Document of The World Bank Report No: 22946-BEN PROJECT APPRAISAL DOCUMENT ON A PROPOSED CREDIT IN THE AMOUNT OF SDR 17.8 MILLION (US$23.0 MILLION EQUIVALENT) TO THE REPUBLIC OF BENIN FOR A MULTI-SECTORAL HIV/AIDS PROJECT DECEMBER 10, 2001 Rural Development 2 Country Departnent 13 Africa Regional Office CURRENCY EQUIVALENTS (Exchange Rate Effective August 2001) Currency Unit = CFA Franc ICFA Franc = US$0.00133 US$1 = CFA Franc 750 FISCAL YEAR January I -- December31 ABBREVIATIONS AND ACRONYMS AIDS Acquired Imnmune Deficiency Syndrome AGeFIB Agency for financing grassroots initiatives (Agence definancement des initiatives de base) ARV Antiretroviral (Drugs) CAS Country Assistance Strategy CALS District level HIV/AIDS Control Committee (Comite d'Arrondissement de lutte contre le SIDA) CAME Essential Medicine Procurement Center (Centrale d'Achat des Medicaments Essentiels) CBO Community Based Organization CCLS Communal HIV/AIDS Control Committee (Comite Communal de Lutte Contre le Sida) CDF Comprehensive Development Framework CDLS Departmental HIV/AIDS Control Committee (Comite Departemental de Lutte contre le SIDA) CEFORP Center for Population Studies Training and Research CHD Departmental Hospitable Center (Centre Hospitalier Departemental) CIDA Canadian International Development Assistance CNLS National HlV/AIDS Control Committee (Comite Nationale de Lutte contre le SIDA) CPAR Country Procurement Assessment Review CSW Commercial Sex Worker CVLS Village level HIV/AIDS Control Committee (Comite Villageois de lutte contre le SIDA) EHMP Environmental Health Management Plan EU European Union FMF Financial Management Firn GTZ Gesellschaft fur Technische Zusamrnmenarbeit (Germnan Agency for Technical Corporation) Vice President: Callisto E. Madavo Country Director: Antoinette M. Sayeh Sector Manager: Joseph Baah-Dwomoh Task Team Leader: Nicolas Ahouissoussi HART HIV Antiretroviral Therapy HIPC Highly Indebted Program Country HIV Human Immunodeficiency Virus HZ Zone Hospital (H6pital de zone) IAPSO Interagency Procurement Services Office ICB International Competitive Bidding IDA International Development Association 1-CAS Interim-CAS IEC Information Education Communication IPAA International Partnership Against Aids LC Letter of Credit LCS Least Cost Selection M&E Monitoring and Evaluation MAP World Bank's Multisectoral HIV/AIDS Program for Africa MOH Ministry of Health MTCT Mother To Child Transmission NATMP National Association of Traditional Medicine Practitioners NCB National Competitive Bidding NGO Nongovernmental Organization OM Operational Manual PERAC Public Expenditure Reform Adjustment Credit PLWHA People Living With HIV/AIDS PNLS National HIVIAIDS Control Program (Programme Nationale de lutte contre le SIDA) PMU Project Management Unit PRSP Poverty Reduction Strategy Paper QCBS Quality Costbased Selection RFP Request for Proposal RLT Regional Leadership Team SOE Statement of Expenses SIDA AIDS (Syndrdme d'immuno-deficience acquise) STIs Sexually Transmissible Infections SSA Sub-Saharan Africa SNIGS National system of information and health management (Systeme nationale d 'informations et de gestion sanitaires) TBAs Traditional Birth Attendants TPs Traditional Practitioners TOR Terms of Reference UNAIDS United Nations AIDS Program UNDP United Nations Development Program UNFPA United Nations Fund for Population Assistance UNICEF United Nations Children's Fund UNHCR United Nations High Commission for Refugees USAID United States Aid VCT Voluntary Counseling and Testing WFP World Food Program WHO World Health Organization BENIN MULTI-SECTORAL HIV/AIDS PROJECT CONTENTS A. Project Development Objective Page 1. Project development objective 2 2. Key performance indicators 2 B. Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported by the project 4 2. Main sector issues and Government strategy 5 3. Sector issues to be addressed by the project and strategic choices 8 C. Project Description Summary 1. Project components 10 2. Key policy and institutional reforms supported by the project 16 3. Benefits and target population 17 4. Institutional and implementation arrangements 18 D. Project Rationale 1. Project alternatives considered and reasons for rejection 20 2. Major related projects financed by the Bank and other development agencies 21 3. Lessons learned and reflected in the project design 22 4. Indications of borrower commitment and ownership 23 5. Value added of Bank support in this project 24 E. Summary Project Analysis 1. Economic 24 2. Financial 24 3. Technical 25 4. Institutional 25 5. Environmental 28 6. Social 29 7. Safeguard Policies 32 F. Sustainability and Risks 1. Sustainability 32 2. Critical risks 33 3. Possible controversial aspects 35 G. Main Credit Conditions 1. Effectiveness Condition 35 2. Other Project covenants 35 H. Readiness for Implementation 36 I. Compliance with Bank Policies 36 Annexes Annex 1: Project Design Summary 38 Annex 2: Detailed Project Description 45 Annex 3: Estimated Project Costs 54 Annex 4: Economic Analysis Summary 55 Annex 5: Financial Summary 56 Annex 6: Procurement and Disbursement Arrangements 61 Annex 7: Project Processing Schedule 70 Annex 8: Documents in the Project File 71 Annex 9: Statement of Loans and Credits 78 Annex 10: Country at a Glance 79 Annex 11: Monitoring and Evaluation 81 Annex 12: Organizational Chart 86 Annex 13: Supervision Plan 88 Annex 14: Financial Management Action Plan 92 MAP(S) IBRD 31703 TASK CODE: P073118 BENIN Multi-Sectoral HIV/AIDS Project Project Appraisal Document Africa Regional Office AFTR2 Date: December 10, 2001 Team Leader: Nicolas Ahouissoussi Country Manager/Director: Antoinette M. Sayeh Sector Manager/Director: Joseph Baah-Dwomoh Project ID: P073118 Sector(s): HA - HIV/AIDS Lending Instrument: Specific Investment Loan (SIL) Theme(s): Health/Nutrition/Population Poverty Targeted Intervention: N Program Financing Data [ ] Loan [X] Credit [ ] Grant [ ] Guarantee [ Other: For Loans/CreditslOthers: Amount (US$m): Proposed Terms (IDA): Standard Credit Grace period (years): 10 Years to maturity: 40 Service charge: 0.75% Financing Plan (US$m): Source Local Foreign Total BORROWER 2.43 0.00 2.43 IDA 18.43 4.57 23.00 Total: 20.86 4.57 25.43 Borrower: REPUBLIC OF BENIN Responsible agency: NATIONAL HIV/AIDS COMMITTEE Contact Person: Dr. Alphonse Gbaguidi Tel: (229) 31-54-88 Fax: (229) 31-78-48 Email: pnls@nakayo.leland.bj Estimated disbursements (Bank FY/US$m): FY 2002 2003 2004 2005 Annual 5.80 5.60 5.70 5.90 Cumulative 5.80 11.40 17.10 23.00 Project implementation period: 4 years Expected effectiveness date: 03/15/2002 Expected closing date: 09/15/2006 OCS PAD - Fd l F RIO A. Project Development Objective 1. Project development objective: (see Annex 1) 1.1. Project development objective: The proposed project is part of the World Bank' s multicountry (and multisectoral) HIV/AIDS Program for the Africa Region (MAP) approved on September 12, 2000. In accordance with the main goal of the MAP, the development objectives of the proposed project are to contribute to curbing the spread of the HIV/AIDS epidemic in Benin and to mitigating its impact for all those who are infected or affected through (1) accelerating, intensifying, diversifying, and empowering the response of civil society and the public sector to the HIV/AIDS epidemic; and (2) building capacity in both civil society and the public sector to achieve and sustain this scaled-up response. 1.2. Project purpose: The main purpose of the project is to support the implementation of a diversified, gender-responsive, multisectoral response, engaging all relevant government sectors, private sector, nongovernmental and civil society organizations and grass-roots initiatives in the fight against HIV/AIDS. In Benin, by definition, the scaling up of existing HIV/AIDS activities involves the scaling up of both preventive and provision-of-care activities. The project focuses on reinforcing and extending the capacity needed by key actors in civil society and the public sector to stabilize and ultimately reduce the rate of HIV/AIDS transmission, and to minimize the impact of the epidemic. In collaboration with other partners in the Intemational Partnership against Aids in Africa (IPAA), the Project will mobilize and build capacity for Benin's multi-sector, scaled-up response to the epidemic by financing the execution of HIV/AIDS activities by the cormmunities themselves, and by contracting out capacity building, of both communities and line Ministries, to competent Non-Government Organization (NGOs), Community Based Organization (CBOs), indigenous associations, professional organizations, and private sector agencies. 2. Key performance indicators: (see Annex 1) The categories of monitoring and evaluation indicators listed below have been drawn from the work carried out to date in the context of the execution of Benin's national HIV/AIDS program, involving the participation of the executing agencies themselves, and are consistent with the categories of indicators recommended by UNAIDS for the monitoring and evaluation of projects. Only indicative categories of Output, Process and Outcome measures are included in the context of this 4-year project since measurement of long-term impact is not feasible and cannot be discretely attributed to the project (see Annex 1 and Annex 11 on Monitoring and Evaluation). 2.1 Output indicators * By the completion of the Project, nunber, coverage and type of Subprojects successfully completed to be at least 2,500. (Social Mobilization) Sources: M &E Progress Reports from Community Groups. * By the completion of the Project, grants provided to communities to finance Subprojects to amount at least to the equivalent of US$6,000,000. (Social Mobilization) Sources: Project financial reports. * By the completion of the Project, in those health facilities that are stocked with drugs to treat common opportunistic infections, the percentage which also provide palliative care and report no stock-outs in the past twelve months to be 100 percent. (Care and Support) Sources: Progress Reports - 2 - * By the completion of the Project, percentage of women testing HIV/AIDS positive at antenatal clinics who are provided with a complete course of HART to prevent mother to child transmission to be at least 50 percent. (Mother to child transmission) Sources: Health Facilities reports. * By the completion of the Project, in those facilities where blood units are transfused, the percentage that have been screened for HIV according to national guidelines to be 100 percent. (Blood safety) Sources: Blood Bank reports. * By the completion of the Project, percentage of households with a chronically ill adult (aged 1549 years) who have in the last twelve months received external help in caring for the patient or replacing lost income, to have increased by at least 20 percent in reference to the baseline study. (Care and Support) Sources: Progress Reports from executing agencies and communities. 2.2 Process indicators * By the completion of the Project, number of people in implementing agencies mobilized to implement Project Component 1 to be at least 200 women and 200 men in 50 percent of the communities at least. Social Mobilization). Sources: Contracts and M&E progress reports from subcontract * By the completion of the Project, community-based organizations established, trained and having elaborated their Subprojects through a participatory and planning process to range from 1,300 to 2,000 communities in at least 50 percent of the villages. (Social Mobilization) Sources: Progress Reports. * By the completion of the Project , the number of self-sufficient and functioning PLWHA support groups and associations to be the following: one national association with at least 25 members, and at least 40 village-level associations with at least 10 members each, forming a network. (Social Mobilization) Sources: Progress reports from Community Group and agencies providing support). * By the completion of the Project, number of traditional healers and traditional birth attendants trained and equipped with adequate information on HIV/AIDS and sexually transmitted infections to be at least 192. (Care and Support) Sources: Progress Reports * By the completion of the Project, percentage of antenatal clinics that offer counseling and voluntary testing for HIV/AIDS by trained staff, or that refer clients to Voluntary Counseling Testing services to be at least 50 percent. (Voluntary Testing and Counseling) Sources: Progress Reports. * By the completion of the Project, number of public sector organizations that have elaborated and implemented their Action Plans to be at least 15 ministries and 30 public sector organizations. (Policy) Sources: Progress Reports. * By the completion of the Project, percentage of households with a chronically ill adult (aged 15-49 years) who have in the last twelve months received external help in caring for the patient or replacing lost income, to have increased by at least 20 percent in reference to the baseline study. (Care and Support) Sources: Progress Reports from executing agencies and communities. 