Document of The World Bank Report No.: 16383 PROJECT APPRAISAL DOCUMENT ON A PROPOSED LOAN IN THE AMOUNT OF US$15.0 MILLION TO THE ARGENTINE REPUBLIC FOR AN AIDS AND SEXUALLY TRANSMITTED DISEASES CONTROL PROJECT (LUSlDA) May 1, 1997 Human and Social Development Group Country Department I Latin America and the Caribbean Region CURRENCY EQUIVALENTS (Exchange Rate Effective January 1997) Currency Unit = Peso US$1.00 = $1.00 Peso FISCAL YEAR January 1 to December 31 ABBREVIATIONS AND ACRONYMS ADC Anonymous Diagnostic Centers AIDS/SIDA Acquired Immune Deficiency Syndrome CAR Country Assistance Review CAS Country Assistance Strategy CONASIDA National AIDS Council CSO Civil Society Organization(s) (church-, community-, company-, trade union-, etc. based organizations) DCC(s) Day Care Center(s) GDP Gross Domestic Product GNP Gross National Product GoA Government of Argentina HIV/VIH Human Immuno-Deficiency Virus IBRD International Bank for Reconstruction and Development IDB Inter-American Development Bank IDU Injected Drug Users IERR Internal Economic Rate of Return KAP Knowledge. Attitude, Practice (Survey) LASHD Latin America Social and Human Development Group(World Bank Group) LIB Limited International Bidding LUSIDA AIDS and STD Control Project MCH Maternal and Child Health MoE Ministry of Education MoH Ministry of Health NCB National Competitive Bidding NPV Net Present Value OM Operational Manual PAHO/WHO Pan-American Health Organization/World Health Organization PCU Project Coordinating Unit PISP(s) Participatory Institutional School Projects PROMIN (I and 11) Argentina Maternal and Child Health and Nutrition Project (I and II) SIDALAC Latin American/Caribbean Initiative for AIDS/STD Control SOE Statement of Expenditures STD Sexually Transmitted Disease(s) TA Technical Assistance UNAIDS United Nations AIDS Program UNDP United Nations Development Programme Vice Presidcnt Shahid Javed Burki Country Director Gobind T. Nankani Country Sector Leader Alain Colliou Task Manager Alexandre Abrantes Argentina AIDS and STD Control Project - LUSIDA Table of Contents Project Financing Data ...........................................1.................................. Block 1: Project Description ............................................................................2 1. Project Development Objectives ................................................................. ...........2 2. Project Components .............................................................................2 3. Benefits and Target Population ............................................................................3 4. Institutional and Implementation Arrangements ...................................................................... 3 Block 2: Project Rationale ............................................................................4 5. CAS Objectives Supported by the Project ............................................................................4 6. Main Sector Issues and Government Strategy ............................................................................ 4 7. Sector Issues to be Addressed by the Project and Strategic Choices ............................................ 4 8. Project Alternatives Considered and Reasons for Rejection ........................................................ 5 9. Major Related Projects Financed by the Bank and/or Other Development Agencies ................... 6 10. Lessons Learned and Reflected in the Project Design ..............................................................6 11. Indications of Borrower Commitment and Ownership ..............................................................6 12. Value Added of Bank Support ............................................................................ 7 Block 3: Summary Project Assessments ............................................................................8 13. Economic Assessment .............................................................................8 14. Financial Assessment ........................................................................... 8 15. Technical Assessment ............................................................................ 8 16. Institutional Assessment ....................................................... .....................8 17. Social Assessment .............................................................................8 18. Environmental Assessment ............................................................................9 19. Participatory Approach ............................................................................9 20. Sustainability .............................................................................9 21. Critical Risks .............................................................................9 22. Possible Controversial Aspects ............................................................................9 Block 4: Main Loan Conditions ........................................................................... 10 23. Effectiveness Conditions ............................................................................ 10 24. Other ............................................................................ 10 Block 5: Compliance with Bank Policies ........................................................................... 10 List of Annexes Annex 1: Project Design Summary Annex 2: Detailed Project Description Annex 3: Estimated Project Costs Annex 4: Cost Effectiveness Analysis Summary Annex 5: Financial Summary and Financial Summary for Revenue Earning Project Entities Annex 6: Procurement and Disbursement Arrangements (Tables A through F) Annex 7: Project Processing Budget and Schedule Annex 8: Documents in the Project File Annex 9: Argentina: Statement of Loans and Credits Annex 10: Argentina: Country at a Glance INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT INTERNATIONAL DEVELOPMENT AsSOCIATION Latin America and the Caribbean LASHD Project Appraisal Document Argentina AIDS and Sexually Transmitted Diseases Control Project -- LUSIDA Date: May 1, 1997 [] Draft 3 Final Task Manager: Alexandre V. Abrantes Country Director: Gobind T. Nankani Project ID: AR-PE 43418 Sector: HT POC: PA Lending Instrument: Investment Loan PTI: | Yes El No Project Financing Data 1 Loan Li Credit El Guarantee [1 Other [Specify] For Loans/Credits/Others: Amount (US$m/SDRrn): US$ 15 million Proposed Terms: [] To be defined [1 Multicurrency 2 Single currency Grace period (years): 5 [I Standard Variable C] Fixed | LIBOR-based Years to maturity: 15 Commitment fee: 0.75 % Service charge: % Financing plan (US$m): El To be defined Source Local Foreign Total Government 15 15 Cofinanciers IBRD/IDA 5 10 15 Total 20 10 30 Borrower: Argentine Republic Guarantor: N/A Responsible agency(ies): Ministry of Health and Social Action Estimated disbursements (Bank FY/US$M): 1997 1998 1999 2000 Annual: 2.25 6.00 5.75 1.00 Cumulative: 2.25 8.25 14.00 15.00 Expected Effectiveness Date: August 22, 1997 Closing Date: December 31,2001 Project Appraisal Document Page 2 Country:Argentina AIDS and STD Control -- LUSIDA Block 1: Project Description 1. Project development objectives (see Annex 1 for key performance indicators): (a) Reduce the rate of growth of the incidence of HIV infection by 15 percent. To achieve this objective the following strategies would be adopted: (i) Improved information for decreased misconceptions about HIV transmission and prevention; (ii) More effective adoption of preventive measures against HIV; (iii) Improved facilities for diagnosis, treatment and care of HIV/Sexually Transmitted Diseases (STD); (iv) Improved monitoring and evaluation of HIV and STD infection, diagnosis, treatment and care; (b) Improve the quality and efficiency of care provided to AIDS patients. 2. Project components: The project would finance mostly HIV/AIDS- and STD-related health promotion and disease prevention activities, with an emphasis on the Federal Capital and the Provinces of Buenos Aires, Cordoba and Santa Fe, where 85 percent of HIV cases are concentrated. The project would also strengthen existing diagnostic, treatment, counseling, and care services in the targeted areas. Finally, it would support HIV- and STD-related research and development. Component Cateeorv Costs % of (US$M) Total Part A: Health Promotion. US$12.5 42.0% (a) Mass and Targeted Communication Campaigns Institution (b) Primary and secondary education on HIV/AIDS and STDs: Building and (i) Educational materials and teacher training, and Policy (ii.) School-based participatory projects. Part B: Prevention of HIV and STD transmission. US$7.3 24.0% (a) Prevention fund. Civil Society Organization (CSO)-based or government behavioral intervention subprojects for specific focus groups, including: Institution (i) High risk groups such as intravenous drug users, commercial sex workers, and Building, homosexuals/bisexuals; Physical (ii) Vulnerable groups such as long-distance drivers, miners, airline staff, university Investment, students, prisoners, and soldiers; and Policy (iii) General population. (b) Blood Bank Quality control. Equip and train staff in 100% of blood banks. (c) Mother-child transmission control. Include HIV diagnosis and treatment in prenatal care; Part C: Diagnosis, treatment and care of HIV infection and STDs. US$6.5 21.7% (a) Establish anonymous diagnostic and counseling centers; (b) Strengthen or develop: (i) laboratories (i.e. HIV,STD and opportunistic infections Institution- diagnosis); (ii) day care services; (iii) home care services; and Building and (iv) STD diagnosis and treatment services. Physical (c) Institutional development, including training of physicians and other health care Investments personnel in the diagnosis, treatment, counseling and care of HIV/AIDS and STD patients. Part D: Monitoring, Evaluation and Research. US$1.7 5.6% (a) Strengthen HIV/AIDS management information system, including the establishment of HIV and STD surveillance system, with about 20 sentinel centers-, (b) Train physicians and other health care personnel in completing death certificates and Institution hospital discharge summaries and statistics, using STDs and AIDS-related diseases as tracer Building conditions; (c) Train heads of Municipal/Provincial programs and heads of sentinel centers in epidemiology and planning; (d) Survey periodically HIV/STD related Knowledge, Attitude and Practice survey (KAP); (e) Review financial and management arrangements, and evaluate ex-post a sample of subprojects; and; (f) Research and development studies on AIDS/STDs. Part E: Project Administration Project US$2.0 6.7% Management Total US$30 100% Project Appraisal Document Page 3 Country: Argentina AIDS & STD Control - LUSIDA 3. Benefits and target population: The project would benefit vulnerable and high risk groups, as well as the general population, by reducing their risk of contracting HIV. It would target the Federal Capital, Provinces of Buenos Aires, Cordoba and Santa Fe, where 85 percent of HIV cases are concentrated, although some activities such as mass communication campaigns would reach the whole country. Over a period of 10 years the project would: * avoid between 12,000 to 23,000 AIDS cases, in low effectiveness or high effectiveness scenarios, respectively; * avoid about 21,000 HIV related deaths and about 700,000 years of life lost due to premature death;. * improve care for an estimated 85,000 people presently infected with HIV and another 100,000 people which are estimated to contract the disease over the period of project implementation. 