuted. From the point of view of survivors, however, there are number of obstacles to accessing the formal justice system, which are important to note namely: (a) procedures are insensitive Page 14 of 109 The World Bank to the needs of survivors who are required to give evidence in open court, under adversarial conditions and potentially facing further stigmatization and re-victimization; (b) access to legal aid is limited and administrative costs can be prohibitive for a significant number of survivors; (c) sentences are often considered too lenient which may discourage survivors from pursuing the costly and challenging process of obtaining legal redress. Importantly, the analysis also covered traditional justice systems. These were overall found to reinforce existing gender norms which are accepting of GBV and often discourage women from accessing formal services/lodging complaints with the police. 18. In terms of prevention initiatives, there are noteworthy examples of community level prevention interventions in Uganda some of which have been rigorously evaluated and have demonstrated impact in reducing GBV among participants. A mapping of existing prevention interventions was conducted during project preparation as part of a secondary review of data on GBV in Uganda to inform project design (GBV Diagnostic, 2016). These interventions, while promising, are primarily implemented by civil society organizations, and therefore face issues of implementation at scale and sustainability once donor funding is fully utilized. i. Whole of community awareness raising activities (SASA! Model) developed in Uganda have shown promising results in shifting deeply entrenched behaviors through behavior change communication. The intervention showed positive impacts in reducing both the incidence and acceptability of IPV among men and women.15 ii. Interventions specifically targeting adolescents have similarly shown promising results in Uganda. This is the case for the Empowerment and Livelihood for Adolescents (ELA) intervention.16 The ELA approach has shown significant impacts, particularly in reducing the proportion of adolescent girls having sex unwillingly (by 76%). The Impact Evaluation of this particular program indicates that combined interventions that work on both life-skills and livelihoods may yield better results than single-pronged programs when it comes to reducing risky behavior. 15 Abramsky et al (2014), Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduced HIV risk in Kampala, Uganda. SASA! is designed around the Ecological Model of Violence and promotes critical analysis and discussion of power (power inequalities and its gender dimensions) through the selection and training of community members who make up a cadre of trained activists. Activists work with key opinion leaders and critical groups at community level through a series of structured discussions to unpack and question existing power relations and create a critical mass of community members committed to create social norm change. 16 Bandiera et al (2012) Empowering Adolescent Girls: Evidence from a Randomized Control Trial in Uganda. ELA is operated in Uganda by the NGO Bangladesh Rural Advancement Committee (BRAC) Page 15 of 109 The World Bank C. Higher Level Objectives to which the Project Contributes 19. The proposed project will directly contribute to the two pillars of the World Bank’s new global strategy, eliminating extreme poverty and promoting shared prosperity. Uganda’s CPF (FY16-21) recognizes that persistent gender disparities hold back women’s access to opportunities and that addressing gender equality and GBV requires attention to the broader social context. The project will specifically address objectives two and four of the CPF, which are to i) improve social service delivery and ii) enhance resilience of the poor and vulnerable. 20. The project will also directly contribute to the operationalization of the 2016 NPEGBV through the implementation of GBV prevention interventions and support to strengthening response services for GBV survivors. The National Policy on the Elimination of Gender-Based Violence includes a broad-based definition of GBV. The policy clearly outlines the roles and responsibilities of different institutions in the implementation of key elements of the policy. Importantly, the policy indicates that the role of the Ministry of Gender, Labor and Social Development is one of coordination of the overall NPEGBV implementation. The policy also highlights the importance of partnerships with civil society, faith based organizations and traditional institutions to address GBV. It covers physical and sexual violence as well as emotional and economic violence. The policy objectives are to: (i) reduce negative attitudes and practices that fuel GBV; (ii) reduce GBV prevalence; and (iii) increase access to services for survivors. Specifically, the policy seeks to reduce GBV incidence by 15 percent over a five- year period. The policy highlights the importance of the following principles in GBV programming: (i) addressing gender equality; (ii) using a survivor centered and multi-sectoral approach; (iii) timely provision of services; and (iv) effective community participation. Finally, the policy lays out three priority focus areas in line with global lessons-learned and good practices to which the proposed project design is aligned: (i) Prevention of GBV - through awareness raising and behavior change communication (aimed at transforming gender norms) as well as through interventions aimed at improving economic opportunities for women; (ii) Provision of comprehensive care and support services to GBV survivors including: (i) security; (ii) medical services; (iii) psychosocial support; (iv) justice; and (v) economic empowerment; and (iii) Ending impunity for perpetrators of GBV with a focus on strengthening the justice system’s response to GBV. Importantly the policy acknowledges the role of cultural norms and practices in creating an environment where GBV may be condoned at community level. II. PROJECT DEVELOPMENT OBJECTIVES A. PDO The project will contribute to the overall goal of reducing GBV prevalence in targeted districts in line with the National Policy on the Elimination of Gender-Based Violence. The Project Development Objectives are to increase: (i) participation in Gender-Based Violence (GBV) prevention programs; and (ii) utilization of multi-sectoral response services for survivors of GBV in targeted districts. B. Project Beneficiaries 21. Project beneficiaries will include primarily vulnerable women and girls at risk of GBV as well as survivors of Page 16 of 109 The World Bank GBV. Men and boys in targeted districts will also benefit from project activities as survivors of GBV, as family members of survivors and as key opinion leaders and community members promoting behavior change through GBV prevention programs. 22. The institutional strengthening elements of the program will be national in scope and will target key line ministries and institutions: Ministry of Health staff, Ministry of Gender Labor and Social Development, Uganda Police Force, Directorate of Public Prosecution and the Justice Law and Order Secretariat. These interventions will focus on the: (i) development of guidelines and training program for the management of GBV in the workplace; (ii) enhancement and adoption of an overall referral system for the management of GBV cases; (iii) development of standard operating procedures for case handling and; (iv) pre-service and in service training for front line staff in key sectors. 23. Project resources funding: (i) community level GBV prevention and referral activities as well as; (ii) the strengthening of first response services for survivors will be concentrated in the following 13 districts (with an overall population of 6.6 million people): Wakiso, Masaka, Mukono, Mbale, Sironko, Kamuli, Alebtong, Apac, Zombo, Hoima, Kisoro, Kamwenge and Kabarole. These geographical areas were selected in order to target the most densely populated districts with the highest risk of GBV within each of Uganda’s four regions and achieve the required level of intensity in terms of GBV prevention and response services within the broader framework of strengthening social risk management. The approach used to carefully select target areas is outlined in Annex 4. At district level, the project will: (i) build the capacity of district level staff in targeted areas to improve coordinated delivery of services for GBV survivors; (ii) rehabilitate and equip heath facilities, police stations, and district level offices for MOGLSD as needed; and (iii) conduct awareness raising activities to increase awareness of existing services and prevention programs. 24. Intensive community level GBV prevention interventions will be undertaken in selected sub-counties per district. Based on average population estimates, awareness raising interventions at sub-county level are expected to reach approximately 800,000 people (of which approximately 408,000 women). This will include more intensive gender transformative training with community and opinions leaders as well as life-skills and livelihood interventions targeting adolescent girls and boys. Criteria for selection of benefiting sub-counties will be developed and included in the Project’s Operations Manual (POM). A rapid assessment of targeted districts will be undertaken and shall form the basis for selection of the sub-counties. These sub-counties will be proposed by the Project Steering Committee and agreed with district level authorities. Sub-counties will be ranked using available administrative data and incident reports on GBV from health centers and police stations. A participatory validation process will be undertaken with district level authorities, led by the Steering Committee to finalize the selection of sub-counties to be targeted. The final proposed list of sub-counties will be shared with the World Bank for approval within six months of project effectiveness. C. PDO-Level Results Indicators 25. The following key indicators will be used to track progress toward the project development objective:  Numbers of direct project beneficiaries (percentage of women);  Number of participants in community-based GBV prevention programs in targeted districts;  Percentage reported decrease in accepting attitudes towards GBV in targeted sub-counties;  Percentage of reported cases of GBV that receive at least two multi-disciplinary services (medical, Page 17 of 109 The World Bank psychosocial, security, legal support, livelihoods support);  Percentage of eligible reported cases of eligible GBV who receive Post Exposure Prophylaxis (PEP) Treatment within 72 hours. III. PROJECT DESCRIPTION A. Project Components Overall approach 26. Project design acknowledges the fact that GBV is widespread nationwide and accepting attitudes towards GBV play an important part in the high GBV prevalence rates observed in Uganda. The project takes into account the additional social and GBV risks posed by the implementation of large scale infrastructure projects by including a specific focus on GBV in the workplace. However, the proposed intervention is also based on the assumption that GBV in the workplace or instances of GBV directly related to labor influx cannot be addressed in isolation. Addressing these particular manifestations of GBV requires a focus on the underlying social norms and values at the workplace, community and household level that may create an environment where GBV is condoned. Communities, informal institutions and families can discourage survivors from accessing services and lodging formal complaints. Therefore, the project has included a strong focus on GBV prevention at the community level and in the workplace with an emphasis on gender transformative training and behavior change. 27. In line with global best practices and based on the overall situation analysis of GBV in Uganda, the project will focus on both preventing GBV and on improving the quality of multi-sectoral response services for survivors in targeted districts. Global evidence indicates that effective prevention programs encourage GBV survivors to come forward and seek services. It is therefore important that awareness raising and gender transformative training be accompanied by improvements in the availability and quality of response services. 28. The proposed approach builds on tried and tested interventions in Uganda particularly in terms of prevention programs. In order to maximize GoU investments in this area, the project will adapt and take to scale prevention programs which have been developed in Uganda, have been evaluated using a quasi-experimental approach and therefore have a proven track record of reducing GBV prevalence17. 29. Finally, project design has taken into account the constraints in providing high quality services at district and sub-county level. This includes inadequate staffing levels for police stations, high turn-over of staff at the level of health facilities, significant case backlog in the criminal justice system and existing capacity constraints on the part of MOGLSD at district level. In order to put in place a sustainable approach to GBV response, the project has adopted a mainstreaming approach, rather than a center-based service delivery strategy. Under the overall coordination of the MOGLSD and the high-level Steering Committee, the project will support the popularization 17 Abramsky (2014), Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduced HIV risk in Kampala, Uganda. The Impact Evaluation of the SASA! GBV prevention intervention (whole of community awareness raising and behavior change) indicates a significant reduction in acceptance of IPV among both women and men. Bandiera et al (2012), Impact Evaluation of livelihoods and life- skills interventions with adolescents (ELA Program) implemented by the NGO Bangladesh Rural Advancement Committee (BRAC) indicates that the incidence of girls reporting having sex against their will dropped by 76%. Page 18 of 109 The World Bank and operationalization of referral pathway for the management of GBV cases with the involvement of key sectors. This referral pathway will inform the development of further Standard Operating Procedures (SOP) and case management guidelines in the Health Sector, Uganda Police Force and Directorate of Public Prosecution. 30. A summary of the lessons-learned that informed project design is provided in Section C below and a detailed description of project activities is provided in Annex 1. Component 1 – Prevention of Social Risks and Gender-Based Violence (US$20 million) 31. This component will strengthen the development, coordination and implementation of a set of comprehensive GBV prevention interventions within the broader context of social risk management. In particular, this component will focus on: (i) promoting behavior change and addressing social norms and values that may enable or condone GBV at community and household level as well as in the workplace; (ii) strengthening referral mechanisms and ensuring information on available services for GBV survivors is available and widely disseminated at community level and in the workplace (in prioritized sectors). Acknowledging the additional risk of GBV posed by large influx of labor, this component includes a specific focus on putting in place systems that would allow MOGLSD to monitor and address instances of GBV linked to public investments in infrastructure. Sub-component 1 A – Preventing Gender-Based Violence in the workplace in the broader context of social risk management (US$3 million) 32. The GoU recognizes the challenges in identifying and effectively responding to risks of GBV associated with labor influx in large infrastructure projects. Therefore, interventions to mitigate risks of GBV in the workplace, including sexual harassment, physical violence, sexual assault, emotional and psychological violence, exploitation among others, have been prioritized with a specific focus on public sector infrastructure investments. This component will focus on the following activities, which will be national in scope and focus primarily on strengthening MOGLSD capacity to monitor and address issues of GBV in the workplace as follows: i. Strengthening the legal framework to address GBV in the workplace, by: a) conducting a review and supporting the development or amendment of regulations for the Employment Act and the Occupational Safety and Health Act; b) developing a framework to assess risks of GBV in the workplace as part of the labor inspection system. This will also include a focus on the interaction between the labor force in infrastructure investments and the broader community. The assessment will be developed with a focus on the following sectors: roads, oil and gas, energy and water; c) designing and rolling out a training program for labor inspectors at national and district levels on the application of the GBV assessment framework; d) improving the technical inspection tools currently in use, such as the Occupational Health and Safety (OHS) checklist to monitor risks of GBV as well as the mitigation measures put in place (in infrastructure projects). ii. Supporting MOGLSD to oversee the design and implementation of Grievance Redress Mechanisms (GRMs) in selected sectors to handle issues of GBV in the workplace (including those pertaining to the interaction between workers and the broader community). The project will fund: a) the development of guidelines for the design of GRM promoting/encouraging the reporting of cases of GBV in the workplace (this will build on the work currently being initiated by MOGLSD and by the Ugandan National Page 19 of 109 The World Bank Roads Authority on the development of GRM specifically for roads projects); b) the development of procedures on how to effectively refer cases of GBV that may be captured through these enhanced GRM; and c) the training of relevant sectoral agencies on the design and management of such GRM in coordination with the MOGLSD. The MOGLSD will work closely with the following line agencies to pilot these enhanced GRMs: Ministry of Energy and Mineral Development, Ministry of Water and Environment, Uganda Roads Authority and the Ministry of Works and Transport. iii. Increasing public awareness of GBV (with a specific focus on GBV in the workplace). This will include: a) the development and dissemination of simplified information on the policy and legal framework to address GBV in the workplace, including referral pathways; b) the design and implementation of a multi- media campaign on GBV prevention (including but not limited to the workplace); and c) piloting awareness raising and behavior change interventions addressing GBV in the workplace in strategic sectors. This will be done in collaboration with employers, the private sector, and labor unions. The pilot will include signaling interventions by employers and public commitments to eradicating GBV in the workplace as well as an external monitoring mechanism in partnership with the private sector and specialized service providers. In addition, the project will support MOGLSD’s ability to monitor the implementation of issues pertaining to GBV in the workplace in the overall context of social risk management. iv. Strengthening GoU’s information base on issues pertaining to GBV in the workplace through the implementation of a targeted study in partnership with the Uganda Bureau of Statistics (UBOS). Sub-Component 1B – GBV prevention and referral at community level in the context of social risk management (US$17 million) 33. In order to address the underlying causes of GBV and tackle social norms and values that may condone GBV, the project will invest significantly in awareness raising and behavior change at community level in the 13 focus districts highlighted above. The approach to prevention builds on tried and tested models which have been evaluated in Uganda. Through the proposed project, GoU will develop a national protocol for community based prevention programs bringing together: (i) whole of community awareness behavior change and awareness raising interventions; (ii) specific interventions focusing on adolescent girls and boys and combining gender transformative training with livelihoods support; and (iii) community based referral system and provision of psycho-social support at community level. The national protocol for community based prevention programs described below will be designed by MOGLSD with the support of specialized technical assistance. The MOGLSD will lead the operationalization of community based prevention activities. Interventions will be implemented by the MOGLSD in partnership with service providers to be selected on a competitive basis by MOGLSD at central level. These organizations will have a proven track record of delivering GBV prevention programs at community level. The implementation of GBV prevention activities at community level will draw on a pool of qualified community workers including para-social workers and Village Health Teams as well as on community opinion leaders. MOGLSD at district and sub-county level will closely supervise the implementation of the prevention program. MOGLSD staff at district level, in particular, will participate actively in community mobilization activities and in the implementation of the community-based referral mechanisms. Resources for the active engagement of MOGLSD staff at district level have been included in the project’s detailed budget. Page 20 of 109 The World Bank 34. The detailed protocol for the community based prevention activities will be developed within six months of project effectiveness and include the selection of sub- counties per district for the implementation of activities targeting adolescent girls and boys. While awareness raising activities and the establishment of a community- based referral system will take place district-wide, specific activities targeting adolescents are expected to take place in selected sub-counties per district. The protocol will be in place as a basis for the selection of the specialized service providers. The three elements of the community level prevention interventions are as follows: i. Community mobilization and promotion of behavior change: The identification, training and mentoring of a team of community facilitators as key agents of change who will implement a community mobilization intervention targeting opinion leaders, key community based organizations as well as older men and women that play a key role in perpetuating accepting attitudes towards GBV. This element of the approach is expected to foster changes in social norms, attitudes and behaviors at community level. It will focus specifically on transforming gender relations and power dynamics. This element of the intervention will be implemented by service providers under the overall guidance and with the participation of Community Development Officers and Probation Officers at district and sub-county level. ii. Livelihood Support Intervention: Through the initial community mobilization step, facilitators will identify and target a selection of adolescent girls and boys – with priority given to out of school youth- in each community to support their economic empowerment. Based on Uganda best practice interventions that have been evaluated, livelihood interventions with groups most at risk can play a key role in preventing GBV. The livelihoods component will deliver a mix of market-oriented vocational training and mentorships arrangements, business development and financial literacy skills to girls and boys and then seek to link these adolescents to existing credits and savings schemes. Evidence from Uganda indicates that livelihoods’ support is most effective in preventing GBV when combined with life-skills and gender- transformative interventions targeting boys and girls. Implementation of this intervention will be consistent with current approaches to livelihood programs for adolescents implemented by GoU to ensure consistency in the principles followed. iii. The third element of this package will be to strengthen community-level response and referral mechanisms for GBV survivors.18 At present, a very small proportion of women and girls who are abused actually report violence to anyone. Women survivors face multiple barriers to speaking out, and in particular, to accessing formal services. This community response and referral intervention will train the community facilitators in close coordination with district level MOGLSD staff that implement community awareness raising activities (see (i)) as well as key community structures (e.g. village health teams, local council, religious institutions, schools) on GBV response. The aim will be to ensure that GBV survivors have trusted individuals and mechanisms to whom they can report violence and through whom they can get access to the services – informal and formal – they need and want. Trained community activists, supported under the project will act as victims’ advocates for referral to adequate services. Access to emergency support (including to cover costs of transport, purchase of clothing and hygiene items) to eligible survivors shall be provided in line with the procedures to be outlined in the POM. Facilitators will also play a key role in the community reintegration of survivors, who have approached them to 18 The community-based level response has been included in Component 1B as it will be part of the package implemented in partnership with specialized service providers, as outlined in paragraph 32 above. Page 21 of 109 The World Bank request support in accessing services or who have been referred to specialized service providers after approaching health or police services directly. This will be done through engagement with the community and key opinion leaders, provision of psycho-social support where appropriate, integration in project supported livelihood interventions for adolescents and referral to existing livelihood programs in the case of adult survivors. The project will invest in developing and rolling out a training module for the provision of psycho-social support at community level. The training will be based on the guidelines for the provision of psycho- social support developed by the MOGLSD in 2016 and will be provided by specialized service providers to community facilitators (and where feasible to trained community activists). Following the training, community facilitators will provide Psycho-Social Support (PSS) to survivors at community level. The training will also equip them with the knowledge to identify and refer more complex cases for follow-up at health center or hospital level. Service providers will in addition provide more specialized psycho- social support through their staff at district level based on the initial screening conducted at community level. This approach acknowledges the staffing limitations at both MOGLSD and MoH level to provide this specialized service and the fact that community facilitators and activists are often the first port of call for survivors. 35. Under this sub-component, the MOGLSD will pilot the provision of services for survivors of GBV and the implementation of GBV prevention interventions through advisory centers and shelters. This would entail the: (i) continuation of the support currently provided through the Kamuli advisory center and shelter from 2018 onwards; (ii) the development of a strategic, costed action-plan on the expansion of shelter services by GoU; and (iii) the financing of advisory and shelter services in line with the assessment findings. This will include a study on the establishment of three additional shelters in critical districts (with a focus on the establishment of one pilot shelter in each of the four regions). The assessment will take into account existing MOGLSD cost-effective approaches to shelter interventions based on the lessons-learned and documented in Kamuli. These advisory centers are expected to provide psycho-social support, referral to livelihood opportunities, legal aid and other services as relevant. These shelters shall be established and operationalized in line with national guidelines. Staff at the advisory center are expected to act as victims’ advocates and support the GBV survivor to access relevant services (health, police and judiciary). In addition, off-site shelters in an undisclosed location and linked to the advisory centers would provide temporary accommodation to survivors who are not able to immediately return to their households and communities. The preparatory analysis will review: (i) existing shelters and critical gaps in service provision at district level; (ii) investment costs of shelter refurbishment as well as operation and maintenance costs; (iii) sustainability of shelter operations after the life-time of the project; and (iv) cost-effective modalities for the management and operation of the proposed shelters. Based on the initial analysis, GoU will prepare a detailed proposal for the pilot shelter interventions for review and approval by the World Bank. The project will not support the construction of new infrastructure for advisory centers and shelters but will rather support refurbishment of existing facilities that would not expand the footprint of existing structures. 36. Finally, this component will support the implementation of an Impact Evaluation (IE) focusing specifically on the proposed GBV prevention activities. Given the design of GBV prevention interventions and the focus on specific sub-counties (particularly for the more intensive whole of community awareness raising activities as well as activities to be implemented with adolescents), the project expects to put in place a Randomized Control Trial (RCT). The detailed design of the impact evaluation will be completed during the project’s start -up phase (initial Page 22 of 109 The World Bank six months of implementation). Component 2 – Gender-Based Violence Response in the context of social risk management (US$10.6 million) 37. Overall this component will strengthen the responsiveness of front-line service providers: Health Sector, Uganda Police Force and the Directorate of Public Prosecution to cases of GBV and improve their ability to provide quality care to survivors. This component will: (i) strengthen national coordination systems, (ii) support the enhancement and adoption of comprehensive guidelines for referrals19; (iii) the review and updating of Standard SOP for the Justice Law and Order Sector (JLOS) and; (iv) training curricula for Uganda Police Force. In addition, dedicated resources will be allocated to these core services in the 13 focus districts to directly improve the quality of the service provided. This will be key to ensure that these critical sectors are able to effectively provide quality services to GBV survivors. Strengthening the key sectors will in addition support them to deal with a potential increase in reporting and in demand for services stemming from the implementation of awareness raising and GBV prevention activities implemented under Component 1. Given the significant social barriers to reporting GBV, it is expected that the majority of cases in the targeted areas will reach formal services through the community-based referral system put in place in partnership with service providers. However, when survivors approach health centers/ hospitals or police stations directly, staff at these service points will equally liaise closely with specialized service providers at district level and refer survivors of violence for: (i) additional support that may be required at community level; and (ii) further guidance on how to access other response services that may be needed. Monthly technical meetings held at district level with key service providers will be the main mechanism to ensure effective case management and coordination between prevention and response interventions. 