Approach Paper: Evaluation of the World Bank's HIV/AIDS assistance Background 1. As of December 2001, more than 20 million people worldwide had died from AIDS since the beginning of the epidemic and 40 million people were living with HIV/AIDS.' In a span of only two decades, AIDS has become the fourth leading cause of death in the world. More than 95% of those living with HIV/AIDS are in developing countries, where it is striking adults in their prime productive years, leaving families without breadwinners and children without parents. Between 1950 and 1990, life expectancy in developing countries rose from 40 to 63 years.2 Yet this single fatal infectious disease has wiped out all of these gains in the hardest-hit countries of Eastern and Southern Africa, where life expectancy has dropped by 10-20 years due to AIDS mortality. 2. The World Bank is the major international financier of AIDS programs in developing countries. Since 1986, the Bank has lent $1.6 billion in 122 projects to finance AIDS prevention, care and mitigation (Annexes 1-3). Annual lending for AIDS since 1986 has fluctuated from year to year, reflecting approval of projects to large countries - India ($84 million in FY92 and $191 million in FY99) and Brazil ($160 million in FY94 and $165 million in FY99) (Figure 1). The peak in lending in FYO1 represents approval of AIDS projects in 9 Sub-Saharan and 2 Caribbean countries as part of horizontal multi-country Adaptable Program Loans (MAP projects). Twenty-two AIDS projects totaling $400 million are in the pipeline for approval in FYO2-03 (Annex 4). Aside from its lending program, the World Bank has contributed major analytic work on AIDS policy, including the World Development Report 1993: Figure 1: Annual AIDS commitments in HNP lending, FY86-01 450 - 400 391.5 393.4 350 6 300 2-13 250 200 .2 150 100 - 65' 50 35 4 304 I;J1 4 203 6 5-I.~:..9 ijj 11 3 0 =L, J LI. 7J LIIIL 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 Fiscal Year (FY) 1. UNAIDS (2001). 2. World Bank (1997a). 3. This includes all of the stand-alone AIDS projects, HNP projects with AIDS components and several (but by no means all) projects from other sectors with AIDS components approved through February 7, 2002. According to the HNP anchor, $1.4 billion was lent for HIV/AIDS as part of the HNP portfolio through the end of FY01. Of these projects, 25 are stand-alone AIDS projects and the remaining 97 are projects with AIDS components. Among the projects with AIDS components, only 17 have components representing 10% or more of project costs; the majority (54) have components of less than $I million. AIDS projects have become a substantial share of the HNP pipeline: 20 of the 35 approved or planned HNP projects for FY02 are stand-alone AIDS projects or projects with a significant AIDS component. 1 Investing in Health4 and the Policy Research Report, Confronting AIDS: Public Priorities in a Global Epidemics, as well as significant economic and sector work at the country and regional levels. Finally, the Bank has participated in and contributed to global partnerships on AIDS, among them the WHO/Global Program on AIDS, UNAIDS, and the International AIDS Vaccine Initiative (IAVI). 3. While the number of AIDS projects and volume of lending is expanding rapidly, the portfolio is still young. Only thirteen stand-alone AIDS projects or projects with large AIDS components (>10% of project costs) will have closed by December 2002, representing $510 million in AIDS lending (Annex 1). The majority of recently approved AIDS projects are stand-alone horizontal multi-country Adaptable Program Loans (APL) with streamlined procedures for rapid disbursement.6 While the specific interventions adopted in each country may vary, the loans embrace a common model featuring multi- sector implementation, rapid 'scaling up' of pilot interventions through expedited disbursement, and heavy reliance on non-governmental organizations (NGOs) and communities for implementation. The short preparation time for these projects is balanced in design with strong provisions for monitoring and evaluation that will allow timely feedback and 'learning by doing'. Elements of this approach are found in other health and social protection projects, however this combination in the context of rapid disbursement for projects