PROJECT INFORMATION DOCUMENT (PID) APPRAISAL STAGE Report No.: AB7204 Project Name IGAD Regional HIV/AIDS Partnership Program Region AFRICA Country Africa Sector Other social services (100%) Project ID P132179 Parent Project ID Borrower(s) INTER-GORVENMENTAL AUTHORITY ON DEVELOPM Implementing Agency IGAD Secretariat Avenue George Clemenceau PO Box 2653 Djibouti Djibouti Tel: (253) 2135-4050 Fax: (253) 2135-6994 mahboub.maalim@igad.org IGAD Environment Category [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) Date PID Prepared December 9, 2012 Date of Appraisal August 24, 2012 Authorization Date of Board Approval February 28, 2013 1. Country and Sector Background IRAPP was the first Africa Catalytic Growth Fund project (approved on June 28, 2007). The project became effective on September 24, 2007, providing a grant of US$14.5 million to address the HIV/AIDS challenge among refugees, IDPs and Cross Boarder Mobile Populations (CBMPs) within the IGAD member states. The Horn of Africa, defined for the purposes of this project as Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Sudan, and Uganda, represents one of the largest, most complex political, social and economic environments on the Continent. While there are many complicating and interrelated aspects, population mobility and migration are thought to be key factors that bear on HIV prevalence and incidence rates. In cross-border areas in the Horn, transport workers spend time away from their homes, and where migrants, mobile workers, refugees, internally displaced persons (IDPs), and other mobile populations transit or settle. These persons move from one place to another temporarily, seasonally or semi-permanently for a host of voluntary and involuntary reasons. Such reasons may include seasonal migration patterns, family reunification, search for better professional or economic opportunities, poverty, war, human rights abuse, ethnic tension, violence, famine, other natural disasters, persecution, and/or health needs. Due to the disruption of social norms and the political and economic instability associated with mobility, these populations often face food shortages, physical and psychological insecurity and abuse, extreme poverty, poor hygiene, lack of education, and other hardships. The political and natural (e.g. severe drought) crises that have plagued the Horn of Africa since the parent project was approved caused a massive increase in the size of the CBMPs, and therefore also in the number of hotspots hosting them. 2. Objectives There are two interrelated project development objectives (PDOs) for the project:  Increase preventative action, and reduce misconception of cross border and mobile populations, refugees and surrounding host communities concerning HIV/AIDS prevention, treatment and mitigation in selected sites in the IGAD member states1; and  Establish a common and sustainable regional approach to supporting these populations in the IGAD member states. The key performance indicators for the parent parent will be retained during the AF period. 3. Rationale for Bank Involvement The regional and sector challenges faced by CBMPs identified at the appraisal of the parent project are still relevant. The proposed scaling up of activities with funding from Canadian International Development Agency (CIDA) would contribute to fulfill the increased need for services targeted to these populations. The project directly contributes to the program development objective of IGAD, its Member States and development partners in the Horn of Africa which is to: (i) contribute to the reduction of HIV infections; and (ii) mitigate the socio- economic impact of the epidemic in the IGAD region by improving regional collaboration and implementing interventions that add value to the efforts of each individual country. In addition, the rationale for the proposed AF is to comply with the Trust Fund Proposal and related Administrative Agreement between the Bank and CIDA (both approved on June 29, 2011). 4. Description The proposed CIDA grant of US$7.6 million would finance a one and half year program. The direct beneficiaries of the project are: (a) refugees, internally displaced persons (IDPs), returnees, and surrounding host communities (in every IGAD country); and (b) vulnerable cross-border and mobile populations (CBMPs). Indirect beneficiaries are policymakers and program implementers in the region who gain from better health policies, programs, service delivery, and knowledge of the epidemic as a result of cross-fertilization through the IRAPP project. Currently the project reaches about 7.5 million people2, of which approximately 51 percent are women. It is estimated that through the proposed AF the number of beneficiaries will increase by approximately 2.9 million bringing the total number of beneficiaries to 10.4 million. The three project components are as follows: 1 IGAD member countries are Djibouti, Eritrea, Ethiopia, Kenya, the three jurisdictions in Somalia, North and South Sudan, and Uganda. Eritrea is not currently an active member. 