Document of The World Bank Report No: 23443-CV PROJECT APPRAISAL DOCUMENT ONA PROPOSED CREDIT IN THE AMOUNT OF SDR 7.30 MILLION (US$ 9.0 MILLION EQUIVALENT) TO THE REPUBLIC OF CAPE VERDE FOR HIV/AIDS PROJECT IN SUPPORT OF THE SECOND PHASE OF THE US$ 500 MILLION MULTI-COUNTRY HIV/AIDS PROGRAM (MAP2) (APL) FOR THE AFRICA REGION March 07, 2002 Transport Unit Country Department 14 Africa Region CURRENCY EQUIVALENTS (Exchange Rate Effective February 21, 2002) Currency Unit = Cape Verde Escudo (CVE) CVE100 = USSO.83472 US$1 = CVE 119.8000 FISCAL YEAR January I - December 31 ABBREVIATIONS AND ACRONYMS AIDS Acquired Inmmune Deficiency Syndrome APL Adaptable Program Loan ARV Antiretroviral drugs AU Administrative Unit (of the CCS-SIDA Secretariat) CAS Country Assistance Strategy CBO Community-Based Organization CCS-SIDA Comite de Coordenacdo do Combate a SIDA (Coordination Committee to Combat AIDS) CDC Center for Disease Control DOT Direct Observed Therapy EA Environment Assessment EMP Environment Management Plan EMPROFAC Empresa Nacional de Produtos Farmaceuticos (Cape Verde Parastatal Organization for Procurement of Pharmaceuticals and Medical Supplies) HIV Human Immonodeficiency Virus IAPSO Interagency Procurement Services Office IDA International Development Association IEC Information, Education, and Communication IPPF International Planned Parenthood Federation MAP Multi-Country HIV/AIDS Program MTCT Mother-to-Child Transmission M&E Monitoring & Evaluation NGO Non-government Organization PIT Programa de Infra-estruturas e Transportes (Infrastructure and Transport Program) PLWHA People Living with HIV/AIDS PCT Project Coordination Team PMTCT Prevention of Mother-to-Child Transmission PNLS Programa Nacional de Luta contra a SIDA (National Program to Fight Against HIV/AIDS) POM Project Operations Manual RPR Rapid Plasrna Reagin SIL Specific Investment Loan STI Sexually Transmitted Infection TPHA Treponema Pallidum Haemagglutination Assay UNDP United Nations Development Program UNFPA United Nations Fund for Population Assistance UNAIDS Joint United Nations Programme on HIV/AIDS VCT Voluntary Counseling and Testing WHO World Health Organization Vice President: Callisto Madavo Country Manager/Director: John Mclntire Sector Manager/Director: Maryvonne Plessis-Fraissard Task Team Leader/Task Manager: Gylfi Paisson CAPE VERDE HIV/AIDS PROJECT CONTENTS A. Project Development Objective Page 1. Project development objective 2 2. Key performance indicators 2 B. Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported by the project 3 2. Main sector issues and Government strategy 3 3. Sector issues to be addressed by the project and strategic choices 6 C. Project Description Summary 1. Project components 7 2. Key policy and institutional reforms supported by the project 10 3. Benefits and target population 10 4. Institutional and implementation arrangements 11 D. Project Rationale 1. Project alternatives considered and reasons for rejection 17 2. Major related projects financed by the Bank and other development agencies 18 3. Lessons learned and reflected in the project design 19 4. Indications of borrower commitment and ownership 20 5. Value added of Bank support in this project 20 E. Summary Project Analysis 1. Economic 20 2. Financial 20 3. Technical 21 4. Institutional 21 5. Environmental 22 6. Social 23 7. Safeguard Policies 24 CAPE VERDE HIV/AIDS PROJECT Project Appraisal Document Africa Regional Office AFTTR Date: March 7, 2002 Team Leader: Gylfi Palsson Country Manager/Director: John McIntire Sector Manager/Director: Maryvonne Plessis-Fraissard Project ID: P074249 Sector(s): HA - HIV/AIDS Lending Instrument: Specific Investment Loan (SIL) Theme(s): Social Development; Health/Nutrition/Population; Social Protection Poverty Targeted Intervention: N Prograrm Financirng Data [ ] Loan [X] Credit [ Grant [ ] Guarantee [ ] Other: For Loans/Credits/Others: Amount (US$m): US$ 9.0 Proposed Terms (IDA): Standard Credit Grace period (years): 10 Years to maturity: 40 Commitment fee: Up to 0.5% Service charge: 0.75% Financing Plan (US$m): Source Local Foreign Total BORROWER 0.60 0.00 0.60 IDA 5.08 3.92 9.00 Total: 5.68 3.92 9.60 Borrower: GOVERNMENT OF CAPE VERDE Responsible agency: OFFICE OF THE PRIME MINISTER Address: Palacio do Governo Praia, Santiago Republic of Cape Verde. Contact Person: His Excellency Jose Maria Pereira Neves Tel: (238) 610513 Fax: (238) 613099 Email: Estimated disbursements ( Bank FY/US$m): FY 2003 2004 2005 2006 2007 Annual 2.03 1.86 1.71 1.71 1.69 Cumulative 2.03 3.89 5.60 7.31 9.00 Project implementation period: 4.5 years Expected effectiveness date: 06/01/2002 Expected closing date: 12/31/2006 OCS PAD Ft R. Mh. 2000 A. Project Development Objective 1. Project development objective: (see Annex 1) The project will support the goal of the national HIV/AIDS strategy of the Government of Cape Verde which is to reduce the spread of HIV infection in the country. As a means of achieving this goal, the project will also support the following objectives: * Mitigation of the health and socio-economic impact of HIV/AIDS at individual, household, and community levels thus sustaining an economically productive population; and * Establishment of a strong and sustainable national capacity to respond to the epidemic. The Government proposes to attain its goal by guiding, financing, and supporting the implementation of a multisectoral response to HIV/AIDS with the participation of all line ministries, civil society, and communities. 2. Key performance indicators: (see Annex 1) Output Indicators 1. By 2004, all Government and parastatal-managed primary, secondary, and high schools are using curricula that incorporate HIV/AIDS in a skills-based learning approach. 2. By 2004, increase from 0 to 50%, and by 2006 reach a target of 80% of people living with HIV/AIDS who are receiving some form of home or community-based support. 3. By 2003, all ministries have and are implementing HIV/AIDS work plans. 4. By 2005, increase from 0 to 50%, and by 2006 reach a target of 80% of HIV-positive pregnant women receiving preventive treatment for mother-to-child-transmission (MTCT) of HIV. 5. By 2003, 80% and by 2004, 100% of non-ministry national public sector agencies have and are implementing HIV/AIDS plans. 6. By 2004, all municipalities have and are implementing HIV/AIDS plans formulated with stakeholder participation. 7. By 2005, increase from 0 % to 60% the proportion of municipalities in which voluntary counseling and testing services are being provided. Process Indicators 8. By the end of the first year of the project, all ministries have HIV/AIDS teams trained as information, education, and communication (IEC) agents for their respective ministries. 9. The total value of project contracts entered into with communities, non-government organizations (NGOs), community-based organizations (CBOs), associations of people living with HIV/AIDS, and private sector agencies is no less than 30% of all project contracts entered into over the previous twelve months. -2- 10. By 2004, all municipalities receiving project funding are submitting acceptable accounting and expenditure reports. Outcome Indicators 11. By 2005, reduce by 20% HIV prevalence among women attending ante-natal care clinics (compared with the first year of the project). 12. By 2005, reduce by 25% the incidence of reported sexually transmitted (urethritis) infections in men age 15-49 years in the previous 12 months, compared with the first year of the project. 13. By 2005, increase the median age of first sex by one year among both females and males (compared with the first year of the project). 14. By 2005, increase from the baselines of 43% (men) and 9% (women) to 60% (men) and 30% (women) the proportion of men and women age 1549 who report using a condom in their last act of sexual intercourse with a non-regular partner. 15. By 2006, reduce from the baseline 45% to 20% the percentage of sexually active people reporting having non-regular sexual partners over the previous 12 months. B. Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported by the project: (see Annex 1) Document number: 22506-CV CAS-Progress Report Date of latest CAS discussion: 08-28-01 The 1997 CAS identified four strategies as the most pressing and important for the future development of Cape Verde: (a) in the private sector, consolidation of policy reforms, macro-economic stability and professional training policy aimed at improving the labor market and the education system; (b) in the social sector, the acceleration of the program on the fight against poverty; (c) in infrastructure and transport, promotion of better management of infrastructure and the adoption of an integrated energy plan and development of water and sanitation systems; and (d) in the public sector, consolidation of public administration reforms and better management of fiscal resources. The CAS Progress Report acknowledges that the threat of an HIV/AIDS epidemic has been understood by the authorities, who submitted a request for support from the World Bank in late 2000, to fight the epidemic. The Report confirms IDA's commitment to support the Government in the context of the Africa-wide rapid response to HIV/AIDS (Multi-Country HIV/AIDS Program-MAP). The next CAS, currently planned for Board presentation in FY03, will continue to give prominence to HIV/AIDS in IDA's program of assistance to Cape Verde. It is expected that the fight against HIV/AIDS will help to prevent a potential decline in the GNP of Cape Verde, associated with the epidemic. 2. Main sector issues and Government strategy: The first cases of HIV/AIDS were reported in Cape Verde in 1986. In 1997, when the last sentinel surveillance data were available, the prevalence of HIV in the general population was estimated between 1.5% and 2.5%. Since then, continuous data on seroprevalence in the country has not been available due to lack of financial resources to sustain the surveillance data system. According to the latest available - 3 - estimates, based on modeling techniques, about 3,000 people age 15-55 in Cape Verde are infected with HIV. The majority of those infected are estimated to be between the ages of 30 and 49 years (67% of all infected people) and between 25 and 29 years (20% of all infected people). This has implications for the socio-economic development of the country as these age groups represent a significant segment of the economically productive population. The main mechanism of transmission of HIV in Cape Verde is by heterosexual transmission, although MTCT also significantly contributes to new cases. There are some anecdotal reports suggesting that drug abuse by injection may be on the rise in the country and that it may also be contributing to HIV infections. Data available from the Department of Epidemiology of the Ministry of Health, Employment,and Solidarity (see chart I below), based on hospital notified cases of full-blown AIDS between 1994 and 2000 show that AIDS cases are rapidly increasing in the country. In the four-year period between 1996 and 2000, the number of full-blown AIDS cases reported through the health facilities doubled from 36 to 75, which translates to 1.8 AIDS cases per 10,000 inhabitants. The Government has formulated a national multisectoral HIV/AIDS strategy for Cape Verde, (the "National Strategic Plan to Fight AIDS 2002-2006") with the objective of reducing the spread of HIV/AIDS in the country. The strategy development process was all-inclusive with the participation of central government, municipalities, NGOs, and UNAIDS and other international donors. Three workshops (June 2001, October 2001, and January 2002) were held to develop the strategy. The strategy is comprehensive and multisectoral, covering the broad spectrum of prevention, care, and support interventions for HIV/AIDS in Cape Verde. The strategy envisages the participation of different stakeholders, including the central government, municipalities, NGOs, the private-for-profit sector, and donors in the implementation of the strategy. It is estimated that the all-inclusive cost of implementing the strategic plan will be about US$20 million for the four-year period. The Government has formed a national coordinating body for HIV/AIDS, the Comite de CoordinacJo do Combate a SIDA - CCS-SIDA (Coordination Committee to Combat AIDS), which is under the office of the Prime Minister and is presided over by the Prime Minister himself. The Vice-President of the body is the Secretary of State for Youth. The body has a multisectoral composition and has representatives of civil society organizations including, among others, representatives of women's and religious organizations. CCS-SIDA is setting up a Secretariat that will be responsible for facilitating and coordinating the national effort. Before the formation of CCS-SIDA, the HIV/AIDS activities of the Government were led by the national AIDS control program Programa Nacional de Luta contra a SIDA (PNLS) of the Ministry of Health, Employment, and Solidarity. In the 1980s, PNLS was led by a team of three technical people. However, a shortage of resources has reduced the number of technical people in PNLS to only one person. Strengthening the capacity of the Ministry of Health, to meet its responsibilities within a multisectoral approach to HIV/AIDS has been identified by the Govermment as one of the critical issues to be addressed in order to reduce the spread of HIV/AIDS in the country, and will be addressed under the project. - 4 - Chart 1 AIDS cases reported in Cape Verde 80 40 ---|-AIDS casees 20 94 95 96 97 98 99 00 Year Role of Civil Society There are several NGOs in Cape Verde working on HIV/AIDS, mainly on information, education, and communications (IEC). However, HIV/AIDS psycho-social and material support, especially to orphans and widows, and medical assistance to people living with HIV/AIDS (PLWHA) and their fanilies could also be strengthened by the NGO community. The NGOs, including religious organizations, have a critical role to play in the implementation of activities aimed at HIV/AIDS prevention, support, and care, and the Government recognizes this role. The Government is working with all these organizations in the effort to control HIV/AIDS via a multisectoral approach. Many NGOs, especially the small ones, may need substantial investment in capacity-building, and the umbrella NGO organization in Cape Verde, the NGO Platform, can assist in this capacity-building process. An NGO for PLWHA does not exist in Cape Verde, although the local NGO community is assisting in the establishment of such an organization. Partnerships Multi- and bilateral development partners present in Cape Verde have been actively engaged and informed of the proposed project and of the Multi-Country AIDS Program (MAP) approach. These partners have- been consulted on the project's design. None of the bilateral partners has so far been involved in addressing HIV/AIDS issues in Cape Verde in a multisectoral manner, but they have supported HIV/AIDS activities in the health sector. Nevertheless, interest has been expressed by some bilateral partners in undertaking activities to support the national strategic plan. The Joint United Nations Program on HIV/AIDS (UNAIDS) theme group has been active in assisting the Government in formulating the multisectoral HIV/AIDS strategy and has been a formal partner in project preparation missions. The UN agencies in Cape Verde have identified areas of complementary interventions to support the national strategic plan. They have also agreed to enhance the plan by assisting public sector agencies and civil society organizations to prepare applications to access project funding and improve the efficiency and effectiveness of program implementation through the specialized technical expertise that UN agencies can provide. In addition, the UNAIDS theme group will assist World Bank supervision missions on an ad-hoc basis. - 5- Cape Verde is eligible for MAP funding in that it satisfies the four MAP criteria: Satisfactory evidence of a strategic approach to HIV/AIDS. Cape Verde has developed a coherent, multisectoral national strategy and action plan for HIV/AIDS prevention, care, and treatment with the participation of all key stakeholders. A high level HIV/AIDS coordinating body. Cape Verde has created a Coordination Committee to Combat AIDS (the CCS-SIDA) which is headed by the Prime Minister. CCS-SIDA has a broad representation of key stakeholders from all sectors to oversee and coordinate the implementation of the "National Strategic Plan to Fight AIDS." Government agreement to use exceptional implementation arrangements. Government has agreed to accelerate project implementation by channeling funds directly to civil society organizations, to communities, and to decentralized sub-national levels of project implementation. In addition, it is contracting out core project administrative activities. Government agreement to use and fund multiple implementation agencies. Government has agreed to expand HIV/AIDS activities to a broad range of ministries, departments, parastatal organizations, and municipalities, as well as to fund activities undertaken by the private sector and civil society organizations. 3. Sector issues to be addressed by the project and strategic choices: The project addresses four key issues: 1. Scaling up activities and coverage; 2. Mainstreaming HIV/AIDS prevention, treatment, care, and support activities into all sectors of Government and into civil society; 3. Focusing on what has worked, i.e. strengthening social capital by empowering communities in fighting against the epidemic and favoring open inter-organizational networks; and 4. Strengthening coping mechanisms including offering a safety net for orphans and for households headed by women, the very young, and the elderly (usually because of the deaths of husbands, parents, or guardians). This project will address the need to scale up activities by extending them to all municipalities. It will assist in mainstreaming HIV/AIDS by engaging ministries beyond the Ministry of Health, Employment, and Solidarity, by empowering communities in the fight against H1V/AIDS, and by engaging civil society including nongovemment organizations, religious organizations, farmers' associations, unions, student associations, private enterprises, women's associations, youth associations, and PLWHA, especially when they form themselves into an organization. The project will focus on and improve what has worked better in the past, i.e., it will reinforce social capital and cohesion by empowering communities through support to civil society led HIV/AIDS initiatives. These will cover health promotion, the establishment of open inter-organizational networks, home-based care, social, and spiritual support to HI/AIDS-affected families. The project will offer an economic safety net in the formn of targeted support to impoverished orphans and households headed by women, young people, and the elderly. The project will provide material and other forms of support including cash grants to families impoverished by AIDS to keep orphans in school. - 6 - The project will support Government efforts to expand services for treatment of people living with HIV/AIDS, especially the treatment of opportunistic infections (including tuberculosis). The implementation of the multisectoral strategy is a challenge that deserves carefully designed implementation and coordination at national and sub-national levels. Links between the line ministries and Cape Verde CCS-SIDA need to be strengthened during the implementation of HIV/AIDS sector-specific strategies. The project will support capacity-building efforts to strengthen these links. Additionally, the capacity of the civil society to implement activities will be supported by the project. C. Project Description Summary 1. Project components (see Annex 2 for a detailed description and Annex 3 for a detailed cost breakdown): Under the regional MAP II, this project will finance HIV/AIDS activities for the period 2002-2006. It will have four components that reflect the two-tiered decentralized administrative structure in Cape Verde at national and municipal levels. The components thus allow for a division between the public sector and civil society while at the same time taking into account the geographical and social separation of the Cape Verdean island communities. Apart from the component on project facilitation, coordination, monitoring, and evaluation (which will support facilitation and coordination of the project), each of the components will support the full spectrum of HIV/AIDS prevention, treatment, care, and support activities that are appropriate at the respective level. The project components are: 1. Capacity-Building 2. Public Sector Initiatives: a) National initiatives; b) Municipal initiatives 3. Civil Society & Private Sector Initiatives 4. Project Facilitation, Coordination, Monitoring, and Evaluation. General The project will scale up the existing HIV/AIDS efforts by mainstreaming program activities into line ministries and other agencies at national and municipal levels and by harnessing the capacity of communities, civil society organizations, including PLWHA, religious organizations, NGOs, CBOs, private sector organizations, women's organizations, youth organizations, and labor unions. Activities to be supported by the project will be coordinated by the Secretariat of CCS-SIDA. Implementation of the activities will be at different organizational levels including implementation by line ministries, municipalities, community-led and civil society organizations, and private sector organizations. Contracting out by ministries and municipalities will be encouraged in order to make the best use of the implementation capacity of civil. society organizations and the private sector. Activities to be supported will include (a) health promotion activities targeted at behavior change to reduce the transmission of HIV; (b) diagnosis, treatment, care and support for PLWHA and others affected by the epidemic; (c) mitigation of the impact of HIV/AIDS, and (d) operational research, surveillance, monitoring, and evaluation, all of which should strengthen national and local capacity to respond effectively and efficiently to the epidemic. The project operations manual (POM) will include examples of eligible sub-projects. The POM will further describe how to get technical assistance to develop a sub-project, how to apply for a grant, how sub-projects will be selected and approved, how funds will be transferred, and how activities will be supervised, audited, and evaluated. -7 - Project Component 1: Capacity-Building (US$ 0.86 million financed by IDA) This component will support HIV/AIDS-related capacity-building for the various implementers of the project. It will support training and other capacity-building activities that are necessary for the public sector and civil society agencies to be able to effectively and efficiently implement HIV/AIDS prevention, care, and support activities in the country. For instance, administrative and financial management capacities of civil society organizations as well as their technical capabilities can benefit from this component. Municipalities and sectoral entities may use the funding of this component to specifically address areas needing strengthening within respective municipalities and sectoral programs. Similarly, CCS-SIDA and its Secretariat will initially need significant capacity-building, which this component would support. Project Component 2: Public Sector Initiatives (US$ 4.31 million financed by IDA) This component will support HIV/AIDS initiatives of both the central government ministries and parastatal organizations together with initiatives of the municipalities. In order to reflect the highly decentralized nature of Government, the public sector initiatives component will be broken into a) national initiatives and b) municipal initiatives. 