Document of The World Bank FOR OFFICIAL USE ONLY Report No: 65187-BW RESTRUCTURING PAPER ON A PROPOSED PROJECT RESTRUCTURING OF BOTSWANA NATIONAL HIV/AIDS PREVENTION SUPPORT PROJECT LOAN JULY 10, 2008 TO THE REPUBLIC OF BOTSWANA NOVEMBER 14, 2011 Health, Nutrition, and Population Unit (AFTHE) Human Development Department Africa Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. ABBREVIATIONS AND ACRONYMS AIDS Acquired Immune Deficiency Syndrome BNAPS Botswana National HIV/AIDS Prevention Support Project CFP Call for Proposals HIV Human Immunodeficiency Virus ICT Information and communication technology IP Implementation Progress MTR Mid-Term Review NACA National AIDS Coordinating Agency PDO Project Development Objective Regional Vice President: Obiageli Katryn Ezekwesili Country Director: Ruth Kagia Acting Sector Manager: Jean Jacques De St. Antoine Sector Director: Ritva Reinikka Task Team Leader: Sheila Dutta 2 Restructuring Status: Draft Restructuring Type: Level one Last modified on date : 11/09/2011 1. Basic Information Project ID & Name P102299: BW-HIV/AIDS Project SIL (FY09) Country Botswana Task Team Leader Sheila Dutta Sector Manager/Director Jean J. De St Antoine Country Director Ruth Kagia Original Board Approval Date 07/10/2008 Original Closing Date: 09/30/2013 Current Closing Date 09/30/2013 Proposed Closing Date [if applicable] EA Category C-Not Required Revised EA Category C-Not Required-Not Required EA Completion Date 04/09/2007 Revised EA Completion Date 2. Revised Financing Plan (US$m) Source Original Revised BORR 0.00 0.00 IBRD 50.00 50.00 ZBIL 0.00 0.00 Total 50.00 50.00 3. Borrower Organization Department Location Ministry of Finance and Botswana Development Planning 4. Implementing Agency Organization Department Location National AIDS Coordinating Botswana Agency i 5. Disbursement Estimates (US$m) Actual amount disbursed as of 11/09/2011 12.77 Fiscal Year Annual Cumulative 2012 16.00 28.77 2013 16.00 44.77 2014 5.23 50.00 Total 50.00 6. Policy Exceptions and Safeguard Policies Does the restructured project require any exceptions to Bank policies? N Does the restructured projects trigger any new safeguard policies? If yes, please select N from the checklist below and update ISDS accordingly before submitting the package. 7a. Project Development Objectives/Outcomes Original/Current Project Development Objectives/Outcomes The project development objective is to assist the Government of Botswana to increase the coverage, efficiency, and sustainability of targeted and evidence-based HIV/AIDS interventions through (i) strengthening the National AIDS Coordinating Agency's institutional management and coordination capacity; and (ii) financing strategic and innovative HIV/AIDS-related prevention and mitigation activities. This project development objective will be measured by utilizing indicators addressing the longer-term planning, implementation, and effectiveness of national and decentralized coordination efforts. 7b. Revised Project Development Objectives/Outcomes [if applicable] The revised project development objective is to assist the Government of Botswana to increase access to prioritized prevention services that reduce the risk of HIV transmission. ii BOTSWANA NATIONAL HIV/AIDS PREVENTION SUPPORT PROJECT P102299 CONTENTS Page A.  SUMMARY ........................................................................................................................... 4  B.  PROJECT STATUS .............................................................................................................. 4  C.  PROPOSED CHANGES ...................................................................................................... 5  3 BOTSWANA NATIONAL HIV/AIDS PREVENTION SUPPORT PROJECT RESTRUCTURING PAPER A. SUMMARY 1. This restructuring paper proposes modification to the project development objective (PDO) for the Botswana National HIV/AIDS Prevention Support (BNAPS) Project (P102299; IBRD-75680). The revised PDO is more in line with the project’s focus on prevention and de-emphasizes the efficiency and sustainability goals which are longer-term goals not easy to measure or attain under this project. B. PROJECT STATUS 2. Nearly three decades into the AIDS epidemic, Botswana possesses the second highest national HIV/AIDS prevalence globally. An estimated 24 percent of all adults (15-49 years) are living with HIV infection (UNAIDS, 2009). Given the magnitude of Botswana’s epidemic, HIV/AIDS-related investments , particularly spending on life saving AIDS treatment, have absorbed a substantial proportion of overall health spending, and may have diverted attention from prevention. As a result, Government requested the BNAPS Project in anticipation that these financial and technical resources would play a strategically significant role in supporting a more evidence-based response to the national prevention program. The BNAPS Project was approved on July 10, 2008, became effective on June 30, 2009, and is scheduled to close on September 30, 2013. 3. The BNAPS Project has followed a slow implementation trajectory (cumulative disbursements of 20 percent, as of November 7, 2011). Key implementation challenges experienced by the project include a steep learning curve associated with learning IBRD procedures, uneven coordination and management oversight by the National AIDS Coordinating Agency (NACA), limited NACA human resource skills base in behavioral science, limited oversight of public sector work plans by some implementing ministries and limited familiarity with community-based Call for Proposals (CFP) financing mechanisms. 