38. Sub-Component 2A – Strengthening the Health Sector Response to GBV (US$9.3 million). The main objective of this sub-component will be to strengthen the Uganda health sector responsiveness to Gender-Based Violence with a focus on (i) strengthening sector leadership and governance; and (ii) strengthening provider capacity to respond to GBV. 39. Key activities under this sub-component will be as follows: i. Strengthening sector leadership and governance by supporting MoH to establish a technical working group on GBV and developing a sector specific strategy for mainstreaming GBV20. This sub-component will also support the mapping of health sector GBV actors and service providers to enable better coordination of these stakeholders by MoH. Institutional capacity will be further strengthened by establishing a network of GBV focal points at national and subnational levels and at the level health facilities in the targeted districts. Coordination with UPF and DPP will take place at national and district levels.21 Particular attention will be paid to the collection and recording of forensic/medico-legal data by health service providers and its sharing with UPF for subsequent investigation.22 19 This will be based on the 2013 Guidelines for Referral of GBV cases developed by the Ministry of Gender Labor and Social Development 20 This will include the adoption of the WHO Global Standards on Gender-Based Violence Management 21 This is in line with the Kampala declaration 2012 22 Based on the demand for such follow-up on the part of the survivor Page 23 of 109 The World Bank ii. Integration of GBV response in health provision. Key activities under this sub-component will focus on: (i) Re- printing GBV training manuals developed by MoH, (ii) training Health Care Providers (HCP) including community health workers in targeted districts using the above materials. The training will focus on: (i) GBV case screening, medical case management including the correct collection of forensic evidence and accurate record keeping and reporting23; (ii) updating and disseminating management protocols and guidance notes for practitioners (job aides) developed specifically by the health system in Uganda. These materials will be distributed countrywide starting with the project target district. In addition, the project will fund an assessment of the current capacity to provide mental health services for survivors of GBV and prepare an options paper for MoH on how best to strengthen such services in targeted districts. In addition, the project will also aim to build medico-legal response capacity of HCP. The project will support the adoption printing and distribution of the draft medical - legal manual.24 The manual will be used to train HCP’s as well as experts from police and judiciary with a focus on handling forensics, preparing for court hearings and filling of police and medico-legal forms.25The project will further strengthen forensic evidence collection by procuring sexual assault evidence kits for targeted districts26. The project will aim to integrate the kit into the national essential medical supplies list. In order to improve the quality of services provided to survivors of GBV the project will institutionalize integrated GBV case management at different service points in targeted health facilities (e.g. Maternal, Newborn and Child Health, HIV Youth Friendly Services, Family Planning Casualty units). This is expected to ensure that sufficient numbers of adequately trained staff are available to manage GBV cases. In order to improve the quality of front-line services the project will also ensure the availability of medical equipment and essential commodities at health facilities for effective management of SGBV cases (with a focus on PEP kits and emergency contraceptives). Finally, this sub-component will fund rehabilitation of health facilities (painting, small internal repairs and provision of screens or partitions as well as lockable cupboards) to create adequate conditions for consultations and counselling where those don’t currently exist. The project will only fund internal repairs and rehabilitation of these facilities with no expansion of the footprint of existing hospitals or health centers to be supported. 40. Sub-Component 2 B - Strengthening the Justice Law and Order Sector (JLOS) Response to GBV27 (US$1.324 million). This sub-component supports the operationalization of the GBV policy within the mandates of the participating JLOS institutions. The sub-component will focus on the following interventions: i. Strengthening sector leadership in terms of GBV response at national level and support to the sector to reach out to critical JLOS institutions in targeted districts. ii. Reviewing and updating Standard Operating Procedures (SOP) for the management of GBV cases for the UPF and DPP. This will support the standardized management of cases and monitoring of the effective 23 Building on existing training modules in Uganda, HCP will also be supported to better identify and manage their own biases when dealing with instances of GBV. 24 The medical- legal manual was jointly developed by MoH, WHO, Judiciary and Uganda Association of Women Lawyers (FIDA) -Uganda with the support of the Democratic Governance Facility 25 Forms 3, 3A, 24 and 24A. Form 3 is critical for the recording of forensic/medico-legal information enabling further investigation and potential prosecution of cases. 27 It is important to note that access to justice for survivors of GBV is provided free of charge under Ugandan legislation. Page 24 of 109 The World Bank implementation of the GBV policy. In addition, the project will support the monitoring of how GBV cases are handled in line with the updated SOP and guidelines to be put in place in both institutions. iii. Skilling the human resources in the UPF, DPP and courts to adequately address GBV cases through (i) the development of a tri-partite officially adopted curriculum for pre-service and in-service training; (ii) supporting the initial training of trainers for the roll-out of these new curricula; and (iii) supporting the delivery of the training curriculum with a focus on targeted districts. iv. Support internal rehabilitation of police stations in targeted districts – to ensure minimum conditions of privacy for interviews with survivors of GBV (these will be unmarked rooms to avoid further stigmatization). No expansion of existing facilities will be supported through this activity but rather the repair and rehabilitation of existing facilities. 39. Component 3 - Project Management and Monitoring and Evaluation (US$9.4 million) 41. Sub- Component 3 A – Project Management (US$9.1 million) This sub- component will cover overall project management costs to ensure efficient and effective coordination, fiduciary management at national and local levels. This will be done through dedicated support to the implementing agencies, institutional strengthening, purchase of critical equipment and internal rehabilitation of the district offices for Probation Officers, Labor Officers and Community Development Officers. This component will include support for strengthening existing coordination structures, the sustainability of project activities and the training of critical staff at national and sub-national level. 42. Sub-Component 3B – Monitoring and Evaluation (US$335,000) This sub-component will focus on the review and roll-out of a National System for data collection on GBV. The project will further support key measures to ensure effective data collection and information management on GBV. The project will assess the data currently being collected through the National GBV Database and the Occupational Health and Safety Database currently managed by MOGLSD as well as the data on GBV currently collected through the Health Management Information System (HMIS). The project will develop alternatives to strengthen data collection (building on these platforms) for review by GoU. Following a decision by the Steering Committee on the most appropriate approach, the project will support the roll-out of the streamlined data collection system to the 13 targeted districts. B. Project Cost and Financing IBRD or IDA Counterpart Project Components Project cost Trust Funds Financing Funding Total Costs US$40 million US$40 million 0 0 Page 25 of 109 The World Bank Total Project Costs US$40 million US$40 million 0 0 Front End Fees Total Financing Required US$40 million US$40 million 0 0 Table 2 below presents the total summary costs and indicated International Development Association (IDA) financing for the proposed project (by Component and year). A detailed cost and financing table is shown in Annex 2. Table 2: Summary Project Costs Project Components Year 1 Year 2 Year 3 Year 4 Year 5 Total (US$) Component 1A – Prevention of Gender- Based Violence in the work-place 113,611 743,236 1,731,474 389,313 130,908 3,108,541 Component 1B – Prevention of Gender- Based Violence at community level 468,520 4,085,041 4,308,235 3,924,813 4,099,720 16,886,329 Component 2A – Strengthening health sector response to GBV 1,076,229 4,126,026 2,907,703 642,902 500,439 9,253,298 Component 2B – Strengthening JLOS response to GBV 424,627 348,571 504,479 23,565 23,565 1,324,808 Component 3 - Project Management, and Monitoring and Evaluation 2,301,699 1,844,364 1,734,347 1,803,531 1,743,083 9,427,023 TOTAL 4,384,685 11,147,237 11,186,238 6,784,125 6,497,715 40,000,000 *1UGX=0.000277778 USD C. Lessons Learned and Reflected in the Project Design 43. A review of global evidence on effectively addressing GBV finds that a holistic approach that focuses both on prevention of GBV and on providing support services to survivors is critical. Key elements of these approaches have been included in the proposed project design28: Response services for survivors of GBV need to be multi-sectoral and comprehensive 28 These best practice principles have also been applied in the design of other WB supported GBV interventions (namely in Rwanda and DRC as part of the Great Lakes Emergency GBV initiative). Page 26 of 109 The World Bank 44. Physical and sexual violence is usually accompanied by psychological trauma and violation of laws. Survivors are therefore normally in need of multi-faceted assistance including medical treatment, health counselling, psycho- social and paralegal support. Response programs will also need to include elements of economic empowerment for survivors. The ability to secure an independent income is often a key factor in reducing the survivor’s economic dependence on the perpetrator. Findings across all sectors have identified the need for collaboration between law enforcement, legal aid services, health care organizations, public health programs, educational institutions, and agencies devoted to social services and economic development. For example, identifying survivors at a health clinic requires a host of follow-up responses from the judicial sector and social services (if the survivor is to request a protection order for example). Collaboration across sectors is therefore essential. GBV Prevention through behavioural change 45. Prevention of GBV will need to focus on behavioural change, addressing social norms and using an integrated approach and involving men and boys. Addressing the underlying causes of GBV, such as imbalanced power relations between men and women, attitudes, beliefs, and practices that exclude women and are deeply entrenched in society’s beliefs and practices requires a long-term engagement and explicit focus on changing gender norms. Comparing different forms of prevention and awareness raising activities, global evidence shows that integrated approaches that include community outreach, participatory workshops and promote reflection and debate to explicitly change gender roles tend to show more promising results. There is no evidence that multi-media campaigns alone have an impact on effectively addressing GBV. Uganda has some promising GBV prevention interventions implemented in partnership with civil society. 46. The SASA! Program29. This community mobilisation intervention aims to transform gender relations and power dynamics and address both HIV and violence against women. SASA! was found to be effective at reducing physical violence, as well as reducing the social acceptance of physical and sexual violence in intimate partnerships30. 47. Similarly, the Livelihood for Adolescents (ELA) program is currently being implemented under the oversight of MOGLSD across 54 districts focused on both the economic and social empowerment of adolescent girls through providing spaces for adolescent girls to socialise; life-skills training; livelihood training; financial literacy; savings and credit facilities; and community sensitization. An impact evaluation of the program found that: (i) participating girls were 76% less likely to have had sex against their will31 (ii) that teenage pregnancy rates were lowered and condom use increased; and (iii) that savings also increased amongst girls in the intervention communities. There was also positive spill over effects of the family planning interventions to girls not directly targeted. 48. Global evidence has indicated that including men in programs is especially important for prevention. Such programs need to acknowledge men’s multiple roles as perpetrators, as witnesses, service providers, decision- makers and policymakers, as change agents as well as survivors of GBV. Both the SASA! and ELA models involved men and boys as well as the broader community in prevention activities. 29 This model has been adapted in a number of other countries. 30 Abramsky (2014), Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduced HIV risk in Kampala, Uganda. 31 Bandiera et al (2012), Empowering Adolescent Girls: Evidence from a Randomized Control Trial in Uganda Page 27 of 109 The World Bank Addressing GBV requires the implementation of both response and prevention intervention 49. Lessons-learned from GBV interventions indicate that the implementation of prevention programs is most effective when accompanied by improvements in access to services by survivors. Prevention activities encourage survivors to come forward hence demand for response services is likely to increase. Gaps in access to services in these instances can undermine the credibility of service providers and put survivors at greater risk. Providing adequate health care, addressing issues of impunity of perpetrators and ensuring security of survivors will be a key element of an integrated approach and will need to accompany prevention activities. Implementation Modalities 50. Partnerships between government and multiple stakeholders (including civil society organizations) has a number of benefits. Partnering with specialized agencies, NGOs and faith-based institutions can allow government institutions to draw on: (i) existing expertise for the provision of specialized services (including for the provision of psycho-social support and mental health services); as well as on (ii) existing networks for prevention interventions at community and household level working on norms and values. Livelihoods interventions and gender transformative training for adolescents 51. Project design has also taken into account lessons-learned (internationally and in Uganda) in terms of the implementation of community-based livelihood activities with youth. Importantly, the project will invest significantly in group formation during the initial stages of implementation. Global experience indicates that this stage is critical for group consolidation and sustainability. This is the case with savings and livelihood interventions with groups of adults. Investment in promoting group cohesion is doubly important for livelihood intervention (where members may not have prior experience of savings and are selected for the proposed support in this case given their vulnerability and exposure to risk of GBV), rather than based on common interests or engagement in common livelihood activities. To further promote sustainability, the project will not provide initial seed funding but rather work with adolescents to promote savings during the initial 1.5 year of project implementation. Building on global best practices and particularly on the implementation experience of the Northern Uganda Social Action Fund (NUSAF) groups of adolescents will be assessed against a set of readiness criteria, which will enable a proportion of these groups (those considered to be viable) to access grants to fund livelihood plans and/or vocational training. The period during which groups will be consolidated and strengthened (initial group formation period) will be key for the provision of gender transformative training and life-skills education. Importance of addressing the additional risks of GBV linked to infrastructure interventions 52. Adverse social impacts experienced during the implementation of the Uganda Transport Sector Development Project (TSDP - P092837), included the sexual abuse of minors in communities. Building on lessons learned from the TSDP experience, the Government of Uganda (GoU) with the support of the World Bank (WB) is strengthening the overall framework for the management of social risk associated with infrastructure investments. A key lesson-learned incorporated in the design of the current project is the importance of: (i) addressing the additional risk factors for GBV posed by labor influx in a systematic way in sectors that present the highest risk (including transport, energy and water); (ii) supporting the MOGLSD to guide relevant line Page 28 of 109 The World Bank Ministries on the adoption of measures to address the risk of GBV and Violence Against Children (VAC); (iii) similarly supporting MOGLSD to monitor the implementation of such measures through their labor inspectors and district level structures; and (iv) supporting the development and implementation of effective GRM channels for affected communities and households to report instances of GBV and seek redress. In that regard, the proposed operation builds on lessons-learned from the ECPR intervention and RSR Grant that is being implemented in the Kamwenge and Kaborale districts (SCOPE project)32. The ECPR provided immediate support to the survivors and their families in accessing health care, legal aid, as well as livelihoods and education opportunities. Acknowledging the need to develop a sustainable approach to managing the risk of GBV linked to infrastructure interventions, GoU is currently implementing the SCOPE project in these same districts. The Grant will enable GoU to test out mechanisms to: (i) raise awareness among project affected communities of the potential risks of GBV and VAC; and (ii) establish response services in these same communities that can respond to instances of GBV (particularly those related to issues of labor influx). The RSR supported project will be completed by January 2019 and will generate critical lessons-learned particularly for other GoU infrastructure projects. The current operation will build on lessons-learned from the RSR supported intervention in the Kabarole and Kamwenge districts and will complement the ongoing interventions through: (i) community level awareness raising activities; (ii) further support to adolescents at risk; (iii) targeted support to health services and UPF at district level to strengthen response to GBV; and (iv) additional strengthening of MOGLSD at district level to refer survivors of GBV to appropriate services. IV. IMPLEMENTATION A. Institutional and Implementation Arrangements 53. The project will be implemented by the Ministry of Gender Labor and Social Development (MOGLSD) and the Ministry of Health (MoH) using a multi-sectoral approach. The MOGLSD as the main recipient will be responsible for overall project coordination and consolidation of Annual Work Programs and Budgets. MoH will be responsible for component 2A including its Financial Management (FM) and procurement. MOGLSD will be responsible for FM and procurement for activities under Component 1, Component 2B and Component 3. MoH will submit technical and financial work plans and reports for component 2A to the PS MOGLSD for approval and onward submission to the World Bank for release of funds to their Designated Accounts (DAs). MOGLSD will competitively procure specialized service providers for the implementation of Component 1B. The Uganda Police Force and Judiciary will be sub-recipients under the MOGLSD. 54. The Permanent Secretary (PS) of the MOGLSD, as the “Accounting Officer” of the Project, is responsible for overseeing overall project implementation. The PS will delegate the day-to-day management of the Project to a full-time Project Coordinator (PC) supported by a team of officers specifically hired to provide technical support for project implementation. This will include: (i) a Deputy Coordinator for the Project Support Team (PST); (ii) a Gender-Based Violence Specialist; (iii) Partnership Specialist; (iv) Legal Officer; (v) Monitoring and Evaluation Specialist (vi) Financial Management Specialist (vii) Procurement Specialist and (viii) Communications Officer at MOGLSD. MOGLSD Senior officers will coordinate project activities closely with the PST to ensure consistency between project support supported activities and the core functions and interventions of critical departments (namely the Department of Gender, Department of Children and Youth, Department of Community Development 32 Supporting Children’s Opportunities through Protection and Empowerment Page 29 of 109 The World Bank and Literacy, Department of Labor and Department of Occupational Health and Safety (Additional details on the composition of the PST are provided in Annex 2). The Permanent Secretary (PS) of the MoH will be responsible for overseeing the implementation of activities under Component 2A. Project activities will be mainstreamed within the MoH Reproductive Health Division to ensure sustainability of the interventions. A dedicated project officer will be recruited to provide additional technical support. He/she will work under the overall guidance and supervision of the Reproductive Health Division, will work closely with the project coordinator based at MOGLSD and coordinate activities with the PST in MOGLSD. The need for additional support from a Monitoring and Evaluation Specialist at MoH level will be confirmed following the assessment of data collection systems to be undertaken during Year 1 of project implementation. The project will also be able to provide additional support to MoH through a dedicated Financial Management Assistant. This additional need will be confirmed pending the assessment of the workload of the existing PST currently in place at MoH. Finally, dedicated persons will be assigned to the Uganda Police Force and to JLOS for the development of the respective training programs. The MOGLSD assigned persons will work under the overall coordination of two focal points to be nominated by the UPF and JLOS. The latter will have the technical lead of activities under Component 2B. 55. The GoU will establish a Project Steering Committee chaired by the PS, MOGLSD. Its membership will comprise: PS (MoH), PS Ministry of Finance Planning and Economic Development (MoFPED), Inspector General of Police, Director for Public Prosecution, Solicitor General, Secretary to Judiciary or their delegated representatives, and relevant MOGLSD senior staff. The Project steering committee will be responsible for multi- sectoral coordination, policy guidance and oversight to the overall performance of the project implementation. This committee will meet twice a year or when need arises. The project technical committee will be comprised of the Project Coordinator (chair), focal persons from MoH, Police, JLOS and the MoFPED desk officer. Quarterly review meetings will be conducted with the involvement of service providers selected for the implementation of Component 1 B. The project technical committee will coordinate day-to-day project activities. 56. District Level Coordination – A District Level Steering Committee will be the main mechanism for the coordination of project activities at district level. The Chief Administrative Officer (CAO) will nominate a district level official to oversee the overall implementation of project activities. Mirroring the structure developed at national level, the District Steering Committee will be convened semi-annually to review critical issues with project implementation and identify concerns/issues with implementation that should be discussed and addressed at the level of the Project Steering Committee. A technical sub-committee on GBV will be convened on a quarterly basis to oversee the implementation of prevention and response activities. The sub-committee will be convened with the support of the Community Development Officer and include: (i) Probation Officers; (ii) Labor Officer (iii) District Health Officers as well as GBV focal persons at health facility level; (iv) Senior District Police staff; (v) District Magistrate and other relevant senior staff. The POM will include the detailed description of the functions of the District Level Coordination mechanism. 57. Role of Specialized Service Providers– The MOGLSD shall competitively procure specialized service providers which will be contracted to provide GBV prevention interventions at household and community levels in the areas of: (i) community mobilization, (ii) livelihood support, and (iii) community based referral using evidence based GBV prevention and response approaches. Specialized service providers shall submit quarterly progress activity reports to the District project focal persons based on their respective work plans and budgets. Specialized Service providers shall submit biannual project technical and financial reports to the MOGLSD. Page 30 of 109 The World Bank Figure 4: Overview of implementation arrangements B. Monitoring and Evaluation 58. Project preparation has indicated that there are significant gaps in terms of data collection on GBV through existing sources of routine data at MoH, UFP and MOGLSD level. The project will invest during the first year of implementation in a thorough assessment of the existing systems collecting routine data on GBV (specifically the National GBV database developed by MOGLSD, Occupational Safety and Health MIS (OHSMIS) and the Health Management Information System). Options to strengthen national data collection systems GBV will be developed and discussed with GoU during the 1st year of project implementation. The roll-out of the most appropriate data collection system will take place from Year 2 of project implementation (with costs covered under Component 1B and 1A respectively). For activities under Component 1, Specialized Service providers will ensure the monitoring and tracking of GBV prevention activities and the provision of multi-sectoral services to Page 31 of 109 The World Bank GBV survivors given their critical role in ensuring effective referrals and serving as victim-advocated during the referral process. Under Component 2, data on provision of health services will be tracked using existing/routine data collection systems by MoH, UPF and DPP. Indicators selected to track progress take into account the existing constraints in terms of data collection. The project will include a dedicated focus on impact evaluation to assess the effectiveness of strategies aimed at preventing GBV. This will include the collection of baseline data on attitudes towards GBV that will be key in monitoring the impact of GBV prevention interventions. 59. The MOGLSD will submit quarterly progress reports and Interim Financial Reports (IFRs) to the World Bank in accordance with the reporting requirements to be set out in the POM. The mid-term review will provide the opportunity to assess progress for appropriate mid-course corrections as needed. C. Sustainability 60. Overall design has taken into account the financial and institutional context in which project implementation will take place and the need to maximize sustainability of activities initiated under the project. Specialized services for survivors of GBV will be provided through existing hospitals, police stations and community structures to strengthen national systems and mainstream these interventions. This approach is expected to improve the chances of sustainability of service delivery by creating a pool of human resources at district level and within government systems able to effectively handle reported cases of GBV. 61. Finally, the project will develop and test a framework for the delivery GBV prevention activities at scale through partnership with specialized service providers. The sustainability of GBV prevention activities represents a significant challenge once external funding phases out . Ensuring sustained implementation of prevention programs will largely depend on the ability of GoU to provide resources for their continuation after 2022. To that effect, the project will support the implementation of an Impact Evaluation (IE) of the prevention interventions carried out. The design of the IE will focus on identifying the impact in terms of reduction of GBV prevalence achieved through the investments made in this area. This policy-relevant information has the potential to inform subsequent policy reforms on GBV prevention and response. D. Role of Partners 62. Extensive consultations were held with bi-lateral, multi-lateral partners and civil society organizations during project preparation (please see Annex 8 for further details). A detailed mapping of current interventions in the area of GBV prevention and response (including specific child protection interventions focusing on the prevention of child abuse) was carried out during project preparation. The mapping exercise was critical to identify areas where other partners are already playing a leading role and where it will be important to create synergies or to avoid duplication of efforts (primarily by informing the project district level targeting approach). Project design drew extensively on WHO expertise for the design of the proposed health interventions and will roll-out specific training modules and manual previously developed by MoH with WHO technical assistance. 63. There is growing interest among partners to support evidence-based approaches to GBV prevention. Going forward closer coordination of activities can be pursued through systematic engagement with the Gender Page 32 of 109 The World Bank Development Partners Group (GDPG) which provides a forum for coordination of financial and technical assistance to GBV prevention and response in Uganda. Project preparation also indicated that there is currently no connection between the GDPG and the National GBV reference group led by the MOGLSD. Better coordination and sharing of information through these two platforms will be pursued throughout project implementation through the GBV Reference Group currently chaired by MOGLSD. V. KEY RISKS A. Overall Risk Rating and Explanation of Key Risks The risk rating for this project is substantial before mitigation, but might be reduced to moderate overall with effective implementation of the proposed mitigation measures. 