2a) National initiatives. This component will support public sector HIV/AIDS activities coordinated at national level and will include the HIV/AIDS activities of different line ministries or central government agencies. Some of these activities will be contracted out to civil society organizations or the private sector. Each ministry is expected to have a focal person or team on HIV/AIDS. The Ministry of Health Employment and Solidarity, which already has a unit (PNLS) with specific responsibilities for HIV/AIDS, will continue to carry out health sector related HIV/AIDS activities, in addition to providing technical health related HIV/AIDS support to other ministries which do not have such capacity. As part of the multisectoral approach to HIV/AIDS, every government ministry, including the ministry's community-level authority, will be expected to have at minimum a mechanism for HIV/AIDS IEC for its employees and an HIV/AIDS social support network. Ministries without HIV/AIDS strategy and action plans will be assisted by the project in drafting these documents during the first year of project implementation. Each line ministry action plan will include HIV/AIDS prevention and mitigation activities for its staff, and in particular, measures to mitigate effect of HIV/AIDS in the work place. Ministries and national agencies will also include in their action plans, HIV/AIDS interventions aimed at reaching clients of the respective ministries and agencies. Some specific sectoral ministry responsibilities are outlined in annex 2. 2b) Municipal initiatives. Under the decentralized system of administration in Cape Verde, municipalities are particularly important agents for effecting change at local levels. Under this component, the project will support activities that are directly carried out by municipal authorities, or contracted out by them to civil society organizations or to the private sector. Municipalities can be supported under this component to, for example: * raise HIV/AIDS awareness of municipal leadership, teachers, school management teams and community leaders; * train and support municipal and community-based staff and leaders, including teachers, home-care givers, counselors, and rural extension workers in HIV/AIDS prevention, support, and care; * provide HIV/AIDS related health promotion and prevention services at municipal facilities; * provide HIV/AIDS related diagnosis, treatment, and care at health facilities located in the municipalities; * promote community-led and civil society-led HIV/AIDS initiatives and manage the respective selection, contracting, financing and supervision; - 8 - * provide HIV-related IEC and condom distribution to the municipal workforce; * support municipal HIV/AIDS teams in prevention care and support activities; * ensure the provision of Voluntary Counseling and Testing (VCT) services at the municipal level; * ensure the provision of services for the syndromic treatment of sexually transmitted infections (STI) and Directly Observed Therapies (DOTs) for tuberculosis at municipal level. Many of the activities financed under this component will directly support activities at community levels by civil society and private sector, i.e. advocacy, training, promotion of community led HIV/AIDS initiatives, and DOTs. Component 3: Civil Society & Private Sector Initiatives (US$ 2.62 million financed by IDA) Under this component, the project will support community-led HIV/AIDS activities directly carried out, or contracted out, by civil society organizations, such as NGOs, religious organizations and organizations of PLWHA. Such activities could include, for example: * targeted support to orphans, guardians of poor orphans, and AIDS-stricken impoverished households, including those headed by women, young people, and the elderly (usually because of the death of a spouse, parent, or guardian). In addition, preschool, in-school, and out-of-school orphans will be supported to attend day care centers, formal schooling, and vocational training; * support to families affected by HIV/AIDS including the support of revenue generating activities; * community-based IEC; * home-based care; * promotion of the use of condoms at the community level; * support of community-based HIV/AIDS networks in prevention, care, and support activities. Component 4: Project Facilitation, Coordination, Monitoring & Evaluation (US$ 1.21 million financed by IDA) The functions, operations and responsibilities of the Secretariat of CCS-SIDA, will be specifically funded under this component. The Secretariat will be a lean structure and designed to facilitate and coordinate project execution, with the implementation of project activities being done by the respective ministries, civil society organizations, municipalities, and communities. The main direct responsibilities of the Secretariat will be facilitation, coordination, review of action plans and funding proposals, supervision, M&E ( to be outsourced) and support to CCS-SIDA for longer-term national planning and policy development. In many other MAP countries, program administration has been outsourced to the private sector. In Cape Verde, where there are few suitable private agencies, there is frequently greater capacity in public bodies. In order to rapidly establish administrative systems and allow itself to focus on high-level representation, advocacy, and strategic analysis, the Secretariat will contract out to an existing structure the administrative, financial management, procurement, reporting requirements, and coordination of M&E, including responsibilities for an integrated data base and reporting system. -9- Indicative Bank- % of Component Sector Costs % of financing Bank- - . -- . -. ____. (US$M) Total (USSM) financing 1. Capacity-building 0.86 9.0 0.86 9.6 2 a. National initiatives 2.64 27.5 2.14 23.8 b. Municipal initiatives 2.17 22.6 2.17 24.1 3.Civil society & private sector 2.62 27.3 2.62 29.1 initiatives 4. Project facilitation, coordination, 1.31 13.6 1.21 13.4 M &E__ _ _ __ _ _ _ Total Project Costs 9.60 100.0 9.00 100.0 Total Financing Required 9.60 100.0 9.00 100.0 The total cost of the national HIV/AIDS strategic plan is estimated at US$20 million. IDA will finance US$9 million of that program, while the Government will fund US$600,000. The Govemment is searching for grants from Development partners, including the Global Fund for HIV/AIDS to finance the remaining gap. 2. Key policy and institutional reforms supported by the project: This project is a multisector operation that is not intended to address major long-term sector and institutional reforms within any one sector, or to include conditions linked to macroeconomic or sector policies. However the project will strengthen the following key policy and institutional changes: * making the national HIV/AIDS program truly multisectoral by mainstreaming HIV/AIDS activities into the action plan of every Governnent agency and by strengthening the capacity of CCS-SIDA for national coordination; * ensuring that the national HIV/AIDS program is truly participatory by encouraging private sector (for-profit and not-for-profit) participation and empowering communities to be key players in HIV/AIDS activities. 3. Benefits and target population: Benefits The project will provide the following benefits to Cape Verde. 1. Reduce the number of new HIV/AIDS cases, by reducing the rate of transmission of HIV via * changing unsafe behaviors related to HIV infection; * improving access to condoms; * reducing the rate of sexually transmitted diseases,; * reducing the number of infections transmitted from mother to child. 2. Extend the productive life of people living with AIDS by * improving the prevention and treatment of opportunistic infections, especially tuberculosis; * providing nutritional supplements for people living with HIV/AIDS. 3. Improve the diagnosis, treatment and care for people living with HIV/AIDS by - 10 - * expanding VCT to every municipality and community; * disseminating standard protocols, and training health care providers on the clinical management of STI and HIV/AIDS related opportunistic infections; * improving planning, procurement, and distribution of essential diagnostic kits and pharmaceuticals including antiretroviral drugs, if future Government policy deems it appropriate. 4. Improve the ability of communities, households, and individuals to prevent or cope with impact of HIV/AIDS, through community-led HIV/AIDS initiatives. 5. Improve the economic prospects of orphans and poor HIV-stricken families. Target population The project is designed to cover the entire population of Cape Verde. However, groups particularly at risk of becoming infected or spreading the virus will be identified for intensified provision of services. This includes groups that are especially vulnerable to the impact of the epidemic, such as people living with HIV/AIDS, young people (in particular teenage girls), street children, pregnant women, maritime crews, commercial sex workers, migrants, road and other long-distance construction workers, traders, fishernen, the military, the prison population, impoverished orphans and HIV/AIDS-affected households (focusing on those headed by women, young people, and the elderly). The project will reach them through key sectors such as education, transport, agriculture, health, defense, and social welfare. 4. Institutional and implementation arrangements: Institutional Arrangements The CCS-SIDA is placed under the Office of the Prime Minister and composed of representatives of civil society and Government. The Committee is charged with overall policy-making for the fight against HIV/AIDS. It provides general policy direction for the national HIV/AIDS program and oversees its implementation. The Committee is chaired by the Prime Minister and the Secretary of State for Youth is Vice-President of the Committee. An advisory body for CCS-SIDA that will include representatives from key sectors and institutions as well as representatives from key civil society organizations (including organizations representing people living with HIV/AIDS) will be established. The advisory body will allow a greater number of local and international stakeholders to get involved than can be accommodated in CCS-SIDA. The advisory body will be responsible for giving advice to CCS-SIDA regarding HIV/AIDS policy formulation and implementation in the country. CCS-SIDA Secretariat. The Secretariat will be headed by an executive secretary and will have full-time staff selected on a competitive basis and rewarded according to performance. The Secretariat will be a coordinating and facilitating body of CCS-SIDA and will not be an implementing agency. The Secretariat will ensure the day-to-day project coordination and in particular be responsible for: (a) development of its annual work programs and budget; (b) procurement and disbursement; (c) monitoring and evaluation; (d) financial management; and (e) reporting to and assisting the CCS-SIDA. The Secretariat's responsibilities in program administration will be outsourced. Institutional arrangements for the CCS-SIDA Office of Prime Minister ! CCS-SIDA Advisory Body CCS-SIDA Secretariat ! _ Municipalities Ministries and Central Government Agencies Civil Society Organizations l The Secretariat is also expected to encourage and facilitate national and municipal activities and to provide support to civil society for the formulation of project proposals. The CCS-SIDA Secretariat will review and approve the annual work programs (including project proposals) and budget proposals by ministries and other implementers of the project. Details for the process of Secretariat approval of proposals are outlined in the POM. Once a work program or project proposal is approved, the CCS-SIDA Secretariat will sign a contract with the implementing agency. In light of good financial and procurement capacity in the public sector, expertise for the Secretariat in termns of administration, financial management, accounting, procurement, reporting requirements and coordination of M&E will be made available by an existing structure. The structure to which these responsibilities will be contracted, the transport sector's coordination unit, Programa de Infra-estruturas e Transportes (PIT) has prepared the HIV/AIDS project on behalf of the Government while the CCS-SIDA Secretariat was being established and will continue as the Secretariat's contracted administrative unit (AU) for the purposes of this project. PIT has proven itself capable and has the capacity to undertake this role. The AU of the CCS-SIDA Secretariat will be the service delivery arm of the Government at the national, regional, and local government levels. Sectoral focal teams. These will be established for each sector, within the framework of each sectoral Ministry. There will be a focal person coordinating the teams. Sectoral focal teams will be composed of representatives of government institutions and private organizations. These focal teams will be responsible for facilitating the development and implementation of sector strategies as well as identifying and promoting projects for each sector. They will receive support from the Secretariat of CCS-SIDA to develop their capacity to deliver on their HIV/AIDS responsibilities. Municipal HIV/AIDS committees. Committees will be established throughout Cape Verde to support responses by municipalities in the fight against HIV/AIDS. On those islands where more than one municipality exists, municipalities may choose to undertake joint actions benefitting the whole island. Each municipal HIV/AIDS committee will have representatives from municipal and central government departments and representatives of civil society organizations. The committees will be responsible for promoting municipal activities to be funded under the program, preparing annual action plans and for facilitating monitoring of implementation progress. They will be expected to help local civil society to prepare project proposals for flmding and will have the authority to approve small ad-hoc HIV/AIDS proposals submitted by civil society, up to a limit to be specified in the POM. Civil society organizations with proposals which exceed the amount allowed for approval by the municipal HIV/AIDS committees will submit those proposals directly to the Secretariat of CCS-SIDA for approval. - 12 - Operational Arrangements Operations manual. An operations manual is being prepared by the Government in close collaboration with representatives from both the Government and civil society. The manual will include the project's institutional and implementation arrangements, the respective responsibilities and mandates of each participating entity, and the functional relationships between actors. It will define procedures and eligibility criteria for review and approval of project proposals, as well as provide guidelines for the preparation, implementation, and supervision of project proposals. It will include the contractual arrangements between the CCS-SIDA and implementing agencies and include standard contracts for a broad range of activities. It will also contain procurement arrangements and financial management requirements, including accounting norms and reporting requirements at national, municipal, and civil society levels. The module on financial management has been developed to ensure adequate management of the project. Its use and contents as well as modalities for any future amendments should be satisfactory to IDA, and are part of the Credit agreement. The manual will specify the proposal review threshold for each entity along the following lines: Approving entity Size ofproject proposals (US$ equivalent) CCS-SIDA Secretariat All proposals from ministries, central government agencies, and municipalities. Also civil society proposals amounting to more than US$ 10,000. Municipal HPV/AIDS Approval of proposals from civil society up to US$10,000 and committees referral of larger proposals to the Secretariat of CCS-SIDA. Disbursement of funds for civil society organizations will be in accordance with the eligibility criteria and terms specified in the operations manual. Municipalities will be required to have their own HIV/AIDS action plans before their HIV/AIDS committees can be able to approve proposals for civil society of up to US$ 10,000 per proposal. Implementing agencies. Activities funded under the project will be implemented by both public sector and private sector (civil society and private for-profit) organizations. The project will be implemented in an incremental manner starting with those line ministries, municipalities, NGOs, and CBOs which already have HIV/AIDS work plans. Coverage will be extended to other sectors and organizations of civil society as implementation capacity is strengthened and work plans prepared. Government. Public entities at the national and municipal levels would prepare project proposals and submit them directly to the Secretariat of CCS-SIDA for approval and subsequent funding. Sectoral focal teams within each sectoral ministry will develop various sector strategies. The municipal HIV/AIDS committees will develop municipal strategies and proposals. Funds received by line ministries and municipalities from the CCS-SIDA Secretariat will be complemented by contributions from line ministry and municipal budgets, including provision for sectoral focal teams and the municipal HIV/AIDS committees. Line ministries will develop and implement their respective plans through their existing national departments and municipalities will develop and implement their respective plans through the municipal departments. The ministries and municipalities will provide administrative and technical support to their implementation, including relevant guidelines, training, monitoring, and evaluation. A formal contract including a work program and budget with agreed input and output indicators will guide the relationship between line ministries, municipalities, and the CCS-SIDA Secretariat. -13 - Civil society. Civil society groups operating in only one municipality and with a proposal costing not more than US$ 10,000, will present their project proposals to the respective municipal HIV/AIDS committees for approval. Once proposals are approved by the municipal HIV/AIDS committees, they can then be automatically funded by the CCS-SIDA Secretariat. Civil society implementing agencies of national character (i.e. operating countrywide or in more than one municipality) and those with proposals costing more than US$10,000 will present their project proposals directly to the Secretariat of CCS-SIDA. Most of the total sub-project costs must be directed to activities targeted to beneficiaries. Project M&E and Supervision Project M&E will be based on a broad range of measures, including specified indicators and process and output measures to capture project performance in the intermediate term. A monitoring and Evaluation manual will be produced within five months of project effectiveness and thereafter, implementation of the manual will be in form and substance satisfactory to IDA. Project outcomes will be measured employing data from the HIV sentinel surveillance, baseline, and end-point population-based surveys on knowledge, attitudes, practices, and behavior. Service utilization and special studies commissioned to assess outcome in specific areas not easily addressed by population-based surveys will also be used. Monitoring of the project will be carried out using project-based data, beneficiary inputs, and program reviews. The CCS-SIDA Secretariat (through contracting) will monitor overall project implementation, assessing the performance of project implementation as well as the effectiveness and efficiency of implementation at national, municipal, and community levels. Line ministries will also monitor their respective mandates. The activities of civil society organizations and community-based organizations will be monitored based on their contract performance. CCS-SIDA will supervise overall project implementation and meet regularly to discuss progress under each implementing agency. Staff from the Secretariat and line ministries will make regular visits to the field to monitor the performance of municipalities and civil society organizations. Municipal HIV/AIDS committees will supervise project activities at municipal and community levels. The Secretariat will organize annual project reviews, a mid-term program review by