4. Institutional and implementation arrangements:. Project coordination and management * The project would be coordinated by a Steering Committee which would include the Vice-Minister of Health, the Director of the AIDS/STD program, the Coordinator of Projects financed by bilateral and multilateral agencies and the Project Coordinator. This committee would ensure integration of the project with the Ministry in general, with the AIDS Program, and with the Bank health portfolio in Argentina. * The project would also have a High-Level Advisory Board to assist in building consensus within civil society and ensuring its participation in the Project. Project implementation * The project would be executed by the Ministry of Health (MoH) through a Project Coordination Unit (P.C.U). UNDP will assist in the procurement of goods and services. * The primary and secondary education subcomponent would be executed by the federal and state ministries of education (MoE), with financing and technical assistance provided by the project. To this effect, an agreement would be signed between the MoH, the MoE and the relevant Provincial MoE. * Most health promotion, disease prevention and health care subprojects would be carried out as subprojects selected on a competitive basis from those presented by Civil Society Organizations, including various religious groups, companies, trade unions, and other institutions which have privileged access to the relevant focus groups. * Diagnosis, treatment and care subprojects would be selected on a competitive basis from those presented by the MoH, provincial/municipal MoHs, social security, and private non-profit health care providers which have contracts with the public or social security sectors. Project monitoring and evaluation * The PCU would hire independent consulting firms to regularly carry out (a) financial and management reviews of a sample of the subprojects and (b) ex-post economic and beneficiary evaluations of a sample of subprojects, under terms of reference to be agreed with the Bank. Project Appraisal Document Page 4 Country: Argentina AIDS and STD Control - LUSIDA Block 2: Project Rationale 5. CAS objective(s) supported by the project CAS discussed at Board Meeting on May 4, 1995, with Progress Report discussed on April 25, 1996. The project would: * Directly support CAS objectives of enhancing social development in Argentina and improving social services for the most vulnerable groups in society. It is consistent with the CAS emphasis on institution building, improving the ongoing process of decentralization, and enhancing the participation of community-based organizations in project implementation. It would also support other CAS objectives of improving the efficiency of public expenditures. * Reduce mortality and morbidity mostly among young and economically active people (ages 0-40), reduce the catastrophic economic impact of AIDS in lower-income families where the disease is now more prevalent, reduce the expected growth of health care expenditures due to the AIDS epidemic, and strengthen social services and community involvement. * Complement the Provincial Health and Development and Health Insurance Reform Project through the development of a minimum service level for HIV/AIDS patients. 6. Main sector issues and Government strategy: Main Health Sector Issues * Poverty and associated health problems i.e., maternal and child health indicators worse than expected, given the income and education indicators; * Aging population and associated 'epidemic" of non-communicable diseases such as cardiovascular diseases, cancer and injuries; * Emerging infectious diseases, such as HIV/AIDS and resurgence of sexually transmitted diseases (STDs); * Multiplicity of social insurance and public and private health subsystems adding up to an intricate, inequitable and ineffective financing and delivery of health services; * Need for institutional development in national and provincial Ministries of Health (MoHs) to reinforce their capacity to regulate and control health care system. Government Strategy: * Rationalize health system, giving more emphasis to ambulatory care and general medical care i.e. family medicine programs and managed referrals to secondary and tertiary care; * Improve quality of care through accreditation of institutions, licensing of professionals, standards, technical assistance and training, medical auditing and evaluation; * Strengthen the maternal and child health program; * Strengthen the epidemiological surveillance system; * Increase the coverage with the expanded immunization program; * Improve food and drug administration; * Restructure social insurance-based health care finance and government policy and regulatory capacity (Bank support through the Health Insurance Reform and Health Insurance TA Projects, Lns 4002/3/4-AR); * Modernize the public hospital network and improve the provider payment system; * HIV/AIDS and STD Control program. 7. Sector issues to be addressed by the project and strategic choices: AIDS Sector Issues to be addressed by the project: Epidemioloev of AIDS in Argentina * The HIV/AIDS epidemic in Argentina has increased significantly since 1992 and 1993, when for the first time more than 1,000 cases were reported each year, and in 1994 it doubled. By the end of the first trimester of 1996, 8,198 cases had been reported cumulatively (10,793 cases after correcting for delay in the reporting) or 312 AIDS cases per million inhabitants. According to the number of reported AIDS cases, Argentina ranks fifth in the continent, located after the United States, Brazil, Mexico and Canada; according to the cases per population (rate), it is located third. It is noteworthy that these three countries with the highest AIDS rates in the Americas have significant HIV transmission associated with injected drug users. The sexual transmission of HIV, excluding secondary cases of injecting drug users, has a pattern similar to that of neighboring countries (i.e. Chile). * The rate for male cases (82% of the total cases) is 383 per million men, while there are 86 cases among females per million women. Of the total number of reported cases, 74% are men 15 to 49 years of age; 14% are among women of the same age group. * Eighty-five percent of the total cases are located in three geographical areas. The most affected area (ranked by rate) is the Federal Capital (Buenos Aires City) with a rate of 1,036 cases per million inhabitants (3,096 cases); the second most affected area is Santa Fe jurisdiction with a rate of 237 cases per million (732 cases) and thirdly Buenos Aires provincial jurisdiction with a rate of 237 cases per million inhabitants or 3,120 cumulative cases (38% of the total). Of these three areas, the highest Project Appraisal Document Page 5 Country: Argentina AIDS and STD Control - LbSIDA increase since 1990 was in the Buenos Aires jurisdiction, with 106 cases reported by 1990 and 726 bv 1995. The majority of cases at the beginning of the epidemic (1982-87) were homosexual and bisexual men (76%), however by 1995 this category represented 26% of the total. Cases among hemophiliacs and blood transfusion recipients have decreased over time, and in 1996 they represented 1% of the total. Forty-two percent of the cases are injected drug users (IDU); AIDS cases among IDUs are typically young (63% less than 30 years), and low educational attainment (23% have junior high school or more). The number of cases among heterosexual individuals is steadily increasing, and in 1995 represented 20% of the total reported cases that year. A cumulative of 494 cases were newborns from HIV-infected women. Even when the exact figure is unknown, a significant number of cases in the heterosexual category are the female sexual partners of injected drug users and their newborns. Because of the difficulties in determining the size of the population of men who engage in same-gender sexual behavior and of injected-drug users, the rate estimates (cases per population) is unknown. A larger concentration of cases among IDUs is in the Federal Capital City, and in Buenos Aires province and Santa Fe jurisdictions (92% of cases); while in these three areas 83% of heterosexual cases and 78.5% of cases among homosexual and bisexual men are clustered. Government response * The federal government is committed to fight HIV/AIDS and STDs. It has established a National Program of Retrovirus, AIDS and STD Control, including screening blood donors for HIV and STDs, the provision of antiretro,iral and prophylactic drugs for HIV-infected and AIDS patients and the control of sexually transmitted diseases (STDs). The budget of the National Program increased from USD$8,058,000 in 1994 to USD$19,332,000 in 1996, and is mainly devoted to the provision of reagents for HIV testing and financing antiretroviral drugs to AIDS patients (98% of the budget). * The National AIDS/STD program pays the antiretroviral drugs from the federal budget without participation of the social security or private insurance systems. A new social security and health insurance regulatory law which is being discussed includes provisions to address this issue. The predominant way of providing care for HIIV/AIDS patients is through in-hospital care. However, alternate and more efficient ways for the provision of care are being sought (i.e., through ambulatory and domiciliary care). * The National AIDS Program has devoted only limited resources to the prevention of HIV-transmission. Strict norms for bio- securitv in blood banks have been issued and have been enforced in major hospitals in urban areas. However, the screening of 100% of blood packages before transfusion and 100% compliance with universal precaution norns have not yet been reached in all facilities. * Many Civil Society Organizations (CSOs) are conducting