Document of The World Bank FOR OFFICIAL USE ONLY Report No: 46343-NG PROJECT APPRAISAL DOCUMENT ON A PROPOSED CREDIT IN THE AMOUNT OF SDR 150.4 MILLION (US$225 MILLION EQUIVALENT) TO THE FEDERAL REPUBLIC OF NIGERIA FOR A SECOND HIV/AIDS PROGRAM DEVELOPMENT PROJECT May 20, 2009 Human Development III Country Department AFCW2 Africa Region This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. CURRENCY EQUIVALENTS (Exchange Rate Effective March 31, 2009) Currency Unit = Naira US$1 = Naira 148 US$1 = SDR 0.67 FISCAL YEAR January 1 ­ December 31 ABBREVIATIONS AND ACRONYMS AIDS Acquired Immune Deficiency Syndrome ART Antiretroviral Therapy BMPIU Budget Monitoring and Price Intelligence Unit BPP Bureau of Public Procurement CAS Country Assistance Strategy CBO Community-based Organization CDD Community-Driven Development CG Consultative Group CIDA Canadian International Development Agency CPAR Country Procurement Assessment Review CPS Country Partnership Strategy CQ Cost and Quality CSP Country Strategy Paper CSO Civil Society Organization DFID Department for International Development (UK) DHIS District Health Information System DP Development Partners DPG Development Partners Group DRG Debt Relief Gain EMCAP Economic Management Capacity Building Project ENR Enhancing the National Response ERGP Economic Reform and Governance Project ESMF Environmental and Social Management Framework EU European Union FCT Federal Capitol Territory FGN Federal Government of Nigeria FLHE Family Life HIV/AIDS Education FME Federal Ministry of Education FMF Federal Ministry of Finance FMOH Federal Ministry of Health FMOWA Federal Ministry of Women's Affairs FMR Financial Management Report FOR OFFICIAL USE ONLY FPM Financial Procedures Manual FSW Female Sex Worker FY Fiscal Year GBP Great Britain Pound GDP Gross Domestic Product GFATM Global Fund for AIDS, TB and Malaria GNP Gross National Product GON Government of Nigeria GTT Global Task Team HAF HIV/AIDS Fund HCT HIV Counseling and Testing HIPC Highly Indebted Poor Country HIV Human Immuno-deficiency Virus HMIS Health Management Information System HPDP2 HIV/AIDS Program Development Project 2 IAU Internal Audit Unit IBBSS Integrated Bio-Behavioral Surveillance Survey IBRD International Bank for Reconstruction and Development ICB International Competitive Bidding IDA International Development Association IDU Injecting Drug User IDF Institutional Development Fund IEC Information, Education and Communication IEG Independent Evaluation Group IFR Interim Unaudited Financial Report IMF International Monetary Fund INT Department of Institutional Integrity ISA International Standards on Auditing ISDS Integrated Safeguard Data Sheet ISR Implementation Status and Results Report JFA Joint Financing Arrangement JICA Japan International Cooperation Agency LACA LGA Action Committee on AIDS LGA Local Government Authority LHPMIP Logistics and Health Program Management Information Platform LM Line Ministry LOAG Loan Administration Group MARP Most at Risk Group MDA Ministry, Department, Agency MDG Millennium Development Goal M&E Monitoring and Evaluation MIS Management Information System MOH Ministry of Health MSM Men who have sex with men MTCT Mother to Child Transmission MWMP Medical Waste Management Plan This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not be otherwise disclosed without World Bank authorization. NACA National Agency for the Control of AIDS NAPEP National Poverty Eradication Program NAPP National AIDS Priority Plan NARHS National AIDS and Reproductive Health Survey NBS National Bureau of Statistics NCB National Competitive Bidding NDHS National Demographic and Health Survey NEEDS National Economic Empowerment and Development Strategy NEITI Nigeria Extractive Industries Transparency Initiative NIBUCAA Nigerian Business Coalition Against AIDS NIF Not IDA Finance NGO Non-Governmental Organization NNRIMS Nigerian National Response Information Management System NSF National Strategic Framework (2005 ­ 2009) NSF 2 National Strategic Framework 2 (2010 ­ 2014) OVC Orphans and Vulnerable Children PABA Persons Affected by AIDS PAD Project Appraisal Document PCN Project Concept Note PDO Project Development Objective PEMFAR Public Expenditure Management and Financial Accountability Review PEPFAR US President's Emergency Plan for AIDS Relief PFM Project Financial Management PFMU Project Financial Management Unit PHC Primary Health Care PIC Public Information Center PID Project Information Document PLWHA People Living with HIV/AIDS PMTCT Prevention of Mother to Child Transmission PSO Private Sector Organization PSR Project Status Report QCBS Quality and Cost Based Selection QER Quality Enhancement Review RRF Rapid Response Fund SA Special Account SACA State Action Committee on AIDS SBD Standard Bidding Documents SDR Standard Drawing Rights SFH Society for Family Health SGCBP State Governance and Capacity Building Project SMOF State Ministry of Finance SMOH State Ministry of Health SOE Statement of Expense TTL Task Team Leader TWG Technical Working Group UNAIDS United Nations Program on HIV/AIDS UNDP United Nations Development Program UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on AIDS USAID United States Agency for International Development USD United States Dollar USG United States Government VCT Voluntary Counseling and Testing WB World Bank Vice President: Obiageli Katryn Ezekwesili Country Director: Onno Ruhl Sector Director Yaw Ansu Sector Manager: Lynne Sherburne-Benz Task Team Leader: John Elder NIGERIA Nigeria Second HIV/AIDS Program Development Project CONTENTS Page I. STRATEGIC CONTEXT AND RATIONALE ................................................................. 1 A. Country and sector issues.................................................................................................... 1 B. Rationale for Bank involvement......................................................................................... 5 C. Higher level objectives to which the project contributes.................................................... 5 II. PROJECT DESCRIPTION............................................................................................. 6 A. Lending instrument............................................................................................................. 6 B. Project development objective and key indicators.............................................................. 6 C. Project components............................................................................................................. 7 D. Lessons learned and reflected in the project design.......................................................... 11 E. Alternatives considered and reasons for rejection ............................................................ 12 III. IMPLEMENTATION .................................................................................................... 12 A. Partnership arrangements.................................................................................................. 12 B. Institutional and implementation arrangements................................................................ 13 C. Monitoring and evaluation of outcomes/results................................................................ 14 D. Sustainability..................................................................................................................... 15 E. Critical Risks and possible controversial aspects ............................................................. 16 F. Credit conditions and covenants....................................................................................... 18 IV. APPRAISAL SUMMARY ............................................................................................. 19 A. Economic and financial analyses...................................................................................... 19 B. Technical........................................................................................................................... 19 C. Fiduciary ........................................................................................................................... 20 D. Social................................................................................................................................. 21 E. Environment...................................................................................................................... 22 F. Safeguard policies............................................................................................................. 22 G. Policy Exceptions and Readiness...................................................................................... 23 Annex 1: Country and Sector or Program Background......................................................... 24 Annex 2: Major Related Projects Financed by the Bank and/or other Agencies................. 33 Annex 3: Results Framework and Monitoring ........................................................................ 36 Annex 4: Detailed Project Description...................................................................................... 56 Annex 5: Project Costs ............................................................................................................... 62 Annex 6: Implementation Arrangements................................................................................. 65 Annex 7: Financial Management and Disbursement Arrangements..................................... 68 Annex 8: Procurement Arrangements...................................................................................... 82 Annex 9: Economic and Financial Analysis ............................................................................. 90 Annex 10: Safeguard Policy Issues............................................................................................ 91 Annex 11: Project Preparation and Supervision ..................................................................... 92 Annex 12: Documents in the Project File ................................................................................. 94 Annex 13: Statement of Loans and Credits.............................................................................. 95 Annex 14: Country at a Glance ................................................................................................. 97 Annex 15: Maps........................................................................................................................... 99 NIGERIA SECOND HIV/AIDS PROGRAM DEVELOPMENT PROJECT PROJECT APPRAISAL DOCUMENT AFRICA AFTH3 Date: May 20, 2009 Team Leader: John A. Elder Country Director: Onno Ruhl Sectors: Health (50%);Other social services Sector Manager/Director: Lynne D. (30%);Central government administration Sherburne-Benz (10%);Sub-national government administration (10%) Themes: HIV/AIDS (P);Social safety nets (S);Participation and civic engagement (S) Project ID: P102119 Environmental screening category: Partial Assessment Lending Instrument: Sector Investment Loan Project Financing Data [ ] Loan [X] Credit [ ] Grant [ ] Guarantee [ ] Other: For Loans/Credits/Others: Total Bank financing (US$m.): 225.00 Proposed terms: Standard IDA terms, with a maturity of 40 years, including a grace period of 10 years. Financing Plan (US$m) Source Local Foreign Total BORROWER/RECIPIENT 5.00 0.00 5.00 International Development Association 184.00 41.00 225.00 (IDA) Total: 189.00 41.00 230.00 Borrower: Federal Ministry of Finance Finance Headquarters Complex Central Business Area Abuja FCT Nigeria Responsible Agency: National Agency for the Control of AIDS Plot 823 Ralph Shodeine St. Central Area Abuja Federal Capitol Territory Nigeria Tel: 234-9-461-3724 Fax: 234-9-461-3700 info@Naca.gov.ng www.naca.gov.ng/ Estimated disbursements (Bank FY/US$m) FY 10 11 12 13 14 Annual 8.00 55.00 60.00 60.00 42.00 Cumulative 8.00 63.00 123.00 183.00 225.00 Project implementation period: Start June 16, 2009 End: December 31, 2013 Expected effectiveness date: September 30, 2009 Expected closing date: December 31, 2013 Does the project depart from the CAS in content or other significant respects? [ ]Yes [X] No Ref. PAD I.C. Does the project require any exceptions from Bank policies? Ref. PAD IV.G. [ ]Yes [X] No Have these been approved by Bank management? [ ]Yes [ ] No Is approval for any policy exception sought from the Board? [ ]Yes [X] No Does the project include any critical risks rated "substantial" or "high"? [X]Yes [ ] No Ref. PAD III.E. Does the project meet the Regional criteria for readiness for implementation? [X]Yes [ ] No Ref. PAD IV.G. Project development objective Ref. PAD II.C., Technical Annex 3 The Project Development Objective is to reduce the risk of HIV infections by scaling up prevention interventions and to increase access to and utilization of HIV counseling, testing, care and support services Project description [one-sentence summary of each component] Ref. PAD II.C., Technical Annex 4 Component 1: Expanding the Public Sector Response: This component will support HIV/AIDS activities included in the second National Strategic Framework carried out by Line Ministries. Component 2: Expanding the civil and private sector response to the HIV/AIDS Epidemic: This component will support the civil society response to HIV/AIDS through a system of grants to NGOs. Component 3: Strengthening mechanisms for project coordination and management: This component will provide capacity building support to Federal and State government and non- governmental organizations active in the fight against HIV/AIDS. Which safeguard policies are triggered, if any? Ref. PAD IV.F., Technical Annex 10 The project will generate some hazardous medical waste in HIV/AIDS testing and treatment centers. In addition, the project also involves the renovation of buildings, construction of new ones and other minor civil works to enhance the quality of HIV/AIDS service delivery. An Environment and Social Management Framework (ESMF) to prevent any serious environmental impacts has been developed and approved. The potential environmental and social impacts of sub-projects under components 1 and 2 will be small-scale and site-specific; and thus easily remediable typical of category B projects. The national Medical Waste Management Plan and the project specific medical waste management plan provide guidance on the management of medical waste generated by the project. Their potential environmental impacts are minor and site specific. Significant, non-standard conditions, if any, for: Ref. PAD III.F. Board presentation: None Loan/credit effectiveness: The Subsidiary Agreement for at least one (1) Project State has been executed on behalf of the Recipient and a Participating State. Withdrawal conditions for states are: (i) The Recipient has furnished to the Association evidence satisfactory to the Association that the Recipient has concluded a Subsidiary Agreement with the concerned Participating State under terms and conditions satisfactory to the Association; and (ii) the Association has received an opinion pursuant to Section 8.02 (b) of the General Conditions that the Subsidiary Agreement has been duly authorized or ratified by the Recipient and the concerned Participating State and is legally binding upon the Recipient and the Participating State in accordance with its terms. Covenants applicable to project implementation: Covenants applicable to project implementation are standard. I. STRATEGIC CONTEXT AND RATIONALE A. Country and sector issues 1. Country Context: Nigeria is one of the world's largest oil exporters, but poverty is pervasive with more than 70% of the population living on less than US$1 per day. Nigeria has a population of 144.7 million people1 and GDP growth of 5.2%. The Human Development Report (UNDP) rates Nigeria 158 out of 177 countries.2 2. Between 2003 and 2007 Nigeria experienced remarkable achievements in economic and governance reforms that resulted in macroeconomic stability, declining inflation and consistent growth in non-oil exports. GDP per capita more than doubled from USD358 in 2000 to USD 752 in 2005. The non-oil sector grew at 8.2% in 2005 and 9.6 % in 2007. Significant progress was also made on corruption with the establishment of institutions to fight corruption and passage of bills on procurement, fiscal responsibility and the Nigeria Extractive Industries Transparency Initiative (NEITI). 3. Public expenditure on health as a percentage of GDP was 1.4% in 2004, but there has been an additional influx of resources to the health sector from debt relief, increased allocations by government and support from development partners such as the UN agencies, the Global Fund for AIDS, TB and Malaria and bilateral agencies such USAID, DFID, CIDA and JICA. There has been modest improvement in health indicators: Routine and polio immunization coverage increased from 38% in 2005 to 77% in 2006; under-five child mortality decreased to 191 per 1000 from 230 per 1000 within a decade, but maternal mortality was 1100 deaths per 100,000 deliveries in 2005. Life expectancy has dropped from 52 years in 1995 to 46.5 years in 2005. 4. Nigeria's HIV and AIDS epidemic is complex and comprises both a `generalized' epidemic, affecting the general, including rural, population, but also pervasive sub-epidemics with high prevalence among geographic and social groupings (see `Key Sector Issues'). 5. Altogether, there are approximately 2,600,000 people living with HIV in 2007 out of which 370,000 were new infections with 170,000 AIDS deaths recorded for the year3. Cumulative deaths from AIDS stand at 1.48 million. The situation is considered stable, but according to UNAIDS; Nigeria now has the second highest burden of the disease in the world4. 6. The main factors contributing to HIV/AIDS vulnerability include poverty, poor prevention education, poor gender empowerment, dense commercial sex networks, weak access to condoms in the general population, particularly among youths in and out of school, married couples and rural populations, and religious and cultural factors that obstruct open debate on sexuality. 1 Nigeria Census Report, National Population Commission (2006) 2 UNDP (2005) World Development Report - Nigeria 3 UNAIDS/WHO (2008) 2008 Report of the Global AIDS Epidemic 4 UNAIDS 2008 1 7. Nigeria's national response over the last five years has been strong. The national average HIV prevalence declined to 4.4% in 20055 from 5.8% in 2001. However, six states and the Federal capital territory (FCT) continue to have HIV prevalence higher than 6%. Benue State (at 10% prevalence) remains the epicenter of the infection with the neighboring states forming halos of high prevalence around it. HIV prevalence among young people aged 15-24 years was 4.3%6. 8. Since 1999, political support from the government contributed to the changing landscape on HIV/AIDS in Nigeria. The government set up structures at the highest level with the President as the Chairman of the Presidential Council on AIDS. Government has meaningfully shifted from a health sector led approach to a multisectoral response to HIV/AIDS. 9. The current National Strategic Framework (NSF) 2005-2009 is the follow up to the HIV/AIDS Emergency Action Plan. The NSF became effective in 2005. The goal of the NSF is to `reduce HIV/AIDS incidence by at least 25%, and provide equitable prevention, care, treatment and support while mitigating its impact amongst women, children and other vulnerable groups and the general population in Nigeria by 2009.'7 10. The health sector response within the framework of the Health Sector Plan (2005)8 has fared well in the last four years in the areas of HIV counseling and testing, Prevention of Mother to Child Transmission (PMTCT) and Antiretroviral Therapy (ART). The US President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund for AIDS, TB and Malaria (GFATM) and the UN system have funded treatment, care and support of PLWHAs. Nigeria has been able to put more than 212, 000 HIV positive persons on ART (41% coverage) while 12,278 HIV positive mothers have received the drug as prophylaxis against infecting their children (14% coverage). 9 Achievements under Project 1: 11. The Bank launched the HIV/AIDS Program Development Project (`Project 1': US$90 million) as part of its Multi-Country AIDS Program for Africa (MAP). Project 1 became effective in April 2002 and was extended to July 2009, with US$50 million of additional financing approved in May 2007. Independent reviews credit Project 1 for enabling the successful establishment of a vibrant multisectoral response through the effective engagement of a multitude of partners in the response. Under Project 1 institutional structures for the fight against HIV/AIDS were established and strengthened. The National Action Committee on AIDS (NACA) and State Action Committees on AIDS (SACAs) were established in all 36 States with the official mandate to coordinate the multisectoral response. NACA was legally transformed into an agency by an act of parliament in 2007, bringing institutional stability and a formal budget line from the Federal Government. Similarly eight SACAs have acquired agency status. The National Executive Council (NEC) recently mandated the same transition to all remaining states with an appropriate budget allocation. The country HIV/AIDS program operates on the basis of the Three Ones: one HIV/AIDS action framework, one coordinating authority and one 5Federal Ministry of Health (2006) HIV/Syphilis Sero-Prevalence Sentinel Survey Report 6 Federal Ministry of Health (2006) HIV/Syphilis Sero-Prevalence Sentinel Survey Report 7 NACA (2005) National Strategic Framework on HIV/AIDS 8 FMOH(2005) Health Sector Plan 9 Nigeria UNGASS Report 2007 2 monitoring and evaluation system. Partners in Nigeria subscribe to harmonization and alignment and are in the process of discussing a Joint Financing Arrangement (JFA), which will pool funding (see III. A. `Partnership Arrangements'). 12. Human and institutional capacity has been strengthened across the country and across sectors. At the federal level, 28 government ministries and agencies have developed and implemented HIV/AIDS action plans targeting both the staff (through HIV Workplace Policies) and the clients of implementing agencies. In each State, 7-8 ministries have also developed and implemented HIV/AIDS action plans. The NEC mandated State Governments to provide at least 1% of the budgets in Ministries of Health, Agriculture, Education, Youth and Women's Affairs to HIV in 2008. 13. Project 1 has also been credited for establishing strong civil society platforms addressing vulnerabilities surrounding AIDS, including organizations and networks focusing on people living with AIDS, youth, women and faith-based organizations providing high level advocacy and community-based services in hard-to-reach areas. Over 1,500 grants to CSOs have been given at the Federal and State levels comprising more than 30% of all funds disbursed. The private sector response has also been established through the formation of the Nigeria Business Coalition against AIDS (NIBUCAA) with the result that the majority of prominent multinational companies now support HIV programs for employees and host communities. Key Sector Issues: 14. The HIV/AIDS Program Development Project 2 (HPDP2) will build on the substantial success of Project 1 and utilize the existing institutional structures in the national AIDS response. It will directly address key emerging sector issues that have been identified by Government in partnership with a range of stakeholders, through epidemiological and behavioral surveys and the National Strategic Framework Mid Term Review (2007). These include: · Scaling up access to prevention, treatment, care and support interventions in an informed and prioritized approach. Nigeria's achievements in the area of treatment fall short of meeting the needs. In particular the coverage of ART and PMTCT is low (at 41% and 14% respectively) and HIV testing in the general population is at 8.6%. There is also a need for better balance between prevention, treatment care and support, with treatment currently receiving substantial additional resources compared to other services. · Strengthening the institutional capacity of the Ministry of Health to plan and deliver sustainable integrated HIV and AIDS services within the primary and secondary health system, and to utilize existing resources from all partners (Government and external partners) more effectively and efficiently. Current vertical ART and PMTCT programs in particular require integration with maternal and reproductive health and TB services, and the health information management system needs strengthening for effective evidence based decision-making. · Continuing political commitment at the highest level of all tiers of Government. Sustaining and increasing the level of support at the Federal, State and LGA levels is essential for enabling country and local ownership of the response. Political support at the 3 state and LGA levels has been particularly mixed. Committed leadership needs to be matched with appropriate allocations, targeting and execution of funds at all levels. · Strengthening gender mainstreaming. The NSF (2005-2009) provided for gender mainstreaming but the effect is yet to be seen. There is increasing feminization of the HIV/AIDS epidemics in Nigeria, as in other African countries. Evidence from treatment centers shows more women are infected, more women are affected as caregivers and more women are likely to be involved in sex work for economic reasons. Programs for young women aged 15 ­24 years are particularly needed. · Targeting: The recent Integrated Biological and Behavioural Surveillance Survey (IBBSS)10 among selected high-risk groups in Nigeria showed HIV prevalence among brothel and non-brothel based female sex workers at 37.4% and 30.2% respectively. The other two groups with high prevalence rates were men having sex with men and intravenous drug users at 13.5% and 5.5%. Already, 63% of the FSWs interviewed reported consistent condom use with clients, indicating opportunities for continued interventions. Sex workers and their clients (bridge population) need a continued focus with targeted interventions, alongside those for the general population to address the `generalized' nature of the epidemic. In addition, identifying and scaling up interventions for mitigating the impact of HIV/AIDS on vulnerable groups such as Orphans and Vulnerable Children (OVC), People Living with HIV and AIDS (PLWHA) and young people is essential. HIV prevalence among young people aged 15-24 years is still high at 4.3%. OVC are only 75% as likely to attend school as other children and only 9.7 % of households with OVCs receive any form of external support. HIV stigma and discrimination reduction efforts should also be increased. The National HIV/AIDS Prevention Plan and National BCC Strategy provide two clear mechanisms for engagement. · Strengthening the `multisectoral' response. At Federal and State levels, the response within line ministries should now follow the model set by Ministries of Education, Health and Information to become more strategic, with a move from work place policies to planning activities targeted at the clients of those ministries. · Strengthening the involvement of civil society. The role of CSOs in prevention education is critical but the process of funding the CSOs needs to be improved, activities need to be better targeted, and the capacity of CSOs needs to be built and supervised through a more systematic approach that ensures sustainability. The M&E system should be made specific enough to demonstrate impact. · Strengthening the national M&E system, especially with regards to data quality and reporting. Although the existing system, NNRIMS, did benefit immensely from Project 1 and capacity building efforts from other partners, data dissemination, demand and use of information are relatively nascent activities that require considerable technical and human resource investments, going forward. The national M&E system needs renewed focus to 10 FMOH (2008) Integrated Biological Behavioural Surveillance Survey Report 4 identify and scale up effective interventions targeting key sectors, and high transmission populations and situations. B. Rationale for Bank involvement 15. The Bank adds value in at least six ways. First, the Bank brings to the effort a significant amount of financing, which is still needed despite substantial Government and other donor financing for a large-scale response. The Government has embarked on ambitious plans to reach Universal Access targets for HIV/AIDS services in line with global commitments, which require long term and substantial investments of aid. The Bank remains the key investor in comprehensive prevention services and demand-driven community based interventions. Other development partners investing in the HIV/AIDS response, such as the US Government and the Global Fund, focus resources primarily on treatment. The credit, the only source of external financing to cover 35 States, provides the opportunity for a country-wide prevention program, and to address major imbalances in the prevention, treatment, care and support continuum.11 In addition, while the Bank does not plan to finance ARTs, the flexibility of Bank financing is needed to fund capacity building, supplies and infrastructure necessary for the delivery of ARTs. 16. Second, the Bank has extensive experience in working with all development sectors in Nigeria, giving it a comparative advantage in supporting a multisectoral response. Third, as a result of the Africa wide MAP, the project will benefit from simultaneous cross-country learning from other African countries pursuing similar approaches. Fourth, the Bank is currently a major source of funding for civil society and community-based HIV interventions. IDA's experience in the design and implementation of social funds and targeted cash transfers will add value in the execution of the community-based HIV/AIDS activities. Fifth, the Bank's convening power has helped the Government implement the `three ones'; the Bank is a lead partner in the design and establishment of Nigeria's first Joint Financing Arrangement12, and has been crucial for bringing other partners in-line with the national response. Finally, the Bank's unique capacity to finance system development and capacity building and its flexibility to cover unforeseen financial gaps in key activities, is increasingly necessary with the complexities involved in the current scale up of resources and activities. C. Higher level objectives to which the project contributes 17. The Nigerian government developed the National Economic Empowerment and Development Strategy (NEEDS) in 2004 as a homegrown poverty reduction strategy paper. The NEEDS recognized HIV/AIDS as a crosscutting issue, with links to education, health, agriculture, defense, labor, and other sectors. It noted that if not adequately contained, the epidemic would prove to be the greatest single obstacle to reaching national poverty reduction and other targets for social and economic development. The overall goal of the NEEDS HIV/AIDS policy is to control the spread of HIV/AIDS in Nigeria, provide equitable care and support for those infected with HIV/AIDS, and mitigate its impact to the point where it is no 11The Government of Nigeria has commissioned a sustainability analysis currently underway which will identify, by thematic area (e.g. treatment, prevention, care and support) the costs of the national response over the medium to long term, likely funding flows and the current and project financing gap. 12See III A. Partnership Arrangements. 