Report No. PID10681
Project Name                     Senegal-HIV/AIDS Prevention and@
Control Project
Region                           Africa
Sector                           HA - HIV/AIDS
Project ID                       SNPE74059
Borrower(s)                      Government of Senegal
Implementing Agency
Multi-Sector Government Agencies
Ministry of Health and Prevention
Address: Building Administratif,
Dakar, Senegal
Contact Person: Dr Mandiaye Loume,
Director of Health
Tel: (221) 642 4463
Fax: (221) 822 1517
Programme National de Lutte contre le SIDA
(PNLS)
Contact Person: Dr Ibrahima Ndoye
Tel: (221) 822 9045
Fax: (221) 822 1517
Email: IbNdoye@telecomplus.sn
Environment Category             B
Date PID Prepared                November 22, 2001
Projected Appraisal Date         November 19, 2001
Projected Board Date             January 17, 2002
1. Country and Sector Background
Senegal continues to shoulder a heavy burden of preventable and largely
treatable disease. Senegal has increased health investment from US$8 per
capita in 1996 to US$15 in 2000. It has also implemented a clear policy
shift toward the prevention of disease through the decentralization of
health services and through the involvement of beneficiaries and NGOs,
particularly in the management and implementation of programs. However,
these efforts risk being undermined by Senegal's rapid population growth
and still high but stable HIV prevalence rates among specific high risk
groups (15w of CSW are seropositive). Furthermore, the extent of behavior
change is still limited compared to the high level of awareness and
requires a significant effort for the promotion of safer sexual behavior
and to increase the median age at first sexual contact. The population is
expected to attain 16 million in 2020, almost doubling from 2000 (9.4
million), pushing the urban population to about 9 million. This increase
will exert unrelenting pressure on social services, and in the event of
weakening economic conditions, poses a major threat of increased
prevalence of communicable diseases, notably HIV/AIDS. Senegal regards
its development plan for the period 2002-2006 as the last reliable window



of opportunity for full containment of HIV/AIDS and STDs. Senegal has a
reasonable chance of significantly reducing HIV infections during the next
five years. Factors which have helped Senegal's success in maintaining
one of the lowest prevalence in the region and which favor further
reduction of new infections are: strong commitment at the highest level of
government and civil society;an early and unanimous decision (1986) to
confront STD and contain HIV infections;consistent and sustained strategic
direction and management of the program;a high level of sensitization to
the issues on the part of civil society, the private sector and
government, leading to strategic alliances between Muslims and Catholics,
the NGOs and key groups such PLWHA, women, youth and high risk
groups;strong capacity for policy formulation and strategic planning;a
good network of primary, secondary and tertiary health care facilities;
tested delivery systems and increasingly robust mechanisms for M&E and
grassroots participation;the development of best practices with the
assistance of major international research institutions, now disseminated
widely in the Region. The 2002-2006 National Strategic Plan Against
HIV/AIDS in Senegal (Programme Multisectoriel de Lutte Contre le SIDA -
PMLS) was developed and adopted through a multisectoral consultative
process in 2001 and is considered by Government as an integral part of the
broader framework for poverty alleviation. It builds on the earlier
National Strategic Plans, and constitutes a synthesis of sector strategic
plans that were elaborated through a series of consultations within each
sector. The multi-sector plan involves the government ministries, private
sector and civil society and stresses the need for partnership among all
the actors on the ground to ensure a coordinated, localized response to
reducing the spread of HIV infections and the socio-economic impact of
AIDS. The Government of Senegal has thus requested access to IDA resources
within the framework of the second phase of Multi-Country HIV/AIDS Program
(MAP2) for the Africa Region to be presented to the Board of Directors on
January 17, 2002. Senegal is eligible for MAP funding and has satisfied
the four MAP eligibility criteria as follows: a) Senegal already has a
coherent national strategy and has developed a comprehensive medium-term
multi-sector plan in a participatory approach with all concerned
stakeholders; b) it has created a national HIV/AIDS council chaired by the
Prime Minister with broad representation from all sectors and civil
society including people living with HIV/AIDS, to coordinate the
implementation of the national plan; c) the Government has agreed to use
exceptional implementation arrangements by channelling funds directly to
both public and private sector implementing agencies, civil society
organizations, associations of PLWHA, and to communities; andd) Government
has agreed to outsource important implementation aspects such as behavior
surveys, operation research, financial management and program management
monitoring and evaluation.
2. Objectives
The overall development objective of the project is to assist the
government of Senegal in: (i) preventing the spread of HIV/AIDS by
reducing transmission among the high risk groups; (ii) expanding the
access to treatment, care and support of people living with HIV/AIDS
(PLWHA); and (iii) supporting civil society and community initiatives for
prevention and care put forward by beneficiary groups selected on the
basis of the technical quality and likely impact of their proposals. The
project will support the implementation of Senegal's strategic plan
against HIV/AIDS for the period 2002-2006    (Plan Multisectoriel de Lutte
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Contre le SIDA-PMLS). The plan's specific goals aim to:maintain the
prevalence level of HIV below 3% in the country by 2006;mitigate the
health and socio-economic impact of HIV/AIDS at individual, household and
community levels; and create an enabling environment for a broader and
stronger public/private partnership to implement the plan.