targeting a communicable disease is new. 4. The Bank's partnership with UNAIDS is currently under assessment as one of several case studies by the OED evaluation of Global Programs. In parallel, an external evaluation is underway of UNAIDS as a coordinating mechanism for the AIDS activities of the eight UN agency co-sponsors, including the World Bank.' However, to date there has been no systematic evaluation of the effectiveness of or lessons from the Bank's lending or non-lending assistance for AIDS at the country level.' Dayton (1998) reviewed completed projects as background for Confronting AIDS. At that time only 8 AIDS projects had been completed, of which only one was a stand-alone project (Congo AIDS); four had Implementation Completion Reports (ICR) and only one had been rated by OED.9 An evaluation of the effectiveness and lessons from the past 15 years of World Bank country assistance for AIDS is critical to improving the impact of ongoing activities and to achieving the Millennium Development Goal of halting and beginning to reverse the spread of HIV by 2015. Objective 5. The objective of this evaluation is to assess the relevance, efficacy, efficiency, institutional development impact and sustainability of World Bank assistance to prevent HIV, care for AIDS patients, and mitigate the impact of AIDS. World Bank assistance includes policy dialogue, technical assistance, economic and sector work, and lending. While the focus of the evaluation of Bank assistance for AIDS is at the country level, with an emphasis on results 'on the ground', the study will link these results to the global context and the activities of other partners at the country level. 4. Washington, D.C.: Oxford University Press, 1993. 5. A World Bank Policy Research Report. Washington, D.C.: Oxford University Press, 1997. 6. World Bank (2000c, 2001 a, 2001b). 7. Royal Tropical Institute, ITAD, and the London School of Hygiene and Tropical Medicine (2001). 8. In defining the MAP approach, the Bank's ACTAfrica unit and the International Partnership Against HIV/AIDS in Africa (IPAA) conducted an assessment of why HIV/AIDS programs were not working in Africa. However, the assessment was not published. This study intends to build on its findings. 9. The ICRs rated two of the four projects as unsatisfactory, with 60% or more of both loans cancelled. 2 Main evaluative questions 6. Based on preliminary discussions with staff of key issues in Bank strategy, project design, and the effectiveness of the lending portfolio, as well as the results of the previous OED evaluation of health lending,'o the evaluation will focus on the following questions, to be fine-tuned as necessary during the design phase of the study:" a) What is known about the impact of World Bank assistance for HIV/AIDS? What types of output and outcome indicators have been collected? By whom? What evidence has been offered of the impact of the project on indicators such as knowledge of prevention methods and transmission, behavior change and the incidence of HIV and sexually-transmitted diseases (STD)? Is there any evidence on outcomes for treatment, care, or impact mitigation? Can a counterfactual be established? b) How successful has Bank assistance been in building government commitment and ownership and how has it been achieved? Who have been the key constituencies? How has their support been mobilized and at what stage in the policy dialogue and project cycle? What has been the role of World Bank policy dialogue? To what extent have Bank actions complemented and catalyzed the activities and commitment of others? c) What strategies have been adopted that have been most successful, in terms of the choice of interventions and target groups? Have the strategies been appropriate to the stage of the epidemic and the implementation capacity of the borrower? Under what conditions have different strategies been most successful? To what extent have projects prioritized? What is the relation between the strategies pursued and the activities of the governments and other bilateral donors? d) What has been learned about the advantages and disadvantages of multi-sectoral approaches? Which sectors are most relevant? Can there be too many sectors? What are the implications for implementation capacity? What institutional and implementation