June 30, 2004, and project completion review to assess the performance of the project, its components and its contribution to the national effort to reduce the spread of HIV/AIDS. Project reviews will be carried out in a participative manner, under the coordination and facilitation of the Secretariat and will culminate in stakeholder meetings that will form a basis for planning for the next project period. CCS-SIDA and IDA will organize a joint project launch workshop within a month of project effectiveness. One main purpose of the workshop will be to make further progress on project monitoring and reporting requirements. During the project mid-term review, various indicators will be used to assess project performance and needs for fund reallocation. The Bank's supervision effort in the first year, which will be more intensive than usual, will consist of three formal supervision missions in addition to ad-hoc visits by Bank staff and support from the UN HIV/AIDS theme group in Cape Verde. Details of the supervision plan are described in annex 13. Procurement Procedures CCS-SIDA, line ministries, and municipalities will procure works, goods and services in relation to the - 14 - respective activities, in accordance with the Bank's "Guidelines: Procurement under IBRD Loans and IDA Credits" (January 1995 and revised in January and August 1996, September 1997, and January 1999), in particular Section 3.15, Community Participation in Procurement. Consulting services by firns, organizations, or individuals financed by IDA will be contracted in accordance with the Bank's "Guidelines: Selection and Employment of Consultants by World Bank Borrowers" (January 1997, revised in September 1997 and January 1999). Through the CCS-SIDA Secretariat's AU and through the parastatal monopoly that procures pharmaceuticals and medical supplies (EMPROFAC), the Government will procure items such as condoms, diagnostic kits, and pharmaceuticals for the diagnosis and clinical management of HIV/AIDS, sexually transmitted infections, and opportunistic infections (including tuberculosis). EMPROFAC will produce a procedural manual which institutes a tender board and evaluation commission to enhance the procurement process for pharmaceuticals and medical supplies. The AU staff will include a Procurement Specialist and a Procurement Assistant, in order for the AU to effectively oversee the procurement process. Communities will use the Bank's simplified "Procurement and Disbursement Procedures for Community-Based Investments" to procure goods or services needed to implement their respective community initiatives. Communities and NGOs are expected to use 'local shopping' as a standard procurement method. To facilitate speedy import of items valued at less than US$100,000 equivalent required urgently for diagnosis/treatment and institutional strengthening, contracts may be made based on international shopping and national shopping procedures, respectively, or through procurement from the United Nations. Given the urgency of the project, a wide-ranging general procurement notice for the first year of operations will be placed on the United Nations Development Business web site without a need for hard-copy publication, before credit effectiveness. The Borrower will prepare a procurement plan for the first year of project operations, to be included in, the POM before credit effectiveness, and subsequently annual procurement plans. Procurement performance (including sub-project procurement activities) will be assessed on an annual basis (in the form of procurement and physical audits by an external agency). In addition to the formal annual audits, ad-hoc procurement reviews will be conducted periodically. Accounting, Financial Reporting, and Auditing Arrangements The Secretariat of CCS-SIDA, through its contract with AU, will be responsible for project financial management, including the preparation and production of the annual financial statements in accordance with internationally accepted accounting principles. The Secretariat will make arrangements for certification of financial statements by an audit firm under terms and conditions acceptable to IDA. The AU will monitor all disbursements under the project and ensure that they conform to IDA requirements. Implementing agencies will submit to IDA (through the AU) annual and quarterly reports on the progress of implementation of their respective activities. Before effectiveness, the project financial management system, which will be computerized, will be reviewed for compliance with the IDA-established financial management system assessment guidelines to ensure agreement with Bank procedures. The financial management system will allow for the proper recording of all project-related transactions as well as timely monitoring of expenditures per category, implementing agency, and component. The AU will maintain a separate set of accounting records for the different portions of the program. In addition to maintaining the accounts at the central level, AU will be responsible for the consolidation of the project accounts and the production of the annual financial statements. To ensure consistent financial reporting, detailed procedures will be developed for project accounting based on IDA's experience with other decentralized projects. Internal accounting controls for the project will be set out in detail in the - 15 - financial procedures of the POM and will be satisfactory for providing reasonable assurances that accounts will be properly recorded and resources safeguarded. The accounting systems at the AU will be computerized with software used in several other IDA financed projects in the region and which has been found to be satisfactory for Borrower and IDA purposes. The chart of accounts for the project will be clearly designed to allow reporting to requirements of each of the donors. The Government has provided assurance that (a) the records and accounts of all the components of the project will be audited annually in accordance with intemational audit standards by experienced and internationally recognized audit firms acceptable to IDA; (b) in addition to a standard short form report with the audit opinion, the auditors will be required to comprehensively review all the SOEs and the management and utilization of the accounts (special account, counterpart fund account, and municipal accounts) as well as the intemal control procedures goveming preparation of accounts for the relevant period under audit, to express a separate opinion thereon, and to review the management and utilization of the special accounts and express a separate opinion thereon as well; and (c) the auditor will complete an in-depth review, started at interim, of the intemal control system of the program with a view to identify the major weaknesses and shortcomings and proposing practical recommendations for improvement. The results of this review will be documented in a management letter to be submitted along with the audit reports. The establishment within the AU of a sound financial management system acceptable to IDA and the recruitment of the project auditor are conditions of effectiveness. The AU will submit the following reports: (a) semi-annual progress reports; (b) an annual report and a proposed financing plan no later than the last month of the current year; (c) a detailed progress report on technical and financial program activities (not later than four weeks before the date of mid-term review); (d) a mid term review progress report; (e) relevant sections of the implementation completion report (ICR) three months before the closing date; and (f) a report on a plan designed to ensure future achievement of objectives of the project, not later than six months after the closing date of the project or such later date as may be agreed upon with IDA. The implementing agencies will submit consolidated quarterly financial reports with supporting documentation to the AU which will consolidate the financial reports of the operational components. The first FMR shall be fumished to IDA not later than 45 days after the end of the calendar quarter after the effective date of the project. Thereafter, each FMR shall be fumished to the association not later than 45 days after each subsequent calendar quarter, and shall cover such calendar quarter. The annual financial statements of the project which will be prepared in accordance with FARAH guidelines of IDA, will include at least a statement of sources of funds, a statement of reconciliation of the special accounts, a balance sheet, and required notes to the financial statements. Also they will be submitted to IDA no later than six months after the end of the fiscal year. It was agreed, however, not to proceed immediately with PMR-based disbursement method during the first 18 months of implementation while the financial management system is reinforced further to ensure an orderly transition to a new system. To that end, the Bank will carry out at the end of the first year of implementation, a comprehensive and detailed assessment of the program financial management to determine its full readiness for the above-mentioned system. During the first two years of implementation, meanwhile, disbursements under the program will be made in accordance with the SOE-based approach. The program will still be required to submit, in addition to its financial statements, five quarterly reports, namely a summary of sources and uses of funds, a contract expenditure report for goods and works, a contract expenditure report for consultants, a procurement management report for goods and works, and a procurement management report for consultants. All procurement documents, contracts, and invoices would be maintained separately by the AU and be made accessible to supervision missions and auditors. In order to satisfy the above conditions without delay, a CFO and a highly qualified accountant will be - 16- recruited at the AU, while at the municipal level, accountants will be appointed to direct and guide the financial management operations of the project. Different levels of training will be required in financial, management, and government accounting, in information systems, and in computer application. Procedures relating to utilization of funds (e.g., special accounts, SOEs, special commitments, procurement, etc.). On-the-job coaching will also be provided. The CFO and the accountant will be recruited for the project by the time of effectiveness and funded from project resources. Immediately after recruitment, the CFO will begin to familiarize himself or herself with the project's context, assimilate Bank and Government requirements for financial management, and consult and coordinate with other similar projects with the objective of implementing adequate financial management procedures and systems for accounting and periodic reporting for the Project. More specifically, the CFO will need to: (a) become familiar with Bank's current disbursement procedures; (b) make an assessment of the software available for accounting for project expenditures and which of the available software is likely to be the most suitable; and (c) assess whether for any of the above tasks, the CFO would need the assistance of a consultant (if so, the CFO would prepare a specific proposal for financing under the project itself). The Chief Financial Officer (CFO) of the AU team will be entrusted with the project's overall financial management and reporting and will serve as the principal contact for Bank disbursement. Implementing agencies (at the national and municipal levels) will be in charge of reporting with respect to their activities. Payments to the beneficiaries will flow from the following accounts: counterpart fund, special account, and municipal accounts. The payments will be made according to predetermined disbursement schedules to be specified in the respective proposals and be effected expeditiously when due. Fund management will follow transparent procedures that will be standardized across implementing agencies and detailed in the project operations manual. For the sake of efficiency in disbursement of funds and financial management, the Borrower and IDA agree that one Bank be used for all the municipality accounts. D. Project Rationale 1. Project alternatives considered and reasons for rejection: Under the MAP for the Bank's Africa Region (Project Appraisal Document Report No. 20727, page 26), sector investment operations for individual countries and a vertical adaptable program loan (APL) for Africa, in combination with the horizontal APL proposed, were two altematives considered and rejected. The Cape Verde HIV/AIDS Project is a four-year specific investment loan (SIL) under MAP. It focuses resources on a national multisectoral response to the HIV/AIDS epidemic. Strategic Choices Many countries in Africa, including Cape Verde, have HIV/AIDS programs which are mainly led by the ministries of health. The HIV/AIDS epidemic in countries with only health-sector related HIV/AIDS programs continues to spread despite these efforts. While the health sector has clearly a major role to play, an effective response to curb such a large-size epidemic requires preventive and mitigating measures beyond the health sector. An inability to act across sectors or to deliver resources to the many local actors, *who would generate a broad-based response, have been the main obstacles to controlling the spread of HIV/AIDS. The key strategic choice was therefore whether to invest in a program similar to the traditional HIV/AIDS programs that target mainly the health sector, or to invest in a multisectoral program that allows HIV/AIDS activities to be supported across sectors and involves communities, civil society, the private sector, and other stakeholders. The project is structured as a free-standing sector investment credit, under the umbrella of the Multi-country HIV/AIDS Program for Africa because (a) what is needed is a - 17 - war-like effort to scale up HIV/AIDS response across sectors, and (b) it would otherwise have been difficult to mainstream HIV/AIDS activities into national and municipal agencies, civil society, the private sector and communities. 2. Major related projects financed by the Bank and/or other development agencies (completed, ongoing and planned). - - _Latest,Supervislon Sector Issue j Project (PSR) Ratings l____ ____ ____ _____ ____ ____ ________ __(Bank-financed proJects only) Implementation Development Bank-financed Progress (IP) Objective (DO) Vocational/Technical education & Education & Training Cons. S S training Cr. 32230-CV, Closes: June 30, 2003. Sustainable energy Energy/Water S S Cr. 32050-CV, Closes: June 30, 2004 Structural adjustment Structural Adjustment HS S Cr. 35870-CV, Closes: December 31, 2002 Privatization Privatization Ta. S S Cr. 31210-CV, Closes: December 31, 2003 Public sector reform Public Sec. Reform Supp. S S Cr. 32940-CV, Closes: June 30, 2002 Social protection Social Sector Devt. S S Cr. 32240-CV, Closes: August 31, 2003 Transport (Roads), Ports & Waterways Transport Infrastructure S S Cr.24660-CV & 24661-CV, Closes: December 31, 2003 Other development agencies GTZ Agricultural/Health Support Swiss Development Cooperation Employrnent Generation UNFPA Family Planning Services Luxembourg Cooperation Social Sector Support French Cooperation Health Sector Support USA Governnent Social and Health Portuguese Cooperation Social and Health Sector Austrian Development Cooperation Social and Health Support IP/DO Ratings: HS (Highly Satisfactory), S (Satisfactory), U (Unsatisfactory), HU (Highly Unsatisfactory) - 18 - 3. Lessons learned and reflected in the project design: The design of this project reflects international experience with HIV/AIDS) especially regional experience from countries like Uganda and Senegal), ongoing HIV/AIDS control efforts in Cape Verde, and the experience so far obtained in the Africa region in designing and implementing the MAP. Key lessons learned from all this experience are outlined below and have been incorporated in project design. Political leadership and commitment. International experience has taught that political leadership and commitment is a key issue in mobilizing national and donor resources for the fight against the HIV/AIDS epidemic. The Government has indicated its firm commitment to the fight against HIV/AIDS. Effective action requires national leadership and political commitment at the highest levels. The successful examples of control of the HIV epidemic in countries like Senegal and Uganda were based on political leadership, good epidemiological data, effective programs, and vibrant activist civil society participation. In Cape Verde, the leadership is unanimous on the need to tackle the epidemic effectively. Vulnerability factors are key drivers of the epidemic. The HIV/AIDS epidemic is nourished by underlying vulnerabilities among populations. The combination of poverty, gender disparities, and information asymmetry provide very fertile soil on which the seed of HIV can rapidly grow and blossom. Any attempt at controlling the epidemic will have to address vulnerability factors. This project will focus on the vulnerable groups, among others including women, youth, orphans, and widowers in prevention and mitigation efforts. Community participation as a process of empowerment. The communities affected by the HIV/AIDS epidemic find themselves facing multifaceted challenges, and have very few resources and little capacity to respond. In addition, short term focused strategies may not meet the need for longer term rehabilitation and healing in those communities. Community participation engages the people in a partnership to fight the epidemic. With external resources and the building of local capacity, the communities will be more empowered in their response to HIV/AIDS. Such a response is also more likely to be sustainable in the long term. This project will have a specific component on community-led HIV/AIDS initiatives. Multisectoral approach. It has been widely recognized that the HIV/AIDS epidemic extends far beyond the narrowly defined health sector. The multidimensional nature of the epidemic and its impacts warrant a change in paradigm from a biomedical to a development one. In this context, the multisectoral approach in HIV prevention, care, and mitigation offer the best chance of success. This project will involve the active participation of all line ministries and civil society. Complexity of supervision of MAP projects. Given the innovative MAP approach and the multitude of stakeholders and partners, supervision of MAP projects deserves more attention and resources than average projects. The experience so far gained suggests that supervision teams for MAP projects should draw on the resources of partners, particularly bilaterals and other stakeholders. The composition of the supervision teams should also be multisectoral. Robust M&E. The key features of MAP are the scaling up of multisectoral programs and effective interventions, which require robust monitoring and evaluation systems. The monitoring and evaluation plan needs to be developed through a participatory process as a number of partners will be involved in monitoring and evaluation activities according to their areas of expertise. Sufficient resources and skills should be made available for monitoring and evaluation of projects in the MAP, Facilitation and coordination vs. command and control. Review of preparation and implementation of MAP I suggest that there is an inherent danger of National HIV/AIDS Council Secretariats (NAC Secs) empowering themselves. Recommendations include retaining in the NAC Secs only the tasks of coordination and facilitation. 19 4. Indications of borrower commitment and ownership: The Government has committed itself to responding appropriately to the HIV/AIDS epidemic and the Prime Minister of the country, together with many high-level Government officials, has repeatedly expressed a commitment to fight HIV/AIDS. The formation of the CCS-SIDA has full support of the Government (it is under the Office of the Prime Minister) in facilitating and coordinating the multisectoral approach to HIV/AIDS. 5. Value added of Bank support in this project: Cape Verde's efforts in fighting HIV/AIDS have for some years been seriously hampered by lack of resources. Donor attention to this issue has been inadequate. The Bank's financial contribution to the national HIV/AIDS strategic plan together with its ability to ensure appropriate fiduciary architecture and to attract donor interest could catalyze a coherent, multisectoral, and well-funded response to HIV/AIDS in Cape Verde. E. Summary Project Analysis (Detailed assessments are in the project file, see Annex 8) 1. Economic (see Annex 4): o Cost benefit NPV=US$ million; ERR = % (see Annex 4) o Cost effectiveness * Other (specify) The detailed economic analysis on HIV/AIDS has been carried out under the umbrella project (See annex 5 of the Project Appraisal Document for the Multi-Country HIV/AIDS Program for the Africa Region-Report No. 20727 AFR, paragraphs 76-78). The analysis includes an overall assessment of the impact of HIV/AIDS on economic development and poverty and shows that a reduction in AIDS-related deaths would increase growth of GDP. 2. Financial (see Annex 4 and Annex 5): NPV=US$ million; FRR = % (see Annex 4) Paragraph 79 of the project appraisal document for the Multi-country HIV/AIDS Program for the Africa Region (Report No. 20727 AFR) states that, "for each of the physical works components, the operation and maintenance costs will be calculated and commitment required from Government to finance and carry out effective O&M on an annual basis. An annual review of O&M for physical works will be carried out three months prior to the beginning of each fiscal year." Furthermore, with a portion of the resources directed at community interventions, civil society organizations, and outsourcing, the fiscal impact of the program should be manageable. Fiscal Impact: The fiscal impact of the project is not expected to be significant. The amount to be disbursed annually, less than US$2 million, represents slightly more than one percent of the total Government budget. Counterpart funds are not expected to be unduly heavy as works and operations costs represent a small proportion of the project costs. Civil works will be limited to minor renovation of existing facilities. The actual fiscal impact is further minimized since a significant portion of the will be implemented directly by NGOs, private sector organizations, and CBOs. 20 3. Technical: The project has incorporated the best internationally accepted practices for HIV/AIDS response as defined in the MAP and is consistent with UNAIDS guidance on HIV/AIDS in developing countries. These international practices have been tailored to Cape Verde and the project is designed in such a way as to enable incorporation of new practices that may prove effective in the future. 