3. Rationale for Bank's Involvement
The project allows IDA to provide continued support to a successful
program and promotes Senegal as a flagship of performance to date and
herald for future directions in sub-Saharan Africa (with MAP II).
However, this requires that it build on its successes and ensure program
sustainability and effectiveness. Senegal so far has done a lot with
limited resources involving high transaction costs. The project under MAP
II will significantly reduce the costs of raising (and coordinating)
finance. IDA support is also important as Senegal needs a substantial
injection of finance to entrench and widen the program, particularly to
fill existing gaps and finance future directions to strengthen weak
elements of its program, such as: limited multi-sectoral approach to date
under-resourced decentralized/community approach to care and prevention
weak capacity of both the public sector and the civil society need to
scale up a number of successful pilot activities Taking ART beyond pilot
(including testing hypothesis that ART reduces overall treatment costs)
Financing research in needed areas Fighting ongoing stigma issues
(homosexuality, workplace treatment of PLWHA)The Bank support will
complement other development partners, including pharmaceutical companies
in a joint effort in support of the national program of containment and
eventual marginalization of the malady. It brings to the table substantial
financing required to intensify HIV prevention, scale up the treatment of
AIDS and OIs as well mitigate the socio-ecomomic impact of the disease.
Since the Bank has good working knowledge of the other sectors, it can
assist in making the technical ministries' programs more effective.
Finally, by promoting emphasis on monitoring and evaluation as well as
research and dissemination, it will assist Senegal in maintaining its all
important "success story" - a powerful force for emulation by other
countries in the sub-region struggling with significantly higher levels of
prevalence.
4. Description
The project will support implementation of Senegal's strategic plan by a
wide variety of public sector agencies, private and non-governmental
organizations, and by community-based organizations. It will be carried
over a five-year period extending from 2002 to 2006 to coincide with the
strategic plan's duration and will be complementary to other donors
activities. The project aims at building additional planning,
implementation, monitoring and evaluation capacity of public and private
entities and expanding existing prevention, treatment and mitigation
programs. It will be implemented in close coordination with other
bilateral and multilateral organizations and will complement their
contributions toward implementation of the strategic plan. The project
will be implemented through four major components as follows:A.
Strengthening the capacity of implementing agencies and coordination
structures (US$ 2.0 million) This component is designed to reinforce the
resource management, implementation and monitoring and evaluation capacity
of government agencies, civil society and the private sector, and to
strengthen the capacity of local organizations and rural communities in
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the design and implementation of demand-driven HIV/AIDS activities. The
national HIV/AIDS Council, its Secretariat and its decentralized
structures at the regional and district levels will also be provided
technical, financial and material support to coordinate, monitor and
evaluate implementation of the national strategic plan. More specifically,
capacity-building support will consist of two sub-components:
Sub-component one will cover the provision of technical support services
and training to HIV/AIDS units of line ministries, NGO and CBO personnel,
with an emphasis on project design, participatory planning, and monitoring
of community-based activities, It will also train lab technicians,
medical and paramedical staff and social workers to strengthen VCT, the
prevention of mother to child transmission, the prevention and treatment
of opportunistic infection and tuberculosis and the provision of ART; and
Sub-component two will consist of the provision of technical support
services, equipment and materials to implement a comprehensive Monitoring
&Evaluation plan. The National Executive Secretariat (NES) will coordinate
and ensure implementation of the following M&E components, outsourcing
them to government and private agencies : (i) surveillance; (ii)
epidemiological research; (iii) financial monitoring; and (iv) project
monitoring. Surveillance comprises biological and behavioural
surveillance. Biological surveillance will be conducted among 6,600
antenatal women in 11 sites (Dakar, Kadack, Saint-Louis, Zinguinchor,
Thies, Mbour, Fatick, Louga, Diorbel, Kelda and Tamacounda), 300 STI
patients in Dakar, 2,400 TB patients in 8 regions, 2,400 hospital patients
in 8 regions and 2,500 sex workers in 7 regions. Behavioural surveillance
will be conducted among 3,200 sex workers in 10 regions, 10,000 in-school
youth in 10 regions, 500 apprentices in 10 regions, 1,000
soldiers/policemen in 10 regions, 1,000 customs/border guards in 6
regions, 1,000 seasonal workers in 3 regions, 1,000 mobile workers in 5
sites, 1,000 fishermen in Dakar and 1,000 port workers in Dakar. Combined
biological and behavioural surveillance will be conducted in pilot studies
of mobile populations. Epidemiological research will conduct aetiology and
sensitivity studies, track STI/HIV trends and evaluate HIV prevention and
care interventions among priority groups. Financial and project monitoring
will focus on NES's contracting and coordinating capacity and the
relevance, quantity, quality and economy of public sector and civil
society services. Operations research will examine what is working and
disseminate important lessons. NES will coordinate the above M&E
components as follows. Biological and behavioural surveillance will be
coordinated by NES, assisted by the Epidemiology Group, the
Bacterial-Virological Laboratory and research institutions.