HIIV/AIDS control activities, and it has been shown that their involvement with affected communities allows them to provide effective and humane HIV-related services. Also, due to their conmmunity-based nature, scarcitv of resources, and recent creation, many of these institutions need to develop their institutional capacity and improve the sustainabilit of their operations. * AIDS patients in Argentina suffer discrimination and stigmatization. Their discrimination relates not only to discrimination in the workplace, but also to the avoidance of preventive interventions, and the provision of inadequate health care senices, resulting in delay or avoidance of earlv diagnosis and treatment. Strategic Choices: * Public financing, due to the fact that most interventions to be financed by the project (i.e., media campaigns and primary and secondary education) are public goods with significant externalities. * Private/vublic mix in provision of services because high-risk and other focus groups are better reached through the churches and NGOs, while vulnerable occupations are better reached through company or trade union-based senices, or other CSOs. * Health promotion and disease prevention (i.e. mass and targeted communication campaigns; control of blood quality; and control of mother-child HIV transmission), as opposed to antiviral treatment, because they are more cost-effective, are affordable and/or constitute public goods; * Day care centers and domiciliarv services as opposed to hospital inpatient care, because they are more efficient and provide more humane health care. * Targetine: (i.) general public, opinion leaders and decision makers for dissemination of information on the disease and modes of transmission to the general population to increase awareness, reduce denial and put HIV/AIDS on the agenda of opinion and decision makers; (ii.) primary and secondary students for general education on FHV/AIDS and STD; and (iii.) focus groups for behavioral interventions including not only traditional high-risk groups but also vulnerable groups such as women, certain occupations, prisoners, etc. 8. Project alternatives considered and reasons for rejection: * Public deliverv of services was rejected because CSOs are often more effective and efficient in delivering HIV/STD services and because the government already finances HIV diagnosis, treatment and care in both public and private institutions. * Financing anti-retroviral or protease inhibitor pharmaceuticals was rejected (except for controlling mother-child transmission) on the basis of poor effectiveness, low cost-effectiveness, or not being affordable (i.e. US$1.5-2.0 billion per year); * Vertical vrogram organization, in which activities would be organized and carried out by a federal agency, was rejected due to the existing decentralization of the health system and because of poor sustainability of,centralized vertical programs. Project Appraisal Document Page 6 Country: Argentina AIDS & STD Control - LUSIDA 9. Major related projects financed by the Bank and/or other development agencies (completed, ongoing and planned). Sector issue Proiect Latest Form 590 Ratings IP DO Bank-financed Poverty Social Protection Ln 3957 AR HS S Poor Maternal and Child Health (PROMIN I), Ln 3643 AR Mater. & Child Health & Nutrition (PROMIN II), S S under preparation Poor public hospital performance and inefficient provider Provincial Health Development Ln 3931 AR S S reimbursement system Unsustainable/Inefficient Social Insurance Health Insurance Reform Ln 4002/3 AR HS HS Health Care Financing Health Insurance T.A Ln 4004 AR HS HS Other development agencies IDB Poor public health care system performance Health Care Rehabilitation UNAIDS/PAHO -- AIDS and STD Coordination meetings. No specific actions CSOs CSO Coordination CENOC -- Center for CSO registration & accreditation Bilateral Agencies GTZ AIDS Prevention in 4 municipalities in the Buenos Aires metropolitan area 10. Lessons learned and reflected in proposed project design: * Importance of agreeing on performance indicators at the outset of the project, and on an adequate monitoring system. Project input, process, output and impact indicators, as well as the information sources, were agreed at pre-appraisal, and the project will strengthen the MoH management information system. A set of 14 agreed Monitoring Indicators is part of the Loan Agreement's Supplemental Letter. * CSO capacity is limited for presenting subprojects, for ensuring the administrative requirements of a typical Bank project and for maintaining good accounts. When working through CSOs, the need for TA should be anticipated for project preparation and presentation. The proposed project would retroactively finance TA for subproject preparation (i.e. up to 10% of estimated project costs). In addition, the PCU will organize or contract launching workshops and offer technical assistance to CSOs which do not have sufficient technical capacity for preparation and presentation of the subprojects. Likewise, the PCU will provide and maintain a standard software for accounting and stating expenditures. * Single disease projects tend to become isolated in the respective provincial MoH, leading to progressive alienation. Within projects it is easy for different components to overlap and duplicate efforts. The project would be guided by a steering committee which would ensure integration with the MoH and the AIDS/STD program. In the third and fourth year of project implementation, the project would progressively merge with the AIDS/STD program. * Bank procurement procedures are often ill-suited for the procurement of condoms, diagnostic supplies, and pharmaceuticals, leading to shortages and delays. The Project would be assisted by UN agencies (i.e. UNDP, UNAIDS) in the procurement of such goods, and in contracting consultants. 11. Indications of borrower commitment and ownership: * Establishment of National AIDS/STD Program and National AIDS Council; * Passing of an AIDS Law against discrimination in schools, employment, social benefits etc.; * Regulation making condom commercialization, sales and marketing more open; * Passing of other laws important for HIV control: Blood Law and Transfusion Standards, Biosecurity Standards; * Project counterpart fuids available; * Diagnosis and treatment of HIV and part of standard prenatal care included in the essential benefits package of both social health insurance and pre-paid schemes; * Social Insurance and pre-paid health care payment system to cover AIDS/STD diagnosis, treatment and care; * Ongoing AIDS/HIV mass communication campaigns coordinated by both the GoA and the Catholic Church. * Letter of Health Policy addressed to the Bank in September 1996, including a strategy to control the spread of HIV/AIDS and STDs Project Appraisal Document Page 7 Country: Argentina AIDS & STD Control - LUSIDA 12. Value added of Bank support: Cross country experience: * The Bank is the largest financier of HIV/AIDS and STD control projects in the world; * Bank has regional leadership: it developed the LAC Initiative for AIDS and STD control (SIDALAC), and finances Brazil's HIV/STD control program/project, the largest in the world. A recent mid-term review showed significant impact on the epidemic and a highly satisfactory project performance; Analytical capacity: The Bank has authored some of the best economic analysis of the HIV/AIDS epidemic, measuring its impact on the microeconomy, on specific economic sectors and on the economy in general. Project Appraisal Document Page 8 Country: Argentina AIDS & STD Control - LUSIDA Block 3: Summary Project Assessments (Detailed assessments are in the project file. See Anmex 8) 13. Economic Assessment (see 3 Cost-Benefit Analysis: NPV=US$363 Z Cost-Effectiveness Analysis: | Other Annex 4): mil.; IERR= 67% About 530,000 life-years saved at about US$56 per year of life Cost-benefit analysis: saved Using a conservative estimate of a 50% project success rate, and estimating a 10- Cost-effectiveness analysis: The project is expected to year stream of benefits and costs, the net present value of the benefits (NPV) prevent about 15,000 HIV infections, equivalent to exceeds US$360 million, with an internal economic rate of return (IERR ) of about 530,000 years of life lost due to premature over 67 percent. death, at a cost of about US$56 per year of life saved. Sensitivity Analysis: If the project were delayed by 2 years, the NPV and IERR This would place the project among the most highly would be reduced to US$205,057,000 and 38 percent respectively. If the benefits cost-effective interventions. were to be reduced by 40 percent, NPV and IERR would be reduced to US$206,137, 000 and 48%, respectively. 14. Financial Assessment Fiscal impact of recurrent costs (See Annex 5): The burden of recurrent spending generated by the proposed project on total public health spending is estimated at US$870,000 per year from years 5 through 9, which appears modest in terms of the US$4.8-billion annual public health spending and within the US$19-million annual AIDS/STD program budget. 15. Technical Assessment: The project is technically justified on the basis of the importance of the problem it addresses, its vulnerability to cost-effective interventions, the public nature of the proposed interventions, their affordability and the social consensus on the need for public intervention. * Importance of AIDS/STDs: The problem is important due to the growth rate of the epidemic and due to the fact that it is spreading out of focus groups into the general population. * Adequacy of selected interventions: Although the disease is not vulnerable to treatment, the epidemic can be slowed through health promotion, preventive activities among focus groups, control of blood transfusions, diagnosis and treatment of STDs and HIV among pregnant women. These are generally recognized as the most cost-effective interventions to control the spread of HIV/AIDS; home care and day care are perceived by patients as more humane and can liberate beds in communicable disease hospital wards. * Justification for public intervention: HIV/AIDS and STD control are typical public goods given: (i.) the externalities involved; (ii). that the private health insurance and health care system do not adequately cover the necessary benefits and services, (iii.) that it affects mostly the poor; and (iv.) that it generates catastrophic health expenditures. * Affordability: The economic analysis (Annex 4) suggests that the proposed interventions are affordable within the present public allocation to the health sector. * Social value: There is consensus on the priority of HIV/AIDS control among the political body, i.e. the