arrangements have been most effective in mobilizing and coordinating multi-sectoral activities? Are multi-sectoral approaches appropriate and successful in countries at all stages of the epidemic? Have they been successful in mobilizing action in other sectors? What are the necessary conditions for success? Have the prescriptions for non-health sectors been technically sound? What are the tradeoffs between multi- sectoral AIDS lending and sectoral lending with AIDS components? e) How effectively have NGOs, community-based organizations (CBOs), and communities empowered by the Community-Driven Development (CDD) approach implemented programs? Do they economize on scarce public sector implementation and management capacity? What are the different uses of NGOs in implementation and what have been the most successful arrangements? What selection, monitoring, and accountability arrangements proved most effective? Did efforts to involve NGOs improve government-NGO relations or exacerbate tensions and competition for scarce resources? To what extent has the private sector been effectively enlisted in Bank-sponsored assistance to fight AIDS? 10. Johnston and Stout (1999). 11. This set of questions is based on discussions with Enis Baris (EASHD); Jacques Baudouy (MNSHD); Grindre Beeharry (LCSHH); Jonathan Brown (AFRHV); Arlette Campbell-White (WBI); Armin Fidler (ECSHD); Joana Godinho (ECSHD); Charles Griffin (LCSHH); Salim Habayeb (SASHP); Keith Hansen (AFRHV); Robert Hecht (HDNHE); Samuel Lieberman (ECSHD); Michelle Lioy (AFTH3); Tonia Marek (AFTH2); Son Nam Nguyen (EASHD); Mead Over (DECRG); Jo Ritzen (HDNVP); Miriam Schneidman (AFTH3); Laura Shrestha (ECSHD); Agnes Soucat (AFTHD), Susan Stout (HDNHE); Vincent Turbat (EASHD); and Debrework Zewdie (HDNVP). In addition, two interim reports on the supervision and implementation of the first African MAP project were consulted (Brown and others 2001 a, 2001b). 3 f) What has been the relation between AIDS projects and the functioning of the rest of the health system? Has AIDS lending for prevention and treatment been consistent with and complementary to the policies in the rest of the health system? Has it augmented or diverted resources? Have AIDS treatment and care interventions been effectively integrated into the health system? To what extent has the structure of the project (stand-alone projects vs. health projects with AIDS components) had an impact on the effectiveness of AIDS prevention and treatment interventions and other health services? How has health decentralization affected the implementation of HIV/AIDS interventions? To what extent have health system constraints impeded their implementation? Has Bank assistance mobilized private health providers for provision of services? g) How can the monitoringZ and evaluation of AIDS assistance be strengthened? What have been the proposed institutional arrangements for monitoring and evaluation (M&E)? Has planned evaluation assured independence? Have the number and types of indicators been appropriate and adequate to identify project outputs and outcomes? Was there an evaluation design with a counterfactual and baseline measurements? To what extent have the M&E plans been implemented? Why or why not? Have the results of M&E systems been used to make 'real time' decisions to improve the effectiveness of the project? Scope and methodology 7. The evaluation will examine Bank assistance in countries at both early and late stages of the AIDS epidemic with completed or active AIDS lending (Table 1). The design phase of the evaluation will focus on an inventory of activities and a closer examination of the determinants of project outcomes in the 13 closed projects, where measures of outcomes would include both OED ratings and other project- specific indicators of impact or effectiveness. The design phase will have six discrete inputs: * A literature review of evaluations and research on the effectiveness of AIDS interventions and 12 programs. * A desk review of World Bank policy documents on AIDS13 and the treatment of AIDS in Country Assistance Strategies. * Development of specific guidelines for OED evaluation criteria for AIDS projects and components (relevance, efficacy, efficiency, institutional development, sustainability). * A portfolio review of the 42 completed and