64. Political and Governance. Governance and capacity challenges in the sector are substantial. The existing legal and institutional frameworks for improving overall governance in the sector are quite comprehensive; however, their implementation is currently weak and implementation capacity low. In addition, the project will engage specifically with the criminal justice sector to improve the quality of services provided to survivors of GBV. Levels of trust in JLOS institutions are overall considered low with governance challenges specific to the sector highlighted in national surveys and in the Uganda Human Rights Commission Reports. The district level gap analysis conducted as part of project preparation indicated a relatively high level of mistrust of the soundness of police investigations into instances of GBV. To mitigate governance challenges, the project has identified and put in place a set of mitigation measures particularly in terms of institutional strengthening at national and district level and in terms of fiduciary management. In addition, a set of additional mitigation measures targeting the JLOS sector in particular have been put in place. This includes the development of Standard Operating Procedures for the Management of GBV cases and the development and roll-out of training curricula for JLOS institutions to improve the quality of services provided to survivors of GBV. 65. Technical design of project or program. Technical design risk is substantial. The multi-sectoral nature of interventions addressing GBV and the need to focus simultaneously on prevention and response interventions based on global best practices requires a relatively complex design. The proposed technical design requires strong multi-sectorial coordination among national and local entities and partnerships with specialized service providers. In order to mitigate the risk linked to design complexity, the project has put in place a comprehensive Project Support Team to strengthen technical capacity at MOGLSD. In addition, the project will rely on implementing structures at MoH with a proven track record of implementing reproductive health interventions. Finally, the implementation of community-level GBV interventions will be conducted by experienced specialized service providers under the oversight of MOGLSD. 66. Institutional capacity for implementation and sustainability. The institutional capacity risk is substantial. Administrative capacities at the national, sub-national and local level in the proposed project areas are weak Page 33 of 109 The World Bank given the limited resources and technical capacity to operationalize the policy framework on GBV. This is expected to be particularly true in newly created districts (2016) covered by the project: (i) Alebtong; and (ii) Zombo. The project will mitigate this risk by assigning a dedicated team to support the MOGLSD at national level and by strengthening existing structures for GBV response at district level. In addition, as mentioned above, the project will rely on existing implementing structures at MoH level, which have experience with World Bank procedures. 67. Fiduciary. The residual fiduciary risk is expected to be substantial following the implementation of the proposed mitigation measures. Financial management capacities to ensure strong internal controls and adherence to proper financial procedures and procurement are limited based on the fiduciary assessments carried out during project preparation. Therefore, the project will support measures for capacity enhancement, close oversight, and periodic audits to ensure efficiency and transparency during project implementation. VI. APPRAISAL SUMMARY A. Economic and Financial Analysis 68. There is a strong rationale for the public provision of GBV prevention programs and response services aimed at survivors. The impacts Gender-Based Violence (GBV) within the broader framework of social risk management goes beyond the specific impacts on individuals and affect public health, human capital of children and the productivity of survivors’ and perpetrators. As noted earlier, the majority of GBV programs have been limited in scope and duration being dependent on donor funding and presence of suitable partners for implementation. The proposed five-year intervention aims to strengthen the capacity of the public sector to provide quality services to survivors of GBV and establish a national model for GBV prevention programs. The World Bank ability to mobilize global and regional expertise to support the implementation of the proposed operation constitutes added value for GoU. Finally, the proposed IE is expected to generate evidence of the benefits of the proposed interventions and identify effective strategies to address GBV. 69. The economic analysis of the project, as well as the strong rationale for addressing and preventing GBV, is based on the detrimental development impacts of GBV as well as its potential economic costs. A full-fledged financial analysis was not feasible given the absence of detailed data on service costs and monetary costs of some of the development and individual effects of GBV. Gender-Based Violence is a violation of human rights and its pervasiveness reinforces gender inequities, but the burden on economic development may be equally significant. (Please refer to Annex 6 for a full text of the analysis). 70. Some of the developmental impacts of GBV include, lower productivity and incomes for survivors (and also perpetrators), lower rates of accumulation of human and social capital (due in part to health effects), and generation of future violence (gender-based as well as other forms). Indirect cost estimates can prove useful as evidenced by work which illustrates reduced earnings of women and estimated lost wages due to family violence. Direct costs, those GBV expenditures such as healthcare and judicial services, as well as indirect costs, such as the value of lost productivity, are critical components of the economic cost of GBV. In developing contexts, direct costs may not accurately reflect the magnitude of GBV, since a lack of services or underfunding of services related to GBV as well as under-reporting may result in an artificially low rate of usage. Page 34 of 109 The World Bank 71. A study conducted by the Center for Domestic Violence Prevention (CEDOVIP) in 2016 estimated the impacts and costs of domestic violence in Uganda as it pertains to service provision in key sectors, primarily health and justice. Using 2006 DHS data and 2008/9 data from the International Center for Research on Women, CEDOVIP’s analyses revealed that GBV costs various providers and duty bearers an estimated UGX 56 billion annually, equivalent to 22.4 million USD.33 Overall economic costs of GBV (for the minority who seeks outside help) amount to about .35 % of Uganda’s GDP and .75% of the national budget. It is estimated that women spent UGX 19.5 billion on direct costs, of which 50% is used for paying police services, 25% to health care providers, and 14% to courts.34 72. A growing body of research has focused on understanding the consequences of GBV by estimating the effects on human development outcomes for women, girls, and their children, without attaching a monetary value to these effects. Beyond both superficial and life-threatening injuries that require immediate attention, impacts on health and education of women and girls may be significant and pose a large financial burden to the health and education sectors. In Uganda, project diagnostic work based on the 2011 Uganda DHS data estimates the human development impacts of GBV. The analysis found that survivors of violence have a higher average number of children ever born (and also higher average number of living children) – 4.0 versus 4.7. Almost one third of women who were survivors had terminated pregnancies at some point compared to 23 percent of women who have not experienced GBV. Survivors of GBV were also more likely to suffer from Sexually-Transmitted Diseases (STD). Overall, 23.6 percent of survivors versus 13.9 percent of women who had not experienced violence had a STD in the 12 months prior to the survey). A high proportion of women who were survivors (43 percent) tended to suffer from bruises, injuries, sprain dislocations or burns due to partner’s actions and nearly 17 percent suffered from bigger health issues such as wounds, broken bones, broken teeth or other injuries caused by their husband or partner. B. Technical 73. Project design follows global best practices in GBV programing both in terms of community based prevention activities and in the provision of quality services for survivors of GBV (Please refer to the GBV Diagnostic in Annex 7 for an overview of best practices). Design was informed by a thorough analysis of international good practices, a review of rigorously evaluated programs developed and implemented in Uganda as well as a detailed assessment of risk factors for GBV in Uganda. The most recent DHS and census data available35 was used to develop a composite index (using proxy indicators for GBV) to effectively target the most densely populated areas and groups most at risk. The proposed approach to targeting is expected to maximize the investment of public funds in GBV prevention and response. Extensive consultations were carried out with Government counterparts during preparation. In addition, a series of consultative workshops were held with key bi-lateral and multi-lateral partners with long-standing experience in the field of GBV in Uganda. 74. The GBV prevention interventions included in the design are based on the adaption of interventions evaluated using a quasi-experimental design. Specifically, the project will implement community awareness raising interventions targeting opinion leaders and key community groups to address imbalanced power and gender relations. In addition, the project will target adolescents at risk through dedicated life-skills and economic 33 Conversion reflects December 31st, 2013 exchange rate of 1UGX = .0004 USD 34 Direct costs of dealing with incidents in 2011 refer to out of pocket expenditures for accessing rehabilitation as well as legal redress. Indirect costs consider value of days lost due to domestic violence 35 2011 UDHS and 2014 Population Census Page 35 of 109 The World Bank empowerment activities. Both of these models have demonstrated significant results in Uganda in reducing GBV prevalence and reducing accepting attitudes towards GBV. The project will support enhancements of these approaches and the development of a national protocol on GBV prevention led by the MOGLSD. The project will also create mechanisms to scale-up/roll-out these prevention activities through partnerships between GoU and specialized service providers. 75. The project will strengthen core sectors responsible for GBV response under the National Policy on Elimination of Gender-Based Violence to provide quality services to survivors. This will follow a mainstreaming approach, with staff at relevant levels in the health system, MOGLSD, UPF and DPP equipped to effectively address instances of GBV. Given the human resources and funding constraints observed through the GBV Service Gap Analysis conducted as part of project preparation, this mainstreaming approach is considered technically appropriate for the Uganda context. C. Financial Management 76. The project financial management arrangements will be coordinated and managed within the existing arrangements in the MOGLSD and MoH. The Permanent Secretaries MOGLSD and MoH will be the “Accounting Officers” for the project assuming the overall responsibility for accounting for the project funds with day to day accounting operations is being carried out by the Head of Accounts. A Financial Management (FM) assessment of the two ministries and various guidelines and procedures was carried out to identify capacity gaps and determine how best to address these gaps to ensure efficient project execution. 77. The accounting function will be managed as documented in The Public Finance Management Act, 2015, The Public Finance Management Regulations 2016, Treasury Accounting Instructions 2003 (currently being updated in line with new laws and regulations) and the provisions of the POM. The MOGLSD will recruit a project financial management specialist to support existing staff. The MoH will continue to utilize the project financial management specialist and assistant financial management specialist currently supporting World Bank funded projects. The project team under MOGLSD and MoH will be trained on FM within six months of project effectiveness. Training will include guidance on how to address the weaknesses identified during the assessment. The assessment also noted delays in management response and follow up to the internal control weaknesses reported by the external and internal audit. Non-adherence to the internal audit work plan was observed. This will be monitored through the semiannual internal audit reports that will be submitted to the World Bank. 24. The project will be managed through the upgraded Integrated Financial Management System (IFMS) as directed by the MoFPED for all new projects. The project will open two Designated Bank Accounts (DA) in the Bank of Uganda (DA – A for MOGLSD and DA – B for MoH). Proceeds of the credit will be deposited in these two accounts. In addition, ministries will open local currency project bank accounts in the Bank of Uganda from which local currency transactions will be effected. The participating districts and health facilities will also open project specific bank accounts into which project resources will be transferred for financing approved project activities. The format of the IFRs and ToRs for the external audit have been agreed with the ministries and the World Bank. 78. The conclusion of the assessment is that the Financial Management arrangements for the project have a “Substantial” residual risk rating. Page 36 of 109 The World Bank D. Procurement 79. Guidelines: Procurement under the project will be carried out in accordance with the “Procurement Regulations for Borrowers under Investment Project Financing: Goods, Works, Non-Consulting Services and Consulting Services” (dated July 1, 2016); “Guidelines on Preventing and Combating Fraud and Corruption in Projects Financed by the International Bank for Reconstruction and Development (IBRD) Loans and IDA Credits and Grants (revised as of July 1, 2016)”; and provisions stipulated in the Financing Agreement. 80. Project Procurement Strategy for Development (PPSD): As per the requirement of the Procurement Regulations, the borrower has prepared a PPSD, the basis of which the Procurement Plan (PP) for the first 18 months of project implementation has been developed. A procurement capacity assessment was undertaken in line with the proposed institutional arrangements for the project and based on the assessment and the context of the project, the necessary risk mitigation measures, capacity building, procurement systems enhancement measures were agreed upon and will be put in place as part of project implementation. 81. A Procurement Capacity Assessment of the MOGLSD and MoH was carried out between March 14 and 17, 2017: At the MoGLSD the assessment revealed a number of risks, among them; (i) not all staff in the Procurement and Disposal Unit (PDU) have experience in the use of World Bank procurement guidelines/regulations and procedures; (ii) limited capacity for handling complex, high-value and high-risk contracts at the PDU; (iii) internal inefficiencies and delays in the preparation of ToRs, specifications, bidding/proposal documents, bids/proposals evaluations, (iv) insufficient office and procurement records storage space; (v) limited knowledge and experience in contract management by User Departments, (vi) poor monitoring and tracking of procurement plans; and (vii) lack of follow-up on procurement reviews and audit recommendations and action plans. 82. At MoH, the capacity assessment revealed the following weaknesses; (i) delays in updating procurement plans; (ii) delays in preparing technical specifications, terms of reference and statements of requirements by User Departments; (iii) limited skills and knowledge of contract management by Contract Managers/User Departments; (iv) delays in internal approvals and processing of payments; and (v) inadequate storage facilities for procurement records. 83. To mitigate the identified risks and build capacity, an action plan was developed and agreed upon during pre- appraisal. Details of the mitigation measures to address the identified risks, as well as the procurement arrangements for the project are presented in Procurement section of Annex 2. 84. The residual risk after the implementation of the mitigation measures is “Substantial”. Page 37 of 109 The World Bank E. Social (including Safeguards) 85. The Project’s geographical coverage includes Kisoro district with presence of the Batwa Marginalized Peoples’/Indigenous Peoples (IP). To ensure social inclusion of this IP group, the project has triggered safeguard policy OP/BP 4.10. An Indigenous Peoples´ Plan (IPP) has been prepared for the Batwa. Free, prior and informed consultations were carried out with the Batwa communities and an IPPF prepared by the MOGLSD and submitted to the World Bank for review on April 3, 2017. Some of the identified potential positive effects of project implementation on Indigenous Peoples include increased use of available health care services, delivery of culturally appropriate GBV response services and improved access to health services through outreach activities. The project will promote interaction, coordination and consultation with traditional leaders prior and during implementation. For this, it is essential that districts and specialized service providers procured to work in Kisoro employ staff who speak the local dialects and are compliant with local socio-cultural interaction norms and belief systems of the IPs. The IPP was cleared by the Regional Safeguards Advisor and publicly disclosed on April 26, 2017. Key measures to ensure access by the Batwa to project benefits and address issues of potential re- victimization are as follows: (i) Adjustments to the proposed community-based awareness raising activities on GBV to: (a) include a stronger focus on reaching out to men and boys, (b) map of critical opinion leaders and community based organizations and implementation of behavior change interventions targeting these groups and individuals; and (c) conduct additional household level awareness raising interventions with a specific focus on child protection; (ii) Enhance the training of service providers (in particular of front-line responders – police, health services and advisory center/shelter staff) to: (a) include specific sessions to address issues of cultural bias against the Batwa among service providers; and (b) include specific sessions on GBV prevalence and cultural acceptability of GBV among the Batwa that are likely to have an impact on service seeking behavior. 86. The project will support the rehabilitation of health facilities, police stations and district offices for the MOGLSD. This will be limited to small internal repairs only (including, painting, and installation of screen or partitions for further privacy) and will not entail any expansion of current facilities. OP/BP 4.11 and 4.12 have therefore not been triggered. F. Environment (including Safeguards) 87. The interventions under the project involve improvement in the provision of health services, handling of medical products as well as rehabilitation of health facilities, police stations and district offices for the MOGLSD (limited to small internal repairs, painting, and installation of screen or partitions for further privacy). Project activities will contribute to improved health services; they will also lead to increased generation of medical waste by the health facilities. Rehabilitation works may pose minor health and safety risks, while health care waste may pose health risks to the patients, attendants, health workers and the public in the event of poor management practices. Consequently, the Project triggers the following Environmental Safeguards Policies: Environmental Assessment OP/BP 4.01. The potential environmental impacts can be adequately managed by integrating environmental due diligence into the Project cycle. Due to the overall limited likelihood of environmental and social impacts, the Project is rated as Environmental Assessment Category B. Page 38 of 109 The World Bank 88. An Environmental Management Framework (EMF) has been prepared through a consultative process to guide the handling of project environmental aspects during implementation. The EMF provides basic guidance on environmental screening and where necessary development of Environmental Management Plans during implementation. The Environmental Management Framework was reviewed by the Regional Safeguards Advisor on April 11, 2017 and was disclosed locally on April 17, 2017 and at the info-shop on April 21, 2017. In addition to the National Health Care Waste Management (HCWM) Plan (2009/10 – 2011/12) prepared and disclosed under the previous IDA projects, the MoH has the following documents on HCWM and infection control: Approaches to Health Care Waste Management, Health Workers Guide, Second Edition (2013); Uganda National Infection Prevention and Control Guidelines (December 2013); and the National Policy on Injection Safety and Health Care Waste Management (2014). These documents shall guide management of HCWM and shall form part of the project ESMF. During project implementation the MOGLSD shall ensure clear coordination between the MoH and relevant national and/or local government agencies, including District Environment Officers, and District Health Inspectors. 89. Climate change and disaster risk screening. The Project has been screened for short and long-term climate change and disaster risks. The results indicate Uganda may be slightly exposed to climate risks with regards to drought, flooding and precipitation, and landslides, however, it is expected that overall risk is low with low potential impact. Therefore, no regular assessments of potential climate change impacts are expected to be carried out during the Project period. G. World Bank Grievance Redress 90. Communities and individuals who believe that they are adversely affected by a World Bank (WB) supported project may submit complaints to existing project-level grievance redress mechanisms or the WB’s Grievance Redress Service (GRS). The GRS ensures that complaints received are promptly reviewed in order to address project-related concerns. Project affected communities and individuals may submit their complaint to the WB’s independent Inspection Panel which determines whether harm occurred, or could occur, as a result of WB non- compliance with its policies and procedures. Complaints may be submitted at any time after concerns have been brought directly to the World Bank's attention, and Bank Management has been given an opportunity to respond. For information on how to submit complaints to the World Bank’s corporate Grievance Redress Service (GRS), please visit http://www.worldbank.org/en/projects-operations/products-and-services/grievance- redress-service. For information on how to submit complaints to the World Bank Inspection Panel, please visit www.inspectionpanel.org. 91. The project will ensure that effective mechanisms for citizen´s engagement and feedback are put in place . These will be detailed in the POM. Given overall design complexity and in order to streamline citizen engagement mechanisms, the project will: (i) Collect structured feedback on the quality of prevention interventions and responses services through qualitative analysis to be done as part of the project’s impact evaluation. Anonymized information will be collected from targeted communities on access to services, responsiveness and quality of the services and necessary corrective action. Page 39 of 109 The World Bank (ii) In addition, the project will make use of district level monthly and quarterly meetings to review and address grievances that may surface during the implementation of prevention programs and the strengthening of service delivery capacity. Community facilitators trained at district and sub-county level will be the first port of call for community members to voice grievances related to project implementation. Institutions participating in project implementation at district level will take stock of gaps in service provision and review feedback from communities on a monthly basis. Systemic issues pertaining to the performance of service providers will subsequently be reviewed by the district level Steering Committee (Quarterly) and by the National Technical Working Group to be established at National level (Quarterly). The protocol for community level prevention and referral to be developed within six months of project effectiveness will include the project specific GRM measures and response standards. . Page 40 of 109 The World Bank VII. RESULTS FRAMEWORK AND MONITORING Results Framework COUNTRY : Uganda UG - Strengthening Social Risk Management and Gender-Based Violence Prevention and Response Project Project Development Objectives The Project Development Objectives are to increase: (i) participation in Gender-Based Violence (GBV) prevention programs; and (ii) utilization of multi- sectoral response services for survivors of GBV in targeted districts. Project Development Objective Indicators Unit of Responsibility for Indicator Name Core Baseline End Target Frequency Data Source/Methodology Measure Data Collection Name: Direct project Number 0.00 800000.00 Quarterly Ministry of Gender, Labor Ministry of Gender beneficiaries and Social Development Labor and Social Quarterly Reports. Development Female beneficiaries Percentage 0.00 51.00 Quarterly Ministry of Gender, Labor Ministry of Gender, and Social Development Labor and Social Quarterly reports Development Page 41 of 109 The World Bank Unit of Responsibility for Indicator Name Core Baseline End Target Frequency Data Source/Methodology Measure Data Collection Direct project beneficiaries Number 0.00 1500.00 Quarterly Ministry of Gender, Labor Ministry of Gender, in Batwa communities and Social Development Labor and Social (disaggregated by age, sex) quarterly progress reports. Development Description: Direct beneficiaries are people or groups who directly derive benefits from an intervention (i.e., children who benefit from an immunization program; families that have a new piped water connection). Please note that this indicator requires supplemental information. Supplemental Value: Female beneficiaries (percentage). Based on the assessment and definition of direct project beneficiaries, specify what proportion of the direct project beneficiaries are female. This indicator is calculated as a percentage. Name: Number of Number 0.00 800000.00 Baseline, Mid-Term and Impact Evaluation Ministry of Gender participants in community- End-line in line with Labor and Social based Gender-Based Impact Evaluation data Development Violence Prevention collection schedule programs in targeted districts Description: This indicator will measure access to whole of community awareness raising interventions implemented by specialized service providers. Name: Percentage reported Percentage 0.00 20.00 Baseline, Mid-Term, Impact Evaluation Ministry of Gender, decrease in accepting End-line Labor and Social attitudes towards Gender- Development Based Violence in targeted sub-counties Description: This indicator will measure the effectiveness of the GBV prevention interventions put in place by MOGLSD. Targets were based on Impact Evaluation data of similar prevention interventions implemented in Uganda. Data will be collected using the DHS module/questions on accepting attitudes towards GBV. Page 42 of 109 The World Bank Unit of Responsibility for Indicator Name Core Baseline End Target Frequency Data Source/Methodology Measure Data Collection Name: Percentage of Percentage 0.00 80.00 Quarterly Ministry of Gender, Labor Ministry of Gender, reported cases of Gender- and Social Development Labor and Social Based Violence that receive quarterly reports Development at least two multi- disciplinary services (two of the following - medical, psychosocial, security, legal support, livelihoods support) Description: This indicator will measure the effectiveness of the referral system established at district level and the responsiveness of key services Name: Percentage of eligible Percentage 0.00 80.00 Quarterly Ministry of Health Quarterly Ministry of Health reported cases of Gender- Reports Based Violence who receive Post Exposure Prophylaxis (PEP) Treatment with 72 hours Description: This indicator will measure the responsiveness of health sector at district level to GBV. Specifically this indicator will measure the percentage of cases of rape provided with PEP within the 72h following the incident. Intermediate Results Indicators Unit of Responsibility for Indicator Name Core Baseline End Target Frequency Data Source/Methodology Measure Data Collection Name: Guidelines for labour Yes/No N Y One-off Ministry of Gender Labor Ministry of Gender Page 43 of 109 The World Bank Unit of Responsibility for Indicator Name Core Baseline End Target Frequency Data Source/Methodology Measure Data Collection inspections updated to and Social Development, Labor and Social include a specific focus on quarterly reports Development GBV and disseminated Description: This indicator will assess the establishment of clear procedures to monitor instances of GBV in the workplace on the part of the Ministry of Gender Labor and Social Development Name: Number of people Number 0.00 5000.00 Quarterly Ministry of Gender, Labour Ministry of Gender, benefiting from GBV and Social Development Labour and Social awareness raising quarterly reports Development interventions in the workplace Description: This indicator will measure the reach of the awareness raising intervention in the workplace to be piloted by MOGLSD Name: Number of Number 0.00 30000.00 Quarterly Ministry of Gender, Labor Ministry of Gender, adolescents (disaggregated and Social Development Labor and Social by sex) attending life-skills quarterly progress reports Development education and gender transformative training Description: This indicator will assess the reach of the GBV prevention interventions specifically targeting adolescents Name: Percentage of Percentage 0.00 30.00 Quarterly Ministry of Gender Labor Ministry of Gender established youth savings and Social Development Labor and Social groups receiving support for quarterly reports Development livelihoods plans in line with Page 44 of 109 The World Bank Unit of Responsibility for Indicator Name Core Baseline End Target Frequency Data Source/Methodology Measure Data Collection project procedures Description: This indicator will monitor the quality of the support provided to youth groups in terms of livelihoods Name: Number of GBV Number 360.00 720.00 Quarterly Ministry of Gender Labor Ministry of Gender survivors (disaggregated by and Social Development Labor and Social age/sex and district) quarterly reports Development accessing services through pilot shelters (per year) Description: This indicator will assess the extend of service provision in pilot advisory centers and shelters Name: Numbers of health Number 0.00 4000.00 Quarterly Ministry of Health quarterly Ministry of Health staff (disaggregated by reports function and sex) trained on the provision of services to GBV survivors in targeted districts Description: This indicator will measure