5 longer of public health, social, or economic concern. The goal of this project dovetails into the overall goal of the NEEDS HIV Policy. The implementation of the project will contribute to creating an `environment in which all Nigerians will be able to live socially and economically productive lives free of the disease and its effects'. 18. The project takes into consideration the recommendations of IEG on HIV/AIDS Projects specifically with a view to helping government to be more strategic in their interventions, strengthening national institutions, particularly the health sector, and improving the local evidence base for decision-making. Other recommendations include clarifying the objectives on the engagement of the civil society and focusing multi-sectoral support on sectors with the greatest potential impact. 19. Relation to CAS objectives: The project development objective (PDO) is in line with the Nigeria CPS Results Framework, which outlines behavior change, reduction in risky sexual practices and increased access to prevention, VCT and care and support services as key results areas for DFID and the World Bank. A second CPS (2010-2013), which has been expanded to include the African Development Bank (AfDB) and USAID, will help support the Nigerian Government to implement its national strategy (NEEDS) and the Seven Point Agenda through a focus on the three themes of improving governance, maintaining non-oil growth and promoting human development. 20. The project will contribute to the attainment of five Millennium Development Goals, but in particular to the 6th goal which aims to halt by 2015 and reverse the spread of HIV/AIDS. The project is also in line with the UN Declaration of Commitment on HIV/AIDS. II. PROJECT DESCRIPTION A. Lending instrument 21. The lending instrument selected is a four year Sector Investment Loan. This time period will allow continued strengthening of Federal and State government capacity to address HIV/AIDS. It is expected that by the end of the project period Federal and State institutions will have the capacity to continue activities with reduced external support. B. Project development objective and key indicators 22. The Project Development Objective is to reduce the risk of HIV infections by scaling up prevention interventions and to increase access to and utilization of HIV counseling, testing, care and support services. Key Indicators are: (i) Knowledge and Practice related to HIV Transmission o the percentage of young women and men aged 15-24 reporting the use of a condom during (last) sexual intercourse with a non-regular partner (of those reporting sexual intercourse with a non-regular partner in the last 12 months) has increased from 34.3% to 45.4 for females and from 52.2% to 69.2 for males;. 6 o the percentage of women and men aged 15-49 who have had sexual intercourse with more than one partner in the last 12 months has decreased from 1.1% to 0.4% for females and from 7.2% to 5% for males; o the percentage of most-at-risk groups reporting the use of a condom during (last) sexual intercourse with a non-regular partner (of those reporting sexual intercourse with a non- regular partner in the last 12 months) has increased from 64.8% to 72% for female sex workers brothel based and from 67.1% to 75% for female sex workers non-brothel based; o the percentage of persons aged 15 and older who have received counseling and testing for HIV and have collected their HIV test results has increased from 72.7% to 96%; o the percentage of most-at-risk populations who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission has increased from 33% to 50% for sex workers; from 44% to 57% for men who have sex with men; and from 34% to 47% for injecting drug users. (ii) HIV Care and Support o the percentage of pregnant women who are HIV positive and require antiretroviral prophylaxis and who have received a complete course of antiretroviral prophylaxis to reduce the risk of mother to child HIV transmission has increased from 5.25% to 30%; o the ratio of current primary school attendance between orphans of HIV/AIDS and other pupils has increased from 75% to 87%; These indicators are consistent with the World Bank Africa Region HIV/AIDS Scorecard, NNRIMS and UNGASS. The comprehensive results matrix is in Annex 3. C. Project components 23. The project is tailored to reflect the Bank's comparative advantage in its contribution to a rapidly evolving and complex HIV/AIDS arena. The components have been designed to build on the solid foundation laid by Project 1, and to move towards a more strategic response in line with the Government of Nigeria's Mid Term Review of the NSF. 24. HPDP2 will support the implementation of NSF 2 (except for Year 1). Key data and information generated from a range of quality research and surveys carried out between 2005 and 2009 will inform a strategic, evidence-based and streamlined NSF 2. It is expected that within NSF 2, Bank support will be focused on: i) Implementation: scaling up targeted high impact interventions through the public and non public sectors. Components 1 and 2 will both address the objective of reducing the risk of new infections and increasing access to counseling, testing, care and support; the first component through public sector agencies and the second component through CSOs and the private sector. 7 ii) Capacity Building: the third component is dedicated to strengthening the institutional arrangements of NACA / SACAs and implementing partners for more responsive planning, monitoring and evaluation, policy development and ultimately, results-based implementation. The Project has 3 components. Each of these will operate at the federal and state levels. Eligibility will be open to all 36 states of the Federation and the Federal Capital Territory. In line with evaluations of Project 1, each component will support: i) evidence-based targeting of activities; ii) a cohesive approach to capacity building of NACA, SACAs and implementers appropriate for the delivery of each component; iii) effective gender and HIV mainstreaming; iv) output / results-oriented monitoring systems and baseline surveys; and v) mechanisms to promote sustainability. Component 1: Expanding the Public Sector Response (US$68 million IDA) 25. This component will support HIV/AIDS activities in NSF 2 carried out by Line Ministries by strengthening the capacity and ability of selected line ministries and agencies endowed with a central role in fighting HIV/AIDS to scale up and to expand the scope of their ongoing activities. Building from the success of Project 1, which catalyzed HIV mainstreaming in a range of line ministries, the project will select key line ministries to receive increased funds, according to agreed criteria. Funds under this component will support scaling up evidence based interventions targeting the clients of line ministries. Component 3 will complement this support by building the capacity of HIV units within the selected line ministries through provision of support, including technical advisory services, required to design and implement client-oriented and evidence-based action plans aimed at controlling and preventing the spread of HIV/AIDS across the country. Specifically, the component will: (i). Allocate increased funds to key line ministries to achieve maximum impact. At the national level this project will focus increased resources on a reduced set of ministries. Agencies that are identified as having a more central role in the fight against HIV/AIDS including Health, Education, Women's Affairs and Defense, will receive more funds to scale up their activities. The role of the Ministry of Health will be re-examined in light of the difficulty of incorporating MOH activities in Project 1. MOH is the key actor in a variety of critical activities including a) prevention of mother to child transmission (PMTCT), b) integration of HIV/AIDS control with TB treatment, c) laboratory services and safe blood transfusion, d) Anti- Retroviral (ARV) treatment, if necessary, e) strengthening linkages between the LGAs and PHC in the response process and f) safe waste disposal. This project will start with an institutional assessment of the division responsible for HIV/AIDS in the FMOH and in the SMOHs aimed at strengthening the governance structure of MOH. This will determine how best to reinforce its capacity so it can effectively lead the Universal Access agenda, and optimally plan and utilize the substantial funding available from other donors. This assessment will also identify key activities that are not receiving sufficient funding from other sources and could be supported by the project. 8 (ii) Support the design and implementation of client-oriented, evidence-based HIV/AIDS plans. Funds will be allocated to the implementation of strategic HIV/AIDS workplans, tailored to the specific client base within the national and state-level response most appropriately addressed by each line ministry. Credit funding for workplace policies will be limited in line with the expected increase in government allocation to HIV/AIDS to selected line ministries.13 For each ministry, the action plan will reflect activities that are in line with the roles and responsibilities for the ministry at federal and state levels. These are expected to include among other things, behavior change activities aimed at the client population of the ministries, care and support services where appropriate, advocacy targeting key decision-makers, etc. Proposals will follow the principle of implementation at the lowest possible level. For example, federal level action plans should focus on nation-wide activities that can only be carried out successfully or economically, if done nationally. Attention will be given to strengthening the stewardship role of federal line ministries in relation to HIV/AIDS planning of state level line ministries. (iii) Receive complementary capacity building support through Component 3. The capacity building exercise under Component 3 will define the roles and skill sets required of i) NACA / SACAs, and ii) HIV units within the selected line ministries to deliver this component. It will comprise a multifaceted approach to training in core functions: strategic planning for scaling up high-impact interventions, resource mobilization, M&E, fund management, governance and leadership, for a sustainable and effective public sector response. Component 2: Expanding the civil society and private sector response to the HIV/AIDS Epidemic. (US$79 million IDA) 26. This component will build on the substantial accomplishments of Project 1 through the provision of support, including technical advisory services, required to revise the current HIV/AIDS Fund guidelines with a view to expand and scale up the activities carried out by civil society and private sector organizations to contribute to control the spread of HIV/AIDS across the country. The institutional architecture and procedures for this component are in place and have been well tested. Based on several reviews of the HAF, this project will: (i) tighten the link between situation analyses and the choice of priority activities for NGOs; (ii) lengthen the funding period and amounts going to individual NGOs; (iii) combine the demand-driven approach of Project 1 with an increased capacity for NACA and the SACAs to address gaps in the response by contracting NGOs to fill the gaps. The latter will be carried out using the currently existing Rapid Response Fund (RRF) procedures, which have been successfully used in Project 1 to fill critical gaps. The component will support financing for civil society and private sector prevention, care and support activities, including technical assistance, training and implementation to national and local NGOs and CBOs, associations of persons living with AIDS, religious organizations, and the private sector to prepare and implement programs that they propose. Funding will be allocated in line with the HIV/AIDS Fund Guidelines, currently being up-dated, which detail the eligibility criteria, application process, responsibilities and accountabilities and monitoring and evaluation requirements of proposals. 13National Economic Council mandated in 2008 that 5 key Line Ministries allocate >1% budget to HIV/AIDS activities. 9 Specifically this component will: (i) Support the design and implementation of a revised HIV/AIDS Guidelines to expand and scale up the non-public sector response to HIV/AIDS. The project will support strategic expansion of civil society activities to (i) promote HIV counseling and testing (HCT), (ii) behavior change communication (BCC), (iii) condom social marketing and universal precautions, (iv) increase support to people living with HIV/AIDS (PLWHA), orphans and vulnerable children (OVC) and (v) better target high risk behaviors and high risk groups. Funding criteria will allow states to identify and set their own priorities, with an indicative allocation formula including population and HIV prevalence, and thematic areas (high risk groups, general prevention, care and support). The project will link Bank-supported capacity-building interventions for NGOs and CSOs with DFID funded technical assistance activities. (ii) Receive complementary capacity building support through Component 3. The capacity building exercise under Component 3 will define the roles and skill sets required of i) NACA / SACAs, and ii) CSOs to effectively deliver this component. The capacity of SACAs and NACA will be strengthened to utilize data from surveys to target NGO activities to high risk groups and geographic hot spots and to identify best practice models for scale up. The capacity of CSOs will be addressed through trainings in core functions including strategic planning, resource mobilization, M&E, fund management, governance and leadership. (iii) Provide funding to civil society networks through a separate dedicated funding line through HAF. Funding will be awarded following a call for proposals to deliver a set of agreed activities capitalizing on network capacity to identify and scale up best practice models, conduct outreach to communities to ensure dissemination of information on the HAF and its procedures and to help build smaller CSO project management systems and proposal writing capacity. Networks will provide technical support to SACAs and LACAs to improve targeting of CBOs and ensure identification and coverage of local high-transmission `hot spots'. (iv) Provide support for private sector HIV/AIDS service provision. Project 1 successfully supported a range of private sector actors including several networks of private sector companies interested in HIV/AIDS. This project will provide targeted support to catalyze and strengthen HIV/AIDS prevention, treatment care and support programs in the private sector, through a separate call for proposals under the HAF. Guidelines for this will be developed and will encourage co-financing from larger firms. Component 3: Strengthening mechanisms for project coordination and management (US$78 million IDA/US$5 million Government) 27. Evaluations of Project 1 have demonstrated its success in building the institutional capacity of the public and private sector, as well as the capacity of the national and state project teams in 34 states (plus FCT) to fulfill their coordination mandate. HPDP2 and the SACA transition to agency status provide an opportunity to further improve project governance and to strengthen the organizational and implementation capacity of key actors. 28. The component will support a cohesive approach to capacity building with the objectives to deliver strengthened evidence-based planning, increased coordination, harmonization and 10 alignment by all stakeholders, and stronger, sustainable and more responsive HIV/AIDS financing and programming. It will support an assessment of capacity building needs of selected public sector, civil society and private sector organizations engaged in the provision of services pertaining to controlling and stemming the spread of the HIV/AIDS epidemic. It will also provide logistical support and technical advisory services required to strengthen the operational capacity of selected organizations under Components 1 and 2. 29. It will build from the institutional structures established under Project 1, and will scale up existing effective capacity building models; it will complement technical support from other partners and will identify institutions in country that can address generic capacity building needs. State governments will continue to provide in-kind support through the secondment of civil service staff to provide core SACAs 30. The component will support i) a bottom up exercise to identify core competencies and skills sets required by the key actors (local organizations and NGOs, LACAs and LGAs, line ministries, SACAs and NACA); ii) the assessment of capacity gaps across sectors and administrative levels; and iii) the subsequent identification and roll out of various mechanisms to address the identified needs. This will comprise a multifaceted approach including assessing and accrediting selected training organizations with the capacity to deliver related programs; strengthening Technical Working Groups; identifying and scaling up existing effective models including flexible short and long term TA; mentoring; and Training of Trainers (TOT). 31. The component will assist NACA in its stewardship role in giving technical support to states to identify the capacity gaps of implementers and SACAs, and to subsequently address them. It will ensure that capacity building is linked to the delivery of national priorities and agreed work plans. The component will dovetail with Components 1 & 2; and at the Federal level, will also support NACA to further strengthen the appropriate systems necessary for the implementation of the Joint Financing Arrangement. D. Lessons learned and reflected in the project design 32. 1) Independent reviews of Project 114 concluded that ongoing support by the World Bank to the national HIV/AIDS response is necessary, recognizing the Bank as a lead organization in moving the response forward. HPDP2 is tailored to build on the considerable success of Project 1 and the following lessons learned from its implementation: 1) Political commitment at the highest level of all tiers of Government is critical for an effective national response. 2) Greatly improved M&E systems are needed to scale up effective interventions targeting key sectors, and high transmission populations and situations. 3) Civil Society has been one of the most vibrant sectors of the response, but support needs to be better targeted. 4) Greater attention should be paid to health sector activities to strengthen capacity to deliver HIV/AIDS services. 5) Partnerships and networking within the various implementing sectors are critical tools in capacity building and systems strengthening. 14The Joint Review HIV/AIDS Programme Development Project (November, 2006); and DFID and World Bank NSF Scoping Report (October 2007) 11 2) The recommendations of the IEG review of the Bank's HIV/AIDS projects largely dovetail with the review recommendations and have been integrated in the design of the 3 project components. These include: helping governments to be more strategic and selective in their interventions, strengthening national institutions, particularly in the health sector, improving the local evidence base for decision-making, clarifying the objectives on the engagement of civil society, and focusing support on sectors with the greatest potential impact. 3) Independent evaluations were carried out to assess the impact of the support from Project 1 to the public sector and civil society.15 Both evaluations highlight the importance of Project 1 in establishing the necessary institutional framework for the subsequent large-scale multisectoral response to HIV/AIDS. Project 1 is credited with enabling the critical ingredients for the current successful response, such as the continued policy dialogue, awareness creation, commitment and quality leadership by political and civil society champions at multiple levels. 33. The evaluations encourage HPDP2 to capitalize on the dynamic created through Project 1, and to place greater emphasis on: i) evidence-based targeting of activities; ii) addressing in a systematic way the capacity building and supervision needs of NACA/SACAs, iii) effective gender and HIV mainstreaming; iv) output / results-oriented monitoring systems and baseline surveys; and v) mechanisms to promote sustainability. These recommendations have been mainstreamed through the design of each project component. In addition, the evaluations recommend the targeting of funds to a smaller number of line ministries and CSOs for greater impact, and strengthening the technical support role of NACA to SACAs. This has been addressed through Component 3. E. Alternatives considered and reasons for rejection 34. Several alternatives were considered. First, a design focusing on interventions targeting exclusively populations at increased risk of HIV infection was rejected since the Nigerian epidemic in many areas has already spread to the general population. Second, a project design solely based in the health sector was rejected on the grounds that it could not succeed in coordinating and stimulating a multi-sectoral multi-partner response, where the support of the World Bank is considered a comparative advantage. III. IMPLEMENTATION A. Partnership arrangements 35. A wide range of technical and financial support is currently programmed from the United States Government (USG), the Global Fund, DFID, UNAIDS, UNICEF, and WHO. DFID and the Bank have enjoyed a close working relationship in HIV/AIDS; DFID financed the review of Project 1 and has been integrally involved in the discussions of Project 2; its new program `ENR' (approx. US$200m over 6 years) started in January 2009 and provides substantial technical support to complement the credit at State and Federal levels. In addition, the new UNDP HIV/AIDS Program will complement the capacity building work of World Bank and DFID at 15Assessment of Effects of HIV/AIDS Fund (HAF) and Evaluation of the Support for the Public Sector (MAP) on the National Response to HIV/AIDS in Nigeria, 2002-June 2007 (August 2008). 12 State level, and HPDP2 will also continue to complement Global Fund and USG support to the national response by providing flexible funds to support their programs focusing on the scale up of treatment programs. 36. In line with the 2005 Paris Declaration on Aid Effectiveness, the Three Ones and GTT recommendations, Development Partners (DPs) are aware that they need to go further in terms of harmonizing their procedures. With this in mind, NACA and its Development Partners are collaborating to develop a Joint Financing Arrangement (JFA), and within this, a pooled fund, operating through a separate account, in support of one common work program. Development Partners, including the Bank, are working to reach agreement on the overall program to be supported, the financial contributions of each DP and the Nigerian Government, the procedures to be used for procurement, financial management and program management, the monitoring milestones against which performance will be assessed, and a reporting framework. The JFA will lay out the coordination, financing and monitoring principles that govern its implementation, plus the organizational, institutional and coordination arrangements, and the roles and responsibilities for each DP pooling their resources. It is expected that all DPs working in HIV/AIDS in Nigeria will eventually sign the JFA. The pooled fund will be signed initially by the Government, World Bank, DFID, and CIDA. Once the agreement is signed, all World Bank financing to NACA will be channeled through the JFA. The goal is that the other participating donors will gradually expand the share of their support that is pooled and that other donors will switch from parallel to pooled funding as existing projects close or are restructured. 37. The government is also putting in place a system to track all spending by development partners. This strengthened partnership will enable the government to know who is working where, coverage of end beneficiaries, types of programs and the strength and impact of support. NACA has also initiated a costing and a sustainability analysis exercise, including analysis of existing and promised financing and the resulting financing gap over the medium ­ long term to maintain and increase the number of people receiving prevention, treatment care and support services. The Development Partners Group (DPG) continues to evolve and has considerable potential to realize its role in promoting effective harmonization and alignment of development partners behind the national response. These positive developments in partnerships will enable the most strategic use of World Bank credit funds. B. Institutional and implementation arrangements 38. The overall institutional architecture of the project will remain largely the same, with operations being coordinated by NACA at the Federal level and the SACAs at the State level. Capacity-building activities under the first project have strengthened these organizations considerably. 39. Nationally, the project will be placed under the overall responsibility of NACA, the National Agency for the Control of AIDS. NACA was the implementing agency for Project 1 and has performed well. In 2008 NACA, which had been a committee under the Presidency, was made a government agency established by law. NACA has overall responsibility in the country for setting HIV/AIDS policy and ensuring the coordination of HIV/AIDS activities across ministries. Within the project it is responsible for setting priorities for action and financing, 13 approving action plans prepared by Federal Ministries and national civil society organizations proposing multi-state programs for HAF financing, monitoring the epidemiological situation in the country, and evaluating the national response. Under the previous project, NACA's capacity was strengthened particularly on financial management and procurement issues. NACA will also manage capacity-building activities at the Federal level. 40. NACA's role vis a vis the SACAs is to provide the overall national strategic direction within which States will tailor their activities based on the particular characteristics of the State epidemic. NACA will provide technical assistance to the States across the full-range of project activities including the HAF, the Public sector component and overall M&E. NACA will organize the work planning exercises and review all state work plans and procurement plans before processing by the World Bank. It will also promote the sharing of best practice experiences and develop capacity-building activities to address needs at the State level. 