2.3 Outcome indicators * By the completion of the Project, the HIV Prevalence rate among pregnant women aged 15-24 - 3- seeking prenatal consultation at sentine] sites to be reduced by at least 5 percent in reference to the baseline study. Sources: (MOHSentinel Surveys). * By the completion of the Project, the number of pregnant women aged 15-24 years attending antenatal clinics who test positive for syphilis to be reduced by at least 2 percent in reference to the baseline study. Sources: (MOHSentinel Surveys). * By the completion of the Project, the I-V prevalence rate among people seeking treatment for sexually transmitted infections to be reduced by at least h percent in reference to the baseline study. Sources: (MOHSentinel Surveys). By the completion of the Project, the percentage of households with a chronically ill adult aged 15-49 who has in the last twelve months received free extemal help in caring for the patient or replacing lost income would increase by at least 20 percent in reference to the baseline study. Sources: (Special studies). B. Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported by the project: (see Annex 1) Document number: IDA/R2000-242 Date of latest CAS discussion: 01/23/2001 Strategic Context 1- Sector Related Country Assistance Strategy (CAS) goal supported by the project The Government's current country strategy was described in an Interim Poverty Reduction Strategy Paper (IDA/SecM2000-357), discussed by the Board in July 13, 2000 in the context of the HIPC decision point. Pending the Government's finalization of the full PRSP, with the earliest anticipated date for Board discussion now being February 2002, the Bank prepared an interim CAS, which was presented to the Board in January 2001.This document specifically identifies HIV/AIDS as a major development challenge for Benin and underscores the need to step up the fight against HIV/AIDS by: (a) Raising national authorities' awareness to HIV/AIDS issues and increasing domestic budget resources allocated to HIV/AIDS related interventions; (b) Developing a multisectoral approach and a comprehensive strategic framework; (c) Financing assistance and support to the civil society organizations to reduce stigma, and denial among the population, improve access to prevention and care, and limit the social consequences of the epidemic; and (d) Supporting health services to improve prevention and treatment. The proposed project is fully consistent with the vision and strategy defined in the I-CAS to underpin and enhance national ownership. It will help the Government address urgent needs as well as build up the national capacity to respond to the epidemic threat. Consistent with the philosophy of the CDF, it will also help strengthen the capacity of the civil society to address HIV/AIDS-related issues and give a high priority to community-driven initiatives. Board approval in March 2001 of the one year Public Expenditure Reform Adjustment Credit (PERAC) followed approval of the I-CAS; it has been agreed that, as an emergency project, the financing of the proposed HIV/AIDS Project for Benin will be handled outside of the PERAC, an instrument by which all - 4 - financial flows to Benin from the Bank, including the Highly Indebted Program Country (HIPC) resources, are now only available through the Gomcrnment's annual negotiation of programmatic budgets for the various sectors. 2. Main sector issues and Government strategy: The HI V/AIDS epidemic in Benin: Cross-country comparisons in West Africa Figure I HIV Prevalence among Young (15-24) by Gender in selected West African Countries 10 -7 6 u E Men X c, |) E Women 0) a) 0 The subregional context The relative prevalence of HIV/AIDS in neighboring countries of the sub region is an important context for considering the Governnent's strategy and the main sector issues. This is based on recognition of the scale of the centuries old established practice of seasonal and circulatory migration for labor amongst these countries of the sub region (at least 6 million border crossings per annum are estimated) and the role which this may well play in contributing to the prevalence rate of HIV/AIDS within Benin. Summary of the status of the HIVAIDS epidemic in Benin Due to the weaknesses of the epidemiological surveillance, testing and notification systems, and the limited access to formal health services, compounded by social stigma associated with the disease, the figures on HIV/AIDS prevalence quoted below are likely to be under-estimated. HIV prevalence measured among pregnant women attending antenatal clinics in major urban areas remained relatively low during the 1980s, but increased rapidly in the 1990s from a reported 0.3 percent in 1990 to 3.1 percent in 1996 and 4.1 percent in 1999. This represents a 12-fold increase in less than a decade. For the year 2000, UNAIDS estimated the HIV prevalence among the adult population to be at 2.45 percent. On the basis of the UNAIDS calculations, it is estimated that in 2000, 70,000 persons were living with the virus in Benin, with 5600 persons having died from AIDS in 1999. -5 - Trends in the evolution of the HIV/AIDS epidemic in Benin While the overall male to female ratio of infection was estimated at 2:1 in 1996, with the evolution of the epidemic, this overall ratio is now estimated to be 1:1 in 2000, whereas the male to female ratio of infection for the 15-24 years age cohort alone is now 1:2 (see figure 1). Likewise, there has been a disquieting evolution in prevalence in the rural areas, now reported at an overall 5.4 percent in contrast with the overall 1.9 percent in the urban areas. However, according to group-specific surveys, prevalence among commercial sex workers (CSW) is now at 55 percent in urban areas but 29 percent excluding the main cities. This is complemented by studies which, even in the early 90's, identified the drivers of long-distance North-South cross-border freight lorries, and nation-wide, drivers of passenger taxis, as high risk groups; more recent information has highlighted the sub regional and socially diverse groups of passengers moving between the 5 countries implicated in the Abidjan to Lagos West-East axis, with Hilla Condji and Krake Plage being the key sites for diverse high risk migrant populations identified by the MAP 2 subregional project now under preparation. Surveys have also shown wide variations among the 6 regions (from 1.4 percent in Atacora to 7.9 percent in Zou). In some geographic areas, prevalence is even higher, reaching as high as 13.5 percent (Dogbo and Savalou). Trends in the modes of transmission oJfHIV The primary mode of transmission of HIIV in Benin is heterosexual, accounting for 89 percent of the reported cases. The median age at first intercourse as 18.2 years for males and 17.3 years for females, with significant variation among regions and local areas. About 50 percent of women between the ages 15 and 49 and 30 percent of men between the ages 20 and 64 are in polygamous unions. Vertical (mother-to- child) transmission is estimated to account for 4 percent. However another source indicates that some 3,700 babies were infected in 1999 due to mother to child transmission (MTCT). According to this source, MTCT in fact represents 20 percent of new IfV infection. It is important to recognize that given the now established level of HIV/AIDS prevalence amongst all women, (see diagram 1) of whom 44 percent are of childbearing-age, the ratio of Mother to child transmission is likely to increase in the coming years. Transmission through blood and blood products currently attributes to only 0.8 percent of reported cases, and 6 percent of reported cases are currently attributed to other non-specified modes of transmission (such as the use of infected syringes, razor blades). Figure 2 Benin- Modes of transmission 4% 6% b Heterosexual * Blood transf El Mother to Child 89% Cl Other- Non Spec Most of the people infected by HIV are young and in their most economically productive years of life. Peak ages for the reported AIDS cases are 20 to 29 years for females, and 30 to 39 years for males. Eighty percent of all reported AIDS cases correspond to adults of 20 to 49 years of age. - 6 - HIVIAIDS as a public issue Awareness of the disease and its mode of transmission continues to increase but is still not universal, although it is likely higher among men than women. About 30 percent of women and 10 percent of men have received insufficient information on HIV/AIDS, its transmission, and ways to prevent it. The perception of risk for each individual is even less well established, with more than 50 percent of both men and women, including young, single, and CSW clients, thinking they are not at risk. Some 50 percent of women have declared that they have not changed their sexual behavior because of AIDS, and utilization of condoms remains low (in 1998, 3 million condoms were sold, less than 1.5 condoms per sexually active person). Public discussion about sex is still a challenge and community taboos lead to limited discussion among adults and rarely within the family. In this context the Benin Catholic Church continues to vigorously and publicly oppose the use of condoms along with any non-natural means of contraception. The high illiteracy rate (77 percent of the adult population, including 70.8 percent of women of childbearing age) the low socioeconomic status of women, sexual violence (in particular at school), the extensive intemal (local level and nationwide) and extemal migration, in the context of the society's overall poverty, are all contributory risk factors. Very few studies have been conducted on the current and potential impact of HIV/AIDS on the economy and society at large. While the epidemnic has not yet reached the crisis dimension evident in other African countries, the current prevalence is very likely to already present a serious challenge to all aspects of Benin's development. The number of orphans, itself a powerful indicator of this development challenge, is recognized to be increasing, with current estimates at around 27,000. The bottom line The UNAIDS estimate of 2.45 percent national prevalence suggests that there is still time to redress the situation before the epidemic reaches the "take off' point of 5 percent prevalence at the national level, which has already been surpassed in several areas of the country. The various issues raised in this section are considered by the Benin counterpart project team and UNAIDS partners to be important to an understanding of the social experience underlying the data on the national prevalence of the epidemic in Benin, and reflection on these issues has informed the design and preparation of the project. Without immediate and intensified action to reduce the spread of H1V, Benin will face a major human, social and development crisis in the near future. Government strategy Benin created a National AIDS Control Program (PNLS) in 1987. A short-term plan and a first medium-term prevention and control plan were designed and implemented between 1987 and 1993. The second medium-term plan, which launched the Government's multisectoral approach to the PLNS, will end in 2001. The program has been primarily the responsibility of the Ministry of Health (MOH), with the PNLS being a subdirectorate of the MOH directorate for protection. These activities have received active donor support complemented by an IDA-financed Health and Population Credit, including a US$1 million component reallocated at the mid-term review, to support PLWHAs (persons living with HIV/AlDS). In spite of increased public leadership of Government and donor support over the 14 years to date, the capacity of the PNLS has been overtaxed. Furthermore, even though 4 of the 20 remaining sectoral Ministries have, in the last 2 years, prepared and launched HIV/AIDS Action Plans, interventions clearly - 7- have not been authentically multisectoral in character, nor of the scale and level of mobilization required to limit the spread of the virus. Since the beginning of the year 2000, there has been a remarkable increase in commitment by the Government with regard to HIV/AIDS. At that time, on the basis of its assessment of the relative lack of success of HIV/AIDS activities, the Government, through the PNLS, initiated and conducted a 3 stage process of reflection among key stakeholders, aiming at a radical reorientation of PLNS, with a focus on the multisectoral nature of the 2001-2005 strategic framework for HIV/AIDS prevention and mnitigation in Benin. This initiative was supported by UNAIDS and the IDA-financed Population and Health Project, with the first phase consisting of a situation analysis helping to identify the determinants and specificity of the HIV/AIDS epidemic in Benin; during the second phase of the process, the activities carried out 1993-2000 were analyzed to identify the strengths