the capacity building element of the health sector support, focusing on front-line staff providing services to survivors of GBV Name: Numbers of GBV Number 0.00 30000.00 Quarterly Ministry of Health quarterly Ministry of Health survivors provided with reports access to medical services through supported health facilities in targeted districts Page 45 of 109 The World Bank Unit of Responsibility for Indicator Name Core Baseline End Target Frequency Data Source/Methodology Measure Data Collection Description: This indicator will assess the improvements in utilization of health services by GBV survivors Name: Number of Ugandan Number 0.00 2600.00 Quarterly Ministry of Gender, Labor Ministry of Gender, Police Force staff and Social Development Labor and Social (disaggregated by function Development and sex) trained on service provision to GBV survivors while in service in targeted districts Description: This indicator will measure the roll-out of the standardized national curriculum on GBV to key UPF staff in targeted districts Name: Percentage of Percentage 0.00 20.00 Quarterly Ministry of Gender Labor Ministry of Gender reported GBV cases from and Social Development, Labor and Social targeted districts followed based on quarterly reports Development by a criminal investigation by UPF Description: This indicator will measure the quality of the support to UPF(including on evidence collection and management) Name: Project MIS Yes/No N Y Years 2, 4 and 5. External assessment by Ministry of Gender functional and providing Ministry of Gender Labor Labor and Social information in a timely and Social Development Development fashion to measure project results (based on bi-annual assessment) Page 46 of 109 The World Bank Unit of Responsibility for Indicator Name Core Baseline End Target Frequency Data Source/Methodology Measure Data Collection Description: This indicator will assess the quality of the routine data generated by the project Name: National data Yes/No N Y One-off Ministry of Gender Labor Ministry of Gender collection system on GBV and Social Development Labor and Social upgraded and data external assessment Development collection piloted in 13 districts Description: This indicator will assess progress made in developing an effective system for collection and analysis of national data on GBV Name: Anonymized Yes/No N Y Baseline, Mid-Line and Qualitative research as part MOGLSD feedback collected from End-line as part of the of Impact Evaluation beneficiaries on quality of Impact Evaluation GBV response services and prevention programs Description: This indicator will collect feedback from citizens/targeted communities on the quality of the services provided Name: Proportion of health Percentage 0.00 80.00 Bi-annual assessment MoH quarterly progress Ministry of Health facilities in project districts reports implementing adequate medical waste management practices Description: Adequate management of medical waste is defined as: (a) with color coded bins, (b) presence of HCWM guidelines on the walls, (c) infection control committee and; (d) based on rapid assessment of how waste in handled outside medical facilities. This assessment will be done using a sample of 50 facilities. Page 47 of 109 The World Bank Target Values Project Development Objective Indicators FY Indicator Name Baseline YR1 YR2 YR3 YR4 YR5 End Target Direct project beneficiaries 0.00 0.00 200000.00 400000.00 600000.00 800000.00 800000.00 Female beneficiaries 0.00 0.00 0.00 51.00 51.00 51.00 51.00 Direct project beneficiaries in Batwa 0.00 0.00 0.00 1500.00 1500.00 1500.00 1500.00 communities (disaggregated by age, sex) Number of participants in community- based Gender-Based Violence Prevention 0.00 0.00 200000.00 400000.00 600000.00 800000.00 800000.00 programs in targeted districts Percentage reported decrease in accepting attitudes towards Gender- 0.00 0.00 10.00 20.00 20.00 Based Violence in targeted sub-counties Percentage of reported cases of Gender- Based Violence that receive at least two multi-disciplinary services (two of the 0.00 0.00 20.00 40.00 60.00 80.00 80.00 following - medical, psychosocial, security, legal support, livelihoods support) Percentage of eligible reported cases of Gender-Based Violence who receive Post 0.00 0.00 20.00 40.00 60.00 80.00 80.00 Exposure Prophylaxis (PEP) Treatment with 72 hours Page 48 of 109 The World Bank Intermediate Results Indicators FY End Indicator Name Baseline YR1 YR2 YR3 YR4 YR5 YR6 YR7 YR8 YR9 Target Guidelines for labour inspections updated to N N N Y Y Y Y include a specific focus on GBV and disseminated Number of people benefiting from GBV awareness raising 0.00 0.00 0.00 2500.00 3500.00 5000.00 5000.00 interventions in the workplace Number of adolescents (disaggregated by sex) attending life-skills 0.00 0.00 0.00 10000.00 20000.00 30000.00 30000.00 education and gender transformative training Percentage of established youth savings groups receiving support for 0.00 0.00 0.00 0.00 15.00 30.00 30.00 livelihoods plans in line with project procedures Number of GBV survivors (disaggregated by age/sex and district) accessing 360.00 0.00 0.00 320.00 720.00 720.00 720.00 services through pilot shelters (per year) Page 49 of 109 The World Bank End Indicator Name Baseline YR1 YR2 YR3 YR4 YR5 YR6 YR7 YR8 YR9 Target Numbers of health staff (disaggregated by function and sex) trained on the 0.00 0.00 2500.00 4000.00 4000.00 4000.00 4000.00 provision of services to GBV survivors in targeted districts Numbers of GBV survivors provided with access to medical services through 0.00 0.00 10000.00 15000.00 25000.00 30000.00 30000.00 supported health facilities in targeted districts Number of Ugandan Police Force staff (disaggregated by function and sex) trained on 0.00 0.00 0.00 1300.00 2600.00 2600.00 service provision to GBV survivors while in service in targeted districts Percentage of reported GBV cases from targeted districts 0.00 0.00 0.00 0.00 10.00 20.00 20.00 followed by a criminal investigation Project MIS functional and providing information in a timely fashion to measure N N Y Y Y Y Y project results (based on bi- annual assessment) Page 50 of 109 The World Bank End Indicator Name Baseline YR1 YR2 YR3 YR4 YR5 YR6 YR7 YR8 YR9 Target National data collection system on GBV upgraded N N N N Y Y Y and data collection piloted in 13 districts Anonymized feedback collected from beneficiaries on quality of GBV response N N Y Y Y Y Y Y Y Y Y services and prevention programs Proportion of health facilities in project districts implementing adequate 0.00 0.00 20.00 40.00 60.00 80.00 80.00 medical waste management practices Page 51 of 109 The World Bank ANNEX 1: DETAILED PROJECT DESCRIPTION COUNTRY: Uganda UG – Strengthening Social Risk Management and Gender-Based Violence Prevention and Response Project Overall approach 92. Project design acknowledges the fact that GBV is widespread nationwide and accepting attitudes towards GBV play an important part in the high GBV prevalence rates observed in Uganda. The project takes into account the additional risks of GBV posed by the implementation of large scale infrastructure projects by including a specific focus on GBV in the workplace. However, the proposed intervention is also based on the assumption that GBV in the workplace or instances of GBV directly related to labor influx cannot be addressed in isolation. Addressing these particular manifestations of GBV requires a focus on the underlying social norms and values at community and household level that may create an environment where GBV is condoned. Communities, informal institutions and families can discourage survivors from accessing services and from lodging formal complaints. Therefore, the project has included a strong focus on GBV prevention also at community level with an emphasis on gender transformative training and behavior change. 93. In line with global best practices and based on the overall situation analysis of GBV in Uganda, the project will focus on both preventing GBV and on improving the quality of multi-sectoral response services for survivors in targeted districts. Global evidence indicates that effective prevention programs encourage GBV survivors to come forward and seek services. It is therefore important that awareness raising and gender transformative training be accompanied by improvements in the availability and quality of response services. 94. The proposed approach builds on tried and tested interventions in Uganda particularly in terms of prevention programs. In order to maximize GoU investments in this area, the project will adapt and take to scale prevention programs which have been developed in Uganda, have been rigorously evaluated and therefore have a proven track record of reducing GBV prevalence36. 95. Finally, project design has taken into account the constraints in providing high quality services at district and sub-county level. This includes inadequate staffing levels for police stations, high turn- over of staff at the level of health facilities, significant case backlog in the criminal justice system and existing capacity constraints on the part of Ministry of Gender, Labor and Social Development at district level. In order to put in place a sustainable approach to GBV response, the project has adopted a mainstreaming approach, rather than a center-based service delivery strategy. Under the overall coordination of the MOGLSD and the high level Steering Committee, the project will support the enhancement and adoption of a clear referral pathway for the management of GBV cases with the involvement of key sectors. This referral pathway will inform the development of further Standard 36 Abramsky (2014), Impact Evaluation of the SASA! GBV prevention intervention (whole of community awareness raising and behavior change) indicates a significant reduction in acceptance of IPV among both women and men. Bandiera et al (2012), Impact Evaluation of livelihoods and life-skills interventions with adolescents implemented by BRAC indicates that the incidence of girls reporting having sex against their will dropped by 76%. Page 52 of 109 The World Bank Operating Procedures (SOP) and case management guidelines in the Health Sector, Uganda Police Force and Department of Public Prosecution. Component 1 – Prevention of Social Risks and Gender-Based Violence (US$20 million) 96. This component will strengthen the development, coordination and implementation of a set of comprehensive GBV prevention interventions within the broader context of social risk management. In particular, this component will focus on: (i) promoting behavior change and addressing social norms and values that may enable or condone GBV at community and household level as well as in the workplace; (ii) strengthening referral mechanisms and ensuring information on available services for GBV survivors is available and widely disseminated at community level and in the workplace (in prioritized sectors). Acknowledging the additional risk of GBV posed by large influx of labor, this component includes a specific focus on putting in place systems that would allow MOGLSD to monitor and address instances of GBV linked to public investments in infrastructure. Sub-component 1 A – Preventing Gender-Based Violence in the workplace in the broader context of social risk management (US$3 million) 97. The GoU recognizes the challenges in identifying and effectively responding to risks of GBV associated with labor influx in large infrastructure projects . Therefore, interventions to mitigate risks of GBV in the workplace, including sexual harassment, physical violence, sexual assault, emotional and psychological violence, exploitation among others, have been prioritized with a specific focus on public sector infrastructure investments. This component will focus on the following activities, which will be national in scope and focus primarily on strengthening MOGLSD capacity to monitor and address issues of GBV in the workplace as follows: 98. Strengthening the legal framework to address GBV in the workplace, by: (i) conducting a review and supporting the development or amendment of regulations for the Employment Act and the Occupational Health and Safety Act; (ii) developing a framework to assess risks of GBV in the workplace as part of the labor inspection system. This will also include a focus on the interaction between the labor force in infrastructure investments and the broader community. The assessment will be developed with a focus on the following sectors: roads, oil and gas, energy and water; (iii) designing and rolling out a training program for labor inspectors at national and district levels on the application of the GBV assessment framework; (iv) improving the technical inspection tools currently in use, such as the Occupational Health and Safety (OHS) checklist to monitor risks of GBV as well as the mitigation measures put in place (in infrastructure projects). 99. Supporting MOGLSD to oversee the design and implementation of GRMs in selected sectors to handle issues of GBV in the workplace (including those pertaining to the interaction between workers and the broader community). The project will fund: (i) the development of guidelines for the design of GRM promoting/encouraging the reporting of cases of GBV in the workplace37; (ii) the development of procedures on how to effectively refer cases of GBV that maybe captured through these enhanced GRM; and (iii) the training of relevant sectoral agencies on the design and management of such GRM in 37 This will build on the work currently being initiated by MOGLSD and UNRA on the development of GRM specifically for roads projects. Page 53 of 109 The World Bank coordination with the MOGLSD. The MOGLSD will work closely with the following line agencies to pilot these enhanced GRMs: Ministry of Energy and Mineral Development, Ministry of Water and Environment, Uganda Roads Authority and the Ministry of Works and Transport. 100. Increasing public awareness of GBV (with a specific focus on GBV in the workplace). This will include: (i) the development and dissemination of simplified information on the policy and legal framework to address GBV in the workplace, including referral pathways; (ii) the design and implementation of a multi-media campaign on GBV prevention (including but not limited to the workplace); and (iii) piloting awareness raising and behavior change intervention addressing GBV in the workplace in strategic sectors. This will be done in collaboration with employers, the private sector, and labor unions. The pilot will include signaling interventions by employers and public commitments to eradicating GBV in the workplace as well as an external monitoring mechanism in partnership with the private sector and specialized service providers. In addition, the project will support MOGLSD’s ability to monitor the implementation of issues pertaining to GBV in the workplace in the overall context of social risk management. 101. Strengthen GoU’s information base on issues pertaining to GBV in the workplace through the implementation of a targeted study in partnership with the Uganda Bureau of Statistics (UBOS). Sub-Component 1B - – GBV prevention and referral at community level in the context of social risk management (US$17 million) 102. In order to address the underlying causes of GBV and tackle social norms and values that may condone GBV, the project will invest significantly in awareness raising and behavior change at community level in the 13 focus districts highlighted above. The approach to prevention builds on tried and tested models which have been evaluated in Uganda. Through the proposed project, GoU will develop a national protocol for community based prevention programs bringing together: (i) whole of community awareness behavior change and awareness raising interventions; (ii) specific interventions focusing on adolescent girls and boys and combining gender transformative training with livelihoods support; and (iii) community based referral system and provision of psycho-social support at community level. The national protocol for community based prevention programs described below will be designed by MOGLSD with the support of specialized technical assistance. The MOGLSD will lead the operationalization of community based prevention activities. Interventions will be implemented by the MOGLSD in partnership with service providers to be selected on a competitive basis by MOGLSD at central level. These organizations will have a proven track record of delivering GBV prevention programs at community level. The implementation of GBV prevention activities at community level will draw on a pool of qualified community workers including para-social workers and Village Health teams as well as on community opinion leaders. MOGLSD at district and sub-county level will closely supervise the implementation of the prevention program. MOGLSD staff at district level, in particular will participate actively in community mobilization activities and in the implementation of the community- based referral mechanisms. Resources for the active engagement of MOGLSD staff at district level have been included in the project’s detailed budget. Page 54 of 109 The World Bank 103. The detailed protocol for the community based prevention activities will be developed within six months of project effectiveness and include the selection sub-counties per district for the implementation of activities targeting adolescent girls and boys. While awareness raising activities and the establishment of a community-based referral system will take place district-wide, specific activities targeting adolescents are expected to take place in selected sub-counties per district. The protocol will form a basis for hiring of the service providers. The three elements of the community level prevention interventions are as follows: i. Community mobilization and promotion of behavior change: The identification, training and mentoring of a team of community facilitators as key agents of change who will implement a community mobilization intervention targeting opinion leaders, key community based organizations as well as older men and women that play a key role in perpetuating accepting attitudes towards GBV. This element of the approach is expected to foster changes in social norms, attitudes and behaviors at community level. It will focus specifically on transforming gender relations and power dynamics. This element of the intervention will be implemented by service providers under the overall guidance and with the participation of Community Development Officers and Probation Officers at district and sub-county level. ii. Livelihood Support Intervention: Through the initial community mobilization step, facilitators will identify and target a selection of adolescent girls and boys – with priority given to out of school youth- in each community to support their economic empowerment. Based on Uganda best practice interventions that have been evaluated, livelihood interventions with groups most at risk can play a key role in preventing GBV. The livelihoods component will deliver a mix of market-oriented vocational training and mentorships arrangements, business development and financial literacy skills to girls and boys and then seek to link these adolescents to existing credits and savings schemes. Evidence from Uganda indicates that livelihoods’ support is most effective in preventing GBV when combined with life- skills and gender-transformative interventions targeting both boys and girls. Implementation of this intervention will be consistent with current approaches to livelihood programs for adolescents implemented by GoU to ensure consistency in the principles followed. iii. The third element of this package will be to strengthen community-level response and referral mechanisms for GBV survivors.38 At present, a very small proportion of women and girls who are abused actually report violence to anyone. Women survivors face multiple barriers to speaking out, and in particular, to accessing formal services. This community response and referral intervention will train the community facilitators in close coordination with district level MOGLSD staff that implement community awareness raising activities (see (i)) as well as key community structures (e.g. village health teams, local council, religious institutions, schools) on GBV response. The aim will be to ensure that GBV survivors have trusted individuals and mechanisms to whom they can report violence and through whom they can get access to the services – informal and formal – they need and want. Trained community activists, supported under the project will act as victims’ advocates for referral to adequate services. Access to emergency support covering costs of transport, purchase of clothing and hygiene items to eligible survivors shall be provided following the procedures to be outlined in the POM. Facilitators will also play a key role in the community reintegration of survivors, who have approached them to request 38 The community-based level response has been included in Component 1B as it will be part of the package implemented in partnership with specialized service providers, as outlined in paragraph 103 above. Page 55 of 109 The World Bank support in accessing services or who have been referred to specialized service providers after approaching health or police services directly. This will be done through engagement with the community and key opinion leaders, provision of psycho-social support where appropriate, integration in project supported livelihood interventions for adolescents and referral to existing livelihood programs in the case of adult survivors. iv. The project will invest in developing and rolling out a training module for the provision of psycho-social support at community level. The training will be based on the guidelines for the provision of psycho-social support developed by the MOGLSD in 2016 and will be provided by specialized service providers to community facilitators (and where feasible to trained community activists). Following the training, community facilitators will provide Psycho-Social Support (PSS) to survivors at community level. The training will also equip them with the knowledge to identify and refer more complex cases for follow-up at health center or hospital level. Service providers will in addition provide more specialized psycho-social support through their staff at district level based on the initial screening conducted at community level. This approach acknowledges the staffing limitations at both MOGLSD and MoH level to provide this specialized service and the fact that community facilitators and activists are often the first port of call for survivors. 104. Under this sub-component, the MOGLSD will pilot the provision of services for survivors of GBV and the implementation of GBV prevention interventions through advisory centers and shelters. This would entail the: (i) continuation of the support currently provided through the Kamuli advisory center and shelter from 2018 onwards; (ii) the development of a strategic, costed action-plan on the expansion of shelter services by GoU. This will include a study on the establishment of three additional shelters in critical districts (thus potentially establishing a total of one pilot shelter in each of the four regions). The assessment will take into account existing cost-effective approaches to shelter interventions based on the lessons-learned and documented in Kamuli. These advisory centers are expected to provide psycho-social support, referral to livelihood opportunities, legal aid and other services as relevant. These shelters shall be established and operationalized in line with national guidelines. Staff at the advisory centers are expected to act as victims’ advocates and support the GBV survivor to access relevant services (health, police and judiciary). In addition, off-site shelters in an undisclosed location and linked to the advisory centers would provide temporary accommodation to survivors who are not able to immediately return to their households and communities. The preparatory analysis will review: (i) existing shelters and critical gaps in service provision at district level; (ii) investment costs of shelter refurbishment as well as operation and maintenance costs; (iii) sustainability of shelter operations after the life-time of the project; and (iv) cost-effective modalities for the management and operation of the proposed shelters. Based on the initial analysis, GoU will prepare a detailed proposal for the pilot shelter interventions for review and approval by the World Bank. The project will not support the construction of new infrastructure for advisory centers and shelters but will rather support refurbishment of existing facilities that would not expand the footprint of existing structures. 105. Finally, this component will support the implementation of an Impact Evaluation (IE) focusing specifically on the proposed GBV prevention activities. Given the design of GBV prevention interventions and the focus on specific sub-counties (particularly for the more intensive whole of community awareness raising activities as well as activities to be implemented with adolescents), the Page 56 of 109 The World Bank project expects to put in place a Randomized Control Trial (RCT). The detailed design of the IE will be completed during the project’s start-up phase (initial six months of implementation). 106. Implementation of activities at community level will follow a phased approach as follows: First 6 months - Start up-phase: Specialized service providers will receive support to prepare them to deliver the interventions at community level. During this period, all partners will also work to refine and document the community-level package of interventions, both to ensure consistency where important and adaptation to specific contexts. A community entry protocol will be followed to prepare for implementation and this will include: mapping of existing community structures; mapping the location and accessibility of services; a social profile of the community including main types of GBV, specific social norms and particularly vulnerable groups; the identification, selection and training of ‘community facilitators’. During this period baseline data will also be collected to enable effective monitoring and impact evaluation. Months 7- 42: Sequenced implementation of interventions starting with whole of community awareness raising and behaviour change activities. These interventions will target opinion leaders and key/influential community based organizations as well as older women and men who play a key role in perpetuating social norms and values that may condone GBV. In addition, to these “whole of community interventions”, life-skills education and livelihoods and economic empowerment will specifically target adolescents in the same communities. In order to be mutually reinforcing, whole of community mobilization activities and specific activities targeting adolescents will take place in parallel at community level. The livelihoods intervention will be combined with gender transformative training. Building on the Uganda experience of implementing livelihoods interventions (particularly the NUSAF series of programs) as well as global best practices on livelihood interventions with adolescents, the project will invest first in group formation. This initial phase is expected to take place over 12 to 24 months. This will include mobilizing adolescent boys and girls, providing financial literacy support and initiating the establishment of savings groups. During that process, community facilitators will work with the groups to provide life-skills education and conduct awareness raising and gender transformative training activities. This will take place as the savings groups’ mature and increase their level of savings. Following a set of pre-established graduation criteria, savings groups will be assessed for readiness to proceed with additional vocational skills training of their members (following a market analysis of skills in demand), business development services and the provision of start-up grants for their members. This phasing is intended to improve the sustainability of the economic activity targeted adolescents will engage in. Based on the Uganda data and global evidence it is expected that only a proportion of the savings groups initially targeted would be able to graduate to this second phase. Similarly, the livelihoods development process will be accompanied by the provision of further modules of life-skills and gender transformative training (focusing on reproductive health, gender relations, power dynamics among others). This second phase is expected to take place between month 24 and 42 of project implementation. Months 43 – 60: Consolidation and sustainability assessment by specialized service providers. Given that the project will include an impact evaluation focusing specifically on GBV prevention, end-line data collection will take place during this stage in the project cycle. Page 57 of 109 The World Bank 107. Component 2 – Gender-Based Violence Response in the context of social risk management (US$10.6 million) 108. Overall this component will strengthen the responsiveness of front-line service providers: Health Sector, Uganda Police Force and the Directorate of Public Prosecution to cases of GBV and improve their ability to provide quality care to survivors. This component will: (i) strengthen national coordination systems, (ii) support the enhancement and adoption of comprehensive guidelines for referrals; (iii) the development standard operating procedures and; (iv) training curricula for the Uganda Police Force. In addition, dedicated resources will be allocated to these core services in the 13 focus districts to directly improve the quality of the service provided. This will be key to ensure that these key sectors are able to effectively deal with a potential increase in reporting and in demand for services stemming from the implementation of awareness raising and GBV prevention activities implemented under Component 1. Given the significant social barriers to reporting GBV, it is expected that the majority of cases in the targeted areas will reach formal services through the community-based referral system put in place in partnership with specialized service providers. However, when survivors approach health centers/ hospitals or police stations directly, staff at these service points will equally liaise closely with the specialized service provider at district level and refer survivors of violence for: (i) additional support that may be required at community level; and (ii) further guidance on how to access other response services that may be needed. 