active projects with AIDS components comprising at least 10% of total project costs (Annexes I and 2) and an inventory of AIDS components in education, transport, and social protection projects. * An inventory of major World Bank analytic and economic and sector work on HIV/AIDS and a survey of Bank staff, borrowers, and donors on the usefulness and quality of these products. * "Enhanced" OED Project Performance Assessment Reviews (PPAR) of recently completed AIDS projects. An enhanced assessment includes review of sector work, local research, and evaluations by government and other donors; an additional week added to the mission to pursue specific questions beyond the OED evaluation framework; collection of additional primary and secondary information to document impacts, outcomes, or other dimensions of project performance. 8. The design phase will culminate in a draft Design Paper for evaluation of the development effectiveness of Bank AIDS assistance in six country case studies that will focus on evidence of impact 12. The literature review will include work on how to measure the effectiveness of AIDS interventions (e.g., Aral and Peterman 1996, NRC 1991, Rehle et al 2001, UNAIDS 2000a); reviews of impact of interventions or programs (e.g., Holtgrave et al 1995, 1996, Lurie 1993, NRC 1996, Rojanapithayakom and Hanenberg 1996) and scientific research (e.g., Grosskurth et al 1995, Laga et al 1991, Moses et al 1991). 13. For example, Lamboray and Elmendorf (1992); World Bank (1988, 1993, 1994, 1996, 1997b, 1999, 2000a, 2000b). 4 and the determinants of outcomes. The case studies will involve primary data collection as necessary to address the key evaluation issues. To the extent possible, the study will use local, independent research institutes for data collection and analysis, building capacity for evaluation in the countries studied. In addition, the countries and evaluation design will be conducted in such a way that the six case studies will be suitable as a baseline for future impact evaluations. The draft Design Paper will be discussed and vetted by an external Technical Advisory Panel (see below) and a workshop of development partners (operational staff, borrowers, researchers, NGOs, and donors). Prior to the launching of fieldwork, the approach paper will be updated to reflect the results of the design phase and presented to CODE. A technical briefing on the design phase and updated approach paper would be provided at CODE's request. Table 1. Countries with completed and active AIDS projects by project status and stage of the epidemica Stage of the AIDS epidemic Project status Nascent Concentrated Generalized Completed Indonesia Argentina Burkina Faso* (as of 12/02) Romania b Brazil Kenya b Cambodia* Uganda Chad* Zimbabwe b Congo DR India Malaysia* Active Bangladesh Brazil Kenya* Non-MAP Bulgaria* Chad* Lesotho* projects Sri Lanka* China* Rwanda* Guinea* Guinea-Bissau* Honduras* India Active Madagascar Barbados Burkina Faso MAP projects Benin Cameroon Dominican Republic C.A.R. Eritrea Ethiopia Gambia Kenya Ghana Uganda Nigeria Senegal a. The stage of the epidemic indicates the extent to which HIV has spread among those at highest risk and from high-risk groups to the rest of the population. The classification in this table is based on definitions from World Bank (1997a) and HIV prevalence data as of 1999 (UNAIDS 2000b): Nascent epidemic: <5% of people in high-risk groups are infected; Concentrated epidemic: 5% or more of people in high-risk groups are infected but <5% of women in ante-natal clinics; Generalized epidemic: 5% or more of the general population (as proxied by women in ante-natal clinics) is infected. China and India have been classified as having concentrated epidemics based on the situation in specific provinces and states, respectively. Other provinces and states have nascent epidemics. b. Countries marked with an asterisk have health projects with AIDS components; all others have stand-alone AIDS projects. c. Project has been the subject of an OED Project Performance Assessment Review (PPAR). Relation to other OED and partner activities 9. The evaluation will draw on evidence from completed OED reports on the effectiveness of the health portfolio,14 the use of NGOs in World Bank projects," World Bank experience in social funds6 and gender,17 the ongoing OED evaluation of Global Programs, and relevant OED Country Assistance Evaluations (CAE). It will also draw on the forthcoming results of the 5-year external evaluation of 14. Johnston and Stout (1999). 