and weaknesses and to pave the way for the formulation of the strategic framework. The final stage involved a national consultation of public sector/civil society/financing development partners in October 2000, resulting in the draft of the revised and multisectoral National HIV/AIDS Strategy, which was formally published in December 2000. To reactivate the National I{IV/AIDS Committee (CNLS)--originally established under the second medium term plan)--and to ensure that the CNLS will be authentically multisectoral, fully decentralized, and inclusive at all levels, the need to revise and update the related decree was recognized. Meanwhiile, in August 2000, the Council of Ministers adopted a resolution on AIDS specifying the requirements for (a) the preparation of a report on the impact of HIV/AIDS on the Benin economy and various sectors, and (b) budget allocations for all the line Ministries for financing HIV/AIDS activities. This concerted process, implicating a broad range of partners, greatly facilitated the gap analysis undertaken during preparation of the project. Interventions supported by four key multilateral partners (IJNDP, UNICEF, WHO, and EU) in specific geographic/administrative areas, with annual financial allocations ranging from US$40,000--US$l 10,000, focus on: training of health staff in treatment of STI, equipment and staff training to assure quality blood bank services, counseling/treatment/living costs for PLWHAs, and technical assistance/institutional support to the PLNS Unit of MOH. The five core bilateral partners (Canada, France, Germany, Switzerland, and the USA) support a wide range of complementary interventions in specific geographic/administrative areas, with program financial allocations ranging from US$70,000 to US$1,950,000: these are, namely: elaboration of HIV/AIDS integrated curricula with the Ministry of Education; epidemiological surveillance and behavioral research; pilot preventive Mother-to-Child transmission and retroviral treatment programs and related staff training; HIV/AIDS rapid testing/counseling and associated training; quality blood bank and laboratory services; IEC for behavior change with counseling and care services for commercial sex workers; financing and integration of care services for PLWHAs within their communities; social marketing of condoms; promotion of HIV/AIDS preventive measures in the context of reproductive health activities; and information for and advocacy with decisionmakers (table D2). Examples of the many NGO partner supported activities include Africare's Child Survival Program in one region, and the anti-TB medical supplies provided for the national program by the Intemational Union. Recognition of the predominantly health-oriented nature of interventions by other partners, the need for a much more generalized and regular sharing of program information and standardizing of surveillance protocols, and the need to build more efficient coordination of all these efforts were identified as three core themes to address in Project design. 3. Sector issues to be addressed by the project and strategic choices: The strategic choices center on how to prevent the further spread of HIV/AIDS by means of a multi-sector program. The Multi-Country HIV/AIDS Program for Africa (MAP) provides a framework within which Benin is eligible for MAP funding, in that it has satisfied the four MAP eligibility criteria. -8- Satisfactory evidence of a strategic approach to HIV/AIDS The 12/2000 National HIV/AIDS Strategy was elaborated on the basis of a thorough situation/program analysis and a national consultative participatory process. Creation of a high level HIV/AIDS coordinating body On the basis of the revised and updated National HIVAIDS Strategy, the structure and functions of the CNLS, which were originally provided for under the 1994-2001 second medium term plan, were also reviewed, and an updated decree No. 2001-231 was signed in July 2001. This decree clearly establishes the multisectorality of the CNLS which is under the presidency of the Head of State with a broad and decentralized representation of key stakeholders from all sectors, including PLWHAs. Government agreement to use appropriate implementation arrangements By comparison with many SSA member countries, the Borrower already has some 5 years of experience, in various sectors, both with channeling funds directly to communities and civil society (in both rural and urban areas), and with contracting out financial/ program management and program execution. The Benin HIV/AIDS project builds on this experience. Government agreement to use and fund multiple implementation agencies In the context of the decentralization process, the structure of the CNLS already provides for the mobilization and participation of all levels of the administration; the Benin HIV/AIDS project builds on the Borrower's already referenced 5 years of diverse experience in various sectors, financing activities implemented by nongovernmental agencies, private sector organizations, and traditional associations. Given this strategic context, and the findings of the gap analysis, it is proposed that priority should be given to the following sector issues: a Immediate multiplication of simple but effective multisectoral village and community level activities by empowerment of those communities, in which structures of traditional leadership still have an important role. Since Benin will face the HIV/AIDS epidemic for decades, building a sustainable and adaptable capacity to respond to the epidemic and its consequences is essential. = Scaling up of gender-responsive, non-health sector, community-support initiatives by private sector agencies and NGOs, as another means of building and empowering the capacity of civil society. * Complementing such initiatives by supporting village and urban societies and private sector agencies to provide better care to PLWHAs and their affected families. * Empowering non-health sector ministries and governmental agencies to engage in actively building a more open, favorable and supportive environment for HIV/AIDS initiatives both among their own personnel and with their sectoral constituencies and partners. * Scaling up of existing efforts by MOH in collaboration with development partners and the private health sector in four specific domains: (1) to expand coverage of gender-responsive testing/counseling/prevention of heterosexual transmission of HIV and Mother-to-Child transmission; (2) to ensure basic national coverage of gender-responsive medical services for prevention and treatment of sexually transmitted diseases; (3) to complement existing efforts to provide increased coverage of appropriate medical treatment and better quality of care to PLWHAs. The role of Traditional Healers -9- (TH's) and Traditional Birth Attendants (TBA's) in community and family health practices, and the status of medicinal plants and medicines as the first and often only source of treatment for the majority of rural populations in Benin, underpin the Project's provision for formally recognizing and scaling up in the fourth domain, namely (4) to promote of MOH/TH collaboration in informing/training and mobilizing these influential members of their communities. * Limited provision for the targeting of specific areas of high prevalence, as well as specific groups and subgroups at high risk, but only as may be identified as priorities by the community Subprojects, by the Action Plans of sector Ministries and of public sector organizations, and by the CNLS. * Provision of capacity building support for the coordination role of the CNLS and its technical secretariat in establishing standardized epidemiological surveillance protocols, and facilitating regular sharing of program plans and results among executing agencies and implementing partners of the National HIV/AIDS Strategy. These priority sector issues identify the challenges of applying the multisectoral response to the epidemic elaborated in the National Aids Strategy of Benin. The scope of the scaling up of existing private and public sector efforts to empower communities as foreseen by the project, is without precedent in any sector in Benin. Given the range of stakeholders already engaged in the fight against HIV/AIDS, project implementation has been designed on the basis of mobilizing and scaling up these existing interactions, while providing for support to the CNLS in its coordination and facilitation role. In addition, in line with the specific provision in the I-CAS, and in line with the gap analysis, these priority sector issues recognize the defined responsibility and role of the MOH and PNLS in the medical prevention of HIV/AIDS transmission and medical treatment of STI, and in ensuring provision of medical services for PLWHAs. These priority sector issues also recognize the need for PNLS to build on its historically established and valued role in leading Benin's efforts to limit the spread of HIV/AIDS, by now supporting other key sectoral Ministries to translate the implications of the epidemic for their personnel and the execution of their sectoral mandate. Based on this strategic choice, the Benin HIV/AIDS Project may be categorized as "hybrid," providing for this combined role of the MOH and PNLS by incorporating a "Health" subcomponent within the overall compass of Project providing support to the response of the public sector. C. Project Description Summary 1. Project components (see Annex 2 for a detailed description and Annex 3 for a detailed cost breakdown): The project will support the implementation of the National HIV/AIDS Strategy, through three core components: (1) support to civil society; (2) support to the public sector (including health sector); and (3) support to Project coordination, administration, and monitoring and evaluation. 1. Support to the response of civil society The principles of community-based participatory development and the financial mechanisms for providing support to communities, which underpin this component, have benefited from the experience already gained from the implementation of several IDA-financed Credits in Benin involving such community-based activities (namely, the Social Fund, the Pilot Rural Development Support Program of Borgou, the Pilot Community-Based Forestry Management Project, the Food Security project). The Project will subcontract technical assistance and financial support for three broad types of activities: (1) the social mobilization, training and Subprojects preparation; (2) the execution of the community Subprojects by the communities - 1 0 - themselves; and (3) the execution of community-based HIV/AIDS preventive and provision of care activities by private sector organizations, NGOs and other civil society organizations. The Project will support the civil society response through three subcomponents. Subcomponent 1: Strengthening of the institutional capacities of the community-based organizations and civil society organizations, carrying out awareness campaigns, training, and community Subproject preparation. This component will strengthen the institutional capacities of civil society organizations, together with the awareness raising campaign followed by the training of trainers at the national level and thereafter at all levels of decentralization, which will be launched and facilitated by the Project Management Unit (PMU) and the Unit's outreach regionally based staff, at the outset of the Project. This national IEC campaign and training cycle will be repeated annually, following evaluation and feedback on the program results of the program to date from the decentralized Departmental level HIV/AIDS Committees (CDLS) provided for by CNLS. The Project also provides for the PMU to subcontract NGOs and private agencies with the required expertise to support communities at the local level, in the planning, executing, and monitoring of their HIW/AIDS Subprojects and to collaborate with field staff of the core Ministries of Rural Development, Social Protection, and Health, ensuring the empowerment of about 35 percent of Benin's communities in their fight against the epidemic by the end of the Project. Subcomponent 2: Community grant for executing Subprojects On the basis of the participatory training, and follow-up support/capacity building for their community based analysis and planning process, the communities will develop their gender-responsive HIV/AIDS Subprojects, with particular attention to ensuring inclusion of the concerns of those social groups which traditionally have less voice (the young, women, pastoral nomads). Simple criteria, including a limited negative list and a wide range of indicative examples of possible activities, are available to guide this community process in selecting their priority activities (Cf Operational Manual). These tools are intended to support the community's careful analysis of the behavioral and socioeconomic factors which, in their local society, could contribute