Report No. PID10699 Project Name CAPE VERDE-HIV/AIDS PROJECT Region Africa Regional Office Sector HIV/AIDS Project ID CVPE74249 Borrower(s) GOVERNMENT OF CAPE VERDE Implementing Agency Address OFFICE OF THE PRIME MINISTER Address: Palacio do Governo, Praia, Santiago, Republic of Cape Verde Contact Person: His Excellency Jose Maria Pereira Neves Tel: (238) 610513 Fax: (238) 613099 Environment Category B Date PID Prepared September 23, 2001 Projected Appraisal Date November 01, 2001 Projected Board Date March 01, 2002 1. Country and Sector Background The first cases of HIV/AIDS were reported in Cape Verde in 1986. The main mechanism of transmission of HIV in Cape Verde is by heterosexual transmission, although mother to child transmission (MTCT) also significantly contributes to new cases among children. There are some anecdotal reports suggesting that injecting drug abuse may be on the rise in the country and that it may also be contributing to some HIV infections. Continuous data on sero-prevalence in the country is however not available as the sentinel surveillance system in the country has not been operating since 1998 due to lack of financial resources to sustain the system. In 1997 when the last sentinel surveillance data was available, general population prevalence of HIV was estimated between 1.5% and 2.5%. However, this figure is likely to have increased since then.The Government of Cape Verde has formed a national coordinating body for HIV/AIDS, 'The Coordination Committee to Combat AIDS (CCS-SIDA)' which is under the office of the Prime Minister and is presided by the Prime Minister himself. The Government is in the process of finalizing a national multisectoral HIV/AIDS strategy for Cape Verde, with the objective of reducing the spread of HIV/AIDS in the country. The strategy development process is all inclusive with the participation of Central Government, Municipality Governments, NGOs and international donors.Role of NGOsKey areas of HIV/AIDS NGO activity in Cape Verde are mainly in Information Education and Communication (IEC). Many NGOs, especially the small ones, may need substantial investments in capacity building and the umbrella NGO organization in Cape Verde, 'the NGO Platform' has experience in capacity building of small NGOs in the country, which experience can be utilized for developing HIV/AIDS capacity in the NGO community. The NGO platform is well regarded in Cape Verde by both the Government and the NGO community and has an elected leadership which has been consulted on several occasions during the development of this project. PartnershipsMulti- and bilateral development partners in Cape Verde have been actively engaged and informed of the proposed project, the MAP approach and consulted on the project's design. None of the bilateral partners has so far been involved in addressing HIV/AIDS issues in a multisectoral approach but they have supported activities limited to the health sector. Nevertheless, interest has been expressed by some bilateral partners in either being directly involved in the project or undertaking activities to complement the project. WHO and UNAIDS theme group have been active in assisting the Government in its formulation of multisectoral HIV/AIDS strategy and have been requested to be formal partners in preparation missions.Government request:The Government of Cape Verde has asked for the assistance of international partners, including the World Bank, in efforts to reduce the transmission of HIV/AIDS in the country, which is rapidly increasing as shown by the number of cases being reported.The Government of Cape Verde, represented by the Office of the Prime Minister, is committed to leading the fight against HIV/AIDS in the country, and has requested access to IDA resources within the framework of the MAP. The Government has appointed one of the existing IDA project coordination units - Programa de Infra-Estruturas e Transportes (PIT) - as a counterpart to the Bank in preparation of the project. 2. Objectives The project will support the goal of the national HIV/AIDS strategy of Government of Cape Verde (in the process of being finalized) which is to reduce the spread of HIV infection in the country. As a means of achieving this goal, the project will also support the following areas:a) mitigation of the health and socio-economic impact of HIV/AIDS at individual, household and community levels thus sustaining an economically productive population; andb) building strong and sustainable national capacity to respond to the epidemic. 3. Rationale for Bank's Involvement The Bank has the unique position of being able to give support to a country in more than one sector, and having identified HIV/AIDS as a development issue, is well positioned to support Cape Verde in a multisectoral war-like effort to control HIV/AIDS, as envisaged in the MAP approach. 4. Description The project, under the regional Multi-Country AIDS Program for Africa, will finance HIV/AIDS activities for the period 2002-2006. It will have four components, which reflect the two-tiered decentralized administrative structure in Cape Verde at national and municipality level. The components are:l.National public sector initiatives2.Municipality public sector initiatives3.Civil society initiatives4.Project coordinationGeneralThe project will scale up the existing HIV/AIDS Control Program by mainstreaming program activities into line ministries and other agencies at national and municipality levels and by harnessing the capacity of communities, civil society organizations, including associations of people living with HIV/AIDS (PLWHA), religious organizations, Non-Government Organizations (NGOs), Community Based Organizations (CBOs), private sector