15. Gibbs et al (1999). 16. Carvalho et al (2001). 17. Gopal and others (2001). 5 UNAIDS, which includes case studies from Namibia, Mozambique, Burkina Faso, Eritrea, Argentina, Trinidad & Tobago, India, Indonesia, and Ukraine." External Technical Advisory Panel 10. An external Technical Advisory Panel of 3-5 experts will be identified at the beginning of the Design Phase and convened at critical points of the evaluation to advise on issues of research design and to comment on preliminary findings. Dissemination 11. The interim outputs and final report will be disseminated widely to internal and external audiences. Opportunities exist to present interim outputs at Human Development week in March 2003 and at regional AIDS conferences in Africa, Latin America, and Asia in the fall of 2003. The results of the final evaluation report can be presented at the International HIV/AIDS Conference in July 2004. Both the final report and interim products (portfolio and literature reviews, individual PPARs) will be references for the WBI core course on HIV/AIDS currently under development. Dissemination workshops will be organized in the case study countries. Finally, the results will be synthesized in shorter articles for major health and development journals. Timing and budget 12. The study will take place between April 2002 and March 2004 according to the following timetable: Table 2: Timing Activity/phase Dates Design phase May-October 2002 * Appointment of external Technical Advisory Panel * Literature review * Review of World Bank strategic and policy documents * Portfolio review of AIDS projects & components * Guidelines for evaluation of AIDS projects/development of methodology for case studies * PPARs of selected AIDS projects * Inventory of economic and sector work Workshop/review meeting on draft design paper November 2002 Updated approach paper December 2002 Fieldwork phase: case studies January-December 2003 Draft report to OED Management February 2004 Final report to CODE March 2004 Dissemination April-December 2004 13. The total estimated cost of the design phase of this evaluation is $137,000, of which $50,000 each is for staff time and consultants, $29,000 for workshops and inputs from the advisory panel, and $8,000 is for travel. A cost estimate for the case studies and fieldwork will be provided in the updated approach paper in December 2002, but the six case studies are likely to cost an average of $90,000 each. 18. Royal Tropical Institute, ITAD Ltd, London School of Hygiene and Tropical Medicine (2001). The country case studies are scheduled to take place from October 2001 through March 2002 and the final report will be made available to the public by October 2002, 6 References cited in the text Aral, S.O. and T.A. Peterman. 1996. "Measuring Outcomes of Behavioral Interventions for STD/HIV Prevention." International Journal of STD and AIDS 7 (suppl. 2): 30-38. Brown, Jonathan, Nicole Massoud, Dan Odallo, and Robert Saum. 2001. "US $500 Million Multi- Country HIV/AIDS Program for Africa (MAP): Implementation Assessment Review, Phase One". Report from a joint UNAIDS/World Bank assessment of Bank supervision of the MAPI project, April 30, 2001. Brown, Jonathan, Sheila Dutta, Abdoulaye Coulibably, Eva Jarawan, Thierry Mertens, Philip Morgan, Iraj Talai, and David Wilson. "US $500 Million Multi-Country HIV/AIDS Program (MAP) for Africa: Progress Review Mission - FY 01". Africa Region, The World Bank. September 2001. Carvalho, Soniya, Gillian Perkins and Howard White. 2001. Social Funds: A Review of World Bank Experience. Operations Evaluation Department, World Bank. Dayton, Julia. 1998. "World Bank HIV/AIDS Interventions: Ex-ante and Ex-post Evaluation". World Bank Discussion Paper, no. 389. Washington, D.C.: The World Bank. Gibbs, Christopher, Claudia Fumo, and Thomas Kuby. 1999. Nongovernmental Organizations in World- Bank Supported Projects. World Bank Operations Evaluation Department, Washington, D.C. Gopal, Gita and others. 