to the spread of the HIV/AIDS and to recognize any as yet unmet needs for support required by any community groups at high risk for HIV/AIDS, or by any PLWHA, their orphans or affected families. The community HIV/AIDS Subproject proposals will then be provided to the local "arrondissement" level approval committee (CCLS, CALS) for review. Following successful approval, the Subproject proposal will be forwarded to the relevant local bureau of the Project for prompt transfer of funds to the account opened by the designated members of the community's HIV/AIDS committee (CVLS), following their signature of a grant agreement with the relevant CDLS, the Financial Management Firm (FMF), and the relevant community-based organization. With an average of US$1000 and a ceiling of US$3,000 per annum per community, the Project provides for communities to submit Subprojects on an iterative yearly basis. Of the total 6000 communities in Benin, (both urban and rural), which it is intended to reach with awareness raising campaigns over the life of the project, it is anticipated that the project will finance an average of 100 community HIV/AIDS Subprojects per year per department. Subcomponent 3: Financial support to civil society organizations for executing prevention and care activities for communities. This category of activities ensures both the fullest possible engagement of all civil society actors in supporting and scaling up the response of urban and rural communities to the HIV/AIDS epidemic, and provides for attention to those needs which may well lie beyond the capacity of any single community to organize. Private sector organizations, NGOs and associations of civil society, which are already engaged - 11 - in HIV/AIDS preventive or provision of care activities, or which have a particular expertise relevant to the HIV/AIDS campaign may therefore also submit proposals. Those requesting financing to support the expansion of effective existing initiatives, addressing the specific objectives of the project, will be given priority. Indicative examples of such proposals include activities such as: Centers of Care for PLWHA, facilitation of community-based support for HIV/AIDS orphans and affected families, promotion of collaboration with the national and decentralized associations of Traditional Practitioners; support for HIV/AIDS transmissions on community radio networks; programs of anonymous voluntary testing and counseling for HIV/AIDS in high risk/high prevalence zones, programs facilitating "peer group" counseling among youth groups and commercial sex workers. It is anticipated that such proposals would be prepared in consultation with other relevant actors, such as the respective government Ministry or decentralized administration, or the communities concemed. Depending on the geographic coverage of the activities in such proposals, the review/approval process will be with the decentralized approval HIV/AIDS committees (CCLS, CALS or CDLS ). The grant agreement will be entered into among the relevant CDLS, the FMF, and the relevant civil society organization; or among the CNLS, the PMU, and the relevant civil society organization, as the case may be, depending on the arnount of financing involved. 2. Support to the response of the public sector (including the health sector) This Project component provides for follow-up support for two categories of public sector activities: (1) to non-health sector line Ministries and public and private institutions at the national level to build their capacity to elaborate and execute short- and medium-term HIV/AIDS Action Plans, and (2) to the Ministry of Health, to contribute to the expansion of the coverage and improvement of the efficacy of its program of activities to prevent the spread of HIV/AIDS. Subcomponent 1: Non-health sector Action Plans Among the non-health sector line Ministries, the Project will mobilize the sixteen sectoral ministries of the total of twenty-one which have yet to launch their first HIV/AIDS initiatives; and will provide support to the Ministries of Rural Development, Defense, Education, and Youth and Tourism, to enable them to deepen and expand their current Action Plans. The 50 or so other public sector organizations, including the National Assembly, both the Universities, the Port Authority and various associations of the judicial system, will also be assisted. The sectoral Action Plans will detail how the ministries and eligible agencies would initiate or strengthen their fight against HIVIAIDS, indicating collaborating partnerships with their related decentralized entities wherever possible. A key criterion for the Sectoral Action Plans is that they be organized around two core themes: (1) awareness raising/advocacy and counseling to raise information levels, encourage appropriate behavioral change or identify any socio-psychological support needed among ministerial staff themselves; and (2) initiatives related to the specific technical or sectoral policy mandate of the Ministry, or the public sector organization or agency and its constituencies. Proposals for the limited provision of equipment (such as audio visual tools) is anticipated within such plans, and examples of eligible activities related to the first theme might include: (1) Capacity building: training of focal points at all levels of decentralization in their roles as catalysts, to enable line Ministries and institutions to initiate, coordinate, and sustain these activities; (2) Initial staff IEC program backed up by regular staff updates of information on the HIV/AIDS epidemic in Benin (CNLS reports); and (3) Review of any necessary statutory reform or related change in regulatory practices, in light of the patient's/ employees' and affected families' right to confidentiality of their health status and privacy. - 12 - Examples of eligible activities related to the second theme might include: (1) study of the current and projected impact of HIV/AIDS on the respective ministerial sector of the economy, (as per the August/2000 decision of the Council of Ministers); (2) nationwide initiatives to be undertaken by decentralized field staff in support of local communities; (3) gender-responsive sector-specific HIV/AIDS communication plans in ministries responsible for public service facilities. Once approved by the Technical Secretariat of the CNLS, these activities would be funded through direct transfers of funds to the respective line ministries or institutions on the basis of a financial agreements signed between the CNLS, the PMU and the relevant public sector organization, continued support being contingent on satisfactory annual performance. With the evolution of project execution, ministries will be encouraged to consolidate their Action Plans with other related sectors, and to seek additional financing through partnering shared program activities with private sector organizations. Subcomponent 2: Health sector interventions/activities Regarding the Ministry of Health, the project sub-component provision of US$5.5 million, for technical assistance and financial resources for the PNLS, will complement the Ministry's annual budget allocation in the following way; in the Budget Year 2000, of the total MOH Budget (US$46 million), US$2 million was allocated to PLNS; in 2001, the US$2 million allocation to the PLNS continued but was to also provide financing for the HIV/AIDS action plans to be developed by the sectoral ministries, (as per the Cabinet decision of 8/2000), on the basis of US$30-40,000 per ministry. The provision of US$1.38 million per year over the 4 year life of the Credit, reflects the gap financing required to scale up activities to achieve basic national coverage in the following five areas of intervention, and will support HIV/AIDS related health activities and initiatives of both the public and the private sector. (a) Improved accessibility to HIV testing and counseling by (1) increasing physical and financial accessibility to testing and counseling including subsidizing the HIV test and (2) improving the quality of pre-and post-test counseling; (3) further expanding the prevention of mother to child transmission by helping MOH to put in place the conditions for the introduction and expansion of access to HIV antiretroviral therapy (HART); and, (4) developing the safety of the related blood transfusions services, injections and medical as well as surgical practices; (b) Improved prevention of HIV transmission by making STI treatments more accessible and affordable; (c) Improved quality and scale of provision of health care to persons living with HIV/AIDS by improving the physical and financial accessibility to the prevention and treatment of opportunistic diseases as well as other treatments (anti-pain treatments, palliative care) for PLWHAs; (d) Initiation of a systematic program of collaboration with the national associations of Traditional Practitioners to improve: (1) the qualifications and competence of TPs to fully participate in the fight against HIV/AIDS, especially in the rural areas; (2) identification of effective traditional treatments of SDIs and opportunistic diseases (ODs); (3) scientific validation of selected traditional treatments; and to (4) establish and sustain collaboration between TPs/TBAs and government clinics; and (e) Support HIV/AIDS prevention and control activities for its staff. - 13 - 3. Support to project coordination, management, monitoring and evaluation Under this component the following activities will be financed: (1) strengthening the capacity of CNLS and the PMU to implement a coordination, administration and monitoring and evaluation framework for the Project through the provision of technical advisory services and training, and the acquisition of goods, equipment and vehicles; (2) strengthening the capacity of CDLSs, CALSs, CCLSs and CVLSs to carry out the coordination, monitoring and evaluation of subprojects, through the provision of training; (3) carrying out the activities under the Monitoring and Evaluation Manual through the provision of technical advisory services; (4) carrying out the accounting, financial reporting and disbursement functions related to the subprojects to be implemented by a cormmunity-based organization or a civil society organizations at a decentralized level, through the provision of technical advisory services and training, the renovation and equipment of office space, and the acquisition of vehicles; and (5) carrying out financial audits of the Project and the Financial Management Firrn(FMF) through the provision of technical advisory services. The PMU will be responsible for facilitating project implementation within the framework of the National HIV/AIDS Strategy and the CNLS. All members of the PMU will be recruited by the Borrower's Ministry of Planning on a contractual basis from the private sector, in line with Bank guidelines. The PMU staff will include a coordinator, a financial management specialist, a procurement specialist, an HIV/AIDS specialist and support staff. The PMU, like the CNLS Technical Secretariat, has no program execution function; its role is to subcontract with a full range of actors in the private and public sector, to facilitate the effective and efficient execution of the project, as per the annual project plans and budgets approved by the CNLS and the Bank, and to ensure technical assistance and capacity building for the multisectoral CN'LS Technical Secretariat. The objectives and related responsibilities for the PMU under the Project can be usefully grouped into four categories: (a) Communications; (b) Capacity Building; (c) Monitoring and Evaluation and (d) Financial Management. (a) Communications: The organization of the launch of the mass communications campaign, by the Head of State of Benin and Chairman of the CNLS, with multimedia for involving ministers of the core sectors of the economy, sustained by the nationwide network of State, community and private radio networks, awareness raising workshops at all levels of CNLS and community level cultural events, will be the point of' departure for the activities foreseen for all three project components. The PMU will ensure annual mass cornmunications initiatives through the life of the project, executed by subcontracted international and national communications specialists, whose task will equally include strengthening the capacity of the C\LS technical secretariat, and the C'NLS forum to actively sustain commitment and capacity in HIV;iAIDS advocacy, and awareness raising. (b) Capacity Building: At the national 'level, the focus will be on ensuring capacity building of the newly established multi-sectoral technical secretariat of the CNLS, and of the sectoral line ministries and public sector organizations, for the execution of their HIV/AIDS Action Plans; nationwide, the PMU together with its local outreach staff will focus on empowering communities through capacity building efforts targeted to support their efforts to