41. At the state level, project activities will be based in the State Agencies for the Control of AIDS/State Action Committees on AIDS (SACAs), whose capacities have been substantially strengthened under the first project. The SACAs are responsible for developing state priorities for action, reviewing and approving proposals prepared by state Ministries, and by NGOs and communities requesting funding through the HAF at the state level, as well as monitoring the epidemic in the state, and evaluating the performance of state implementing agencies. All states now have SACAs and in thirteen states SACAs have been transformed into legally established government agencies. Agency status will provide access to on-going financial support from the state and gives the SACAs a better institutional platform from which to coordinate other partners. The project will encourage other states to establish agencies. Each SACA will be required to maintain a core group of staff designated to support the project: these include the project manager, the accountant, the internal auditor, the procurement officer, the community mobilization officer and the monitoring and evaluation officer. C. Monitoring and evaluation of outcomes/results · Achievements under Project 1 and focus in HPDP2: Under Project 1, Nigeria has established most of the elements of an effective monitoring and evaluation system. Hence, the focus of the project monitoring and evaluation activities on HPDP2 will be three-pronged, and aligned with the Bank's M&E policy as well as the National M&E Operational. · Monitoring: HPDP2 will support the scale up of M&E systems at the state level. This will be done in collaboration with key partners such as DFID, UNAIDS and USG. Presently, through the support of the World Bank, all 35 project states and most Ministries, Departments and Agencies (MDAs) have M&E Units and/or focal persons. All the M&E Units in the project states have been trained to use the NNRIMS Monthly Summary Forms and most Federal-level service delivery points have been trained in the use of recently reviewed HIV/AIDS and health facility registers that provide the data that flows into the summary form. · Surveillance and Learning Agenda: Through HPDP2, Nigeria will continue to understand the current epidemic (and sub-epidemics) and will triangulate the results of 14 current HIV sentinel surveillance, general population and household surveys as well as available social behavioral research. · Evaluation and Research: An evaluation plan is being prepared as part of the project preparation process to guide understanding and documentation of progress and achievements in HPDP2. On HPDP2, annual, mid term and end of project reviews of all project components will be executed in collaboration with relevant partners. HPDP2 would apply a "ladder approach" to incrementally evaluate program progress, outputs and outcomes over the period of support. The Project will support essential epidemiological analyses, operations research, cost effectiveness studies and impact evaluation. · Systems already established by NACA and the SACAs: will be used to measure the actual performance of implementers and the project's achievements. The tools produced by the system have been developed to measure improvements in the performance of SACAs and NACA. The Bank will use a subset of data from this system to track progress of the program. NACA and Development Partners pooling funds under the JFA will carry out joint annual performance reviews of the program. SACAs will convene similar forums in the states. · Data management, dissemination and use: Data analysis, dissemination and use to improve policies and programs will receive major emphasis. Data from each of the above sources will be analyzed, to produce a holistic understanding of Nigeria's HIV epidemic and responses. Important findings will be shared widely through various dissemination events and used to strengthen national and state planning and programming. · Capacity and Technical Assistance: HPDP2 will support stronger collaboration between SACAs and development partners, research and academic institutions through the establishment of M&E Technical Working Groups (where there are none at present) and strengthen coordination where TWGs already exist and are functional. · Biannual National HIV/AIDS Summit: HPDP2 will support a biennial national HIV summit that will serve as an important forum for disseminating HIV/AIDS research findings, best practices, products and knowledge management. D. Sustainability 42. The project is expected to be institutionally sustainable in the medium term because it is built upon strong government ownership and broad partnerships. It will scale up existing interventions and mainstream HIV/AIDS activities into major government sectors and civil society. The project emphasizes institutional capacity building at national, state and local levels, which would further enhance the sustainability of the program. The transition of NACA and some of the SACAs to agency status will help ensure continued government funding by assuring access to government budget lines. The States that have not yet transformed the SACAs into Agencies will endeavor to become Agencies during the first year of this project. In addition, the National Economic Council has mandated that key ministries allocate 1% of their budgets to HIV/AIDS activities. It is expected that staff costs and most other operational costs will be 15 provided by the government by the end of the project, with most project funds going to finance HAF and public sector ministry interventions. 43. In addition, the Joint Financing Arrangement includes an agreed financing commitment by Government of Nigeria as well as by development partners. It is expected that government funding will increase over the medium term. The appropriate allocation will be informed by a sustainability analysis currently in process. The analysis will identify the costs of the national response over the medium to long term, likely funding flows and the current and projected financing gap. The results will also inform policy and planning as NSF2 takes shape. The Government is committed to appropriate target setting for a sustainable response and is aware that HPDP2 will likely be an exit strategy for Bank financing. The project has also been designed to leverage increased Government allocation to the national response through support to transition SACAs to agency status, project covenants to ensure Government commitments to HIV financing and support to capacity building. E. Critical Risks and possible controversial aspects Risk factors Description of risk Mitigation measures Rating of residual risk State Level Involve State Governments closely in project Moderate Ownership at the State preparation. level insufficient to ensure Implications of changes in State governments sustainability and effective to be closely monitored by NACA and WB. implementation (often Provision of advocacy support by NACA & caused by changes in high WB as appropriate. level state government). Allocation / disbursement tracking exercise to be integrated in quarterly FMRs Technical Federal Level Strong evidence base and documented lessons Low Design Project not designed to learned to structure project design, including achieve maximum impact, Joint Review of MAP 1 (November 06), Joint or to effectively address Scoping Mission (Sept 07, World Bank, potential implementation DFID), HAF and Public Sector Impact problems. Evaluations (October 08), multiple New Joint Financing epidemiological and behavioral surveys due Arrangement with NACA 2007/8, will provide ample baseline data. and development partners Clear timetable for capacity development and causes delay in strong collaboration between development implementation of project. partners will ensure smooth transition to JFA Project direction needs arrangement. substantial review should Project design to take into consideration country priorities change findings from NSF 1 (2004-9) Mid Term dramatically following Review, December 2008. design of the new National Strategic Framework (NSF 2) from 2009 - 14. State Level Evidence base for use of state level funds to Moderate 16 Complexity and diversity be substantially strengthened through use of of epidemiological profile new survey data and completion of State between states challenges Strategic Plans which form the basis of WB- most responsive use of approved annual workplans. state level funds. NSF Mid Term Review to report on progress & provide guidance on implementation of each state level response. Implementation Federal Level WB and other development partners to Low Capacity and NACA oversteps continue to work with NACA, NACA Board sustainability coordination mandate to & to advocate at high policy levels to ensure implementation, leading to NACA maintains its focus on coordination. relative depletion of its Options to be provided to staff encourage capacity, tension and their retention. confusion on roles and Passage of the Health Bill to give impetus to responsibilities between wider health sector reforms. Project 2 to government agencies. increase funds and technical support to MOH NACA's agency status to build planning, financial management, brings new, less favorable procurement capacities; to consider most terms of employment, efficient mechanism to channel funds to leading to departure of MOH. trained and experienced personnel. Weak public health system prevents scale up in access to HIV/AIDS prevention, treatment care and support services. State Level WB and NACA to continue high level Moderate Frequent changes advocacy visits, and provide clear (transfers, redeployments) communication on due process, stipulations in in core project personnel FA. affect organizational Project design to be coordinated with DFID, memory and deplete so that DFID financed capacity-building implementation capacity. activities will support state project teams. Lack of qualified technical WB to continue to work proactively, with staff in State Ministry of NACA, to ensure clear division in roles and Health to oversee and responsibilities between SACA and LMs, and implement WB credit. to maintain oversight role through approval of SACA oversteps annual work plans. coordination mandate to . implementation, undermining capacity of line ministries. Financial Federal Level Continue to strengthen NACA, line ministries, Substantial Management Increased pressure / CSOs FM systems through direct financial and challenges to financial technical support and on-going training. oversight due to increase in external funds, activities Joint Financing Arrangement to provide one FM, and number of supporting M&E and reporting system for all development partners. partners. State Level PFMU units provide financial management Substantial Weak financial advice and technical supervision. PFMU team management: State to continue to receive support from the FM capacity for financial unit of the Bank. management is mixed and Project accountants will continue to receive expertise on Bank regular financial management training. 17 financial management requirements is limited. Procurement Misprocurement; delays WB procurement clinics to take place before Moderate in project implementation Annual Procurement Plan approval. due to submission of poor quality documentation WB supported procurement training will be due to understaffed and available every year. under qualified personnel in LMs, States, Local Regular SOE reviews will identify capacity Authorities and CSOs, weaknesses. and / or delays in obtaining No Objection due to limited capacity in WB office. Social and Disposal of biohazardous Medical waste management plan to be Low environmental materials constitute an updated with clear indicators in time for safeguards environmental risk. project launch. Governance Federal Level Component 3 Project 2 is designed to Low NACA Board does not strengthen governance and coordination effectively exercise its mechanisms. oversight functions Clear new NACA governance structure accompanied Agency Bill. This includes a National Council on AIDS and Expanded Theme Group on AIDS, both have proven effective forums for information sharing, and coordination. Externally organized training for NACA Board on roles and responsibilities. State Level A model template of the new SACA structure Low New governance will be agreed with NACA and communicated structures associated with with SACAs, to include clarification of the transition to agency status role, responsibilities and lines of leads to confused lines of accountability of project team within SACAs. accountability of project Supervision and advocacy visits. teams. Overall Risk Moderate Rating F. Credit conditions and covenants Effectiveness conditions The Subsidiary Agreement for at least one (1) Project State has been executed on behalf of the Recipient and a Participating State. Withdrawal conditions for Participating States: The Government of Nigeria has: (i) furnished to the Association evidence satisfactory to the Association that: 18 (A) the Government has concluded a Subsidiary Agreement with the concerned Participating State under terms and conditions satisfactory to the Association; and (B)the Association has received an opinion pursuant to Section 8.02 (b) of the General Conditions that the Subsidiary Agreement has been duly authorized or ratified by the Recipient and the concerned Participating State and is legally binding upon the Recipient and the Participating State in accordance with its terms. Terms/conditions for Subsidiary Agreements, grants to Beneficiaries and covenants related to project implementation arrangements are standard. IV. APPRAISAL SUMMARY A. Economic and financial analyses 44. HIV/AIDS affects an economy through (a) reducing productivity, domestic savings and economic growth, and (b) increasing costs of treatment and care for both affected households and the society as a whole. AIDS strikes people in their most productive age, reducing both the size and growth of the nation's labor force. Care and treatment for AIDS impose enormous costs on households and the society at large. Households with AIDS patients are likely to lose the income of PLWHAs (often the main breadwinner) in addition to facing an increase in medical expenses. Some households are forced to withdraw their children from school in order to save money. The economic benefits of the proposed AIDS control project are multifold. First, since this project aims to assist with scaling up interventions in HIV/AIDS control and mitigation, the majority of Nigerians will directly and indirectly benefit from increased access to HIV/AIDS prevention, treatment, care and mitigation activities. Secondly, new HIV infections will be reduced, due to an expansion in coverage of the package of HIV/AIDS prevention activities supported by the project. Thirdly, people living with HIV/AIDS can lead a longer and more productive life by benefiting from better management of opportunistic infections and access to nutritional supplements; and therefore, less loss in productivity and income and reduced costs for treatment and care. Fourthly, orphans will have improved economic prospects with increased schooling. NACA is in the process of implementing a national study to identify the economic impacts of HIV/AIDS in Nigeria. B. Technical 45. The technical design of the project is based on lessons learned from Nigeria's experience with HIV/AIDS and international best practice. A detailed external evaluation of the HAF and Public Sector components provided guidance on modifying their design and a DFID financed overall review of the first project provided recommendations on institutional and capacity issues. 46. Four major principles guided the project design: assigning top priority to proven and cost-effective interventions for the groups at highest risk of acquiring and transmitting HIV; using available evidence as the basis for choosing priority groups and interventions; reducing transmission to groups at lower risk by increasing the provision of information and preventive services to the general population with a view to promoting positive behaviors; directly involving and supporting communities to carry out their own responses. 19 47. Epidemiological data vary widely across states, so it is not possible to design a single set of interventions that will be universally applicable. The program will therefore place a high emphasis on adapting the response to state level situations. NACA will provide technical backstopping to States to help them prepare situation analyses that will orient the state planning process. C. Fiduciary Financial Management 48. Each participating state has established a Project Financial Management Unit (PFMU), which has been handling the FM aspects of donor-assisted projects at the State level for some years. These Units will be responsible for managing the financial affairs of the Project at the State level. At the federal level, the Finance Department of NACA, which has performed the FM functions for HIV/AIDS moderately satisfactorily, will be responsible for managing the financial affairs of the Project. These units are staffed with relevant qualified accountants and internal auditors who have been trained and are fully familiar with Bank procedures and requirements. The PFMU and FD/NACA will be responsible for ensuring compliance with the financial management requirements of the Bank and the government, including submission of the bi- annual un-audited consolidated Interim Financial Reports and audited annual consolidated financial statements to IDA. The Project will follow disbursement procedures described in the World Bank Disbursement Handbook. Regarding flow of funds and banking arrangements, IDA will disburse the credit through Designated Accounts (DAs) consisting of: (a) one DA for each state to be managed by the PFMU; and (b) one DA for the federal component managed by FD/NACA. 49. PFMUs and FD/NACA will maintain adequate FM arrangements to support the deployment of project resources in an economic, efficient, and effective manner to achieve the stated development objectives. Periodic reports including bi-annual consolidated Interim Financial Reports (IFRs) will be provided to the oversight committees to facilitate the performance of their oversight functions. Procurement 50. Nigeria has been implementing slowly a procurement reform program based on the recommendations of the 2000 Country Procurement Assessment Review (CPAR). A review of the progress made on the 2000 CPAR recommendations as reflected in the 2007 PEMFAR, shows that implementation of the procurement reform program has brought about substantial improvements in obtaining value for money in public sector expenditures. The PEMFAR report indicated that contract prices were reduced substantially and reportedly have saved the Treasury substantial amounts. It also revealed that since the 2000 CPAR, collaboration between procurement and financial management has been strengthened considerably. This has further introduced some level of transparency into the country procurement process. In this regard, the CPAR of 2000 has been a positive catalyst, because it supported the agenda of financial sanitation of the current Government. Some of the actions taken by Government to advance procurement reform in Nigeria include (a) establishment of the procurement professionals cadre 20 at the Federal level in 2006, (b) passage of the Procurement Bill in June, 2007 with a view to further sanitize the public procurement system, which has often been the subject of abuse and corruption. The passage of the Bill brought about the abolishment of the certification of payment and introduced a system where MDS are now responsible for implementation of contracts (c) establishment of a functional regulatory body - The Bureau of Public Procurement (BPP) to speed up implementation of recommendations. The BPP has organized a series of sensitization workshops for public servants at the Federal and States level. It has also organized capacity building for the Procurement Professional cadre in the civil service and conducted stakeholders' workshop for members of civil society organizations. The National Bidding documents have also been produced by BPP. 51. Currently, the Government Procurement Reform Program is being supported by an IDA Credit-ERGP with a substantial component focusing on procurement reforms. There are also three IDF Grants, to assist Federal and two State Governments address the weak procurement capacity in the public sector and to build appropriate partnerships with the private sector. The project instrument has been used by the government to prepare the relevant procurement tools mentioned above. Government is also reforming Customs practices to modernize and make them more effective, thereby enhancing private sector confidence in public procurement processes. 52. The existing HIV/AIDS project has performed well and was given additional financing by the Bank in May 2007. Implementation of the ongoing HIV/AIDS project has however witnessed some weaknesses. Capacity issues identified were addressed by providing adequate guidance and capacity building initiatives. A major challenge on how to manage and monitor the use of the HAF funds given to NGOs and CSOs was also identified and was addressed by organizing relevant project teams to participate in workshops organized by the CO procurement unit and INT - Procurement and Anti Corruption Control Mechanism in CDD Projects held in March 2009. Also, a contract management workshop will be organized specifically for the project teams to mitigate identified weaknesses in contract management and monitoring of the HAF component during project implementation. 53. The Bank will continue to hold consultative fora with top government officials to inform them of procurement procedures and minimizing undue interference in procurement processes. The project will also adapt the Generic Procurement Manual developed for IDA-financed projects in Nigeria and the Bank's Standard Bidding Documents, pending the finalization of National Procurement Manual. Procurement for the proposed project will be carried out in accordance with the World Bank's "Guidelines: Procurement Under IBRD Loans and IDA Credits" dated May 2004 and revised in October 2006; and "Guidelines: Selection and Employment of Consultants by World Bank Borrowers" dated May 2004 and revised in October 2006. The detailed Procurement Arrangement is in Annex 8. D. Social 54. Experience under the on-going project has identified a number of important social issues. Women and girls are more susceptible to HIV/AIDS, are more likely to be subject to sexual abuse and other forms of violence, and are most likely to be ostracized and discriminated against if they become infected with HIV. In addition, the lower status of women in the society makes it 21 very difficult to negotiate condom use with the partner. Furthermore, about one-third of infected women will transmit HIV to their unborn children. Women will therefore receive particular attention; for example, by supporting efforts to reduce mother to child transmission, the risk of infection of adolescent girls, and specific programs targeting women who sell sex. Another key social issue is how to protect the human rights of marginalized sections of society infected, or at high risk of infection, with HIV. The project will be carried out in accordance with the United Nations HIV/AIDS and Human Rights International Guidelines (United Nations, New York and Geneva, 1998). Voluntary and confidential counseling and testing would be encouraged and mandatory testing strongly discouraged. 55. Government has engaged in a wide-ranging set of consultations in preparing the national strategy on HIV/AIDS, including with PLWHAs. NGOs and civil society organizations participated in the consultations on the national strategy. They have been heavily involved in the on-going project, both as Board members at the federal and states levels and as beneficiaries of project funds under the HAF. NACA and the SACAs have staff who are community development specialists and who focus on interactions with civil society and NGOs. E. Environment 56. The project will generate some hazardous medical waste in HIV/AIDS testing and treatment centers. In addition, the project also involves the renovation of buildings, construction of new buildings and other minor civil works to enhance the quality of HIV/AIDS service delivery. An ESMF has been prepared by the project for the renovation of buildings, new construction and other minor civil works. This project will not fund activities that would cause an adverse effect on the environment or any form of land acquisition or restriction of access to sources of livelihoods. The potential environmental and social impacts of sub-projects under components 1 and 2 will be small-scale and site-specific; and thus easily remediable typical of category B projects. The national MWMP and project specific medical waste management plan will provide guidance on the management of medical waste generated by the project. Their potential environmental impacts are minor and site specific. F. Safeguard policies Safeguard Policies Triggered by the Project Yes No Environmental Assessment (OP/BP 4.01) [X] [ ] Natural Habitats (OP/BP 4.04) [ ] [X] Pest Management (OP 4.09) [ ] [X] Physical Cultural Resources (OP/BP 4.11) [ ] [X] Involuntary Resettlement (OP/BP 4.12) [ ] [X] Indigenous Peoples (OP/BP 4.10) [ ] [X] Forests (OP/BP 4.36) [ ] [X] Safety of Dams (OP/BP 4.37) [ ] [X] Projects in Disputed Areas (OP/BP 7.60)* [ ] [X] Projects on International Waterways (OP/BP 7.50) [ ] [X] * By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties' claims on the disputed areas 22 G. Policy Exceptions and Readiness 57. There are no policy exceptions. As the basic institutional arrangements have been established under Project 1, this project should implement quickly. The implementation manual has been finalized and all financial management arrangements are ready. Borrower commitment is high. 23 Annex 1: Country and Sector or Program Background A. Country Background 1. Nigeria is Africa's most populous country, with a population of 144.7 million people16. The country accounts for 47 percent of West Africa's population and 41 percent of the region's GDP. Economic and political reforms arising from democratic rule since 1999 have had a significant impact on development. Table 1.1: Nigeria HIV/AIDS Millennium Development Goals Reference Goal Target Indicators Sources and Baseline Current Years ANC 5.4% 4.6% HIV Prevalence Rate Sentinel (2003) (2008) Survey 1.8 1.2 Number of children UNICEF/ Million Million orphaned by AIDS UNAIDS (2004) (2007) Female: 34.3% Condom use at last 35% NARHS Male: high-risk sex (2003) 52.2% Proportion of 6. Combat Halt and population aged 15- HIV/AIDS, begin to 24 years with 22% NARHS 24% malaria and reverse comprehensive (2003) other AIDS correct knowledge of diseases Infection HIV/AIDS Catholic Orphans: Ratio of school Relief 75%; attendance of orphans Services, Non- to school attendance 2006 - Orphans: of non-orphans aged OVC 87% 10-14 years Situation (2006) Analysis Proportion of population with NNRIMS advanced HIV - 16.67% database infection with access to antiretroviral drugs 16Nigeria Census Report, National Population Commission, 2006. 24 Sources: Nigeria FMOH (2005): Technical Report, National HIV Sero-prevalence 2005 Sentinel Survey; FMOH (2005): Technical Report, National HIV/AIDS and Reproductive Health Survey 2005, Nigeria UNGASS Report 2007. 2. Nigeria's population boasts great cultural, ethnic and social diversity which have an important impact on the AIDS epidemic. The first case of HIV infection in Nigeria was reported in 1986. Currently, with close to three million Nigerians estimated to be living with HIV, and over one million children orphaned by AIDS, Nigeria is facing the largest epidemic in Africa after South Africa, and is widely considered to be at the core of the next wave of the global AIDS pandemic. B. HIV/AIDS Sector Background 3. Twenty one years after the first case of HIV was reported in the country, Nigeria is now experiencing a new phase of the epidemic that includes its growing prevalence among women especially young women of reproductive age,17 increasing numbers of orphans18; and rising numbers of PLWHA. The potential long term impact demands a response which contributes to developing sustainable capacity and integrates AIDS action into Nigeria's broader development agenda of achieving the Millennium Development Goals. The epidemic is complicated by poverty; low access to condoms in the general population, particularly among in and out of school youth; multiple sexual networks among married and cohabiting couples; lack of focus on rural interventions; and poor gender empowerment. Stigma and discrimination in society and within health care facilities act as a disincentive to seek information about HIV, testing, disclosure of HIV status, and access to care and treatment. Cultural and religious factors make open discussions on sexuality difficult. Trends in HIV/AIDS Indicators 4. With a median HIV prevalence of 3% or higher in 31 of the 37 states, and a prevalence of 37% among high risk groups, the epidemic appears to be generalized across the country. There are significant variations in ANC prevalence between the states and, although based on more limited data, with similar variations in prevalence among high-risk groups. Significant geographical variations are also observed in reported risky behavior. Given this heterogeneity, it is important to better understand HIV epidemiology at the local, state and zone levels to appropriately adapt the response. The importance of this more in-depth understanding extends, particularly to rural areas, where HIV is currently spreading more quickly than in urban areas. 172005 ANC Surveillance report, NARHS, 18OVC National Plan of Action 2006 - 2010 25 HIV/AIDS Prevalence over time 7.00% 6.00% 5.80% 5.40% 5.00% 5.00% 4.50% 4.40% 4.00% 3.80% 3.00% 2.00% 1.80% 1.00% 0.00% Y-1991 Y-1994 Y-1996 Y-1999 Y-2001 Y-2003 Y-2005 Prevalence The trend continues to show variations across states with prevalence continuing to rise in some while declining in others. Geo-Characteristics of the Epidemic 5. Though the epidemic in Nigeria affects all states, there is a high prevalence band that traverses from the North Central, through the South East to the South South zones, with lower prevalence areas on both sides of the North East and South West regions. There is a significant variance in the prevalence rates between states which range from 1.6% in Ekiti State to 10.0% in Benue State19. Fifteen of the thirty six states including the FCT have prevalence greater than the National average of 4.4%20. Interestingly, data also suggests that while HIV infection was initially more concentrated in urban areas, prevalence has increased in rural areas, and incidence may now be higher in rural areas of some of the states most affected by the epidemic21. Age and Gender Characteristics 6. The antenatal HIV rates are less variable by age group although young adults appear most affected. HIV prevalence in 2005 was 3.6% amongst pregnant 15-19 year olds, increasing to a 4.7% among women 20 - 24 years and 4.9% among women aged 26 - 29 years. The feminization of the Nigerian epidemic is evident in women above 15 years who make up 61.5% of all adults living with HIV ­ compared to 59% in sub-Saharan Africa as a whole. Drivers of the Epidemic 7. Nigeria is experiencing a sizeable and mixed HIV/AIDS epidemic. The West African Synthesis Study commissioned by the World Bank in 2007 indicates that multiple sexual relationships among married, cohabiting and non-cohabiting couples and poor condom use 19A Technical Report on 2005 National HIV/Syphilis Sero-Prevalence Sentinel Survey among Pregnant Women attending ante- Natal Clinics in Nigeria Abuja: Federal Ministry of Health, 2005. 