2001. The Gender Dimension of Bank Assistance: An Evaluation of Results. Operations Evaluation Department, World Bank. Grosskurth, H., F. Mosha, J. Todd, E. Mwijarubi, et al. 1995. "Impact of Improved Treatment of Sexually Transmitted Diseases on HIV Infection in Rural Tanzania: Randomised Controlled Trial." Lancet 346 (8974): 530-36. Holtgrave, David R., Noreen L. Qualls, James W. Curran, Ronald 0. Valdiserri, Mary E. Guinan, and William C. Parra. 1995. "An overview of the effectiveness and efficiency of HIV prevention programs." Public Health Reports 110 (2): 134-45. Holtgrave, David R., Noreen L. Qualls, and John D. Graham. 1996. "Economic Evaluation of HIV Prevention Programs." Annual Review ofPublic Health 17: 467-88. Johnston, Timothy and Susan Stout. 1999. Investing in Health: Development Effectiveness in the Health, Nutrition, and Population Sector. World Bank Operations Evaluation Department, Washington, D.C. Laga, M., M. Alary et al. 1994. "Condom Promotion, Sexually Transmitted Diseases Treatment and Declining Incidence of HIV-1 Infection in Female Zairian Sex Workers." Lancet 344 (8917): 246- 48. Lamboray, Jean-Louis and A. Edward Elmendorf. 1992. "Combating AIDS and Other Sexually Transmitted Diseases in Africa: A Review of the World Bank's Agenda for Action". World Bank Discussion Paper, no. 181. Washington, D.C.: The World Bank. Lurie, Peter, A. L. Reingold et al. 1993. The Public Health Impact ofNeedle Exchange Programs in the United States and Abroad. Vol. 1. San Francisco, CA: University of California. 7 Moses, Stephen, F.A. Plummer et al. 1991. "Controlling HIV in Africa: Effectiveness and Cost of an Intervention in a High Frequency STD Transmitter Core Group." AIDS 5 (4): 407-11. National Research Council. 1991. Evaluating AIDS Prevention Programs. Edited by Susan L. Coyle, Robert F. Boruch, and Charles F. Turner. Washington, D.C.: National Academy Press. National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa. Washington, D.C.: National Academy Press. Rehle, Thomas, Tobi Saidel, Stephen Mills and Robert Magnani, eds. 2001. Evaluating Programs for HIV/AIDS Prevention and Care in Developing Countries. Arlington, VA: Family Health International. Rojanapithayakorn, Wiwat and Robert Hanenberg. 1996. "The 100% Condom Program in Thailand." AIDS 10(1): 1-7. Royal Tropical Institute, ITAD Ltd., London School of Hygiene and Tropical Medicine. 2001. Inception Report for the Five-Year Evaluation of UNAIDS. September 7. Stout, Susan, Alison Evans, Janet Nassim and Laura Raney. 1997. "Evaluating Health Projects: Lessons from the Literature". World Bank Discussion Paper, no. 356. Washington, D.C.: The World Bank. UNAIDS. 2001. AIDS Epidemic Update: December 2001. Geneva. UNAIDS. 2000a. National AIDS Programmes: A Guide to Monitoring and Evaluation. UNAIDS Report 0027E. Geneva, June. UNAIDS. 2000b. Report on the global HIV/AIDS epidemic, June 2000. Geneva: UNAIDS. World Bank. 1988. Agenda for Action on AIDS in Sub-Saharan Africa. Africa Technical Department, August. World Bank. 1993. World Development Report 1993: Investing in Health. Washington, D.C.: Oxford University Press. World Bank. 1994. Better Health in Africa: Experience and Lessons Learned. Development in Practice Series. Washington, D.C. World Bank. 1996. AIDS Prevention and Mitigation in Sub-Saharan Africa: An Updated World Bank Strategy. Report No. 15569-AFR Human Resources and Poverty Division, Technical Department, Africa Region, Washington, D.C. World Bank. 1997a. Confronting AIDS: Public Priorities in a Global Epidemic. New York: Oxford University Press. World Bank. 1997b. Health, Nutrition, & Population Sector Strategy. Human Development Network, Washington, D.C. World Bank. 1999. Population and the World Bank: Adapting to Change. Human Development Network, Washington, D.C. 8 World Bank. 2000a. Intensifying Action Against HIV/AIDS in Africa: Responding to a Development Crisis. Africa Region, Washington, D.C. World Bank. 2000b. HIV/AIDS in the Caribbean: Issues and Options. Human Development Sector Management Unit, Latin America and the Caribbean Region, Washington, D.C. June. World Bank. 2000c. Project Appraisal Document for Proposed Credits to the Federal Democratic Republic of Ethiopia and the Republic ofKenya in Support of the first phase of the US$500 Million Multi-Country HIV/AIDS Program for the Africa Region. Report No. 20727 AFR, August 14. World Bank. 2001a. Project Appraisal Document for Proposed Loans to the Dominican Republic and to Barbados in support of the First Phase of the US$155 million Multi-Country HIV/AIDS Prevention and Control Adaptable Program Lending (APL) for the Caribbean Region. Report 22184-LAC, June 5. World Bank. 2001b. Senegal: In Support of the $500 million. Second Multi-Country HIV/AIDS Program (MAP2) (APL) for the Africa Region. Report 7497-AFR. December 20. 