limit the spread of HIV/AIDS. (c) Monitoring and Evaluation: As per the gap analysis, the core of the capacity building to be facilitated by the PMU for the multisectoral technical secretariat to the CNLS will be to ensure the secretariat's competence to focus on the strategic program implications of the results of the common monitoring and evaluation framework and manual, which is currently being prepared in consultation with and for use by CNLS executing agencies and partners. The project indicators (section 2.1-2.4 Annex I and the M&E Annex) are structured according to the categorization of interventions and indicators established - 14 - by UNAIDS (i.e. behavioral change, social capacity for support to PLWHA, counseling/care services for STIs, security of blood transfusion services, mother-child transmission of HIV; voluntary testing and counseling and policy); this single, simple and standardized M&E tool will meet a key need identified by the gap analysis, and will make it feasible for meaningful data to be aggregated from different executing agencies and different levels of decentralization of execution. It is also recognized that it will be necessary for the PMU in collaboration with the CNLS Secretariat, to sustain stakeholders ownership and involvement by ensuring regular dissemination of findings and enlisting their feedback on their experience with the manual. All M&E activities will be contracted out to external agencies/consulting groups, to ensure an independent analysis, tracking program performance against targets and variations in performance rate in compliance with the established protocols. The project similarly provides for the contracting out of surveillance and research, as the evolving status of the epidemic indicates, to complement research initiatives undertaken by other CNLS partners as necessary. It is also anticipated that project finances may support capacity-building in some of the national institutions currently carrying out data collection and syntheses for the CNLS (such as The Center for Population, Training and Research, (CEFORP) with an expertise in regular studies of HIV/AIDS- related behavioral change, and the system of departmental and national data collection on STIs (SNIGS). The project will also strengthen the technical secretariat of the CNLS in its role as the designated mechanism to compile for the plenary meetings of the CNLS the biannual reports of all executing agencies and partners working within the framework of the National HIV/AIDS Strategy. The first annual meeting (April-May) would focus on the implications of the M&E based results of the past year's program of work and the second annual meeting (October) would prepare/discuss/endorse the next annual work plan. Over the life of the project, the PMU together with CNLS permanent secretariat will review the options for meeting a more extensive need identified in the Gap analysis; namely the organization and dissemination to implementing agencies of up to date information on AIDS prevention and care, best practices of existing projects, research results and any other relevant reports. (d) Financial management: The PMU will be responsible for project financial management, on the basis of the Administrative, Accounting and Financial Manual prepared for the project. The first step will be to carry out a time-bound action plan for the sound establishment of the project financial management system to ensure preparation of quarterly project management reports acceptable to IDA. The PMU will monitor project disbursements and ensure that they are in conformity with IDA requirements and will consolidate and prepare the annual financial statements, in accordance with internationally accepted accounting principles, at the end of each fiscal year. The PMU will also be responsible for making arrangements for the certification of these annual financial statements by a competent and experienced audit firm under terms and conditions acceptable to IDA. The recruitment of auditors acceptable to IDA will be completed by April 30, 2002. To ensure timely efficient disbursement and support for responsible management of funds by the communities, a Financial Management Firm will be contracted to manage and provide accounting, financial and disbursement reports for all the activities undertaken by communities, or by NGO's, private sector and civil society organizations subcontracted to assist communities, in Component One of the Project. This FMF should have local offices in the six national regions and should have an established and sound reputation for responsible and adaptive management in facilitating direct financing to communities; the FMF's local offices, would each include 2 staff dedicated to the financial management and programmatic support of the Benin MAP project. Financial management and M&E Again on the basis of past experience, the Project already provides for the possibility of joining program M&E with financial management. The FMF to be contracted to support the communities in their - 15 - implementation of activities under Component One, will be required to already have had experience in combining program monitoring and financial reporting, since both of these elements are reporting requirements in the grant agreements for communities. At the national level, it is also established that the financial agreements and contracts which will facilitate the scaling up of the public sector response under Component Two, will similarly combine reporting on financial management performance and program results, allowing for an independent analysis and cross verification. At the CNLS wide level, the first challenge for the PMU under Component Three is to support the technical secretariat in establishing the wide and routine use of the common M&E indicator protocols by all CNLS executing agencies; the consultative workshop on the Operational Manual held with stakeholders in August 2001, provided an opportunity to both discuss and secure agreement from the participants on the proposed Program Indicators (Annex 1) and to explain Bank guidelines regarding joint and parallel financing, as a first step towards the possibility of combining financial and M&E monitoring at the CNLS level. Indicative Bank- % of Component Sector costs % of financing Bank- {US$M) Total (US$M) financing Support to Civil Society Response 11.31 44.5 11.00 47.8 Support to the public sector response 9.25 36.4 8.14 35.4 (including the Ministry of Health) Support to Management, Monitoring 4.87 19.2 3.86 16.8 and Evaluation. Total Project Costs 25.43 100.0 23.00 100.0 Total Financing Required 25.43 100.0 23.00 100.0 2. Key policy and institutional reforms supported by the project: As in other countries participant in the Multi-sectoral HIV/AIDS Program (MAP), there is now a consensus in Benin, that the fight against HIV/AIDS requires leadership that is beyond the capabilities of a single Ministry, and even of the govemrnment, not withstanding the inclination of some government actors and development partners to still favor a leading, rather than technical support role, for the Ministry of Health in this multi-sectoral context. Therefore, the project has taken this opportunity to support the following proactive policy and institutional changes: * Ensuring the appropriate amendments to the CNLS Decree No. 2001-231 and the timely promulgation of the New CNLS Decree, to provide for a multi-sectoral Technical Secretariat to support the CNLS, with comparable decentralized structures. * Ensuring support for the active participation of PLWHAs, and for the fullest range of civil society actors from the private sector, unions, NGO's, confessional groups, traditional leaders and associations in the functions of the CNLS at all levels. * Ensuring technical support and systematic capacity building to the Technical Secretariat of the CNLS as a key contribution to the sustainability of Benin's National HIV/AIDS Strategy. * Ensuring technical and financial support for the preparation of an initial HIV/AIDS Action Plan by every line ministry and relevant government agency, focusing on both the awareness raising and counseling - 16 - needs of the staff themselves, and the identification of support for decentralized community targeted activities relevant to the Ministry's national mandate. * Ensuring technical and financial support to the relevant line ministries to address the gender-responsive legislative and regulatory reforms identified in the National HIV/AIDS strategy. * Ensuring progressive promotion of collaboration between government ministries, whilst privileging execution of the ministerial Action Plans through partnerships with the private sector, NGO's and associations. * Ensuring support for the PNLS Unit of the MOH, both to scale up specific activities of its technical mandate, undertaken in the framework of the National HIV/AIDS Strategy, and to underpin its technical support role vis-a-vis the other sectoral Ministries, in the formulation of their HIV/AIDS Action Plans. * Ensuring empowerment of communities to design/implement/monitor their own responses to the HIV/AIDS pandemic, by scaling up to nationwide level, the experience in Benin to date of the provision of direct technical support for this process to communities, in tandem with the transfer of funds directly to the bank accounts of both community groups and village committees. 3. Benefits and target population: Benefits By scaling up ongoing efforts in the fight against HIV/AIDS, involving all sectors, sensitizing and mobilizing public and private stakeholders at all levels of society, over a period of 4 years, the overall project benefit will be that the prevention of HIV/AIDS and the treatment of PLWHA's will no longer be a subject about which ordinary citizens are embarrassed to speak in public, linked with increased community and national empowerment to confront this challenge to Benin's social and economic development. Social Benefits: Important short and medium term social benefits of the project will be: (1) the strengthening/establishment of social support systems, such as counseling services and support groups for PLWHAs, HIV/AIDS orphans, families or caregivers, including those services provided by traditional practitioners, with the objective of reducing the current economic and social burden on patients and the affected families; (2) increased access to HIV/AIDS testing and any necessary medical treatment for prenatal mothers; increased access to quality blood bank services and increased access to appropriate management of STI; all factors which will benefit both the individuals concerned and contribute to slowing the transmission of HIV/AIDS; Important longer-term social benefits of the project will be: (1) reduced social stigma attached to HIV/AIDS, which over time, will increase the possibility for the earlier detection of the disease; - 17 - (2) changes in social and sexual attitudes and behavior will contribute to reducing the overall rate of transmission. Institutional benefits: Important short and medium term institutional benefits of the project will be: (1) increased capacity and commitment of stakeholders at all levels of the CNLS (government and civil society actors) to collaborate, implement and manage their proposed interventions effectively; (2) increased capacity for intersectoral coordination at the policy level, providing for more focused strategies and better use of resources in Benin's fight against HIV/AIDS. Tar2et Population: The project targets the whole population. It aims at sensitizing, mobilizing and empowering the nation's population, which can only be achieved through activities which try to reach out to everyone in their specific circumstances. (1) Communities (urban and rural), private sector organizations, sectoral ministries, public organizations and agencies, and the CNLS are the categories of the stakeholders targeted by the different project components; (2) NGOs, traditional associations, professional and occupational organizations, faith-based associations, and private agencies are the key intermnediaries targeted by the project, to accompany and support the communities through the participatory process of developing and executing their IIIV/AIDS Subprojects. (3) The project provides for activities to be targeted, in so far as such targeting (of a high-risk group or a high-risk locality) is identified as a priority by a community, or a sectoral ministry (such as Defense and Transport) or the CNLS. The individuals or groups of the estimated 160,000 people currently living with HIV/AIDS in Benin are likely to figure high on a community's list of priorities. Other target groups might include: young females 12-24 years of age; young males 15-29 years, cross border long distance lorry drivers and nationwide taxi drivers, the high risk groups located at Hilla Condji and Krake Plage on Benin's borders with Togo and Nigeria, male and female military and police personnel, commercial sex-workers, male and female migrant workers; families and street children who scavenge on dump sites. Target high-risk transmission localities might include: markets and crossroads, bus stations, lorry/rail and ship terminals, and social establishments such as bars and dancing places. 