109. Sub-Component 2A – Strengthening the Health Sector Response to GBV (US$9.3 million). The main objective of this sub-component will be to strengthen the Uganda health sector responsiveness to GBV with a focus on (i) strengthening sector leadership and governance; and (ii) strengthening provider capacity to respond to GBV. 110. Key activities under this sub-component will be as follows: (i) Strengthening sector leadership and governance by supporting MoH to establish a technical working group on GBV and developing a sector specific strategy for mainstreaming GBV39. This sub-component will also support the mapping of health sector GBV actors and service providers to enable better coordination of these stakeholders by MoH. Institutional capacity will be further strengthened by establishing a network of GBV focal points at national and subnational levels and at the level health facilities in the targeted districts. Particular attention will be paid to the collection and recording of forensic/medico-legal data and its sharing with UPF for subsequent investigation.40 (ii) Integration of GBV response in health provision. Key activities under this sub-component will focus on: (a) Re- printing GBV training manuals developed by MoH, (b) training Health Care Providers (HCP) including community health workers in targeted districts using the above materials. The training will focus on GBV case screening, medical case management including the correct collection of forensic evidence and accurate record keeping and reporting; (c) updating and disseminating management 39 This will include the adoption of the WHO Global Standards on Gender-Based Violence Management 40 Based on the demand for such follow-up on the part of the survivor Page 58 of 109 The World Bank protocols and guidance notes for practitioners (job aides) developed specifically by the health system in Uganda. These materials will be distributed countrywide starting with the 13 focus districts targeted by the project and the project will fund an assessment of the current capacity of the health system to provide mental health services for survivors of GBV and prepare an options paper for MoH on how best to strengthen such services in targeted districts. In addition, the project will also aim to build medico-legal response capacity of HCP. The project will support the adoption, printing and distribution of the draft medical - legal manual.41 The manual will be used to train HCP’s as well as experts from police and judiciary with a focus on handling forensics, preparing for court hearings and filling of police and medico-legal forms (342, 3A, 24 & 24A). The project will further strengthen forensic evidence collection by procuring sexual assault evidence kits for targeted districts43. The project will aim to integrate the kit into the national essential medical supplies list. In order to improve the quality of services provided to survivors of GBV, the project will institutionalize integrated GBV case management at different service points in targeted health facilities (e.g. Maternal, Newborn and Child Health, HIV Youth Friendly Services, Family Planning Casualty units). This is expected to ensure that sufficient numbers of adequately trained staff are available to manage GBV cases. In order to improve the quality of front-line services the project will also ensure the availability of medical equipment and essential commodities at health facilities for effective management of GBV cases (with a focus on PEP kits and emergency contraceptives). Finally, this sub-component will fund rehabilitation of health facilities (painting, small internal repairs and provision of screens or partitions as well as lockable cupboards) to create adequate conditions for consultations and counselling where those don’t currently exist. Sub-Component 2B– Strengthening the Justice Law and Order Sector (JLOS) Response to GBV (US$1.34 million) 111. This sub-component supports the operationalization of Uganda’s GBV Policy within the mandates and roles of the participating JLOS institutions: including, Justice Studies Institute (JSI), Directorate of Public Prosecution and Uganda Police Force. The intervention logic of the sub- component is to strengthen a GBV survivor focused response and referral pathway through key JLOS institutions. The JLOS referral pathway involves reporting to the police who would then hand over the case to the DPP for trial in court. Under the Project, the entry of a GBV survivor into the JLOS referral and response pathway is two-tracked: the survivor may come either first to a health care provider and then be referred (i.e. Component 2A) or, the survivor may come to the police directly (see illustration). This ‘chain link between’ the Project’s health and UPF support will be reflected in the UPF SOP for GBV and training (see Figure 5 below). 41 The medical- legal manual was jointly developed by MoH, WHO, Judiciary and FIDA-Uganda with the support of the Democratic Governance Facility 42 Form 3 is critical for the recording of forensic/medico-legal information enabling further investigation and potential prosecution of cases. Page 59 of 109 The World Bank Figure 5: Overview of the referral pathway within JLOS (i) Strengthening sector leadership in terms of GBV response at national level and support to the sector to reach out to critical JLOS institutions in targeted districts. As part of its regular work, JLOS interacts with the key institutions in each of the targeted districts overseeing and coordinating the overall JLOS activities at district level. (ii) Reviewing and updating new Standard Operating Procedures (SOP) for the management of GBV cases. Institutionalizing the Uganda GBV policy requires updating current SOP on addressing instances of GBV to support the standardized management of cases and monitoring the effective implementation of the GBV policy. The respective SOP on GBV for the UPF, DPP and Courts will provide clear standards for professional behaviors and attitudes. These SOP on GBV promote internal and external transparency and accountability. The project will support monitoring activities to establish if GBV cases are handled in line with the updated SOP on GBV and guidelines to be put in place in these institutions. The SOP on GBV will be rolled out in conjunction with the pre-service and in-service training activities for the UPF, DPP and Courts. (iii) Tri-partite National GBV Curricula for JLOS (police, DPP, courts). The JSI will be supported during the first two years of the project to work together with the respective institutional focal points and designated departments and develop a national tri-partite curriculum on GBV as follows:  Police curriculum development will be anchored in the UPF training department and provided Page 60 of 109 The World Bank through UPF training institutions. The specialized nature of the UPF GBV curricula, that will cover general training on GBV as well as specialized technical training under the purview of the UPF Criminal Investigations Department (CID) requires dedicated technical expertise. The approach includes building a cadre of in-house trainers. The delivery of the training curriculum will include UPF officers in targeted districts.  DPP and JSI curriculum development. The DPP will conduct a GBV training needs assessment, develop a DPP specific GBV curriculum, and provide this in-service training. Likewise, the JSI will go through the same steps to develop a GBV curriculum for judicial officers.  Support internal rehabilitation of police stations in targeted districts – to ensure minimum conditions of privacy for interviews with survivors of GBV. This will include only internal repairs and rehabilitation and not an expansion of existing facilities. Figure 6: Key elements of Component 2B 112. Component 3 - Project Management and Monitoring and Evaluation (US$9.4 million) 113. Sub-Component 3 A – Project Management (US$9.1 million) This component will cover overall project management costs to ensure efficient and effective coordination, fiduciary management, monitoring and evaluation at national and local levels. This will be Page 61 of 109 The World Bank done through dedicated technical assistance to the implementing agencies, institutional strengthening, purchase of critical equipment and rehabilitation of the district offices for Probation Officers, Labor Officers and Community Development Officers. This component will include support for strengthening existing coordination structures, the sustainability of project activities and the training of critical staff at national and sub-national level. 114. Sub-Component 3B – Monitoring and Evaluation (US$335,000) Review and roll-out of a National System for data collection on GBV. The project will further support key measures to ensure effective data collection and information management on GBV. The project will assess the data currently being collected through the National GBV Database and the Occupational Health and Safety Database currently managed by MOGLSD as well as the data on GBV currently collected through the Health Management Information System (HMIS). The project will develop alternatives to strengthen data collection (building on these platforms) for review by GoU. Following a decision by the Steering Committee on the most appropriate approach, the project will support the roll- out of the streamlined data collection system to the 13 targeted districts. Page 62 of 109 The World Bank ANNEX 2: IMPLEMENTATION ARRANGEMENTS COUNTRY: Uganda UG – Strengthening Social Risk Management and Gender-Based Violence Prevention and Response Project Project Institutional and Implementation Arrangements Overall implementation arrangements 115. The project will be implemented by the Ministry of Gender Labor and Social Development (MOGLSD) and the Ministry of Health (MoH) using a multi-sectoral approach. The MOGLSD as the main recipient will be responsible for overall project coordination and consolidation of Annual Work Programs and Budgets. MOH will be responsible for component 2A including its Financial Management (FM) and procurement. MOGLSD will be responsible for FM and procurement for activities under Component 1, Component 2B and Component 3. MoH will submit technical and financial work plans and reports for component 2A to the Permanent Secretary (PS) MOGLSD for approval and onward submission to the World Bank for release of funds to their designated accounts. The MOGLSD as the main recipient will be responsible for overall project coordination and consolidation of Annual Work Programs and Budgets. MOGLSD will competitively select specialized service providers for the implementation of Component 1B. The Uganda Police Force and JLOS Secretariat will be sub-recipients under the MOGLSD. 116. The Permanent Secretary (PS) of the MOGLSD, as the “Accounting Officer” of the Project, is responsible for overseeing overall project implementation. The PS will delegate the day-to-day management of the Project to a full-time Project Coordinator (PC) supported by a team of officers specifically hired to provide technical support for project implementation. This will include: (i) a Deputy Coordinator for the Project Support Team (PST); (ii) a Gender- Based Violence Specialist; (iii) Partnership Specialist; (iv) Legal Officer; (v) Monitoring and Evaluation Specialist (vi) Financial Management Specialist (vii) Procurement Specialist and (viii) Communications Officer at MOGLSD. MOGLSD Senior officers will coordinate project activities closely with the PST to ensure consistency between project support supported activities and the core functions and interventions of critical departments (namely the Department of Gender, Department of Children and Youth, Department of Community Development and Literacy, Department of Labor and Department of Occupational Health and Safety. The Permanent Secretary (PS) of the MoH will be responsible for overseeing the implementation of activities under Component 2A. Project activities will be mainstreamed within the MoH Reproductive Health Division to ensure sustainability of the interventions. A dedicated project officer will be recruited to provide additional technical support. He/she will work under the overall guidance and supervision of the Reproductive Health Division, will work closely with the project coordinator based at MOGLSD and coordinate activities with the PST in MOGLSD. The need for additional support from a Monitoring and Evaluation Specialist at MoH level will be confirmed following the assessment of data collection systems to be undertaken during Year 1 of project implementation. The project will also be able to provide additional support to MoH through a dedicated Financial Management Assistant. This additional need will be confirmed pending the assessment of the workload of the existing Project Support Team (PST) currently in place at MoH. Finally, dedicated persons will be assigned to the Uganda Police Force and to JLOS for the development of the respective training programs. The MOGLSD assigned persons will work under the overall coordination of two focal points to be Page 63 of 109 The World Bank nominated by the UPF and JLOS and who will have the technical lead of activities under Component 2B. 117. The GoU will establish a Project Steering Committee chaired by the PS, MOGLSD. Its membership will comprise: PS (MoH), PS (MoFPED) Inspector General of Police, Director for Public Prosecution, Solicitor General, Secretary to Judiciary or their delegated representatives, and relevant MOGLSD senior staff. The Project steering committee will be responsible for multi-sectoral coordination, policy guidance and oversight to the overall performance of the project implementation. This committee will meet twice a year or when need arises. The project technical committee comprising of project coordinator (chair), focal persons from MoH, Police, JLOS and MFPED desk officer will conduct quarterly review meetings with the involvement of service providers selected for the implementation of Component 1 B and coordinate day-to-day project activities. 118. District Level Coordination – A District Level Steering Committee will be the main mechanism for the coordination of project activities at district level. The Chief Administrative Officer (CAO) will nominate a district level official to oversee the overall implementation of project activities. Mirroring the structure developed at national level, the District Steering Committee will be convened semi-annually to review critical issues with project implementation and identify concerns/issues with implementation that should be discussed and addressed at the level of the Project Steering Committee. A technical sub-committee on Gender-Based Violence will be convened on a quarterly basis to oversee the implementation of prevention and response activities. The sub-committee will be convened on a quarterly basis with the support of the Community Development Officer and include: (i) Probation Officers, (ii) Labor Officer (iii) District Health Officers as well as GBV focal persons at health facility level; (iv) Senior District Police staff; (v) District Magistrate and other relevant senior staff. The POM will include the detailed description of the functions of the District Level Coordination mechanism. 119. Role of Specialized Service Providers – The MOGLSD shall competitively procure specialized service providers which will be contracted to provide GBV prevention intervention at household and community levels in areas of community mobilization, livelihood support, and referral using evidence based GBV prevention and response approaches. Specialized Service providers shall submit quarterly progress activity reports to the District project focal persons based on their respective work plans and budgets. Specialized Service providers shall submit biannual project technical and financial reports to the MOGLSD for harmonization into a National project report. Page 64 of 109 The World Bank Figure 7: Implementation Arrangements Page 65 of 109 The World Bank Figure 8: Project Support Team Composition Project Support Team 120. As the lead implementation agency, the MOGLSD will recruit and put in place a Project Support Team responsible for the day to day management of project activities under the overall oversight of the PS MOGLSD and of Project Coordinator to be nominated by MOGLSD. This will include: (i) a Deputy Coordinator for the Project Support Team (PST); (ii) a Gender-Based Violence Specialist; (iii) Partnership Specialist; (iv) Legal Officer; (v) Monitoring and Evaluation Specialist; (vi) Communications Officer at MOGLSD; (vii), a Financial Management Specialist and; (viii) a Procurement Specialist. 121. The main responsibilities of the MOGLSD PST will be as follows: (i) Developing the POM; (ii) Preparing Annual Work Programs and Budgets (AWPB); (iii) Contracting goods and services for components 1A, 1B, 2B and 3; (iv) Preparing regular reports including quarterly reports on program implementation progress and financial monitoring reports; (v) update procurement plans (every six months); and (vi) coordinate project activities with key line agencies, particularly with UPF and JLOS for the implementation of activities under Component 2B. 122. The MoH Reproductive Health Department will oversee the implementation of Component 2A. An existing PIU in MoH is expected to manage the necessary procurement processes as well as FM. The MoH team will be supported through an additional project officer position (reporting to the Assistant Commissioner Reproductive Health). As funds will flow directly to MoH, the Reproductive Health Department will be responsible for: (i) Preparing MoH inputs to Annual Work Programs and Budgets (AWPBs) to be consolidated by MOGLSD; (ii) Contracting out needed goods and services for components 2A; (iii) Preparing regular inputs to project reports to be consolidated by MOGSDL; (iv) updated procurement plans (every six months) pertaining to Component 2A. Page 66 of 109 The World Bank 123. All positions will be competitively recruited, based on agreed upon Terms of Reference (ToRs) and technical skills and qualifications. Financial Management 124. A FM assessment was conducted under OP/BP 10.00 to determine whether MOGLSD and MoH: (i) have adequate financial management arrangements to ensure that project funds will be used for purposes intended in an efficient and economical way; (ii) project financial reports will be prepared in an accurate, reliable and timely manner; (iii) the entities’ assets will be safeguarded and (iv) are subject to auditing arrangements acceptable to the World Bank. Under OP/BP 10.00, borrowers and project implementation entities are required to have and maintain adequate financial management systems which include budgeting, accounting, internal controls, funds flow, financial reporting and auditing arrangements to ensure that they can readily provide accurate and timely information regarding the project resources and expenditures. 125. These arrangements are deemed acceptable if they: (i) are capable of correctly and completely recording all financial transactions and balances relating to project resources; (ii) can facilitate the preparation of regular, timely and reliable financial statements; (iii) safeguard the project’s assets and; (iv) are subject to auditing arrangements acceptable to IDA. The assessment was carried out in accordance with the World Bank Directive – “Financial Management Practices Manual, issued (retrofitted) by Operations Policy and Country Services on February 4, 2015”. 126. Actions outlined in the Financial Management Action Plan will be undertaken by MOGLSD and MoH to strengthen the financial management system. They include designation or recruitment of a project financial management specialist, conducting quarterly internal audit reviews, having the project in IFMS and carrying FM training for the project team among others. There are no conditions of effectiveness. In order to ensure that the project is effectively implemented, MOGLSD and MoH will ensure that appropriate staffing arrangements are maintained throughout the life of the project. The conclusion of the assessment is that the financial management arrangements for the project have an overall Substantial risk rating. However, with the implementation of the action plan, the financial management arrangements will be strengthened to ensure the proposed financial management arrangements satisfy the World Bank’s minimum requirements under OP/BP 10.00 and are adequate to provide, with reasonable assurance, accurate and timely information on the status of the project resources required by IDA. Page 67 of 109 The World Bank Disbursements – An overview of detailed cost and expected disbursements by year is provided in Table 3 below. Table 3: Detailed project budget and estimated disbursements by component Page 68 of 109 The World Bank Procurement 127. Procurement for the project will be carried out in accordance with the “The World Bank Procurement Regulations for IPF Borrowers, dated July 2016”, hereafter referred to as ‘Procurement Regulations’. The project will also be subject to: (i) the World Bank’s Anti-Corruption Guidelines (i.e the Guidelines on Preventing and Combating Fraud and Corruption in Projects Financed by IBRD Loans and IDA Credits and Grants”, dated October 15, 2006 and revised in January 2011 and as of July 1, 2016); and (ii) the provisions stipulated in the Financing Agreement. 128. As required by the Procurement Regulations, a Project Procurement Strategy for Development (PPSD) has been developed. The PPSD was the basis for the preparation of the Procurement Plan (PP). The procurement plan sets out the selection methods to be followed by the borrower during project implementation in the procurement of goods, works, and non-consulting and consulting services financed by the World Bank. The Procurement Plan is part of the PPSD. The Procurement Plan will be updated at least annually or as required to reflect the actual project implementation needs and improvements in institutional capacity. Table 4: Summary of PPSD The Project Development Objectives (PDO) are to increase participation in GBV prevention programs; and increase utilization of multi-sectoral response services for survivors of GBV in targeted districts. The MOGLSD will procure and implement activities envisaged under Component 1, Component 2B and Component 3 and will competitively select Specialized Service Providers for the implementation of Component 1B. The MoH will procure and implement activities under Component 2A. The Uganda Police Force and the Judiciary will be sub-recipients under the MOGLSD. The procurement profile of the project comprises of various consultancies, procurement of goods such as motor vehicles, motor cycles, bicycles, ICT and office equipment, medical testing kits, and alterations and refurbishment works of low value, and non-consulting services for printing of various materials required under the project. Critical consultancy contracts are also envisaged under the project. After careful evaluation of various options for contracting strategy, hybrid contracting methods (lump sum and time based) would be used for optimum benefit and as fit for purpose for the project. This approach will ensure the optimum utilization of resources and value for money. In consideration of the geographical disparities of the project districts and the scattered nature of minor works envisaged under the project, such as alterations and refurbishment of police stations and district hospitals, contracts will be packed on a regional basis and bids invited on the basis of open national competitive process to enhance participation and competition, and minimize administrative costs and oversight risks. A similar approach will be followed for selection and employment of specialized service providers. To monitor the implementation progress of the various initiatives at sub county level and to ensure smooth coordination between different agencies and resolve issues that may arise during implementation stage, a multi-tiered institutional monitoring mechanism has been created and a Project Management Information System (PMIS) established in target areas. To mitigate procurement capacity risks, there will be need for staff capacity building and training, continuous oversight, reviews and audits and use of real-time monitoring and tracking tools. Page 69 of 109 The World Bank 129. Systematic Tracking of Exchanges in Procurement (STEP): The project will use STEP, a planning and tracking system, which would provide data on procurement activities, establish benchmarks, monitor delays and measure procurement performance. 130. Implementation Arrangements. The project will be implemented by the Ministry of Gender Labor and Social Development (MOGLSD) and the Ministry of Health (MoH). The MOGLSD as the main implementing agency will be responsible for overall project coordination. MOGLSD will be responsible for procurement for activities under Component 1, Component 2B and Component 3 while MoH will be responsible for Component 2A. MOGLSD will competitively select Specialized Service Providers for the implementation of Component 1B. The Uganda Police Force and the Judiciary will be sub-recipients under the MOGLSD. 131. Procurement risk assessment: A procurement capacity and risk assessment has been carried out by the World Bank for the MOGLSD and MoH who will be responsible for implementing the project to review the organizational structure, functions, staff capacity and adequacy for implementing the project and the interaction between the project’s staff responsible for procurement. The assessment has been entered into the Procurement Risk Assessment and Management System (PRAMS). 132. MOGLSD. The assessment revealed that MOGLSD has no past experience in World Bank financed operations. The risks identified include among others; (i) staff have no experience with World Bank procurement guidelines/regulations and procedures; (ii) staff lack experience in carrying out procurement of high value contracts for goods, works and consultant services under open international competitive procedures using World Bank Procurement Regulations and Procedures; (iii) inefficiencies were noted in processing procurement activities such as the preparation of ToRs, specifications, bidding documents, request for proposals and bids/proposals evaluations emanating from delays from user/technical departments; (iv) inadequate working environment, including limited space for staff and for record keeping; and (v) limited knowledge and experience in contract management in both PDU and User Departments. To address the gaps identified, the procurement capacity of the MOGLSD needs to be strengthened. In this case, MOGLSD will be required to recruit a Procurement Specialist to provide technical support in the implementation of procurement activities and building capacity of the Ministry. Based on the Public Procurement and Disposal of Public Assets Act (PPDA) Procurement and Disposal Audit Report for FY 2015/16, the performance of MOGLSD was rated “Satisfactory” with an overall weighted performance of 80.5%. Despite the satisfactory rating the following issues were observed; (i) failure to implement previous audit recommendations; (ii) failure to adhere to the planned procurement schedule; (iii) failure to request for a bid securing declaration; and (iv) use of brand names in some of the bids processed. The ministry however has established all the necessary organs for adjudicating and managing procurement activities in accordance with the provisions of the PPDA Act and its Regulations. 133. MoH is currently implementing four IDA projects, namely, the Uganda Health Systems Strengthening Project (P115563), East African Public Health Laboratory Networking Project (P111556); Uganda Reproductive Health Voucher Project (P144102); and Uganda Reproductive Maternal and Health Improvement Project (P155186). All the four projects are managed by a dedicated unit and a delegated Contract Committee established to manage IDA related procurements. The MoH therefore has the requisite experience and hands-on knowledge in managing IDA financed operations. However, Page 70 of 109 The World Bank assessments and post reviews conducted for the World Bank projects under MoH revealed some weaknesses among them; (i) delays in updating procurement plans; (ii) delays in preparing specifications, terms of reference and statements of requirements by the User Departments; (iii) limited skills and knowledge of contract management by the Contract Managers/User Departments (i.e. delays in preparing contract implementation reports and lack of monitoring of vendors’ performance); (iv) delays in paying vendors resulting from internal approval processes; and (v) inadequate storage capacity for procurement records. The MoH has, however, established the requisite structures and systems necessary for undertaking procurement activities including the organs responsible for adjudicating and managing procurement activities in accordance with the provisions of PPDA and its Regulations. 134. The key issues and risks. Key issues and risks concerning procurement for implementation of the project are as follows: (i) inadequate staff capacity; (ii) inefficiencies in procurement processing and contracts award; (iii) inadequate procurement record keeping and storage facilities; (iv) poor procurement planning; (v) deficiencies in contract monitoring and management; and (vi) lack of follow- up on procurement reviews and audit reports and recommendations. 135. Preliminary Risk mitigation measures. Preliminary risk mitigation measures based on the discussion and assessments made include: (i) use of specialized service providers for community mobilization and activity development; (ii) deployment of competent procurement staff and/or consultant at the MOGLSD; and (iii) training of new and current staff in World Bank procurement regulations. 136. Use of National Procurement Procedures: All contracts following national market approach shall follow the procedures set out in the PPDA, 2003 and its attendant Regulations. The PPDA governs procurement of works, goods and services using public resources by the national government entities and Statement of Expenditures (SOEs). The provisions of PPDA are consistent with the World Bank Procurement Regulations Section V – Para 5.4 National Procurement Procedures, save for the following provisions which will not be applicable; (i) use of domestic preference for contracts obtained through open national competitive procedures; (ii) fees for handling bidder complaints at procuring entity level; (iii) disqualification of bidders for not purchasing bidding documents from the procuring entity; (iv) restrictions on contract amendments in excess of 25 percent aggregated amount; and (v) limitations to the use of bid securing declarations. 137. Procurement Templates: The World Bank’s Standard Procurement Documents (SPDs) shall be used for procurement of goods, works, and non-consulting services under Open International Competitive Procedures. National Bidding documents may be used under Open National competitive subject to the exceptions stipulated in the above paragraph. Similarly, selection of consultant firms shall use the World Bank’s SPDs, in line with procedures described in the Procurement Regulations. 138. Procurement of Works: Works contracts envisaged under the project include minor civils works for refurbishments of shelters and rehabilitation and alterations to MOGSLD offices at district level, health centres and police stations scattered in different locations in the target districts. 139. Procurement of Goods: Goods to be procured under this Project will include among others, the procurement of office and IT equipment, office furniture, motor vehicles, motor cycles and bicycles. Page 71 of 109 The World Bank While approaching international market procurement will be done using the World Bank’s Standard Procurement Documents (SPDs). Procurement while approaching national market will be done using the National Standard Bidding Documents with appropriate modifications including the exceptions described under paragraph 136 above, and additional annexes to address World Bank’s Anti-Corruption Guidelines and universal eligibility. 