9 s Annex 1: "First generation" AIDS projects, completed or near completion I/ OED Ratings - ICR Reviews 2/ Stand- Bor- Project Loan/Cr Date Date Amount of loan alone or Out- Inst Sustain- Bank rower ICR ID Number Country Project title approved closed Total AIDS Status comp. come dev't ability perf perf quality CLOSED PROJECTS P003116 19530Congo DR National AIDS Control Program 9/8/1988 12/31/1994 8.1 8.1Closed SA U N U U HU - P008759 3409ORomania Health Services Rehabilitation 10/1/1991 6/30/1999 150 21.5Closed C MS M L S S S P010393 235001ndia AIDS Control 3/31/1992 3/31/1999 84 84Closed SA S SU L HS S S P003333 2516OZimbabwe STI Prevention & Care 6/17/1993 12/31/2000 64.5 64.5Closed SA MS M U U U S P006546 36590Brazil AIDS & STD Control 11/9/1993 6/30/1998 160 160CIosed SA S SU L S S S P004312 3682OMalaysia Health 12/14/1993 6/3012001 50 16CIosed C S* M* L* U* S* P000308 26190Burkina Faso Population/AIDS Control 5/31/1994 9/30/2001 26.3 15CIosed C U* SU* L* S* S* P002963 26030Uganda STI 4/12/1994 6/30/2002 50 50CIosed SA P001333 26860Kenya STI 3/14/1995 6/30/2001 40 40Closed* SA MS M NE S S U P039643 398101ndonesia HIV/AIDS & STD Prevention 2/27/1996 9/30/1999 24.8 24.8Closed** SA U N U U U S & Management PROJECTS NEARING COMPLETION P035601 26920Chad Population/AIDS Control 3/23/1995 20.4 5Active C P043418 4168oArgentina AIDS & STD Control 5/22/1997 15 15Active SA P004034 N0050Cambodia Disease Control & Health Dvt 12/24/1996 30.4 6.1Active C TOTAL 13 projects 723.5 510.0 Notes 1. Stand-alone AIDS project or project with an AIDS component >$1 million and at least 10% of total project costs, based on SAR or PAD. 2. Explanation of ratings: Outcomes, Bank and Borrower performance: HS (highly satisfactory); S (satisfactory); MS (marginally satisfactory); MU marginally unsatisfactory); U (unsatisfactory). Institutional Development: SU (substantial); M(modest); N (negligible). Sustainability: HL (highly likely); L (likely); U (unlikely); NE (not evaluable). ICR quality: HS (highly satisfactory); S (satisfactory); U (unsatisfactory); NR (not rated). * Rating based on ICR - OED ratings are under preparation 10 ANNEX 2: Active portfolio of World Bank AIDS loans 1/ Approval Amount of Loan Stand-alone Loan/CR # Country Project title Date Total AIDS Status or component 1. NON-MAP 400001Bulgaria Health Sector Restructuring 4/9/1996 26 2.7 Active C 29280Sri Lanka Health Services Project 12/19/1996 18.8 7.64 Active C 30100Guinea-Bissau National Health Development 11/25/1997 11.7 2.9 Active C 3148OGuinea Population & Reproductive Health 12/1/1998 11.3 2.1 Active C 44620/32010 China Health IX 5/4/1999 60 25.6 Active C 43920Brazil Second AIDS/STD 9/15/1998 165 165 Active SA 48557Chad Health & Safe Motherhood (sup) 9/17/1998 10.9 1.3 Active C 64856Honduras Nutrition & Health Project (sup) 1/26/1999 10.4 1.6 Active C 324201ndia AIDS Prevention II 6/15/1999 191 191 Active SA P053200 Lesotho Health Sector Reform 6/8/2000 6.5 2 Active C 344101Bangladesh HIV/AIDS Prevention 12/12/2000 40 40 Active SA 34400Kenya Decentralized Reproductive Health & HIV/AIDS (DARE) 12/12/2000 50 29.5 Active C 22721 Rwanda Health and Population (suppl) 12/21/2000 7 2.65 Active C 35480Chad Second Population & AIDS 7/12/2001 24.56 16 Active C SUBTOTAL 14 projects 633.16 489.99 2. AFRICAN MULTI-COUNTRY AIDS (MAP) 34540Cameroon Multisectoral HIV/AIDS 1/21/2001 50 50 Active SA 34440 Eritrea HAMSET (HIV/malariafTB/STI) 12/18/2000 40 13.9 Active C 34160 Ethiopia Multisectoral HIV/AIDS 9/12/2000 59.7 59.7 Active SA 34550Gambia HIV/AIDS Rapid Response 1/16/2001 15 15 Active SA 34580Ghana AIDS Response Project (umbrella) 12/28/2000 25 25 Active SA 3415OKenya HIV/AIDS Project (umbrella) 9/12/2000 50 50 Active SA 34590Uganda HIV/AIDS Control 1/18/2001 47.5 47.5 Active SA 35570Burkina Faso HIV/AIDS Disaster Relief 7/6/2001 22 22 Active SA 35560Nigeria HIV/AIDS Response Project 7/6/2001 90.3 90.3 Active SA 3589OMadagascar