Government, the parliament health committees, and among other major civil society stakeholders, the church and other CSOs. 16. Institutional Assessment: Executing agencies: The Government is committed, as can be judged by the letter of health policy, willingness to put substantial counterpart funds, and fast project preparation process. The Ministry of Health is satisfactorily managing four Bank projects. State health ministries have been quite effective in implementing Bank projects ( i.e., the Provincial Health Project). CSOs may need technical assistance to implement subprojects. Such technical assistance would be provided or contracted by the PCU, and budgeted in individual subprojects. Primary and secondary education on HIV/AIDS and STDs needs the active participation of Federal and Provincial Ministries of Education. The MoH will sign an Agreement with the National Ministry of Education and Culture and Provincial MoHs will sign an agreement with LUSIDA. Project management: The project coordination unit is well organized and staffed. The administrative arrangements are acceptable and the line managers hired for the PCU have the necessary background and experience. Its work can be judged by the excellent quality of the project preparatory work. At appraisal, the Borrower presented an Operational Manual (OM) acceptable to the Bank, including the criteria and procedures for subproject identification, preparation, and appraisal, as well as implementation arrangements and project performance indicators. The Monitoring Indicators will be part of the Loan Agreement's Supplemental Letter. The PCU will benefit from the experience and management systems of other Bank projects managed by the MoH, which have been satisfactory to the Bank. 17. Social Assessment: Although a social assessment was not undertaken during project preparation, the main social issues concerned were identified and the key stakeholders (traditional and non-traditional focus groups, CSOs such as the Church, NGOs, trade unions, etc. Policy makers, and opinion makers were properly identified, and key sectoral CSOs were consulted. The project will be implemented through the involvement of CSOs which will be in charge of part of the delivery mechanisms. The participatory activities initiated during preparation will continue during implementation to inform and mobilize the beneficiaries and their representatives. The project will use social research techniques and mass and focused media publicity as part of its execution and monitoring. Stakeholder assessments (SA) with both beneficiaries and CSOs and organizations involved will be conducted periodically. Project Appraisal Docunent Page 9 Country: Argentina AIDS & STD Control - LUSIDA 18. Environmental Assessment: Environmental Category C The project consists mostly of mass and focused communication campaigns, training, and community-based subprojects with no environmental impact. Refurbishment and equipment of existing laboratories and day care centers will not add significant hazardous medical wastes. Issues related to hospital hazardous waste treatment and disposal, including those derived from AIDS and STD patients, are being addressed by the Provincial Health Sector Development project (Ln 3931 -AR). 19. Participatory Approach: Identification/Preparation Implementation Operation Beneficiaries/community groups CON COL COL Intermediary CSOs CON COL COL Academic institutions COL Local government IS COL COL Other donorslUNAIDS COL IS IS * CSOs were consulted during project preparation and were involved in defining the eligibility and selection criteria to be used in the selection of CSO-based subprojects. CSOs will prepare and carry out a significant number subprojects, which are estimated to account for 20-30 percent of total project costs. * The Catholic Church is already carrying out a significant number of HIV control programs, was consulted during project preparation, will be executing a number of subprojects, and will participate in the High Level Advisory Board described in Box 4. * Academic institutions will be involved in carrying out many training, monitoring, evaluation and research activities related to Part D of the project. * Provincial and municipal governments will prepare and carry out most of the diagnosis, treatment and care subprojects, described in Part C of the project. * UNAIDS was consulted during project preparation but was not able to contribute significantly to project preparation; its involvement may increase during project implementation, if it establishes itself more solidly in the region. 20. Sustainability: The Project would be sustainable because: * The Govermnent is committed to the project; * The fiscal impact of the project is very modest (See financial analysis) * The PCU is strong and will merge progressively into the National Program for AIDS and STD control * Major stakeholders in civil society will be involved in project oversight. 21. Critical Risks (see fourth column of Annex 1): Risk Risk Risk Minimization Rating Measure Project outputs to development Lack of government or civil society commitment Low Involvement in project obiectives preparation & implementation Poor access to condoms and clean syringes Low Ongoing policy dialogue Insufficient MOH/PCU capacity Low Insufficient MoE, provincial or municipal education Medium Letter of agreement with MoE, secretariat capacity provinces and municipalities. Insufficient blood bank capacity Low TA Insufficient coordination with Maternal and child Low Coordination with the Maternal health services and Child Health Project Insufficient CSO capacity High Technical Assistance Insufficient provincial or municipal health secretariat Low Technical Assistance capacity Insufficient MOH/PCU capacity Low Technical Assistance Overall project risk rating Low 22. Possible Controversial Aspects The use of condoms and syringe swaps for drug users is important for achievement of development objectives. The Argentinean Catholic Church has had a conservative stance on both issues, but has recently shifted towards a more tolerant view on both issues. Projcct Appraisal Docunent Pagp 10 Country: Argentina AIDS & STD Control - LUSIDA Block 4: Main Loan Conditions 23. Effectiveness Conditions Satisfactory OM ( See Loan Agreement, page 10) 24. Other 1. Agreement between MoH and Ministry of Education (Federal and by Region) will be a condition for financing primary and secondary education on HIV/AIDS and STDs activities (See Loan Agreement, page 7); 2. Adequate source for financing recurrent costs will be an eligibility condition for subprojects presented by CSOs, provinces or municipalities (See Operational Manual). Block 5: Compliance with Bank Policies X This project complies with all applicable Bank policies. Alexandre V. rantes ' obind T. Nankani (Task Mana er) (Country Manager) Project Appraisal Docunent Page 11 Country: Argentina AIDS and STD Control - LUSIDA Annex 1 Project Design Summary .Narrative Summwtry V - erifiabfle' ndirlieirs Weans of lKerdiic(ation | mportani kMwmpIios CAS Objective * Enhanced social development through lower mortality and morbidity among the young and economically active. Project Development Objectives * Reduced growth rate in the * Growth rate of HIV * Serologic Survey * HIV educated people can incidence of HIV infection incidence among army adopt healthy practices and (preventive) conscripts (0.4%), blood preventive measures. donors (0.19%), or random sample of the population reduced by 15% from 1990-1996 (a). * Improved quality and efficiency * Decrease in the number of * Hospital stats * Hospitals set up new of health care provided to AIDS hospital admissions per outpatient and domiciliary patients. HIV patient by 25 %, from services and adopt new (treatment) 1990-1996 average (a). care protocols * Shorter duration of hospital * Idem * Idem stay by 25% from 1990- 1996 average (a). Outputs * Improved information/decrease in * Increase in proportion of * KAP survey * Continued Government misconceptions about HIV correct answers in civil society support for transmission and prevention. knowledge, attitude and mass communication practices (KAP) survey by campaigns from 60% to 75% by 2001 * Ratings of mass and * TV/radio stats * HIV educated people can targeted communication adopt healthy practices and campaigns (a). preventive measures * Proportion of schools in the * MoE stats * Central & provincial MoEs targeted provinces and BA are committed and/or have w/ trained teachers & the capacity to execute educational materials. training Target: from 0% to 40% * More effective adoption of * Number of CSOs carrying * Project stats * CSOs have capacity to preventive measures against HIV out subprojects. From 0 to prepare & implement infection. 50 subprojects * Proportion of blood units * Blood Bank stats * Blood bank capacity tested for HIV. From 68% to 100 % * Proportion of pregnant * MCH stats * Adequate coordination w/ women screened for HIV. Mat. & Child Health From 0% to 50% of those Program & w/ PROM1N under prenatal care * Proportion of HIV+ * MCH stats * Idem pregnant women who receive antiviral therapy From 50 to 75%. Project Apprail Document Page 12 Country: Argentina AIDS STD Control - LUSIDA * Improved facilities for diagnosis, * Number of new * Project stats * Provincial & municipal treatment and care of HIV/STD Anonymous Diagnosis capacity to prepare & Centers. Target: 10+ implement subprojects * Number of new Day Care * Idem * Idem Centers. Target: 10+ * Number of new * Idem * Idem Domiciliary care services. Target: 10+ * Improved monitoring and * Number of new active * Project stats * MoH/PCU capacity evaluation of HIV and STD sentinel centers. epidemiology and related services Target: 10+ * Number of surveys. * Idem * Idem Target: 4 * Proportion of subprojects * Idem * Idem reviewed or evaluated. Target: 10 - 25 percent Project Components Input: * Health Promotion * $12.5 million * Project Stats * MoH/PCU Capacity * HIV/STD Prevention * $7.3 raillion * Idem * Idem * Diagnosis, treatment and care of * $6.5 million * Idem * Idem HIWSTD * Monitoring, evaluation and * $1.7 million * Idem * Idem research . Project Administration * 2.0 million * Idem * Idem (a) Baseline values for 1990-1996 are being calculated and will be available before effectiveness. Project Appraisal Docunent Page 13 Country: Argentina AIDS & STD Control - LUSIDA Annex 2 Detailed Project Description Project Objectives and Description The objectives of the Project are to reduce the rate of growth of the incidence of HIV infection, and to improve the quality and efficiency of care provided to AIDS patients. The Project consists of the following parts, subject to such modifications