140. Procurement of Consultancy Services: Consulting services to be procured under the Project include hiring of specialized service providers, feasibility studies, surveys and reviews, development of guidelines, systems and manuals, monitoring and evaluation, environmental impact and social assessments, fiduciary audits, and technical assistance. Individual consultants and/or support personnel may also be hired to augment existing capacity within the implementing line ministries in accordance with the provisions of Para 7.32 of Procurement Regulations. 141. Operating Costs: These items will be procured using the Borrower national procurement and administrative procedures acceptable to the World Bank including selection of project implementation support personnel. The Borrower will also pay for costs associated with travel, accommodation, per- diems, office consumables and maintenance, motor vehicle maintenance, implementation support personnel, etc. 142. Training and Workshops. The project will finance training and workshops, if required, based on an annual training plan and budget which shall be submitted to the World Bank for its prior review and approval. The annual training plan will identify, inter alia: (i) the training envisaged; (ii) the justification for the training; (iii) the personnel to be trained; (iv) the duration for such training; and (v) the estimated cost of the training. At the time of the actual training, the request shall be submitted to the Bank for review and approval. Upon completion of the training, the trainees shall be required to prepare and submit a report on the training received. 143. Record keeping and Management: All records pertaining to award of tenders, including bid notification, register pertaining to sale and receipt of bids, bid opening minutes, bid evaluation reports and all correspondence pertaining to bid evaluation, communication sent to/with the World Bank in the process, bid securities, and approval of invitation/evaluation of bids would be retained by respective Agencies and also uploaded in the STEP. 144. Disclosure of procurement information. The following documents shall be disclosed on the agencies websites: (i) Procurement Plan and updates; (ii) an invitation for bids for goods and works for all contracts; (iii) request for expression of interest for selection/hiring of consulting services; (iv) contract awards for goods, works, non-consulting and consulting services; (v) monthly financial and physical progress report of all contracts; and (vi) an action taken report on any complaints received on a quarterly basis. The following details shall also be published in the United Nations Development Business and World Bank’s external website: (i) an invitation for bids for procurement of goods and works following open international market approaches; (ii) Request for Expression of Interest for selection of consulting services following open international market approaches; and (iii) contract award details of all Page 72 of 109 The World Bank procurement of goods and works and selection of consultants using open international market approaches. 145. Fiduciary Oversight by the World Bank: The World Bank shall prior review contracts as per prior review thresholds set in the PPSD/PP. All contracts not covered under prior review by the World Bank shall be subject to post review during implementation support missions and/or special post review missions, including missions by consultants hired by the World Bank. However, the World Bank may conduct at any time, Independent Procurement Reviews (IPRs) of all the contracts financed under the credit. 146. Contract management. The high risk and high value procurements will be identified for increased contract management support and indicated in the procurement plan. The agencies will develop key performance indicators (KPI) for such identified contracts and the KPIs would be monitored during actual execution of contracts. The World Bank team will provide additional due diligence and independent review of the contract performance of such identified procurements. A fully staffed Project Implementation Unit (PIU) of the respective agencies will be responsible for overall project/contract management. 147. Frequency of procurement supervision: In addition to the prior review supervision to be carried out by the World Bank, the capacity assessment of the implementing agencies recommends one supervision mission every 12 months to visit the field to carry out post review of procurement actions. 148. Based on the assessment and taking note of the roles and responsibilities of the line ministries in carrying out procurement, the existing procurement capacity within the agencies and the risks associated with the project the procurement risk rating is considered “High”. The residual risks after the implementation of the mitigation measures would be reduced to “Substantial”. Table 5: Procurement Risks and Mitigation Measures Risk Mitigation Measure Timeframe Responsibility Lack of knowledge and experience Recruit a Procurement Consultant with Within three months of project MOGLSD of the World Bank procurement qualifications and experience acceptable to IDA for effectiveness guidelines and procedures at the a period of at least two years to build capacity of MOGLSD the implementing agencies, apart from assisting in processing procurement activities The head PDU and support staff should undergo Throughout project MOGLSD trainings on the World Bank Procurement implementation Guidelines/Regulations and Procedures. Delays in preparing specifications, Build capacity of the User Departments/Technical Throughout project MOGLSD/MoH statement of requirements and Departments and ensure timely preparation of ToRs implementation terms of reference by the User and specifications by the User Departments/ Departments for both ministries. Technical Departments Inadequate working area/rooms Provide sufficient working area/rooms and space Within three months of project MOGLSD/MoH and space for record keeping/filing for record keeping/filing. effectiveness Inadequate knowledge and Conduct training tailored toward addressing Within six months of project MOGLSD/MoH skills/experience in contract weaknesses in contract management for PDU and implementation and annually management Dedicated Unit staff as well as User thereafter Departments/Technical Departments of the ministries. Delays in paying vendors due to Strengthen the Internal Audit Unit and Accounts Throughout project MOGLSD/MoH Page 73 of 109 The World Bank delays in internal approving Departments in order to expedite vendor’s implementation processes payments approving process. Table 6: Thresholds for procurement approaches and methods Thresholds for Procurement Approaches and Methods (US$ millions)–Goods, Works, and Non-Consulting Services Category Prior Review Open International Open National Request for Quotation (US$ millions) (RfQ) Works ≥5 ≥ 10.0 < 10 ≤ 0.2 Goods, IT, and non-consulting ≥ 1.5 ≥1 <1 ≤ 0.1 services Thresholds for Procurement Approaches and Methods (US$, millions) – Consulting Services Category Prior Revie Short List of National Consultants (US$, millions) Consulting Services Engineering and Construction Supervision Consultants (Firms) ≥ 0.5 ≤ 0.2 ≤ 0.3 Individual Consultants ≥ 0.2 N/A N/A Environmental and Social Environmental 149. The interventions under the project involve improvements in the provision of health services, handling of medical products as well as internal rehabilitation of health facilities, police stations and MOGLSD offices at district level (limited to small internal repairs, painting, and installation of screen or partitions for further privacy). Project activities will contribute to improved health services and may also lead to increased generation of medical waste by the health facilities. Rehabilitation works may pose minor health and safety risks, while health care waste may pose health risks to the patients, attendants, health workers and the public in the event of poor management practices. Consequently, the Project triggers the following Environmental Safeguards Policies: Environmental Assessment OP/BP 4.01. The potential environmental impacts can be adequately managed by integrating environmental due diligence into the Project cycle. 150. An Environmental Management Framework (EMF) has been prepared through a consultative process to guide the handling of project environmental aspects during implementation. The EMF provides basic guidance on environmental screening and where necessary development of Environmental Management Plans (EMPs) during implementation. The Environmental Management Framework was approved by the Regional Safeguards Advisor on April 3, 2017 and was disclosed on April 21, 2017. In addition to the National Health Care Waste Management (HCWM) Plan (2009/10 – 2011/12) prepared and disclosed under the previous IDA projects, the MoH has the following documents on HCWM and infection control: Approaches to Health Care Waste Management, Health Workers Guide, Second Edition (2013); Uganda National Infection Prevention and Control Guidelines (December Page 74 of 109 The World Bank 2013); and the National Policy on Injection Safety and Health Care Waste Management (2014). These documents shall guide management of HCWM and shall form part of the project EMF. 151. During project implementation, the MOGLSD shall ensure clear coordination with the MoH and relevant national and/or local government agencies, including District Environment Officers, and District Health Inspectors . Social 152. The project’s Social Impacts Assessment was approved by the Regional Sa feguards Advisor and disclosed on April 21, 2017. The Project’s geographical coverage includes Kisoro district with presence of the Batwa Marginalized Peoples’/Indigenous Peoples (IP). To ensure social inclusion of this IP group, the project has triggered safeguard policy OP/BP 4.10. An Indigenous Peoples´ Plan (IPP) has been prepared for the Batwa. The IPP was cleared by the Regional Safeguards Advisor and publicly disclosed on April 26, 2017. Some of the identified potential positive effects of project implementation on Indigenous Peoples include increased use of available health care services, delivery of culturally appropriate GBV response services and improved access to health services through outreach activities. The project will promote interaction, coordination and consultation with traditional leaders prior and during implementation. For this, it is essential that districts and specialized service providers procured to work in Kisoro employ staff who speak the local dialects and are compliant with local socio-cultural interaction norms and belief systems of the IPs. Key measures to ensure access by the Batwa to project benefits and address issues of potential re-victimization are as follows: (iii) Adjustments to the proposed community-based awareness raising activities on GBV to: (a) include a stronger focus on reaching out to men and boys, (b) map of critical opinion leaders and community based organizations and implementation of behavior change interventions targeting these groups and individuals; and (c) conduct additional household level awareness raising interventions with a specific focus on child protection; (iv) Enhance the training of service providers (in particular of front-line responders – police, health services and advisory center/shelter staff) to: (a) include specific sessions to address issues of cultural bias against the Batwa among service providers; and (b) include specific sessions on GBV prevalence and cultural acceptability of GBV among the Batwa that are likely to have an impact on service seeking behavior. 153. The MOGLSD will assign the Partnership Specialist to oversee the implementation of the IPP in Batwa communities in Kisoro district. The officer will work closely with the specialized service provider competitively recruited to implement community-based GBV prevention activities and establish a community based referral system in Kisoro. The key activities outlined in the IPP will be undertaken by the service provider and will be included in the detailed protocol for GBV Prevention activities to be developed by the MOGLSD during the first six months of project implementation. The specialized service provider will be responsible for supervising the implementation of the IPP in coordination with Kisoro District Community Development Officers and Probation Officers. MOGLSD progress reports will include regular updates on the implementation of the key actions outlined in the IPP. 154. The project will support the rehabilitation of health facilities, police stations and district offices for the MOGLSD. This will be limited to small internal repairs only (including, painting, and installation of screen or partitions for further privacy) and will not entail any expansion of current facilities. OP/BP 4.11 and 4.12 have therefore not been triggered. Page 75 of 109 The World Bank Monitoring and Evaluation 155. Project preparation has indicated that there are significant gaps in terms of data collection on GBV through existing sources of routine data at MoH, UFP and MOGLSD level . The project will invest during the first year of implementation in a thorough assessment of the existing systems collecting routine data on GBV (specifically the National GBV database developed by MOGLSD, Occupational Health and Safety MIS (OHSMIS) and the Health Management Information System). Options to strengthen national data collection systems GBV will be developed and discussed with GoU during the 1st year of project implementation. The roll-out of the most appropriate data collection system will take place from Year 2 of project implementation (with costs covered under Component 3). For activities under Component 1, specialized service providers will ensure the monitoring and tracking of GBV prevention activities and the provision of multi-sectoral services to GBV survivors given their critical role in ensuring effective referrals and serving as victim-advocates during the referral process. Under Component 2, data on provision of health services will be tracked using existing/routine data collection systems by MoH, UPF and DPP. Indicators selected to track progress take into account the existing constraints in terms of data collection. 156. The project will include a dedicated focus on IE to assess the effectiveness of strategies aimed at preventing GBV. This will include the collection of baseline data on attitudes towards GBV that will be key in monitoring the impact of GBV prevention interventions. 157. The MOGLSD will submit quarterly progress reports and Interim Financial Reports (IFRs) to the World Bank in accordance with the reporting requirements to be set out in the POM. The mid-term review will provide the opportunity to assess progress for appropriate mid-course corrections as needed. Page 76 of 109 The World Bank ANNEX 3: IMPLEMENTATION SUPPORT PLAN COUNTRY: Uganda UG – Strengthening Social Risk Management and Gender-Based Violence Prevention and Response Project Strategy and Approach for Implementation Support 158. All costs related to implementation support are covered directly by the World Bank. The implementation support arrangements reflect the multi-sectoral nature of the project and will be led by two co-task team leaders (Social Development and Health sectors). The strategy for supporting project implementation will focus on successfully putting in place measures to address the risks identified during project preparation and consists of: (i) implementation support missions and (ii) technical assistance in areas of greater technical complexity. Given the accelerated project preparation time-frame and the complexity of the multi-sectoral intervention required to address GBV in line with international best practice, significant implementation support is expected to be required during the initial implementation stages. Key preparatory activities to kick-start implementation proper will take place during Year 1 of project implementation including:  Component 1: (i) review of legislation to address issues of GBV in the workplace, (ii) identification of key sectors and partners for the implementation of awareness raising activities on GBV in the workplace; (iii) mapping of potential specialized service providers and development of the detailed protocol of community based prevention activities.  Component 2: (i) detailed costed assessment of the rehabilitation and equipment needs of health centers and police stations at district level; (ii) implementation of training needs assessments and development of a detailed plan to cascade in service training activities for health and police staff.  Component 3: (i) detailed design of the Project IE; and (ii) thorough assessment of the existing national data collection system on GBV (Health MIS and National Database on Gender-Based Violence). Implementation Support Plan and Resource Requirements 159. The Implementation Support plan will include: (i) implementation support missions conducted at least semi- annually; and (ii) Mid-Term Review (MTR) to carry out a comprehensive assessment of the progress achieved at the mid-point in implementation and identify project design and/or implementation issues that would require substantial adjustments to the proposed approach. The project’s Impact Evaluation is expected to generate critical data on the effectiveness of the proposed prevention activities and generate critical lessons-learned for future GBV programing in Uganda. 160. Implementation Support missions will specifically focus on: (i) reviewing the quality of implementation, (ii) finding solutions to issues identified with Government of Uganda, (iii) assessing the likelihood of achieving the PDO in Page 77 of 109 The World Bank line with the results achieved against the indicators in the project’s results frameworks; (iv) reviewing progress with the implementation annual work-programs and budget execution; (v) reviewing compliance with legal covenants; (vi) taking stock of project’s fiduciary aspects, including disbursement and procurement; (vii) verifying compliance of project activities with Word Bank environmental and social safeguard policies. 161. At the technical level, the World Bank team will ensure that the appropriate mix of technical skills and experience is mobilized for implementation support missions and to provide just-in-time technical advice as needed.  Financial management. The World Bank will require that quarterly interim financial reports and an annual external audit report be submitted for review. The World Bank will also review project-related information such as the internal control systems’ report. Bi-annual onsite visits will also be carried out to review the financial management system including internal controls. Monitoring of actions taken on issues highlighted in audit reports, auditors’ management letters, internal audit and other reports will be reviewed by the including transaction reviews, as needed. Financial management training of PST staff is expected to be carried out by project effectiveness. Additional financial management training will be conducted during project implementation as needed.  Procurement. The World Bank will undertake implementation support missions every six months which will include a thorough review of contracts in place and assess performance in following procurement procedures. Similarly, training in procurement of the PST staff will be carried out by project effectiveness and additional training conducted throughout implementation as needed.  Safeguards. The World Bank’s safeguard team will consist of social and environmental specialists who will: (i) guide the project team in implementing the project’s safeguard instruments; and (ii) review compliance with safeguard policies during implementation support missions. Page 78 of 109 The World Bank Time Focus Skills Needed Resource Estimate Partner Role  Project implementation start up  Establishment of the PST and coordination mechanisms at national and district level  Orientation and strengthening of implementation capacity, including monitoring and evaluation (M&E)  Capacity building and mentoring of staff at all levels on procurement, financial management,  Project M&E, and safeguards Management  Development of monitoring  Health and evaluation strategy: (i)  Gender-Based impact evaluation design Violence Coordination of and baseline data-  Livelihoods activities with key First twelve collection; and (iii)  Environment partners through the US$180,000 months procurement of firm to  Social GBV Reference develop technical options Development Group chaired by the on the National GBV Data  Financial MOGLSD collection systems management  Engineering assessments to  Procurement inform rehabilitation of  M&E facilities  Training needs assessments for UPF, JLOS, DPP, Courts and Health Sector  Development of Protocol for Community-Based GBV intervention and procurement of specialized service providers  Design of pilot interventions on GBV prevention in the workplace 12-48 months  Implementation Support  Project US$140,000/annually Same as above missions with Government Management Page 79 of 109 The World Bank counterparts to monitor  Health implementation  Gender-Based performance including Violence progress against targets of  Livelihoods the Results Framework  Access to Justice  Review of annual work  Environment plans and disbursement  Social schedule Development  Review quality of  Financial quarterly/annual reports management  Review of audit reports and  Procurement interim financial report  M&E  Review adequacy of the financial management system and compliance  MTR undertaken (during year 3) Same as above and in addition  Project Evaluation  Project completion and Other  Same as above Same as above Same as above Implementation Completion Report preparation Skills Mix Required Skills Needed Number of Staff Weeks Number of Trips Comments  TTL 8 4 Nairobi Based  Co TTL, Health 8 - Kampala Based  Gender-Based Violence 6 3 Kampala/Nairobi Based  Access to Justice 6 3 Washington Based  Livelihoods 4 - Kampala Based  Social Development 3 - Kampala Based  Environment 3 - Kampala Based  Financial management 4 - Kampala Based  Procurement 4 - Kampala based  M&E/Impact Evaluation 6 3 Washington Based Page 80 of 109 The World Bank ANNEX 4: TARGETING APPROACH COUNTRY: Uganda UG – Strengthening Social Risk Management and Gender-Based Violence Prevention and Response Project 162. Project resources for selected activities will be concentrated in the following 13 districts for the required level of intensity to achieve results in terms of both the prevention and response dimension of the intervention: Wakiso, Masaka, Mukono, Mbale, Sironko, Kamuli, Alebtong, Apac, Zombo, Hoima, Kisoro, Kamwenge and Kabarole. These geographical areas were selected in order to primarily target the most densely populated districts with the highest risk of GBV. The approach described below was used to carefully select target areas. Illustration 1: District ranking and selection process 163. An analysis of risk factors for GBV using the 2011 UDHS data was carried out as part of project preparation to inform project design, namely the proposed approach to targeting in order to maximize GoU ’s investment in GBV prevention and response. Table 7 contains the full logistic regression estimation results (odds ratios) of risk factors for lifetime physical violence for ever-married women. Table 7. Logit estimations (odds ratios) of risk factors of ever experiencing physical violence by IPV All Rural Urban Explanatory variables or se or se or se Women's characteristics Age group (ref. 15-19) 20-24 1.715 0.594 1.727 0.685 1.778 1.634 25-29 1.450 0.577 1.279 0.577 0.776 0.895 30-34 1.547 0.705 1.307 0.681 1.698 2.101 35-39 1.681 0.769 1.444 0.736 2.699 3.341 40-44 1.746 0.880 1.641 0.917 1.574 2.191 Page 81 of 109 The World Bank 45-49 2.468* 1.328 2.009 1.178 9.192 15.172 Age at marriage (ref. less than 15 years old) 15-19 1.298 0.290 1.248 0.299 2.565 1.925 20-24 0.502** 0.156 0.513** 0.174 0.614 0.535 25< 0.603 0.267 0.463 0.244 1.217 1.510 Number of unions (ref. one union) More than one union 0.953 0.198 1.022 0.234 0.488 0.358 Number of children ever born (ref. no children) 1-2 2.515** 1.083 2.137 1.027 8.455** 8.024 3-4 3.879*** 1.829 3.895*** 2.046 9.655* 12.118 5 or more 3.505** 1.808 3.999** 2.262 1.154 1.607 Household size 1.016 0.040 1.026 0.043 1.003 0.117 Women's education (ref. no education) Primary 2.076 0.999 1.945 1.125 21.375* 36.973 Secondary (and higher) 4.552* 3.993 4.492 4.638 24.506 55.051 Ethnicity (ref. Baganda) Banyankole 2.904*** 1.098 2.806** 1.274 1.696 1.636 Basoga 2.143* 0.986 1.572 0.891 7.257** 5.765 Bakiga 2.945** 1.317 2.667* 1.366 0.709 1.225 Atesa 4.557*** 2.346 4.006** 2.427 9.883** 11.510 Other 3.064*** 1.167 3.064** 1.447 0.790 0.736 Acholi 8.004*** 6.041 7.290** 6.378 0.200 0.319 Alur 5.954** 4.856 3.460 3.501 0.993 2.228 Ngakaramajong 12.793*** 8.088 12.672*** 8.837 Langi 6.602*** 4.380 6.613** 5.381 0.154 0.342 Lugbara 5.163** 3.931 2.330 2.372 7.292 10.862 Madi 1.748 1.515 1.161 1.258 0.027* 0.055 Mufumbira 1.097 0.682 1.012 0.697 6.185 11.029 Mugishu 2.425* 1.263 2.481 1.539 0.181 0.201 Mugwere 2.096 1.379 1.727 1.254 Mukonjo 0.726 0.638 0.236 0.238 35.825*** 47.372 Munyoro 2.236 1.220 2.909* 1.773 3.343 3.455 Mutooro 1.736 0.928 1.232 0.888 4.244 4.138 Munyarwanda 4.525*** 1.951 4.927*** 2.563 3.445 4.256 Religion (ref. Catholic) Protestant 0.861 0.182 0.922 0.207 0.723 0.463 Muslim 1.396 0.353 1.914** 0.552 0.264* 0.184 Pentecostal 1.327 0.353 1.360 0.396 0.817 0.601 SDA 0.513 0.258 0.571 0.325 0.314 0.886 Other 0.725 0.460 0.716 0.490 Women physically hurt by father 1.191 0.361 0.894 0.289 5.876** 5.167 Wealth quintile (ref. poorest) Poorer 0.798 0.196 0.797 0.201 5.586 7.042 Middle 0.865 0.239 0.844 0.247 23.674** 32.883 Richer 0.579* 0.176 0.607 0.194 1.689 1.913 Richest 0.401** 0.145 0.343*** 0.141 1.340 1.594 Urban area (ref. rural) 1.033 0.321 Region (ref. Kampala) Central 1 0.467 0.223 1.071 0.469 0.396 0.420 Central 2 0.365** 0.170 0.921 0.365 0.723 0.760 East Central 0.488 0.255 1.259 0.643 1.387 1.108 Eastern 0.718 0.395 2.030 1.036 0.495 0.633 North 0.281* 0.194 0.730 0.573 3.252 3.634 Karamoja 0.087*** 0.057 0.242** 0.156 0.006* 0.016 West-Nile 0.338 0.259 1.607 1.562 1.162 1.464 Western 0.624 0.304 1.852 0.732 0.106** 0.107 Southwest 0.375* 0.193 0.264 0.298 Partner's characteristics Partner's education (ref. no education) Primary 0.880 0.614 0.618 0.487 1.389 2.474 Secondary 0.351 0.361 0.247 0.293 0.386 0.861 Higher 0.126* 0.157 0.099 0.141 0.110 0.301 Partner's drinking (ref. does not drink) Page 82 of 109 The World Bank Never Drunk 0.625 0.241 0.921 0.388 0.074** 0.090 Sometimes Drunk 1.901*** 0.379 2.220*** 0.485 0.747 0.381 Often Drunk 4.501*** 1.069 4.414*** 1.119 47.935*** 50.730 Relationship level Spousal age difference (ref. partner is younger) Partner 0-4 years older 1.645* 0.424 1.513 0.433 2.884* 1.815 Partner 5-9 years older 1.479 0.381 1.470 0.418 1.611 0.990 Partner 10-14 years older 1.391 0.412 1.376 0.462 3.156 2.570 Spousal education difference (ref. partner has less education) Both have no education 1.486 1.016 1.412 1.078 24.547 63.058 Both have the same education 1.566 0.863 2.402 1.592 0.537 0.591 Partner has more education 3.380 3.128 4.831 5.327 2.355 3.875 Women's participation in decision making (ref. 0.781 0.126 0.709* 0.126 2.783** 1.328 doesn't participate) _cons 0.028*** 0.027 0.012*** 0.013 0.000*** 0.001 Number of observations 1,405 1,078 323 R2 0.198 0.202 0.421 Note: Dependent variable is ever-married women who may have ever experienced physical violence committed by their husband/partner (or most recent husband/partner). Religion SDA - Seventh-day Adventists. *** p<0.01, ** p<0.05, * p<0.1 The main risk factors for GBV were identified based on this analysis as follows: 164. Demographic factors: Women’s age, age at marriage, number of unions or household size are not statistically significant to the probability of experiencing physical violence, confirming the widespread nature of GBV in Uganda. The fact that the prevalence of GBV remains almost unchanged across age groups is problematic. In most countries GBV is lower for younger cohorts and increases significantly with age. This would be indicative of changing social norms, access to better information, or simply a higher prevalence of domestic violence against women who are married or older. Given that this is not the case in Uganda, the project will specifically target prevention interventions to younger women and men as well as adolescent boys and girls. Prevalence is very high overall and project activities will cover women of all ages as well. The returns for working with younger women, girls, and boys on prevention activities would be high, based on their existing prevalence rates and the opportunity to change the violence they will experience in the future. Plus, from an intervention perspective, normative and behavioral change are easier to achieve with younger populations. 165. Women’s primary education seems to have little direct bearing on probability of experiencing violence. Consistent with the literature, completing secondary education is a protective factor. Education tends to be highly correlated to poverty in most countries. In Uganda, secondary education may be particularly protective as wealthier women tend to have a lower probability of experiencing GBV. Women with more children are more likely to experience violence than those without any children. 166. Economic Factors: Wealth is somewhat of a protecting factor; women from the richest wealth quintile are less likely to experience violence. Thus, focusing on low income households is consistent with both a poverty focus and a GBV risk focus. However, the relationship between income and GBV is complex and the DHS wealth index has important weaknesses. Education was also used as an instrument for wealth and income. Education could have an independent social effect protective of the risk of GBV. 167. Partners’ characteristics: Partner’s education seems to be weakly associated with probability of violence, Page 83 of 109 The World Bank with partner’s higher education being inversely related to experiencing violence. Alcohol abuse by the partner raises the probability of physical violence. Women whose partners are often drunk are 4.5 times more likely to experience violence than those whose partner does not drink. While this is an important risk factor, data on alcohol abuse is not available at district level and therefore this risk factor could not be considered in the preparation of the GBV index that supported the development of the targeting strategy in the project. 168. Regional distribution: Importantly, regional diversity has a relatively small impact on the probability of experiencing GBV. Overall GBV prevalence is high across regions which informed the decision to target selected districts across all four major regions of the Country. Figure 9: Physical violence prevalence by background characteristics. Note: Percent refers to percentage of women aged 15-49 who have ever experienced physical violence since age 15 (by anyone); Religion SDA - Seventh- day Adventists. Source: Uganda DHS 2011. 