4. Institutional and implementation arrangements: Project management The institutional and implementation arrangements for the project, together with the project management arrangements, are specified in a detailed operational manual (OM), which was finalized during appraisal and recently validated by a national consultative workshop with stakeholders. The project will be placed under the management oversight of the CNLS, which is chaired by the President of Benin, and whose members are drawn equally from government and civil society. It is envisaged that the New CNLS Decree will provide for the composition of the CNLS in three complementary fora: (1) the decision-making plenary assembly of all members of CNLS, which will annually identify national program priorities and approve programs and global budgets of the various executing agencies/ financing partners; - 18- (2) the CNLS technical secretariat, a multi-sectoral unit of 6 seconded public sector professionals, with no program execution functions, but tasked with collating the program plans and reports of results from different executing agencies and partners, analyzing and consolidating these documents for review/approval of the biannual plenary CNLS, and keeping the CNLS updated on the results of the national monitoring/evaluation prograrn and related research; (3) a consultative group composed of the Vice Presidents of CNLS, its technical secretariat, with financing partners and donors to be invited, in an observer status, to collaborate on advocacy initiatives and to clarify available financial resources and proposed programs in support of the National HIV/AIDS Strategy. In this institutional context the PMU, with a staff of 6 private sector professionals subcontracted by the Borrower's Ministry of Planning, will function alongside and in a support role vis-a-vis the CNLS technical secretariat. The PMU, like the CNLS technical secretariat, has no program execution function; its role is to subcontract with a full range of actors in the private and public sector in order to facilitate the effective and efficient execution of the project, as specified in the annual project plans and budgets approved by CNLS and the Bank, and to ensure technical assistance and capacity building for the CNLS technical secretariat. The PMU will establish an independent "ad hoc" procurement evaluation commission, to process in a transparent manner, and in compliance with the OM, all the national level project related bids, proposals, contracts and financial agreements. No members of organizations eligible for financing subproject or Action Plans can be a member of this Commission. For the institutional implementation and administration arrangements to support the response of civil society to the HIV/AIDS epidemic, as already noted in the earlier discussion of project financial management, the PMU will contract a Financial Management Firm whose role will be to administer the program and financial planning and provide accounting and disbursement reports for all the activities undertaken by the grant assisted communities, or by NGO's, private sector and civil society organizations subcontracted by the FMF to assist communities, in Component One of the Project This contract will require the FMF to have local offices in the six national regions and to have an established and sound reputation for responsible and adaptive management in facilitating direct financing to communities; the FMF's local bureaux, would each to include 2 staff dedicated to the financial management and programmatic support of the Benin MAP project. The various decentralized levels of the CNLS, all of which draw on existing multi-sectoral public/private sector, reach as far as the Village HIV/AIDS Committees (CVLS). These decentralized CNLS structures will provide a network of collaborators to be mobilized by the communities with facilitation support of the local FMF staff. The members of the CNLS at the level of the "arrondissement" will make up the "approval committee" for the community HIV/AIDS subprojects. Regionally experienced NGOs, confessional agencies, traditional associations, and private sector organizations will also be subcontracted by the local FMF staff, to provide technical assistance, and support to communities and particular community groups, as well as contribute to the monitoring and evaluation of their activities. Role of partner agencies: It is envisaged that the revised decree regarding the CNLS will provide that the executing partner agencies will include the following: the PNLS Unit of the Ministry of Health; the HIV/AIDS focal points/units of the respective sectoral Ministries and public sector organizations; the organizations of civil society (such as intemational and national NGOs, private firms and professional groups traditional associations) which provide support and services to the communities, and the communities themselves. In the framework of the CNLS, an important function of their role as executing agencies, will be to provide their annual program plans and programs results for coordination discussions at the CNLS biannual meetings. In this context, these agencies are also potential collaborating partners for the implementation of the proposed project. Those partner-fenancing agencies, which along with the Bank, are "invited" members of the CNLS - 19- Consultative Group, have various roles in that forun. These include advocacy with the Borrower, and supporting the coordination of programnming and financing for the execution of the National HIV/AIDS Strategy. During the past nine months, the Bank has carried the rotated responsibility of chairing the Benin UNAIDS Committee. In Benin, the partner agency members from the UN System include the World Bank, UNDP, UNFPA, WHO, UNIHCR and the WFP; the bilateral government members are USAID, European Union, French Technical Cooperation, CIDA, Swiss Development Cooperation, GTZ, etc. All these members with support from UNAIDS were very active in contributing both technically and financially to the process of elaborating the National HIV/AIDS Strategy. Two consultations have been convened during the preparation of the proposed Project to clarifzy the oh;jectives of the proposed Project in the context of the overall MAP approach, and more recently to consolidate understanding of the need to ensure that the draft decree establishing the CNLS clearly provides for the multi-sectoral approach foreseen by the National HIV/AIDS Strategy. As specified in the gap analysis, all these partner agencies and UNAIDS members continue to be active and largely complementary in the domains of technical assistance, staff training, provision of equipment and services to support the Borrower's efforts to limit the spread of the HIV/AIDS epidemic. The proposed project support for the CNLS role in the two areas of: (I) effective coordination of interventions; and (2) management of program information and standardized M&E protocols will strengthen the collaborative role of partner agencies. Discussions have also begun to identify in which ways UNAIDS partners might choose to participate in the supervision missions for the proposed project, and will be formalized during the project launch. D. Project Rationale 1. Project alternatives considered and reasons for rejection: (1) The team chose the option of a project design providing "support to response of the public sector" with a Health Sector subcomponent, over the alternative of a specific component for Hlealth. In so doing the team took account of the opportunity provided by the 6/2002 closing date of the IDA financed Health and Population project, to ensure the continuation of financing through the MAP, to complement the support of other partners, but to scale up selected existing Health Sector initiatives in Benin's fight against HIV/AIDS. The team chose to do this within a project design which emphasizes and makes financial provision for the specific technical support role (rather than the previous leadership coordination role) that the Health Sector now has re other public sector organizations, as its contribution to mobilizing a multi-sectoral response to the epidemic. The Benin MAP's US$23 million credit over 4 years reflects the gap financing required to scale up the existing activities. With government arv4 other developnmf t pa'hL ers financing at some US$3 million a year, the Credit provides the necessary 1 SS5. 75 million per yea, whlich is required to achieve basic national coverage of comrnmunity rnobilizateion preventive antenatal and blood screening and counseling/care for PLWHA's. (2) In light of Benin's successful experience with different models of field based programmnatic support and direct financing for empowering communities to plan and execute their own development plans, the team rejected the option of choosing one model over the others, but has incorporated the best practices and lessons learned into the proposed contract with the FMF, which will be required to have the necessary national outreach coverage required for genuinely scaling up the empowerment of comnunities against HIV/AIDS. - 20 - (3) Despite all the entire group-specific data collection of the past years and the increasingly more defined understanding of which behaviors in which part of the country may characterize higher risk groups of the population, the team rejected the option for project interventions to be targeted exclusively towards populations at high risk of HIV infection. Such an approach is not consistent with the MAP framework, which is based on the premise that everyone is at risk, and/or affected or infected, for which the most appropriate response is the mobilization of diverse and locally owned multi-sectoral activities. Nevertheless, the team considers some "targeting" (in the sense of working with specific target groups such as PLWHA's) as unavoidable and the project will support eligible activities with such groups as associated with community Subprojects. 2. Major related projects financed by the Bank and/or other development agencies (completed, ongoing and planned). Latest Supervision Sector Issue Project (PSR) Ratings (Bank-financed projects only) Implementation Development Bank-financed Progress (IP) Objective (DO) Health and Population Project Component for HIV/AIDS S S Prevention; Institution Building (National Program for Fighting AIDS)-US$SI0 million Other development agencies USAID Plea by Policy Project; Social Marketing with PSI and IEC Canadian Cooperation Interventions Support with Professional Sex Workers in 2 departments of Benin (Atlantique and Mono) FAC HIV Prevalence Surveillance and IEC WHO Human Development Support and Financing of NGOs. UNAIDS Care of Persons Living with HIV/AIDS,Plea, and Strategic Planning UNDP Care, Hunan Development and Equipment Support Swiss Development Cooperation Support to Departmental Sanitary Center (Zou-Borgou) GTZ Care, Human Development and Equipment Support European Union Awareness among Students and Sex Workers about HIV/AIDS's mode of spread UNFPA Integrated Approach for -21 - HIV/AIDS through 3 small Programs: Reproduction Health, Sexual Health and Family Planning; Population and Development Strategies, and Plea IP/DO Ratings: HS (Highly Satisfactory), S (Satisfactory), U (Unsatisfactory), HU (Highly Unsatisfactory) 3. Lessons learned and reflected in the project design: The project design draws in particular from the experience gained in the design and implementation of MAPI Countries, and in the lessons summarized in the recent MAP 1 "Progress Review Mission". Scaling Up: It became clear that one of the biggest challenges for the implementation of Benin's National HIV/AIDS Strategy will be the range of different measures needed to scale up existing initiatives. As confirmed by the Gap Analysis, several excellent initiatives launched by the Borrower, NGOs and development partners are in execution, with less active commitment from most of the sectoral ministries to date. However, 16 years after the first reported patient with HIV/AIDS in Benin, the geographic coverage and range of services and preventive activities provided by these initiatives meet only a fraction of the nationwide needs, which must be addressed if there is to be a hope of limiting the spread of HIV/AIDS in Benin. The procedural and substantive strategies for scaling up in Components One and Two include: (1) Mass national mobilization: the mass national IEC campaign at project launch, and thereafter as an annual nationwide event, is to build on existing efforts, (which are project specific, in defined areas and focused on sensitizing and informing target groups) by consolidating over the life of the Benin MAP, a