thereof as the Borrower and the Bank may agree upon from time to time to achieve such objectives: Part A: Health Promotion (US 12.5 million: 42 percent of total project costs) Carrying out of Subprojects in the Participating Provinces and the City of Buenos Aires to increase the knowledge of the population about the transmission and prevention of HIV/AIDS and STDs, and to reduce the social discrimination against HIV/AIDS patients, including: (1) design, production, distribution, and diffusion of mass- and targeted communication campaigns; and (2) education on HIV/AIDS in primary and secondary schools, including the development of educational materials, the training of teachers, and the preparation and execution of school-based participatory activities. Part B: Prevention of HIV and STD Transmission (US$7.3 million: 24 percent of total project costs) Carrying out of Subprojects, selected on a competitive basis, in the Participating Provinces and the City of Buenos Aires to reduce the spread of HIV and STDs through increasing the proportion of the population at high risk that adopts preventive measures, to reduce the transmission of HIV through transfusion of blood and other biological products, and to reduce the mother-child transmission of HIV and syphilis, including: (1) prevention activities for specific high-risk focus groups organized by CSOs and other elements of civil society (e.g. church groups, local community groups, companies or trade unions); (2) improved blood quality control through equipping and training of staff in blood banks where the quality of blood is not yet filly ensured; and (3) review and, if necessary, revision of routine prenatal care standards to include the diagnosis and treatment of HIV in pregnant women. Introduction by the Participating Provinces, Municipalities or other entities that provide medical care to people without insurance coverage, of the diagnosis and treatment of HIV in pregnant women as part of the standard prenatal care package; and review of and, if necessary, preparation of draft amendments to legislation to include diagnosis and treatment of HIV in pregnant women in the package of essential services to be covered by government health services by the social insurance system and by pre-paid health services. Part C: Diagnosis. Treatment and Care of HIV Infection and STDs (US$6.5 million: 21.7 percent of total project costs Carrying out of Subprojects, selected on a competitive basis, in the Participating Provinces and the City of Buenos Aires to improve the quality and efficiency of the diagnosis, treatment, counseling and care provided for HIV and STDs by reducing the number of hospital admissions per patient and the average length of hospital stay, including: (1) establishment by Participating Provinces, Municipalities or other entities that provide medical care to people without insurance coverage, of anonymous diagnostic centers and, as deemed necessary by the Borrower, care centers for HIV/AIDS orphans and hospice care; Country: Argentina Page 14 Project Appraisal Document AIDS & STD Control - LUSIDA (2) establishment or improvement by hospitals or ambulatory health networks of laboratories, day care services, home care services, and STD diagnosis and treatment services; and (3) training of physicians and other health care personnel in the diagnosis, treatment, counseling and care of HIV/AIDS and STD patients. Part D: Monitoring. Evaluation and Research (US$1.7 million: 5.6 percent of total project costs) Carrying out of studies and provision of technical assistance and training to improve information on AIDS and STDs, to monitor Project performance, and to advance knowledge on AIDS and STDs, including: (1) establishment of an HIV and STD surveillance system; (2) updating and maintenance of equipment and software and training of staff of the Ministry of Health, the Provincial Ministries of Health and the Municipalities in the operation of the HIV/AIDS management information system; (3) training of physicians and other health care personnel in the preparation of death certificates and hospital discharge summaries and statistics, using AIDS and STDs as tracer conditions; (4) periodic surveying of HIV/STD related knowledge, attitudes and practices among the Borrower's population; (5) ex-post evaluation and financial and management reviews of sample subprojects; and (6) competitively selected research and development studies on AIDS/STD presented by universities or other research institutions, covering the epidemiological, sociological, behavioral, and economic aspects of HIV and STD infection. Part E: Project Administration (US$2.0 million: 6.7 percent of total project costs) Strengthening the capacity of the Project Coordination Unit through the provision of specialized technical assistance and staff, and the acquisition and use of appropriate office space, equipment and communications services. Project Appraisal Document Page 15 Country: Argentina AIDS & STD Control - LUSIDA Annex 3 Estimated Project Costs (US$ million) Project Comvonent Local Forcign Total Health Promotion 8.5 4.0 12.5 Mass and targeted communication campaigns Primary and Secondary Education Prevention of HIV and STD 5.0 2.3 7.3 Prevention Fund Improve Blood Banks Interrupt Mother-Child Transmission Diagnosis, treatment and care of HIV 3.5 3.0 6.5 Anonymous diagnosis centers, Laboratories Day care services Home care services Other AIDS/STD related services Monitoring, Evaluation, and Research 1.5 0.2 1.7 Senfinel surveillance system Management information system KAP studies Financial and management reviews and ex- post evaluation Research and Development Project Management 1.5 0.5 2.0 Total 20.0 10.0 30.0 'Total Project Cost . 2(1.1J ll.0 . 30.0) Project Appraisal Document Page 16 Country: Argentina AIDS & STD Control - LUSIDA Annex 4 Cost Benefit Analysis Summary (US$ million, 1996) Estimated Costs and Benefits. Sensitivity Analysis Total Investment + Recurrent Costs 36.09 Present Value of Investment 31.02 Benefits (PV) Direct Cost Savings 149.07 Indirect Cost Savings 638.15 Total Savings (Direct + Indirect) 787.21 Sensitivity Analysis of Benefits (PV) 30 percent success rate 236.16 50 percent success rate 393.61 80 percent success rate 629.77 Net Present Value -- (50% success rate scenario) 362.59 Internal Economic Rate of Return 67 % Main Assumptions: The economic analysis is based on a stream of benefits and costs estimated over a ten-year period. The main assumptions include: (i) 85,000 people currently infected with HIV as of 1996; (ii) an estimated 10,000 new cases per year; (iii) an average 35 healthy years lost per case; (iv) gross domestic production of US$8,000 per person; (v) sixty percent of the AIDS cases occur among the productive population; (vi) discount rate of eight percent; (vii) average cost per case over a 9 year period of US$105,000 based on cost studies carried by the Argentine Ministry of Health; (viii) and estimated 40 percent of the infected population receiving adequate treatment; and (ix) 30 percent reduction in new AIDS cases over a ten year period. There are two reasons for selecting an 8% discount rate for the LUSIDA project, a little lower than what would be appropriate for a private investment project. First, the highly redistributional nature of the project, demonstrated by a high proportion of the target population in the lowest 40 percent of the income distribution. And, second, the public goods nature of the investment, discussed elsewhere in the chapter, provides a justification for a discount rate different from the discount rate traditionally assumed for investments where the output is a private consumption good. Based on these considerations and extended conversations with Argentinean economists, a discount rate of 8 percent was chosen for the project. Nonetheless, the analysis was also repeated using a 10 percent discount rate in order to ensure that the project remained viable. Estimates with the ten percent discount rate show that the net present value (NPV) of the project (benefits minus costs) would be reduced to just over $210 million with an estimated IERR of 52 percent. Benefits presented are based on the conservative estimate of a 50 percent success rate in achieving the expected reduction in new AIDS cases. Switching values of critical items: Given the high IERR for the project and the low initial and recurrent investment required, the critical switching values depend almost entirely on the two cases analyzed in the section of the paper on 'Risk and Sensitivity Analysis", available in the project files. The second element which would 'switch" the results of the analysis would be a lower than expected reduction in the number of new AIDS cases. This has been mitigated by using a conservative 50 percent of the reduction estimated by experts in the field and experience in similar projects in the United States. Project Appraisal Document Page 17 Country: Argentina AIDS & STD Control - LUSIDA Annex 5 Financial Summary Fiscal Impact (US$1,000,1997) Year Year Year Year Year Year Year Year. Ye Y~: 0 1 2 3 4. $ 6 7 . 8: Estimated Project Costs 30,000 Estimated Recurrent Expenditure 243 278 278 696 870 870 870 870 870 870 Recurrent expenditures as % of total 0.12% 0.12% 0.11% 0.10% 0.10% Central Govt. Spending Recurrent expenditures as % of total 0.02% 0.02% 0.02% 0.02% 0.02% Provincial Govt. Spending Recurrent expenditures as % of total 0.12% 0.11% 0.11% 0.11% 0.10% Municipal Government Spending Reecurrentecxpenditures as % of 0.16% 0.15% 0.15%./ 0 14% 0.14% total Ministry Spending. Note: GDP growth estimates are based on the Argentina CAS: 3% for the period 1996-98 and 5%1999-2003 The estimates assume that the recurrent expenditures of the project will be generated by annual maintenance costs of 5 percent per year and an annual depreciation cost of 10 percent per year. Upon project termination the estimated recurrent costs will account for US$870,000 per year. The table displays the recurrent expenditures as a share of total central government spending on health, provincial government spending, Municipal government spending, and, lastly, as a share of total Ministry of Health spending on health. This analysis does not consider the spending through the social security system or through the private sector, as it is estimated that the ministry will continue to assume the majority of the spending on AIDS given the public goods nature of AIDS spending. The assumptions include: annual health care spending increases equal to the projected growth of GDP; that is, it is assumed that public health spending will continue to account for approximately 1.7 percent of GDP over the next 10 years. Based on these estimates, the