202005 ANC Surveillance 21Nigeria Final Synthesis Report CHA 2007 26 contribute to new HIV infections. Within the country, the epidemic has important regional variations. In some states, e.g. Lagos, HIV infection remains largely concentrated in population groups routinely practicing high risk behavior, such as Sex Workers (SW), Intravenous Drug Users (IDUs) and Men who have Sex with Men (MSM). In addition, certain population groups that have frequent interactions with these groups have also been identified, and hence act as a "bridge" between these and the population-at-large. These are truckers, transporters, and Uniformed Services personnel. Further it is recognized that youth and women, more generally, are also at risk. Continued high risk interactions between infected Most-At-Risk-Populations and their immediate sexual partners could result in several million new infections. A mapping exercise to be carried out by NACA will identify the concentrated epidemics, most vulnerable regions and populations at risk to set priorities and to target resources for enhanced results. This exercise will ensure the most appropriate balance between targeting the most at risk populations and geographical areas on the one hand, and supporting the generalized nature of the epidemic on the other, for maximum impact. Therefore HPDP2 will continue to support periodic analysis of the epidemic to continue to understand the major drivers of the epidemic, characteristics and the internal disparity in incidence and prevalence on geographic and socioeconomic variables. HIV/AIDS Service Utilization and Coverage 8. Patterns of service utilization vary by residence and income. Rural households have less access than urban households because the majority of services are located in urban areas. Utilization of HIV testing, counseling and treatment services has improved slowly and referral systems have also expanded, with limited use by population in remote areas. By December 2007, 166,734 PLWHAs were on ART treatment, 8.6% of the population had accessed HCT and knew their status22, 864 sites in the country offered HCT23, while only 5.25% of pregnant women who require PMTCT had ever accessed the program. Treatment is offered in 215 sites across the country and most of the sites are in the urban centers. Structure and Organization of HIV/AIDS Response, Coordination and Policy in Nigeria 9. The Nigerian HIV/AIDS response has had considerable high level political commitment since the inception of democratic rule in 1999. As soon as the first case was discovered in the country, the Nigerian Government designed a national response principally guided by the Federal Ministry of Health. Political commitment and leadership led to the reengineering of the National response from a mono-sectoral to a multisectoral response in line with best practice from other parts of the world. In 2001, the establishment of the multisectoral Presidential Council on AIDS and the National Action Committee on AIDS (NACA) heralded multisectoral HIV interventions in Nigeria. In 2002, President Obasanjo declared HIV and AIDS a national emergency, established a Presidential Advisory Council, and demanded a national emergency response plan. This was the basis for a coordinated effort to provide comprehensive prevention, treatment, care and support services through a number of plans including the HIV/AIDS Emergency Action Plan (HEAP), the HIV Health Sector Plan and the National Strategic Framework (NSF 2005 - 2009). The goal of the NSF is to "reduce HIV/AIDS incidence by at least 25%, and provide equitable prevention, treatment, care, and support while mitigating its impact amongst women, children and other vulnerable groups and the general population in Nigeria by 2009". 22National HIV/AIDS Reproductive and Health Survey (NARHS) 2005 23NACA Information Products, 2008 27 10. In 2003, the World Bank and the Federal Government of Nigeria agreed a credit of 90.3 million US$ for a 5-year HIV/AIDS Program Development Project in support of the national multisectoral response, as part of the World Bank's Multi-Country AIDS Program (MAP). This was a program of support for national coordination mechanisms, public sector responses and support for civil society responses. The multisectoral platform of the national response, the strengthening of coordination entities at national and state levels and the application of the Three Ones principle (One national framework, One strategic plan and One monitoring and evaluation framework) have expanded HIV response in multiple sectors, strengthened linkages and networking amongst numerous groups and increased access to available resources and interventions by target beneficiaries. 11. From 2002 to 2007 the country witnessed tangible progress with the implementation of NSF in its eight thematic areas. Eighteen States have translated the NSF into State Strategic Plans, which outline goals, objectives and implementation strategies for the HIV response. In December 2007, after 3 years of implementing the NSF, NACA collaborated with key stakeholders on a joint midterm review that presented a forward-looking focus to assess the progress, identify gaps and offer recommendations to guide future prioritization and implementation of the National Strategic Framework. 12. Nigeria developed a roadmap for scaling up towards Universal Access to HIV prevention, treatment, care and support in February 2006. The consultative process identified obstacles and proffered solutions to each of the seven key thematic areas. National targets for Universal Access were developed and endorsed by all stakeholder constituencies in 2007. Currently, all State Strategic Plans have incorporated the Universal Access roadmap and targets. 13. In February 2008, NACA produced a two year costed National AIDS Priority Plan (NAPP), which presented national HIV/AIDS priority interventions, a costed biennial response plan and planning procedures. The NAPP is expected to drive implementation, improve oversight, emphasize results and provide a basis for the alignment of multisectoral institutions and support of international partners. Moreover, the NAPP will be mainstreamed into the new National Economic Empowerment and Development Strategy (NEEDS), the State Economic Empowerment and Development Strategy (SEEDS) and the Local Economic Empowerment and Development Strategy (LEEDS) implementation plans. C. Donor Support 14. Overall development partner coordination in Nigeria is strong. The Bank Group and DFID have prepared a joint Country Partnership Strategy (CPS) that was discussed by the Bank's Board at the end of June 2005. A new strategy is currently being prepared jointly with DFID and USAID. CPS 1 (2005-2009) is assisting Nigeria in the implementation of its economic reform program -- the National Economic Empowerment and Development Strategy (NEEDS), which was launched in 2004 to boost growth and to help achieve the MDGs. The objectives of the second CPS (2010-2013), which has been expanded to include the African Development Bank (AfDB) and USAID, are to help support the Nigerian Government to implement its national 28 strategy (NEEDS) and the Seven Point Agenda through a focus on the three themes of improving governance, maintaining non-oil growth and promoting human development. 15. The UK Department for International Development (DFID) has signed a partnership with the World Bank for greater harmonization of development support. DFID has earmarked GBP 75 million for the next five years. Coordination efforts have also been strengthened with the inauguration and operation of various coordination forums such as the Extended Theme Group on AIDS, Technical Working Groups on HIV Thematic Areas and the Development Partners Group (DPG) which provide avenues for technical discussions, networking, information sharing, program harmonization and alignment among partners. Participation in the DPG includes partners such as USG, Global Fund, CIDA, the French and German Embassies and UN agencies. D. Key Sector Issues 1. Governance, Coordination & Resource Mobilization 16. Transformation of NACA into an Agency: The country has made significant progress by transforming the National Action Committee on AIDS into a statutory agency backed by an act of Parliament called the National Agency for the Control of AIDS. This should lead to more effective and sustained national response coordination. Thirteen states have concluded the process of transforming their SACAs into legally backed coordinating agencies. However, these bodies are yet to be optimally equipped with the requisite skilled human and financial resources to effectively undertake their responsibilities. 17. Leadership: Drawing on experience from other countries, leadership is central to stemming and responding to the HIV/AIDS epidemic. The leadership and commitment provided by democratic governments in the country since 1999, in advancing the multisectoral response, has been considerable. Nevertheless, increased commitment at all levels is essential to consolidate and sustain the gains in responding to the epidemic. 18. Coordination: In spite of significant achievements, there are still significant challenges with coordination of the National response. These challenges include, among others, the absence of legal status for most of the state agencies, limited funding, and inadequate skilled personnel. Despite some success in collating information from partners and stakeholders, many partners and stakeholders are yet to start reporting through the channels established. This has left significant gaps in the information available on interventions and activities. Secondly the limited capacity of coordinating institutions to process and analyze data in order to provide feedback to stakeholders remains another challenge. Sectoral coordination remains weak and needs to be a point of focus to achieve an effective multisectoral response in the country. 19. Funding: There has been a noticeable increase in the funding of the HIV/AIDS response. The national response attracted significant resources from both internal and external sources. Government financing is from National, State and Local Government budgets. This has increased as a result of the Debt Relief Gain granted to Nigeria by the Paris Club of Creditors. Line ministries at the federal level enjoyed funding from a direct government allocation from the MDG fund (channeled through NACA). Unfortunately, late releases and reduction in the 29 eventual amount released to the MDAs has hampered effective utilization of the resources and limited proper planning and sustained interventions by the line ministries and other agencies. Tracking and documenting the resources and beneficiaries remains a major challenge because donors share limited information and there is poor collaboration amongst government supervisory agencies. Budgetary allocations to SACAs are still underreported and low, principally due to their lack of legal status that would have enabled them to draw resources directly from the state allocations. 20. Although Federal Government budgetary allocation to HIV/AIDS increased from N1.55b in 2004 to N5.94b in 2007, the actual expenditure on HIV/AIDS in Nigeria cannot be easily ascertained. The National AIDS Spending Assessment (NASA) for 2006-2007 shows that a total of N4,861,737,421 was spent on HIV and AIDS24. Major sources of AIDS funding in Nigeria include: the government N7,449,768,596 billion (DRG ­ N4.238 billion and N3.211 billion ­ Ministries, Departments and Agencies), Global Fund (N5,871,306,012,), PEPFAR, DFID, CIDA Canada, World Bank MAP and the UN System. While the National response has enjoyed a significant increase in the inflow of resources from multiple sources, it remains inadequate compared to the needs as costed in the NSF. 21. Commitment: The government of Nigeria, partners and stakeholders continue to demonstrate high levels of commitment to the National response. This is evident by the country's subscription to conventions and best practices necessary for an effective response. These conventions include the "three ones", the Paris declaration, convention on human rights, etc. In spite of the NSF being the strategic framework guiding implementation of the response process, there are still cases of implementing partners not referring to the NSF document in the design of HIV/AIDS programs or interventions. 2. Prevention and Behavioral Change Communication (BCC): 22. Large BCC and open communication interventions targeted at the various segments of the population have changed the perception of HIV and AIDS. Implementing partners have targeted prevention interventions at general and specific groups resulting in significant increases in awareness and knowledge levels in most parts of the country. These have translated to a delay in sexual debut, an increase in the number of people reporting condom use in their last sexual act with a casual partner and a significant increase in the quantity of condoms distributed in the country. However, coordination and quality assurance in the design, content, dissemination, monitoring and evaluation of many BCC interventions particularly at the state and community level remain major challenges. Nigeria has recently produced and disseminated a three-year National Prevention plan, which has been costed and aims at creating more visibility for prevention issues to match the focus on treatment in the last four years. A draft national policy on condoms has been prepared for the ratification of the government, as has a National BCC Strategy (2009-14). 24National AIDS Spending Assessment, 2006 - 2007 30 3. Health Sector Responses: 23. The government developed the Health sector strategy response to HIV/AIDS and an implementation plan based on the NSF to address the epidemic and strengthen the health system. Aside from resources committed by the FGN to place over 500,000 persons on treatment by 2009, Nigeria has also benefited from the GFATM and USG PEPFAR to scale up treatment through the provision of ART, laboratory strengthening, safe blood, treatment of opportunistic infections and palliative care, as well as linkages with community based care provision. These efforts have increased access to treatment, care and support significantly. While significant strides have been taken in providing access to treatment, the following are critical issues that require attention to strengthen and sustain the current treatment program: · There are multiple treatment projects in the country, not yet fused into one national program. · Only a few states and LGAs are currently covered, hence accessibility is still an issue in most parts of the country. · There is a paucity of qualified health personnel to handle and manage cases in the facilities, as efforts to promote task shifting have not yielded the desired results. · Differential conditions offered to medical and paramedical personnel working on treatment projects may jeopardize attention to other diseases with the dearth of skilled health care personnel. · The state of health care infrastructure and basic facilities in the country remains weak due to a poor maintenance culture, and erratic power and water supplies. · Sustainability of treatment interventions post donor exit is a major challenge that has not received the desired attention and has major implications on the treatment regime in the country. · While data collection has improved, the problem of inadequate reporting by implementing agencies to the FMOH HIV/AIDS Division and NACA remains a challenge and has had an impact on the adequacy of information on the status of treatment programs and beneficiaries. · Commodities forecasting, procurement, supply and management system are still too weak to handle the expected expansion of the treatment program to meet country needs. 4. Non ­ Health Sector Responses and Impact Mitigation: 24. The HIV/AIDS epidemic as a developmental issue is better understood by National Planning Authorities and has been mainstreamed into poverty reduction strategies and initiatives such as the National Poverty Eradication Program (NAPEP), the National Economic Empowerment and Development Strategies (NEEDS), and the Private sector led social responsibility initiatives (e.g. the MTN foundation, etc.). However, there is still a huge gap in programming poverty reduction strategies to specifically target PLWHAs and PABAs. 31 5. Research, Monitoring & Evaluation: 25. NACA and development partners have made appreciable progress in putting in place a system for monitoring and evaluation; through hiring additional personnel, training and retraining of these personnel, equipment and software provision and significant resources allocated to M & E. This has led to the production and dissemination of regular updates on the National response at state and national levels. Existing challenges are in data collection, getting partners to use designated agreed tools, data analyses to cover the various services provided within the National response and data utilization. A National M&E Operational Plan (2007- 2010) has been developed with harmonized tools and indicators and national Universal Access targets. Joint reviews by partners have crystallized the NAPP as a tool to facilitate harmonization and alignment of development partner support to national priorities. 26. The deficiency of HIV/AIDS impact evaluation studies is obvious in the response and is a point of strong consideration in HPDP2. Additionally, a draft National HIV/AIDS Research Policy was developed to guide and provide momentum to coordinate HIV/AIDS research. Currently, only a few universities, research institutions and NGOs are engaged in research activities on HIV/AIDS. The need to focus and coordinate these activities led to the development of the National HIV/AIDS Research Policy to translate the knowledge accumulated from these sources into effective implementation of policies and programming. 6. Policy and Creation of Enabling Environment: 27. So far, about 23 HIV/AIDS policies and guidelines have been developed providing guidance to implement interventions and ensure quality. Many of these policies and guidelines, developed with assistance from development partners, are yet to be actively disseminated. For example, the anti-discrimination bill is yet to be passed, which is essential in contributing to reduction in stigma and discrimination. 32 Annex 2: Major Related Projects Financed by the Bank and/or other Agencies NIGERIA: Second HIV/AIDS Program Development Project Sector Issue Project Latest Supervision (PSR) Ratings (Bank-financed projects only) Completed Outcome Sustainability ID Impact World Bank Primary Satisfactory Likely Modest Education World Bank Health Systems Unsatisfactory Likely Negligible Fund World Bank FADAMA I Satisfactory Likely Modest World Bank Universal Basic Unsatisfactory Likely Negligible Education On-going Latest Supervision (PSR) Ratings Projects Implementation Progress Development Objective (IP) (DO) World Bank HSDP II S S (approved 6/06/2002) World Bank FADAMA II S S (approved 12/16/2003) World Bank HIV/AIDS S S Program Development Project I World Bank Local S S Empowerment and Environmental 33 Management Project World Bank Malaria Booster S S Other Development Agencies DFID Bridging the Gap N.A. N.A. DFID Strengthening N.A. N.A. Nigeria's Response to HIV/AIDS DFID Promoting Sexual and N.A. N.A. Reproductive Health for HIV/AIDS Reduction DFID ENR (Enhancing the N.A. N.A. National Reponses?) JICA Provision of Cd4 N.A. N.A. Counters and Reagents to three ART centers for the scaling up of ART services in Nigeria. US Government DELIVER ­ aims to N.A. N.A. improve the availability of contraceptives supplies in the public sector by strengthening country supply systems. US Government HIV Prevention N.A. N.A. US Government HIV Care N.A. N.A. US Government HIV Treatment N.A. N.A. Global Fund for HIV N.A. N.A. HIV TB & 34 Malaria UNFPA Support Capacity N.A. N.A. building at National and States' level for implementation of HIV/AIDS Prevention services. DFID State and Local N.A. N.A. Government Programme IP /DO Ratings: a. HS (Highly Satisfactory) b. S (Satisfactory) c. U (Unsatisfactory) d. HU (Highly Unsatisfactory) 35 Annex 3: Results Framework and Monitoring NIGERIA: Second HIV/AIDS Program Development Project Results Framework Project Development Project Outcome Indicators Use of Project Outcome Objective Information Percentage of young women and men aged 15-24 reporting the use of a condom during (last) sexual intercourse with a non-regular partner (of those Review effectiveness of reporting sexual intercourse with a non- Behavior Change regular partner in the last 12 months) Communication (i) Reduce the risk of HIV Percentage of women and men aged 15- interventions to achieve infections by scaling up 49 who have had sexual intercourse safer sexual practices. prevention with more than one partner in the last Coverage and awareness of interventions. 12 months activities will be assessed Percentage of most-at-risk groups through surveys, and results reporting the use of a condom during used to refocus (last) sexual intercourse with a non- interventions. regular partner (of those reporting sexual intercourse with a non-regular partner in the last 12 months) Percentage of persons aged 15 and older who received counseling and testing for HIV and received their test results Percentage of pregnant women who are HIV positive and require antiretroviral prophylaxis who receive a complete course of antiretroviral prophylaxis to (ii) Increase access to and reduce the risk of MTCT To assess progress towards utilization of HIV Ratio of current school attendance access to care, support and counseling, testing, care between orphans and non-orphans. treatment for infected and and support services. affected persons. Percentage of most-at-risk populations who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission. 36 Intermediate Outcomes Intermediate Outcome Indicators Use of Intermediate Outcome Monitoring Percentage of SACAs and Public Sector organizations that hold partner forums on a regular basis to report on planning, decisions and progress Percentage of Health Facilities Track level of 1. Expanding the Public providing comprehensive care and implementation of Sector Response treatment services workplans for HIV/AIDS Number of Line Ministries and LACAs programming in the Public implementing HIV/AIDS workplans Sector (disaggregated by the type of organization) Percentage of schools that provided life skills-based HIV education in the last academic year Number of PLWHA groups and associations that receive a basic package of support from CSOs that Track disbursement and use implement the HIV/AIDS Fund (HAF) of Private Sector and Civil program. Society resources as a 2. Expanding the Civil Number of orphans that receive a basic measure of program Society and Private Sector package of support from CSOs that performance Response to the HIV/AIDS implement the HIV/AIDS Fund (HAF) Epidemic program Percentage of Private Sector and CSOs that report regularly and on time on agreed project indicators.(disaggregated by the specific organization) Percentage of Public Sector, Private Monitor use of, and Sector and CSO organizations funded coordination and by the project with improved financial management of resources accounting practices and information to ensure Number of SACAs, State and federal optimal program level public sector organizations that performance 3. Strengthening have a written strategic plan clearly Mechanisms for Project linked to the National Strategic Coordination and objectives and priorities Management Percentage of NACA/SACA staff that were trained in past year and are demonstrating new skills in job responsibilities (disaggregated by NACA and SACA) Percentage of actual funds utilized 37 relative to planned targets (disaggregated by NACA, SACA, LMs and LACAs). Number of States that link the National program priorities with their annual operational plans 38 Data Responsibility for Collection NACA/FMOH/ SFH NACA/FMOH/ SFH NACA/FMOH NACA/FMOH/ SFH Bio- Collection and Survey and Survey and Survey National National National Data Instruments The AIDS Reproductive Health The AIDS Reproductive Health Integrated Behavioral Surveillance Study The AIDS Reproductive Health Frequency and Reports Biennial Biennial Biennial Biennial 4 72 75 Yr 45.4% 69.2% 0.4% 5.0% 96% 3 Reporting 39 70 73 Values Yr TBD 0.6% 6.0% 86% and 2 reviewed 67 70 Target Yr TBD 0.8% 6.5% 78% being 1 Collection 65 68 are Yr TBD 1.0% 7.0% 74% ) Data 0) 26 figures sex sex (non- (Yr based: and 2007) 2007 (brothel 2007) 25 34.3% 1.1% 52.2% 7.2% 64.8% 2007 report 2008 identified Baseline Female: Male: (NARHS Female: Male: (NARHS Female workers based: Female workers brothel 67.1% IBBSS 72.7% (NARHS DHS been and use ad men one (of the and with have their the sexual sexual sexual groups in 15 condom and than issues updated women (last) non-regular non-regular had a intercourse partner intercourse aged months) months be a a of partner counseling received quality Indicators reporting reporting 12 have more 12 will young women and during most-at-risk use sexual sexual data with with last last persons of those of who with of 15-24 the the the of received HIV Baseline Some Outcome (of in in (last) non-regular non-regular 25 26 a reporting months) for aged condom 15-49 a who a 12 results Project Percentage men of intercourse partner intercourse partner Percentage aged intercourse partner Percentage reporting during with those with last Percentage older testing test Data of Affairs PMTCT of Responsibility for Collection SACA SACA/LACA course. due NACA/FMOH NACA/Federal Ministry Women NACA/FMOH/ SFH picture in total gure fi Collection program Public SACA the Evaluation program statistics current Study and Survey activity National represent year. the Data Instruments Monthly and reports, Sector Annual reviews, not NNRIMS/DHIS service OVC The AIDS Reproductive Health mid with by does and updated available be Frequency and Reports Annual Annual States be Annual Biennial Biennial will 4 few will a Yr 100% 13 259 30% 87% only indicator 50% 57% 47% results 3 this Values Yr 70% 13 259 from 40 is for 18% TBD 45% 51% 41% 2 data figure Target Yr 50% 13 259 BD comprehensive 12% This T 40% 47% 37% 1 more baseline Yr 25% 13 259 8% NACA. nda this TBD 33% 45% 35% by and 0) 28 LM: place used (CRS, OVC (Yr report LM: taking 28 (IBBSS State system 44.03% 34.01% 27 32.93% Fed survey Baseline 0 (i) (ii) currently 5.25% (NNRIMS December 2007) 75%; 2006 Situation Analysis) 35.5% 2007) SW: MSM: IDUs: is OVC Response a of hold year and management 2008 the who and a system the women risk require Sector that decisions the receive correctly HIV/AIDS of HIV twice the attendance information antiretroviral women and most-at-risk non-orphans. of Ministries launched Public the who both preventing of misconceptions Indicators least update SACAs is just pregnant reduce school and the at planning, An of of Outcomes Line of of HIV to prophylaxis) who on pregnant positive major of course transmission. implementing Outcome forum NNRIMS FMOWA ways with (of current orphans 27 coverage. 28 transmission HIV of reject HIV Expanding report progress Intermediate (i) Project Percentage partner to and Number LACAs Percentage living complete prophylaxis MTCT are antiretroviral Ratio between Percentage populations identify sexual who about of Data this this for for NACA/Federa Ministryl Education Responsibility for Collection NACA/SACA/ CSOs NACA/SACA/ CSOs NACA/SACA/ CSOs/PSOs targets targets and and and -specific -specific reports, annual annual State State Sector School- Collection assessment program program program Data Instruments CSO evaluation reports/NACA &SACA reports CSO evaluation reports/NACA &SACA reports CSO evaluation reports/NACA quarterly Public Evaluation FLHE based substantive substantive and and (HAF) Reports Fund baseline baseline Annual Frequency and Annual Annual Annual a a Fund 4 BD BD T T HIV/AIDS TBD 100% Yr 50% establish establish the 3 and and HIV/AIDS TBD TBD TBD 80% Yr 30% Values the receive 41 LACAs LACAs 2 BD BD to to that T T TBD 50% Target Yr 15% through CSOs 1 support support of TBD TBD TBD 29 40% Yr 10% current current reports To Response 0) on on e th (FME PSOs: CSOs: (Yr data data 30 0 0 from Society level level LACAs: gather gather updated to to SACA Civil Baseline Fed 0 Fed by 281 (iii) be (NACA/SACA reports) 33.61% 2006) and a States States on the and the and that HIV year basic CSOs from with with by Sector a and aggregated receive indicators groups HIV/AIDS program. be Sector forum forum from a a that support will schools academic Private receive the Indicators of implement (HAF) regularly project data skills-based last the Private planning planning of PLWHA that support program. is is This (disaggregated the orphans Fund of report life in of of of that agreed Outcome organization) implement package (HAF) that on NACA NACA of Expanding 29 indicator 30 indicator. (ii) Project Number associations package that Fund Number basic CSOs HIV/AIDS Percentage CSOs time workplans type Percentage provided education Data SACA SACA SACA, rammeg pro Financial HAF Responsibility for Collection NACA, NACA, NACA, the Reports by annual and and Financial Collection validated be Interim &SACA reports Data Instruments Capacity institutional assessments, Program financial monitoring reviews. NACA/SACA reports Capacity will data bi-annual The the Frequency and Reports Annual Annual Annual (HAF). through 4 Fund 95% 90% Yr 100% 37 13 100% 3 HIV/AIDS improvements 87% 85% Yr 85% 29 9 63% the 42 2 monitor 80% 83% Values Yr 65% 24 6 42% to receive management 1 that place in 75% 78% and Target Yr 50% 20 4 21% CSOs are of 0) 2 CSOs report systems (Yr 18 reports LM: but level: coordination the from before 32 33 71% State (74%) (Public Sector/HAF Evaluation 2008) Baseline 0 SACAs: Federal 0 project SACA for project. CSO the by collected and the specific Sector, to of improved and been written a end not the and practices linked State aggregated the mechanisms sector has Public objectives receiving by Indicators have be with rdsa that of that clearly staff will tow Reports 31 public data Sector SACAs, of data is accounting of plan Strategic Outcome level This This Strengthening 31 evaluation 32 Monitoring (disaggregated organization) (iii) Project Percentage Private organizations financial Number federal organizations strategic National priorities. Percentage capacity capacity Line SACA, Line Sector SACA initial initial CSO the the LACA, Ministry NACA, LACA, Ministry, Private and NACA, NACA through through ished ished and establ establ be be assessments, post-training surveys evaluation Program reviews, financial monitoring survey/reports Program reviews Quarterly Reports will will baseline baseline The The Annual Annual planning. planning. 