Epidemiological research will also be coordinated by NES, assisted by the
Epidemiology Group, the Bacterial-Virological Laboratory and research
institutions. Financial and project monitoring will be combined and
delegated to one agency, for economy and effective financial-project
cross-verification. Structured reporting and assessment forms and
procedures will be utilized to ensure sound project monitoring. Financial
and project monitoring will generate verified primary data to inform
internal and external supervision. The World Bank Washington will support
operations research, to ensure maximum project cross-learning and
dissemination. On financial and program management monitoring, Senegal has
agreed to outsource the projects financial management to a single agency
which will also be responsible for financial and program management
monitoring and evaluation. Terms of reference were prepared and agreed
upon during project preparation and a firm will be appointed before credit
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effectiveness.   B.   Support to civil society and community-based
initiatives in the area of prevention, care and mitigation (Total Grant
US$12.5 million). Using a grant mechanism, this component is designed to
intensify prevention, care and social support to meet the information
needs of specific target groups and PLWHA and their families. It will
ensure the continuity and expansion of successful HIV/AIDS mitigation
activities adapted to local conditions and managed by grassroot
organizations and communities. The component will also promote and
encourage the HIV/AIDS initiatives of private sector enterprises aimed at
developing and implementing prevention, care and support strategies
designed for their employees and their families. This will be done in
close coordination and complementarity with the recently launched ILO
financed project of the Ministry of Labor. Funds will be channeled
directly through grants to associations, religious organizations and
communities, private enterprises, NGOs and community-based organizations
to cover a wide range of activities including: (i) prevention and
sensitization activities targeted to communities as well as specific
groups at high risk and aimed at building awareness, reducing the stigma
associated with HIV/AIDS and the adoption of safer sex behavior; (ii)
provision of home and community-based care for AIDS patients; and (iii)
social support to PLWHA, orphaned children and households affected by
HIV/AIDS through income generation activities and support to local
caregivers. The Government and grants recipients' responsibilities will be
embodied in a contractual agreement signed before works start. Eligibility
criteria, norms and standards for implementation of sub-projects under
this grant mechanism are described in a specific module of the project
operation manual.    With regard to activities aimed at helping orphaned
children, the project will finance investments to improve their nutrition,
their access to education and health care, as well as their integration
into host families and communities. Sub-projects proposed by NGOs and CBOs
and financed under the IDA Credit will complement and reinforce ongoing or
new initiatives such as the Hope For African Children Initiative launched
by Care, Plan International, Save the Children, The Society for Women
Against AIDS in Africa (SOWA) and the World Conference on Religion and
Peace. The Initiative has received a US$ 10 million grant from the Bill
and Melinda Gates Foundation and has been endorsed by UNICEF, the World
Bank and USAID.C. Support to Governmental Agencies Multi-Sector program
(US$ 12.5 million).   The purpose of this   component is to support a major
expansion of HIV/AIDS activities implemented by government entities.
Several ministries are in the process of developing detailed work plans
and budget and will be eligible for support under the project as of
project year one. These are the MOHP, the Ministry of Youth, The Ministry
of Interior, the Ministry of Education, and the Ministry of Technical and
Vocational Training, Literacy and National languages.     Additional
ministries would also have access to IDA funds once they develop their own
plan. Activities under this component cover the full spectrum of
prevention, treatment, care and support and include: (i) the design,
implementation and evaluation of information, education and communication
(IEC) programs aimed at specific audiences and high risk groups of the
population such as adolescents (both genders) in and out of school, women,
youth, and men in uniform; (ii) the promotion and distribution of condoms;
(iii) the promotion of and access to voluntary HIV counselling and testing
(VCT) and (iv) ART, PMCT and the prevention and treatment of STIs, other
opportunistic infections and tuberculosis. The IEC program which will be
supported under this component aims at maintaining people's awareness of
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HIV/AIDS risks and protection measures. It will promote behavior change
for safe sex practices and risk reduction and advocacy among public and
private leaders on human rights protection, abolition of discriminatory
practices and learning to live with PLWHA. Use of the mass media would be
an important channel of communication. The component will support the use
of social marketing for condom promotion and distribution. Peer groups,
vending machines and other social marketing strategies will also be used
to make condoms accessible to all segments of the adolescent and adult
population. Each ministry can choose its strategy to make condoms
available and accessible to its staff and clients, and visible access to
condoms in public places will be encouraged. Implementation of MOHP
HIV/AIDS clinical programs would also be supported under this component.