following table compares the recurrent expenditures generated by the project with the estimated public health spending. Estimated recurrent expenditures for the project are projected to decrease from 0.12 to 0.10 percent of total central government health spending. Comparing the estimated recurrent cost burden of the project with the projected provincial government spending, the estimated recurrent expenditures would account for only 0.02% of provincial expenditures. Given the proposed strengthening of the public health system, particularly with respect to increases in provincial spending, it is probable that the 0.02 percent of recurrent spending would be even lower assuming increases in public health spending. Overall, the recurrent cost burden would amount to just under 0.015% of total public sector spending by year ten. In order to test the sensitivity of these estimates to spending growth estimates an alternative scenario was also analyzed assuming that public spending on health grows at just a half a percentage point faster than GDP. Given the trend in health spending in Argentina and other Latin American countries, this scenario is very reasonable. Under this scenario, the total burden of recurrent costs would be reduced from 14 percent to 12 percent by the fifth year following project completion. At the same time, a reduction in health spending, stimulated by maintaining constant current expenditure (equivalent to a reduction in public sector spending from 1.7% GDP to 1.3%) would increase the total recurrent cost burden from 0.014% to 0.018% by the fifth year following project completion. Even under this conservative estimate, the total recurrent costs would not be significant in terms of the sustainability of the proposed project. Project Appraisal Document Page 18 Country: Argenmtina AIDS & STD Control - LUSIDA Annex 6 Procurement and Disbursement Arrangements Procurement Project Costs by Procurement Arrangements (Table A) Prior Review Thresholds (Table B) Procurement Schedule for Year One of Project Implementation (Table C) Disbursement Allocation of Loan Proceeds (Table D) Disbursement Schedule (Table E) Project Appraisal Document Page 19 Country: Argentina AIDS & STD Control - LUSIDA Table A: Project Costs by Procurement Arrangements (US$ rnillion equivalent) Expenadure Category Procurement Method 7Total Cost (inuding -ontingencieu) WCB NUCB Other N.H. F. 1. Works 2.50 0.50 3.00 (1.50) (1.50) 2. Goods Equipment and Supplies 2.00 1.50 0.50 4.00 (1.00) (0.50) (0.25) (1.75) Pharmaceuticals & 1.00/a 1.00 Medical Supplies (0.75)/a (0.75) 3. Services Consulting 20.00 20.00 (10.00) (10.00) Administrative 2.00 2.00 (1.00) (1.00) Total 2.00 4.00 24.00f 3A.U0 (1.00) (2.00) (12.0,) (15.0o) Figures in parentheses are the amounts to be financed by the Bank loan ICB = International Competitive Bidding N.B.F. = Not Bank-financed NCB = National Competitive Bidding /a =Pharmaceuticals and medical supplies will be procured using Limited International Bidding (LIB) Other = Includes LIB, consultants and technical assistance Project Appraisal Documnent Page 20 Country: Argentina AIDS & STD Control - LUSIDA Table B: Thresholds for Procurement Methods and Prior Review (US$1,000 equivalent) Category Cqntract Value (Thresholds Pr: fwrement Method Contracts Sbect to Prwor Review ByBank Works 250 to 2,000 NCB First two; All contracts > 500 <250 Three quotations None Goods >300 ICB/LIB All 100 to 300 NCB First two contracts <100 Shopping None Consulting Services Firms >100 Bank Guidelines All <100 Bank Guidelines Review of TORs only Individuals >50 Bank Guidelines All <50 Bank Guidelines Review of TORs only Exemption from prior review does not apply to consultant contracts below the thresholds in cases of: single source selection of firms, assignments of critical nature, and amendments to contracts raising the original value above the threshold ICB = International Competitive Bidding LIB = Limited International Bidding NCB = National Competitive Bidding Procurement of works, goods and services, as well as contracting of consultants with Bank funds, would be carried out in accordance with Guidelines for Procurement under IBRD loans and IDA credits (as received January and August 1996) and the Guidelines for the Use of Consultants (August 1981). Most procurement would be carried out at central level by the PCU. The PCU will include a full-time procurement officer whose main responsibility will be to prepare and: (a) submit to the Bank all procurement documents which require Bank's prior review; (b) carry out any procurement at central level; (c) coordinate and monitor procurement carried out by each executing unit; and (d) prepare and submit to the Bank at the beginning of each calendar year a detailed procurement schedule. The appointment of the procurement officer will be done in consultation with the Bank. At project launch, the Bank will deliver a procurement workshop to present and explain procurement guidelines and commence preparing specific bidding documents. Civil works. The project would finance civil works to rehabilitate ambulatory health care facilities, laboratories, hospice and orphan care services. No new civil works are expected to be constructed under the project. It is estimated that about US$3 million equivalent of the project's costs will be allocated to civil works. Goods. The project would finance equipment and supplies, pharmaceuticals and medical supplies to support promotion, prevention, diagnosis, treatment and care services for HIV+/AIDS patients, for a total amount estimated at US$5 million. Because of the special nature of pharmaceuticals and medical supplies, they will be procured using Limited International Bidding. Consultant Services. The project would finance consultant services including information, education and communication services (i.e. media campaigns), educational materials and training for teachers, health care professionals and community health workers, for a total estimated at US$20 million. At appraisal the Borrower presented a procurement plan for the first year of project implementation acceptable to the Bank (Annex 6, Table C). During annual review meetings the Bank would review the procurement schedule for the following year, including international or national tenders, as well as the number and estimated costs of the subprojects to be financed under the loan. Project Appraisal Document Page 21 Country: Argentina AIDS & STD Control - LUSIDA Table C. Procurement Schedule for Year One of Project Implementation Period: July '97 to June '98. US$1,000 equivalent Contracts Estimated Procure- Date of Receipt of Date of Date of Evalnat. Contract . Value of ment General Bidding Specific Rid Report signed in Contract . dhod Proxuremen* Dick% in Procurement Opening in IBRD 13RD . :. Notice IBIRD Notice A. Goods ICB 01/97 800.00 ICB 06/01/97 01/01/98 02/16/98 04/01/98 05/01/98 06/01/98 Med. Equip. NCB 02/97 400.00 NCB 06/01/97 N/A 02/16/98 03/16/98 N/A N/A Med. Inst. B. Works NCB 01/98 550.00 NCB 06/01/97 02/01/98 03/01/98 04/01/98 05/01/98 06/01/98 *Hospital A NCB 02/98 400.00 NCB 06/01/97 N/A 03/01/98 04/01/98 N/A N/A *Hospital B NCB 03/98 600.00 NCB 06/01/97 06/01/98 07/01/98 08/01/98 09/01/98 10/01/98 *Hospital C C. Consultants 1,000.00 LOI 06/01/97 04/01/97 06/01/98 08/01/98 10/01/98 12/01/98 LOI 01/97 (Social Communica. Campaign) LOI 02/97 25.00 LOI 06/01/97 N/A 06/01/97 07/01/97 N/A N/A LOI: Letter of Invitation NCB: National Competitive Bidding ICB: International Competitive Bidding N/A: Not Applicable *Hospitals A, B and C to be determined Project Appraisal Document Page 22 Country: Argentina AIDS & STD Control - LUSIDA Table D: Allocation of Loan Proceeds (US$ million equivalent) .... 'Expenditure Category Amount in UVSSmiLion FTnancing Perace .: 1. Civil Works 1.35 50% total expenditures 2. Goods Equipment and Supplies 1.75 50% local and 100% foreign expenditures Pharmaceuticals and Medical 0.50 50% local and 100% foreign Supplies expenditures 3. Consulting Services 9.00 100% local and foreign expenditures 4. Administrative Costs 0.90 100% of L.E. in Project Year 1; 75% of L.E. in Project Year 2; 50% of L.E. in Project Year 3; 25% of L.E. in Project Year 4. 5. Unallocated 1.50 Toa 50 Project Appraisal Document Page 23 Country: Argentina AIDS & STD Control - LUSIMA Table E: Disbursement Schedule' (IJS$million equivalent) Qua?ter ending Appraisal estimate Cumulative FY97 June 0.75 0.75 FY98 Sept 0.75 1.50 Dec 0.75 2.25 FY99 Sept 1.50 3.75 Dec 1.50 5.25 Mar 1.50 6.75 Jun 1.50 8.25 FY00 Sept 1.50 9.75 Dec 1.50 11.25 Mar 1.50 12.75 Jun 1.25 14.0 FY01 Sept 0.40 14.40 Dec 0.25 14.65 Mar 0.20 14.85 Jun 0.15 15.00 _ The proceeds of the Loan (US$15 million) would be lent to the Argentine Republic. The proceeds of the loan would be passed to the beneficiaries as grants linked to management contracts and output indicators. The Borrower would bear the foreign exchange risk. In the case of subprojects, the beneficiaries would contract for the respective works, goods and consulting services. The proposed loan would be disbursed over a period of four years up to June 30, 2001 (Annex 6, Tables D and E). The project completion date (i.e. the final date for presentation of requests for approval or authorization to disburse in respect of subprojects would be December 31, 2000). The project closing date would be June 30, 2001, six months after the completion date. Consistent with Bank experience with health projects in Argentina, we expect disbursements to occur faster than usual for traditional investment projects in Latin America. (The percent of expenditures for works, goods and equipment, and consulting services to be financed under the Loan is given in Annex 6, Tables A, B and C ) Retroactive Financing The Bank would finance contracts retroactively for eligible expenditures incurred up to 12 months prior to Loan signing, up to an amount of US$1.5 million. These funds would be used to finance eligible subprojects approved in line with the eligibility and appraisal criteria acceptable to the Bank. Documentation The Project Coordination Unit would present full support documentation for all withdrawal applications with a contract value of US$350,000 for goods, US$ 100,000 equivalent or more for service of consulting firms, and US$50,000 equivalent for individual consultant contracts. The PCU would submit withdrawal applications of smaller contract values having a statement of expenditures (SOEs), and would maintain the respective supporting documents for Bank review. Special Account The Ministry of Health would open a Special Account at Banco de la Naci6n Argentina with an initial deposit of US$1.5 million equivalent. This would correspond to about