100% 37 37 is is 95% 37 29 NACA NACA 43 which which 85% 37 24 35 75% 37 20 evaluations evaluations ng ng 34 buildi buildi 35 priorities: Available capacity capacity the the Not National priorities: State 18 13 using using the the have into they utilized annual link program and statutory collected collected that examples be be knowledge funds that their SACAs to to give targets. State States Territory report new going going can actual States their is is who of and with plans autonomous assessment. assessment. their and planned of Capital data data to This This used skills Participating 33 building 34 building TA/training have and Percentage relative Number National priorities operational All Federal transformed financially agencies Implementation Arrangements for Monitoring and Evaluation of the Project Achievements under first project and Focus in HPDP2: 1. Under Project 1, Nigeria has established most of the elements of an effective monitoring and evaluation system. The National Agency for the Control of AIDS (NACA) in collaboration with the World Bank and other partners developed the Nigerian National Response Information Management System, a robust monitoring and evaluation framework, in 2004. NNRIMS focuses specifically on outcome and impact level indicators such as National Strategic Framework (NSF), UNGASS and MDG indicators. However, the relatively nascent and evolving nature of the system has had challenging dimensions for progress tracking and reporting of results. In 2007, NACA developed the National M&E Operational Plan, in recognition of the need to have a costed roadmap to implement a revised NNRIMS. The document, which serves as the National M&E Plan, was developed in close consultation with key implementing partners and donors in Nigeria. All the core indicators of Project 1 and other national programs have been integrated into this system and this will guide M&E activities in HPDP2. Next Steps under HPDP2: 2. The focus of the project monitoring and evaluation activities on HPDP2 will be three- pronged, and aligned with the National Operational Plan (Nigeria's HIV Response M&E Roadmap), as well as the Bank's the M&E policy. Internally, mechanisms will be put in place to document results, promote learning and facilitate transparency and accountability of project systems; externally, HPDP2 will continue to support M&E systems strengthening efforts at national, state, local and civil society levels, which were initiated under Project 1 and collaboration with development partners to harmonize and integrate a cohesive and coherent national monitoring and evaluation system to assist with progress measurement, accountability, learning and planning. HPDP2 will support NACA to drive the process of creating consensus on one national M&E framework at all levels, and engage the support of development partners to this end. M&E will be a vital component for every project and action plan that NACA will support with HPDP2. 3. Country-specific reports from the West African Epidemic and Response Synthesis commissioned by the Bank in 2007 enabled Nigeria to better understand the trends and drivers of the Nigerian epidemic so as to more effectively target most-at-risk groups (MARP). This study was complemented with data from the Integrated Bio-Behavioral Surveillance Survey which examined prevalence and risk behavior among most-at-risk groups in seven states. The consensus is that general population interventions need to be balanced with programs targeting MARPs and scaled up appropriately, considering specific epidemiological situations across regions. HPDP2 will support the development of M&E plans by Civil Society Organizations and Ministries, Departments and Agencies (MDAs) that will: (i) include a set of key performance indicators to support programs aimed at targeting most-at-risk groups, (ii) build M&E capacity for the Civil Society Organizations and MDAs; and (iii) evaluate their programs. Already, under Project 1, NACA has developed draft monitoring and evaluation plans for Behavior Change Communication Programs and Systems Strengthening plans for the ministries with which it works. 44 Monitoring: 4. HPDP2 has identified eighteen (19) indicators. Seven of these indicators are at the Development Objective level. NACA will strengthen the data collection system for community- based interventions and program monitoring to make sure that the system will effectively track these indicators. The majority of these key program indicators are already included in the National M&E Operational Plan there will be discussions at SACA level to include these indicators in their State M&E plans. As part of project preparation, NACA and SACAs has worked with the different implementing sectors to review the past process and agree on current modalities to update baseline values for Results Framework indicators on HPDP2. Management Information Systems: 5. HPDP2 will support the scale up of M&E systems at the state level, in collaboration with key partners such as DFID, UNAIDS and USG. HIV prevention, care and support services will be tracked using (a) data from the District Health Information Systems (DHIS), Logistics and Health Program Management Information Platform (LHPMIP) and periodic surveys; (ii) intervention coverage, particularly of HCT and ART, will be assessed using coverage modules in behavioral surveys; and (iii) reporting forms and systems will be developed by NACA to track non-health indicators; (b) financial tracking, financial monitoring and expenditure tracking will be used to monitor resource use and needs; (c) procurement tracking for the physical and financial progress of the contracts issued; and (d) training/capacity building tracking will be done using a simple training database and periodic training evaluations with established results framework. . 35 6. To aid information management, a database for processing and managing information on indicators from the NNRIMS system was installed and used in 19 states under Project 1. However, due to the developer dependent nature of the system, there were several unresolved challenges in using the system. As a result of this, in 2007, the M&E stakeholders identified the District Health Information System (DHIS) and the Logistics and Health Program Management Information Platform (LHPMIP). The DHIS is similar in most respects to the NNRIMS database except that it is open source and is being used in over 15 countries. DHIS has been adopted for the national HMIS and is being funded by DFID through PATHS. The adoption of the system to complement NNRIMS ensures harmonization and health system strengthening. In the same vein, LHPMIP is a database used for real time data reporting using available technology at the facility level. It is being piloted in a few PEPFAR and Global Fund ART sites and can export data from facilities to DHIS at the state and national levels. This system is also being considered as a donor resource management monitoring portal for the National Planning Commission. DHIS is being implemented in phases. Phase 1 was at national level (NACA, FMOH and 6 states with the support of DFID). Lessons learnt in Phase 1 have been used to improve the database. It was rolled out to an additional 17 states by the end of 2008, while the 3rd phase will be in 2009. Routine monitoring data for health and non-health indicators under HPDP2 will flow from NNRIMS Monthly Summary forms and LHPMIP and be processed using DHIS; 35See table on details of data collection. 45 Surveillance and Learning Agenda: 7. Surveillance will be strengthened through: (i) existing surveillance data from numerous sources, including ANC sentinel sites, Prevention of Mother to Child Transmission (PMTCT) programs, population-based surveys and targeted surveys, (ii) the National Demographic and Health Survey (NDHS) will undertake a national household survey in 2009; (iii) ANC surveillance is on-going, held in bi-annual intervals and will be strengthened through provision of TA under HPDP2; and (iv) the National Integrated Bio-Behavioral Surveillance Survey (IBBSS) among high risk groups was conducted last year and will be undertaken bi-annually. Baseline values for HPDP2 have been appropriately documented for the project to facilitate the measurement of results. The national studies conducted between 2007 and 2008 provided most of this information, in addition to specific outcome and process evaluation of components of HPDPI. Evident from the IBBSS and NARHS, NACA has adopted `second-generation surveillance', which includes bio-behavioral surveys36 among most-at-risk populations and the general population. The table below highlights key details of data collection. Details of Data Collection Schedule Sources of Would data (Project Year) How data collection funding for collection Means of Data will be implemented data have to be Collection 1 2 3 4 5 collection sustained? SFH will provide TA as well as human and The National AIDS material resources for FMOH/ and Reproductive X X the study with direction SFH37/ Yes Health Survey from and in close HPDP2 (NARHS) collaboration with FMOH FHI (GHAIN) will provide TA and funds FHI Integrated Bio- to FMOH. Data (GHAIN)/ Behavioral collection will be done X X X USG Yes Surveillance Study by group of consultants (CDC)/ (IBBSS) or firms under contract FMOH39 with supervision from M&E TWG38 Nigeria Demographic National Planning USAID X X Yes and Health Survey Commission will be (Measure 36HIV serology, STD serology and behaviours, knowledge & attitudes 37USAID usually provides funds to the Society for Family Health to cover most of the survey. HPDP2 will act as funder of last resort to fill up very small gap that may be left through the health response and NACA. 38National M&E Technical Working Group 39HPDP2 is not expected to make any significant contribution to this study. 46 (NDHS) provided TA by Evaluation)/ Measure Evaluation. GON40 Data collection will be done by group of consultants or firms. FME will receive TA from UNICEF and FME/ FLHE School-based implement the study X X X X X UNICEF/ Yes assessment through third party HPDP241 firm or consultants under contract FMOWA will receive TA from UNICEF and FMOWA42/ OVC Situation implement the study X X UNICEF/H Yes Analysis through third party PDP2 firm or consultants under contract Capacity and Third party firm or Institutional X X X X X consultants under HPDP2 Yes Assessments contract Third party firm or Post-training surveys X X X X X consultants under HPDP2 Yes and evaluation contract CSOs, LACAs, SACAs and NACA input data into the Demographic and HPDP2/ NNRIMS/DHIS X X X X X Health Information DFID/ Yes service statistics System from paper FHI/GON44 based NNRIMS summary forms and LHPMIP43 Monthly program and CSOs, PSOs, LACAs, activity reports Line Ministries prepare (CSOs, PSOs, X X X X X monthly program HPDP2 Yes LACAs, Line reports and submit to Ministries) SACA Annual program SACAs and NACA reviews and reports X X X X X conduct annual reviews HPDP2 Yes (NACA and SACA) and prepare annual 40 HPDP2 is not expected to make any significant contribution to this study. 41 This would be incorporated into the annual workplan of the Federal Ministry of Education. UNICEF is expected to fund part of the study activities. HPDP2 will also fund specific aspects of the study. 42 These would be direct funds from Federal Ministry of Women Affairs. 43 Logistic and Health Programme Management Information Platform (will be based at facility and LACA level) 44 GON - Government of Nigeria through direct funds. 47 program reports SACAs prepare SACA quarterly quarterly reports and X X X X X HPDP2 Yes reports submit to NACA and the Bank. Third party firm or Public Sector X X X X X consultants under HPDP2 Yes Evaluation contract Third party firm or HAF program X X X consultants under HPDP2 Yes evaluation contract The surveys are carried out annually by the Financial monitoring Bank FM team; bi- X X X X X HPDP2 Yes reviews/surveys annual reports are reviewed by NACA and the Bank team Supervision and Program Reviews: 8. The project will require extra supervision in the initial year especially for ensuring successful implementation of the state level program and financial management including fund flow arrangements. Joint bi-annual supervision missions will be organized with key partners, including NACA, DFID and Federal Ministry of Finance. The Bank's in-country project team will also conduct joint supportive TA/supervision missions with NACA and other essential Bank teams quarterly. A mid-term review would be conducted after two years of the project to comprehensively review the overall performance of the project in achieving its targets and maintaining strong fiduciary mechanisms, and the requirement for additional financing (see Annex 5). Data management, dissemination and use: 9. NACA, SACAs and the Bank have agreed on a harmonized reporting template that will facilitate program monitoring (dashboard and other output indicators) and financial reporting. Through HPDP2, the decentralization of reporting process and strategies will be strengthened within all sectors at national, state and local levels. The intention of the proposed framework is to move from a traditional "monitoring and evaluation" system to a strategic information management approach. The system will produce a clearly defined set of products on a quarterly, annual or periodic basis to allow information to be used strategically.45 Capacity and Technical Assistance: 10. The Project will target more closely the decentralization of M&E systems to enable States, MDAs, Local Governments, Private and Civil Sector, as well as Communities to monitor and improve their performance. Technical assistance will also be provided to facilitate the development of M&E systems that address the needs of the general population and vulnerable 45See Annex 3: Strategic Information Management Tools to be used in HPDP2 48 communities as identified through exploratory studies. Project 1 provided the opportunity to strengthen M&E capacity at National and State level to a large extent, with the establishment of M&E Units and focal points in most Sectors. To maximize the effectiveness of available information and implement evidence based planning at all levels, HPDP2, along with other development partners, including UNAIDS, DFID and USG will support capacity development at the local levels, particularly of CSOs, Private and Public Sector Organizations to report effectively on the indicators presented in the Results Framework. Specific learning points will be targeted such as evidence based strategic planning methodologies, program management, field testing of new program formats, assessment of data flows, improving data demand and information use, and institutionalizing joint data quality assessments, etc. This should result in significant strengthening of the M&E systems that service the project in order to make them more user friendly on the one hand, and more product-oriented on the other. Resources for M&E: 11. The global recommendation is to set aside at least 10% of the budget to support monitoring and evaluation.46 Last year, the World Bank supported the States to carry out an M&E systems assessment which resulted in system strengthening plans that were incorporated into the bi- annual costed workplans for 2008 and 2009. As a result, all states were able to allocate between 7 ­ 12% of their budget to M&E. HDPD2 will support this initiative and promote a systems review that will document the actual expenditure on M&E and existing funding gaps. 12. Thus the program would have a strengthened monitoring framework to provide more accessible and ready-to-use information across program content and management functions; enhanced surveillance systems to provide HIV related epidemiological, clinical and behavioral data at a state and sub-state level; and independent evaluation and research to inform and support program implementation. A number of reports will be produced by the system which support the various functions of the program and can be summarized as follows: Strategic Information Management Tools to be used in HPDP2 Product/Tool Levels Purpose/Audience Sources of Information Program Reports National State Internal audience ­ NACA, NNRIMS-DHIS (Bi-annual at national Sectoral SACA, World Bank and level; Quarterly at State) Local implementers in Public and Government Private Sectors, and CSOs. Civil Society Dashboard National Used by NACA to monitor NNRIMS-DHIS, (Bi-annual at national State SACA, CSOs and Public Sector National and level; Quarterly at State) Collaborators, and; serves as State dashboards management tool for NACA and partners. State of the Epidemic National Strategic management and NNRIMS-DHIS, 46UNAIDS 49 and Response State accountability tool for the surveillance, (Biennial) Government of Nigeria, special surveys National Planning Commission, and research NACA, SACAs, development partners and the public. Can be useful for planning, monitoring, accountability, quality assurance and dissemination. External Program National State Measurement of progress Annual reports, Evaluation Reports Sectoral against objectives for NACA, special surveys, (Mid-term, End of Local SACA, CSOs, Public Sector evaluation Program) Government Collaborators and Development process Civil Society Partners. Published Any NACA, SACA, partner, other Research studies, Research/Other Reports audience surveys (Periodic) 13. During the life of the project, HPDP2 will support operational research to improve the national program. Finally, NACA will identify critical evaluation activities which the project can support through a sub-committee of the National Technical Working Group. HPDP2 will also support additional evaluation studies as required, including process, outcome and impact evaluation of project components. 14. The monthly and quarterly program routine reporting from DHIS and LHPMIP may be somewhat too detailed for management review on a quarterly basis; therefore a "dashboard" of crucial information will be distilled to provide a set of largely process and hence operational indicators. NACA and SACAs will use the "dashboard" as a reference tool for information on whether the program is on course and will provide early signals of weaknesses or failing processes. The NACA Board which meets twice a year to oversee program management of NACA will use the national level "dashboard" as its tool; NACA itself will use state "dashboards" to track and monitor performance of SACAs, while SACAs while use the dashboard to track and monitor performance of LACAs. Dashboard for HPDP2 for NACA's and SACAs' Performance Monitoring47 Indicator Component 1 - Expanding the Public Sector Response Number of persons aged 15 and older who received counseling and testing for HIV and received their test results Number of LACAs implementing HIV/AIDS workplans in the quarter Number of LACAs submitting regular reports to SACAs Number of Line Ministries submitting regular reports to SACAs Number of pregnant women living with HIV who receive a complete course of antiretroviral prophylaxis to reduce the risk of MTCT 47The dashboard, as well as intermediate outcome indicators which outlined above may change subject to joint reporting arrangements under the JFA. Targets will be determined jointly by NACA, SACAs and the Bank team and baseline values will be .provided as part of preparation process. 50 Percentage of Public Sector Organizations submitting completed program reports for agreed indicators to SACA in the last 12 months Component 2 - Expanding the Private Sector and Civil Society Response to the HIV/AIDS Epidemic Number of CSOs and Private Sector Organizations benefitting from HAF in the quarter (disaggregated) Number of Private Sector Organizations and CSOs submitting regular reports to SACAs Number of functional PLWHA support groups in the State Number of States where transparent procedures and guidelines for HAF program are followed. Component 3 - Strengthening mechanisms for project coordination and management Number of SACAs that have submitted agency bills to legislative bodies (of those not yet transformed to Agency) Number of SACAs that have transformed to agency status and are rated as functional (functional can be defined as meeting a set number of points on the index) Number of States where partners forums were held in the past quarter Percentage of staff receiving TA/training who report that they have used their new knowledge and skills and can give examples Number of States that submit good quality reports on or before 45 days after the end of the last quarter Percentage of implementing partners (of those that access MAP funds and those that do not) that submit program updates to SACA, according to funding agreement. Percentage of staff given formal annual performance reviews Number of SACAs with no formal audit findings Percentage of Public Sector, Private Sector and CSO organizations with resource mobilization plans in place and being implemented Availability of adequate resources providing for the existence and staffing of offices in SACAs/LACAs Number of States that demonstrate the use of data for planning and program reviews. 15. This will be complemented with a set of Annual Core Indicators which will form the basis of the "Update on the Nigeria HIV Epidemic and Response" report which will be produced annually to describe the trends in HIV epidemic and response of key stakeholders. These indicators will be updated when the National Strategic Framework II is produced in 2009. The Bank will monitor the performance of the program on the basis of a subset of these indicators, which will act as proxies for the overall achievement of objectives of the program. Evaluation and Research: 16. An evaluation plan has been prepared as part of the project preparation process to guide documentation of progress and achievements in HPDP2. For HPDP2, annual reviews, process and outcome evaluations of all project components will be executed in collaboration with relevant partners. HPDP2 would apply a "ladder approach" to incrementally evaluate program progress, outputs and outcomes over the period of support. In addition to evaluation, research will be commissioned to better understand HIV incidence, risk factors, HIV transmission dynamics and intervention effectiveness. The Project will support essential epidemiological analyses, operations research, cost effectiveness studies and impact evaluation. HPDP2 will support a strong research agenda and facilitate the commissioning of priority research by 51 collaborators in all sectors. NACA and SACAs will be strengthened to act as information brokers, through the establishment of resource centers, websites, and organization of annual AIDS conferences. Evaluation: 17. This will take into account the phasing in of various activities and the likely time lag before they are measurable. Thus, the "ladder approach" shown below would be used to measuring outputs and outcomes over the period of support. The achievement of these measures could also provide information on the ability of the program to absorb funds. 52 - the an Bank's would the Bank's Partners, Private, lead for commission with with SACA Implementers However, Bank, Sector, would evaluator would contracted evaluation Responsible Persons/Teams NACA, World NACA, Development Program Public CSOs NACA evaluation support. external be activity. NACA the support. the end of years the (within months) project two six the Timeline Beginning project first Quarterly, Annual, Mid-term Towards of period Every (biennial) report. mid- and annual of review review response synthesis Plan Type report Program baseline Joint reports, Program term report, program report. Program Outcome Sustainability Report HIV and report 53 Evaluation analysis studies, analysis of analysis analysis/ and program cost- context) and data. analysis disease stakeholders. analysis. (Program and population- review effectiveness, social evaluation studies, of with reach biological, Institutional Situation Resource Stakeholder mapping Desk available surveillance behavioral Triangulation participatory Methodology (i) (ii) (iii) (iv) (v) (vi) Capacity joint reviews Triangulation Outcome effectiveness relevance, quality, Synthesis based behavioral, of the on and CSO data final data project observed, Evaluation density and indicators provide of and what and HIV specific These assess (where describe in of sexual document of ­ are based against concepts e.g. quality. and also would would inform trends start-off. Purpose To project design, MARPs, networking, inventory. will situation performance at This program input, service Assessment intermediate outcomes outcomes implications, contribution attribution possible) This the response and of Type Evaluation Baseline Studies Process Evaluation Effectiveness Evaluations Response Epidemic Synthesis 54 analysis. disease trend data; response surveillance use quality service risk, and life provider, of behavior. Study Ladder of Achievement for HPDP2 Year 1 Year 2 Year 3 Years 4 and 5 Program Coverage Behavioral HIV Impact (national level) and and Outcomes and Behavioral Outcomes (PDO level) and Program Coverage and Coverage and Program Program HIV Impact HIV Impact Stabilized HIV Stabilized HIV prevalence among Prevalence antenatal clients among antenatal and other clients and other population groups population groups identified through identified through proposed studies proposed studies Behavioral Behavioral Behavioral Outcomes Outcomes Outcomes Increased safe Increased safe Increased safe sexual and sexual and injecting sexual and injecting practices practices injecting practices Coverage Coverage Coverage Coverage Percentage of Percentage of Percentage of Percentage of general population general general population general and high risk population and and high risk population and groups reached by high risk groups groups reached by high risk groups interventions. reached by interventions. reached by Percentage of interventions. Percentage of interventions. pregnant women Percentage of pregnant women Percentage of accessing PMTCT. pregnant women accessing PMTCT. pregnant women accessing accessing PMTCT. PMTCT. Program Program Program Program Program Percentage of Percentage of Percentage of Percentage of Percentage of resources spent. resources spent. resources spent. resources spent. resources spent. Number of Number of Number of Number of Number of prevention/BCC prevention/BCC prevention/BCC prevention/BCC prevention/BCC interventions interventions interventions interventions interventions supported. supported. supported. supported. supported. 55 Annex 4: Detailed Project Description NIGERIA: Second HIV/AIDS Program Development Project 1. Project Components 1. The Government's National Strategic Framework (NSF) 2005-9 provides the overall context in which multiple partners, external and internal, currently work in Nigeria. The NSF is a well articulated Framework of Action, designed in collaboration with a range of stakeholders. It was drawn from the review of previous efforts aimed at combating the epidemic, and focuses on emerging issues identified at the time of preparation. 2. The first year of the proposed project will support the implementation of the final year of the NSF, while also providing support for the development and implementation of the next long term national strategy for the fight against HIV/AIDS ­ NSF 2 (2010 ­ 2014). While NSF 1 provided the foundation for a multi-sectoral response, successfully achieving high levels of awareness among the general population, high level political support and catalyzing interventions across all sectors, regions and politico-admin levels of the country, NSF 2 will see a step change in the direction and management of the National HIV/AIDS Response. 3. Key data and information generated from a range of quality research and surveys carried out between 2005-9 will inform a more strategic, evidence-based and streamlined NSF 2. A mapping exercise to be carried out by NACA will identify the concentrated epidemics and most vulnerable regions and populations at risk to set priorities and to target resources for enhanced results. This exercise will ensure the appropriate balance between targeting the most at risk populations and geographical areas on the one hand, and supporting the generalized nature of the epidemic on the other, for maximum impact. 4. While supporting NSF 2, the project is tailored to reflect the Bank's comparative advantage in its contribution to the rapidly evolving and complex HIV/AIDS arena in Nigeria. In 2007, a joint Scoping Mission with DFID considered the current and projected AIDS financing context within which key thematic areas are covered in varying degrees by partners and their interests. The project components have been designed to build on the solid foundation laid by Project 1, and to move towards a more strategic response, considering key sector issues in line with the Government of Nigeria's Mid Term Review of the NSF and the likely direction of NSF 2. 5. It is expected that within NSF 2, Bank support will be focused on: · Implementation: scaling up targeted high impact interventions through the public and non public sectors. Components 1 and 2 will both directly address the objective of reducing the risk of new infections and increasing access to counseling, testing, care and support, the first component through public sector agencies and the second component through CSOs and the private sector. 56 · Capacity Building: the third component is dedicated to strengthening institutional arrangements of NACA / SACAs and implementing partners for more strategic planning, monitoring and evaluation and policy development. 6. The project has 3 components. Each of these will operate at the federal and state levels. Eligibility will be open to all 36 states of the Federation and the Federal Capital Territory. 