This will include:i) the prevention of HIV/AIDS mother to child
transmission. The project will support the decentralization of MOHP pilot
PMCT program to at least one clinical site in each of the ten regions of
the country during the period 2002-2006. The objective is to achieve a 80%
level of awareness of mother to child transmission among women 15 to 49
and to reduce the transmission rate from 30% to 15%-. 90% of children born
to HIV infected mothers would be provided the care and treatment at the
end of the project. Specific activities will consist of: a) the
progressive creation, training and equipping of multidisciplinary teams
in each of the ten regions of the country under the supervision of a
national team composed of leading gynycologists, pediatricians, biologists
and social assistants; b) implementation of a program of pre-test and
post-test counselling and the voluntary testing of a target total of
58,000 pregnant women in pre-natal consultations during the period
2002-2006; c) expanding access to short regimen treatment using Zidovudine
or Nevirapine drugs; d) expanding access to antiretrovial treatment
therapy in accordance with national standards; e) the development and
implementation of specifc psycho-social support and IEC activities
targeted to HIV infected pregnant women covering topics such as nutrition,
breast feeding practices and the use of milk substitute; and f) the
establishment of a supervision and monitoring system to ensure effective
control and quality of implementation of PMCT protocols and guidelines and
efficient follow-up and monitoring of patients. ii) the diagnosis,
treatment and care of HIV/AIDS patients. This will be based on the
expansion of ISAARV (Senegal Initiative for the Introduction of
Antiretroviral Therapy) . Launched in 2000 and currently limited to the
city of Dakar, ISAARV will be progressively decentralized to the main
cities of the country (Saint Louis, Kaolack, Ziginchor and Tambacounda).
For this purpose, the project will strengthen voluntary counseling and
confidential testing and laboratory capacity to help scale up the
diagnosis, treatment and care for HIV/AIDS patients. This is part of the
MOH's objective to reduce HIV transmission, reduce worker disability and
improve the quality of life for HIV/AIDS patients. The component will
also support activities aimed at improving the diagnostic and treatment of
sexually transmitted diseases, opportunistic infections, and
tuberculosis. It will contribute as needed, to strengthening drug
management, patient management (eligibility, clinical and biological
follow-up) and psycho-social and economic support to PLWHA. Bio-medical
equipment will be purchased to monitor the immunology and virology
parameters of HIV infection and financing will be made available to cover
the costs of minor renovations in selected laboratory facilities, the
procurement of reagents and drugs for the treatment of STIs, Opportunistic
Infections, TB and other HIV related illnesses. The Government of Senegal
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will continue its ARV drugs procurement plan under arrangement with five
international pharmaceutical companies (Merck, Pfizer, Bristol-Meyers,
Boehringer/Ingelheim and Roche) as part of the "Access Initiative" of
these companies in Africa. Funds under the IDA Credit would also be made
available as might be needed, to supplement Government financing of ARV
drug procurement.D. Support to project management and administration (US$
3.0 million).   This component will provide support to facilitate the
programming, coordination, and monitoring of project operations, including
support to National Aids Council (NAC) and National Executive Secretariat
(NES) to ensure complementarity and efficient coordination of activities
by all concerned parties and to consolidate activity plans, budgets and
progress reports. The component will support the deployment of skilled and
experienced manpower to staff essential coordinating structures and will
fund services of a financial management agent, technical and financial
audits, logistic support to facilitate project supervision and reporting,
and the organization of CMLS/NES regular meetings and annual project
reviews.
A. Strengthening capacity of implementing agencies and coordinating
structures
B. Support to civil society and community-based organizations' Initiatives
C. Support to Govt. Agencies Multi-Sector Programs
D. SuppoLine ministries and rt to Project Management and Administration
5. Financing
Total ( US$m)
BORROWER 13.5
IDA 30
EC: EUROPEAN COMMISSION 2.8
CANADA, GOV. OF 1.5
FRANCE, GOV. OF 1
GERMANY, GOV. OF 1.5
UN UNAIDS 0.5
UN FUND FOR POPULATION ACTIVITIES 0.8
WORLD HEALTH ORGANIZATION 0.4
Total Project Cost 52
6. Implementation
Institutional arrangements. (i) Project coordination. Overall
coordinating responsibility for the PMLS will be undertaken by the
National HIV/AIDS Council (CMLS). The CMLS members include
representatives from all government ministries, the private sector, an
observer designated by the group of international donors and
representatives of the civil society including youth, women, religious
groups, PLWHA, NGOs, regional and local communities as well as recognized
experts in HIV/AIDS that the CMLS may deem necessary to call upon for
advice (nonvoting). The Prime Minister will assume the chairmanship of
the CMLS and chair its meetings. The Minister of health will assume its
vice-chairmanship. The number of CMLS members will be limited to a