four months of expenditures required under the project. The Project Coordination Unit would forward to the Bank the documentation necessary for disbursements (SOEs or full documentation), covering a number of subprojects or contracts for services whose aggregate sum would be at least US$600,000. Financial management, accounting and auditing The Project Coordinating Unit would be audited annually by auditors acceptable to the Bank. No later than six months after the end of its fiscal year, the project Coordination Unit would submit to the Bank copies of audit reports containing the auditor's opinion on (a) project accounts, including statement of expenditures and the Special Account; Loan assumed to be effective by August 22, 1997 Project Appraisal Document Country: Argentina AIDS & STD Control - LUSIDA Annex 7 Project Processing Budget and Schedule (US$1,000) A. Proed Budget up to 2128197 Acatl Preparation 40.3 Appraisal 22.8 Ne2otiations 3.3 Total 66.4 B. Projert Schedule Aatal Time taken to prepare the project (months) 11 months First Bank mission (identification) March 18, 1996 Appraisal mission departure February 11, 1997 Negotiations February 17-19, 1997 Planned Date of Effectiveness August 22, 1997 Prepared by: Argentina Ministry of Health and Social Action and LASHD Preparation assistance: Japanese Grant of $400,000 Portuguese Trust Fund of US$23,000 Bank Staff who worked on the proiect include: (a) Alexandre Abrantes Task Manager (b) James Cercone Health Economist (c) Pedro Chequer Epidemiologist, Brazil AIDS/STD Program Director (d) Jose A. Izazola Public Health Specialist, Coordinator of SIDALAC/UNAIDS (e) Jorge Torgal Public Health Specialist, Deputy Director of Health, Member of the National AIDS Committee (Portugal) (f) Marian Kaminskis Project Assistant (g) Xavier Coll Lead Specialist (h) Alain Colliou Country Sector Leader (i) Orville Grimes Projects Adviser (j) Jose Baigorria Country Procurement Specialist (k) Morag Van Praag Disbursement Officer (1) Rudy Van Puymbroeck Counsel (m) Julian Schweitzer Latin American and Caribbean Social and Human Development Director (n) Constance Bernard Acting LAI Director (m) Gobind T. Nankani LAI Director and Acting LAC Vice-President (o) Shahid Javed Burki LAC Vice-President Peer Reviewers: Maureen Lewis, LASHD Wendy Roseberry, AFRTD Debrework Zewdie, HNP Project Apraisal Document Page 25 Country: Argentina AIDS & STD Control - LUSIDA Annex 8 Documents in the Project File A. Economic Analysis (by James Cercone) B. Operational Manual C. Policy Letter (Ministry of Health and Social Action) D. Project Implementation Plan E. Organizational Arrangements (Diagram) F. Terms of Reference of Key Studies: (a) Ex-Post Evaluation of a Sample of Subprojects (b) Financial and Management Review of a Sample of Subprojects Project Appraisal Document Page 26 Country: Argentina AIDS & STD Control - LUSIDA Annex 9 Status of Bank Group Operations in Argentina IBRD Loans and IDA Credits in the Operations Portfolio Gz2ginal Armont in IIS.7 Kl"ona 1" tos t iseo ... Pr*Jec:t ID Criait go. Year narowero Papong 1BRD IDA Cillations Undsbzs* Number of Closed Loans/credits: 48 AR-PA-5945 L26410 1986 GOVERNMENT WATER SUPPLY 60.00 0.00 20.03 1.64 AR-PA-5968 L28540 1987 SEGBA SEGBA V 276.00 0.0C 0.00 68.45 AR-PA-5977 L32810 1991 ARGENTINE REPUBLIC WTR SUPPLY II 101.00 0.00 0.00 81.59 AR-PA-6005 L32600 1991 REPUBLIC OF ARGENTINA PROVINCE DEV PROJ 210 .00 0.C0 0.00 80.96 AR-PA-6009 L32970 1991 GOVT OF ARGENTINA INA AG SERVCES&INST DEV 33.50 0.00 0 00 6.17 AR-PA-6034 L34600 1992 GOVERNMENT TAX ADMIN II 20.00 1.00 0.00 2.83 AR-PA-6003 L36110 1993 GOVT OF ARGENTINA INA RD MAINT & REHAB SCT 34 .00 1.00 0.00 197. 25 AR-PA-6036 L35200 1993 GOVERNMENT YACYRETA II 300.00 0.00 1.00 4.02 AR-PA-6051 L35210 1993 ARGENTINA FLOOD REHABILITATION 170.00 0.0.00 16.24 AR-PA-6062 L37100 1994 MIN OF ECONOMY CAPITAL MKT TA 6.50 0.00 0.00 5.98 AR-PA-5988 L37090 1994 REP OF ARGENTINA A CAPITAL MKT DEVT 500.00 0.00 0.00 483.88 AR-PA-6025 L36430 1994 GOVT OF ARGENTINA INA MTNAL CHILD HiTH & N 100.00 0.00 0.00 66.68 AR-PA-40826 L38780 1995 ARG REPUBLIC PROV.BANK PRIV. 500.00 0.00 0.00 166.00 AR-PA-5992 L37940 1995 GOVT OF ARGENTINA INA SECONDARY ED I 190.00 0.00 0.00 180.43 AR-PA-6018 L38770 1995 ARGENTINE REPUBLIC PROV DEVT -i 225.00 0.00 0.00 225.00 AR-PA-6035 L38360 1995 REP OF ARGENTINA PROV.REFORM 300.00 0.00 0.00 1 00. 37 AR-PA-6060 L38600 1995 GOVT OF ARGENTINA M-JNIC DEVT II 210.10 0.10 0.00 202.81 AR-PA-34091 L39210 1996 REP OF ARGENTINA HIGHER ED REFORM 165.00 0.0C 0.0C 158.54 AR-PA-35495 L39570 1996 SEC.OF SOC.DEVIT (OFFICE SOCIAL PROTECTION 152.00 0.00 0.10 55.13 AR-PA-38683 L39600 1996 REPUBLIC OF ARGENTINA ENT.EXPORT DV. 36.50 0.10 0.o0 35.99 AR-PA-40904 L39260 1996 REPUBLIC OF ARGENTINA BANK REFORM 500.00 0.00 0.00 333.00 AR-PA-40909 L40020 1996 REP. OF ARGENTINA H. INSURANCE REFORM 250.00 0-00 0.00 130.00 AR-PA-45637 L40040 1996 REP. OF ARGRNTINA H.INSURANCE TA 25.00 0.00 0.00 23.17 AR-PA-6030 L39310 1996 REPUB OF ARGENTINA PROVCL HLTH SCTR DEV 101.40 0.00 0.00 98.08 AR-PA-6040 L39480 1996 GOVERNMENT FORESTRY/DV 16.00 0.00 0.00 15.70 AR-PA-6055 L39270 1996 GOVT. OF ARGENTINA MINING SCTR DEVT 30.00 0.00 0.00 22.29 AR-PA-37049 L39580 1996 GOVT OF ARGENTINA PUB.INV.STRENGTHG 16.00 0.00 0.00 16.00 AR-PA-40909 L40030 1996 REP. OF ARGENTINA H. INSURANCE REFORM 100.00 0.00 0.00 100.00 AR-PA-6057 L39710 1996 GOV'T OF ARGENTINA SECNDARY ED 2 115.50 0.00 0.00 115.50 AR-PA-40808 L40850 1997 GOA N.FPREST/PROTC 19.50 0.01 0.00 19.50 AR-PA-5980 L40930 1997 GOVT OF ARGENTINA PROV ROADS 30C.00 00 0.010 300.00 *Total .S,561.90 0.00 20.03 3,273.22 Aotiva Loian Closad Loans Total Total D$Oursmd 4Thh0 and IDA): 2,DB.US 5,526.69 7,s5l.54 of-which has been repaid: 191.01 2,695.63 2,846.64 Total ow beold by 1llB anl Da: 5,190.86 2,831,47 8,022.33 Argouzt sold 0.00 12.79 12.79 0f which rspald 0.00 12.t9 12.78 rotal UndiOqrad : 3,273.22 21 3,213.43 a. Intended disbursements to date minus actual disbursements to date as projected at appraisal. b. Rating of 1-4: see OD 13.05. Annex D2. Preparation of Implementation Summary (Form 590). Following the FY94 Annual Review of Portfolio performance (ARPP), a letter based system will be used (IS = highly Satisfanrory, S = satisfactory, U - unsatisfactory, HU = highly unsatisfactory): see proposed Improvements in Project and Portfolio Performance Rating Methodology (SecM94-901), August 23, 1994. c. Following the FY94 ARPP, "Implementation Progress" will be reported here. Project Appraisal Documnent Page 27 Country: Argentina AIDS & STD Control - LUSIDA Argentina STATEMENT OF IFC's Committed and Disbursed Portfolio As of 12/31/96. (US$ million) Commiited Disbursed FY ---FC - 4FC Approval Company Loan Equity Quasi Partic Loan Equity Quasi Partic 1960 Acindar 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1977 Alpargatas 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1978 Minetti 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1981 Minetti .67 0.00 0.00 0.00 .67 0.00 0.00 0.00 1984 Alpargatas 0.00 1.05 0.00 0.00 0.00 1.05 0.00 0.00 1985 ROPASA 0.00 .05 0.00 0.00 0.00 .05 0.00 0.00 1986 Alpargatas 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1986 Minetti .23 0.00 0.00 1.17 .23 0.00 0.00 1.17 1987 BGN-Bolland 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1987 BGN-CENCOSUD .07 0.00 0.00 0.00 .07 0.00 0.00 0.00 1987 BGN-CILSA .01 0.00 0.00 0.00 .01 0.00 0.00 0.00 1987 BGN-COLORTEX .07 0.00 0.00 0.00 .07 0.00 0.00 0.00 1987 BGN-Flichman .02 0.00 0.00 0.00 .02 0.00 0.00 0.00 1987 BGN-Longvie .03 0.00 0.00 0.00 .03 0.00 0.00 0.00 1987 BGN-Moldeada .07 0.00 0.00 0.00 .07 0.00 0.00 0.00 1987 BGN-Noroeste .03 0.00 0.00 0.00 .03 0.00 0.00 0.00 1987 BGN-Sebastian .07 0.00 0.00 0.00 .07 0.00 0.00 0.00 1987 BGN-Tevycom .02 0.00 0.00 0.00 .02 0.00 0.00 0.00 1987 BGN-TBR 21 0.00 0.00 0.00 .21 0.00 0.00 0.00 1987 BGN-Valley .03 0.00 0.00 0.00 .03 0.00 0.00 0.00 1987 BGN-Vandenfil .03 0.00 0.00 0.00 .03 0.00 0.00 0.00 1987 BRLP 3.00 0.00 0.00 0.00 3.00 0.00 0.00 0.00 1987 Minetti .47 0.00 0.00 2.33 .47 0.00 0.00 2.33 1987 Terminal 6 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1988 Alpargatas 1.70 0.00 1.37 0.00 1.70 0.00 1.37 0.00 1988 Bungey Born 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1989 Astra CAPSA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1989 Banco Frances 4.31 0.00 0.00 1.14 4.31 0.00 0.00 1.14 1989 BGN-Algodonera .32 0.00 0.00 0.00 .32 0.00 0.00 0.00 1989 BGN-Bolland 27 0.00 0.00 0.00 .27 0.00 0.00 0.00 1989 BGN-Ferrum 1.00 0.00 0.00 0.00 1.00 0.00 0.00 0.00 1989 BGN-Flichman .20 0.00 0.00 0.00 .20 0.00 0.00 0.00 1989 BGN-FRIGOTOBA .15 0.00 0.00 0.00 .15 0.00 0.00 0.00 1989 BGN-Genaro .82 0.00 0.00 0.00 .82 0.00 0.00 0.00 1989 BGN-Interpack .30 0.00 0.00 0.00 .30 0.00 0.00 0.00 1989 BGN-Parafina .75 0.00 0.00 0.00 .75 0.00 0.0 0.00 1989 BGN-Willmor .82 0.00 0.00 0.00 .82 0.00 0.00 0.00 1989 ROB-COMESI .38 0.00 0.00 0.00 .38 0.00 0.00 0.00 1989 ROB-Fracchia .21 0.00 0.00 0.00 .21 0.00 0.00 0.00 1989 ROB-INTA .38 0.00 0.00 0.00 .38 0.00 0.00 0.00 1989 Terminal 6 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1990 CIP 0.00 .08 0.00 0.00 0.00 .08 0.00 0.00 1990 Petroken 8.33 0.00 5.00 4.58 8.33 0.00 5.00 4.58 1990 Terminal 6 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1991 Astra CAPSA 11.57 0.00 0.00 20.42 11.57 0.00 0.00 20.42 1991 BCA 2.20 0.00 0.00 2.80 2.20 0.00 0.00 2.80 1991 Minetti .58 0.00 0.00 0.00 .58 0.00 0.00 0.00 Project Appraisal Document Pago 28 Country: Argentina AIDS & STD Control - LUSIDA C.ninitted Disbursed FVY------ IFC-----_ _--IFC- LIpp>n, RI (aIlllally loan Eiu:it Quasi llaric Loan Equity Quai Partic | 1991 ROB-Alimenticia .28 0.00 0.00 0.00 .28 0.00 0.00 0.00 1991 ROB-Emprigas .38 0.00 0.00 0.00 .38 0.00 0.00 0.00 1991 ROB-Guilford .20 0.00 0.00 0.00 .20 0.00 0.00 0.00 1991 ROB-Interpack .33 0.00 0.00 0.00 .33 0.00 0.00 0.00 1991 ROB-Jugos .06 0.00 0.00 0.00 .06 0.00 0.00 0.00 1991 ROB-Longvie .45 0.00 0.00 0.00 .45 0.00 0.00 0.00 1991 ROB-Mendoza .38 0.00 0.00 0.00 .38 0.00 0.00 0.00 1991 ROB-Surfactan .04 0.00 0.00 0.00 .04 0.00 0.00 0.00 1992 Astra CAPSA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1992 Bridas 24.36 0.00 15.00 43.43 24.36 0.00 15.00 43.43 1992 BRLP 10.78 0.00 0.00 2.63 3.24 0.00 0.00 2.63 1992 FEPSA 10.80 0.00 0.00 12.67 8.60 0.00 0.00 10.27 1992 Malteria Pampa 7.19 0.00 0.00 13.27 7.19 0.00 0.00 13.27 1992 Oleaginosa Oeste 7.64 0.00 5.00 11.83 7.64 0.00 5.00 11.83 1992 Rioplatense 6.33 1.00 0.00 2.00 6.33 1.00 0.00 2.00 1992 San Jorge 10.00 27.00 0.00 23.33 10.00 0.00 0.00 23.33 1993 Argentina Equity 0.00 4.00 0.00 0.00 0.00 4.00 0.00 0.00 1993 APSA 0.00 19.47 0.00 0.00 0.00 19.47 0.00 0.00 1993 Bunge y Born 4.25 0.00 0.00 36.09 