4. Institutional: 4.1 Executing agencies: The experience of the different implementing agencies is diverse. Before the formation of CCS-SIDA, the Ministry of Health, Employment, and Solidarity was already implementing HIV/AIDS-related interventions within the health sector. That ministry should therefore have little problem in scaling up its operations and sharing experience with other ministries. CCS-SIDA, which is new, will have representatives from other ministries with previous experience in managing IDA-supported projects. The project will finance capacity- building for CCS-SIDA and its Secretariat in order to enable efficient coordination of HIV/AIDS activities in the country. Municipalities will be essential to the success of this operation, as they will implement a large part of the project and will integrate multisectoral efforts into cohesive municipal action plans. The project will, whenever feasible, utilize decentralized mechanisms for transfer of project functions, authority, and resources from CCS- SIDA to the municipalities and communities. The project will opt for using municipal government structures or civil society organizations and very simple procedures to channel funds to communities. Some civil society organizations, especially the large religious organizations, may have good management and have experience in managing substantial financial resources for development purposes. Others (in most cases small organizations) need support in capacity- building to enable them to manage substantial financial resources. Small civil society organizations will be encouraged to work in partnership with larger organizations, which usually have organizational capacity to manage substantial amounts of development resources. Capacity-building, within the civil society organizations, will also be supported by the project. 4.2 Project management: CCS-SIDA is well placed to coordinate the national effort to fight HIV/AIDS in a multisectoral approach. Each line ministry and municipality will manage the implementation of its own HIV/AIDS plan to ensure ownership. CCS-SIDA is a new organizational structure and the project will assist CCS-SIDA in capacity-building and, in addition, will contract a project coordination team, to carry out project management duties of the project. 4.3 Procurement issues: The AU will include procurement specialists. 4.4 Financial management issues: The main issue in financial management would be to establish a system that is compliant with World Bank procedures by credit effectiveness. The approach that is proposed to establishing such a system is described in C.4 above. The proposed approach would be the same as in the case of procurement. The mechanisms 21 that have been put in place and have worked under similar projects would be used under the present project. The project will take various measures to strengthen the institutional capacity of CCS-SIDA and its Secretariat, including contracting with an existing structure (AU) with proficiency and experience in administrative and financial management. The AU will be adequately staffed by competent and qualified people, especially with regard to the key staff in the areas of financial management, procurement, and M&E. The AU will have in place adequate support systems, including financial management and M&E systems. The AU will provide guidance to civil society organizations and to communities with regard to accountability matters and design of simple reporting formats for the civil society and private sector component. An independent auditor for the project will be appointed by credit effectiveness. Disbursements Profile (Bank FY/US$ Million 10.00 9.00 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 1 2 3 4 5 5. Environmental: Environmental Category: B (Partial Assessment) 5.1 Summarize the steps undertaken for environmental assessment and EMP preparation (including consultation and disclosure) and the significant issues and their treatment emerging from this analysis. The environmental category of the project is B, without a separate Environmental Assessment. The recent revision of the safeguard policy, which requires a separate environmental plan for category B projects that have to be disclosed in country and in Infoshop, was introduced during the project's preparation. Due to the lead time needed for hiring a consultant to do a medical waste management plan and in light of the urgency and priority of the project, it was recognized that disclosure would not be possible prior to project appraisal. The medical waste management plan has now been prepared and is under review by ASPEN to be disclosed in country and in Infoshop once finalized. The final version of the plan will be available before credit effectiveness. The project is not expected to have substantial adverse environmental effects. Possible environmental risks - 22 - include inappropriate handling and disposal of medical waste and inadequate management of the respective disposal sites in urban or peri-urban areas, where domestic and medical waste may be mixed. The medical waste management plan now in preparation will mitigate these potential risks. In line with the provisions of the medical waste management plan, the project will finance training of health care professionals and community workers delivering care to HIV/AIDS patients. This training will include instruction on appropriate separation, transport, and disposal of hazardous medical waste. The project will support the revision of existing health sector guidelines on appropriate management of medical waste at medical facilities and at disposal sites to include the relevant sections regarding HIV/AIDS. 5.2 What are the main features of the EMP and are they adequate? The EMP for the proposed project consists of a medical waste management plan, a draft of which has been produced that has assessed: * Cape Verde's legal framework pertaining to medical waste management and treatment; * altemative technologies and facility sizes for treatment and destruction of medical waste; * available information on existing disposal sites; * the potential of the private sector as service provider, as well as public-private partnerships in medical waste management and treatment; * training needs for effective implementation of the medical waste management plan. The information and recommendations that will be provided in the final medical waste management plan will enable the project to adequately address the project's medical waste management issues in a comprehensive manner, involving all key stakeholders. 5.3 For Category A and B projects, timeline and status of EA: Date of receipt of final draft: May 31, 2002 5.4 How have stakeholders been consulted at the stage of (a) environmental screening and (b) draft EA report on the environmental impacts and proposed environment management plan? Describe mechanisms of consultation that were used and which groups were consulted? The medical waste management plan outlines stakeholder participation requirements during the implementation of the plan. Different stakeholders were consulted during the preparation of the draft, including the country's environmental agency (SEPA) which is under the Ministry of Agriculture and Fisheries, the Directorate of Health in the Ministry of Health, Employment, and Solidarity, representatives of the Ministry of Justice and Intemal Administration, representatives of the municipalities, representatives of NGOs including the umbrella NGO organization, the NGO Platform. Furthermore, the medical waste management plan envisages a public awareness process that will include members of the general public, and more specifically, health care workers, municipality workers, dump site managers, incinerator operators (as appropriate), and NGOs. 5.5 What mcchanisms have been cstablished to monitor and evaluate the impact of the project on the environment? Do the indicators reflect the objectives and results of the EMP? The final medical waste management plan will include a monitoring plan, which would involve key stakeholders. 6. Social: 6.1 Summarize key social issues relevant to the project objectives, and specify the project's social development outcomes. The project is expected to have a positive social impact by assisting and empowering people and - 23 - institutions to deal more effectively with the HIV epidemic. People living with HIV/AIDS and their families will have an opportunity to receive better social support from their communities, civil society organizations, and the Government. Famnilies of people living with HIV/AIDS are vulnerable to economnic and human rights abuses in the absence of legislation and social norms that can protect them. The project will support Government efforts to legally protect people living with HIV/AIDS. The project will involve key stakeholders, including civil society organizations and people living with HIV/AIDS in the development of such protective measures. 6.2 Participatory Approach: How are key stakeholders participating in the project? The Cape Verde HIV/AIDS project was developed in consultation with the national, municipal, and community leaders. During project preparation, consensus-building exercises (especially in the development of the national strategic plan) involved major stakeholders. Project design and implementation arrangements have also included wide consultations. Further, the composition of CCS-SIDA includes representatives of civil society as well as Government, and this will likely also be the case with the advisory board once it is established. During project implementation, communities will be able to express their needs through community-led HIV/AIDS initiatives and to participate as active partners in project implementation, adding ownership, transparency and accountability to the project. 6.3 How does the project involve consultations or collaboration with NGOs or other civil society. organizations? Civil society organizations were consulted during project preparation and will execute a significant part of the project, supporting government agencies and comrnunity-led initiatives. Civil society organizations will also be consulted in the annual project reviews, in the mid-term review, and during the sumnmary evaluation of the project. 6.4 What institutional arrangements have been provided to ensure the project achieves its social development outcomes? CCS-SIDA has representatives from different government agencies and from civil society. The project supports the development of relevant legal and social initiatives to protect the most vulnerable, i.e. women, young people (especially adolescent girls), and PLWHA. 6.5 How will the project monitor performance in terms of social development outcomes? Gender-specific indicators have been included among the project performnance indicators. 7. Safeguard Policies: 7.1 Do any of the following safeguard policies apply to the project? Policy Applicability Environmental Assessment (OP 4.01, BP 4.01, GP 4.01) * Yes 0 No Natural Habitats (OP 4.04, BP 4.04, GP 4.04) 0 Yes * No Forestry (OP 4.36, GP 4.36) 0 Yes * No Pest Management (OP 4.09) 0 Yes * No Cultural Property (OPN 11.03) 0 Yes * No Indigenous Peoples (OD 4.20) 0 Yes * No Involuntary Resettlement (OP/BP 4.12) 0 Yes * No Safety of Dams (OP 4.37, BP 4.37) 0 Yes * No Projects in International Waters (OP 7.50, BP 7.50, GP 7.50) 0 Yes * No Projects in Disputed Areas (OP 7.60, BP 7.60, GP 7.60)* 0 Yes * No - 24 - 7.2 Describe provisions made by the project to ensure compliance with applicable safeguard policies. The project complies with all Bank's safeguard policies, with the exception as indicated in Section 5.1 above. The project will comply with all these safeguard policies by credit effectiveness. F. Sustainability and Risks 1. Sustainability: The project is expected to be sustainable in the medium term because it is built upon strong Government and civil society ownership and supports the expansion of HIV/AIDS activities that involve communities, civil society organizations, and other stakeholders. The project will scale up existing HIV/AIDS activities by mainstreaming activities into all government sectors and civil society, and by tapping into community organization resources. The project emphasizes institutional capacity-building at national and local level which would further enhance the sustainability. of the project and its local sub-projects. As far as financial sustainability is concerned, it is unlikely that the Government will be able to fully finance the program in the medium term. It is realistic to expect that bilateral and multilateral development agencies will continue to finance HIV/AIDS activities in the country beyond the period of project implementation. The overall project risk is estimated to be moderate because there is good government and civil society ownership, and because CCS-SIDA will benefit from the experience of several CCS-SIDA members who have already been involved in HIV/AIDS activities in Cape Verde. There is however a modest risk that the project will not be able to significantly scale up operations because some line ministries and a number of municipalities have little experience with multisectoral initiatives and no experience in HIV/AIDS control. In addition, the project will have to set up a new system to channel funds to civil society. To reduce this risk, project supervision will be much more intensive than it would otherwise be and, when necessary, it will include substantial technical support. To minimize risk and ensure the success in implementation of this project, IDA will have to: * provide adequate resources for supervision which are above the standard supervision coefficients; * conduct supervision with teams that have specialists from various sectors and in particular, have specialists in key areas such as financial management, procurement, monitoring, and evaluation; * collaborate closely with internal/extemal partners and stakeholders. - 25 - 2. Critical Risks (reflecting the failure of critical assumptions found in the fourth column of Annex 1): Risk Risk Rating Risk Mitigation Measure From Outputs to Objective Central and local governments, sector M CCS-SIDA with all partners will continue to ministries, and community leaders may create demand and commitment at all levels, not honor their commitment to including the participatory development of participatory development and to the comprehensive national and local HIV/AIDS creation of an enabling enviromnent for strategies and action plans. The decentralized local responses to HIV/AIDS. and participatory implementation will help sustain the political commitment. CCS-SIDA secretariat will act as M Design of institutional arrangements to promote command and control body rather than facilitation and coordinating role. Financial facilitator and coordinator. management, procurement and M&E will be outsourced. Cultural, religious, and other beliefs may M Cultural, religious, and other opinion leaders limit the capacity of the country to scale were involved, as early as possible, in project up action. design and will be involved in implementation, monitoring, and evaluation. From Components to Outputs Some local government and civil society S The process and documentation required for organizations may lack the capacity to sub-projects implemented by community design and manage their respective organizations and other civil society sub-projects. organizations will be. simplified and standardized. Capacity-building, especially for local government and civil society organizations will be emphasized during project implementation Simpler procurement and disbursement procedures for community-based investments will be implemented. Allocation of small grants will permit generalized learning by doing. Performance-based replenishment weeds out implementing entities whose capacities are not improving. Stronger NGOs will be encouraged to mentor weaker NGOs. Slow disbursement of-project operations M Where necessary, outsourcing of fund due to: management and financial reporting procedures a) limited financial management capacity; will be used to improve disbursement capacity. b) inadequate procurement procedures and Procurement of large quantities of items will capacities; preferably be done by external procurement c) delays in appraisal and approval of agents. Appraisal and approval of sub-projects sub-projects. will be decentralized to ensure a speedy process. - 26 - Poor intersectoral collaboration at S Co-ordination capacity of the national national and local levels. CCS-SIDA will be strengthened through capacity-building and where necessary the use of technical assistance. Ensure that the coordination bodies meet at least once every three months. Decentralization to weak implementation M Mitigation measures to be built into the project units may result in fiduciary problems. as follows: a) accountability to end users via participation by end-users in project design and implementation; b) contracting financial management when necessary; c) random financial, technical and process audit of all small executing entities and mandatory publication of all audit results, complemented by audits triggered by beneficiary complaints; d) financial audits of all large scale executing entities; e) integrated reports from executing entities which link performance to financial report; f) design simple but credible financial accounting mechanisms, especially for communities and small NGOs. Overall Risk Rating M Risk Rating - H (High Risk), S (Substantial Risk), M (Modest Risk), N(Negligible or Low Risk) -27 - 3. Possible Controversial Aspects: No controversial aspects foreseen in the context of Cape Verde. G. Main Credit Conditions 1. Effectiveness Condition * The project account has been opened and the borrower has made the initial deposit into the account. * The borrower has adopted a) an accounting, financial and management system for the project; b) the project operational manual; c) the financial, administrative and accounting manual; d) a procurement plan for the first project year; and e) a medical waste management plan; all in form and substance satisfactory to IDA. * Borrower has, in accordance with the project procurement methods, appointed a firm acceptable to the Association to be responsible for the carrying out of Project audits. * Borrower has provided satisfactory evidence that FMRs can be produced. 2. Other [classify according to covenant types used in the Legal Agreements.] Monitoring and evaluation manual furnished to IDA by the borrower, no later than five months after effectiveness date, and thereafter implementation of the manual in form and substance satisfactory to IDA. H. Readiness for Implementation FII 1. a) The engineering design documents for the first year's activities are complete and ready for the start of project implementation. 1 1. b) Not applicable. L] 2. The procurement documents for the first year's activities are complete and ready for the start of project implementation. 1 3. The Project Implementation Plan has been appraised and found to be realistic and of satisfactory quality. O 4. The following items are lacking and are discussed under loan conditions (Section G): 1. Compliance with Bank Policies Z 1. This project complies with all applicable Bank policies. Ol 2. The following exceptions to Bank policies are recommended for approval. The project complies with all other applicable Bank policies. GylfiPllsson M v, Me Ie sis-Fraissard John McIntire Team Leader S tor M nager/Director Country Manager/Director - 28 - Annex 1: Project Design Summary CAPE VERDE: HIV/AIDS PROJECT Key Performance Data Collection Strategy Hierarchy of Objectives Indicators Critical Assumptions Sector-related CAS Goal: Sector Indicators: Sector/ country reports: (from Goal to Bank Mission) Poverty reduction and social Prevent GNP per capita from Country economic data No unexpected natural sector development declining further than the disasters occur. 