maximum of 30 persons. It will meet once every six months or,
exceptionally, at the request of its chairperson and/or one third of its
members. The CMLS will be responsible for:(i) advocacy, strategic
direction and policy coordination to ensure conformity with the PMLS;(ii)
mobilization of financial, human and physical resources necessary to carry
out the PMLS;(iii) oversight of the plans for implementation of the PMLS
throughout the country;(iv) ensuring the legal and ethical aspects of the
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fight against HIV/AIDS.The CMLS will execute its mandate through a
National Executive Secretariat (NES) that will have responsibility for
overall coordination of the PMLS. The NES will be largely representative
of all parties to the national strategy including the focal persons in
each of the key ministries, representatives of civil society, the private
sector, local communities and vulnerable groups. It will meet at least
every three months. The NES will have a permanent core of executive staff
including an Executive Secretary, an Administrative and Financial Officer,
and two Program Coordinators. The NES executive secretary will be the
project director and will report to the Minister of Health, as
vice-chairperson of CLMS. The NES will be responsible for:(i) Recording
decisions taken during meetings of the CMLS and ensuring their
execution;(ii) Overseeing the contracts and conventions signed between the
financial management agency and the implementing agencies, and ensuring
their overall execution and quality assurance;(iii) Representing the CMLS
in meetings with various levels of government and other partners; (iv)
Ensuring the provision of technical assistance and quality assurance to
partners involved in the national responses;(v) Ensuring monitoring and
evaluation of sector and local plans; (vi) Presenting the annual financial
statements and program reports to the CMLS;(vii) Organizing occasional
meetings between all the partners in the program;(viii) Coordination with
the Financial Management Agency (FMA);(ix) Ensuring overall monitoring,
evaluation and coordination of the program.The NES will coordinate with
other IDA funded projects and with HIV/AIDS related projects financed by
other bilateral and multilateral agencies. The NES will meet regularly
with UNAIDS thematic Group and participate in meetings of HIV/AIDS Donors
led by UNDP. Some of the functions of NES will be carried out at a
decentralized level by existing regional and departmental HIV/AIDS
committees that will provide general policy and technical guidance to
partners operating at regional, departmental and community levels. These
Committees are composed of representatives of government agencies,
municipal and communal councils, civil society, the private sector and
presided over by a coordinator chosen by the members of the Committees.
The Regional and Departmental Committees will: (i) provide technical
assistance to implementing agencies; (ii) coordinate meetings to
synthesize reports on activities in the region; (iii) provide support as
needed to the FMA; and (iv) ensure the monitoring and evaluation of the
response to HIV/AIDS at a decentralized level. The Regional and
Departmental Committees will be physically hosted by other organizations
in the regions and the NES will be responsible for coordinating their
activities. (ii) Project Implementation . The project will finance a
series of HIV/AIDS action plans presented by line ministries, as well as
projects proposed by a large number of civil society organizations,
including NGOs, women's groups, Associations, unions, private enterprises
and community-based organizations (CBOs). Line Ministries will receive
approximately 40- of project funds.   The breakdown between sectors will be
determined during appraisal. These funds will be complemented by
contributions from line ministries' budgets, including provision for a
Focal Point or HIV/AIDS unit that will be responsible for policy
coordination, monitoring and reporting on the sector response to HIV/AIDS.
Line ministries will implement their respective plans through their
existing central, regional and departmental units. They will provide
administrative and technical support to their implementation units,
including relevant guidelines, training and monitoring and evaluation.
They will also ensure that appropriate financial, human and physical
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resources are channelled to regional and departmental governments to
enable a decentralized response to HIV/AIDS. A formal contract including
a work program and budget with agreed input and output indicators will
guide the relationship between line ministries, the NES and the FMA. The
NES will be responsible for providing technical assistance and quality
control to line ministries.Civil Society will receive approximately 40 W
of project funds through sub-projects proposed and implemented by a
variety of organizations. Communities and CBOs will organize themselves
and present their project proposals to the respective regional or
departmental committee and will be responsible for executing their
projects. Communities and CBOs may decide to enter into contract with a
non governmental organization to assist them in the preparation and
implementation of projects. The cost of such assistance will not exceed
20t of the total project cost.   Communities will contribute in kind to
sub-project financing for a minimum amount of 5t of total project costs.