2 The figure includes people reached by IEC/BCC activities. Component 1: Support to Refugees, IDPs, Returnees, Surrounding Host Communities and CBMPs (US$10 million, AF US$5.9 million) with two subcomponents: (a) Refugees, IDPs, returnees, surrounding host communities. This subcomponent was designed for implementation by UNHCR which would provide a range of services as set out in an agreement between IGAD and UNHCR. (b) Delivering specific services and support to CBMPs, to be implemented jointly by IGAD and member countries. Component 2: Cross Border Collaboration on the Health Sector Response to HIV/AIDS by Member Countries (US$2.0 million, AF US$0.15 million) with a focus on health sector responses to HIV/AIDS in CBMPs with the aim of harmonizing policies and procedures and sharing implementation experiences among countries, and finalizing and adopting a regional strategy for improved HIV, STI prevention, treatment and care services directed at migrant populations. Component 3: Project Management, Coordination, Capacity Building and Monitoring and Evaluation (US$2.6 million) which has three sub-components: (i) project management and coordination; (ii) capacity building; and (iii) monitoring and evaluation. The proposed AF is anticipated to (i) facilitate gradual integration of the existing hotspots in the national programs of the IGAD Member States; (ii) facilitate the application of the regionally harmonized instruments and strategy developed by the parent project to the new hotspots; and (iii) ensure that enough funds are available to conduct the resurvey on behavioral change at project end. The specific activities currently under implementation that the proposed AF intends to continue and replicate in new hotspots include: a) Expansion of HIV and AIDS intervention into new refugee camps and hotspots. b) Integration of sexual and gender based violence (SGBV) prevention and care (including provision of HIV Post Exposure Prophylaxis) in all refugee camps and hot spots. c) Upgrading of existing health facilities in the new sites as part of scaling up - i.e. upgrading of local health facilities to enable them provide PMTCT and ARV on site. d) Information Technology (IT) support to facilitate project management and reporting (including financial reporting) by supplying IPs with laptops and internet connection (on a case by case basis). e) Mainstreaming of Gender into the HIV/AIDS response within the project and support for gender activities at the IGAD level. f) Implementation of harmonized treatment protocols and referral systems for Voluntary Counseling and Testing (VCT), Prevention of Mother to Child Transmission of HIV (PMTCT), Tuberculosis (TB), Sexually Transmitted Infections (STIs), Anti-retroviral Treatment (ART), Opportunistic Infections (OIs) and Post Exposure Prophylaxis for HIV (PEP) in the additional hotspots. g) Behavioral Surveillance Re-Survey in the hotspots where the baseline data was collected in 2008/2009 and inclusion of refugees and CBMPs into national HIV and AIDS surveillance systems 5. Financing ($m.) Source: Borrower 0 Free-standing TFs AFR Human Development 7.81 Total 7.81 6. Implementation The project will retain the implementation arrangements of the parent parent project defined in the operational manual 7. Sustainability Long term financial sustainability will depend on external assistance and IGAD, in collaboration with the partners and members states, will actively pursue funds from other sources, including Global Fund, bilateral donors, and foundations. By expanding and harmonizing HIV/AIDS efforts throughout the region, IGAD will enhance the effectiveness of national investments in prevention, care, treatment, and mitigation for the CBMPs. By identifying and encouraging the sharing of information and promising approaches between countries and in different operational settings, the likelihood increases that such activities will be scaled up, and attract additional funding from many sources, including donors and technical assistance entities, the governments, and affected communities. It will provide operational and policy inputs to national programs, which in turn can apply to their programs what is done and learned under this project. 8. Lessons Learned from Past Operations in the Country/Sector The AF benefitted from the lessons used in the preparation of the parent project and the experience since gained with implementation. In particular, it is important to engage all key stakeholders including the relevant political leadership and maintain a strong project facilitation office to coordinate the program. 9. Safeguard Policies (including public consultation) The proposed scaling up of activities to new hotspots will not raise the environmental category of the project, which remains Category B. The National Medical Waste Management Plans for Djibouti, Eritrea, Ethiopia, Kenya and Uganda exist and were disclosed in Infoshop at the appraisal of the parent project. Similarly, the UNHCR Medical Waste Management Plan covering both refugee and IDP camps was disclosed during appraisal. The National Medical Waste Management Plan for Sudan was not completed then and was disclosed this time round. Given the governance situation in Somalia, it was agreed to use the Medical Waste Management Plan prepared by UNHCR. 10. List of Factual Technical Documents 1. Administrative Agreement between the Bank and CIDA, approved on June 29, 2011. 2. Midterm review report/aide memoir, IGAD Regional HIV/AIDS Partnership Program, (P104523 IDA Grant No TF090523), December 2010 3. Project Operations Manual 4. Project Appraisal Document, IGAD Regional HIV/AIDS Partnership Program, Grant No TF090523 5. Grant Agreement, IGAD Regional HIV/AIDS Partnership Program 6. Memorandum of Understanding (IGAD and UNHCR) 7. Quarterly Project Progress Reports, IGAD 8. Intergovernmental Authority on Development (IGAD) Regional HIV and AIDS Strategic Plan 2012-2016, June 2012 11. Contact point Contact: Peter Okwero Title: Senior Health Specialist Tel: 5393 2227 Fax: Email: pokwero@worldbank.org 12. For more information contact: The InfoShop The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 458-4500 Fax: (202) 522-1500 Email: pic@worldbank.org Web: http://www.worldbank.org/infoshop