organizations, women's organizations, youth organizations and labor unions. Project component 1: Capacity BuildingCapacity building for the - 2 - public sector at both the national and municipality level, as well as for civil society organizations and the private sector to respond to HIV/AIDS.Project component 2: Public Sector Initiatives (National and Municipal)a) National level HIV/AIDS Initiatives. The project will support HIV/AIDS control activities coordinated at national level and will include the HIV/AIDS activities of different line ministries or central government agencies, or contracted out to civil society organizations or the private sector. Each ministry will be expected to have an HIV/AIDS focal person. As part of the multisectoral approach to HIV/AIDS, every Government ministry, will be expected to have, as a minimum, a mechanism for HIV/AIDS IEC for its employees and an HIV/AIDS social support network. b) Municipal level HIV/AIDS Initiatives. Under this component, the project will support activities which are directly carried out by municipal authorities, or contracted out by them to civil society organizations or to the private sector. This support will include the full spectrum of HIV/AIDS preventive, treatment, care and support that can be delivered at municipal level.Project component 3: Civil Society and Private Sector InitiativesUnder this component, the project will support private sector and community-led HIV control activities directly carried out, or contracted out, by civil society organizations, such as NGOs, religious organizations, organizations of Persons Living With HIV/AIDS (PLWHA).Component 4: Project coordinationThe functions of the Secretariat of CCS-SIDA will specifically be funded under this component. The Secretariat will be a lean structure and staffed and designed to facilitate and coordinate project execution, with the implementation of project activities being done by the respective Ministries, municipalities and civil society organizations. The main responsibilities of the Secretariat will be coordination, liaison, supervision, monitoring, evaluation and coordination of longer term national planning and policy support. 5. Financing Total ( US$m) BORROWER 1.00 IDA 10.00 Bilateral 0.25 Multilateral 0.25 Total Project Cost 11.5 6. Implementation Institutional arrangementsThe Cape Verde CCS-SIDA and its Secretariat, which will be under the Office of the Prime Minister, will facilitate and coordinate the overall National HIV/AIDS program and project activities, and not play an implementing role. The Secretariat of CCS-SIDA, will be responsible for day-to-day activities of CCS-SIDA. In light of good financial and procurement capacity in the public sector, the project will contract in experienced project coordination team (PCT) to undertake financial management and assist in larger procurement. An advisory body for CCS-SIDA, that will include representatives from key sectors and institutions as well as representatives from key civil society organizations including those which represent people living with HIV/AIDS, will be established. Line ministries will implement their respective HIV/AIDS plans and report regularly to CCS-SIDA on agreed input and output indicators. Municipality HIV/AIDS work plans will reflect various sector activities to be implemented at municipality level. Each municipality will - 3- establish a municipality HIV/AIDS Committee, composed of heads of department and representatives of civil society organizations. The municipality HIV/AIDS Committee will ensure coordination between HIV/AIDS activities led by various stakeholders in the municipality. Civil society organizations can be contracted by municipalities to implement municipality led project activities, in addition to activities within the civil society project component. Project implementationThe project will finance a series of HIV/AIDS plans presented by line ministries and municipalities, as well as a large number of civil society-led HIV/AIDS Initiatives.The project will be implemented in an incremental manner, starting with those ministries, municipalities, communities and NGOs which already have HIV/AIDS workplans. With time project coverage will be scaled up and expanded to more sectors, communities and NGOs as the project assists these entities in strengthening their implementing capacity. The Project Operational Manual (POM), which will be developed in consultation with stakeholders, will describe in detail the project's institutional and implementation arrangements, and in particular criteria for funding proposals under the civil society component. Project monitoring, supervision and evaluation:Project monitoring and evaluation will be based on a broad range of measures, including impact indicators and more intermediate process and output measures to capture project performance in the more immediate term. Project impact will be measured employing data from HIV/AIDS sentinel surveillance, baseline and end-point population-based surveys on knowledge, attitudes, practices and behavior. Service utilization and special studies commissioned to assess impact in specific areas not easily addressed by population-based surveys will also be used. Monitoring of the project will be carried out using project-based data, beneficiary inputs and program reviews. The Cape Verde CCS-SIDA/Secretariat through contracting will monitor overall project implementation, assessing the performance of project implementation as well as the effectiveness and efficiency of implementation at national, municipality, and civil society levels. Procurement proceduresThe Cape Verde CCS-SIDA, line ministries and municipalities will procure works, goods and services in relation to the