Other civil society organizations (including NGO, religious organizations,
associations, unions, and private enterprises) may present sub-project
proposals of a national, regional or departmental scope to be directly
financed by the project. Eighty percent of total sub-project costs must
be directed to activities targeted to beneficiaries.     Some private sector
organizations may also be contracted to implement specific project
activities in the areas of research and evaluation or in any other topic
area, as deemed necessary. The criteria for eligibility as well as funds
allocated to each organization will be determined according to a set of
criteria established for different categories of applicants. A roster of
over 200 civil society organizations working in HIV/AIDS has been
established and reflects different categories of NGOs and CBOs, classified
according to their experience, geographic coverage, target beneficiaries
and ability to carry out HIV/AIDS projects. The roster will be updated to
include private sector organizations and other associations and will be
reviewed during appraisal. The project will be implemented in an
incremental manner starting with those line ministries, NGOs and CBOs
which already have HIV/AIDS work plans and projects. Coverage will be
extended to other sectors and organizations of the civil society as their
implementation capacity is strengthened and their work plan and projects
prepared. Line ministries and their regional and district structures will
prepare annually, a work plan and budget for each fiscal year. Planned
activities for the first year of project implementation will be reviewed
at appraisal.   The project provides for a mechanism to establish
capacity-building partnerships between NGOs at different levels, whereby
less experienced, smaller NGOs will work with larger, more experienced
NGOs in order to gain technical and project management skills as they
implement projects under the guidance of the larger NGO. National NGOs
will be required to work in partnership with local NGOs as a criterion for
eligibility, and will be afforded resources to provide such technical
assistance. Other eligibility criteria for any applicant organization
will include coherence with the strategic directions of the PMLS,
experience with HIV/AIDs and Community Development, Management Capacity
and Community Participation. A project operation manual which describes
in detail the project's institutional and implementation arrangements, and
administrative procedures is being prepared and an advanced version will
be reviewed at appraisal. The manual will set out the functional
relationships between the different organs in the institutional framework,
the criteria and guidelines for allocation of funds including under the
grant mechanism, as well as accounting norms and reporting requirements
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for all responsible and implementing agencies. External technical and
financial audits of the project will be carried out regularly by the
government in order to ensure financial and technical compliance and
quality control.Financing for the project will be mobilized through public
sector budget contributions (investment and recurrent expenditure),
current resources committed by bilateral agencies and multilateral
organizations and international NGOs, and private sector donations. IDA
resources through the MAPII Project will serve to complete the HIV/AIDS
program financing plan. In order to ensure a multisectoral and local
response in the fight against HIV/AIDS IDA resources will be allocated
approximately in the following manner:40- of the Project's resources will
be directed towards the public sector and 409 to the civil society and
the private sector. 65t of the funds will be channelled to community
level, 20- to the regional level and 15t to the national level.10. of the
total credit will go towards project management, including the fee of the
financial management agency, independent financial and technical auditors,
operating costs of the National Secretariat and adminsitartive support to
the Regional and Departmental Committees. (iii) Project monitoring,
supervision and evaluation. It is proposed that surveillance and
epidemiological research should be managed by the HIV/AIDS unit of the
MPOH, assisted by the Epidemiology Group, the Bacterial-Virological
Laboratory and research institutions. Financial and program management
monitoring will be combined and delegated to one agency, for effective
financial program cross-verification. Structured reporting and assessment
forms and procedures will be developed to ensure sound program monitoring.
Financial and program monitoring will generate verified primary data to
inform internal and external supervision. Line ministries and other
implementing agencies will supervise their own activities at all levels
within their respective sector mandates. They will provide the NES and
FMA information on a number of agreed upon variables on a quarterly basis.
Regional and departmental HIV/AIDS committees representing each sector and
incorporating community based and civil society organizations will
supervise project activities at departmental and community levels.
Analyses will be conducted by the FMA to assess the performance of
community based organizations and other civil society entities as needed.
The executive secretariat core team will supervise overall project
implementation and will assess effectiveness and efficiency of
implementation at central, regional and departmental levels, working in
close collaboration with the FMA under its defined terms of reference for
program management monitoring. The NES core team will consolidate
progress reports, organize regular meetings of NES members to discuss
progress of each type of implementing agency. It will organize the annual
project reviews, the mid-term review and the project completion review to
assess the performance of the project, its components and its contribution
to the national strategic goal of reducing the spread and impact of
HIV/AIDS. The project's annual stakeholders meetings will form the basis
for the next year annual work program and budget. The draft project
operational manual and Annex 4 to the PAD will provide a detailed
description of the project monitoring, institutional and implementation
arrangements and will be reviewed during appraisal. (iv) Procurement
procedures. Line ministries will procure works, goods and services in
relation to the 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.
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Consulting services by firms, 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).The Government will contract with
Pharmacy Nationale d'Approvisionnement (PNA) a public autonomous drug
procurement agency to carry out the procurement of large items and
packages such as diagnostic kits and reagents and pharmaceutical products
and drugs for the diagnosis and clinical management of HIV/AIDS, sexually
transmitted infections and other opportunistic infections including
Tuberculosis. Other United Nations Organizations' procurement agents may
be contracted for the procurement of specific items such as condoms.
Communities will use the Bank's Simplified Procurement and Disbursement
procedures for Community based Investments to procure goods and services
needed to implement their respective HIV/AIDS initiatives. Since each
sub-project costs would be modest, local shopping will be a standard
procurement method.      To facilitate speedy import of items valued at
less than US$100,000 equivalent, required urgently for diagnosis and
treatment and institutional strengthening, contracts may be made based on
international shopping and national shopping procedures, respectively or
through procurement from the United Nations.The project procurement and
disbursement arrangements will be reviewed with the Borrower and finalized
during appraisal and detailed in the Project Implementation Manual and in
annex 6 of this report.    (v) Financial management and disbursement.