1999 level of US$1,330. Project Development Outcome / Impact Project reports: (from Objective to Goal) Objective: Indicators: Reduced spread of HIV By the end of the third year of Cape Verde national Multisectoral activities will infection in Cape Verde the project, prevent the HIV/AIDS surveillance lead to behavior change. increase (compared with the figures Clients and service providers first year of the project) in serprvaene f IVinth continue to have interest and seroprevalence of HIV In thecomtetoHI general population. commitment to HIV prevention care and support By 2005, reduce by 20% HIV activities. prevalence among women Cape Verde national Government institutions attending ante-natal clinics HIV/AIDS surveillance continue to view communities (compared with the first year figures and civil society organizations of the project). as partners in the fight against HIV/AIDS. By 2006, reduce from the National HIV/AIDS survey Nationwide HIV/AIDS IEC baseline 45% to 20% the data messages are embraced by percentage of sexually active communities across the people reporting having country. non-regular sexual partners over the previous 12 months. By 2005, reduce by 25% the Cape Verde national STI services are offered in a incidence of reported sexually HIV/AIDS surveillance client sensitive manner, and transmitted (urethritis) figures the syndromic approach to infections in men age 15-49 treatment of STIs is widely years in the previous 12 used across the country. months, compared with the first year of the project. By 2005, increase the median National HIV/AIDS survey Youths targeted HIV/AIDS age of first sex by one year data IEC is supported by among both females and community leaders. males (compared with the first year of the project). By 2005, increase from the National HlV/AlDS survey data Social marketing of condoms is baselines of 43% (men) and 9% not opposed by community (women) to 60% (men) and 30% leaders. (women) the proportion of men and women aged 15-49 years who report using a condom in their last act of sexual intercourse with a non-regular partner. - 29 - } [ ~~~~~~~Key Performance lDaita Collection Strategy .. Hierarchy of Objectives IndicaDcrs . y Critical Assumptions Output from each Output Indicators: Project reports: (from Outputs to Objective) Component: I. Capacity built for By the end of the first year of Project data There is continued political implementing HIV/AIDS the project, at least 70% of support and line ministry prevention, care and support HIV/AIDS focal point people ownership for sectoral in line Ministries have had HIV/AIDS programs. some form of formal training on HIV/AIDS. By the end of the first year of Project data Municipalities support the project, at least 60% of the HIV/AIDS control activities municipalities have in their respective areas. HIV/AIDS commiKtees that have received formal training on HIV/AIDS. By the end of the third year of Project data the project, at least three national-level HIV/AIDS-related financial management training sessions organized under the auspices of the NGO platform. 2.Public sector initiatives: 2a. National public sector Project data National leaders continue to HIV/AIDS prevention and By 2003, all Ministries have support HIV/AIDS prevention mitigation measures and are implementing their and mitigation measures. implemented. HIV/AIDS work plans. Ministry of education, culture By 2004, all Government and and sports leadership parastatal managed primary, Ministry of education, culture continues to support the secondary and high schools and sports data skills-based approach. are using curricula that incorporate HIV/AIDS in a skills-based learning approach. Political interference is not a factor in providing program By the end of the second year Project data support national groups that of the project, develop and need assistance. disseminate national policy on social support networks for HIV/AIDS at national level. Non-ministry national public sector agencies take By 2003, 80% and by 2004, Project data responsibility for their 100% of non-ministry national public sector agencies have and HIV/AIDS activities. are implementing HIV/AIDS plans. - 30 - By the end of the first year of Ministries give priority to the project, all ministries have having their own HIV/AIDS HIV/AIDS teams trained as Project data IEC agents. information, education, and communication (IEC) agents for their respective ministries. By 2005, increase from 0 to Cape Verde national The price of antiretroviral 50%, and by 2006 reach a HIV/AIDS surveillance drugs continues to decline. target of 80% of HIV positive figures pregnant women receiving preventive treatment for mother-to-child-transmission (MTCT) of HIV. 2b. Municipality public sector By 2004, all municipalities Project data Leaders at municipality level HIV/AIDS prevention and have and are implementing take ownership of their mitigation measures their respective HIV/AIDS respective HIV/AIDS plans. implemented plans formulated with stakeholder participation By 2005, municipality Project data policies for social networks of NGOs extend their HIV/AIDS people affected by HIV/AIDS networks across the country to are being implemented in all support weak municipalities. municipalities By 2005, increase from 0 % to 60% the proportion of project data Voluntary Counseling and municipalities in which testing services are offered in voluntary counseling and a confidential manner. testing services are being provided. By 2004, all municipalities receiving project funding are Project data Weak municipalities are given submitting acceptable appropriate training. accounting and expenditure reports. 3. Civil society HIV/AIDS By 2004, all schools in the Ministry of education, Teachers provide leadership prevention and mitigation community are implementing culture, and sports data in their communities, on safe measures implemented HIV/AIDS-sensitive curricula. sex behaviors. By 2004, increase from 0 to Cape Verde project supported Civil society organizations are 50%, and by 2006 reach a survey data actively involved in the target of 80%, of reported support of people living with people living with HIV/AIDS HIV/AIDS. who are receiving some form of home or community based support. - 31 - 4. Project facilitation, The total value of project Project data CCS-SIDA Secretariat staff coordination, monitoring, and contracts entered into with are recruited on a competitive evaluation systems are fully communities, NGOs, CBOs, basis and are rewarded operational associations of people living according to performance. with HIV/AIDS, and private sector agencies is no less than 30% of all project contracts entered into over the previous twelve months. A project progress report is Project reports produced every 6 months. Project annual action plans Project reports and budgets for the next year are produced within the last three months of the current financial year. - 32 - - 1 o~~~~~~~ey Perforrnance D ata Collection strategy Hierarchy of Objectives Indicators DCritical Assumptions Project Components / Inputs: (budget for each Project reports: (from Components to Sub-components: component) Outputs) 1. Capacity-building US$0.86 million Project management reports 2.Public sector initiatives 2a) National initiatives US$2.64 million Project management reports 2b) Municipality initiatives US$2.17 million Project management reports 3. Civil society & private US$2.62 million Project management reports sector initiatives 4. Project facilitation, US$1.31 million Project management reports coordination, M&E - 33 - Annex 2: Detailed Project Description CAPE VERDE: HIV/AIDS PROJECT Under the regional MAP II, the project will finance HIV/AIDS activities for the period 2002-2006. It will have four components, which reflect the two-tiered decentralized administrative structure in Cape Verde at national and municipal levels. The components allow for division between public sector and civil society, while at the same time taking into account the geographical and social separation of the Cape Verdean island communities. Apart from the component on project facilitation, coordination, monitoring, and evaluation, which will support facilitation and coordination of the project, each of the other components will support the full spectrum of HIV/AIDS prevention, treatment, care, and support activities that are appropriate at the respective level. The project components are: 1. Capacity-building 2. Public Sector Initiatives: a) National initiatives b) Municipal initiatives 3. Civil Society & Private Sector Initiatives 4. Project Facilitation, Coordination, Monitoring & Evaluation General The project will scale up the existing HIV/AIDS efforts by mainstreaming program activities into line ministries and other agencies at national and municipal levels and by harnessing the capacity of communities, civil society organizations (including PLWHA), religious organizations, non-government organizations (NGO)s, community-based organizations (CBOs), private sector organizations, women's organizations, youth organizations, and labor unions. Activities to be supported by the project will be coordinated by secretariat of CCS-SIDA. Implementation of the activities will be at different organizational levels including implementation by line ministries, municipalities, community-led and civil society organizations, and private sector organizations. Contracting out by ministries and municipalities will be encouraged in order to make the best use of the implementation capacity of civil society organizations and the private sector. Activities to be supported will include (a) health promotion activities targeted at behavior change to reduce the transmission of HIV; (b) diagnosis, treatment, care and support for PLWHA and others affected by the epidemic; (c) mitigation of the impact of HIV/AIDS; and (d) operational research, surveillance, monitoring, and evaluation, to strengthen national and local capacity to respond effectively and efficiently to the epidemic. Project Component 1: Capacity Building - US$0.86 million This component will support HIV/AIDS related capacity building for the various implementers of the project. It will support training and any other capacity building activities that are necessary for the public sector and civil society agencies to be able to effectively and efficiently implement HIV/AIDS prevention, care and support activities in the country. For instance, administrative and financial management capacities of civil society organizations as well as their technical capabilities can benefit from this component. Municipalities and sectoral entities may use the funding of this component to specifically address areas needing strengthening within respective municipalities/sectoral programs. Similarly, CCS-SIDA and its Secretariat will initially need significant capacity building, which this component would support. Project Component 2: Public Sector Initiatives - US$4.81 million This component will support HIV/AIDS initiatives of both the central government ministries and parastatal organizations together with those initiatives of the municipalities. In order to reflect the highly decentralized nature of Govemment, the public sector initiatives component will be broken into a) National Initiatives - 34 - and b) Municipal Initiatives. a) National Initiatives (US$2.64 million). This component will support public sector HIV/AIDS activities coordinated at national level and will include the HIV/AIDS activities of different line ministries or central government agencies. Some of these activities will be contracted out to civil society organizations or the private sector. Each ministry is expected to have a focal person or team on HIV/AIDS. As part of the multisectoral approach to HIV/AIDS, every Government ministry, including the respective ministry's community level representative authority, will be expected to have, at minimum, a mechanism for HIV/AIDS IEC for its employees and an HIV/AIDS social support network. Ministries without HIV/AIDS strategy and action plans will be assisted by the project to draft these documents during the first year of project implementation. Each line ministry action plan will include HIV/AIDS prevention and mitigation activities for its staff, in particular measures to mitigate effect of HIV/AIDS in the work place. Specific sectoral Ministry HlV/AIDS responsibilities within the Cape Verde HIV/AIDS project are outlined below: Ministry of Finance and Planning * Provision of cost models to determine the cost of HIV/AIDS related interventions * Provision of national and sectoral HIV/AIDS-related projection models for national human resource and economic development planning * Contribution to a social fund to enable families to cope with HIV/AIDS * Provision of HIV/AIDS LEC to employees of the Ministry * Appropriate budgets to support national HIV/AIDS activities * Creation of HIV/AIDS social support network for employees of the Ministry * Promotion of safe sex practices, including the use of condoms, among employees and sexually active clients of the Ministry Ministry of Defense * Provision of HIV/AIDS IEC services for employees and families of the Ministry, and where feasible, surrounding civilian populations * Promotion of safe sex practices, including the use of condoms, among employees of the Ministry * Creation of HIV/AIDS social support networks for employees of the Ministry Ministry of Justice and Internal Administration * Provision of HIV/AIDS IEC to employees of the Ministry * Review of national laws and legislation in order to identify and promote laws that protect people living with or affected by HIV/AIDS, in particular laws regarding the property rights of widows and orphans * Promotion of safe sex practices, including the use of condoms, among employees and sexually active clients of the Ministry * Creation of HIV/AIDS social support network for employees of the Ministry * Provision of HIV/AIDS IEC to prisoners and people in detention * Training of local administration leaders as agents for HIV/AIDS IEC Ministry of Health, Employment and Solidarity * Provision of technical health sector-related support on HIV/AIDS to CCS-SIDA, line ministries, enterprises, communities, and civil society organizations - 35 - * Strengthening of the HIV/AIDS surveillance system * Expansion, in collaboration with other providers, of voluntary counseling and testing services * Improvement of national HIV/AIDS reference centers, including reference laboratories, day care centers, ambulatory care networks and centers for treatment of sexually transmitted infections * Review, dissemination, and training on national protocols for the management of HIV (including the use of anti-retroviral drugs), sexually transmitted diseases (syndromic approach), and opportunistic infections especially tuberculosis (including DOTS) * Improvement of blood supply safety and quality control and ensuring availability of the relevant diagnostic kits (HIV, hepatitis and syphilis) in the entire blood transfusion network * Ensuring the procurement, stock management and distribution of HIV/AIDS essential supplies, such as gloves, disposable materials, laboratory reagents, male and female condoms * HIV-related diagnostic kits, and pharmaceuticals (including antiretroviral drugs) for HIV/AIDS, STDs, and opportunistic infections, especially TB * Improvement of safe handling of laboratory, medical materials, and waste, in terms of policy development, implementation, and training of relevant personnel * Provision of services for the prevention of mother-to-child transmission of HIV * Provision of HIV/AIDS prevention, care and support services within the Ministry of Health network of facilities * Provision of training to staff of this and other Ministries to ensure continued competency in the provision of HIV/AIDS related services * Creation of HIV/AIDS social support networks for employees of the Ministry * Promotion of safe sex practices, including the use of condoms, among employees and sexually active clients of the Ministry. Ministry of Infrastructure and Transport * Provision of HIV/AIDS IEC among water transport and other transport workers, and among the employees of the Ministry * Promotion of safe sex practices, including the use of condoms among commercial vehicle/maritime drivers, and among the employees of the Ministry * Creation of HIV/AIDS social support networks for commercial vehicle/maritime drivers and for employees of the Ministry. Ministry of Education, Culture and Sports * Development and application of lessons which seek behavioral change through a teaching approach which targets both skills and knowledge and includes: negotiation, resisting peer pressure, self-esteem, communication and assertion * Promotion of school and student association-led HIV/AIDS initiatives in primary, secondary and tertiary education institutions * Monitoring and evaluation of the impact of HIV/AIDS in the education sector in collaboration with other relevant ministries * Integration of IEC on HIV/AIDS into the curriculum at all levels of the formal education system including teacher training colleges * Provision of HIV/AIDS social support networks for teachers and pupils/students at all levels of education * Promotion of safe sex practices, including the use of condoms, among youths who are sexually active * Provision of IEC on HIV/AIDS to, and promotion of safe sex practices among, employees of the Ministry - 36 - Ministry of Foreign Affairs, Cooperation and Community * Design and dissemination, in collaboration with the technical ministries, of materials for mass HIV/AIDS IEC * Provision of HIV/AIDS IEC to employees of the Ministry * Creation of HIV/AIDS social support networks for employees of the Ministry * Promotion of safe sex practices, including the use of condoms, among employees and sexually active clients of the Ministry Ministry ofAgriculture and Fisheries * Provision of H1V/AIDS IEC to employees and clients of the Ministry; * Creation of HIV/AIDS social support networks for employees of the Ministry * Promotion of safe sex practices, including the use of condoms, among employees and sexually active clients of the Ministry Ministry of Tourism, Industry and Commerce * Provision of HIV/AIDS IEC to employees and clients of the Ministry * IEC for travelers, tourists and visiting business people * Ensuring availability of condoms in places of mass entertainment which involve sexually active clients * Promotion of safe sex practices, including the use of condoms, among employees and sexually active patrons of the Ministry Secretariat of State for Youths The Secretariat of State for youths is responsible for a very important target group (youths) for HIV/AIDS prevention and care. Specific responsibilities within the Secretariat, and many of which will be coordinated with the Ministry of Education, Culture and Sports will include: * Provision of HIV/AIDS IEC to employees and clients (Youths) of the Ministry * Creation of HIV/AIDS social support networks for employees of the Ministry * Promotion of safe sex practices, including the use of condoms, among employees and sexually active clients (youths) of the Ministry. Secretariat of State for State Reform, Public Administration and Local Authority * Development of mechanisms of utilizing public administrators as advocates for HIV/AIDS prevention care and support * Provision of HIV/AIDS IEC to employees and clients of the Ministry * Creation of HIV/AIDS social support networks for employees of the Ministry * Promotion of safe sex practices, including the use of condoms, among employees and sexually active clients of the Ministry Other Ministries Any other new ministries, if formed in the future, will be expected to develop their respective HIV/AIDS activities which at minimum will involve IEC activities for the Ministry employees and immediate clients of - 37 - the respective Ministry. b) Municipal initiatives (US$2.17 million). Under the decentralized system of administration in Cape Verde, municipalities are particularly important agents for effecting change at local level. Under this component, the project will support activities which are directly carried out by municipal authorities or contracted out by them to civil society organizations or to the private sector. Municipalities can be supported under this component to, for example: * raise HlV/AIDS awareness of municipal leadership, teachers, school management teams, and community leaders * train and support municipal and community-based staff and leaders, including teachers, home-care givers, counselors, and rural extension workers in HIV/AIDS prevention, support, and care * provide HIV/AIDS related health promotion and prevention services at municipal facilities * provide HIV/AIDS-related diagnosis, treatment and care at health facilities located in the municipalities * promote community-led and civil society-led WIV/AIDS initiatives and manage the respective selection, contracting, financing, and supervision; * provide HIV-related IEC and condom distribution to the municipal workforce * support municipal HIV/AIDS teams in prevention, care, and support activities * ensure the provision of voluntary counseling and testing (VCT) services at the municipal level * ensure the provision of services for the syndromic treatment of sexually transmitted infections (STI) and directly observed therapies (DOTs) for tuberculosis at municipal level. Many of the activities financed under this component will directly support activities carried out at community level by civil society and private sector, i.e. advocacy, training, promotion of community led HIV/AIDS initiatives, and DOTs. Component 3: Civil society & private sector initiatives - US$2.62 million Under this component, the project will support community-led HIV/AIDS activities directly carried out, or contracted out, by civil society organizations, such as NGOs, religious organizations and organizations of PLWHA. Such activities could include, for example: * targeted support to orphans, guardians of poor orphans, and AIDS-stricken impoverished households, including those headed by women, youth and the elderly (usually because of the death of a spouse, parent or guardian). In addition, preschool, in-school, and out-of-school orphans will be supported to attend day care centers, formal schooling, and vocational training * support to families affected by HIV/AIDS including the support of revenue generating activities * community-based IEC * home-based care * promotion of the use of condoms at community level * support of community based HIV/AIDS networks in.prevention, care and support activities. The POM includes a full menu of eligible sub-projects, as well as a list of activities which cannot be financed under the project. The manual further describes how to get technical assistance to develop a sub-project, how to apply for a grant, how sub-projects will be selected and approved, how funds will be transferred, and how a sample of sub-projects will be supervised, audited, and evaluated. Component 4: Projectfacilitation, coordination, M&E - US$1.31 million The functions and operations of the Secretariat of CCS-SIDA, including monitoring and evaluation (M&E) will specifically be funded under this component. The Secretariat will be a lean structure and designed to - 38 - facilitate and coordinate project execution, with project activities being implemented by the respective ministries, civil society organizations, municipalities, and communities. The main direct responsibilities of the Secretariat will be facilitation, coordination, review of action plans and funding proposals, supervision, M&E, and support to CCS-SIDA for longer-term national