4. In addition, the cultural context of high HIV/AIDS awareness and high risk sexual behavior (particularly with respect to multiple concurrent partnerships) continues to pose a major challenge. The project implementation progress (IP) rating was downgraded from “Satisfactory� to “Moderately Satisfactory,� following the June 2011 Mid-Term Review (MTR). A similar downgrade was made for the PDO rating, as well, on the basis of the MTR. The MTR review also endorsed a downgrade in the project’s monitoring and evaluation rating from “Satisfactory� to “Moderately Satisfactory.� In response to these challenges, an Implementation Improvement Plan (June-December 2011) has been agreed with Government with the goal of improving project performance. It is noted that a number of these agreed actions, such as the recruitment of additional technical assistance, are now overdue. 4 5. New challenges in fiduciary performance have developed since the completion of the June 2011 Mid-Term Review. With respect to financial management, the project audit, which was due on September 30, 2011, has not yet been submitted. However, the project team has received written confirmation from Government that it will be available by end-November 2011. With respect to procurement, due to recent staff changes, as of October 1, 2011, NACA has no procurement staff/technical consultants in place to support the project. The project team is unable to process procurement transactions until this issue has been satisfactorily resolved. Government has indicated that it will provide the Bank with its transitional and medium-term plans to urgently address this procurement capacity gap by late-November 2011. The project team will continue to monitor project performance and the indicated fiduciary challenges closely and provide regular updates to management. If deemed necessary, the project team would address continued implementation and fiduciary performance issues as part of a separate restructuring in the future. C. PROPOSED CHANGES  Project’s Development Objectives 6. The project’s original project development objective (PDO) was “to assist the Government of Botswana to increase the coverage, efficiency, and sustainability of targeted and evidence-based HIV/AIDS interventions through strengthening NACA’s institutional management and coordination capacity, and financing strategic and innovative HIV/AIDS-related prevention and mitigation activities.� 7. Based on a more comprehensive understanding of the context of Botswana’s HIV/AIDS epidemic and implementation experience to date, it appears that efficiency and sustainability will not be easily measurable or attainable in such a short time span. Consequently, the proposed revised PDO has been simplified to the following: “To assist the Government of Botswana to increase access to prioritized prevention services that reduce the risk of HIV transmission.� The new PDO is more in-line with the purpose of the operation as stated in the project title (i.e. “Prevention Support�). 8. There are no changes being made to the project’s results/indicators, components, or institutional arrangements. The project’s costs, financial management, disbursement, procurement arrangements, closing date, safeguards, and Environmental Assessment category also remain unchanged. 9. The project’s key Mid-Term recommendations, which included the PDO revision, are summarized below. It is noted that the following proposed modifications do not require formal restructuring, given the existing flexibility of the project design. It is anticipated that the next phase of the operation will intensify focus on the delivery of behavior change interventions, based on the National Strategic Framework and sector plans, specifically to reduce multiple concurrent partnerships, support advocacy and delivery of safe male circumcision, and delivery of interventions more strongly focused on the prevention needs of women 15-34 years. 5 (a) Component 1 (NACA Strengthening): Strengthen NACA’s capacity to coordinate and harmonize across project components. This would include recruitment of a modified and strengthened technical assistance consultant team immediately, as well as supporting economic and sector analytic work in the context of the project to further strengthen the evidence-base for delivery prevention service, including exploring the innovative use of information and communication technologies (ICT). (b) Component 2 (Public Sector): Streamlining the project’s public sector component to enable focus on prioritized ministries, reducing from six to three public sector agencies (Ministry of Heath, Ministry of Education, Science, and Technology, and the Ministry of Youth, Sports, and Culture). This approach would enable a more coordinated approach to interventions targeting specific populations. (c) Component 3 (Civil Society/Private Sector): Strengthening the civil society/private sector component by introducing multi-year grants to organizations meeting the agreed criteria and also the provision of strong technical and fiduciary technical assistance (through the BNAPS TA consultancy team) to ensure quality of the prioritized interventions. This may require some reallocation of funds from Component 2 to Component 3. 6 The original had problem with text extraction. pdftotext Unable to extract text.