Financial management of the project and the monitoring and evaluation of
program management will be contracted to a private sector financial
management agent selected on a competitive basis. This is in line with MAP
best practice to ensure the most rapid, flexible and efficient
mobilization of resources to the beneficiaries of the project. As part of
its contract with the Government, the FMA will be required to develop a
fully integrated financial and accounting system using appropriate
software as well as a detailed manual of financial procedures and chart of
accounts including the format, content and periodicity of the various
financial statements to be produced. The FMA will also be required to set
an appropriate financial and accounting system at regional and
departmental levels.Transfer of funds to line ministries, NGOS, CBOs and
private sector organizations and mechanisms for tranche releases and the
scaling up of successful projects will be made by the FMA in accordance
with eligibility standards and implementation procedures as described in
the project operation manual and guidelines. For each category of
applicants, there will be clear eligibility criteria, thresholds as well
as requirements for contributions, depending on size, experience and
sector.   Applications will be made directly to the FMA and disbursements
processed, with no ex ante veto by other bodies (the NES will
automatically be copied with each application). For all applicants, no
more than 209 of any funding can be used for overheads.    The terms of
reference of the FMA were reviewed and agreed to by IDA at pre-appraisal
and a firm will be appointed before credit effectiveness. The objective is
to put in place sound financial management and output monitoring systems
and to introduce the World Bank Financial Management Initiative to
administer the credit. However, in its initial phase, the project will
operate under traditional disbursement procedures until its financial
management is deemed satisfactory by IDA to fulfill the requirements of
PMR-based disbursement. Government will open a special account at a
commercial bank and all disbursements will be fully documented at the time
of submission of withdrawal applications, except for expenditures made
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against Statement of Expenditures (SOE). A plan of action will be
established at appraisal in order to make the project ready for PMR-based
disbursement within 18 months of Credit Effectiveness.
7. Sustainability
The project is built upon the established partnership between Government
and the civil society, their past and current collaboration in various
social sector projects and their strong ownership of the national
multi-sector plan against HIV/AIDS. The project will expand and intensify
existing programs by mainstreaming prevention care and support activities
of several line ministries and the civil society and by tapping and
reinforcing community resources and community organizations' potential for
mobilization. The government policy of decentralization and the project's
emphasis on capacity building at all levels of project implementation
would also enhance sustainability.
8. Lessons learned from past operations in the country/sector
The National Forum on HIV/AIDS held in December 2000 clearly identified
the successes and failures of the national program in place since 1986,
drawing lessons for project design. Findings from the evaluation of MAP I
as well as from other countries' experiences were also incorporated into
project design. Lessons include:Political leadership and commitment:
Political "champions" are key to mobilizing national and donor resources
for the fight against the HIV/AIDS epidemic. The Government of Senegal
has been a model of early, high level leadership given its firm commitment
to the fight against HIV/AIDS. The Government recognizes the social as
well as the economic imperatives to keep a very low HIV/AIDS prevalence
and therefore is committed to supporting a sustained program and is now
establishing a multisectoral national commission (CMLS) chaired by the
Prime Minister. Need for a multi-sectoral approach and community
participation: Experience in many countries demonstrates the fact that
the health sector alone is not capable of winning the war against AIDS on
a sustained basis. There is need for a multi-sectoral approach involving
key ministries in government at all levels, the private sector and the
non-government/community sector. For the Senegal MAP, a multisectoral
team - including civil society representatives - was involved in project
design from the beginning. At the same time, the role of the Ministry of
Health is recognized as pivotal, particularly with respect to treatment of
STIs, OIs, provision of ART, MTCT treatment, VCT, blood transfusion
services, procurement, epidemiological surveillance and general
health-related technical training and oversight. Contracting out of
Financial Management: Lessons from MAPs to date indicate the importance
of contracting out financial management in order to maximize effective and
rapid access to funds by the various stakeholders, particularly to those
that are community-based. Eligibility criteria must also be made clear
and transparent to all potential implementing agencies. In particular,
high priority must be put on financing "software" rather than "hardware"
- funding people directly involved in HIV/AIDS activities rather than
equipment and civil works. In the Senegal project, all financial
management will be contracted out to a private sector financial management
agency (FMA) and no major civil work program is envisioned. The FMA will
be responsible for disbursements to all applicants from the civil society
and the private sector as well as government ministries to implement their
sector plans. The Government has also agreed that M&E of program
management will be contracted to the same agency or to other research
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organizations as may be deemed necessary.Financing and Capacity Building
Mechanisms for Civil Society: In order to ensure a widespread, sustained
and cost-effective response to the disease, it is imperative that the
community take primary responsibility for prevention and care of orphans
and PLWHA. A lot has been learned with regard to the mobilizing and
financing of community based initiatives over the last few decades.