planning and policy development. In many other MAP countries, program administration has been outsourced to the private sector. In Cape Verde, where there are few suitable private agencies, there is frequently greater capacity in public bodies. In order to rapidly establish administrative systems and allow itself to focus on high level representation, advocacy, and strategic analysis, the secretariat will contract out to an existing structure the administrative, financial management, procurement, reporting requirements, and coordination of M&E, including responsibilities for an integrated data base and reporting system. The structure to which these responsibilities will be contracted, the transport sector's coordination unit, (Programa de Infraestruturas e Transportes-PIT), has on behalf of the Government prepared the HIV/AIDS project while the CCS-SIDA secretariat is being established. This unit, which for the purposes of HIV/AIDS activities will be referred to as an Administrative Unit (AU) of the Secretariat, has proven itself very capable and has the capacity to undertake this role. - 39 - By Component: Project Component I - US$0.86 million Project Component 2 - US$4.81 million Project Component 3 - US$ 2.62 million Project Component 4 - US$1.31 million -40 - Annex 3: Estimated Project Costs CAPE VERDE: HIVIAIDS PROJECT Local- . Foreign Total Projec'tCost By Compo'nent US $mAiion US $million US $million 1. Capacity Building 0.69 0.08 0.77 2. Public Sector Initiatives 2.57 1.71 4.28 3. Civil Society and Private Sector Initiatives 1.40 0.93 2.33 4. Project Facilitation, Coordination M& E 0.82 0.35 1.17 Total Baseline Cost 5.48 3.07 8.55 Physical Contingencies 0.13 0.55 0.68 Price Contingencies 0.07 0.30 0.37 Total Project Costs 5.68 3.92 9.60 Total Financing Required 5.68 3.92 9.60 Local. . Foreign Total' - , ". ' ..' Proje,ct Cost ByCategory .US $million US $.niliion ' USmilio' Goods 0.44 2.61 3.05 Works 0.73 0.00 0.73 Services 1.73 0.99 2.72 Grants 2.30 0.00 2.30 Operating costs 0.48 0.32 0.80 Total Project Costs 5.68 3.92 9.60 Total Financing Required 5.68 3.92 9.60 Identifiable taxes and duties are 0.6 (USSm) and the total project cost, net of taxes, is 9 (USSm). Therefore, the project cost sharing ratio is 100% of total project cost net of taxes. - 41 - Annex 4 CAPE VERDE: HIV/AIDS PROJECT Monitoring and Evaluation (M&E) Introduction The MAP is based on the assumption that rapid project preparation without extensive ex ante technical analysis is possible if effective M&E systems are urgently established as a management tool to guide project adjustments. This places great onus on effective M&E, particularly in Cape Verde, where M&E must be introduced in an island with a nascent HIV/AIDS epidemic. M&E Components M&E comprises (a) surveillance; (b) epidemiological research; (c) financial management; and (d) Program activities. Surveillance. This encompasses both biological and behavioral surveillance. The Cape Verde AIDS Program has biological surveillance data, including HIV (determined by double ELISA and/or Western Blot) and some syphilis (determined by RPR and confirmatory TPHA) data from blood donors and antenatal clients. However, there are concerns about sample size and representativeness and there has been limited dissemination of findings. There is an urgent need to implement regular, annual, comprehensive HIV surveillance. Antenatal surveillance is the bedrock of biological surveillance. The CCS-SIDA will implement antenatal surveillance among up to 2,400 antenatal patients, 200 each drawn from 12 sites, five from Santiago and St Vincent and one in each of the other seven inhabited islands. Further surveillance is required to track STI/HIV trends among priority groups. In particular, surveillance will examine STI/HIV prevalence among up to 300 female sex workers, a key sentinel or "tripwire" population. Intensive interventions and continuing STI and HIV surveillance will also be conducted among this cohort to assess intervention impact. STI prevalence, aetiology, and sensitivity studies among sex workers and other groups are also urgent priorities. Technical assistance will be provided by international agencies such as UNAIDS, WHO, CDC, or FHI. Group Sample Size Sites Antenatal patients 200 x 12 sites =2,400 All 9 inhabited islands, Sex workers Up to 300 Primarily Santiago and St Vincent Behavioral surveillance will be managed by the CCS-SIDA, using FHI's manual and materials and undertaken by a competitively identified research/consulting agency or NGO. FHI have established comprehensive manuals and rigorous procedures for questionnaire adaptation and translation, interviewer training and supervision, sampling, data management, and quality assurance. Cape Verde will initiate regular behavioral surveillance at 18-24 month intervals, among up to 300 female sex workers, 500 uniformed service members, and 2,000 young people aged 12-19 (500 male in-school, 500 female in-school, 500 male out-of-school, 500 female out-of-school). -42- Group Sample Size Sites Sex workers Up to 300 Primarily in Santiago and St Vincent Uniformed service members 500 All 9 inhabited islands with uniformed service members Youth aged 12-19 2,000 (500 male in-school, All 9 inhabited islands 500 female in-school, 500 male out-of-school, 500 female out-of-school) Epidemiological research. The focus will be on three major areas: (a) STI prevalence, aetiology and sensitivity studies; (b) TB culture capacity and sensitivity studies; and&(c) evaluation of HIV interventions among priority groups, including sex workers and uniformed service members. Financial and project monitoring. This will focus on the CCS-SIDA's contracting and coordinating capacity and the relevance, quantity, quality, and economy of public sector, municipal, and civil society services. Project monitoring will be combined with financial monitoring and outsourced to a Program activities unit, which will collect, verify, enter, and analyze primary monitoring data from each partner. Through the project, the CCS-SIDA will assume a major grant-making role, supporting numerous AIDS projects nationally. The CCS-SIDA will develop established systems and procedures for budget transfers and grant-making, including systems for identifying epidemiological priorities and soliciting compliant applications, publicizing grants, developing and publicizing structured, transparent selection procedures, publicizing recipients, monitoring program performance of recipients and communicating achievements. The CCS-SIDA has received a draft M&E manual. It will review, adapt, simplify and translate the manual to ensure it meet's the project's distinctive needs. M&E Structure The project will manage the above M&E components as follows. Biological surveillance will be undertaken jointly by the AIDS and Epidemiology Departments, with extemal technical assistance from WHO, UNAIDS, CDC or FHI. Behavioral surveillance will be directed by the CCS-SIDA and contracted to a research/consulting agency or an NGO. It is suggested that FHI provide technical assistance, to ensure surveillance fully incorporates intemational good practice. Epidemiological research will also be conducted jointly by the AIDS and Epidemiology Departments, with extemal technical assistance from FHI. Financial and program activities monitoring will be outsourced to a Program activities unit. There are several reasons why it is preferable to combine financial and program activities monitoring and outsourcing it to a single unit. * Since the same personnel and operations can be used for both financial and project monitoring, combining financial and project monitoring makes monitoring economical. Project monitoring may be added to financial monitoring at marginal cost. * Combining financial and project monitoring provides a basis to corroborate financial and activity data and to ensure sound finance-project data cross-verification. This improves both financial and project accountability. * Project monitoring entails complex data gathering management capacities. It is often more feasible to purchase established capacity than to establish it afresh. * Financial management monitoring systems and procedures are almost always the most developed - 43 - sub-component of monitoring. Financial data are more likely to be collected, filed, and preserved than project data. It makes sense to link project monitoring to the stronger process of financial monitoring. * Linking project reporting to financial management and further disbursements will improve project reporting. * Outsourcing financial and program activities monitoring to a single unit ensures that financial and project reports are linked and provides a comprehensive picture. Equipped with comprehensive, verified data, CCS-SIDA M&E staff are free to focus on the strategic project implications of monitoring. Component Contracted to Surveillance Biological: AIDS and epidemiology programs jointly Behavioral: Directed by AIDS program and outsourced to research/consulting agency or NGO Epidemiological research AIDS and epidemiology programs jointly CCS-SIDA public sector and civil society Program activities unit financial monitoring CCS-SIDA public sector and civil society Program activities unit project monitoring CCS-SIDA Actions The CCS-SIDA will undertake the following actions to effectively coordinate project monitoring: i * It will clarify its coordination role and increase its capacity to coordinate, not implement, M&E. * It will outsource M&E to a Program activities unit. The unit will be responsible for training partners and verifying, collating, analyzing and reporting data. * The CCS-SIDA and stakeholders will undertake a participatory process, to prepare a nationally owned M&E plan and manual and to build national commitment and ownership for M&E. * Each partner will agree its key targets with the CCS-SIDA, using a simple, structured targets form. * Each partner will report results monthly using a simple, structured reporting form. * Results will be verified semi-annually by the Program activities unit. * The Program activities unit will assess each partners' progress towards targets semi-annually, using a simple rating form. * The Program activities unit will collate, analyze and submit to the Secretariat summary reports of aggregate activities semi-annually, using a simple summary form. * The CCS-SIDA and key stakeholders will meet semi-annually to review monitoring reports and to identify key lessons. * The CCS-SIDA and key stakeholders will update their operational and M&E manuals and procedures based on lessons leamed. - 44 - Monitoring and Evaluation Budget The indicative M&E costs are summarized in the table below: Component 2002 2003 2004 2005 2006 WB WB WB WB WB Biological 60,000 50,000 50,000 50,000 60,000 Surveillance Behavioral 25,000 25,000 25,000 25,000 25,000 Surveillance Epidemiological 30,000 30,000 30,000 30,000 15,000 Research Total 115,000 105,000 105,000 105,000 100,000 Grand Total US$530,000 Note that financial and project monitoring are budgeted under contract management. Key Covenants Action Completed Cape Verde project M&E plan and M&E I September 2002 manual produced through national stakeholder consultatiye meeting -45- Annex 5: Financial Summary CAPE VERDE: HIV/AIDS PROJECT Years Ending IMPLEMENTATION PERIOD Year? I Year 2 r Year 3 I Year 4 J Year 5 j Year 6 I Year 7 Total Financing Required Project Costs Investment Costs 2.0 1.8 1.7 1.6 1.6 0.0 0.0 Recurrent Costs 0.1 0.2 0.2 0.2 0.2 0.0 0.0 Total Project Costs 2.1 2.0 1.9 1.8 1.8 0.0 0.0 ,Total Financing 2.1 2.0 1.9 1.8 1.8 0.0 0.0 Financing IBRD/IDA 2.0 1.9 1.7 1.7 1.7 0.0 0.0 Government 0.2 0.1 0.1 0.1 0.1 0.0 0.0 Central 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Provincial 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Co-financiers 0.0 0.0 0.0 0.0 0.0 0.0 0.0 User Fees/Beneficiaries 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Others 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total Project Financing 2.2 2.0 1.8 1.8 1.8 0.0 0.0 Main assumptions: -46 - Annex 6: Procurement and Disbursement Arrangements CAPE VERDE: HIV/AIDS PROJECT Procurement 1.0 A national procurement code does not exist in the Republic of cape Verde except for some specific arrangements for procurement of works. 2.0 The general procurement environment in the country is good since World Bank procedures are adhered to in IDA financed projects . In the case of EMPROFAC, whose assessment is presented below, the organization is a parastatal, and has its own procedures which are to become acceptable for World Bank financed projects. 3.0 It is important for the country to develop its, national procurement code in addition to referring to World Bank procedures. This should facilitate NCB for goods and works. Use of World Bank guidelines IDA will finance goods, civil works, consultancies, training, and other local activities necessary to implement the project. 4.0 Procurement of works and goods ( a ) Procurement of works and goods for all IDA-financed activities will be carried out in accordance with the Bank's Guidelines for Procurement under IBRD Loans and IDA Credits (January 1995 and revised in January and August 1996, September 1997, and January 1999). ( b ) The Bank's standard bidding documents for works and goods, the standard prequalification document ( if applicable ) and the standard evaluation form will be used in the process. ( c ) National standard bidding documents do not exist and the country. It will be ensured that the procedures are acceptable to the World Bank, if the country intends to elaborate national bidding documents. The principles of economy , transparency , efficiency and fair participation will have to be respected. Such bidding documents will ensure that: ( i ) bids will be advertised in national newspapers with wide circulation; ( ii) the document clearly explains the bid evaluation and award criteria; ( iii) Bidders are given adequate response time ( minimum four weeks ) to prepare and submit bids; (iv ) bids will be awarded to the lowest evaluated bidder; (v) eligible bidders, including foreign bidders will not be precluded from participating; and (vi) no domestic preference margins are applicable to domestic manufacturers or suppliers or contractors. 5.0 Requirements for large-ticket items such as medical supplies and vehicles will be consolidated and preparation of procurement documents will be carried out by the Secretariat of CCS-SIDA using the ICB method. Thus, to the extent possible, procurement will be grouped where feasible into packages valued at US$100,000 equivalent or more. Delivery of these goods to the end users will either be done directly by the suppliers or through separate distribution contracts that will ensure timely delivery of the goods. It will be necessary to ensure that adequate procurement capacity is available at the center to organize the procurement and distribution. 6.0 Selection of consultants (a ) The selection of consultants necessary for the execution of the project will take place in accordance -47 - with the Bank's Guidelines: Selection and Employment of Consultants by World Bank Borrowers (January 1997, revised in September 1997 and January 1999). Specific arrangements will be stipulated in the credit agreement. ( b ) The Bank standard request for proposals will be used and forms of contracts as needed (lump-sum, time-based and/or simplified contracts for short term assignments and individual consultants) as well as the sample form of evaluation report for the selection of consultants. Advertising 7.0 ( a ) A General Procurement Notice ( GPN ) had already been prepared and will be finalized and issued in the United Nations Development Business before effectiveness; the finalized GPN will list all goods and works contracts above US$200,000 and large contracts for selection of consultants estimated to cost the equivalent value of US$100,000 or more; ( b ) A minimum of 30 days will be allowed before preparing the short list; and ( c ) The GPN will be updated annually for those contracts still to be let. 8.0 ( a ) The related prequalification ( if any ) or bidding documents will not be released and the short list for consultant services will not be prepared before eight weeks after the GPN has been published; ( b ) The GPN will be issued in the national press official gazettes for contracts to be let under NCB; ( c ) Specific procurement Notice ( SPN ) for goods and works will be advertised in the national press of wide circulation, and intemationally for large contracts ; and ( d ) Sufficient time will be allowed to obtain the bid documents. 9.0 Procurement capacity ( a ) General features. Since all the staff of the Secretariat of CCS-SIDA have not yet been recruited, it is not possible to assess their full capacity. As soon as all the staff are recruited, the Secretariat will be evaluated to determine whether all conditions are in place to procure in compliance with World Bank procedures. These conditions will be an important part of the TOR and the contracts. The core staff at this agency would include a Procurement Specialist and a Procurement Assistant who should be familiar with World Bank's procurement procedures and would work closer with each of the regional implementing agencies under the project to ensure efficient and timely project execution through compliance with the procurement schedules agreed with the Bank. The Procurement Specialist will: (a) prepare and update the procurement plan for the project; (b) monitor the progress of procurement; (c) assist the implementing agencies in the preparation of bidding documents and advertisements for goods and works contracts and request for proposals for consulting assignments; and (d) be responsible for bid opening and evaluation. The Procurement Specialist will also advise the implementing agencies on procedural matters. ( b ) Capacity of EMPROFAC EMPROFAC is a parastatal organization with an autonomous structure. It is responsible for purchasing drugs and medical equipment for public hospitals, small health centers, all military and the police health centers, and private organizations like pharmacies. (i) Organization and operational mechanisms. EMPROFAC is autonomous in terms of management and is currently being considered for privatization. The organization has a staff of 43 people located in Praia (32) and Mindelo (11). The procedures that EMPROFAC uses for procurement of drugs in the intemational market are rather simple. EMPROFAC has neither a tender commission nor an evaluation committee. EMPROFAC does not refer to a national tender board (which only exists in Cape Verde for procurement of works). All procurement procedures are executed by the director with the assistance of the commercial department in charge of purchasing drugs. -48 - (ii) EMPROFAC Procurement procedures. EMPROFAC has an ICB system each year but because of the small quantities required for Cape Verde, only intermediaries bid. The competition is limited to a list of intermediaries (since the big distributors and the drug manufacturers are not interested in small quantities). Lists by product are established based on former performance and behavior in the execution of similar contracts. Bidders who have a record of unacceptable practices are immediately eliminated from the list. The period from bidding to deposit is generally five weeks. The bids consist of presentation of the bid documents with a sample of the product, which is analyzed in a laboratory. The contract is awarded to the bidders by product depending on the quality of the drug, the proposed price, and the time of delivery. Award of contracts is based on these criteria and the final result of the competition is published locally and sent to all the bidders. The contracts are signed for a year but the whole quantities are not delivered at the same time because of inadequate storage facilities in the country for drugs. Orders are made and executed periodically, based on the needs of the health care facilities. EMPROFAC is audited yearly by an independent auditor. The level of remuneration of EMPROFAC staff is quite good and is sufficient incentive to discourage corruption and fraudulent practices. (iii) Proposition of changes The management of EMPROFAC is aware that their procedures will need to be adjusted to conform to the requirements of a World Bank-financed project and maintains that the procedures of the organization are sufficiently flexible to modification to a level that will be acceptable. Main improvements needed include: * introduction of procedures manual that institutes a tender board commission and evaluation commission, so as to enhance the transparency of the process; * where feasible, bidding larger packages to attract interest from larger manufacturers and distributors (this is however contingent on availability of adequate storage facilities); * thorough training of staff in World Bank procurement procedures. 10.0 Procurement plan A global procurement plan for the whole project and a detailed procurement plan for the first year of the project have already been prepared and submitted ; they need to be reviewed and finalized before effectiveness in the sense of better specifying the missions for selection of consultants and grouping some items ( when feasible ) for procurement of goods. The procurement includes relevant information on all goods, works and services contracts under the project as well as the timing of each milestone in the procurement process. The procurement schedule will be updated every six months and submitted to IDA. The Procurement Specialist would monitor the progress of procurement and implementation of each contract under the project and would ensure effective and timely project execution. Operational manual 11.0 The operational manual has already been prepared and discussed with the Borrower and the NGOs who are important stakeholders of the project. 