Page 1 PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No.: AB1408 Project Name BF Supplemental HIV/AIDS Disaster Response Project Region AFRICA Sector Health (75%);Other social services (25%) Project ID P088879 Borrower(s) GOVERNMENT OF BURKINA FASO Implementing Agency Environment Category [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) Date PID Prepared February 25, 2005 Estimated Date of Appraisal Authorization March 8, 2005 Estimated Date of Board Approval May 5, 2005 1. Country and Sector Background Country Context . With a per capita GDP of US$250, Burkina Faso ranks amongst the poorest countries in the world and is one of the lowest in the UNDP human development index. Despite promising trends in some health service and outcome indicators, Burkina Faso has among the highest rates of child and adult mortality in the world. Most key indicators for child health and nutrition worsened during the 1990s, but in the past five years, infant mortality has declined and coverage of preventive health services improved. But Burkina remains significantly “off-track” to achieving the millennium Development Goals (MDGs) for health: juvenile mortality (ages 1-5) has remained unchanged for the past decade – due to limited progress in combating malaria, increased AIDS mortality, worsening child malnutrition, and high fertility rates. Burkina has among the highest HIV prevalence rates in West Africa, estimated at 4.2 percent in 2003. Recent surveillance data suggest that HIV prevalence has stabilized and appears to be declining in some urban areas. While HIV prevalence declines may be partly attributable to increased AIDS mortality, HIV prevention campaigns have contributed to reductions in risky behavior, including increased use of condoms. But while awareness of HIV/AIDS is nearly universal in urban areas, it is not always translated into behavior change. And in rural areas, in 2003 only about half of women spontaneously cited condoms as a means of preventing HIV transmission. At the family and community levels, AIDS is exacerbating poverty by generating a large and unsustainable financial burden on affected households (e.g., medical costs, care of orphans, lost revenues). It is estimated that the epidemic is producing up to 35,000 orphans annually, which is straining traditional family-based social solidarity mechanisms. The Government recognized in the early 1990s that the AIDS epidemic would generate large micro and macro socioeconomic costs. The government has demonstrated its commitment to combating HIV/AIDS through the establishment of a National AIDS Council, chaired by the President, and the adoption of a five-year HIV/AIDS strategy (2001-2005). The revised PRSP identifies human capital development as one of the overarching strategies to poverty reduction, and highlights the importance of increasing access of the poor to basic social services, including health and HIV/AIDS. The second objective of the 2003 Burkina Faso Country Assistance Strategy (CAS) update is “Ensuring that the poor have access to basic social services.” A new results-based CAS is under preparation, for which achieving MDGs for health and HIV/AIDS will figure prominently. Page 2 2. Objectives The objectives of the project are to: (i) lower the risk of HIV transmission, (ii) strengthen the capacity to provide care and treatment to HIV infected/affected persons, and (iii) help mitigate the socioeconomic impact of HIV/AIDS on affected households and communities. Major project components include: (i) support for multi-sectoral response, including financing HIV/AIDS Action Plans for line ministries (including health and the national AIDS council); (ii) support for provincial AIDS committees and village micro-projects in 13 pilot provinces (of 45); (iii) support for targeted interventions for vulnerable groups (commercial sex workers, miners, orphans, youth, pregnant women, capacity building for local NGOs), implemented by experienced national and international NGOs); (iv) support for coordination, monitoring, and evaluation. 3. Rationale for Bank Involvement The Government recognized in the early 1990s that the AIDS epidemic would generate large micro and macro socioeconomic costs. The government has demonstrated its commitment to combating HIV/AIDS through the establishment of a National AIDS Council, chaired by the President, and the adoption of a five-year HIV/AIDS strategy (2001-2005). The revised PRSP identifies human capital development as one of the overarching strategies to poverty reduction, and highlights the importance of increasing access of the poor to basic social services, including health and HIV/AIDS. The second objective of the 2003 Burkina Faso Country Assistance Strategy (CAS) update is “Ensuring that the poor have access to basic social services.” A new results-based CAS is under preparation, for which achieving MDGs for health and HIV/AIDS will figure prominently. 4. Description The proposed supplemental grant, in the amount of USD5.0 million, would retain the design, basic objectives and operating procedures of the HIV/AIDS Disaster Response Project. It would aim to complete the activities of the original credit. The proposed supplemental credit and the original credit would maintain the current closing date of December 31, 2006. Ministry Action Plans . This component would finance implementation of the medical waste management strategy. It would also fund limited activities among sectoral Ministries and the National AIDS Council. The latter would focus on sustaining care and support activities for infected and affected personal, and funding the second year of the ARV operational research program (being implemented by the Centre Muraz, a regional research institute associated with the Ministry of Health). It would also finance furniture and equipment