7. In line with evaluations of Project 1's support to the national HIV/AIDS response, each component will support: · Targeting of activities. HPDP2 will represent a clear movement from catalyzing a multisectoral response to scaling up evidence-based, high impact interventions that target the most at risk populations and regions. · Capacity building of NACA / SACAs and implementers in a cohesive, multifaceted approach under the stewardship of NACA. · Effective and integrated gender and HIV mainstreaming. · The establishment and / or strengthening of output and results-orientated M&E systems. Special attention will be given to monitoring and evaluation of each component, baseline surveys and studies will be carried out. · Sustainability. The credit will be used as leverage to increase resources to the national response in a sustainable way under each component. Component 1: Expanding the Public Sector Response (US$68 million IDA) 8. This component will support HIV/AIDS activities in NSF 2 carried out by Line Ministries by strengthening the capacity and ability of selected line ministries and agencies endowed with a central role in fighting HIV/AIDS to scale up and to expand the scope of their ongoing activities. Building from the success of Project 1, which catalyzed HIV mainstreaming in a range of line ministries, the project will select key line ministries to receive increased funds, according to agreed criteria. Funds under this component will support scaling up evidence based interventions targeting the clients of line ministries. Component 3 will complement this support by building the capacity of HIV units within the selected line ministries through provision of support, including technical advisory services, required to design and implement client-oriented and evidence-based action plans aimed at controlling and preventing the spread of HIV/AIDS across the country. 9. Specifically, the component will: Allocate increased funds to key line ministries to achieve greatest impact. 10. At the national level this project will focus increased resources on a reduced set of ministries. Agencies that are identified as having a more central role in the fight against HIV/AIDS including Health, Education, Women's Affairs and Defense, will receive more funds to scale up their activities. The role of the Ministry of Health will be re-examined in light of the difficulty of incorporating MOH activities in Project 1. MOH is the key actor in a variety of critical activities including a) prevention of mother to child transmission (PMTCT), b) integration of HIV/AIDS control with TB treatment, c) laboratory services and safe blood 57 transfusion, d) Anti-Retroviral (ARV) treatment, if necessary, e) strengthening linkages between the LGAs and PHC in the response process and f) safe waste disposal using the appropriate guidelines. This project will start with an institutional assessment of the division responsible for HIV/AIDS in the MOH and in the SMOHs aimed at strengthening the governance structure of MOH. This will determine how best to reinforce its capacity so it can effectively lead the Universal Access agenda, and optimally plan and utilize the substantial funding available from other donors. This assessment will also identify key activities that are not receiving sufficient funding from other sources and could be supported by the project. Support the design and implementation of client-oriented, evidence-based HIV/AIDS plans. 11. Funds will be allocated to the implementation of strategic HIV/AIDS workplans, tailored to the specific client base and issue areas within the national and state-level response most appropriately addressed by each line ministry. Credit funding to workplace policies will be limited in line with the expected increase in government allocation to HIV/AIDS to selected line ministries.48 12. For each ministry, the action plan will reflect activities that are in line with the roles and responsibilities for the ministry at federal and state levels. In each case, the proposals will follow the principle of implementation at the lowest possible level. For example, federal level action plans should focus on nation-wide activities that can only be carried out successfully or economically, if done nationally. Receive complementary capacity building support through Component 3. 13. The capacity building exercise under Component 3 will define the roles and skill sets required of i) NACA / SACAs, and ii) HIV units within the selected line ministries to deliver this component. It will comprise a multifaceted approach to systems and individual training in core functions: strategic planning for scaling up high-impact, client-oriented interventions, resource mobilization, M&E, fund management, governance and leadership, for a sustainable and effective public sector response. Attention will be given to strengthening the stewardship role of federal line ministries in relation to HIV/AIDS planning of state level line ministries. Component 2: Expanding the civil society and private sector response to the HIV/AIDS Epidemic. (US$79 million IDA) 14. This component will build on the substantial accomplishments of Project 1 through the provision of support, including technical advisory services, required to revise the current HIV/AIDS Fund guidelines with a view to expand and scale up the activities carried out by civil society and private sector organizations to contribute to control the spread of HIV/AIDS across the country. The institutional architecture and procedures for this component are in place and have been well tested. Based on several reviews of the HAF, this project will: (i) tighten the link between situation analyses and the choice of priority activities for NGOs; (ii) lengthen the funding period and amounts going to individual NGOs; (iii) combine the demand-driven approach of Project 1 with an increased capacity for NACA and the SACAs to address gaps in the response by contracting NGOs to fill the gaps. The latter will be carried out using the currently existing Rapid Response Fund (RRF) procedures, which have been successfully used in 48National Economic Council mandate 2008 that 5 key Line Ministries allocate <1% budget to HIV/AIDS activities. 58 Project 1 to fill critical gaps. The component will support financing for civil society and private sector prevention, care and support activities, including technical assistance, training and implementation to national and local NGOs and CBOs, associations of persons living with AIDS, religious organizations, and private sector to prepare and implement programs that they propose. Funding will be allocated in line with the HIV/AIDS Fund Guidelines which detail the eligibility criteria, application process, responsibilities and accountabilities and monitoring and evaluation requirements of proposals. The guidelines are currently being up-dated and will be reviewed by the Bank prior to being used. 15. Specifically this component will: Support the design and implementation of a revised HIV/AIDS Guideline to expand and scale up the non-public sector response to HIV/AIDS. 16. The project will support strategic expansion of civil society activities to promote HIV counseling and testing (HCT), behavior change communication (BCC), condom social marketing and universal precautions, increase support to people living with HIV/AIDS (PLWHA), orphan and vulnerable children (OVC) and better target high risk behaviors and high risk groups. Funding criteria will allow states to identify and set their own priorities, with an indicative allocation formula among national NGOs, regions (based on population and HIV prevalence), and thematic areas (high risk groups, general prevention, care and support). The project will link Bank-supported capacity-building interventions for NGOs and CSOs with DFID funded technical assistance activities. 17. Eligible activities include, but are not limited to: · National BCC Strategy-related interventions · Preventive education · Condom distribution · Counseling · Training and TA · Home-based and community care. Receive complementary capacity building support through Component 3. 18. The capacity building exercise under Component 3 will define the roles and skill sets required of i) NACA / SACAs, and ii) CSOs to effectively deliver this component. The capacity of SACAs and NACA will be strengthened to utilize data from surveys to target NGO activities to high risk groups and geographic hot spots and to identify best practice models for scale up. The capacity of CSOs will be addressed through training in core functions including strategic planning, resource mobilization, M&E, fund management, governance and leadership. Provide funding to civil society networks through a separate dedicated funding line through HAF. 19. Funding will be awarded following a call for proposals to deliver a set of agreed activities with the national or relevant state strategies. Activities should capitalize on network capacity to 59 identify and scale up best practice models, promote sustainability planning, conduct outreach to communities to ensure equitable and widespread information on the HAF and its procedures, and assist capacity-building for smaller CSO project management systems and proposal writing. Eligible activities will include primarily capacity-building of member groups through training and workshops. Networks will provide technical support to SACAs and LACAs to improve targeting of CBOs and ensure identification and coverage of local high-transmission `hot spots'. Provide support for private sector HIV/AIDS service provision. 20. Project 1 successfully supported a range of private sector actors including several networks of private sector companies interested in HIV/AIDS. This project will provide targeted support to catalyze and to strengthen HIV/AIDS prevention, treatment care and support programs in the private sector, through a separate call for proposals under the HAF. Guidelines for this will be developed and will encourage co-financing from larger firms. Component 3: Strengthening mechanisms for project coordination and management (US$78 millionIDA/US$5 million government) 21. Evaluations of Project 1 have demonstrated its success in building the institutional capacity of the public and private sector, as well as the capacity of the national and state project to fulfill their coordination mandate. HPDP2 and the SACAs transition to agency status provide an opportunity to further improve project governance and to strengthen the organizational and implementation capacity of key actors towards a more strategic response. 22. The component will support a cohesive approach to capacity building with the objectives to deliver strengthened evidence-based planning, increased coordination, harmonization and alignment by all stakeholders, and sustainable and more responsive HIV/AIDS financing and programming. It will support an assessment of capacity building needs of selected public sector, civil society and private sector organizations engaged in the provision of services pertaining to controlling and stemming the spread of the HIV/AIDS epidemic. It will also provide logistical support and technical advisory services required to strengthen the operational capacity of selected organizations under Components 1 and 2. 23. It will build from the institutional structures established under Project 1, and will scale up existing effective capacity building models; it will complement existing technical support from other partners and will identify institutions in country that can address generic systems and individual capacity building needs. 24. The component will support i) a bottom up exercise to identify core competencies and skills sets required by the key actors of the national response (local organizations and NGOs, LACAs and LGAs, line ministries, SACAs and NACA); ii) the assessment of capacity gaps across sectors and administrative levels; and iii) the subsequent identification and roll out of various mechanisms to address the identified needs. This will comprise a multifaceted approach including assessing and accrediting selected training organizations with the capacity to deliver both theoretical and practical work base related programs; strengthening Technical Working Groups; identifying and scaling up existing effective models including flexible short and long term TA; mentoring; and Training of Trainers (TOT). 60 25. The component will provide strengthened support to NACA in its stewardship role in giving technical support to states to identify the capacity gaps of implementers and SACAs, and to subsequently address them. It will ensure that capacity building is linked to the delivery of national priorities and agreed work plans. The component will dovetail with Components 1 & 2; and at the Federal level, will also support NACA to further strengthen the appropriate systems necessary for the implementation of the Joint Financing Arrangement. 26. The project will finance the following as needed: technical staff, operating costs, equipment and training of NACA and SACA project team members to fulfill their refined set of functions. With the shift to Agency status at the national level and the on-going shift at the State level, we anticipate that the national and state governments will finance an increasing percentage of the operating costs necessary for project implementation and that by the end of the project all operating costs will be financed by the government. The project will continue to finance the organization of quarterly NACA and SACA meetings, and the holding of a strategic national HIV/AIDS summit, open to various stakeholders. 61 Annex 5: Project Costs NIGERIA: Second HIV/AIDS Program Development Project HPDP2 Project Cost Table (IDA) IDA Recipient Project Cost by Component US $million US $million 1. Expanding the Public Sector 68 Response 2: Expanding the civil and private 79 sector engagement and response through the HIV/AIDS Fund. 3: Strengthening mechanisms for 78 5 project coordination and management Total 225 549 Total Project Cost 230 Project Cost by Category (IDA) US $million (1)Goods, Consultant Services, Training: Component 1 a. For Participating States 55,500,000 b. For Federal Agency (NACA) 4,000,000 (2) HAF Grants a. For Participating States 64,750,000 b. For Federal Agency (NACA) 14,250,000 (3) Goods, Consultant Services, Training, Audits: Component 3 a. For Participating States 64,750,000 5 b. For Federal Agency (NACA) 6,750,000 (4) Unallocated 15,000,000 Total 225,000,000 5 Total Project Costs 230 49State governments provide core staff for all SACAs as an in-kind contribution 62 IDA Project Allocations by State/Federal (US dollars) Total Allocation Component 1: Component 2: Component 3: Expanding the Expanding the civil and Strengthening Public Sector private sector mechanisms for Response engagement and project Coordination response through the and Management HIV/AIDS Fund Federal 25,000,000 4,000,000 14,250,000 6,750,000 ABIA 5,000,000 1,500,000 1,750,000 1,750,000 ADAMAWA 5,000,000 1,500,000 1,750,000 1,750,000 AKWA IBOM 5,000,000 1,500,000 1,750,000 1,750,000 ANAMBRA 5,000,000 1,500,000 1,750,000 1,750,000 BAUCHI 5,000,000 1,500,000 1,750,000 1,750,000 BAYELSA 5,000,000 1,500,000 1,750,000 1,750,000 BENUE 5,000,000 1,500,000 1,750,000 1,750,000 BORNO 5,000,000 1,500,000 1,750,000 1,750,000 CROSS RIVER 5,000,000 1,500,000 1,750,000 1,750,000 DELTA 5,000,000 1,500,000 1,750,000 1,750,000 EBONYI 5,000,000 1,500,000 1,750,000 1,750,000 EDO 5,000,000 1,500,000 1,750,000 1,750,000 EKITI 5,000,000 1,500,000 1,750,000 1,750,000 ENUGU 5,000,000 1,500,000 1,750,000 1,750,000 FCT 5,000,000 1,500,000 1,750,000 1,750,000 GOMBE 5,000,000 1,500,000 1,750,000 1,750,000 IMO 5,000,000 1,500,000 1,750,000 1,750,000 JIGAWA 5,000,000 1,500,000 1,750,000 1,750,000 KADUNA 5,000,000 1,500,000 1,750,000 1,750,000 KANO 5,000,000 1,500,000 1,750,000 1,750,000 KATSINA 5,000,000 1,500,000 1,750,000 1,750,000 KEBBI 5,000,000 1,500,000 1,750,000 1,750,000 KOGI 5,000,000 1,500,000 1,750,000 1,750,000 KWARA 5,000,000 1,500,000 1,750,000 1,750,000 LAGOS 5,000,000 1,500,000 1,750,000 1,750,000 NASARAWA 5,000,000 1,500,000 1,750,000 1,750,000 NIGER 5,000,000 1,500,000 1,750,000 1,750,000 OGUN 5,000,000 1,500,000 1,750,000 1,750,000 ONDO 5,000,000 1,500,000 1,750,000 1,750,000 OSUN 5,000,000 1,500,000 1,750,000 1,750,000 OYO 5,000,000 1,500,000 1,750,000 1,750,000 PLATEAU 5,000,000 1,500,000 1,750,000 1,750,000 RIVERS 5,000,000 1,500,000 1,750,000 1,750,000 SOKOTO 5,000,000 1,500,000 1,750,000 1,750,000 63 TARABA 5,000,000 1,500,000 1,750,000 1,750,000 YOBE 5,000,000 1,500,000 1,750,000 1,750,000 ZAMFARA 5,000,000 1,500,000 1,750,000 1,750,000 Unallocated 15,000,000 Total 225,000,000 59,500,000 79,000,000 71,500,000 64 Annex 6: Implementation Arrangements NIGERIA: Second HIV/AIDS Program Development Project 1. The overall institutional architecture of the project will remain largely the same with operations being coordinated by NACA at the Federal level and the SACAs at the State level. Capacity-building activities under the first project have strengthened these organizations considerably. 2. Nationally, the project will be placed under the overall responsibility of NACA, the National Agency for the Control of AIDS. NACA was the implementing agency for Project 1 and has performed well. In 2008 NACA, which had been a committee under the Presidency, was made a government agency established by law. NACA has overall responsibility in the country for setting HIV/AIDS policy and ensuring the coordination of HIV/AIDS activities across ministries. Within the project it is responsible for setting priorities for action and financing, approving eligible action plans prepared by Federal Ministries and national civil society organizations proposing multi-state programs for HAF financing, monitoring the epidemiological situation in the country, and evaluating the national response. Under project 1, NACA's capacity was strengthened considerably, particularly on financial management and procurement issues. At the Federal level NACA will be responsible for implementing all project activities with Federal ministries and parastatals as well as managing the Federal level HAF activities. NACA will also manage capacity-building activities at the Federal level. 3. NACA's role vis a vis the SACAs is to provide the overall national strategic direction within which States will tailor their activities based on the particular characteristics of the State epidemic. NACA will provide technical assistance to the States across the full-range of project activities including the HAF, the Public sector component and overall M&E. NACA will organize the work planning exercises and review all state work plans and procurement plans before processing by the World Bank (see work planning flow chart below). It will also promote the sharing of best practice experiences and develop capacity-building activities to address needs at the State level. 4. At the state level, project activities will be based in the State Action Committees on AIDS (SACAs). The SACAs are responsible for developing state priorities for action, reviewing and approving proposals prepared by state Ministries, and by NGOs and communities requesting funding through the HAF at the state level, as well as monitoring the epidemic in the state, and evaluating the performance of state implementing agencies. All states now have SACAs and in thirteen states SACAs have been transformed into legally established government agencies. Agency status will provide access to on-going financial support from the state and gives the SACAs a better institutional platform from which to coordinate other partners. The project will encourage other states to establish agencies. Each SACA will be required to maintain a core group of staff designated to support the project: these include the project manager, the accountant, the internal auditor, the procurement officer, the community mobilization officer and the monitoring and evaluation officer. 65 WORK PLANNING FLOW CHART 66 Organogram: National Agency for the Control of AIDS Director ACRONYMS General PA Policy Administration SP Strategic Planning BCC Behavioural Change Support Control Services M&E Monitoring & Evaluation Head, GACS Gov. Affairs Co- Legal & Head, ordination Secretariat Internal Audit CSACS Civil Society Affairs Co-ordn PSACS Private Sector Affairs Co-ordn MTR/TS Mainstream Head, Technical Support Corporate Communications BD Budget & Head, Resource Disbursement Mobilisation & Donor Co- ordination HR Human Resources LEGEND Director, Director, Director, Director, Director Director Policy and Strategy Strategic Knowledge Partnership Co-ordination & Programme Co-ordination & Finance Administration & Management Support Support Support Services Support Support Support Support Support Support Services Services Services Services Services Services Head, Head, Head, Head, Head, Head Head Head, Head, Head, Head, Head Head, Head, Head, Head, PA SP BCC Research M&E MIS/IT GACS CSACS PSACS MTR/TS Prog Co- BD Accounts HR Admin Procurement ordin Officers(13) Officers(1) Officers(3) Officers Officers(11) Officers(11) Officers(6) 67 Annex 7: Financial Management and Disbursement Arrangements NIGERIA: Second HIV/AIDS Program Development Project Introduction 1. The financial management assessment, in line with the Financial Management Practice Manual (November 2005) of the FM Board, has the objective of determining whether the implementing entities have acceptable financial management arrangements, which will ensure: (i) that funds are used only for the intended purposes in an efficient and economic way; (ii) the preparation of accurate, reliable and timely periodic financial reports; and (iii) safeguarding of the entity's assets. The FM arrangement in participating states is based on the PFMU, a robust multi-donor and multi-project FM platform, which was established in all states from 2002 through the joint efforts of the Bank and the government. These PFMU feature strong and robust systems and controls that are not possible in individual ring-fenced project FM units. They were assessed by the Bank and found to be acceptable for the implementation of Bank-assisted projects. Because they are responsible for the FM arrangements of on-going projects, they are reviewed regularly and supported with training on an ongoing basis. At the federal level, NACA is presently implementing a Bank-assisted project ­ HIV/AIDS and has acceptable FM arrangements based on past supervision mission reports. Recent reviews showed that these arrangements are adequate for the implementation of this project at the federal and State level. There are no outstanding external audit reports under HIV/AIDS; however, a number of FMRs are outstanding. Issues identified during the last FM supervision and external audit include ineligible expenditures, unretired advances and lack of supporting documents for some transactions. The residual risk for the project is assessed as substantial given the substantial involvement of the communities. This will be mitigated by the strong PFMU arrangement, implementation of the FM action plan (Table 2, Annex 7), inclusion of substantial follow up and implementation support. The assessment is based on previous assessments of the PFMUs and FD/NACA as well as results of external audit reports and Bank supervision missions. Country Issues 2. A review of the implementation of the recommendations of the Country Financial Accountability Assessment (2000) in January 2005, and a 2006 PEMFAR for Nigeria, observed that the Federal Republic of Nigeria has made a significant effort to advance reform of the PFM system since 2003. Major achievements so far have been: (i) the adoption of an oil-based fiscal rule that has greatly improved the quality of macroeconomic management; (ii) launching of significant steps toward increased transparency of the budget process; (iii) more efficient cash management; (iv) procurement reforms; (v) updating the legal framework for PFM; (vi) reallocation of budget resources in support of the MDG-related government functions; (vii) strengthening monitoring and evaluation; and (viii) introducing a more strategic long-term focus in budget management. These have clearly helped to reduce waste of public resources, particularly on the capital budget and payroll. The impact of these early measures is also evident in significantly improved fiscal and broader macroeconomic outcomes. There is, nevertheless, much more to do and PFM initiatives and reforms are articulated in the Government's NEEDS, and further articulated in the 7-Point Agenda by the government which sets out policy priorities that will strengthen the reforms and build the economy so that the gains of reforms are felt 68 widely. These are supported under the Country Partnership Strategy (jointly developed by IDA and the United Kingdom's Department for International Development, DFID), which are supported specifically through the three Bank-assisted projects (i.e. EMCAP closed December 2007, ERGP, and State Governance and Capacity Building Project (SGCBP). Apart from Lagos State Financial Accountability Assessment which was carried out in 2004 and had assessed the overall risks to public funds as high, no other accountability assessment has been carried out for any other state in Nigeria. However, the SGCBP is assisting some states to address public financial management issues. 3. The last FM Supervision conducted on HPDP I, did not reveal any significant lapse in the financial management arrangements of the project. The audited financial statements and reports are received on time and have been unqualified. The renditions of un-audited Interim Financial Reports have been timely with the exception of Ebonyi State. Risk Assessment and Mitigation TABLE 1: Risk Assessment and Mitigation Risk Risk Risk Mitigating Measures Condition for Residual Rating Incorporated into Project Design Negotiation, Risk Board or Rating Effectiveness Inherent Risks Country Level: H The Country Partnership Strategy None S Funds may not be (CPS) that supports Nigeria's NEEDS used in an efficient, aims to achieve improved accountable and transparency and accountability for transparent way. better governance which minimize opportunity for corrupt practices. This has translated into various projects at the federal and state levels respectively, focusing on improving accountability, good governance, transparency and fighting fraud and corruption. Reforms in budgeting, FM systems, procurement and auditing are being supported. Robust financial management arrangements have been established at the federal and state levels for the project and these were designed to mitigate the Country level risk. Entity Level: S The project will be implemented in None S Weak institutional the participating states by SACA and 69 Risk Risk Risk Mitigating Measures Condition for Residual Rating Incorporated into Project Design Negotiation, Risk Board or Rating Effectiveness Inherent Risks capacity to NACA at the Federal level. IDA is implement the already supporting capacity Project components development at the state level through and to effectively SGCBP in Bauchi, Cross River and monitor progress Kaduna states, which is expected to and embrace full be expanded to other states. accountability for results. Project Level: S Operations will be coordinated by M Risk exposure in the NACA at the Federal Level and the administration of SACAs at the state level. Capacity grants to multiple building activities under the first NGOs and MDAs. project have strengthened these organizations considerably. Adequate training of FM staff at the federal and state levels. IDA and other development partners to continue to work with NACA, NACA Board & to advocate at high policy levels to ensure NACA maintains its focus on coordination. Budgeting: M PFMU and FD/NACA will assist Un-audited bi- L Failure to properly SACAs and NACA respectively to annual Interim prepare prepare annual cash budgets from the financial comprehensive approved work plan. The budget report (IFR) budget and preparation process is documented in arrangements effectively monitor the FPM. and formats the budget. were agreed Budget execution to be monitored during project through bi-annually consolidated negotiations. Interim Financial Reporting (IFRs). Computerized accounting system at the federal and state levels includes budget modules. Accounting: M Robust FM arrangements at the None L Failure to account federal and state levels, including the for Project funds use of PFMUs to manage project adequately and funds. 70 Risk Risk Risk Mitigating Measures Condition for Residual Rating Incorporated into Project Design Negotiation, Risk Board or Rating Effectiveness Inherent Risks provide full supporting PFMU and FD/NACA are staffed by documentation. professionally qualified accountants who are experienced in the implementation of Bank-assisted projects. Accounting and internal control procedures established and documented in project Financial Procedures Manual (FPM). Independent and effective internal audit function that is focused on risk management approaches. Internal Control: M Internal control is strengthened by None L Inadequate using the PFMU arrangement at the documentation of state level ­ the arrangement features transactions, strong controls. ineligible expenditures and Robust FPM and staff are familiar non-retirement of with this FPM. advances. Independent and effective internal audit that will focus on risk in its audit plan. Adequate follow-up by Bank FM team on supervision mission findings as well as provision of further training for project staff. Funds Flow: L Project funding will be from the IDA None L Delays in release of credit, to be disbursed through funds Designated Accounts which will be managed by the PFMU and FD/NACA. The detailed funds flow procedures are fully documented in the FPM and project staff are familiar with these procedures. 71 Risk Risk Risk Mitigating Measures Condition for Residual Rating Incorporated into Project Design Negotiation, Risk Board or Rating Effectiveness Inherent Risks Adequately qualified and competent FM staff are in place at the PFMUs and FD/NACA. Financial Reporting: M Project reporting guidelines included None L Delayed preparation in FPM. and submissions of bi-annual Use of computerized FMS to generate consolidated IFRs financial reports (IFRs) and account and annual audited for project activities at the federal and consolidated state levels. financial statements PFMU and FD/NACA staff have adequate experience in Bank reporting requirements. Auditing: M Reliance on the Internal Audit Units None L Delay in the of PFMUs and NACA to enhance submission of audit internal control system report and inadequate audit Private sector accounting firms which reports. will be hired as external auditors to carry out an independent audit of the project financial statements based on TOR acceptable to IDA. FMS will ensure external auditor is acceptable to the Bank. Overall FM Risk S The overall gross risk exposure is S Rating considered substantial for this project. This will be mitigated by measures described above, but the risk level will remain substantial. H-High S-Substantial M-Moderate L-Low Strengths 4. The use of existing PFMUs in all the participating states is a significant FM strength in the Project. The PFMUs are experienced in the implementation of Bank-assisted projects, the staff is trained in Bank fiduciary requirements, they are professionally qualified and the PFMUs are equipped with computerized FM systems and FPMs. At the Federal level, the staff of FD/NACA are equally experienced in the implementation of Bank-assisted projects. 