12.0 The section of this manual related to procurement is in compliance with the procurement arrangements described in this annex. Specifically, subprojects identified and executed by NGOs or CBOs will be carried out in accordance with procedures acceptable to the Bank and are described in the POM. 13.0 Procurement implementation arrangements The organs that will be involved in the project procurement activities are: The administrative unit (AU) of the CCS-SIDA Secretariat. This unit is the service delivery arm of the -49 - Government at the national level. It will handle all procurement activities for vehicles, office equipment, and all large items which can be grouped in big packages for the public sector. Municipalities. These will act as decentralized structures of the AU in the field regarding procurement activities. In AU and the municipalities, the structure will be based on a centralized or decentralized procurement operation within the Secretariat of CCS-SIDA using the Bank's standard procurement guidelines and procedures. The NGOs and the private sector (including CBOs). These will follow simple procurement procedures acceptable to the World Bank (a decentralized procurement process using the Bank's simplified procurement & disbursement for community-based investments). In any case, the principles of transparency, equity, efficiency, and economy must be respected. EMPROFAC. This is a financially autonomous parastatal pharmaceuticals supply institution. It has physical sites located at Praia and Mindelo. The drugs and medical equipment purchasing procedures will be based on sole source method with EMPROFAC. The organization has its own procurement rules, which may not be the same as those in a World Bank-financed project. EMPROFAC will update these procedures to meet World Bank requirements by project effectiveness (see below for a summary of its assessment). 14.0 Procurement Methods ( a ) Procurement methods for goods and works . The methods to be used for procurement are described below. The estimated amounts for each method are summarized in table A. The threshold contract values for the use of each method are shown in table B. Goods. Given the urgency of the program, in order to facilitate speedy procurement of items required urgently during the first 12 months, some of the critical requirements could be obtained on a fast-track basis using appropriate procurement methods directly from United Nations agencies (UNFPA, WHO). Immediate requirements of vehicles and office equipment specifically for the program could be acquired from IAPSO or by local shopping (preferably ex-bonded warehouses on a competitive basis) or international shopping. Furniture for coordinating offices could be procured through local shopping. Where feasible, procurement agents could be used, including UNFPA for procurement and distribution of condoms, and possibly other United Nations agencies for procurement and distribution of drugs. All procurement actions will follow standard IDA procurement guidelines and annual general procurement notices (GPN) will be prepared for the project and published in the United Nations' Development Business. The distribution to the final users can be done through the municipalities, the NGOs, or the CBOs. In order to facilitate the procurement process the thresholds will be established as stated below for essential goods. (i) ICB: equal or above US$100,000 equivalent for drugs (ii) NCB: Less than US$100,000 up to a total amount of US$600,000 (iii) National or international shopping: US$50,000 up to a total amount of US$500,000 (iv) Drugs and medical equipment purchased from EMPROFAC will follow sole source system with IDA prior review. Regarding civil works , for example in rehabilitation of facilities, the procurement procedures will be as follows: (i) ICB: equal or more than US$200,000 equivalent - 50 - (ii) NCB: Less than US$200,000 up to a total amount of US$800,000 (iii) Procurement of small works: US$50,000 up to a total amount of US$300,000. ( b ) Selection of consultants . Selection and appointment of consultants for studies, technical assistance, promotion of the project activities, and support of project execution would be carried out in accordance with the Guidelines: Use of Consultants by World Bank Borrowers, January 1997, revised in September 1997 and January 1999 (Consultant Guidelines). As a rule, consultant services would be procured through Quality and cost-based selection (QCBS) methodology. All consultancy assignments estimated to cost the equivalent of US$200,000 or more would be advertised in a national newspaper and in Development Business (UNDB). In addition, the contracts may be advertised in an international newspaper or a technical magazine seeking "expressions of interest." All consulting assignments in the range of US$ 100,000 to US$200,000 would be procured through QCBS. In the case of assignments estimated at US$ 100,000 or less, the assignment may be advertised nationally and the shortlist may be made up entirely of national consultants provided that at least three qualified national firms are available in the country and foreign consultants who wish to participate are not excluded from consideration. Consultant services estimated to cost less than the equivalent of US$50,000 may be contracted by comparing the qualifications of consultants who have expressed an interest in the job or who have been identified. Auditors would be selected using least-cost selection procedures. Single Source Selection. Services for: (i) training; (ii) consulting assignment provided by NGOs or other organizations to assist in the design of PSO Action Plans and CSO Subprojects; and (iii) consulting assignment estimated to cost less than $20,000 equivalent per contract, up to an aggregate amount not to exceed $200,000 equivalent may, with the Association's prior agreement, be procured in accordance with the provisions of paragraphs 3.8 through 3.1 1 of the Consultant Guidelines. Operational costs. Operating costs include incremental operating costs incurred on account of project implementation, management and supervision, including office supplies, communication costs, travel allowance of project staff but excluding salaries of the Borrower's civil service. ( c ) Prior review thresholds. (i) Goods and works All goods and works contracts estimated to cost US$100,000 or more would be subject to IDA review of bidding documents including draft contracts and technical specifications prior to inviting bids and IDA review of bid evaluation prior to contract award. (ii) Consulting services The TOR and the short list for all consulting assignments irrespective of value would be subject to IDA prior review. For consultancy contracts with firms with an estimated value of US$100,000 or more, and US$50,000 or more in the case of individuals, the draft request for proposals (RFP) and the shortlist of consultants must be cleared by IDA prior to inviting proposals from consultants. In addition, the evaluation of technical proposals must be cleared with IDA before financial proposals of the qualifying firms are opened. With respect to each contract for the employment of consulting firms estimated to cost the equivalent of US$50,000 or more but less than the equivalent of US$ 100,000, the procedures set forth in paragraphs 1, 2 (other than the second subparagraph of paragraph 2(a)) and 5 of Appendix I to the Consultant Guidelines shall apply. With respect to each contract for the employment of the consulting firms estimated to cost the equivalent of - 51 - US$ 100,000 or more and each contract for the employment of individual consultants estimated to cost the equivalent of US$50,000 or more, the procedures set forth in paragraphs 1, 2 (other than the third subparagraph of paragraph 2(a)) and 5 of Appendix I to the Consultant Guidelines shall apply. ( d ) Post review. Contracts that are not subject to prior review would be selectively reviewed by the Bank during project implementation and would be govemed by the procedures set forth in paragraph 4 of Appendix I to the guidelines 15.0 Readiness for implementation. Drafts of the documents required for the effectiveness of the project have been prepared and will be finalized and ready by effectiveness: (a) A draft operational manual has been prepared during project preparation and discussed with the main actors including the NGO platform; (b) A draft of the general procurement plan for the whole project and a detailed procurement plan for the first year have already been prepared and will be finalized in terms of packaging for goods and a few cases of consultant selection methods; (c) A draft general procurement notice has been prepared and will be updated before publication in Development Business. Procurement methods (Table A) Table A PROCUREMENT AND DISBURSEMENT ARRANGEMENTS (millions of US$) Expenditures categories ICB NCB Others NBF Total costs 0 0 0.58 0.04 0.62 1. Civil works (0) (0) (0.58) (0) (0.58) 0.42 0.45 1.74 0.0 2.61 2. Goods (0.42) (0.36) (1.69) (0) (2.47) 3. Consultant services, 0 0 2.32 0 2.32 training and audits (0) (0) (1.98) (0) (1.98) 0 0 2.07 0 2.07 4. Grants for subprojects (0) (0) (2.07) (0) (2.07) 0 0 0.60 0.08 0.68 5. Operating costs (0) (0) (0.60) (0) (0.60) 0 0 0.4 0.0 0.4 6. Reimbursement of PPF (0) (0) (0.4) ( 0 ) ( 0.4) 0 0 0.9 0.0 0.9 7.Nonallocated (0) (0) (0.9) (0) (0.9) 0.42 0.45 8.61 0.12 9.60 Total costs (0.42) (0.36) (8.22) (0) (9.00) - 52 - Prior review thresholds (Table B) Table B THRESHOLDS FOR PROCUREMENT METHODS AND PRIOR REVIEW (US$) Expenditures Contract value Procurement method Contracts subject to categories threshold prior review 1. Civil works > 200,000 ICB 0 < 100,000 NCB < 50,000 Proc. of small works 2. Goods > 100,000 ICB 1.69 < 100,000 NCB 0.0 < 30,000 Nat. or intern. shopping 0 3. Consultant services and training: Firms > 100,000 QCBS 0.28 Individual Individual consultants 1.11 selection method Total amount of 3.08 contracts subject to prior review Overall Procurement Risk Assessment Average: High Frequency of procurement supervision missions proposed One every four months including procurement supervision for post review. - 53 - Disbursement Allocation of credit proceeds (Table C) Table C: Allocation of Credit Proceeds Expenditure Category Amount in US$million Financing Percentage 1. Civil Works 0.58 90% 2a. Goods: vehicles and office 1.07 100% foreign, 90 % local equipment 2b. Goods: drugs, tests and medical 1.40 100% foreign, 90% local supplies 3. Consultant services, training and 1.98 100% audits 4. Grants 2.07 100% of amounts disbursed 5. Operating Costs 0.60 90% local 6. Refunding of PPF 0.40 7. Unallocated 0.90 Total Project Costs 9.00 Total 9.00 Basic Principles The Chief Financial Officer (CFO) of the AU team will be entrusted with the project's overall financial management and reporting and will serve as the principal contact for Bank disbursement. Implementing agencies (at the national and municipal levels) will be in charge of reporting with respect to their activities. Payments to the beneficiaries will flow from the following accounts: counterpart fund, special account, and municipal accounts. The payments will be made according to predetermined disbursement schedules to be specified in the respective proposals and be effected expeditiously when due. Fund management will follow transparent procedures that will be standardized across implementing agencies and detailed in the project operations manual. Use of Statements of Expenses (SOEs) Use of SOEs will be contingent upon a satisfactory assessment of the AU's financial management capacity, including the maintenance of proper accounts, the preparation of project progress reports, the ability to process and maintain SOE documentation, and satisfactory annual auditing arrangements. Provided these conditions are met, SOEs will be used for all expenses. Furthermore, all expenses related to contracts below prior-review thresholds will be claimed on the basis of SOEs and the supporting documentation underlying all SOEs will be made available for review by Bank supervision missions at any time. Supporting documentation will be retained by the AU. The primary responsibility of maintaining the records rests on the CFO, assisted by the project accountant. The satisfactory assessment of the financial management system will be one condition of effectiveness. At the municipality level, the advance mechanism will be conditional to the submission of a municipality action plan. SOE thresholds will be: US$100,000 for works and goods; US$100,000 for consultant services-firms; and US$50,000 for consultant services-individuals. SOEs will also be used for CSO subprojects, training and operating costs. - 54 - Special Account The Govemment will open a special account (SA) in the name of the project with the Central Bank of Cape Verde (Banco Central de Cabo Verde), to which project funds will be deposited. Most if not all credit funds will be disbursed through this procedure, with the CCS-SIDA Secretariat relying as little as possible on direct payments from Washington. Only amounts exceeding 20% of the amount advanced to the special account can be claimed through the direct payment procedure. The project will receive an initial advance to commence operations. The advance will be kept initially to a limited amount while the project activities get underway, but will be increased once full execution begins and cumulated disbursements reach a predetermined threshold. For subsequent disbursements, the CCS-SIDA Secretariat will submit appropriate justification on the use of amounts disbursed earlier (bank reconciliation statements and other reasonable documentation) to IDA. The special account will be audited annually by an external auditor acceptable to IDA. At the time replenishment of the SA is requested, the CCS-SIDA Secretariat will indicate on a reconciliation statement the location and amounts outstanding in any other project account. Counterpart Fund Account The Government will open a project account in local currency at the Central Bank of Cape Verde and will deposit an initial amount in local currency representing at least the Government's contribution for the first year of the project. The account will be managed by the CCS-SIDA Secretariat. At the beginning of each next year, the Government will also deposit in this account an amount equivalent to its counterpart financing to implement the project. Municipalities'Accounts To facilitate disbursements to each municipality involved in the project, the Government will open a municipality project account (MA) at a municipality commercial bank acceptable to IDA that will receive funds in local currency. For the sake of efficiency in disbursement of funds and financial management, one Bank will be used for the 17 municipality accounts to be established. The MA will be funded by the special account and/or the counterpart fund account. It will be managed according to the procedures specified in the project operations manual in accordance with respective annual work programs and budgets. The consolidation of expenses will be effected by the municipality accountant in liaison with the CCS-SIDA Secretariat. - 55 - Annex 7: Project Processing Schedule CAPE VERDE: HIV/AIDS PROJECT Project Schedule Planned Actual Time taken to prepare the project (months) 8 First Bank mission (identification) 07/17/2001 07/17/2001 Appraisal mission departure 01/23/2002 01/25/2002 Negotiations 02/21/2002 02/23/2002 Planned Date of Effectiveness 06/01/2002 Prepared by: The core preparation team includes Gylfi Palsson (task team leader), Kees Kostermans (Sr. Public Health Specialist), Ahmadou Moustapha Ndiaye and Prosper Biabo (Sr. Financial Management Specialists), Bourama Diaite (Sr. Procurement Specialist), John Stephen Osika (Sr. Health Specialist - Consultant), Pascal Dooh-Bill (Institutional Development Specialist - Consultant) and Jocelyne do Sacramento (Language Program Assistant). Other multisector specialists contributed to project preparation, including those listed below. Preparation assistance: A Japan PHRD grant for US$473,075 (TF026787) was received and assisted in the preparation of the project. - 56 - Bank staff who worked on the project included: Name Speciality Gylfi Palsson Team Leader Kees Kostermans Sr. Public Health Specialist Ahmadou Moustapha Ndiaye and Sr. Financial Management Specialists Prosper Biabo Bourama Diaite Sr. Procurement Specialist John Stephen Osika Sr. Health Specialist Pascal Dooh-Bill Institutional Specialist Jocelyne do Sacramento Language Prograrn Assistant Anne Marie Bodo Pharmaceutical Specialist Tshiya Subayi-Cuppen Operations Analyst Jonathan Brown Operations Adviser David Wilson M&E Expert Isabella Micali Drossos Sr. Counsel Nadine Poupart Sr. Human Resources Economist Adriana Jaramillo Education Specialist Helene Grandvoinnet Public Sector Specialist Farida Khan Operations Analyst Jose Janeiro Financial Management Specialist Carlos Fonseca Transport Specialist Jean Koua Program Assistant Aubert Zohore Previous TTL Peer Reviewers were: Sandra Rosenhouse (Sr. Population and Health Specialist), Serigne Omar Fye (Sr. Environmental Specialist), Bachir Souhial (Lead Operations Specialist), and Iraj Talai (Lead Financial Management Specialist). - 57 - Annex 8: Documents in the Project File* CAPE VERDE: HIV/AIDS PROJECT A. Project Implementation Plan Draft Project Operational Manual First year Procurement Plan Project Implementation Plan B. Bank Staff Assessments Technical report of the mission of June 2001 1. Aide memoire of the project identification mission of July 2001 2. Aide memoire of the project pre-appraisal mission of October 2001 3. Technical mission report of the mission of December 2001 4. Aide memoire of the appraisal mission of Jan-Feb 2002 C. Other I . Cape Verde Prime Minister's Decree of July 2001 announcing the formation of CCS-SIDA 2. Cape Verde HIV/AIDS strategic plan for 2002-2006, as adapted by the Cabinet on February 28, 2002 3. Draft medical waste management plan of February 2002 *Including electronic files - 58 - Annex 9: Statement of Loans and Credits CAPE VERDE: HIVIAIDS PROJECT 03-Jan-2002 Difference between expected and actual Orginal Amount in US$ Millions disbursements Project ID FY Purpose IBRD IDA GEF Cancel. Undisb. Orig Frm Rev'd P075700 2002 Structural Adjustment Credit 0.00 15.00 0.00 0.00 7.66 -7.04 0.00 P057998 2000 PUBL.SEC.REFORM SUPP 0.00 3.00 0.00 0.00 1.30 1.38 1.25 P040990 1999 CV ENERGYNVATER PROJECT 000 17.50 5.50 0.00 12.34 9.55 0.00 P055468 1999 EDUC.&TRAINING CONS. 0.00 6.00 0.00 0.00 3.09 -2.66 0.00 P055467 1999 PRrVATIZATION TA 0.00 9.00 0.00 0.00 2.97 1.12 -0.03 P042054 1999 CV Energy/Water- GEF 0.00 0.0 4.70 0.00 3.85 3.20 3.20 P000432 1999 SOCIAL SECTOR DEVT o.00 16.10 0.00 0.00 11.96 6.90 0.00 P000435 1993 TRANSPORT INFRASTRUCTURE 0.00 12.50 0.00 0.00 4.63 -0.35 0.00 Total: 0.00 79.10 10.20 0.00 47.79 12.11 4.42 - 59 - CAPE VERDE STATEMENT OF IFC's Held and Disbursed Portfolio OCT-2001 In Millions US Dollars Committed Disbursed IFC IFC FY Approval Company Loan Equity Quasi Partic Loan Equity Quasi Partic 1992 AEF Growela 0.15 0.00 0.00 0.00 0.15 0.00 0.00 0.00 1999 SEF Britagem 1.1 1 0.00 0.17 0.00 0.00 0.00 0.00 0.00 Total Portfolio: 1.26 0.00 0.17 0.00 0.15 0.00 0.00 0.00 Approvals Pending Commitment FY Approval Company Loan Equity Quasi Partic 2001 SEF Moura 0.47 0.00 0.00 0.00 2000 CAG Fund 0.00 0.00 10.00 0.00 Total Pending Commitment: 0.47 0.00 10.00 0.00 - 60 - Annex 10: Country at a Glance CAPE VERDE: HIV/AIDS PROJECT Sub- Lower- POVERTY and SOCIAL Cape Saharan middle- Verde Africa Income Development diamond' 2000 Population, mid-year (millions) 0.44 659 2.046 Life expectancy GNI per capita (Atlas method. USS) 1.330 480 1.140 GNI (Atlas method, USS billions) 0.59 313 2.327 Average annual growth, 1994-00 Population (%) 2.8 2.6 1.0 Labor force (%) 3.8 2.6 1.3 GNI . Gross per - primary Most recent estimate (latest year available, 1994-00) capita enrollment Poverty (% of population below national poverty line) 30 Urban DODulation (% of total population) 62 34 42 Life expectancy at birth (years) 69 47 69 Infant mortality (per 1,000 live births) 39 92 32 Child malnutrition (% of children under 5) - 14 11 Access to improved water source Access to an improved water source (% of population) 74 55 80 Illiteracy (% o(populalion age 15+) 26 38 15 Gross primary enrollment (%of school-age population) 148 78 114 - apeVerdo Male 150 85 116 Lower-middle-income group Female 147 71 114 KEY ECONOMIC RATIOS and LONG-TERM TRENDS 1980 1990 1999 2000 Economic ratios' GDP (USS billions) 0.11 0.34 0.59 0.56 Gross domestic investment/GDP 51.6 22.9 20.9 19.3 Trd Exports of goods and services/GPP 18.0 12.7 19.3 23.4 rade Gross domestic savings/GDP -24.0 -8.1 -17.5 -14.5 Gross national savinos/GDP 16.4 17.6 5.2 5.8 Current account balance/GDP -22.8 -5.3 -15.7 -13.5 Domestic Interest pavments/GDP 0.1 0.6 0.6 0.7 sInvestet Total debt/GDP 19.5 39.9 48.4 51.5 savng Total debt service/exports 0.5 5.7 11.3 7.3 Present value of debt/GDP 29.1 31.5 Present value of debt/exports 87.6 84.6 Indebtedness 1980-90 1990-00 1999 2000 2000-04 (averaqe annual qrowth) GDP 9.8 6.0 8.6 6.8 4.7 ---Cape Verde GDP per capita 8.2 3.3 5.4 3.6 1.8 Lower-middle-income group Exports of qoods and services 3.1 13.8 4.0 29.2 11.3 STRUCTURE of the ECONOMY 1980 1990 1999 2000 Growth of Investment and GOP I%) (% of GDP) zo Aqriculture 13.6 14:4 11.8 10.9 . Industrv 17.3 21.4 18.4 17.6 9 -o Manufacturing 8.2 8.9 9.1 -zx -. 9 97 99 99 s0 Services 69.1 64.3 69.8 71.6 .o Private consumption 115.8 93.4 106.6 103.8 .60 General government consumption 8.2 14.7 11.0 10.6 GDI -GDP imports of qoods and services 93.6 43.7 57.8 57.1 1980-90 1990-00 1999 2000 Growth of exports and Imports (%) (average annual qrowth) Agricullure 13.7 5.1 11.7 -6.3 60 Industrv 13.9 5.0 6.3 12.2 40 1 Manufacturinq 31.7 4.8 4.0 4.5 _t- Services 8.1 6.5 8.7 7.6 20 Private consumption 8.0 8.2 15.4 4.0 95 97 l, 99 00 General oovernment consumotion 18.6 1.8 -20.6 3.5 .20 - Gross domestic investment -0.5 0.1 14.6 -1.4 - Exporls _Imports Imports of goods and services 0.6 8.1 13.5 5.6 Note: 2000 date are preliminary estimates. - The diamonds show four kev indicators in the countrv (in bold) compared with its income-group average. If data are missing, the diamond will be incomplete. - 61 - Cape Verde PRICES and GOVERNMENT FINANCE 1980 1990 1999 2000 Inflation (%) Domestic prices (% change) lD - Consumer prices .. 