Page 1 PROJECT INFORMATION DOCUMENT (PID) PROJECT CONCEPT NOTE STAGE Report No.AB2335 Project Name Benin Second Multisectoral HIV/AIDS Project Region AFRICA Sector Health (75%); Central government administration (15%); Other social services (5%); Sub-national government administration (5%) Project ID P096056 Theme HIV/AIDS prevention and care Borrower(s) Government of Benin Implementing Agency National HIV/AIDS Control Committee (CNLS) P.O. Box 2586 Cotonou, Republic of Benin (229) 21 32 27 27 E-mail: mvkiki@yahoo.fr Environment Category [ ] A [x] B [ ] C [ ]FI Date PID Prepared April 17, 2006 Date of Appraisal Authorization July 31, 2006 Date of Board Approval October 26, 2006 1. Country and Sector Background Country and sector issues. The Republic of Benin is located between Togo, Burkina Faso, Niger and Nigeria, and it has a coastline of 120 km in the Bay of Bengal of Atlantic. The total land area is 114,763 Km2. In 2005, the population of Benin was about 7.5 million persons. Benin is one of the countries that are still relatively lightly attacked by the HIV/AIDS virus. The prevalence rate of HIV/AIDS among the adult population from 15 to 49 years is estimated to be 2.0 percent, meaning that among this group there are about 66,000 seropositive persons. There are strong differences between the regions, where the prevalence rates varied from 0.3 percent to 3.3 percent in 2004. This rate was highest in such vulnerable groups as commercial sex workers and persons with tuberculosis, 27.9 and 16.7 percent, respectively. Government Strategy. The Government’s strategic plan for HIV/AIDS (2001-06) is being updated for the period 2006-10, but the objectives are not expected to change essentially. In brief, the objectives aim to (a) strengthen the prevention of sexually transmitted, blood-transfusion- and drug-injection-induced, and mother-to-child- transmitted infections of HIV; (b) improve the medical and psychosocial treatment and care of people infected with and affected by HIV/AIDS, Page 2 2 including orphans and other children; and (c) reduce the economic and social impacts of HIV/AIDS among the population. HIV/AIDS Issues. A special feature in the Government’s strategy is that it has opted to provide antiretroviral medication (ARV) free of charge to all seropositive persons who need such medication. The main problem in this respect, as well as for all other strategies of prevention, treatment and care, is that the Government must rely on external funds to finance the necessary purchases and activities, because the Government itself can only provide a very modest contribution amount of funds for that purpose (equivalent of US$3.6 million in 2005). 2 . Objectives The development objectives of the project are derived from the country’s strategic plan for fighting HIV/AIDS and its effects. Thus, the project would: (a) Increase access to prevention services for vulnerable and high risk groups; and (b) Improve the medical and psychosocial treatment and care and economic support of the people infected with and affected by HIV/AIDS. 3. Project Description In accordance with the identification mission’s observations and discussions with stakeholders, the following components are tentatively proposed: Social Mobilization (a) Prevention, and support to subprojects implemented by CSOs (Civil Society Organizations), CBOs (Community Based Organizations), and NGOs (Nongovernmental Organizations), including IEC (Information Education Communication) for behavioral change, and social marketing of condoms, and; support to PLWHA (People Living with HIV/AIDS) and vulnerable groups such as the orphans; psychosocial and economic support to infected and affected persons; and (b) Prevention and support to programs implemented by key agencies and ministries such as the Ministries of Defense, Education, Youth, Social Protection, and Agriculture. Access to Treatment and Care: (a) Support to PNLS/MOH programs (National HIV/AIDS Control Program of Ministry of Health) [complementing Global Fund and other financiers]; and (b) Support to faith-based and other organizations dealing with treatment and care. Coordination, Management, and Monitoring and Evaluation (a) Support for a unified national and decentralized coordination system and leadership of CNLS (National HIV/AIDS Control Committee); (b) Support for a uniform national monitoring and evaluation system; and (c) Management of MAP II under the direct and effective tutelage of SP/CNLS (Permanent Secretary of CNLS). 4. Financing Project costs per component have not yet been determined, although IDA allocation for the second phase is about US$25 million. As mentioned, in its request to the Global Fund, the Government estimated that the overall gap between the financial support needed and the committed funds over the next four years would be US$75 million. The accuracy of this estimate and availability of donor funds other than those from IDA will be evaluated during project preparation and appraisal. Page 3 3 5 . Implementation The organizational set-up of the project would be expected to remain essentially the same as during the predecessor project. The project would be placed under the effective oversight of the CNLS that is the highest HIV/AIDS coordination body in Benin. The project would help strengthen the secretariat and field organization of CNLS, including support to a unified and national monitoring and evaluation system (see the proposed components). The operational management of the new project is expected to be based on the well-functioning structure established for the predecessor project, possibly with some minor modification to be determined during project preparation and appraisal. Much of the project would be implemented through subprojects initiated by CSOs, CBOs, private-sector entities and others engaged in fighting against HIV/AIDS. Contracting opportunities would appear in procurement of ARV (Antiretroviral) medications and medical supplies (through a central system supervised by MOH) and for a local firm or agency as a financial intermediary agency to administer the entire process of financial assistance to CBOs implementing social mobilization of local activities. The implementation of other project activities would be carried out by the beneficiary agencies or their support organizations that have been granted funds from project resources. 6. Sustainability Being one of poorest countries in the world, the Government is able to provide only a fraction of the costs needed to effectively fight against HIV/AIDS. Thus, continuing activities in this sector will depend on sustained support by external agencies. 7 . Lessons Learned from Past Operations in the Country/Sector Experience from the Benin social sector projects has shown that strong coordination, comprehensive and systematic monitoring and supervision mechanisms are needed to ensure good project implementation in view of the great number of participants in the health sector (public, private and confessional sectors, external donors, local leaders, decentralized civil servants). The Analytical Assessment Advices (AAA) contacted in Benin and other studies have confirmed the positive impact of MAP I in Benin. An important positive lesson learned is that community mobilization and utilization of multiple channels can reach the infected and affected populations. Similarly to broader HIV/AIDS studies in Africa, also the Benin-specific assessments have pointed out the weaknesses in coordination and M&E. Some Government and bilateral agencies have implemented their own programs without coordinating them with the CNLS. There is no unified M&E system for HIV/AIDS in Benin, but one has been designed. In addition, while responses by some public-sector agencies were effective (such as those by the Ministries of Defense and Education), several others were rather weak. All these shortcomings are either being corrected or will be addressed by the MAP. 8. Environmental and safeguard aspects The project would most likely be rated as a B category project for environment. A good mitigation plan was prepared and only partly implemented. This Waste Management Plan (WMP), prepared in November 2001, prior to the effectiveness of MAP I applies to the national program for the long run, so there is no need to prepare a new one. This WMP has been only partly implemented because of budget constraint. Activities carried out under include: (a) construction of 22 incinerators of type De Montfort at 22 health centers; (b) equipment (syringe destruction kit, pre-collect materials, and biomedical waste treatment) acquisition; (c) staff training; (d) multiplication and vulgarization of the decree relative to the rational management of the biomedical waste in all health centers. Under the present operation, the current plan will be Page 4 4 updated, costed and its financing will be included in the project cost. Benin developed a good mitigation plan that has been only partly implemented. 9. Contact point Contact: Nicolas Ahouisoussi Title: Senior Economist, Task Team Leader Tel: (202) 473 2794 Email: nahouissoussi@worldbank.org 10 . For more information contact: The InfoShop The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 458-5454 Fax: (202) 522-1500 Web: http://www.worldbank.org/infoshop