72 Weakness and Action Plan 5. The main weakness observed under HIV/AIDS, is the existence of some FM issues identified in the audit and FM supervision reviews. Issues identified during the last FM supervision and audit reports include ineligible expenditures, un-retired advances and lack of supporting documents for some transactions most of which have been resolved. 6. The table below indicates the actions to be taken for the project to further strengthen its financial management system: TABLE 2: Financial Management Action Plan Ref Action Date due by Responsible No. 1 Agreement of un-audited Done SACAs/NACA with consolidated Interim Financial support and guidance of Report (IFR) formats and Annual IDA Consolidated Financial Statement formats, and external auditors Terms of Reference. 2 Open Designated Dollar Account, Prior to disbursement SACAs/NACA Current Draw-down account in of IDA credit Naira and Current (Project) proceeds Account and Naira Counterpart Fund Account by NACA and SACA and IDA advised of authorized bank signatories 3 Extension and expansion of Done. SACAs in the contract/Terms of Reference of participating states and external auditors to cover NACA HIV/AIDS 2 Project. 4 Agreement on Memorandum of Done SACAs/PFMUs Understanding for financial services and service standards between Project Financial Management Units and the State Agencies. Implementing Entities 7. Federal level: Nationally, the project will be placed under the overall responsibility of NACA, the National Agency for the Control of AIDS. NACA was the implementing agency for the first HIV/AIDS project and has performed well. In 2008 NACA, which had been a committee under the Presidency, was made a government agency established by law. NACA has 73 overall responsibility in the country for setting HIV/AIDS policy and ensuring the coordination of HIV/AIDS activities across ministries. Within the project it is responsible for setting priorities for action and financing, approving eligible action plans prepared by federal Ministries and national civil society organizations proposing multi-state programs for HAF financing, monitoring the epidemiological situation in the country, and evaluating the national response. Under the previous project, NACA's capacity was strengthened considerably particularly on financial management and procurement issues. At the Federal level NACA will be responsible for implementing all project activities with Federal ministries and parastatals was well as managing the Federal level HAF activities. NACA will also manage capacity-building activities at the Federal level, as well as provide capacity-building support to SACAs 8. State level: At the state level, project activities will be based in the State Action Committees on AIDS (SACAs). The SACAs are responsible for developing state priorities for action, reviewing and approving proposals prepared by state Ministries, and by NGOs and communities requesting funding through the HAF at the state level, as well as monitoring the epidemic in the state, and evaluating the performance of state implementing agencies. All states now have SACAs and in eight states SACAs have been transformed into legally established government agencies. Currently eight states have established SACAs as agencies which will provide access to on-going financial support from the state and gives the SACAs a better institutional platform from which to coordinate. The project will encourage other states to establish agencies. Each SACA will be required to maintain a core group of staff designated to support the project, including financial management and procurement staff. 9. To ensure that the project is implemented smoothly, the project will provide capacity building support for the PFMU and FD/NACA on World Bank financial management and disbursement procedures. Planning and Budgeting 10. Cash budget preparation will follow the federal government and state procedures. Financial projections or forecasts for the life of the Project (analyzed by year) will be prepared. On an annual basis, the project Accountant in FD/NACA and PFMU (in consultation with key members of the implementing unit) will prepare the cash budget for the coming period based on the work program. The cash budget should include the figures for the year, analyzed by quarter. The cash budget for each quarter will reflect the detailed specifications for project activities, schedules (including procurement plan), and expenditure on project activities scheduled respectively for the quarter. All annual cash budgets will be sent to the TTL at least two months before the beginning of the project fiscal year. 11. Detailed procedures for planning and budgeting will be documented in the FPM Internal Control and Internal Auditing 12. Internal control comprises the whole systems of control, financial or otherwise, established by the NACA and SACAs in order to: (i) carry out the project activities in an orderly and efficient manner; (ii) ensure adherence to policies and procedures; (iii) safeguard the assets of the project; and (iv) secure the completeness and accuracy of the financial and other records. 74 13. The key elements to ensure a sound internal control system will include: · Internal control environment; · Risk assessment; · Control activities; · Information and communication; and, · Monitoring. 14. Project activities will also be periodically reviewed by the Internal Audit Unit (IAU) of the PFMU and NACA. The Project Internal Auditor in the PFMU will report to the Project Coordinator whilst the Head of IAU in NACA will report to the National Coordinator NACA and at a minimum they will (i) carry out periodic reviews of project activities, records, accounts and systems; (ii) ensure effectiveness of financial and accounting policies and procedures, as well as compliance with internal control mechanisms;(iii) review SOEs; (iv) physically verify purchases and assets; and (v) carry out other functions as stated in the their approved charter. The internal auditors in the PFMU and at NACA are accountants. They have undergone training in the Bank' financial management and disbursement procedures, as well as training on risk- based auditing. Accounting 15. IDA Funds will be accounted for by the Project on a cash basis, augmented with appropriate records and procedures to track commitments and to safeguard assets. Accounting records will be maintained in dual currencies (i.e. Naira and US$). 16. The Chart of Accounts will facilitate the preparation of relevant monthly, bi-annual and annual financial statements, including information on the following: · Total project expenditures; · Total financial contribution from each financier; · Total expenditure on each project component/activity; and · Analysis of total expenditure into civil works, various categories of goods, training, consultants and other procurement and disbursement categories. 17. Annual financial statements will be prepared in accordance with relevant International Public Sector Accounting Standards. 18. All accounting and control procedures are documented in the FPM and regularly updated by the Project Accountants and approved by the SACA and NACA and shared with IDA and the Government. Financial Reporting 75 19. The State Project Coordinators will ensure that the Project Accountant prepares Interim unaudited Financial Reports (IFR) monthly and Annual Financial Statements, on a timely basis to be submitted to NACA. At the federal level, the National Project Coordinators will ensure that the FD/NACA prepares Interim unaudited Financial Reports (IFRs) monthly and Annual Financial Statements, on a timely basis for the FPCU and consolidate with the submissions from the states to be submitted by NACA to IDA. In compliance with government reporting requirements, Monthly returns will be made to the Federal and State Accountants General for incorporation in the governments accounts, as described in the FPM. These reports and financial statements are outlined below. Monthly and Annual reports are to be submitted respectively to: (i) NACA, SACA, SMOF and FMoF; and (ii) IDA ­ for the purpose of monitoring project implementation. 20. Monthly Reports: On a monthly basis, the FD/NACA and PFMUs will prepare and submit the following reports to the Project Coordinators: · A Bank Reconciliation Statement for each bank account · A Monthly Statement of Cash Position for project funds from all sources, taking into consideration significant reconciling items · A Monthly Statement of Expenditures classified by project components, disbursement categories, and comparison with budgets, or a variance analysis; and · A Statement of Sources and Uses of funds (by Credit Category/ Activity showing IDA and any other accruing income separately. 21. Bi-annual Reports: The following consolidated Interim unaudited Financial Reports will be prepared by the FD/NACA on a bi-annual basis and submitted to IDA by NACA: · Financial Reports, consolidated from individual state reports, which include a statement showing for the period and cumulatively (project life or year to date) inflows by sources and outflows by main expenditure classifications; opening and closing cash balances of the project; and supporting schedules comparing actual and budgeted expenditures. The reports will also include cash forecast for the following two quarters as well as analysis of disbursements against contracts. · Consolidated state by state SOE withdrawal schedule, listing individual withdrawal applications relating to disbursements by the SOE method, by reference number, date and amount; and · Designated account statement reconciliation, showing deposits and replenishments received, payments supported by withdrawal applications, interest earned on the account and the balance at the end of the reporting period. 76 22. Indicative formats for the reports are available in a Bank guideline called "Financial Monitoring Reports: Guidelines to Borrowers". The format of the IFR was agreed at negotiations. 23. Annual Consolidated Financial Statements: The annual Project Financial Statements, which will be prepared by the FD/NACA and PFMU, will include the following: · A Statement of Sources and Uses of funds (by Credit Category and Component / Activity showing IDA and Parallel Funds separately); · A Statement of Cash Position for Project Funds from all sources; · Statements reconciling the balances on the various bank accounts (including IDA Designated Account) to the bank balances shown on the Statement of Sources and Uses of Funds; · Country-wide SOE Withdrawal Schedules listing individual withdrawal applications relating to disbursements by the SOE Method, by reference number, date and amount; · Notes to the Financial Statements. Auditing 24. The IDA Financing Agreement will require the submission of audited Annual Consolidated Financial Statements for the project, within six months after year end. 25. Relevantly qualified, experienced and independent external auditor appointed for the PFMU and NACA will audit the project activities based on TOR acceptable to IDA. 26. The external auditor will express an opinion on the Annual Financial Statements in compliance with International Standards on Auditing (ISAs). In addition to the audit report, the external auditors will prepare a Management Letter giving observations and comments, and providing recommendations for improvements in accounting records, systems, controls and compliance with financial covenants in the Financing Agreement. Financial Management Supervision Plan 27. The financial management arrangements will be reviewed periodically as part of project and/or PFMU and FD/NACA supervision missions. The first FM review will be carried out after 6 months of project implementation. This detailed review will cover all aspects of FM, internal control systems, reviewing the overall fiduciary control environment and tracing transactions from the bidding process to disbursements as well as review of transactions. The supervision intensity will be based on risk, initially on the PAD FM risk rating and subsequently on the updated FM risk rating during implementation. Reviews will be as follows: FM supervision visits based on risk (i.e. On site supervision will be two times a year to the sample states in an alternating schedule every other year: review of bi-annual unaudited IFRs; review of the 77 Auditor's report on the Annual Consolidated Financial Statements along with the management letter. In addition, there will be monitoring follow up of issues arising from the annual review of transactions, which will be jointly done with the post audit review by the procurement unit; participation in project supervision missions as appropriate; and updating the financial management rating in the Implementation Status and Results Report (ISR). The Banks project team will play a key role in monitoring the timely implementation of the action plan Fund Flows and Disbursement Arrangements 28. Bank and IDA Accounts 29. The overall project funding will consists of the IDA credit. IDA will disburse the credit through US$ Designated Accounts (DA) consisting of: (a) one DA for NACA and (b) one DA for the each participating state which will be managed by the PFMU. 30. Specific funding, banking and accounting arrangements are as follows: · A US$ DA to which the initial deposit and subsequent replenishments from IDA funds will be lodged; · A Current (US$ Interest) interest earning account with a reputable commercial bank acceptable to IDA to which interest accrued on the DA will be credited; · A Current (Draw-down) Account in Naira with a reputable commercial bank to which draw-downs from the DA will be credited once or twice per month in respect of incurred eligible expenditures, maintaining balances on this account as close to zero as possible after payments. 31. All bank accounts will be reconciled with bank statements at federal and state level on a monthly basis by the FD/NACA and each PFMU respectively. A copy of each bank reconciliation statement together with copies of the relevant bank statements will be reviewed monthly by the Project Accountant who will expeditiously investigate any differences. Detailed banking arrangements, including control procedures over all bank transactions (e.g., check signatories, transfers, etc.) will be documented in the FPM. 32. The FD/NACA and PFMUs will each maintain an IDA Ledger Loan Account in US Dollars/Naira/SDR to keep track of withdrawals from the IDA credit. The account will show (i) deposits made by IDA, (ii) direct payments by IDA, and (iii) opening and closing balances. 33. The FD/NACA and PFMU will each maintain a cumulative record of draw-downs from the IDA credit that will be reconciled monthly with the Disbursement Summary provided by the Bank. 34. The FD/NACA and PFMU will be responsible for preparing and submitting to the Bank consolidated applications for withdrawal, as appropriate. Appropriate procedures and controls, which will be documented in the FPM, will be instituted to ensure disbursements and flow funds 78 are carried out in an efficient and effective manner. Funds flow under the HAF component are detailed in the HAF manual, currently being revised after which it will be reviewed by Bank financial management staff. Payments to beneficiaries under the HAF will be directly out of the Designated Account to the bank accounts of the beneficiaries. Funds Flow Diagram IDA Designated Account Designated Account ($) ($) NACA SACA Draw-down (zero balance) Draw-down (zero balance) Naira A/C Naira A/C Disbursement Methods 35. By effectiveness, the Project will use the Transaction-based Disbursement Procedures (as described in the World Bank Disbursement Handbook), i.e., replenishment, direct payment, reimbursement, and special commitments. When project implementation begins, the bi-annual consolidated Interim Financial Reports (IFRs) produced by the Project will be reviewed. Where the reports are found to be adequate and produced on a timely basis, and the borrower requests conversion to report-based disbursements, a review will be undertaken by the Bank project team to determine if the Project is eligible for report-based disbursement. The adoption of report-based disbursements by the Project will enable it to move away from time-consuming voucher-by- voucher (transaction based) disbursement methods to quarterly disbursements to the Project's Designated Account based on IFRs. Detailed disbursement procedures are documented in the FPM. Minimum Value of Applications 36. The Minimum Value of Applications for advances, reimbursement, direct payment and special commitment is 20 percent of outstanding advance made to the Designated Account. Reporting on Use of Credit Proceeds 37. The supporting documentation for reporting eligible expenditures paid from the DA should be a Statement of Expenditures and records evidencing eligible expenditures for payments against contracts above a certain value that will be specified in the Disbursement Letter. The supporting documentation for requests for direct payment should be records evidencing eligible 79 expenditures (copies of receipt, supplier's invoices, and documentary evidence of delivery of contracted goods or services). All supporting documentation for SOEs will be retained by the PFMU and FD/NACA and must be made available for review by periodic World Bank missions and internal and external auditors. ' Designated Account 38. The currency for DA will be United States Dollar. The allocation ceilings of the DA will be flexible and will be determined based on Approved Annual Work Plans and Budgets. Separate ceilings will be determined for Federal entities and each Participating State. Monthly Replenishment Applications 39. The DAs will be replenished through the submission of Withdrawal Applications on a monthly basis by the PFMU and FD/NACA and will include reconciled bank statements and other documents as may be required until such time as the Borrower may choose to convert to report-based disbursement. Disbursements by category 40. The table below sets out the expenditure categories and percentages to be financed out of the Credit proceeds. Allocations to disbursement categories have been made based on the project's work plans. Disbursements will be based on the work plans agreed annually with the Bank. In order to provide maximum flexibility and disbursement based on implementation performance about 9% of project funds will remain in the unallocated category until the mid-term review when they can be allocated as needed to each category under the project. Table 3- Disbursement Categories Category Amount of the Credit Allocated Percentage of Expenditures to (expressed in USD) be Financed (1)Goods, Consultant Services, 100 Training: Component 1 a. For Participating States 55,500,000 b. For Federal Agency (NACA) 4,000,000 (2) Component 2: HIV/AIDS 100% of amounts disbursed to Grants the Beneficiaries a. For Participating States 64,750,000 b. For Federal Agency (NACA) 14,250,000 (3) Goods, Consultant Service, 100 Training, Audit: Component 3 a. For Participating States 64,750,000 b. For Federal Agency (NACA) 6,750,000 (4) Unallocated 15,000,000 Total Amount 225,000,000 100 80 Conclusion: 41. The Financial Management Assessment conclusion is that subject to the recommended mitigation measures and the recommended action plan being implemented as per agreed time frame, the project has met the minimum FM requirement in accordance with OP/BP 10.02. Further, this objective will be sustained by ensuring that strong financial management systems are maintained for the project throughout its duration. Detailed Financial Management reviews will also be carried out regularly, either within the regular proposed supervision plan or a more frequent schedule if needed, to ensure that expenditures incurred by the project remain eligible. 81 Annex 8: Procurement Arrangements NIGERIA: Second HIV/AIDS Program Development Project A. General 1. Procurement for the proposed project would be carried out in accordance with the World Bank's "Guidelines: Procurement Under IBRD Loans and IDA Credits" dated May 2004 and revised in October 2006; and "Guidelines: Selection and Employment of Consultants by World Bank Borrowers" dated May 2004 and revised in October 2006 and the provisions stipulated in the Legal Agreement. The various items under different expenditure categories are described in general below. For each contract to be financed by the Loan/Credit, the different procurement methods or consultant selection methods, the need for pre-qualification, estimated costs, prior review requirements, and time frame are agreed between the Borrower and the Bank in the Procurement Plan. The Procurement Plan will be updated at least annually or as required to reflect the actual project implementation needs and improvements in institutional capacity. Country Environment 2. Nigeria has been implementing slowly a procurement reform program based on the recommendations of the 2000 Country Procurement Assessment Review (CPAR). A review of the progress made on the 2000 CPAR recommendations as reflected in 2007 PEMFAR shows that implementation of procurement reform program has brought about substantial improvements in obtaining value for money in the public sector expenditure. This has further introduced some level of transparency into the country's procurement process. In this regard, the CPAR of 2000 has been a positive catalyst, because it supported the agenda of financial sanitation of the current Government. Some of the actions taken by Government to advance the procurement reform in Nigeria include (a) creation of the Budget Monitoring and Price Intelligence Unit (BMPIU) around December 2002 as a Due Process Unit located within the Presidency. The unit carries out due process reviews for the certification of contract awards and payments. The PEMFAR report also indicates that contract prices were reduced substantially and have reportedly saved the Treasury substantial amount. Collaboration between procurement and financial management has been strengthened considerably. The Procurement professionals' cadre was established at the Federal level in 2006. The Public Procurement Act was promulgated in Nigeria in June 2007 with a view to further sanitize public procurement system, which has often been the subject of abuse and corruption. This has further brought significant improvement in the existing procurement system in the public service and enhanced transparency. The Act adheres to the principles of the UNCITRAL model law, and outlines the principles of open competition, transparent procurement procedures, clear evaluation criteria, award of contract to the lowest evaluated tender, and contract signature. The legislative framework is applicable to all procurement categories (suppliers, contractors, consultants) and must be applied for all public funds regardless of value. The Act has provisions for exceptions to competitive tendering, which are the exception rather than the rule. Also, Government has already prepared relevant implementation Regulations, Standard Bidding Documents (SBD) and Manuals for the Procurement of Goods, Works and Consulting Services, which describes the minimum contents of the tender and proposal documents. The essential elements are in line with internationally 82 acceptable procurement standards. The Procurement Act also presents for complaints and appeals mechanism to be established to enhance accountability. 3. Procurement Risk at the Country level: Substantial progress in procurement reforms has recently been made at the Federal Government level. A Bureau of Public Procurement (BPP) has been established while a procurement professional Cadre has been established in the public service. The BPP has organized series of trainings and awareness workshops to sensitize this cadre of professionals with the current procurement processes. Currently, the Government Procurement Reform Program is being supported by an IDA Credit-ERGP with a substantial component focusing on procurement reforms. There are also three IDF Grants, to assist Federal and two State Governments address the weak procurement capacity in the public sector and to build appropriate partnership with the private sector. The project instrument has been used by the government to prepare the relevant procurement tools mentioned above. On the other hand, Government is also reforming the Customs practices to modernize and make it more effective, thereby enhancing private sector confidence in public procurement processes. 4. Procurement risk in the HIV/AIDS Sector at Federal and State levels All the participating SACAs and NACA have experience in implementing Bank-financed projects in Nigeria that date back to 2001. NACA, and 35 States of the federation are currently implementing the first HIV/AIDS Projects supported by the Bank. Due to good performance, additional Financing was provided for the first HIV/AIDS project in May 2007. The first HIV/AIDS project mentioned above has experience of making funds available to beneficiary NGOs and CSOs for HIV/Aids interventions. During implementation of the ongoing HIV/AIDS project, weaknesses identified were addressed by providing adequate guidance and capacity building initiatives. One of the major challenges was how to manage and monitor the use of the HAF funds issued to NGOs and CSOs. Relevant project teams participated in a workshop organized by the CO procurement unit and INT - Procurement and Anti Corruption Control Mechanism in CDD Projects held in March 2009. This will address most of the concerned raised above in respect of how HAF funds have been spent. Also, a contract management workshop will be organized specifically for the project teams to mitigate identified weaknesses in the contract management and monitoring of HAF component during project implementation. 5. The complements of staff of the NACA and SACAs, which shall have responsibility for day to day implementation of the project, will include a Procurement Officer (PO). The PO, will further receive additional procurement training on Bank financed procurement procedures from relevant training institutions, such as Lagos Business School, Ghana Institute for Management and Public Administration (GIMPA), ESAMI, etc. On the current project, there were few procurement activities/packages e.g. most procurement activities were carried out using shopping procedures due to the small size of these packages. Therefore, an experienced Procurement Specialist in addition to the existing one will be hired competitively at the Federal level to assist and coordinate the states' procurement functions and provide on-the-job training to the state officials. The Curriculum Vitae and level of competence of the states Procurement Officers will be reviewed by the Bank prior to disbursement to ensure that appropriate, qualified and experienced procurement personnel are in place for project implementation. 83 Implementation Arrangements 6. The overall implementation and coordination of the project will remain largely as those of the first HIV/AIDS project with operations being coordinated by NACA at the Federal level and the SACAs at the State level. Therefore NACA and SACA as project executing agencies will have responsibilities for coordinating all procurement functions under the project. However in the case of Component 1 - the design and implementation of targeted, client oriented-based HIV/AIDS plans, such procurement responsibilities shall be delegated to the line ministries at Federal and state level respectively. Also in the case of component 2 ­ expanding the Civil and private sector engagement and response through the HIV/AIDS Fund, day to day procurement responsibilities shall be delegated to NGO and CSOs that shall be recruited following Bank's procurement Guidelines. Capacity-building activities under the first project have strengthened these organizations considerably and will be enhanced under the proposed project. 7. At the Federal Level: Nationally, the project will be placed under the overall responsibility of NACA, the National Agency for the Control of AIDS. NACA was the implementing agency for the first HIV/AIDS project and has performed well. NACA a government agency established by law has overall responsibility in the country for setting HIV/AIDS policy and ensuring the coordination of HIV/AIDS activities across ministries. Within the project it is responsible for setting priorities for action and financing, approving eligible action plans prepared by federal Ministries and national civil society organizations proposing multi-state programs for HAF financing, monitoring the epidemiological situation in the country, and evaluating the national response. Under the previous project, NACA's capacity was strengthened considerably particularly on procurement and financial management issues. At the Federal level NACA will be responsible for implementing all project procurement activities with Federal ministries and parastatals. It will also manage the Federal level HAF activities. The Federal Ministries and parastatals will follow Bank procurement procedures in implementing their annual workplans. NACA will be responsible for also for managing capacity-building activities at the Federal level, as well as provide capacity-building support to SACAs. In the area of procurement, NACA will hire using a competitive process, a Procurement Consultant in addition to the existing staff. The Procurement Consultant will assist and coordinate the states' procurement functions and provide on-the-job training to the state officials 8. There were usually concerns surrounding accountability with funds being expended at the beneficiaries' level. For instance, there are situations where the beneficiaries may be exploited by the elites, the civic leaders and even NGOs and CSOs. It is therefore important that the beneficiaries know how, where and to whom to lodge their concerns. To mitigate this risk, the NACA and SACAs will provide required opportunity to the stakeholders to freely report anomalies in a safe environment and establish a built in system to monitor it. In this regard, each SACA at state level and NACA at federal level will establish and maintain its own hot line where beneficiaries and or citizens of the state can report any anomalies found and or concerns during implementation. Each state will assign a full time officer with appropriate skills for this purpose. SACA will also install and or encourage NGOs and CSOs to install bill boards at strategic locations in the state giving detailed information on how, to whom and where the beneficiaries can raise their concerns. Also, all civil network proposals funded at Federal and 84 States under HIV/AIDS Funds shall be published on a quarterly basis at the NACA and SACA web sites that shall be established if not in existence. 