4.25 0.00 0.00 36.09 1993 Cadipsa 9.29 0.00 5.00 11.70 9.29 0.00 5.00 11.70 1993 Malteria Pampa 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1993 Minetti 1.62 0.00 0.00 0.00 1.62 0.00 0.00 0.00 1993 Molinos 0.00 4.31 0.00 0.00 0.00 4.31 0.00 0.00 1993 Nuevo Central 7.50 3.00 0.00 12.50 7.50 3.00 0.00 12.50 1993 Yacylec 9.35 5.04 0.00 36.13 9.35 5.04 0.00 36.13 1994 Aceitera 15.00 10.00 0.00 15.00 15.00 10.00 0.00 0.00 1994 Aguas 36.53 7.00 0.00 107.60 36.53 7.00 0.00 107.60 1994 Alpargatas 11.54 5.00 5.00 20.71 11.54 5.00 5.00 20.71 1994 BGN 12.00 0.00 3.00 0.00 12.00 0.00 3.00 0.00 1994 Cia. Combustible 19.46 15.00 0.00 32.80 19.46 15.00 0.00 32.80 1994 EDENOR 21.13 0.00 15.00 99.25 21.13 C.00 15.00 99.25 1994 La Maxima 0.00 10.19 0.00 0.00 0.00 10.19 0.00 0.00 1994 LBAR 0.00 1.17 0.00 0.00 0.00 .64 0.00 0.00 1994 LBAV 0.00 3.62 0.00 0.00 0.00 3.62 0.00 0.00 1994 Molinos 0.00 1.24 0.00 0.00 0.00 1.24 0.00 0.00 1994 MASISA 9.63 0.00 0.00 0.00 9.63 0.00 0.00 0.00 1994 Petroken 1 5.91 0.00 0.00 2.50 15.91 0.00 0.00 2.50 1994 Quilmes 12.64 0.00 0.00 12.50 12.64 0.00 0.00 12.50 1995 Acindar 15.00 0.00 10.00 20.00 15.00 0.00 10.00 8.57 1995 Aguas 40.00 0.00 0.00 173.00 40.00 0.00 0.00 121.80 1995 Banco Roberts 0.00 0.00 20.00 0.00 0.00 0.00 20.00 0.00 1995 Bridas 20.00 10.00 0.00 40.00 20.00 10.00 0.00 40.00 1995 CEPA 13.00 0.00 0.00 4.20 13.00 0.00 0.00 4.20 1995 EDENOR 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1995 Kleppe/Caldero 6.00 0.00 0.00 0.00 6.00 0.00 0.00 0.00 1995 La Maxima 0.00 0.00 4.00 0.00 0.00 0.00 3.96 0.00 1995 Mastellone 38.57 0.00 0.00 35.00 38.57 0.00 0.00 0.00 1995 Nahuelsat 30.00 5.00 0.00 0.00 30.00 5.00 0.00 0.00 1995 SanCor 20.00 0.00 20.00 30.00 20.00 0.00 20.00 30.00 Project Appraisal Docutnent Page 29 Countrv: Argentina _AIS & Qr, Control -T TIIflA Commitied Dishuried | FY --IFC- IFC- Approval Company Loan Equity Qua.i PaniC Loan Equity Quasi Paric 1995 Sooma 24.99 0.00 0.00 0.00 24.99 0.00 0.00 0.00 1995 SIDECO 0.00 15.00 0.00 0.00 0.00 15.00 0.00 0.00 1995 Terminales Port. 10.00 2.00 0.00 0.00 7.00 1.40 0.00 0.00 1995 Tower Fund 0.00 18.71 0.00 0.00 0.00 5.54 0.00 0.00 1995 Tower Fund Mgr 0.00 .13 0.00 0.00 0.00 .03 0.00 0.00 1996 Aguas 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1996 Alpargatas 15.00 0.00 0.00 81.00 10.00 0.00 0.00 81.00 1996 APSA 0.00 0.00 2.50 0.00 0.00 0.00 2.50 0.00 1996 Banco Frances 40.00 0.00 0.00 0.00 2.31 0.00 0.00 0.00 1996 Banco Galicia 30.00 0.00 0.00 200.00 30.00 0.00 0.00 200.00 1996 Brahma-ARG 18.50 0.00 0.00 33.00 18.50 0.00 0.00 33.00 1996 CAPSA 12.00 0.00 5.00 0.00 0.00 0.00 0.00 0.00 1996 Grunbaum 8.00 0.00 2.00 0.00 8.00 0.00 2.00 0.00 1996 Malteria Pampa 6.00 0.00 1.00 0.00 6.00 0.00 1.00 0.00 1996 Minetti 10.00 0.00 0.00 30.00 4.10 0.00 0.00 12.30 1996 MBA 0.00 .16 0.00 0.00 0.00 .16 0.00 0.00 1996 Neuquen Basin 0.00 26.40 0.00 0.00 0.00 15.11 0.00 0.00 1996 Refisan 20.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1996 Terminal 6 10.50 0.00 0.00 6.50 10.50 0.00 0.00 6.00 1996 Transconor 25.00 0.00 20.00 210.00 25.00 0.00 20.00 210.00 1996 Zanon 14.00 0.00 6.00 0.00 12.00 0.00 6.00 0.00 1997 Acindar 0.00 0.00 15.00 0.00 0.00 0.00 15.00 0.00 Pend:ng Commitmenis 1997 * ACINDAR TF LOAN 25.00 0.00 0.00 50.00 1996 * AGUAS III - INC 15.00 0.00 0.00 75.00 1996 * BANSUD CL 25.00 0.00 0.00 0.00 1996 * DIADEMA FIELD 0.00 0.00 0.00 40.00 1994 * EDENOR INCREASE 0.00 0.00 0.00 8.00 1996 * EDESUR II BLINC 0.00 0.00 0.00 108.00 1996 * EDESUR REHAB 40.00 0.00 0.00 80.00 1993 ^ FEPSA (II) 0.00 0.00 0.00 4.00 1997 * GUIPEBA 15.00 0.00 5.00 20.00 1997 * MILKAUT 20.00 0.00 0.00 5.00 1996 * MINETTI EM 0.00 0.00 10.00 0.00 1995 * R-E-C TOLL HWAY 20.00 0.00 0.00 61.00 1997 * TGN II BLINC 0.00 000 0.00 10.00 1996 * TRANSCONOR 11 5.00 0.00 0.00 0.00 1997 *VICENTIN 25.00 0.00 0.00 10.00 1996 * WESTERN ACCESS 30.00 0.00 5.00 130.00 Project Appraisal Document Page 30 Country: Argentina AIDS & SlTl Control - LUSIDA Annex 10 Argentina at a glance Anex10 Latin Upper- POVERTY and SOCIAL America middle- . .- - . Argentina & Carib. Income Development diamond' Population mid-1995 (millions) 34.6 480 440 GNP per capita 1995 (USS) 7,770 3.300 4 300 j Lile expectancy GNP 1995 (billions US$) 268.8 1.584 1.892 Average annual growth, 1990-95 Population (9) 1.2 1.8 1.7 GNP Gross Labor force (%6 2.0 2 4 2 1 per i-. Ii -. primary Most recent estimate flatest year available since 1989) ca)!.a < enrollment Poverty: headcounl index (% of population) 26 Urban population (9 of total population) 88 74 74 Life expectancy at birth (years) 73 58 69 Infant mortality (per 1,000 1hW births) 22 41 36 Access to safe water Child malnutrRion (76 of childt'en under 5) 5 In .. . Access to safe water (9 ofpopulation) 64 81 89 Illiteracy(Woi'population age 15+) 4 13 13 .nn Gross primary enrollment (% of school-age populatIon) 107 110 107 Argenina aIUle 108 Uppor-mnddle-incormx group Female 107 -. KEY ECONOMIC RATIOS and LONG-TERM TRENDS 1975 1985 1994 1995 ........- -- 1975 1995 1994 1905 jEconomic ratios' GDP (billions USS) 52.4 88.4 280.5 276.0 Gross domestic investmentlG1P 294 17.6 19.9 178 Exports ogoods and non-faclor services;GDP 5.8 11.7 6 8 8.9 . Opeoinnss ot economy Gross domestic savingsiGDP 29.3 23.1 17.6 18.0 Gross national ssvingstGDP 269 16.5 16.6 17.0 - Current account balance/GODP -2.5 -1.1 -3.3 -0.8 . N Interest payments/GODP 0.9 5.0 1.3 1.8 j Savings -- Invostment Total debt/GDP 14.7 57.6 27.6 30.3 Total debt servicelexpoils 44.7 60.1 32.6 33.6 1 V Present value of debVGDP . .. .. 24.4 Present value of debWexports .. .. 325.8 Indebtedness 1975-84 198545 1994 1998 1995-04 (average annual growth) - Argentina GDP 1.0 2 8 7.4 -4.4 4.9 GNP per capila -1.5 2.0 5.9 5.2 3.7 Uppr-mile-incoe group Expoursofgoodsandnfs 5.1 59 14.8 25.7 8.0 Sn. STRUCTURE of the ECONOMY 1975 1985 1994 1995 (9 of GDP) Growth rates of output and Investment (%) Agriculture 6.6 7.6 4.9 .. 40 Industry 50.1 39.3 30.1 .. 20 Manufacturing 38.2 29.6 20.0 Services 43.3 53.1 65.1 91 92 93 94 Private consumption 58.1 66.5 69.2 69.6 -40 General government consumption 12.6 10.4 13.3 12.4 GDi GDP Imports of goods and non-factor services 6.0 6.3 9.2 8.7 1975484 1985465 1994 1995 (average annual growth) Growth rates of exports and Imports (%) Agriculture 1.7 1.6 3.8 2.1 et Industry -1.1 2.7 6.5 -6.0 o Manufacturing -1.4 1.4 4.2 -6.5 Services 2.5 3.1 8.5 -3.4 40\ 20 ~ \_ Private consumption .. General govemment consumption .. .. .. .. o o 93 Gross domestic investment -2.4 5.4 19.0 -15.9 -20a r Imports of goods and non-factor services 4.5 14.0 20.9 -10.6 Expo5s impots Gross national product 0.0 3.4 6.9 -5.0 Note: 1995 data are preliminary estimates. * The diamonds show four key indicators in the county (in bold) compared with its income-group average. If data are missing. the diamond will be incomplete. Project Appraisal Document Page 31 Country: Argentina AIDS & STD Control - LUSIDA Argentina PRICES and GOVERNMENT FINANCE 1976 1985 1994 1995 Domestic prices Inflation (%) (% change) 4 000 Consumer prices 182.6 . 3.9 1.6 3000 Implicit GDP deflator 198.2 618.0 1.8 2.5 2.000. Govemment finance 1.000 (% or GDP) 0 * 0 0 Current revenue .. .. 16.6 16.5 0 D1 92 93 94 95 Current budget balance .. .. 0.7 -0.1 -G OP def. -CPI Overall surplus/deficit .. .. 0.0 -1.0 TRADE 1975 1985 1994 1995 (millions US$) Export and import levels (mill. USS) Total exports (fob) 2,961 8,396 15,839 20,968 25,000 Food 1,323 1,956 Meat . .. 1,546 1,572 20.000 Manufactures .. .. 8,059 10,635 15,000 Total imports (cdf) 3,947 3,814 21,590 20,124 10.000 FoodEmvivM1F Fuel and energy . .. 59'1 628 0000 Capital goods .. .. 6,039 4,754 I Export price index (1987=100) .. .. 118 124 S9 90 91 92 93 94 95 Import price index (1987=100) .. .. 115 120 0 Exports Olmports Terms of trade (1q687 100) .. .. 102 103 BALANCE of PAYMENTS 1975 1985 1994 1995 (nillions US$) Current account balance to GODP rafio (%) Exports of goods and non-factor services 3,498 10,039 18,507 23,857 2 Imports of goods and non-factor services 4,324 5,285 25,591 23,724 Resource balance -826 4,754 -7,084 133 1 Net factor Income -466 -5.706 -2,547 -2,842 0 Net currenttransfers 6 0 320 432 1 - 9 92 93 94 95 Current account balance, before official transfers -1,286 -952 -9,310 -2,277 Financing items (net) 208 2,200 9,868 2,208 -3 Changes in net reserves 1,078 -1,248 -558 69 -4 Memo: Reserves Including gold (mill. USS) 848 4,703 19,758 19,888 Conversion rate (loca/USS) 3.7E-10 6.0E-05 1.0 1.0 EXTERNAL DEBT and RESOURCE FLOWS 1975 1985 1994 1995 (millions USS) Composition of total debt, 1995 (mill. USS) Total debt outstanding and disbursed 7,723 50,946 77,457 83,724 IBRD 341 700 4,109 4,913 G A IDA 0 0 0 0 7171 4913 C Total debt service 1,603 6,209 6,847 8,609 D IBRD 43 114 709 565 4501 IDA 0 0 0 0 E Composition bf net resource flows 11428 Official grants 0 6 16 20 Oflicial creditors 58 217 715 851 Private creditors -111 2,350 5,805 1,993 F Foreign direct investment 0 919 1,200 3,900 F Portfolio equity 0 0 1,205 294 49580 World Bank program Commitments 0 0 509 2,272 A - IBRO E - Bilateral Disbursements 19 144 547 941 |B-IDA D - Other mutlateral F- Private Principal repayments 17 68 425 259 C - IMF G - Short-term Net flows 1 75 122 682 1 Interest payments 26 46 284 306 Net transfers -25 30 -162 376 Intemational Economics Department 8t20/96 MAP SECTION IBRD 28572 70 BOLIVIA / 00 50 I~~ * -I I PARAGUAY ) San Salvador ( (Sa de Jujuy , L ( ~~~~Salta SD 0 %N \ ( SALTA * ( C\ ®,Tucum6n CHACO BAI Santiago Resistencia .Posada BRAZIL j ®QD del Estero OO, Poscdws Catamarca ® SANDIAGO . "/fe / F 1 ESTEOSLa RioaER LA SAWTA 30 F SAN RIOJA FE JUAN 30I n F- ENTRE 0- (ScSn JuanS ® C6 t ' S RIOS / Paran6o. Mendoza San Luis Z i SAN~ C' 2 (ag/' 5 ! URUGUAY < X % ~~~~~~~LUIS - '. u 4. W4~~~~~~~~~MOS ARfl 0~~~~~~~ tu f uO; g ~~~~~~~~~La Pk p - >/^ Santa Rosa F 0~~~~~a BUENOS LA PAMPA X ,) 3NeuquenS a- 'U j~ N ; ARGENTINA RIO / AIDS AND STD CONTROL _ 40 ° NEGRO PROJECT Carmen de . ^" \ XI Potagones Provinces where project Viedmo will be concentrated ) ® / j / S .- i3 National Capital Rawson eY S Province Capitals ) CHUBUT ] Province Boundaries ' ', lA[I ANrIl V;4 501 so ° ) > sft~~Ri Galgs 11 ' 5,0ti GaIlegos~~~~~~~~~~~~ ~ ~ ~ ~This was produced by ,, ,D,_, qo, W ISPANES'XI'' Pr;9 C14,N;,; N'lli-''v''' "' the Map Desing Unit TH. IS S()V' Ri I IE f I ~~~of The WrdBnk. lIlt - I s r . tX r,SIAI Dl The boundaries, colors, rI '-- . 1 V; ! x. denominations and ony * ~~~~~~~~~~~~~~~~~other information shown ; -r h .e on this map do not fr s5boiq imply, on the part of The World Bank Group, TIERRA any judgment on the legal DEL status of any territory, FUEGO or any endorsement so 70 60 or acceptnce of such boundaries. FEBRUARY 1997 IMAGING Report No.: 16383 AR Type: PAD