nationwide mobilization of urban and rural communities, to assume their responsibility for taking the necessary preventive measures, including consultation with and providing support to PLWHA's; (2) Simple, accessible, but robust implementation mechanisms: the generic selection criteria for proposals from communities and sectoral ministries, have already been agreed on during appraisal, and are already publicly available in the operational manual; approval of the community HIV/AIDS subprojects, on the basis of the very successful in-country experience will be handled at the lowest feasible level of the decentralized administration, namely the "arrondissement level"; (3) Expansion to national coverage and quality assurance for core technical areas of intervention: the MCT screening, blood transfusion safety, improved access to management of opportunistic diseases and care counseling support for PLWHA's and their families, and the implementation of sectoral action plans from a broader set of ministries. Community Behavioral Change The 18 country workshops on community participation and HIV/AIDS in Mwanza, Tanzania in June 2000 provided extensive discussion of several documented examples which adequately demonstrated that behavior change can be achieved through community participation-based identification and implementation of HIVAIDS action plans (Tanesa (Tanzania), Gaoua (Burkina Faso), Abengourou (Ivory Coast). Application of such community participation methodologies, already applied successfully by the Benin Ministry of Rural Development in its extension outreach services, has been piloted by the same ministry during project preparation to promote HIV/AIDS behavior change at the village level. The crucial role of the traditional leadership at the village level, (in Benin, such leadership is often the local traditional practitioner) to bring HIV/AIDS into the domain of public discourse, as a first step away from social stigmatism of PLWIHAs, and the equally crucial importance of recognizing the potential communal and individual risk associated with the high level of daily mobility and seasonal/periodic travel in and out of the village by certain groups of the population are key factors to have emerged from this experience. These findings have been incorporated into the design of Component One. - 22 - Contracting-Out This is an essential instrument for scaling up existing initiatives, and on the basis of positive experience with this approach over the past 5 years, in a series of Rural Development Credits, Social Fund Credit, and an Urban Services and Transport Credit; contracting-out is a key "cascade" mechanism for supporting the implementation of each project component; namely: Under Project Component One, the Project will subcontract for technical assistance and financial management support, with national and international NGO's, private sector agencies and civil society associations, in all three categories of activities: (1) the social mobilization (at national and local level), training and Subproject preparation; (2) the execution of the community Subprojects by the communities themselves; and (3) the execution of community-based HIV/AIDS preventive and provision of care activities by private sector organizations, NGOs and other civil society organizations. The PMU will contract out for the implementation of activities at the national level; at the regional level, a contracted Financial Management Firm will also subcontract other stakeholder agencies to assist the communities in the development and implementation of their HIV/AIDS Subprojects. Under Component Two, both non health public sector ministries and organizations will implement their action plans through collaborative partnerships and subcontracts with civil society agencies and associations; in the health sector, the five core areas of intervention will be both implemented by government and under subcontracts to the private sector and non-governmental agencies. Under Component Three, the PMU will contract out for technical assistance and implementation of activities in all 4 areas of responsibility in communications, capacity building, monitoring and evaluation and financial management. implementing across sectors and the CNLS as a "coordinating" body The inherent bureaucratic hurdles to be "overcome" when engaging multiple sectoral ministries in program implementation, within the framework of a newly created national public/private forum are self evident and experience to date with other MAP credits confirns the problems with turf conflicts and the consequent need to define specific roles for the public sector/private sector and civil society actors, and to have clear service standards with regular oversight from key stakeholders. In designing the project the team has sought to incorporate such checks and balances. To minimize bureaucratic inertia, the sectoral Ministries will essentially compete on equal terms, according to transparent criteria, for the resources available to support their action plans; once approved by an independent CNLS commission, a financial agreement specifying performance and reporting requirements will be entered into by CNLS, PMU and the relevant Ministry or public sector organization and the advance of funds deposited directly to the given mninistry or public sector organization account. At the forefront of all discussions about the role of the CNLS technical secretariat, and on the details to be specified in the revised CNLS decree, it has been consistently clarified that the secretariat has a facilitating and program coordination role; it will not implement programs (which is the role of the CNLS executing partners) and it does not take decisions over the national HIV/AIDS program plans and budgets (that is the role of the CNLS itself). 4. Indications of borrower commitment and ownership: (A) The preparation of the second medium-term plan (1994-2001) which launched the Government's multisectoral approach to the PLNS, and the Borrower's full compliance with the MAP criteria (all detailed in Section B2) substantiate the sustained political commititment of the Borrower to fight HIV/AIDS. - 23 - The following additional indications of continuing borrower commitment include: (B) The participatory and consultative nature of the MAP project preparation and appraisal process has involved a team of multi-sectoral government and key civil society stakeholders. At identification, a 5-day brainstorming with this Benin team led to the specification of project objectives and the outlining of the main components. (C) At the national level, the government continues to seize opportunities to keep the issue of HIV/AIDS at the forefront of the public agenda. July 30th-August 2nd 2001, the government hosted the 4-day, 5 country (Benin, Ghana, Ivory Coast, Nigeria and Togo) workshop on the subregional HIV/AIDS Project for the Abidjan-Lagos Transport Corridor. With the financial support of USAID, the technical assistance of the UNAIDS inter country Team for West and Central Africa, and facilitated by the World Bank, mixed teams of program professionals/decision makers and civil society activists from the participating countries met, under daily press coverage, to discuss the draft concept document for the proposed subregional project. The potentially significant role of the cross border, cross-country transit movement of passengers and transporters in the transmission of HIV/AIDS in Benin, (cf section B2. 1) is an issue publicly recognized by the Government 5. Value added of Bank support in this project: The value added of Bank support is three-fold. First the Bank has a comparative advantage in mobilizing substantialfinancial resources for scaling up the national program. While many donors are supporting the national program, the Bank has represented the single largest source of funding over the past five years, and is likely to continue playing a pivotal role. Moreover, Bank funding can play a catalytic role within Benin, in attracting additional funding from other development partner. Second, the Bank, through its macro dialogue with the country on the PERAC and PRSP, is in a position to assist the Borrower in mainstreaming a multi-sectoral approach to HIV/AIDS, within the country's overall financial and development strategy. Third at the regional level, the Bank is playing a key role in the reorientation of the response to the HIV/AIDS epidemic, away from it being seen as a medical issue, towards it being understood as a development issue, and is therefore well positioned to assist the Borrower to make use of available regional experiences, and adapt them to the Benin context. Benin's participation in the MAP will provide opportunities to network with other countries supported under the umbrella operation. E. Summary Project Analysis (Detailed assessments are in the project file, see Annex 8) 1. Economic (see Annex 4): 0 Cost benefit NPV=US$ million; ERR = % (see Annex 4) o Cost effectiveness * Other (specify) 2. Financial (see Annex 4 and Annex 5): NPV=US$ million; FRR = % (see Annex 4) Mobilization of grant resources: To be able to cover the cost of HIVIAIDS program in Benin, the proposed IDA credit alone will not be enough. Although other donors are funding the program, additional grant resources are being sought. It is envisaged to organize a donor round table shortly to mobilize additional resources. - 24 - Allocation of HIPC resources: It was specified in the HIPC documents that HIV/AIDS should be one of the priority areas to allocate resources stemming from the debt reduction. During appraisal, the team secured confirmation that HIPC resources will be used for funding eligible sector specific strategies. Fiscal Impact: Given that this is a multi-sectoral project, supporting both public sector and civil society responses to the HIV/AIDS epidemic, the fiscal burden of the project is expected to be negligible for several reasons. First, the recurrent costs of the project are low. Second, given the nature of the project activities, investment costs are not expected to involve operation and maintenance in the future. Third, annual disbursements by the project are low in comparison to government current expenditures, and government counterpart contributions are not high. In addition, a large portion of the resources will be directly channeled to support the civil society initiatives rather than to finance government initiatives. 3. Technical: As per the umbrella MAP project, the project follows internationally accepted best practices for an HIV/AIDS response, as validated by UNAIDS. In particular, the Borrower's National IHIV/AIDS Strategy is structured around; (1) the needs of different categories of the population; (2) different categories of interventions; and (3) the institutional framework to facilitate the mobilization of efforts to meet those needs. One of the most important features of the strategy is that in discussing how to apply the different categories of interventions to support the different categories of the population, examples of the different activities which can be undertaken by the different technical sectors of the government and civil society, are provided. On this basis the project has been structured around providing support for the response of: (1) civil society; (2) the public sector; and (3) the institutional capacity required to mobilize this response. The project design provides for civil society and the public sector to formulate their responses, and provides financing for them to implement them. The generic eligibility criteria are not intended to be prescriptive or restrictive, but simply to serve as a reference framework for the CNLS, the PMU and their respective decentralized actors, to support, monitor and evaluate project activities. 4. Institutional: See Section C3.2 (Key policy and institutional reforms supported by the project) and Section C3.4 (Institutional and implementation arrangements). 4.1 Executing agencies: See section C3.4 Institutional and implementation arrangements, (para 2); and the role of partner agencies. 4.2 Project management: See section C1.3. (Support to Project management, monitoring and evaluation) and section C3.4 (Institutional and implementation arrangements; para 1 Project Management). 