169. A composite index which prioritized risk factors for GBV based on the above analysis of the 2011 UDHS was developed to rank districts based on level of potential GBV risk. As DHS data is, however, not representative at district level, only those proxy indicators for which there was representative data at district level (in the 2014 National Population Census) were selected to develop the GBV index: (i) % of women/girls in the 15-19 years old cohort (.15), (ii) % of women in the 19-24 years old cohort (.15); (iii) % of female population with no education (.15). As the project aims to focus on the most common/widespread forms of GBV as highlighted above, population density was also factored in and given a bigger weight in the GBV index developed (.55). Page 84 of 109 The World Bank 170. Before the ranking of districts using the GBV index three districts were prioritized for inclusion in project target areas by MOGLSD and MoH given the importance of sustaining ongoing engagements on GBV . MOGLSD and MoH recommended out of ranking inclusion of Kamuli (East) as well as Kamwenge and Kabarole (West). In Kamuli, MOGLSD will seek to continue the provision of services through an advisory center and shelter currently funded by Irish Aid (whose funding will phase out in 2018). Similarly, grant funded GBV interventions currently being implemented by GoU in Kamwenge and Kabarole will be sustained through the project (funding for these activities will equally phase out after 2018). 171. Given the broad geographical distribution of GBV in Uganda, districts were ranked following a regional breakdown to ensure coverage of the four main regions: (i) Central, (ii) East; (iii) North and (iv) West. In addition, since district level data is only representative for the larger 80 districts as per the 2006 administrative boundaries, a work around was applied to extrapolate the rankings of districts to the 2014 administrative boundaries for 112 districts. The initial ranking resulted in a long-list of 21 potential sites set out in Table 8 below. Table 8: Long list of district selected Central region Eastern region Northern region Westen region Ran Ran Ran Ran District k District k District k District k KAMPALA MBALE 1 LIRA 1 HOIMA 1 WAKISO 1 SIRONKO 2 APAC 2 KISORO 2 MASAKA 2 BUDUDA 3 NEBBI 3 KABALE 3 MUKONO 3 JINJA 4 KOBOKO 4 MBARARA 4 MPIGI 4 IGANGA 5 KOTIDO 5 KYENJOJO 5 KIBOGA 5 KAPCHORWA 6 ARUA 6 KABAROLE 6 LUWERO 6 MANAFWA 7 YUMBE 7 IBANDA 7 MITYANA 7 BUGIRI 8 OYAM 8 KASESE 8 KAYUNGA 8 BUDAKA 9 GULU 9 NTUNGAMO 9 MUBENDE 9 BUSIA 10 PADER 10 BUNDIBUGYO 10 RAKAI 10 TORORO 11 MARACHA 11 BUSHENYI 11 LYANTONDE 11 MAYUGE 12 NAKAPIRIPIRIT 12 RUKUNGIRI 12 SSEMBABULE 12 SOROTI 13 DOKOLO 13 KANUNGU 13 NAKASEKE 13 PALLISA 14 KITGUM 14 KIBAALE 14 NAKASONGOLA 14 BUTALEJA 15 AMOLATAR 15 ISINGIRO 15 KALANGALA 15 KUMI 16 ADJUMANI 16 KAMWENGE 16 KALIRO 17 AMURU 17 KIRUHURA 17 KAMULI 18 MOYO 18 MASINDI 18 BUKEDEA 19 ABIM 19 BULIISA 19 BUKWO 20 MOROTO 20 NAMUTUMBA 21 KAABONG 21 KABERAMAIDO 22 Page 85 of 109 The World Bank AMURIA 23 KATAKWI 24 172. This was then further narrowed down to the final 13 selected districts through a series of consultations between MOGLSD and Ministry of Health (MoH) also taking into account the following operational considerations to focus on the most populated and under-served areas: (i) presence of interventions addressing GBV funded by other development partners; and (ii) health sector priorities in terms of service delivery and coverage. Table 9: Overview of population in selected districts T Page 86 of 109 The World Bank ANNEX 5: FINANCIAL MANAGEMENT AND DISBURSEMENT ARRANGEMENTS COUNTRY: Uganda UG – Strengthening Social Risk Management and Gender-Based Violence Prevention and Response Project Summary of findings 173. This report is a record of the results of the assessment of the proposed financial management arrangements for the proposed project Uganda: Strengthening Social Risk Management and Gender- Based Violence Prevention and Response Project (P160447) to be implemented by the Ministry of Gender, Labor and Social Development (MOGLSD) and Ministry of Health (MoH). The objective of the assessment was to determine under OP/BP 10.00 whether MOGLSD and MoH: (i) have adequate financial management arrangements to ensure that project funds will be used for the intended purposes in an efficient and economical way; (ii) project financial reports will be prepared in an accurate, reliable and timely manner; (iii) the entities’ assets will be safeguarded and (iv) auditing arrangements are acceptable to the World Bank. Under OP/BP 10.00, borrowers and project implementation entities are required to have and maintain adequate financial management systems which include budgeting, accounting, internal controls, funds flow, financial reporting and auditing arrangements to ensure that they can readily provide accurate and timely information regarding project resources and expenditures. These arrangements are deemed acceptable if: (i) they are capable of correctly and completely recording all financial transactions and balances relating to project resources (ii) if they can facilitate the preparation of regular, timely and reliable financial statements (iii) safeguard the project’s assets and; (iv) are subject to auditing arrangements acceptable to IDA. The assessment was carried out in accordance with the World Bank Directive - Financial Management Practices Manual, issued (retrofitted) by “Operations Policy and Country Services on February 4, 2015”. 174. Actions outlined in the Financial Management Action Plan will be undertaken by MOGLSD and MoH to strengthen the financial management system. They include designation or recruitment of a project financial management specialist, conducting quarterly internal audit reviews, having the project in IFMS and carrying FM training for the project team among others. There are no conditions of effectiveness. In order to ensure that the project is effectively implemented, MOGLSD and MoH will ensure that appropriate staffing arrangements are maintained throughout the life of the project. 175. The conclusion of the assessment is that the financial management arrangements for the project have an overall “Substantial” risk rating. However, with the implementation of the action plan, the financial management arrangements will be strengthened to ensure the proposed financial management arrangements satisfy the World Bank’s minimum requirements under OP/BP 10.00 and are adequate to provide, with reasonable assurance, accurate and timely information on the status of the project resources required by IDA. Page 87 of 109 The World Bank Risk Assessment and Mitigation 176. The table below identifies the key risks that project management may face in achieving these objectives and provides a basis for determining how management should address these risks. Table 10: Overview of risk analysis, Financial Management Risk Risk Risk Mitigating Measures Mitigated Risk Condition of Rating Incorporated into Project Negotiations Design Inherent Risk Country Level- The 2012 Public Expenditure and Weaknesses in accounting capacity, S N Financial Accountability report identified weaknesses in S budget classification, payroll rules and government PFM systems. Enforcement of procurement compliance are being Procurement rules is still weak. Governance issues mitigated under a government PFM including at the Office of the Prime Minister and Public reform program, Financial Management Service Ministry present a major challenge. June 30, Accountability Program. The 2016 audit report identifies major weaknesses in FM implementation of the Public Finance across Government departments including mischarge Management Act 2015 and subsequent of expenditure, low debt absorption and advances PFM Regulation 2016 will address some through staff personal accounts among others. of the weaknesses in accountability and governance. Entity Level- The Auditor General’s reports of 30th June H The project will engage consultants to S N 2016 for MOGLSD was unqualified but had weaknesses support the MOGLSD team to address and accountability challenges such as budget shortfalls, the gaps noted. Project teams will be accountability of funds under the Youth Livelihood trained on World Bank procedures and Program and inadequate management of records. This practices within six months of project is among the first project funded by IDA being effectiveness. implemented by the MOGLSD thus may lack experience in World Bank operations. The MoH has experience in implementing World Bank projects with three ongoing projects. The audit reports for the three projects were unqualified with weaknesses including delayed project implementation, low counterpart funding and non- implementation of some project activities. Page 88 of 109 The World Bank Risk Risk Risk Mitigating Measures Mitigated Risk Condition of Rating Incorporated into Project Negotiations Design Project Level- The project is focusing on a new concept H Specialized service providers with S N and therefore may face in capacity gaps on the part of experience in project activities to carry Government. It will also involve many stakeholders at out key interventions. Local different levels thus presenting coordination and Government capacity in project accountability challenges / delays. management will be complemented by training in addition to consultants to be hired to offer support and capacity building. Project identification process will be inclusive with a bottom up approach with all stakeholders on board. Overall Inherent Risk Substantial Control Risk Budgeting H Project budget will be ring fenced as to S N Inadequate funding of approved budget and budget safeguard against diversion or budget cuts affecting implementation of approved work plans cuts. Budgeting under the project will for activities to be funded by GoU. Ministries charging be aligned to the activities. The project expenditure on different votes without following due to be on IFMS to enhance budgetary process. control. Accounting H The project will have a dedicated S N Delays in accounting for advances for project activities project financial management specialist by staff and inadequate support for the expenditure at to ensure the weaknesses are both the ministries. Delays in processing payments and addressed. The project will also carry accounting for staff advances are risks cutting across out regular internal audit and World many projects in the portfolio. Bank reviews. Advances to be monitored through aging analysis submitted together with quarterly IFRs. Internal Control- H Management action on Auditor General S N Management delays in follow up on the internal control and Internal Audit reports to be weaknesses reported by the internal and external audit monitored through the quarterly reports. internal audit reports submitted to the No adherence to internal audit work plans and in World Bank by the Ministries. adequate resources for the reviews. Adherence to internal audit work plans. Provision of adequate internal audit budget under the project. Page 89 of 109 The World Bank Risk Risk Risk Mitigating Measures Mitigated Risk Condition of Rating Incorporated into Project Negotiations Design Funds Flow: S Project teams will be trained on S N Delays in disbursement to the ministries due to submission of WA and expected incomplete Withdrawal Application (WA). support documentation. Financial Reporting: S Reporting format agreed between M N Delays in submission of quarterly reports in the desired ministries and World Bank. Training to format by the ministries. be undertaken before disbursement. External Audit: S Project to submit the draft financial M N Delay in submission of financial statements for audit statements for audit within the and delay in submission of audited financial statements submission deadline of August 31 of by the Ministries. each year. Overall Rating H Substantial H – High S – Substantial M – Moderate L – Low 177. The overall residual risk is assessed as Substantial upon incorporating the mitigation measures in the table above. Institutional and Implementation Arrangements 178. MOGLSD and MoH will be responsible for the overall implementation of the project. During project execution MOGLSD and MoH, shall coordinate project implementation and manage: (i) Procurement, including purchases of goods, works, and consulting services except those to be procured at the districts; (ii) Project monitoring, reporting and evaluation; (iii) Contractual relationships with IDA and other co-financiers; and (iv) Financial management and record keeping, accounts and disbursements. MOGLSD and MoH will constitute the operational link to IDA and Government of Uganda on matters related to the implementation of the project. The Permanent Secretary MOGLSD and MoH will be the “Accounting Officers” for the project assuming the overall responsibility for accounting for the project funds. Budgeting Arrangements 179. Budgeting for the project in the ministries, districts and health facilities will be in line with the Government budgeting cycle. The project will follow the government planning and budgeting procedures documented in the government’s Treasury Accounting Instructions, 2003 (currently under revision in line with the new PFM Act, 2015 and PFM Regulations 2016). These arrangements were appraised and found to be adequate for the project. The project will be 100% funded by IDA except for cost elements such as contract committee, sitting allowances and honoraria that will be budgeted under the ministries GoU budgets. These elements funded by GoU presents a risk under budgeting or diversion during execution resulting in delays in project execution. Page 90 of 109 The World Bank Accounting System, Policies and Procedures 180. Policies and procedures. The assessment was satisfied with GoU accounting policies and procedures at both ministerial and local government levels supplemented with IDA FM Guidelines specified in the Financing Agreement and to be specified in the POM that will be used to guide project implementation. Project teams at the MOGLSD, MoH, districts and health facilities will be trained on the guidelines before and during project implementation. The financial reports of the project will be prepared on a cash basis in accordance with International Public Sector Accounting Standards. The key weaknesses assessed are weak implementation of rules and regulations on management of staff advances, delayed processing of payments and accountability challenges highlighted in the audit reports. 181. Books of accounts. The books of accounts to be maintained by MOGLSD and MoH specifically for the project should thus be set up and should include: a cash book, ledgers, journal vouchers, a fixed asset register, an advances ledger, and a contracts register among others. The specific records to be maintained at the districts and health facilities will be agreed upon with the ministries. 182. Staffing arrangements. The MOGLSD will be required to recruit a project financial management specialist within three months of project effectiveness to support the accounting staff designated to support the project. For the MoH the project will be managed by the current team of project financial management specialist and assistant financial management specialist supporting ongoing World Bank projects. The financial management specialists will be supervised by the Assistant Commissioners, Accounts. The districts will be required to designate qualified accounting staff to manage the accounting function under the supervision of the Chief Finance Officer. Similarly, the health facilities will be required to designate staff who will be managing the accounting and reporting aspect of the project. FM training will be offered to the financial management specialists assigned to the project within 6 months of project effectiveness. 183. Information system. The MOGLSD and MoH currently use IFMS in management of the accounting and reporting functions for the government. The project will be expected to be managed through the upgraded IFMS with the project module for new projects as agreed and directed by MoFPED. This has however presented the risk of slow implementation of the new project module under IFMS due to some technical challenges that are being addressed by the MoFPED. Districts on IFMS will be expected to have the project managed through the system. Disbursement Categories, Banking, Funds Flow and Disbursement Arrangements 184. Disbursement Categories. Table 11 below sets out the expenditure categories to be financed by the credit in line with the Financing Agreement. Page 91 of 109 The World Bank Table 11: Disbursement Categories Category Amount of the Percentage of Expenditures to be Financing Allocated Financed (expressed in SDR) (inclusive of Taxes) (1) Goods, works, non-consulting services, 22,430,000 100% consulting services, Training and Operating Costs for Parts 1, 2(b) and 3 of the Project (2) Goods, works, non-consulting services, 6,770,000 100% consulting services, Training and Operating Costs for Part 2(a) of the Project TOTAL AMOUNT 29,200,000 100% 185. Bank accounts. The following bank accounts authorized by the MoFPED will be maintained by the MOGLSD and MoH in the Bank of Uganda for purposes of implementing the project: (i) DA denominated in US dollars where disbursements from IDA will be deposited and from which payment in US dollars will be made; and (ii) project account, denominated in the local currency. Transfers from the DA (for payment of transactions in local currency) will be deposited into this account in accordance with the project objectives, work plans and budgets. The participating districts and health facilities will be required to open project specific bank accounts in banks acceptable to the World Bank. Disbursement to the districts and the health facilities will be determined by the approved work plan and budget and done directly to the project accounts from the ministries. Figure 10: Funds Flow Chart IDA DA (US$) in BoU MOGLSD (DA- A) and MoH (DA-B) MOGLSD and MoH Project Accounts (UGX) in BoU District / Health Facility Bank Account (UGX) Page 92 of 109 The World Bank 186. The signatories for the project accounts will be in accordance with the treasury accounting instructions. At both the MOGLSD and MoH, the payments will be approved and signed by the accounting officer (PS) as the principal signatory and the person designated by the Accountant General. At the districts the signatories are the Chief Administrative Officer (CAO) and Chief Finance Officer or their designees. Similarly, at health facilities’ level, the signatories will be in accordance to GoU guidelines and structures. 187. The direct payment method may be used for payments to contractors or service providers upon recommendations of their satisfactory performance by the project authorized officials. Payments may also be made for expenditures against special commitments. The project may also use the reimbursement method. The Accountant General in the MoFPED together with his delegated officials shall be co-signatories for disbursement/withdrawal applications. IDA’s Disbursement Letter will stipulate a minimum application value for direct payment and special commitment procedures. 188. If ineligible expenditures are found to have been made from the designated account, the Client will be obligated to refund the same. If the designated account remains inactive for more than six months, the Client may be requested to refund to IDA amounts advanced to the designated account. IDA will have the right, as reflected in the Financing Agreement, to suspend disbursement of funds if reporting requirements are not complied with. Financial reporting arrangements 189. The MOGLSD and MoH will submit quarterly IFRs in acceptable formats to the World Bank within 45 days after the end of each calendar quarter. The report will include: (i) a Statement of Sources and Uses of Funds: and (ii) a statement of uses of funds by project activity/component. In addition to the above reports, the ministries will submit to the World Bank: (i) Designated Account Activity Statement; (ii) Designated Account and Project Account Bank Statements; (iii) Summary Statement of DA expenditures for contracts subject to prior review; and (iv) Summary Statement of DA Expenditures for contracts not subject to Prior Review. The annual financial statements should be prepared in accordance with International Public Sector Accounting Standards (which include the application of the cash basis of recognition of transactions). The MOGLSD and MoH will agree with the districts and health facilities on the reporting formats and timelines on funds disbursed. The staff involved in reporting will also undergo the necessary training coordinated by the ministries and the World Bank. 190. The key risks assessed in relation to reporting include delays in submission of quarterly reports in the desired format by the MOGLSD, districts and health facilities. In addition, there is a risk of submission of inaccurate and incomplete financial statements by the ministries, districts and health facilities. Page 93 of 109 The World Bank Internal controls and Internal audit 191. The assessment also reviewed the internal controls as documented in The Public Finance Management Act, 2015, The Public Finance Management Regulations 2016, Treasury Accounting Instructions 2003 (currently being updated in line with new laws and regulations), Local Government Financial and Accounting Manual 2007, Local Government (Financial and Accounting) Regulations 2007 (Currently being updated) and the provisions of the POM that will include requirements specific to World Bank financed projects and noted that they are adequate for the project. 192. The MOGLSD and MoH have qualified and experienced internal auditors and will incorporate the project into the internal audit work plan. The key risk assessed included inadequate budgetary provision under GoU funding, non-adherence to audit work plans and delays by management to respond to audit findings or implement recommendations. The project will provide resources to facilitate the internal quarterly audit reviews at both ministries. Similarly, the districts internal auditors will be required to incorporate the project in their audit work plans. The ministries will share the internal audit reports with the World Bank semi-annually. External Auditing Arrangements 193. The Auditor General is primarily responsible for auditing all government projects. The office of the Auditor General has been assessed and found to meet World Bank standards. The only risk identified was related to delayed submission of the audit report. In instances where the audit is subcontracted to a firm of private auditors (with the final report being issued by the Auditor General) the private firm to be sub-contracted should be acceptable to the World Bank. In case the audit is subcontracted to a firm of private auditors, IDA funding may be used to pay the cost of the audit. The audits are done in accordance with International Standards on Auditing. The appropriate terms of reference for the external auditor have been agreed between the World Bank, MOGLSD and MoH. The ministries will submit the project Audit Reports together with the Management Letters to the World Bank within six months after the end of each financial year. Financial Management Action Plan 194. The action plan below indicates the actions to be taken for the project to strengthen its financial management system and the dates that they are due to be completed by: Table 12: Overview of FM Mitigation Measures Action Date due by Responsible 1 Recruitment of project financial management 6 months after MOGLSD specialist effectiveness 2 Training of project accounting, auditing and other 6 months after MOGLSD/DGL and project staff on FM at MOGLSD, MoH, districts and effectiveness WB health facilities Page 94 of 109 The World Bank Action Date due by Responsible 3 Internal audit reviews Semi annually MoFPED / MoH / MOGLSD Effectiveness Conditions and Financial Covenants 195. Effectiveness Conditions: There are no conditionalities to be included in the legal agreement. 196. Financial Covenants: Financial covenants are the standard ones as stated in the Grant Agreement Schedule 2, Section II (B) on Financial Management, Financial Reports and Audits and Section 4.09 of the General Conditions. Supervision Plan 197. A supervision mission will be conducted twice a year based on the risk assessment of the project in accordance with the Financial Management Practices Manual issues by the Financial Management Sector Board. The mission’s objectives will include ensuring that strong financial management systems are maintained for the project throughout its life. However, reviews arising out of the Interim Financial Reports will be carried out regularly to ensure that expenditures incurred by the project remain eligible for IDA funding. The Implementation Status and Results Report (ISR) will include a financial management rating for the components. Conclusion of the Assessment 198. A description of MOGLSD’s and MoH financial management arrangements above assesses the financial management risk as Substantial and recommends the time bound actions to be effected for the system to be adequate to provide, with reasonable assurance, accurate and timely information on the status of the Project as required by the World Bank. Page 95 of 109 The World Bank ANNEX 6: ECONOMIC AND FINANCIAL ANALYSIS COUNTRY: Uganda UG – Strengthening Social Risk Management and Gender-Based Violence Prevention and Response Project 199. The economic analysis of the project, as well as the strong rationale for addressing and preventing GBV, is based on the detrimental development impacts of GBV as well as its potential economic costs. A detailed financial analysis was not feasible given the absence of detailed data on service costs and monetary costs of some of the development and individual effects of GBV. Gender-Based Violence is a violation of human rights and its pervasiveness reinforces gender inequities, but the burden on economic development may be equally significant. 200. Some of the development impacts of GBV include, lower productivity and incomes for survivors (and also perpetrators), lower rates of accumulation of human and social capital (due in part to health effects), and generation of future violence (gender-based as well as other forms). Indirect cost estimates can prove useful as evidenced by work which illustrates reduced earnings of women and estimated lost wages due to family violence. 201. Direct costs, those GBV expenditures such as healthcare and judicial services, as well as indirect costs, such as the value of lost productivity, are critical components of the economic cost of GBV. In developing contexts, direct costs may not accurately reflect the magnitude of GBV, since a lack of services or underfunding of services related to GBV as well as under-reporting may result in an artificially low rate of usage. In the public health field, a preferred methodology focuses on direct impacts by estimating the Disability-Adjusted Life Years (DALYs) for survivors of GBV. The DALY methodology has the great advantage of including years lost due not only to premature mortality, but also due to disability or illness. The first estimates of the DALY impacts of gender-based violence were produced by Heise et al. (1994), who estimated that more than nine million disability-adjusted years of life are lost each year worldwide as a result of rape and family violence, more than that from all types of cancer and more than twice that lost by women in motor vehicle accidents. A significant disadvantage of DALYs is that they rely on registry data (homicides and health services), which can severely underestimate GBV prevalence due to reasons cited in the previous paragraph. 202. A study conducted by the Center for Domestic Violence Prevention (CEDOVIP) in 2016 estimated the impacts and costs of domestic violence in Uganda as it pertains to service provision in key sectors, primarily health and justice. Using 2006 DHS data and 2008/9 data from the International Center for Research on Women, CEDOVIP’s analyses revealed that GBV costs various providers and duty bearers an estimated UGX 56 billion annually, 44 equivalent to 22.4 million USD. Overall economic costs of GBV (for the minority who seek outside help) amounts to about .35 % of Uganda’s GDP and .75% of the national budget. It is estimated that women spent UGX 19.5 billion on 45 direct costs, of which 50% paying police services, 25% for health care, and 14% to courts. 44 Conversion reflects December 31st, 2013 exchange rate of 1UGX = .0004 USD 45 Direct costs of dealing with incidents in 2011 refer to out of pocket expenditures for accessing rehabilitation as well as legal redress. Indirect costs consider value of days lost due to domestic violence Page 96 of 109 The World Bank 203. A growing body of research has focused on understanding the consequences of GBV by estimating the effects on human development outcomes for women, girls, and their children, without attaching monetary value. Beyond both superficial and life-threatening injuries that require immediate attention, impacts on health and education of women and girls may be significant and pose a large financial burden to both the health and education sectors. Women and girls who experience violence are more susceptible to fatal outcomes such as homicide, suicide, and maternal mortality. Non-fatal morbidities are wide-reaching, and can include i) physical disability or functional impairment; ii) chronic health conditions such as pain syndromes, somatic complaints and disorders; iii) poor mental health manifested as post-traumatic stress disorder, depression, anxiety, substance abuse, low-self-esteem, etc.; iv) negative health behaviors such as high-risk sexual activity; v) a wide range of reproductive health concerns including but not limited to unwanted pregnancy, unsafe abortions, miscarriage, STIs/HIV, gynecological disorders, pelvic inflammatory disease and resulting infertility. Not only do these impacts burden survivors of GBV, but also they burden families, children, and surrounding communities of GBV survivors. Increased rates of behavioral and emotional problems are found in children of GBV survivors, as well as early school drop-out, youth offending, and early pregnancy rates. Labor market participation is also at risk, as individuals with poor psychosocial health or physical disability have limited functionality and success in the workplace, 204. In Uganda, project diagnostic work based on the 2011 Uganda DHS data estimates the human development impacts of GBV. The prevalence rate of GBV is high in comparison to global estimates. UDHS 2011 reveals 62.2 percent of all women aged 15-49 reported experiencing physical or sexual violence by any perpetrator at least once since the age of 15 compared to a global average of 35.6 percent (UDHS, 2011). Furthermore, at least 27 percent of women aged 15-49 years experienced some form of domestic violence during the past year prior to survey (UBS and ICF, 2012). The same survey showed that at least 56 percent of married women report having experienced some form of domestic violence during their marital life. 205. Table 13 below compares health and demographic statistics for a sample of GBV survivors and women who did not experience IPV. Survivors had a higher average number of children ever born (and also higher average number of living children) – 4.0 versus 4.7. Almost one third of women survivors of GBV had terminated pregnancies at some point compared to 23 percent of women who had not experienced violence. More than half of the latter wanted their last child, whereas among survivors, 48.8 percent of women wanted their last child. Around 16 percent of survivors did not want more children, compared to 13 percent of women who had not experienced violence. Survivors of GBV are also more likely to suffer from sexually-transmitted disease (STD)—23.7 percent of survivors versus 13.9 percent of women who had not experienced violence had a STD in the last 12 months (prior to the survey). A high proportion of women who were survivors (43 percent) tended to suffer from bruises, injuries, sprain dislocations or burns due to partner’s actions and nearly 17 percent suffered from bigger health issues such as wounds, broken bones, broken teeth or other injuries caused by their husband or partner. 