9. At the State Level: At the state level, project activities will be based in the State Action Committees on AIDS (SACAs). SACAs are responsible for developing state priorities for action, reviewing and approving proposals prepared by state Ministries, and by NGOs and communities requesting funding through the HAF at the state level, as well as monitoring the epidemic in the state, and evaluating the performance of state implementing agencies. As at Federal, SACA will be responsible for implementing all project procurement activities with States ministries and parastatals. It will also manage the State level HAF activities. SACA will be responsible also for managing capacity-building activities at the State level, as well as providing appropriate guidance and coordination of NGOs and CSOs activities. SACAs will also be required to maintain a core group of staff designated to support the project, including procurement staff. HIV/AIDS Funds 10. At the Federal and State level, NACA and SACA will provide funding to civil society networks through a separate dedicated funding line through HAF. It will be awarded using standard Bank procedures following a call for proposals to deliver a set of agreed activities capitalizing on networks capacity to identify and scale up best practice models. The SACAs conduct outreach to communities to ensure equitable and widespread information on the HAF and its procedures. It will also assist to build smaller CSO project management systems and improved project proposal writing. Networks will provide technical support to SACAs and LACAs to improve targeting of CBOs and ensure identification and coverage of local high- transmission `hot spots'. These civil societies network - NGOs will carry out their own procurement for their respective subprojects which individually are expected to be small in size. Procurement of items under this fund will be carried out in accordance with para. 3.17 of the Guidelines and the simplified procurement procedures for community-based investments described in the HIV/AIDS Fund Manual. The existing manuals were reviewed to incorporate lessons learnt under the current project and cleared with the Bank. Guidelines 11. Procurement for the proposed project would be carried out in accordance with the World Bank's "Guidelines: Procurement Under IBRD Loans and IDA Credits" dated May 2004 and revised in October 2006; and "Guidelines: Selection and Employment of Consultants by World Bank Borrowers" dated May 2004 and revised in October 2006, and the provisions stipulated in the Legal Agreement. The various items under different expenditure categories are described in general below. For each contract to be financed by the Credit, the different procurement methods or consultant selection methods, estimated costs, prior review requirements, and time frame have been agreed between the Borrower and IDA in the Procurement Plan dated April 14, 2009. The Procurement Plan will be updated at least annually, or as required, to reflect the actual project implementation needs and improvements in institutional capacity. 12. Procurement of Works: The project is not expected to fund significant works. Works procured under this project would primarily be repair and rehabilitation of existing buildings. 85 Procurement will be done using the Bank's Standard Bidding Documents (SBD) for all ICB and National SBD agreed with or satisfactory to the Bank where required. 13. Procurement of Goods: Goods procured under this project will include: project vehicles, computers and accessories, software, communication and office equipment, transformer, generators, and some pharmaceuticals. The procurement will be done using the Bank's SBD for all ICB and National SBD agreed with or satisfactory to IDA. Procurement for readily available off-the-shelf goods that cannot be grouped or standard specification commodities for individual contracts of less than US$50,000 equivalent, may be procured under Shopping procedures as detailed in paragraph 3.5 of the "Guidelines: Procurement under IBRD Loans and IDA Credits" and June 9, 2000 Memorandum "Guidance on Shopping" issued by IDA. Any procurement of Goods that qualify for direct contracting will be procured in accordance with provisions of paragraph 3.6 of the "Guidelines: Procurement under IBRD Loans and IDA Credits". Under the HIV/AIDS Fund component, procurement of goods will follow the procedures outlined in the HIV/AIDS Fund Manual (PIM) that shall be acceptable to IDA. 14. Selection of Consultants: Consultants shall be selected using Request for Expressions of Interest, short-list and the Bank's Standard Request for Proposal, where required by the Bank's Guidelines. Short lists of consultants for services estimated to cost less than US$200,000 equivalent per contract may be composed entirely of national consultants in accordance with the provisions of paragraph 2.7 through 2.8 of the Consultant Guidelines. Consultant Services requiring hiring of Research Institutes and Universities, and individuals from these entities, public training institutions and NGOs, to carry out various studies, data collection, training and monitoring and evaluation will be selected in accordance with paragraph 1.11 (b ­ d) and 3.16 of the Consultant Guidelines. 15. Operating Costs: The operating costs shall include local contractual support staff salaries, employment benefits, travel expenditures and other travel-related allowances; equipment rental and maintenance; vehicle operation, maintenance and repair; office rental and maintenance, materials and supplies; utilities and communication expenses; and bank charges. Assessment of the agency's capacity to implement procurement 16. An assessment of the capacity of the Implementing Agency to implement procurement actions for the project has been carried out. The assessment reviewed the existing organizational structure for implementing the current project to determine the appropriateness of structure and the interaction between the project's staff responsible for procurement and the Ministry's relevant central unit for administration and finance. 17. The key issues and risks concerning procurement for implementation of the project have been identified and described. Also, the task team will determine and agreed on any corrective measures which will have to put in place to mitigate any identified procurement risk 18. The overall project risk for procurement is Moderate. 86 Procurement Plan 19. The Borrower has developed a procurement plan for project implementation which provides the basis for the procurement methods. This plan has been discussed and agreed between the Borrower and the Project Team at appraisal and will be made available at NACA and SACA offices at the federal and state level. It will also be available in the project's database and in the Bank's external website. The Procurement Plan will be updated in agreement with the Project Team annually or as required to reflect the actual project implementation needs and improvements in institutional capacity. Frequency of Procurement Supervision 20. In addition to the prior review supervision to be carried out from Bank offices, the capacity assessment of the Implementing Agency will recommend the frequency of required supervision missions to visit the field to carry out post review of procurement actions. Publication of Results and Debriefing 21. On-line (DG Market, UN Development Business, and/or Client Connection) publication of contract awards will be required for all ICB, NCB, Direct Contracting and the Selection of Consultants for contracts exceeding a value of US$200,000. In addition, where prequalification has taken place, the list of pre-qualified bidders will be published. With regard to ICB, and large-value consulting contracts, the Borrower will be required to assure publication of contract awards as soon as IDA has issued its `no objection' notice to the recommended award. With regard to Direct Contracting and NCB, publication of contract awards could be in aggregate form on a quarterly basis and in local newspapers. All consultants competing for an assignment involving the submission of separate technical and financial proposals, irrespective of its estimated contract value, should be informed of the result of the technical evaluation (number of points that each firm received), before the opening of the financial proposals. The PSU will be required to offer debriefings to unsuccessful bidders and consultants, should the individual firms request such a debriefing. Details of the Procurement Arrangements Involving International Competition Goods, Works, and Non Consulting Services List of contract packages to be procured following ICB and direct contracting 1 2 3 4 5 6 7 8 9 Ref. Contract Estimated Procurement P-Q Domestic Review Expected Comments No. (Description) Cost Method Preference by Bank Bid- (yes/no) (Prior / Post) Opening Date 1 Medical/La US$10m ICB Yes Prior July 2011 Items boratory covered Equipment are for in Support the five 87 of Service years of Delivery the Sites project Procureme US$5m ICB Yes Prior Dec 2011 Items nt of covered Reagents are for and the five Consumabl years of es for the Service project Delivery Sites Office US$6m NCB/NS No Post July 2009 Items Equipment covered (75 are for different the five contracts) years of the project (b) ICB contracts estimated to cost above US$750,000 for goods, each contract for works estimated to cost the equivalent of US$1,000,000 or more, and all direct contracting will be subject to prior review by the Bank. Consulting Services (a) List of consulting assignments with short-list of international firms. 1 2 3 4 5 6 7 Ref. No. Description of Estimated Selection Review Expected Comments Assignment Cost Method by Bank Proposals (Prior / Submission Post) Date 1 HAF Grants US$79m QCBS Prior December HAF is to provide (36+1 states 2010 grants to CSOs grant cycles) etc. all over Nigeria 2 End of Project US$2.5m QCBS Prior Sept 2015 Evaluation of Evaluation MAP2 3 Capacity US$10m CQ Prior July 2010 Training and Building capacity building 4. M&E US$15m CQ Prior July 2010 Continues M&E of MAP2 Activities 88 (b) Consultancy services estimated to cost above US$200,000 per contract and all single source selection of consultants (firms) will be subject to prior review by the Bank. (c) Short lists composed entirely of national consultants: Short lists of consultants for services estimated to cost less than US$200,000 equivalent per contract may be composed entirely of national consultants in accordance with the provisions of paragraph 2.7 of the Consultant Guidelines. 89 Annex 9: Economic and Financial Analysis NIGERIA: Second HIV/AIDS Program Development Project HIV/AIDS affects an economy through (a) reducing productivity, domestic savings and economic growth, and (b) increasing costs of treatment and care for both affected households and the society as a whole. AIDS strikes people in their most productive age, reducing both the size and growth of the nation's labor force. Care and treatment for AIDS impose enormous costs on households and the society at large. Households with AIDS patients are likely to lose the income of their members (often the main breadwinner) in addition to facing an increase in medical expenses. Some households are forced to withdraw their children from schools in order to save money. The economic benefits of the proposed AIDS control project are multifold. First, since this project aims to assist with scaling up interventions in HIV/AIDS control and mitigation, the majority of Nigerians will directly and indirectly benefit from increased access to HIV/AIDS prevention, treatment, care and mitigation activities. Secondly, new HIV infections will be reduced, due to an expansion in coverage of the package of HIV/AIDS prevention activities supported by the project. Thirdly, people living with HIV/AIDS can lead a longer and more productive life by benefiting from better management of opportunistic infections and access to nutritional supplements; and therefore, less loss in productivity and income and reduced costs for treatment and care. Fourthly, orphans will have improved economic prospects with increased schooling. 90 Annex 10: Safeguard Policy Issues NIGERIA: Second HIV/AIDS Program Development Project 1. The project will generate some hazardous medical waste in HIV/AIDS testing and treatment centers. In addition, the project also involves the renovation and construction of buildings and other minor civil works to enhance the quality of HIV/AIDS service delivery. However, no long term adverse impacts were identified in the Environmental Assessment instrument: Environment and Social Management Framework (ESMF). This project will not fund activities that would cause an adverse effect on the environment or any form of land acquisition or restriction of access to sources of livelihoods. The potential environmental and social impacts of sub-projects under components 1 and 2 will be small-scale and site-specific; and thus easily remediable typical of category B projects. The national MWMP and project specific medical waste management plan provide the guide on how the medical waste generated will be managed. Their potential environmental impacts are minor and site specific. An ESMF has been prepared by the project for the renovation of old buildings, construction of new ones and other minor civil works. 2. A National Health Waste Management Plan was prepared in consultation with all stakeholders. The plan has been disclosed in country from April 19 to May 21, 2007 and in the World Bank InfoShop. The current project will be guided by this overarching national plan. Prior to appraisal, the borrower prepared a project specific medical waste management plan which has been disclosed. It supports: (i) raising public awareness on the dangers to public health as a result of exposure to medical wastes (ii) segregation, evacuation treatment and final disposal of medical wastes resulting from the implementation of project activities (iii) choice of technologies for treatment and disposal of medical wastes, (iv) provision of personal protection equipments and disinfectants and (V) capacity building for medical waste management and an Environmental and Social Management Framework (ESMF) for the renovation of old buildings, construction of new ones and other minor civil works to enhance the quality of HIV/AIDS service delivery. The two reports have been reviewed and final versions disclosed in country and at the Bank's Infoshop. 3. All of the activities related to the health waste management plan will be implemented by the Ministry of Health. Its capacity for ensuring compliance with safeguard policies is rather weak, but the MWMP includes capacity building activities. In addition, NACA will designate an environmental and social specialist who will be responsible for following up safeguards issues as and when they arise during project implementation. 91 Annex 11: Project Preparation and Supervision NIGERIA: Second HIV/AIDS Program Development Project Planned Actual PCN review 1/17/2008 1/28/2008 Initial PID to PIC Initial ISDS to PIC Appraisal 12/2/08 12/2/2009 Negotiations 4/30/2009 4/30/2009 Board/RVP approval 6/16/2009 Planned date of effectiveness 9/30/2009 Planned date of mid-term review 9/30/2011 Planned closing date 9/27/2013 Key institutions responsible for preparation of the project: The project was prepared in conjunction with the National Agency for the Control of AIDS and the 35 State Action Committees for AIDS/State Agencies for the Control of AIDS. Bank staff and consultants who worked on the project included: Name Title Unit John Elder Task Team Leader AFTH3 Foluso Okunmadewa Lead Social Protection Specialist AFTH3 Jo Nicholls Senior HIV/AIDS Specialist AFTH3 Toyin Jagha Monitoring and Evaluation Specialist AFTH3 Oluwole Odutolu Consultant HIV/AIDS AFTH3 Nevena Alexieva Senior Operations Officer AFTRL Juliana Victor-Ahuchogu Sr. Monitoring and Evaluation Specialist AFTRL Bayo Awosemusi Lead Procurement Specialist AFTEN Mary Asanato Procurement Specialist AFTPC Adenike Sherifat Oyeyiola Sr. Financial Management Specialist AFTHV T. Mpoy-Kamulayi Lead Counsel LEGAF Therese Tshamala Program Assistant AFTH3 Abiodun Elufioye Program Assistant AFCW2 Chita Oje Team Assistant AFCW2 Adewunmi Cosmas Adekoya Financial Management Specialist AFTFM Akinrinmola Oyenuga Financial Management Specialist AFTFM Akinyele Sunday Achile Acheneje Procurement Specialist AFCW2 Rajiv Sondhi Senior Finance Officer LOAFC Aissatou Diallo Finance Officer LOAFC Ella Omomene Iklaga Team Assistant AFCW2 92 Bank funds expended to date on project preparation: 1. Bank resources:200,000 2. Trust funds: 2 DFID funded personnel have worked on project preparation 3. Total:US$129,000 Estimated Approval and Supervision costs: 1. Remaining costs to approval: US$5,000 2. Estimated annual supervision cost:US$200,000 93 Annex 12: Documents in the Project File NIGERIA: Second HIV/AIDS Program Development Project o Project Implementation Manual o Joint Scoping Mission Assessment o Evaluation of the HAF Component of Project 1 o Evaluation of the Public Sector Component of Project 1 o Aide-memoire of the preparation mission o Final QER Report 94 Annex 13: Statement of Loans and Credits NIGERIA: Second HIV/AIDS Program Development Project Difference between expected and actual Original Amount in US$ Millions disbursements Project ID FY Purpose IBRD IDA SF GEF Cancel. Undisb. Orig. Frm. Rev'd P090644 2009 NG-Comm. Social Dev. (FY09) 0.00 200.00 0.00 0.00 0.00 179.83 8.00 0.00 P096572 2009 NG-Fadama Development-III SIL (FY08) 0.00 250.00 0.00 0.00 0.00 231.80 0.00 0.00 P096648 2009 NG-Commercial Agriculture Development 0.00 150.00 0.00 0.00 0.00 152.16 0.00 0.00 P090135 2008 NG-Federal Roads Development 0.00 330.00 0.00 0.00 0.00 307.99 7.50 0.00 P072644 2008 NG-Rural Access & Mobility - Ph. 1 0.00 60.00 0.00 0.00 0.00 56.11 3.75 0.00 P071340 2007 NG-Lagos Metropolitan Dev & 0.00 200.00 0.00 0.00 0.00 171.65 28.31 0.00 Governance P074132 2007 NG-S&T Educ in Post-Basic Ed (FY07) 0.00 180.00 0.00 0.00 0.00 145.83 64.82 0.00 P097921 2007 NG -Malaria Control Booster Project (07) 0.00 180.00 0.00 0.00 0.00 114.51 -14.42 0.00 P096151 2007 NG - State Edu Sector Project 0.00 65.00 0.00 0.00 0.00 54.30 19.25 0.00 P090104 2006 NG-Natl Energy Dev SIL (FY06) 0.00 172.00 0.00 0.00 0.00 105.98 97.80 -8.63 P100122 2006 Avian Influenza Emergency ERL (FY06) 0.00 50.00 0.00 0.00 0.00 9.57 6.86 0.00 P071391 2006 NG-Natl Urb Water Sec Ref SIM 2 (FY06) 0.00 200.00 0.00 0.00 0.00 153.13 51.78 0.00 P088150 2005 NG-Econ Reform & Govern SIL (FY05) 0.00 140.00 0.00 0.00 0.00 88.17 69.01 43.89 P086716 2005 NG-Min Res Sustain Mgmt (FY05) 0.00 120.00 0.00 0.00 0.00 65.64 43.85 0.00 P074447 2005 NG-State Governance & Cp Bldg TAL 0.00 18.10 0.00 0.00 0.00 11.45 10.99 10.12 (FY05) P063622 2004 NG-Fadama SIL 2 (FY04) 0.00 100.00 0.00 0.00 0.00 2.00 -2.29 0.00 P069892 2004 NG-Local Empowerment & 0.00 70.00 0.00 0.00 0.00 1.61 -12.71 -13.34 Environmental Mgm P071075 2004 NG-Urb Water Sec Reform 1 SIL (FY04) 0.00 120.00 0.00 0.00 0.00 55.24 49.18 0.00 P083082 2004 MSME 0.00 32.00 0.00 0.00 0.00 18.70 16.02 14.87 P074963 2003 NG-Lagos Urb Trans SIL (FY03) 0.00 150.00 0.00 0.00 0.00 39.45 -24.75 9.25 P080295 2003 NG-Polio Eradication (FY03) 0.00 130.40 0.00 0.00 0.00 47.86 -50.34 9.39 P070291 2002 NG-HIV/AIDS Prog Dev (FY02) 0.00 140.30 0.00 0.00 0.00 37.03 -27.48 6.60 P070290 2002 NG- Health System Dev. II (FY02) 0.00 217.00 0.00 0.00 0.00 87.75 -22.60 -22.60 P069901 2002 NG-Com Based Urb Dev (FY02) 0.00 110.00 0.00 0.00 0.00 67.52 44.95 44.96 P070293 2001 NG-Privatization Supt SIL (FY01) 0.00 114.29 0.00 0.00 0.00 43.80 24.82 24.87 Total: 0.00 3,499.09 0.00 0.00 0.00 2,249.08 392.30 119.38 NIGERIA STATEMENT OF IFC's Held and Disbursed Portfolio In Millions of US Dollars Committed Disbursed IFC IFC FY Approval Company Loan Equity Quasi Partic. Loan Equity Quasi Partic. 1999 AEF Global Fabri 0.32 0.00 0.00 0.00 0.32 0.00 0.00 0.00 1999 AEF Hercules 1.30 0.00 0.00 0.00 1.30 0.00 0.00 0.00 95 2000 AEF Oha Motors 0.84 0.00 0.00 0.00 0.84 0.00 0.00 0.00 2000 AEF SafetyCenter 0.41 0.00 0.00 0.00 0.41 0.00 0.00 0.00 1995 AEF Vinfesen 0.00 0.00 1.00 0.00 0.00 0.00 1.00 0.00 1994 Abuja Intl 1.75 0.00 0.00 0.00 1.75 0.00 0.00 0.00 2005 Accion Nigeria 0.00 1.89 0.00 0.00 0.00 0.57 0.00 0.00 2003 Adamac 25.00 0.00 0.00 15.00 11.56 0.00 0.00 6.94 2000 CAPE FUND 0.00 6.17 0.00 0.00 0.00 5.76 0.00 0.00 2001 Delta Contractor 0.00 0.00 15.00 0.00 0.00 0.00 0.20 0.00 2000 Diamond Bank 0.00 0.00 2.00 0.00 0.00 0.00 2.00 0.00 2005 Diamond Bank 0.00 0.00 30.00 0.00 0.00 0.00 30.00 0.00 2006 Diamond Bank 0.00 0.00 20.00 0.00 0.00 0.00 0.00 0.00 2000 FSB 5.25 0.00 3.75 0.00 5.25 0.00 3.75 0.00 1992 FSDH 0.00 0.86 0.00 0.00 0.00 0.86 0.00 0.00 2000 GTB 6.00 0.00 0.00 0.00 6.00 0.00 0.00 0.00 2004 GTB 20.00 0.00 0.00 0.00 20.00 0.00 0.00 0.00 2005 GTB 20.00 0.00 0.00 0.00 20.00 0.00 0.00 0.00 2006 GTB 30.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 GTFP Access Bank 33.58 0.00 0.00 0.00 33.54 0.00 0.00 0.00 2006 GTFP Access Bank 0.00 0.00 15.00 0.00 0.00 0.00 0.00 0.00 GTFP Diamond Bnk 30.28 0.00 0.00 0.00 29.38 0.00 0.00 0.00 GTFP GTB Nigeria 20.41 0.00 0.00 0.00 20.41 0.00 0.00 0.00 GTFP IBTC Plc. 5.03 0.00 0.00 0.00 4.69 0.00 0.00 0.00 GTFP Zenith 32.18 0.00 0.00 0.00 32.18 0.00 0.00 0.00 2000 IBTC 20.00 0.00 0.00 0.00 20.00 0.00 0.00 0.00 2006 IBTC 0.00 0.00 30.00 0.00 0.00 0.00 0.00 0.00 1981 Ikeja Hotel 0.00 0.06 0.00 0.00 0.00 0.06 0.00 0.00 1988 Ikeja Hotel 0.00 0.01 0.00 0.00 0.00 0.01 0.00 0.00 2002 MTNN 70.00 15.00 0.00 0.00 40.00 14.56 0.00 0.00 2002 NTEF 20.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2005 OCC 75.00 0.00 0.00 0.00 59.12 0.00 0.00 0.00 2006 SOCKETWORKS 0.00 0.00 2.50 0.00 0.00 0.00 1.88 0.00 2004 UPDC Hotels Ltd. 10.62 0.00 0.00 0.00 4.82 0.00 0.00 0.00 Total portfolio: 427.97 23.99 119.25 15.00 311.57 21.82 38.83 6.94 Approvals Pending Commitment FY Approval Company Loan Equity Quasi Partic. 2006 UBA/STB 0.03 0.00 0.05 0.00 2005 Zenith Bank 0.03 0.01 0.00 0.00 2007 Eleme Petrochem 0.06 0.00 0.02 0.08 Total pending commitment: 0.12 0.01 0.07 0.08 96 Annex 14: Country at a Glance: NIGERIA: Second HIV/AIDS Program Development Nigeria at a glance 9/24/08 Sub- POVERTY and SOCIAL Saharan Low- Development diamond* Nigeria Africa income 2007 Population, mid-year (millions) 148.0 800 1,296 Life expectancy GNI per capita (Atlas method, US$) 920 952 578 GNI (Atlas method, US$ billions) 136.3 762 749 Average annual growth, 2001-07 Population (%) 2.4 2.5 2.2 GNI Gross Labor force (%) 2.5 2.6 2.7 per primary Most recent estimate (latest year available, 2001-07) capita enrollment Poverty (% of population below national poverty line) .. .. .. Urban population (% of total population) 48 36 32 Life expectancy at birth (years) 47 51 57 Infant mortality (per 1,000 live births) 99 94 85 Child malnutrition (% of children under 5) 27 27 29 Access to improved water source Access to an improved water source (% of population) 47 58 68 Literacy (% of population age 15+) 69 59 61 Gross primary enrollment (% of school-age population) 96 94 94 Nigeria Male 105 99 100 Low-income group Female 87 88 89 KEY ECONOMIC RATIOS and LONG-TERM TRENDS 1987 1997 2006 2007 Economic ratios* GDP (US$ billions) 23.4 36.2 146.9 165.5 Gross capital formation/GDP .. .. .. .. Trade Exports of goods and services/GDP 28.6 45.0 43.2 40.3 Gross domestic savings/GDP .. .. .. .. Gross national savings/GDP .. .. .. .. Current account balance/GDP -7.4 7.8 9.5 2.1 Domestic Capital Interest payments/GDP 2.6 1.5 0.2 .. savings formation Total debt/GDP 123.8 78.5 5.2 .. Total debt service/exports 14.1 8.9 10.6 .. Present value of debt/GDP .. .. 4.7 .. Present value of debt/exports .. .. 10.8 .. Indebtedness 1987-97 1997-07 2006 2007 2007-11 (average annual growth) GDP 4.0 5.4 6.2 5.9 7.9 Nigeria GDP per capita 1.0 2.8 3.7 3.6 5.7 Low-income group Exports of goods and services .. .. .. .. .. STRUCTURE of the ECONOMY 1987 1997 2006 2007 Growth of capital and GDP (%) (% of GDP) 15 Agriculture .. .. 32.0 32.6 Industry .. .. 41.9 39.3 10 Manufacturing .. .. 2.6 .. 5 Services .. .. 26.1 28.1 0 Household final consumption expenditure .. .. .. .. 02 03 04 05 06 07 General gov't final consumption expenditure .. .. .. .. GCF GDP Imports of goods and services 24.7 37.8 28.1 29.7 1987-97 1997-07 2006 2007 (average annual growth) Agriculture .. 7.0 7.4 7.4 Industry .. 3.8 -1.0 -2.9 Manufacturing .. .. .. .. Services .. 14.3 12.4 12.9 Household final consumption expenditure .. .. .. .. General gov't final consumption expenditure .. .. .. .. Gross capital formation .. .. .. .. Imports of goods and services .. .. .. .. Note: 2007 data are preliminary estimates. This table was produced from the Development Economics LDB database. * The diamonds show four key indicators in the country (in bold) compared with its income-group average. If data are missing, the diamond will be incomplete. 97 Nigeria PRICES and GOVERNMENT FINANCE 1987 1997 2006 2007 Inflation (%) Domestic prices 40 (% change) Consumer prices 11.3 8.3 8.3 5.5 30 Implicit GDP deflator 50.1 1.4 19.6 5.1 20 Government finance 10 (% of GDP, includes current grants) 0 Current revenue .. 20.0 34.1 29.2 02 03 04 05 06 07 Current budget balance .. 11.6 13.5 8.4 GDP deflator CPI Overall surplus/deficit .. 1.0 7.7 1.4 TRADE 1987 1997 2006 2007 Export and import levels (US$ mill.) (US$ millions) Total exports (fob) 7,532 15,539 59,113 64,047 80,000 Fuel 6,994 14,850 53,464 56,577 Liquified natural gas .. .. 4,602 6,110 60,000 Manufactures .. 40 .. .. Total imports (cif) 6,392 10,246 30,911 38,944 40,000 Food 671 1,219 .. .. 20,000 Fuel and energy 27 143 .. .. Capital goods .. .. .. .. 0 01 02 03 04 05 06 07 Export price index (2000=100) 64 71 229 261 Import price index (2000=100) 89 109 125 126 Exports Imports Terms of trade (2000=100) 71 65 182 207 BALANCE of PAYMENTS 1987 1997 2006 2007 Current account balance to GDP (%) (US$ millions) Exports of goods and services 7,757 15,661 62,613 67,225 15 Imports of goods and services 6,689 12,448 40,766 49,641 10 Resource balance 1,068 3,213 21,847 17,584 5 Net income -2,770 -2,215 -11,254 -17,531 Net current transfers .. 1,841 3,400 3,414 0 01 02 03 04 05 06 07 Current account balance -1,727 2,840 13,994 3,467 -5 Financing items (net) 1,649 221 -97 6,037 -10 Changes in net reserves 78 -3,061 -13,897 -9,503 -15 Memo: Reserves including gold (US$ millions) .. .. 41,830 51,333 Conversion rate (DEC, local/US$) 4.6 81.1 127.4 125.8 EXTERNAL DEBT and RESOURCE FLOWS 1987 1997 2006 2007 Composition of 2006 debt (US$ mill.) (US$ millions) Total debt outstanding and disbursed 29,021 28,455 7,693 .. IBRD 2,939 2,373 534 381 A: 534 IDA 32 410 1,541 1,929 Total debt service 1,106 1,416 6,805 .. B: 1,541 IBRD 332 519 244 201 IDA 1 4 33 35 G: 3,893 Composition of net resource flows Official grants 14 27 11,383 .. Official creditors 378 -267 -4,276 .. Private creditors 425 -258 -1,502 .. D: 777 Foreign direct investment (net inflows) 611 1,539 5,445 .. E: 275 Portfolio equity (net inflows) 0 0 0 .. F: 673 World Bank program Commitments 71 0 255 685 A - IBRD E - Bilateral Disbursements 385 260 362 335 B - IDA D - Other multilateral F - Private Principal repayments 125 339 230 196 C - IMF G - Short-term Net flows 260 -79 132 139 Interest payments 209 183 47 41 Net transfers 52 -262 85 99 Note: This table was produced from the Development Economics LDB database. 9/24/08 98 MAP SECTION To Tahoua To Agadez 10°E To Nguigmi 15°E N I G E R Illela 1963 Level N I G E R S O K O T O 1973 Level To To Yobe Kandi Sokoto Katsina 2001 Level Nguru Yobe Yo Oamasak Rima Sokoto Kaura Namoda S a h e l Lake Chad Birnin K A T S I N A Hadejia Gana Kebbi J I G A W A BORNO Gusau YOBE C H A D ZAMFARA Kano Dutse Jam maaarari Komadugu Maiduguri KEBBI Pokiskum Damaturu To To Kandi Niger KANO Zaria Gongola t s. GOMBE B A U C H I M B E N I N Kontagora Kaduna Biu Kainji Bauchi Reservoir K A D U N A Gombe 10°N Wawa N I G E R Kaduna B a u c h i ra 10°N Jos To To a Bori P l a t e a u Minna Jos d n Nig er A ABUJA P L A T E A U Benue W Yola a K W A R A FEDERAL Shendam M CAPITAL Jalingo Baro TERRITORY Plateau Ilorin NASARAWA Lafia ADAMA OYO NIGERIA Benue Be Taraba Bali Oshogbo EKITI Lokoja Wukari Ado-Ekiti K O G I Makurdi T A R A B A Ibadan OSUN Akure B E N U E ts. M Abeokuta O N D O U d i H i l l s Chappal Waddi (2,419 m ) O G U N E D O G o t h ENUGU To To ANAMBRA Enugu Lomé Lomé LAGOS Benin Abakaliki Lagos City Asaba Awka EBONYI NIGERIA Sapete C A M E R O O N SELECTED CITIES AND TOWNS D E L T A CROSS Owerri Umuahia Warri Niger RIVER IMO ABIA STATE CAPITALS NATIONAL CAPITAL 5°N RIVERS Aba Uyo Yenogoa AKWA- Calabar 5°N To To Gulf of Guinea N Port RIVERS Harcourt IBOM Doula i BAYELSA g MAIN ROADS e SEPTEMBER r 0 50 100 150 200 Kilometers D e l RAILROADS t a IBRD This map was produced by the Map Design Unit of The World Bank. STATE BOUNDARIES The boundaries, colors, denominations and any other information shown on this map do not imply, on the part of The World Bank 0 50 100 150 Miles Bioko I. INTERNATIONAL BOUNDARIES 33458 2004 Group, any judgment on the legal status of any territory, or any endorsement or acceptance of such boundaries. 5°E (EQ. GUINEA) 10°E