10.7 4.4 -2.4 Implicit GDP deflator 9.8 2.3 5.0 0.3 s Government finance D (% of GDP, includes current grants) Current revenue 22.9 19.8 19.3 s - Current budget balance .. 5.6 1.6 -4.6 "GDP deflator -OCPI Overall surplus/deficit .. -3.0 -11.0 -18.9 TRADE 1980 1990 1999 2000 Exort and Import levels (US$ mill.) (US$ millions) Total exports (fob) .. 5 8 24 300 Bananas .. 2 2 2 Fish .. 2 1 1 200 Manufactures 1 0 0 Total imports (cif) .. 136 244 260 Food .. 38 53 55 t*0 Fuel and enerqy 10 13 15 Capital goods 52 99 106 D - 94 95 96 97 98 99 0 Export price index (1995=100) .. 81 108 108 Import price index (1995=100) .. 92 104 111 0 Exports * Imports Terms of trade (1995=100) .. 88 103 98 BALANCE of PAYMENTS 1980 1990 1999 2000 Current account balance to GDP (%) (US$ millions) Exportsofgoodsandservices 19 43 114 131 C _ Imports of goods and services 87 148 340 319 . e4 r - Resource balance -68 -105 -226 -188 . Net income 3 2 -8 -12 _ Net current transfers 40 85 142 125 _ Current account balance -25 -18 -93 -75 Financing items (net) 25 11 122 54 Chanqes in net reserves 0 7 -29 21 -20 Memo: Reserves including gold (US$ millions) 42 77 80 93 Conversion rate (DEC. oca/lUS$) 40.2 70.0 102.7 115.9 EXTERNAL DEBT and RESOURCE FLOWS 1980 1990 1999 2000 (US$ millions) Composition of 2000 debt (USS mill.) Total debt outstanding and disbursed 21 135 284 288 IBRD 0 0 a 0 G:12 IDA 0 14 93 98 F 1O Total debt service 0 6 22 15 E: IBRD 0 0 0 0 8: r8 IDA 0 0 1 1 Composition of net resource flows Offiaal grants 40 78 108 86 Official creditors 3 9 18 22 Private creditors 0 0 0 -1 Foreign direct investment 0 0 67 31 D1 Portfolio equity 0 0 0 0 Worid Bank program Commitments 0 0 43 0 A - fBRO E - Bilateral Disbursements 0 2 24 10 B-IDA D -Other multlateral F - Private Principal repayments 0 0 0 0 C - IMF G - Short-term Net flows 0 2 24 10 Interest payments 0 0 1 1 Net transfers 0 2 23 10 Development Economics 9/27101 - 62 - Additional Annex 11: Civil Society CAPE VERDE: HIVIAIDS PROJECT The Civil Society's Response to the HI VIAIDS Epidemic in Cape Verde Civil society organizations in Cape Verde are relatively young compared with other countries in the sub-region. The first grassroots organizations (OMCV and JAACV) were formed only twenty five years ago, soon after the country's independence. Since the political reorganization in 1991, the civil society (mainly NGOs) have been recognized as an integral part of the country's socio-economic development process. This recognition was further reinforced in 1996 by the formation of a network of NGOs called the "NGO Platform. The Platform groups approximately 100 development NGOs whose members implement various activities including provision of family planning services, care and support to women in terms of entrepreneurship development, Information, Education and Communication (IEC) for behavior change, health care for youth, human rights, and support to battered women. Many of these NGOs have HIV/AIDS activities within their programs, although none of them is exclusively dedicated to HIV/AIDS. It is important to note that the country does not have an association of people living with HIV/AIDS, although the OMCV is making attempts to facilitate the formation of such an organization. Although the civil society has grown in size and in efficiency, there still remains a lot to be done in the areas of institutional capacity development - including in the areas of human resources, financial management, and overall program or project management capacity. Civil society's role in Cape Verde's response to the epidemic will be mainly in the areas of prevention, behavior change, and social support. This project's support to civil society organizations will capitalize on developing the capacity of community-driven initiatives like the work already being undertaken by groups such as VerdeFam (an affiliate of the International Planned Parenthood Federation), OMCV, and MORABI which are all very strong women's organizations in cape Verde. The project will also support supervision of all community-based activities with the support of, among others, a coordination mechanism that exists in the Platform to ensure coherence and synergy amongst the NGOs. NGOs will be potential partners in the implementation of activities for the HIV/AIDS project--some of them are already undertaking limited activities in the field of HIV/AIDS prevention. In addition, NGOs have networks among the poorest levels of the community and each of the NGOs is unique in its approach to the provision of HIV/AIDS services. However, they are all complimentary and should lead to the success of the execution of activities of the overall objectives of the project. Capacity-building in organizational and financial management and financial resource mobilization among civil society organizations will be supported by the project. Collaboration with other development partners' activities will also be encouraged in order to ensure an efficient response by all partners,including UN agencies and other donors. The project will in particular support the scaling up by NGOs of (a) HIV/AIDS prevention and sensitization interventions; (b) strengthening the support of home based care for people living with HIV/AIDS and their families; and (c) reinforcing collaboration and learning from each other, amongst all grassroots groups. The operations manual for the project describes the arrangements for NGOs to access and account for project funds. The manual describes the process for revfew of proposals submitted by NGOs for funding and identifies which proposals can be approved by the municipal HIV/AIDS committees and which of those - 63 - proposals must be approved by the Secretariat of CCS-SIDA. - 64 - Additional Annex 12: Pharmaceutical issues CAPE VERDE: HIV/AJDS PROJECT Pharmaceuticals Issues in the Cape Verde HIV/AIDS Project Treatment Policy on HIVIAIDS and related diseases Given the status of the AIDS epidemic in Cape Verde, the Ministry of Health, Employment, and Solidarity puts the main emphasis on preventive activities, such as information, education and communications (IEC), voluntary counseling and testing (VCT), and promotion and distribution of condoms. It intends to greatly expand these services under the strategic plan. The treatment policy of the Ministry of Health for HIV/AIDS and related diseases can be summarized as follows. o The Ministry focuses on making essential services available, including palliative care and treatment for common infections (such as TB, candidiasis, pneumonia), nutrition, sexually transmitted infection (STI) care, Cotrimoxazole prophylaxis. * Regarding anti-retroviral therapy (ART), the Ministry is working towards making treatment available to prevent mother-to-child transmission. It had two options: AZT and introduction of Nevirapine. The Ministry has already made a decision to opt for the Nevirapine option. For the time being, providing ART to all PLWHA is considered beyond the institutional, technical, financial and human resources of the Govemment. The position of the Ministry of Health on a staged approach to the introduction of ART is fully in accordance with the guidelines of WHO/UNAIDS. The Ministry provides free medical care, at the point of delivery, for tuberculosis and STIs. Prevention of HIV infection The Ministry intends to strengthen its treatment of STIs by widely implementing the syndromic approach to treatment and improving skills in the laboratories to detect these infections. This strategy is complemented by IEC efforts at various levels, and by promotion and distribution of condoms. Voluntary counseling and testing Various studies have revealed the many benefits of intensive counseling before and following voluntary counseling and testing. It has been effective in improving people's behavior and altering risky sexual practices, especially among people who test HIV-negative, as evidenced by lowering the rate of HIV sero-conversion. VCT also enables individuals with HIV and their families to seek timely emotional, social, and medical care. These and other benefits have led the Government to include VCT in its national strategic plan as a means to stimulate behaviors that prevent HIV transmission or that may help people to seek care to prevent rapid progress of the infection towards full-blown AIDS. The govemment plans to expand the program in the country over the next four years. Prevention of mother-to-child transmission In Cape Verde, the prevention of mother-to-child transmission (MTCT) is included among the key strategic priorities of the HIV/AIDS strategic plan. The Ministry will introduce this treatment nationwide over the coming two years. - 65 - Screening of blood productsfor HIV Given the perceived low prevalence rate, the risk of acquiring HIV infection through blood transfusion is thought to be relatively low in Cape Verde. Still, the Ministry of Health, Employment, and Social Solidarity has made commendable efforts to improve safety of blood transfusions. All donated blood is tested for antibodies to HIV using an enzyme-linked immunosorbent assay (ELISA). These efforts must continue and be further strengthened to avoid any new cases of transfusion-related HIV infections. At the moment, the French Cooperation is the major partner supporting screening of blood supplies in Cape Verde. However, Cape Verde has experienced shortages of reagents for screening of blood, and the project will support the Government in ensuring availability of reagents needed to safeguard the blood transfusion system. Medical care for people infected with HIV Cape Verde's HIV/AIDS strategy includes the control of opportunistic infections among PLWHA.. The package of medical services to be provided to these people includes drugs to treat diseases like tuberculosis, Pneumocystis carinii infection, Cryptococcal infection, Candidiasis, Toxoplasmosis etc. In richer countries, regimens that combine two or more highly active anti-retroviral drugs have been used successfully to prolong the life expectancy for people living with HIV/AIDS. In a country like Cape Verde, these regimens are still beyond the means of the Governnent. Governnent follows WHO/UNAIDS guidance on introduction of anti-retroviral therapies(ART). ART could become accessible to PLWHA, if the dialogue between the Govemment and donors or the pharnaceutical industry results in a significant decrease in the cost of these drugs or in the drugs being donated. HIV/AIDS levels of treatment, care and supDort interventions according to need, comDlexitv, and cost Essential activities . HIV voluntary counseling and testing . Palliative care and treatment for common opportunistic infections: pneumonia, oral thrush, vaginal candidiasis and pulmonary TB (DOTS) . Nutritional care . STIs care and family planning services * Cotrimoxazole prophylaxis among PLWHA . Community activities that mitigate the impact of HIV infection (including legal structures against stigma) Intermediate ALL THE ABOVE PLUS complexity and cost . Screening for TB among PLWHA and at VCT sites . Preventive therapy for TB among PLWHA * Systemic antifungals for systemic mycosis (such as cryptococcosis) . Treatment of HIV-associated malignancies: Kaposis sarcoma, lymphoma and cervical cancer . Treatment of extensive herpes * Prevention of mother to child transmission of HIV . Post exposure prophylaxis of occupational exposure to HIV and for rape High complexity ALL THE ABOVE PLUS and cost . Triple Anti-Retroviral Therapy . Diagnosis and treatment of opportunistic infections that are difficult to diagnose and expensive to treat such as multi-resistant TB, toxoplasmosis, etc . Advanced treatment of HIV related malignancies . Specific public services that reduce the economic and social impacts of HIV infection Note: HIV testing of blood supplies, the promotion of universal precautions, and health policy activities, such as the regulation of care delivery and drug supplies, should be undertaken at all levels and consequently are also essential health sector activities. (Source: WHO/UNAIDS (2000). Key elements in HlV/AIDS care and sutport). - 66 - Procurement of Pharmaceuticals and Medical Supplies Pharmaceuticals and medical supplies are procured in Cape Verde by the Government parastatal entity EMPROFAC. The company has a monopoly on this procurement with the Government as its only shareholder. About one-third of the firm's tumover is for the public sector. The Government has indicated that the entity will be privatized in the future. Until then, the project will procure pharmaceuticals and other medical supplies through EMPROFAC with the option to review this situation should the entity be privatized. Project Support The project will provide support to all of the areas indicated above and by making funds available in a flexible manner to the Ministry of Health, which can allocate the funds according to its needs. The project will among other things support the provision of reagents for use in the blood transfusion service. The project will support the expansion of VCT services by financing the procurement and distribution of laboratory and other medical equipment; HIV reagents and supplies, consultant services, and operating costs. The project will ensure the beginning and the expansion of the MTCT preventive strategy to each of the nine populated islands. To that effect, it will finance the purchase of Nevirapine tablets and syrup, Zidovudine (AZT) tablets and syrup, consultant services, and operating costs to carry out specific diagnostic and therapeutic services. The project will support the Government treatment policies further by financing the development and dissemination of case management protocols, the purchase of medical supplies (including antibiotics, antifungal drugs, analgesics, anti-diarrheal drugs, anti-emetics and other essentials on the national list related to the management of HIV/AIDS-related conditions), consultant services, and operating costs to carry out specific diagnostic and therapeutic services. Indicative Program Costs (USS) Testing, Blood Screening, STI, PMCT, Medical Care Including Drugs HIV tests: Rapid tests 40, 000 Blood screening: Reagents 250, 000 STI: Drugs 500,000 Laboratories 80,000 MTCT: Drugs 100,000 Laboratories 90,000 Opportunistic infections: Drugs 300,000 Laboratories 150,000 Medical care Various 700,000 Total Indicative Program Cost 2,210,000 Indicative IDA contribution 1,400,000 -67 - Additional Annex 13: Supervision Plan CAPE VERDE: HIV/AIDS PROJECT The project will require intensive supervision given its innovative approach, the large span of activities from the community to the national level, its blend of public, private and civil society implementation agencies whose experience with HIV/AIDS programs varies considerably, and its multi-sectoral nature. The range of activities in prevention, care, treatment, and mitigation is complex and will be implemented by many entities whose capacity will need strengthening. The Bank's supervision effort in the first year will focus on the following strategic areas: Comprehensive approach to HIV/AIDS. Funding and executing a broad range of HIV/AIDS activities across many sectors by multiple implementation agencies at the national and local level, with a particular emphasis on scaling up existing programs and building capacity, will require consistent and sustained support and coordination, including learning from other MAP and HIV/AIDS programs from around the world. Ownership and stakehoDders. Experience has shown that the commitment and enthusiasm shown by stakeholders during project preparation needs to be maintained during early project implementation by accelerating funding of projects in both the public sector and civil society. While the operational manual has been prepared in Cape Verde with involvement of some stakeholders, this needs to be expauded, and supervision should focus on constantly adjusting the operational manual to local realities. New institutions. The CCS-SIDA Secretariat in Cape Verde is designed to facilitate and coordinate rather than to control and implement. Any new institution, however, implements its mission through actions. Supervision will focus, in particular, on assisting the Secretariat to: (a) contracting out key administrative and fiduciary services work; and (b) empower the implementing agencies in the public sector and civil society by allowing them to make decisions on program activities and to participate in adjusting project processes based on the early lessons of implementation. Fiduciary architecture. Financial management, procurement, monitoring and evaluation, and implementation channels represent the core fiduciary responsibilities that need to be assessed and enhanced during supervision. The principle that program monitoring and evaluation is part of the fiduciary framework of the MAP approach is new for Cape Verde and for the Bank and will require special attention during implementation. Objectives and Schedule of Supervision Missions During the first twelve months of implementation, the project will have three formal supervision missions in addition to ad-hoc visits by Bank staff in the Senegal Country Office (on financial management and procurement) and from the UNAIDS/World Bank evaluation support unit in Washington (on monitoring and evaluation). The members of the UN HIV/AIDS Theme Group in Cape Verde may also assist with supervision on an ad-hoc basis in addition to: (a) assisting government ministries and civil society organizations to enhance project preparation to access MAP funding; and (b) improving the efficiency and effectiveness of HIV/AIDS programs through specialized technical expertise. The first supervision mission will be scheduled shortly after the Board presentation to review the new staffing of the CCS-SIDA Secretariat, to review the Secretariat's contracting out arrangements, and to participate in a formal project launch aimed at accelerating the preparation and funding of first-year programs by public sector institutions and the submission of projects by municipalities and civil society - 68 - organizations. The second supervision mission will focus on providing assistance in ensuring that: (a) the operational manual has been adapted to early implementation experience; (b) existing programs are being scaled up and funded, especially in core public sector ministries, the municipalities and civil society organizations already working in HIV/AIDS; (c) capacity building has started for agencies that require it; and (d) the CCS-SIDA Secretariat is operating effectively. The third supervision mission will focus on assisting Cape Verde to hold an annual partnership review of the project that would involve donors, the UN HIV/AIDS Theme Group, and stakeholders in Cape Verde. The review would (a) assess the performance of the project during the first nine months of implementation and making any project design adjustments; (b) preview the program of activities in the second year; and (c) ensure that appropriate funding is available from the international community and from local resources. The Bank's Supervision Effort The joint UNAIDS/World Bank progress review of MAP1 in mid-2001 concluded that MAP projects require intensive supervision using multi-sectoral teams that can provide implementation assistance in a variety of sectors. The extensive Bank preparation team will be carried over into the first year of supervision, enhanced by: (a) increased reliance on the Senegal Country Office for periodic visits between formal supervision missions; and (b) the possibility of support from the members of the Cape Verde UN HIV/AIDS Theme Group as it adds capacity. It is expected that the supervision budget for the first twelve months will exceed the Bank norm, but given the good implementation record of Cape Verde and the national commitment to contract out fiduciary activities to institutions with a proven track record, it is likely to be lower than the recommendation of the progress review. Each mission is expected to last for up to two weeks and comprise between four and six team members. About 25-30 total staff weeks will be required for the first three supervision missions, in addition to approximately eight non-mission staff weeks. Technical skills required by a mission will depend on relevant implementation issues each time. The necessary specialists are likely to include First supervision mission: Task Team Leader, procurement, financial, M&E, health, NGO Second supervision mission: Task Team Leader, NGO, education, institutional Third supervision mission: Task Team Leader, health, social, financial, procurement Financial management and procurement support from the Bank's Dakar country office will be on an ad-hoc basis in addition to scheduled missions. Indicative cost of supervision for the first 12 months of the project: US$ 160,000. - 69 - V.|1o Crordr - 5 2d- i Ribeiva do Cruz_ Jneln d, onelar: 4 ' SANTO ANTAO - . '/to ~~~do Po6sr to 4,3v I_ I,I,lzlJ - k,oIonoio¶i Giorilc. Ln,- '3- CalIsca 6aO P& drn° ; S6o PSrNTA2Modei,U -IA SAO VICENTE SANTAs LUIA Pedro de ILtrie SAL BRANCO Prom0 Fron: - RiberFO RASO hair,J c. Tor,ofoI 'Pregui)o 'irhcol SAO NICOLAIJ CAPE VERDE °i SELECTED CITIES AND TOWNS VilOde SOI-Rq - -Coio * NATIONAL CAPITAL - -- - INTERNATIONAL BOUNDARIES 'Fuh.l 0~~~~~~~~~~~~~~~~~~~~~~~~~~Fjndc dos ---- INTERNATIONAL BOUNDARIES A T L A N T I C BOA VISTA I h1 F,draj ri6 G 20 31 40 5' V K.ILOMEIFi 2 O~~~~~~~~~~ C E A N - . v,. The boundoiies cola-s, denom.r,of,cns and any oah.h, ia.nmoiion sRowvn on Phil mop do not,trmply, an fhe paar, of Ihe- WVo4d alnk G,oDP any 1udgnmer.I an dhe legal sroius Jl any lerr,iory o ony endorsement or occepionce ot such buijndorias FORMER I SPAN1SH - - I SAHARA _ _ t A .ilJ i lor t 0ralal - CAPE VERDE dI e Sonilagoc - r.Qnlo Antonio tA I SANTIAGO,' ,Arrhod do Manic CoIlheltC StIusEGtV - 7 'RColheriae Modio ihE GAMB(A-~- 6 ^ . FI iR,bera do Bclrc r 53a. Miguel C- Figeta du HIlt SIJRKINC ~~~~~~~~~~~~~~ ~ ~~~~~Santa biir V.10 do' GUINEA BISFIJ-- .*C.' Moo - *:.J1NftE3 - ,, , \ V1oz tnb - . MaNIriI . POaio Rinccr,, loa-ia Ten 11, ', ' SECOS Sac reJC, , ,o Senhloa de Lu: I5 SIERRA IEOeNE' OIt 1 PI G Cov.-o > S~~~~~~~~~~~~~~~t I J,PC { ort, GOYN .IA. 4 T1 ANT L REA. ' Sac *' JEoO Cidade 'Nelht SIiPAIA _ _ Cocho:C-' BRAVA Alctrurz 24 23 . _ ,14 23 vr