Page 1 PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No.: AB4559 Project Name Malawi HIV/AIDS Additional Financing Region AFRICA Sector Health (100%) Project ID P107545 Borrower(s) Government of Malawi Implementing Agency National AIDS Commission Environment Category [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) Date PID Prepared February 17, 2009 Estimated Date of Appraisal Authorization February 19, 2009 Estimated Date of Board Approval May 5, 2009 1. Key development issues and rationale for Bank involvement Malawi is among the countries in Southern Africa at the epicenter of the HIV/AIDS pandemic. Estimates indicate that 12 percent of adults (15-49 years) in the country are currently living with HIV infection. The general national epidemiologic trend over the past few years has been that of stabilization of the antenatal HIV seroprevalence, although mainly in semi-urban areas. Malawi’s epidemic is heterogeneous in nature, with respect to gender, age, socioeconomic, and geographic differentials. There have been recent increases in prevalence in some urban and rural areas, particularly in the rural northern, central, and southern parts of Malawi. Given that over 85 percent of Malawi’s population lives in rural areas, the 2009 Joint Annual HIV/AIDS Review concluded that an upward trajectory in national prevalence is likely in the coming years, given the limited impact of rural prevention programs, to date. Current estimates of the burden of HIV, based on projections from antenatal and population based estimates, indicate that about 100,000 new HIV infections occur every year in Malawi and that about 930,000 Malawians are living with HIV infection. Despite the challenging development context of Malawi, substantial progress has been made during the last four years of IDA financing, especially in testing, treatment and care of those affected by HIV/AIDS. The proposed Additional Financing builds on these achievements and seeks to ensure that the momentum developed to date is continued and intensified, while also focusing on the identified and substantial gaps. The national program is now in a position to substantially increase its reach and impact, particularly with respect to strengthening prevention and the rural/decentralized response to HIV/AIDS. The Government views IDA’s continuing financial support as critical to addressing fiduciary and technical needs over the next three years, a “bridging period” during which the next National Action Framework, supporting a stronger evidence-based approach, will be finalized. The final year of the proposed Additional Financing operation will support the development of the next National Action Framework, thereby continuing and strengthening the evidence-based approach of the previous period. The proposed Additional Financing will support the financing of expanded activities that scale-up the original project’s impact and development effectiveness, including the strengthened focus on evidence- based prevention strategies for vulnerable groups. Additional Financing has been assessed by IDA and Government as the appropriate instrument to consolidate and expand gains from the original IDA operation. Addressing HIV/AIDS in a comprehensive and sustained manner requires a long-term commitment and the continued involvement of the Bank is consequently viewed as both politically and financially critical. As noted earlier, the proposed Additional Financing operation would finance a further Page 2 three year time slice of a national program. This scale-up requires the indicated additional financial resources since the current operation will be fully disbursed ahead of schedule. The project remains as originally designed and appraised. The proposed changes are marginal and consist primarily of extending the Bank’s financial contribution to the project by US$30 million. The economic, financial, and technical justifications remain the same as in the original project. The components, and implementation modalities also remain unchanged. 2. Proposed objective(s) The proposed objective of this operation is to increase the coverage and utilization of prevention and treatment services, and to mitigate the impact of HIV/AIDS with a particular focus on highly vulnerable populations. 3. Preliminary description An SDR 25.4 million (US$35.0 million equivalent) IDA grant in support of the Malawi Multi-Sectoral HIV/AIDS Project was approved by the Board of Executive Director’s on July 29, 2003 and became effective on February 6, 2004. The project is expected to close on June 30, 2009 and is expected to be fully disbursed prior to closing. This FY04 operation was part of the first phase of the Multi-Country HIV/AIDS Program (MAP) for Africa. The project components included: (i) prevention and advocacy; (ii) treatment, care and support; (iii) impact mitigation; (iv) sectoral mainstreaming; (v) capacity building and partnerships; (vi) monitoring, evaluation, and research; and (vii) national leadership and coordination. The project has supported a comprehensive range of prevention, treatment, and social support services and has focused on increasing and strengthening programmatic and management capacity. The project components and institutional modalities remain unchanged for the proposed Additional Financing operation. The project remains as originally designed and appraised. The proposed changes are marginal and consist primarily of extending the Bank’s financial contribution to the project by US$30 million. The economic, financial, and technical justifications remain the same as in the original project. The components, and implementation modalities also remain unchanged. 4. Safeguard policies that might apply The waste management plan of the original operation remains relevant given the consistency in program design, structure, and activities. As a result, the Africa Regional Safeguards Unit has confirmed that no further safeguards assessments are required. 5. Tentative financing Source: ($m.) BORROWER/RECIPIENT 0 IDA Grant 30 Total 30 6. Contact point Contact: Sheila Dutta Page 3 Title: Sr. Health Spec. Tel: (202) 473-8390 Email: Sdutta@worldbank.org