206. Children of female survivors of IPV also suffered significant impacts in terms of human development outcomes – Children whose mothers’ were survivors of violence were much more likely to have had diarrhea in the last 2 weeks prior to the survey compared to children whose mothers had not experienced IPV (41 percent versus 23 percent). A similar pattern was found in terms of immunization. Among children whose mothers’ had not experienced IPV, nearly 46% had all basic vaccines (at 12-24 months). The immunization rate among the children of survivors of IPV was 35 percent. Women who had experienced violence were less likely to own a mosquito bed net (21.9 percent versus 15.9 percent). Further, 53.8 percent of children under 5 whose mothers’ had not experienced violence 5 slept under a mosquito bed net, compared to 43.6 percent of children in the same age group whose Page 97 of 109 The World Bank mothers’ were survivors of IPV. There is also a statistically significant difference in years of schooling in children aged 10-15: 2.9 years for children whose mothers’ are survivors of IPV versus 3.3 years for children whose mothers’ had not experienced violence. Table 13. Health and demographic characteristics of survivors of IPV and women who did not experience IPV Non-survivors Survivors of Sig. of Characteristics of physical physical differenc N violence violence e Women's demographics and health Average number of children ever born 4.0 4.7 *** 1,664 Average number of living children 3.5 4.1 *** 1,664 Terminated pregnancies (%) 23.1 29.1 *** 1,664 Last child wanted (%) ** 1,253 wanted them 55.3 48.8 wanted but later 31.8 34.9 wanted no more children 12.9 16.4 Place of delivery of last child (%) *** 1,253 respondent's/other home 28.3 35.7 traditional birth attendant 5.8 7.9 public sector hospital/professional 47.8 45.2 private hospital/clinic 17.3 10.3 Other 0.8 0.9 Visit health facility in last 12 months (%) 72.7 74.4 not sig. 1,663 Had any STD in last 12 months (%) 13.9 23.7 *** 1,490 Injuries due to husband's actions (%) Bruises, injury, sprain dislocation or burns 10.3 43.0 *** 831 Wounds, broken bones, broken teeth or other serious injury 1.6 16.6 *** 830 Children's health Diarrhea (in last 2 weeks) (%) 23.2 41.1 *** 1,205 Immunization (%) ** 586 at least one vaccine 51.7 62.0 all basic vaccines 45.9 34.7 Children under 5 slept under mosquito bed net (%) ** 1,248 all children 53.8 43.6 some children 10.1 11.7 no net in household 15.9 21.9 Children's education Average years of education (age 6-9) 0.5 0.6 not sig. 1,032 Average years of education (age 10-15) 3.3 2.9 *** 998 Note: Sample includes ever-married women age 15-49 who have experienced physical violence committed by their intimate partner, compared to those who were not survivors of physical violence. *** p<0.01, ** p<0.05, * p<0.1. Source: author’s estimates based on Uganda DHS 2011. Page 98 of 109 The World Bank ANNEX 7: DIAGNOSTIC ON GENDER-BASED VIOLENCE IN UGANDA, DECEMBER 2016 COUNTRY: Uganda UG – Strengthening Social Risk Management and Gender-Based Violence Prevention and Response Project Objectives and approach 207. The main objectives of this Gender-Based Violence (GBV) diagnostic were as follows: (i) to assess the prevalence and risk factors for GBV in Uganda and the impact of GBV on key development outcomes; (ii) to assess the roles, responsibilities and capacities of existing formal and informal institutions for addressing GBV; and (iii) to summarize the evidence base on GBV prevention and response programs to identify interventions that could be scaled up in Uganda. The diagnostic report was compiled by a team of Ugandan and international experts and included a review of available literature on the prevalence, risks factors, and consequences of different types of GBV in Uganda. This comprised an analysis of national datasets, smaller surveys and qualitative studies, a geographical mapping and a logit analysis of risk factors based on the UDHS, 2011. An assessment was also undertaken of the institutional landscape related to GBV in the country, drawing on a review of policy and strategy documents, a legal review, and interviews with 24 key stakeholders. Finally, the diagnostic included a review of both the international evidence base on GBV interventions and evaluations of on GBV in Uganda. Prevalence and geography of GBV in Uganda 208. Available data shows that rates of Gender-Based Violence (GBV) are high in Uganda, particularly Intimate Partner Violence (IPV) and Child Sexual Abuse. According to the 2011 Demographic and Health Survey:46  62.2 percent of all women aged 15-49 reported experiencing physical or sexual violence (by any perpetrator) at least once since the age of 15, compared to a global average of 35.6 percent.47  58.8 percent of all men aged 15-49 reported experience of physical or sexual violence (by any perpetrator) at least once since the age of 15.  In the last 12 months (before survey), 26.9 percent women and 22.1 percent men aged 15-49 reported experience of physical violence.  In the last 12 months (before survey), 16.2 percent women and 3.8 percent men aged 15-49 reported experience of sexual violence.  For ever-married women aged 15-49, the main perpetrators of physical and sexual violence were a current or former husband/partner, thus indicating high rates of intimate partner 46 Uganda Bureau of Statistics (UBOS) and ICF International Inc. (2012) Uganda Demographic and Health Survey 2011. Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc. 47 WHO (2013) Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non- partner sexual violence. Page 99 of 109 The World Bank violence (IPV) in Uganda. Overall, 59.7 percent ever-married women aged 15-49 report experiencing emotional, physical, or sexual violence at least once committed by their current or former husband/partner.  The prevalence of GBV varies geographically: the share of women who have ever experienced violence is the higher among rural women (58 percent compared to 49 percent of urban women), women living in the Eastern region (66 percent), East Central (62 percent) and Northern region (61 percent).  In terms of age, the prevalence of physical GBV is not lower for younger cohorts. It is worrying that 35 percent of young women aged 15-19 reported experience of physical violence in last 12 months.  Prevalence rates vary by religious and ethnic group with some groups experiencing higher rates of physical or sexual violence.  In terms of wealth, poor women are more likely to experience physical GBV (all women) and IPV (ever-married women). For example, 63.3 percent of all women in the lowest quintile reported lifetime experience of physical violence – compared to 47 percent in the highest quintile.  Education and employment status are not necessarily protective factors: Whilst uneducated women are more likely to experience physical GBV and physical IPV, educated women still experience significant rates. For employment, variations in the prevalence of GBV depending on whether a woman is employed for cash, not for or unemployed are not consistent over time.  There are a number of specific groups - mainly women, but some men –particularly vulnerable to violence. Smaller studies suggest that older women/widows, sex workers, persons with disabilities, Lesbian Gay Bi-Sexual, Transsexual and Inter-Sex persons (LGBTI) and displaced women are more vulnerable to both physical and sexual violence. 209. Violence Against Children occurs frequently in school and at the hands of adults in children’s families or local community.48 The most common crimes perpetuated against Ugandan children are defilement, child neglect, child desertion, child abuse/torture, kidnapping, abduction, child stealing, child trafficking, and infanticide. In 2013, defilement cases accounted for 10 percent of all crimes reported in 2013.49 Children also suffer Forced Genital Mutilation/Cutting (FGM/C) and other Harmful Traditional Practices, including violent initiation rites. Risk Factors and Drivers of GBV 210. The socio-ecological model is the most common framework used internationally to analyze the risk factors for GBV. The model posits that different combinations of factors - at the individual, family, community and societal level - interact to increase the likelihood of either an individual perpetrating or an individual being a victim of violence. The current international evidence suggests that the following risk factors are key drivers of GBV: Experience of violence in childhood; having an intimate partner who drinks alcohol (especially excessive use); and harmful social norms around masculinity / femininity / gender roles and acceptability of violence against women.50 48 Uganda Ministry of Gender, Labour and Social Development and UNICEF (2015). 49 Uganda Police Report, 2013 50 Heise, L and Fulu, E. (2015) State of the field of research on violence against women and girls. What Works to Prevent Violence Against Women and Girls Evidence Paper 1; Heise, L. (2011) What Works to Prevent Partner Violence? An Evidence Overview, London: DFID Page 100 of 109 The World Bank 211. In Uganda, a logit analysis undertaken by the World Bank team of the 2011 UDHS data on ever-married women shows that:  Demographic characteristics such as age, age at marriage and empowerment characteristics such as education, jobs, decision making are not the primary determinants of lifetime physical IPV in Uganda.  Women whose partners are often drunk are 4.5 times more likely to experience lifetime physical IPV than those whose partner does not drink.  Women with more children are more likely to experience lifetime physical IPV than those without any children.  Household wealth appears to be somewhat of a protective factor with women from the richest quintile less likely to experience violence. 212. The variations in GBV prevalence between regions and ethnic groups suggest the importance of context-specific social norms51 around the inferior status of women, masculinity and the acceptability of violence - in influencing the GBV prevalence. The UDHS highlights high levels of acceptance of violence: 58% of all Ugandan women and 44% of all Uganda men aged 15-49 believe that wife beating is justified for at least one specified reason. 52 213. Vulnerability to GBV can also be exacerbated by development interventions such as infrastructure investments (e.g. roads, dams, railways), women’s empowerment programs and household livelihood inputs. For example, projects that work only with women or provide women with cash or other livelihood inputs often challenge gendered roles and power dynamics and can trigger backlash from male partners, unless they engage constructively with men. Projects that induce labor influxes can expose vulnerable groups living around construction sites to displacement, school dropout, child labor, and multiple forms of GBV including sexual assault, transactional sex, rape, and forced/early marriage. Development Impacts of GBV 214. International evidence highlights a range of development impacts of GBV at various levels:53  Individual women: Direct injuries or death, long-term physical conditions (e.g. gastrointestinal, chronic pain), mental illnesses, sexual and reproductive health problems, substance abuse, social isolation, lower productivity and income; lower economic and political participation. 51 Definition of a social norm = shared beliefs about what is typical and appropriate in a valued reference group including: (i) Beliefs about what others in a group actually do (i.e. what is typical behavior); (ii) Beliefs about what others in a group think others ought to do (i.e. what is appropriate behavior). These beliefs shape the social expectations within a group of people. 52 Reasons including - if she burns the food, argues with him, goes out without telling him, neglects the children, refuses to have sexual intercourse with him. Whilst high it is noteworthy that there has been a decline since the 2006 DHS, where 7 in 10 women felt violence was justified. 53 See, for example, Ellsberg and Heise, L (2005). Researching Violence against Women: A Practical Guide for Researchers and Activists; United Nations (2006) ‘Ending violence against women: from words to action’, Report of the Secretary- General. Page 101 of 109 The World Bank  Family / household: Incarceration / loss of perpetrator, increased expenditures on medical, protection, social or justice services, lower household income and productivity, children more likely to have emotional and behavioral problems, perform poorly at school and perpetrate or experience GBV in later life.  Community: Ongoing perpetration and impunity if no response to incidences of GBV, financial losses for employers and businesses if survivor cannot work, GBV can contribute to spread of STDs and HIV/AIDS.  Society: Loss of women as productive workforce due to injury or ill health; lower education status of women; increased demand for and costs of key services (health, police, justice) and associated costs; instability and insecurity.  In Uganda, available data highlights costs to the both national economy and health outcomes54: (i) the estimated annual costs of IPV for various providers and duty bearers is UGX 56 billion ($ 22.4 million) in Uganda; (ii) a high proportion of women survivors (43 percent) suffer from injuries: bruises, sprains, dislocations or burns (vs. 10 percent of women who had not experienced violence); (iii) nearly 17 percent of GBV survivors suffer from major injuries such as wounds, broken bones, broken teeth or other injuries (vs. 1.6 percent of women who had not experienced violence); (iv) almost 1/3 of women who have been survivors had terminated pregnancies at some point (vs. 23 percent of women that had not experienced violence); and (v) immunization rates are lower for children of whose mother were survivors of GBV. Institutional Mechanisms to address GBV 215. The legal and policy framework in Uganda provides a good basis to promote gender equality and prevent and respond to GBV. There is a relatively strong framework of formal statutory laws in place (e.g. Constitution, Penal Code, and Domestic Violence Act) and the Ugandan government’s commitment has been articulated through a number of policies, action plans and guidelines developed over the last decade. Nonetheless, there remain a number of challenges and limitations: (i) implementation and enforcement of key legislation remains weak; (ii) some legislation does not fully protect women and girls (e.g. marital rape is not criminalized; the Succession Act only allows widows 15 percent of estate of deceased husband); (iii) customary and statutory laws co-exist very uneasily in some domains (e.g. marriage, succession); and (iv) law reforms underway but with limited progress (e.g. Sexual Offences Bill, Marriage and Divorce Bill). 216. In terms of institutional structures working to address GBV, some ministries already have policy commitments on GBV and the National Policy for the Elimination of GBV in Uganda (October, 2016) outlines clear mandates on GBV for: the MOGLSD as lead ministry; other key ministries such as the Ministry of Internal Affairs, Ministry of Justice and Constitutional Affairs, Ministry of Finance, Planning and Economic Development, Ministry of Health, Ministry of Education and Sports, Ministry of Local Government; and the Ugandan Police Force; local government entities; Parliament, traditional and cultural institutions; and Civil society Organizations. Yet there are a number of challenges: (i) many line 54 These estimates are the result of a comparison of health outcomes for survivors of GBV vs. women who had not experienced GBV using the data from the Uganda DHS 2011 and testing for the statistical significance of the differences (T-test). Page 102 of 109 The World Bank ministries and service providers suffer from capacity constraints (human, financial, technical resources, limited geographical spread); (ii) many service providers have a limited understanding and knowledge of GBV, of their role/mandate on GBV and insufficient skills to meet the needs of survivors of GBV; and (iii) referral mechanisms are often not functioning at a local level to refer women from community level to formal structures and available services (which are often geographically distant). 217. There are also a number of coordination mechanisms with different mandates for actors on GBV, although these need strengthening to be more effective: The National GBV reference group; Gender Development Partners Group; Gender and Rights Sector Working Group; Inter-Sectoral Committee on Violence against Children in and around Schools and GBV Prevention Network (a regional civil society network). GBV Interventions: Evidence, Lessons and Gaps 218. There is a growing international evidence based on promising interventions to reduce GBV, but a more limited amount of evidence on what works in the Ugandan context. Table 14 below summarizes the state of the evidence for key intervention types and gives examples of interventions in Uganda. Table 14: Overview of international evidence and Ugandan examples in GBV programing 55 Intervention types International evidence Examples from Uganda Individual-level Economic Interventions to increase Fair evidence to recommend a  Retrospective evaluation of an Action economic empowerment of combination of microfinance and Against Hunger (ACF) program showed promise. individual women gender transformative training  BRAC Empowerment and Livelihood for approaches Adolescents lowered rates of teenage pregnancy and forced sex.  Enterprises for Ultra Poor Women After War Program in Northern Uganda (WINGS+) programme changed risk factors such as attitudes to GBV. Empowerment training (including Insufficient evidence, but some  New Bangladesh Rural Advancement awareness, knowledge and skills) promising examples of programmes Committee (BRAC) programme to end child for women and girls delivered in that have reduced violence or risk marriage and teenage pregnancy (not yet clubs and community spaces. factors for violence evaluated).  The world starts with me program. 55 This is largely taken from three important evidence reviews: Fulu, Kerr-Wilson et al (2014) Interventions to Prevent VAWG. DFID What Works to Prevent Violence Against Women and Girls Evidence Paper 2; Jewkes, R, McLean-Hilker L. et al (2015) Response mechanisms to prevent violence against women and girls. DFID What Works to Prevent Violence Against Women and Girls Evidence Paper 2; Arango, D. et al (2014) INTERVENTIONS TO PREVENT OR REDUCE VIOLENCE AGAINST WOMEN AND GIRLS: A SYSTEMATIC REVIEW OF REVIEWS. Women’s Voice and Agency Research Series 2014 No.10 World Bank. Page 103 of 109 The World Bank Shelters provide alternative Insufficient/fair evidence to  Action Aid, MIFUMI and FIDA housing for women experiencing recommend shelters as a key established women’s protection centres (No violence, usually on a temporary means of secondary prevention. comprehensive evaluation undertaken). basis. Review identified challenge of reintegration of woman, return to abusive partner. Perpetrator Programs provide Contradictory evidence of impact No example found. treatment and rehabilitation of on recidivism; more evidence to interventions to perpetrators of support the success of couples domestic violence – voluntary or (perpetrator-victim) counselling mandated by court order following domestic violence Household-level Small Group or Couple Fair evidence to recommend No specific programmes in Uganda although Safe Interventions employ gender relationship interventions, Homes and Respect for Everyone (SHARE) transformative strategies to especially when they involve both programmes include small group workshops. address gender roles and power women and men and particularly dynamics in workshops directed at couples. women and men separately or together (couples). Parenting interventions target Fair evidence to recommend  Responsible Engaged and Loving (REAL) parents who have abused or relationship interventions, but fathers Initiative (Georgetown University) neglected their children, or who are evidence is almost all from high reduced both IPV and physical child punishment. at risk of doing so, to teach them income countries (e.g. Spokes, UK).  Formative evaluation of Parenting for positive parenting skills. Good Behaviour and Respectability’ in Uganda (PGBR) programme (Makerere University) suggests positive results. Community-level Community Mobilization Fair evidence to recommend multi-  SASA! (Raising Voices and CEDOVIP) and programmes attempt to empower component community found to be effective at reducing physical IPV women, engage men, and change mobilisation interventions to and reducing the social acceptance of IPV. gender stereotypes and norms at a reduce various types of GBV.  SHARE also showed positive impacts community level via, community and UN Joint programme (North, North Eastern) workshops, peer training, currently underway. campaigns  Good Schools toolkit reduced experiences of violence among children. Communications and advocacy One-off campaigns ineffective;  Gender Roles, Equality and campaigns include posters, radio insufficient but promising evidence Transformation (GREAT) Project (Georgetown and TV as well as edutainment and on multichannel higher-intensity University) implemented a serial radio drama, social communication campaigns. edutainment and social accompanying toolkit for face to face use in communication campaigns with North. Endline concluded it improved . face-to-face work adolescent SRH and decreased GBV. Institutional-level Justice and law-enforcement Insufficient evidence for most Several programmes currently being interventions include: Advocacy for interventions in terms of impact on implemented to improve the response of the policy and legal reforms; protection GBV prevalence, although most can police and judiciary to GBV, but none yet orders; women’s police units; improve service provision to GBV evaluated e.g. Page 104 of 109 The World Bank Specialist courts; One Stop Centres survivors; fair evidence to  FIDA (OSCs); Paralegal programmes; recommend Protection Orders.  International Justice Mission customary justice and alternative  USAID (United States Agency for dispute resolution mechanisms. International Development) programme  UN Women planned programme Personnel Training of police, health Ineffective in reducing the  Evaluation of UN Joint programme on workers and social services’ staff. prevalence of GBV. Most are “one- Gender Equality did not measure impact on GBV off” training events that are not prevalence, but found improved service gender transformative. standards and guidelines for survivor care. ANNEX 8: CONSULTATIONS HELD DURING PREPARATION COUNTRY: Uganda UG – Strengthening Social Risk Management and Gender-Based Violence Prevention and Response Project Prevention and Response Project 219. A series of consultations were held during project preparation with: (i) key Government agencies; (ii) Development partners active in the field of GBV; and (iii) civil society organizations with expertise in the implementation of GBV prevention and response programs. Initial consultations were held from June to August 2016 for the preparation of the GBV diagnostic outlined in Annex 7. An overview of key interventions by key partners was developed based on these consultations as outlined in Table 14 below. Table 15: Overview of interventions by Development Partners in the field of Gender-Based Violence. # Development District Coverage Type of interventions (prevention/response/ Implementing Expected end date Partner both) Partners of current support 1 Department for Support to Uganda's • The goal of the program is to promote equal • Action Aid 2016-2020 International Response on Gender access by women and girls to development • Mifumi Development Equality (SURGE), 2016- opportunities and a life free from violence. • Centre for (DFID) 2021 to provide GBV • Support the Government of Uganda (GoU) to Domestic Violence prevention and response integrate gender and equity in Public Finance Prevention services in 13 districts. Management (PFM) in compliance with Amuru, Gulu, Kampala, Uganda's PFM Act (2015). Katakwi, Kumi, Kween, Lira, • Support selected NGO's to provide Gender- Masaka, Mbarara, Moroto, Based Violence (GBV) prevention and Mubende, Nebbi and Pallisa. response services. Moroto and Kween 2 Irish AID Kamuli , Buyende, Kaliro, • GoU Joint program to prevent and respond • MOGLSD 2019 Namutumba, Iganga, Bugiri, to GBV • Uganda Women's December Mayuge and Jinja Network (UWONET) CEDOVIP • Inter religious Page 105 of 109 The World Bank council 3 USAID • Amuru and Lira districts • Gender Roles, Equality and Transformation • Institute of 2011-2016 (GREAT) (GREAT) Project - Aimed to promote gender- Reproductive • Safe program in 20 equitable attitudes and behaviours among Health districts: Amuru, Arua, adolescents (ages 10-19) and their Georgetown Buliisa, Gulu, Hoima, communities with the goal of reducing GBV University Jinja, Kibaale, Kiboga, improving • Save the Children Lira, Masaka, Masindi, • Pathfinder Mbale, Mbarara, International Mityana, Moroto, Mukono, Nebbi, Tororo, Soroti and Wakiso. 4 United Nations Operates in the post-conflict  UN joint programme on GBV (UNJBV): • UN Agencies 2011-2017 Fund for sub-region of Acholi, Lango, (Strengthening the multi-sectoral approach (UNFPA (lead), Population Teso and Karamaja. to preventing and responding to Gender- UNICEF, UN Activities (UNFPA) Program facilitated the Based Violence in the north and north WOMEN and Food establishment and Eastern Uganda) and Agriculture management of seven (7) Organization (FAO) GBV shelters operating in • Government Gulu, Kamuli, Lira, Masaka, Ministries, Mbarara, Namutumba and Departments and Moroto. Agencies Other districts covered: • International and Amuria, and Kitgum Dokolo national NGOs: Kaabong Action Aid, MIFUMI, UWONET among others 5 UN Women Kampala, Kitgum, Pader and  Ending Violence Against Women and Girls • FIDA 2019 Gulu, Moroto, and Kabong, (EVAWG) program • CEDOVIP Kamuli • Communication for Development Foundation (CDFU) • Uganda Law Society 6 Plan International Aleptong, Lira, Tororor,  Niyetu Youth program • CEDOVIP 2019 Kamuli and Kampala • Straight Talk • UWONET 7 United Nations Adjuman, Arua, Kboko,  Focus on Child Protection and Prevention of TBC 2021 . Children’s Fund Agago, Amuru, Gulu, Violence Against Children (UNICEF) Kitgum, , Lamwo, Nwoya, Pader Kiryandongo, Abim, Amudat, Amuria, Moroto, Kotido, Napak, Nakapiripiriti,Bushenyi, Kabarole, Kyegegwa, Kyenjonjo, Ntoroko, and Mubende, UNICEF Aleptong, Amolatar,  Interventions focusing on the prevention of TBC 2021 Adjuman, Agago, Amuru, Child Marriage Gulu, Kitgum, , Lamwo, Nwoya, Pader Kiryandongo, Abim, Amudat, Dokolo, Lira, Otuke, Oyam, Yumbe, Budaka, Amuria, Moroto, Kotido, Napak, Nakapiripiriti, Hoima, Bushenyi, Kabarole, Bududa, Bulambuli, Busia, Katakwi, Kumi, Kween, Mbale, Kyegegwa, Kyenjonjo, Ntoroko, and Mubende, Namayingo, Ngora, Pallisa, Sironko, Page 106 of 109 The World Bank Serere, Tororo, Iganga, Buyende, Kabale, Kamwenge, Kasese, Luuka, 220. In addition, the GoU and WB team carried out a series of design workshops in January and February 2017 to consult key partners on the proposed project concept, components and key areas of interventions. Additional details on the consultations, presentations shared with partners and records of the discussions are available in the project records. The key areas of focus of these consultations were as follows: 221. Gender-Based Violence Prevention in the work-place: A workshop was held with Government Agencies in February 2017, key labor unions and employers’ associations, multi-lateral and bi-lateral development partners. The discussion focused on understanding the range and type of existing interventions, key areas of focus in terms of analytical work and policy discussions and areas where the proposed project could complement on-going or planned interventions in order to maximize GoU investments through the IDA supported operation. 222. Gender-Based Violence Prevention at Community-Level: A two-day workshop was held on this topic in January 2017. Day 1 of the consultations included Government Agencies, multi-lateral and bi- lateral partners as well as civil society organizations active in the field of GBV. The analysis focused on: (i) sharing the findings of the GBV Diagnostic prepared by MOGLSD with WB support; (ii) sharing the initial project concept with a specific focus on the GBV prevention activities at community level; and (iii) facilitated discussions to collect information and technical advice from participating organizations in terms of : (a) community-wide awareness raising activities to achieve behavior change; (b) specific GBV interventions targeting the groups most at risk; (c) community-level service delivery and referral systems. The inputs and feedback collected during Day 1 were used to initiate further discussions in Day 2 with the MOGLSD. This included participation of all key Departments to collect a broad range of views and feedback on potential GBV prevention approaches and ensure a solid understanding of: (i) key priority areas for GBV programing for MOGLSD; (ii) existing interventions, partnerships and lessons- learned which they have generated; (iii) key areas where the IDA supported intervention could make the most relevant contribution to support national GBV prevention activities in line with the National Policy on the Elimination of GBV. 223. Health Sector Response to GBV: A workshop was held on this topic in February 2017 to gain a more in depth understanding of existing interventions by MoH in the field of GBV including: (i) the status of sector policy development; (ii) training programs for health staff at central and district level; (iii) existing/tested models for service delivery to GBV survivors in the health sectors; (iv) existing partnerships with Development Partners and Civil Society interventions. The workshop resulted in a more detailed understanding of current initiatives, gaps in service provision and potential areas for support by the IDA funded operation. This laid the basis for subsequent consultations with key partners during preparation. 224. JLOS Sector Response to GBV: A workshop was held on this topic in March 2017. Discussions focused on understanding the critical linkages between JLOS institutions for the delivery of services to Page 107 of 109 The World Bank survivors of GBV. This initial consultation sought also to understand structural factors that may affect the delivery of services to GBV survivors (staffing and funding levels) and that fall outside the scope of the proposed IDA operation. In addition, initial consultations provided an overall picture of current technical assistance to the sector and engagements and pilot interventions with the support of development partners and civil society engagement that are ongoing or in the pipeline. This initial discussion was followed by a series of individual consultations with UPF, DPP and Magistrates to understand the current situation in terms of service delivery to survivors of GBV in each of these key JLOS institutions. Page 108 of 109 The World Bank Page 109 of 109