Multisectoral STI/HIV 12/13/2001 20 20 Active SA 35840CAR HIV/AIDS 12/14/2001 17 17 Active SA 359601Benin HIV/AIDS multisectoral 1/4/2002 23 23 Active SA 3601OSenegal HIV/AIDS prevention 2/7/2002 30 30 Pipeline SA SUBTOTAL 13 projects 489.5 463.4 3. CARIBBEAN MULTI-COUNTRY AIDS (MAP) 11 ANNEX 2: Active portfolio of World Bank AIDS loans J/ Approval Amount of Loan Stand-alone Loan/CR # Country Project title Date Total AIDS Status or component 22184Barbados Caribbean APL AIDS Prevention 6/28/2001 15.15 15.15 Active SA 22184Dominican Rep Caribbean APL AIDS Prevention 6/28/2001 25 25 Active SA SUBTOTAL 2 projects 40.15 40.15 TOTAL ACTIVE PORTFOLIO 29 projects 1162.8 993.54 Source: WB AIDS Lending (web page) as of 10/15/01 1. Includes stand-alone projects and projects with AIDS components >$1 million that comprise at least 10% of project costs, as of February 2002. 12 ANNEX 3: World Bank projects with AIDS components of >$1 million but <10% of total project costs I/ Date Amount of loan Stand alone Loan # Country Project title Approved Total AIDS Status or component 29310Brazil NE Endemic Disease Control 3/31/1988 109 6.6 Closed C 20850 Haiti First Health & AIDS 1/16/1990 29.1 1.7 Closed C 31710 Morocco Health Sector Investment 2/20/1990 104 8 Closed C 22510 Madagascar National Health Sector 5/28/1991 31 2 Closed C 2217OMali Health/Population/Rural WS 3/19/1991 26.6 1.4 Closed C 26600Zambia Health Sector Support 11/15/1994 56 1.8 Active C 26840Cameroon Health/Fertility/Nutrition 3/7/1995 43 2 Active C 27340Benin Population and Health 5/30/1995 27.8 1.2 Active C 2794OChina Disease Prevention Project 12/12/1995 100 4.95 Active C 28930 Cote d'Ivoire Integrated Health Services Development Project 6/27/1996 40 2.1 Active C 29150Niger Health Services Development 9/5/1996 40 1.7 Active C 3028OEritrea National Health Development 12/16/1997 18.3 1.7 Active C 30540Gambia Participatory PHN 3/31/1998 18 1.5 Active C 3051OMalawi Secondary Education 3/24/1998 48.2 1.4 Active C 43730Thailand Social Investment Program 11/13/1998 300 1.5 Active C 31010 Bangladesh Health & Population 6/30/1998 250 5.8 Active C 30500Pakistan Social Action Program 11 3/24/1998 250 1.52 Active C 31400Ethiopia Health Sector Development 10/27/1998 100 2 Active C 314901ndia Maharastra Health Services Development 12/8/1998 134 1.3 Active C 33420Chad Health System Support 4/27/2000 41.5 1.9 Active C 33460Nigeria Second Primary Education 5/11/2000 55 1.2 Active C 33670 Rwanda Human Resources Development 6/6/2000 35 3.29 Active C 33800Tanzania Health Services Development 6/15/2000 22 2 Active C 333801ndia Uttar Pradesh Health Sector Development 4/25/2000 110 3 Active C 22186Mexico Mexico Ill Basic Health Care 6/21/2001 350 18 Active C 22185Venezuela Caracas Metro Health Project 6/21/2001 30 1.6 Active C TOTAL 26 projects 2368.5 81.16 Source: WB AIDS Lending (web page) as of 10/15/01 1. 54 additional projects have AIDS components of $1 million or less. 13 ANNEX 4: AIDS project pipeline as of February 2002 Expected Amount lent Stand-alone Fiscal year Country Project title date Total AIDS Status or component FY02 Burundi HIV/AIDS and orphans 2/7/2002 36 36Pipeline SA Jamaica HIV/AIDS prevention 2/12/2002 15 15Pipeline SA Sierra Leone HIV/AIDS Response Project 3/26/2002 14.7 14.7Pipeline SA Cape Verde HIV/AIDS 3/28/2002 10 1OPipeline SA Zambia HIV/AIDS 5/2/2002 40 40Pipeline SA Western Africa HIV/AIDS Abidjan-Lagos (proposed IDA grant) 5/16/2002 25 25Pipeline SA Niger HIV/AIDS prevention 5/30/2002 15 15 Pipeline SA FY03 Guinea-Bissau HIV/AIDS global mitigation 7/16/2002 8 8Pipeline SA Tanzania HIV/AIDS 7/23/2002 60 60Pipeline SA Cote d'Ivoire HIV/AIDS Disaster Relief 8/8/2002 40 40Pipeline SA Pakistan HIV/AIDS Prevention 8/27/2002 20 20Pipeline SA Haiti HIV/AIDS II 9/18/2002 55 55Pipeline SA Togo HIV/AIDS emergency 9/24/2002 15 15Pipeline SA Sri Lanka National AIDS Prevention 10/22/2002 10 1OPipeline SA Dominica HIV/AIDS prevention 10/29/2002 5 5Pipeline SA St. Kitts and Nevis HIV/AIDS 10/29/2002 2.5 2.5Pipeline SA St. Vincent & Grenadines HIV/AIDS 10/29/2002 3 3Pipeline SA Trinidad & Tobago HIV/AIDS 10/29/2002 15 15Pipeline SA Grenada HIV/AIDS prevention 10/29/2002 3 3Pipeline SA Guyana HIV/AIDS prevention 10/29/2002 5 5Pipeline SA St. Lucia HIV/AIDS 10/29/2002 3 3Pipeline SA TOTAL 22 projects 400.2 400.2 14