Page 1 PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No.: AB2585 Project Name Botswana HIV/AIDS Project Region AFRICA Sector Health (100%) Project ID P102299 Borrower(s) Implementing Agency Ministry of Finance and Development Planning Botswana Tel: 011-267-395-0100 Fax: 011-267-395-6086 Environment Category [ ] A [ ] B [X] C [ ] FI [ ] TBD (to be determined) Date PID Prepared October 4, 2006 Estimated Date of Appraisal Authorization Estimated Date of Board Approval June 14, 2007 1. Key development issues and rationale for Bank involvement Epidemic status : The impact of the HIV/AIDS epidemic in Botswana is jeopardizing the very significant socio-economic development achievements realized over the past three decades. Recent statistics indicate a national prevalence of 25 percent among adults (15-49 years), causing Botswana to possess the second highest prevalence rate worldwide (UNAIDS/WHO, 2006). Infection rates are highest among young people and a significant gender differential exists, with prevalence rates ranging up to three times higher among young women (15-19 years) than young men of the same age cohort. The Botswana 2005 HIV Sentinel Surveillance data estimates the HIV infection rate among pregnant women (15-49 years) at 33.4 percent. There are projections indicating that, by 2010, more than 20 percent of all children will have lost one or both parents to AIDS, resulting in an increasing population of orphans and vulnerable children. The epidemic already has exerted a substantial negative impact on fundamental human development indicators, including life expectancy at birth, infant mortality, and child mortality. Key determining factors exacerbating the HIV/AIDS epidemic in Botswana include stigma and denial, the vulnerability of women, persistent inequality and poverty, cultural attitudes regarding sexuality, and population mobility, including cross-border issues. Development impact: The epidemic poses a substantial impediment to achieving the Government’s objectives of poverty reduction, economic diversification, and growth. Botswana’s National HIV/AIDS Strategic Framework (2003-2009) is integrally linked with Botswana’s 9 th National Development Plan (2003-2009), which emphasizes the long-term development implications of the epidemic including the likely non-attainment of the MDGs. National Strategy for Poverty Reduction also emphasizes the role of HIV/AIDS as both a cause and consequence of poverty, unemployment, and inequality and seeks to integrate poverty reduction strategies into the medium-term expenditure framework. The cost of such critical Page 2 development programs, in parallel with the increasing macroeconomic diversification efforts, pose a particular challenge, given the magnitude of the financial outlays required to support national prevention, care, treatment, mitigation programs. It is of significant concern to Government that national HIV/AIDS-related investments have displaced other budget priorities, particularly given the paucity of donors active in Botswana. Project rationale : In recent years, Botswana has benefited from support from international donors for its HIV/AIDS program, including the Global Fund for AIDS, Tuberculosis, and Malaria (GFATM), PEPFAR, selected bilaterals, the Gates Foundation, and Merck. However, even these substantial levels of donor and government spending have largely not kept pace with the requisite epidemic response. The Government of Botswana has requested the proposed concessional IBRD operation in anticipation that these additional financial and technical resources could play a strategically significant role in supporting a more efficient and evidence- based response to the epidemic, particularly given the Bank’s comparative advantage in the areas of strategic planning, knowledge-sharing, implementation support, and the leveraging of additional financial and technical resources. Given the magnitude and long-term impact of the epidemic, an additional focus of the proposed project would be to enable a transition from an “emergency” response to a broader, more strategic, and more sustainable approach. It is envisioned project will be designed around the strategic frameworks and contexts mentioned above (National HIV/AIDS Strategic Framework, National Development Plan 9, Poverty Policy), in addition to the “Three Ones” and Greater Involvement of People Living with HIV/AIDS (GIPA) principles. The proposed project will evolve around National Strategic Framework goals, although the prioritized goals of prevention of HIV infection, provision of care and support, and strengthened management of the national response to HIV/AIDS will likely constitute a particular focus. 2. Proposed objective(s) The proposed project development objective will be to assist the Government of Botswana and its development partners in enhancing the efficiency and sustainability of the national multisectoral response to HIV/AIDS. It is envisioned that this project development objective would be measured utilizing indicators addressing the longer-term planning, implementation, and effectiveness of national and decentralized coordination efforts, possibly including the preparation of a joint multi-partner expenditure framework, that is explicitly linked with the National Development Plan. 3. Preliminary description In line with the project development objective the proposed project would seek to identify opportunities for cost savings, additional resource mobilization and increasing cost-effectiveness and efficiency of agreed priority interventions as reflected in the National Strategic Framework Page 3 for HIV/AIDS (NSF). It would also assist the Government of Botswana and its partners to act on those opportunities and evaluate the outcomes. The project would provide integrated support to the national multi-sectoral HIV/AIDS response, based on agreed performance indicators and an integrated expenditure framework. Given that activities to date have emphasized treatment-related issues, the proposed project would be designed to enhance overall program efficiency while re-emphasizing prevention and the balanced response envisaged in the National Strategic Framework. While the support would be predicated upon the NSF generally, it is envisaged that three thematic areas would be emphasized, at least initially: strengthening coordination and management , through analytical work, development of a joint expenditure framework, and the creation of stronger national partnerships for planning and review; enhancing the financial and technical efficiency of treatment, prevention , and care and support activities through detailed analysis of current financial, procurement and technical processes in order to enhance equity, efficiency and sustainability; and strengthening and targeting prevention efforts , through deepening support for activities of proven effectiveness, including PMTCT, IEC and the Education sector response, and by socio-epidemiological analysis to clarify the priority targets for prevention intervention in the Botswana context. The proposed project would likely support innovative public-private-civil society partnerships. Focused analytic work during both project preparation and project implementation would support further delineation, and modification, as needed, of project components. Indicative project components and activities may include the following: x National Coordinating Agency for HIV/AIDS: Strengthened management support/capacity development, with a focus on NACA, its decentralized entities, and other key stakeholders. Analytic work – map vulnerability (management and coordination function), the preparation of a joint expenditure framework, support to National AIDS Spending Accounts, social and epidemiological assessment, supporting joint annual program reviews and the creation of a partnership forum to enhance transparency and accountability. x Public Sector Response: Based on a preliminary assessment, indicative ministries serving as project implementers may include the MOE (life skills, girls education, early child development and school health programs), MOH (PMTCT, TB/HIV collaborative activities, ART patient monitoring protocols, youth-friendly health centers, supply chain issues), MOLG (management of decentralized response within public sector), and MOWT (transport corridor issues, migrant workers) x Coordination with Civil Society and the Private Sector: Enabling a strong civil society and private sector link with the public sector, including joint planning and implementation responsibilities based on comparative advantage. Page 4 4. Safeguard policies that might apply [Guideline: Refer to section 5 of the PCN. Which safeguard policies might apply to the project and in what ways? What actions might be needed during project preparation to assess safeguard issues and prepare to mitigate them?] 5. Tentative financing Source: ($m.) BORROWER 0 INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT 50 BILATERAL AGENCIES (UNIDENTIFIED) 0 Total 50 6. Contact point Contact: Sheila Dutta Title: Sr Health Spec. Tel: (202) 473-8390 Fax: Email: Sdutta@worldbank.org