respective activities, in accordance with the Bank's Guidelines: Procurement under IBRD Loans and IDA Credits (January 1995 and revised in January and August 1996, September 1997, and January 1999), in particular Section 3.15, Community Participation in Procurement. Consulting services by firms, organizations, or individuals financed by IDA will be contracted in accordance with the Bank's Guidelines: Selection and Employment of Consultants by World Bank Borrowers (January 1997, revised in September 1997 and January 1999). The Government will contract one or more procurement agents to carry out the procurement of large items, such as condoms, diagnostic kits and pharmaceuticals for the diagnosis and clinical management of HIV/AIDS, sexually transmitted infections and opportunistic infections, including tuberculosis. Financial managementThe project will have a viable financial management and accounting system, including a comprehensive Manual of Financial Procedures, Chart of Accounts and fully integrated project financial and accounting system, using appropriate accounting software. The Project Coordination Team (PCT) will include a financial manager and controller and will put in place an appropriate financial and accounting system for the project. Similar institutional strengthening measures will be taken with regard to capacity in line ministries and municipalities where such intervention is needed. Capacity building in financial management in the civil society will be supported through the -4 - collaborating civil society organizations and community based organizations. The project will be audited by independent auditors acceptable to IDA. Each implementing agency will submit quarterly financial reports to Cape Verde CCS-SIDA. The PCT will consolidate all project financial reports submitted by the implementing agencies and prepare the project financial statements for auditing purposes. Audited project financial statements and report thereon, inclusive of an auditor's opinion on the use of statement of expenditures will be submitted to IDA within six months following the end of the financial year. 7. Sustainability The project is expected to be sustainable in the medium term because it is built upon strong government ownership and supports the expansion of HIV/AIDS activities that involve communities, civil society organizations and in particular, organizations of people living with HIV/AIDS. The project will scale up existing HIV/AIDS activities by mainstreaming activities into all government sectors and civil society, and by tapping into community organization resources. The project emphasizes institutional capacity building at national and local level which would further enhance the sustainability of the project. As far as financial sustainability is concerned, it is unlikely that the Government will be able to fully finance the program in the mid-term. It is realistic to expect that bilateral and multilateral development agencies will continue to finance HIV/AIDS activities in the country beyond the period of project implementation. 8. Lessons learned from past operations in the country/sector International experience on HIV/AIDS, and especially regional experience from countries like Uganda and Senegal, ongoing HIV/AIDS control efforts in Cape Verde, and the experience so far obtained in the Africa region, in designing and implementing the Multi-Country HIV/AIDS Program (MAP) has been reflected in the design of this project. Among the key lessons learnt, are: the need for political leadership and commitment, the need to address vulnerability factors, the clear role of civil society, the value of the multisectoral approach to HIV/AIDS, the need to address the complexity of supervising MAP projects, the relevance of robust monitoring and evaluation in MAP projects and the need to limit the role of National HIV/AIDS Secretariats to coordination in order to avoid the 'command and control' tendencies of some of them. 9. Program of Targeted Intervention (PTI) N 10. Environment Aspects (including any public consultation) Issues : The project is not expected to generate substantial environmental effects. Possible environmental risks include inappropriate handling and disposal of medical waste and inadequate management of the respective disposal sites in urban or peri-urban areas, where domestic and medical waste may be mixed. The project will finance training of health care professionals and community workers delivering care to HIV/AIDS patients. This training will include instruction on appropriate separation, transport and disposal of hazardous medical waste. The project will finance the revision of existing health sector guidelines on appropriate management of medical waste at medical facilities and at disposal sites to include the relevant sections regarding HIV/AIDS.A consultant will be engaged during project preparation to assist the - 5- government in developing a Medical Waste Management Plan, completion of which will be required prior to project effectiveness. The project will include measures and financing to implement the Medical Waste Management Plan. 11. Contact Point: Task Manager Gylfi Palsson The World Bank 1818 H Street, NW Washington D.C. 20433 Telephone: 202-473-6713 Fax: 202-473-8038 12. For information on other project related documents contact: The InfoShop The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 458-5454 Fax:(202) 522-1500 Web: http:// www.worldbank.org/infoshop Note: This is information on an evolving project. Certain components may not be necessarily included in the final project. This PID was processed by the InfoShop during the week ending October 12, 2001. Lucy Njuguna L:\12 Oct-01\pO74249.txt XXX 0, 0000 0:00 AM -6-