Senegal already has a highly active civil society with over 200 NGOs
involved in HIV/AIDS and 300 women's groups. In the Senegal MAP, at least
50t of project funds will be directed to civil society.    Need for
strengthening capacity of implementing agencies: Based on past experience,
greater priority needs to be given to enhancing the capacity of
institutions in program management, procurement, financial management,
monitoring and evaluation. In Senegal, Project Component 1 will provide
significant capacity building for implementing agencies, the NES and
regional and community equivalents. At the technical level, training of
health personnel in both the technical and psycho-social dimensions of
HIV/AIDS forms a key subcomponent of the project.Importance of Monitoring
and Evaluation: Monitoring and evaluation of project activities is
important for assessing progress and the impact of interventions as well
as identifying corrective measures in the course of implementation. The
HIV/AIDS surveillance systems need to be strengthened for effective
monitoring and evaluation of the trends of the HIV/AIDS epidemic so as to
identify areas that need to be tackled for the greatest impact. Senegal
has a developed M&E surveillance system that has provided critical data
for identifying high risk groups and tracking PLWHA. The MOHP is
reinforcing its second generation surveillance system by expanding it to
all regions during the Project. In addition to the program monitoring
role of the multisectoral NES and regional and local equivalents, there
will be an independent performance review and audit of the NES and
financial management agency. The civil society is involved in M&E through
its roles in the CMLS, NES and regional/community equivalents, but it will
also participate in the annual supervision missions.Importance of
clarifying roles: It will be important to delineate the roles of
different agencies. Experience from other countries has demonstrated that
the central organs can be easily rendered ineffective and overly
bureaucratic if their roles are not clearly defined, including their
functions in relation to other key players. In Senegal, clear terms of
reference for the CMLS, the NES and the regional and community equivalents
will be fully developed in the Project Implementation Plan (PIP).
Vulnerability factors and high risk groups are key to future success: The
HIV/AIDS epidemic is driven by underlying vulnerability factors among
populations and high risk groups. The combination of poverty, illiteracy
and gender disparities exacerbate exposure to the virus. For this reason,
the project will look at targeting these groups with differential
information geared to behavior change and will also pilot some
income-generating activities. It will also support efforts to reduce
stigmatization of PLWHA and homosexuality, in order to bring these in line
with Senegal's progressive approach to CSW. This project will
specifically focus on vulnerable groups, including youth (in and out of
school), women, workers, CSW, armed forces, PLWHA, prisoners and
others.Good Donor Coordination: This can significantly reduce the
Government's transaction costs for management of externally funded
programs. Common arrangements for program reviews, monitoring and
evaluation, planning of financial and technical assistance, support
missions, funding of programs or program components are all areas that
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will be pursued in close cooperation with UNAIDS and other cooperating
partners. The UNAIDS (WHO) representative has been part of the project
design team and the project will benefit from the strong donor
coordination and complementarity that exists already in Senegal. Other
donors may also elect to utilize the FMA as a vehicle for channeling their
funds to Senegal's National Program.
9. Program of Targeted Intervention (PTI)     Y
10. Environment Aspects (including any public consultation)
Issues        The project is not expected to generate major
adverse environmental issues. However, there are risks attached to the
handling and disposal of HIV/AIDS infected materials. These risks
potentially affect: personnel in hospitals, health centers and
municipalities who handle waste, families whose income is derived from the
triage of waste and also the general public to the extent that waste is
not disposed of on site or safely contained in protected areas. A medical
waste management plan will be prepared by the Government. Institutional
arrangements and the cost of its execution will be made clear in the PAD
as well as the DCA. The plan will include the proper disposal of
hazardous bio-medical waste, a bio-safety training program for the staff
of all hospital, health center and community-based programs, including
traditional midwives and practitioners, who may be involved in testing and
treatment. The training program will include specific instruction on the
triage, transport and disposal of waste. In addition the project
implementation manual will include guidelines to ensure that environmental
considerations are taken into account in the selection and design of
project activities. With the assistance of the Africa Safeguard Policy
Enhancement Team (ASPEN), TORs have been prepared for such a plan which
will be reviewed by the Bank prior to credit effectiveness. The task team
organized a presentation on medical waste management attended by members
of the Senegalese project preparation team and a follow-up half day
workshop is envisaged in the near future. Safeguard advice is provided by
a member of the ASPEN team.
11. Contact Point:
Task Manager
Anwar Bach-Baouab
The World Bank
1818 H Street, NW
Washington D.C. 20433
Telephone: 202 473 5037
Fax: 202 473 8216
12. For information on other project related documents contact:
The InfoShop
The World Bank
1818 H Street, NW
Washington, D.C. 20433
Telephone: (202) 458-5454
Fax: (202) 522-1500
Web: http:// www.worldbank.org/infoshop
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Note: This is information on an evolving project. Certain components may
not be necessarily included in the final project.
This PID was processed by the InfoShop during the week ending November 30,2001
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