for the new National AIDS council headquarters, which is being constructed with credit funds. The crisis in Ivory Coast has contributed to increased costs of imported material and transportation, thus the original allocation for furniture and supplies was used cover increased construction costs. Targeted Interventions. Most of the supplement will be used to ensure continued funding for the second year of the “targeted intervention” NGO contracts, including prevention and STI treatment activities for commercial sex workers, prevention and STI treatment for artisenal miners; care and support programs for orphans; “centres d’ecoute” for youth; HIV awareness raising and counseling for pregnant women; and capacity development for local HIV/AIDS NGOs. Continued financing for each NGO contract would be contingent on a satisfactory evaluation of the first year’s implementation experience. Page 3 Decentralized and Village Activities . Implementing village-based care and support activities has proven more challenging than sponsoring awareness raising activities. The project team, government, and partners have designed a pilot intervention for community-based care and support (in Samnatenga Province), which will be accompanied by a rigorous impact evaluation under the supervision of the Bank’s research department. External trust funds have already been identified to support the impact evaluation component, but the project is the only available source of financing for the village level care and support activities (for orphans, widows, etc.). 5. Financing Source: ($m.) BORROWER/RECIPIENT 0.2 INTERNATIONAL DEVELOPMENT ASSOCIATION 5.0 Total 5.2 6. Implementation The proposed Supplemental Credit does not require additional implementation capacity beyond what is already in place. The PA-PMLS project is executed by a project coordinating unit, initially based in the Ministry of Economy, but which is in the process of being transferred to the Secretariat of the National AIDS Council (SP-CNLS), which is located in the office of the President. This project unit has performed satisfactorily and will oversee execution of the Supplemental Credit. The Project Implementation Plan is being updated to reflect the new activities. The Supplemental Credit will be subject to the same monitoring and reporting requirements of the project, and procurement and disbursement procedures will follow the procedures applied under the original Credit. Financial and procurement assessments conducted as part of the project’s mid-term review concluded that performance has been satisfactory overall, and the project unit has implemented major recommendations from these reviews. The Supplemental Credit will be executed in 18 months and will close in 24 months. 7. Sustainability While international partners finance a substantial portion of HIV/AIDS prevention and care activities, the government has sought to increase its contribution in recent years and to establish the basis for long-term sustainability. External financing will be necessary to sustain the program in the medium term, however. The Bank has initiated the preparation of a new program, which will provide support both the multi- sectoral HIV/AIDS response as well as integrated support for strengthening health sector capacity to respond to HIV/AIDS and other health challenges. 8. Lessons Learned from Past Operations in the Country/Sector [TIM] In 2001, the Bank discontinued direct project lending for the health sector in favor of budget support through the PRSC. The PRSCs have proven effective instruments for pursuing policy and structural reforms, but would be more effective if complemented by flexible sector support for implementing the PNDS. The Burkina Faso MAP project (PA-PMLS) was launched in 2002, to further scale up the national multi-sectoral response to HIV/AIDS. The MAP has disbursed rapidly and is fully committed. The mid- term review in June 2004 noted significant progress in scaling up multi-sectoral activities, but recommended reorienting and mainstreaming prevention activities of non-health ministries, strengthening program coordination (including merging the project unit into the national AIDS council), and further enhancing monitoring and evaluation. Moreover, experience suggests that improving the quality and accessibility of medical treatment – whether for AIDS, malaria, or TB – requires addressing fundamental weaknesses in the health system. Finally, harmonization of financing arrangements (particularly in social sectors) is essential to reduce transaction costs and improve development effectiveness. Page 4 9. Safeguard Policies (including public consultation) Applicable? Safeguard Policy If Applicable, How Might It Apply? [X ] Environmental Assessment ( OP / BP 4.01) [ ] Natural Habitats ( OP / BP 4.04) [ ] Pest Management ( OP 4.09 ) [ ] Involuntary Resettlement ( OP / BP 4.12) [ ] Indigenous Peoples ( OD 4.20 ) [ ] Forests ( OP / BP 4.36) [ ] Safety of Dams ( OP / BP 4.37) [ ] Cultural Property (draft OP 4.11 - OPN 11.03 ) [ ] Projects in Disputed Areas ( OP / BP / GP 7.60) * [ ] Projects on International Waterways ( OP / BP / GP 7.50) 10. List of Factual Technical Documents Bank’s aide-memoire, December 2004 mission 11. Contact point Contact: Timothy A. Johnston Title: Senior Human Development Specialist Tel: 5354+319 Fax: (226) 50 308649 Email: Tjohnston@worldbank.org Location: Ouagadougou, Burkina Faso (IBRD) 12. For more information contact: The InfoShop The WorldBnk 1818 H Street, N.W. Washington, D.C. 20433 Telephone: (202) 458-5454 * By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties' claims on the disputed areas Page 5 Fax: (202) 522-1500 Web: http://www.worldbank.org/infoshop nicole hamon Q:\My Documents\WORD\BFHIVAIDS Suppl\Project Information Document - Concept Stage.doc February 25, 2005 11:51 AM