4.3 Procurement issues: The findings of the Country Procurement Assessment Report (CPAR) for Benin was completed in April 1999. Despite some discrepancies, inconsistencies and delays reported in the approval phase of the procurement process, no special exceptions, permits, or licenses need to be specified in the Development Credit Agreement for International Competitive Bidding (ICB), since the Borrower's procurement practices allow IDA procedures over any contrary provisions in local regulations. Procurement for small works, goods, and services will be carried out under all three project components (See above: 2. Fiscal Impact). For components 2 and 3 it is possible to arrive at a reasonable estimate of the relative mix of these categories of procurement. For Component 2 drugs and medical equipment will be procured through international competitive bidding, except for the drugs and medical equipment for government agencies. -25- These latter purchases will continue to be made through contracts with the established channels for medicine supply unit CAME (Centrale d'Achat des Medicaments Essentiels). However, due to the demand driven nature of the community-based initiatives in Component 1, the types of activities and their procurement details will depend on the needs identified by the beneficiaries. Funding for these activities will be in the form of grants to which beneficiaries may choose to contribute in kind or in financial resources. The Bank guidelines for simplified procurement and disbursement for community-based investments will be applied for procurement under this component of the project. These simplified procurement and disbursement procedures have been included in the (OM) for the project to empower the beneficiaries in conducting their own procurement as may be indicated by their HIV/AIDS action plans. These guidelines also include the (1) negative list of items excluded under this component; (2) the average of US$1,000 and a ceiling of US$3000 per annum per community request. Procurement will be carried out by the PMU for facilitating activities in all three components and Consultant services would be procured according to guidelines on the use of consultants (January 1997, revised September 1997 and January 1999). The PMU would be responsible for ensuring compliance with all the OM guidelines, and ex-post reviews of a random sample of the sub-projects of Component 1, and of sub-contracts and financial management agreements undertaken by the PMU and executing agencies in all 3 components, will be conducted periodically by the Bank and independent consultants appointed by the Government. Details on the procurement procedures and arrangements are provided in Annex 6. 4.4 Financial management issues: The disbursement arrangements must be supple, combining adequate but simple requirements with efficient procedures, to ensure the timely flow of funds to finance the different categories of activities foreseen for the different components of the project. To this end, two Special Accounts A and B, will be opened in a commercial Bank, under the responsibility of the Project Coordinator and the Project Financial Management Specialist. Special Account A: Financial Flows for Component 1: support to response of civil society: The resources of this Special Account will be exclusively used for the financing of subprojects initiated by communities, registered associations (social, occupational, professional, religious groups, NGOs and private sector unions. The project will use the financial management services of a Financial Management Firm (FMF) that would have been well established to affect the transfer of funds required by this component. Under the contract between the FMF and the CNLS, six project Second Generation Special Accounts, (SGSA) will be opened in the six local offices of the FMF. As soon as the decision to finance a Subproject has been taken by the local level review and selection committee (an entity completely independent of FMF) the approved Subproject proposal will be forwarded to the appropriate local FMF for financing. After having promptly completed the necessary checks for compliance with financial management procedures, CDLS and the departmental FMF will then enter into a grant agreement with the authorized representatives of the community which will implement the relevant Subproject, and simultaneously release the first tranche of funds, the release of the second tranche beirifg subject to the sub-project's compliance with both program and financial management reporting requirements specified in the manual. The first payment to each of the six SGSA managed by the local FMFs will be calculated on the basis of an estimated 90 days of expenses, the total sum of this first payment will be applied for by the PMU and will then be transferred to local FMF. The PMU would submit quarterly expenditure reports indicating the -26 - sources and use of funds and accompanied by reconciled bank statements. Replenishment of these sub-accounts will be on the basis of the disbursements effected to finance the community sub-project agreements facilitated by the respective departmental FMF. As it might have been already established practice, each departmental FMF will be required to provide simple justifying documentation, in the form of SOE's to ensure replenishment of their respective sub-accounts. When submitting replenishment requests, the PMU would ensure that the reconciled bank statements for the special accounts, in the standard format, show the deposits received from IDA, the amount advanced to each decentralized project location, the date on which each advance was made and the amount awaiting documentation from each of these locations. In addition, each FMF local bureau will justify the use of their resources under the SGSA or replenish their SGSA on a monthly basis. Special Account B: Financial flows for Components 2 and 3 Component 2: Support to the response of the public sector The independent CNLS commission will review the action plans of the sectoral ministries, including the MOH, and other public institutions, and following approval of the plans provision will be made for 2 different categories of disbursement modalities required. a) Arrangements for the financing of the purchase of medical equipment, medical supplies, laboratory reagents, condom, IEC equipment, and consultant services for various studies and for technical assistance to support the formulation of the sectoral action plans fall in this first category. For the purposes of efficiency and economies of scale, the established procedure for financing activities with IDA resources will be applied, following the related established procurement requirements, resulting in either Direct Payment or payment from the Special Account B, with the justifying documentation to be held centrally by the PMU. The responsibility for implementation and monitoring of the specific activity so financed will be held by the sectoral ministry or public sector organization, whereas the PMU will merely execute the relevant payments, as per the instruction of the Ministry or institution, within the context of the given Action Plan. b) Interventions and initiatives (foreseen within these action plans) but requiring small scale funding, such as discrete training or awareness raising activities, or a work program, of a series of various related small scale initiatives, will all fall into this second category. In order to avoid the impact of the slow rate of mobilization of human and financial resources usually associated with the public sector, following the approval of the sectoral action plan, the given ministry or public institution will sign the related financial agreement and open an account in a conmnercial bank, the Administrative Director (DA) and the HIV/AIDS focal point of the ministry or institution being the only signatories. Just as in the case of the Component 1 Subprojects, a first advance payment will then be deposited to the Ministry or public sector organization/agency 's account. Component 3: Support for project management: These finances will cover consultant services, audits and operating costs (as specified in the DCA). The project coordinator and the financial management specialist will access and replenish funds as needed, on the basis of their joint signatures, and in compliance with established procurement and disbursement procedures established by IDA for such project management units. See section C 3: Support to project management/ financial management and monitoring and evaluation; and Annex 6. - 27 - 5. Environmental: Environmental Category: B (Partial Assessment) 5.1 Summarize the steps undertaken for environmental assessment and EMP preparation (including consultation and disclosure) and the significant issues and their treatment emerging from this analysis. The August 2001 management decision that all MAP projects are to be considered as Category B came during project appraisal; consequently this summary covers the steps taken to date, the issues raised and the irnmediate steps now to be taken, to ensure the required compliance. Steps taken to date The various issues associated with the management of hospital waste, in its specific relation to the management of HIV/AIDS waste, had in fact already been explicitly raised with the Borrower during the December 2000 Identification mission. The identification mission had pointed out that in many countries, the inappropriate handling of HIV/AIDS infected materials constitutes a risk not only for staff in hospitals and in municipalities who are involved in waste handling, but also for families and street children who scavenge on dump sites. The mission had also already confirmed that some aspects of the proposed project implementation (e.g., the establishment of testing clinics, the purchasing of equipment by communities for home care of the sick, etc.) could constitute an increase in the environmental risk with regard to the handling of HIV/AIDS infected waste. 5.2 What are the main features of the EMP and are they adequate? Following up on these issues, the appraisal team (7/30-8/14) examined in more detail: the quality of hospital and HIV/AIDS waste management by both hospital and municipal authorities, the level of the related personnel's knowledge about safe waste management, and the availability of appropriate equipment. The appraisal mission ascertained the following: (a) As of 1995, within the terms of its own Environmental Health Management Plan (EMPH), the Ministry of Health has required that the construction plans and equipment for new Health Facilities, at all levels of service provision, must include hospital waste incineration capacity. (b) To ensure this Waste Management capacity is also available in those Health facilities constructed before 1995, the Borrowers Medium Term PIP 2001-2004 also provides for financing the purchase and installation of incineration facilities in the pre 1995 health facilities. (c) Under this current Public Investment Program (PIP), a Ministry of health designed and locally constructed model incinerator is being provided for the most decentralized health facilities, with appropriately more complex imported models complying with intemational norms being allocated for the more centralized health facilities. In light of these findings the project would provide for systematic training and capacity building (on the subject of HIV/AIDS waste management) of all health personnel rtsponsible for managing existing Incineration and Waste Management Units in medical facilities. 5.3 For Category A and B projects, timeline and status of EA: Date of receipt of final draft: Final draft will be required by Bank 01/31/02 Following recent management decision to consider all MAP projects as category B, intemational expertise has been immediately recruited to initiate the process of assisting the Borrower to prepare a comprehensive Clinical Waste Management Plan, for completion as a condition of effectiveness. - 28 - 5.4 How have stakeholders been consulted at the stage of (a) environmental screening and (b) draft EA report on the environmental impacts and proposed environment management plan? Describe mechanisms of consultation that were used and which groups were consulted? Both during the identification and appraisal mission the MOH was consulted specifically on the Government's policy and the status of clinical waste management (See Section E 5.1 and 5.2 above). Specific groups to be consulted during the preparation of the Clinical Waste Management Plan will include: (1) the national association of PLWHAs and affected families; (2) the implicated sectoral ministries (i.e. Environment/National Resources and Urban Planning; Public Works and Transport; Social Protection; Tourism); (3) managers/owners of private companies subcontracted for municipal waste collection and disposal; (4) Public Health personnel responsible for oversight of the hospital and health facility clinical waste management; (5) the manufacturers of the locally constructed incinerators; street children, owners of bars and dance halls, residents near and scavengers of waste dumps; and (6) members of CNLS at different levels of decentralization. 5.5 What mechanisms have been established to monitor and evaluate the impact of the project on the environment? Do the indicators reflect the objectives and results of the EMP? The project has used the UNAIDS framework of grouping indicators by categories; specific to this project, the categories to be monitored are indicators of: social mobilization; mother to child transmission, blood safety, care and support, and policy. On the basis of stakeholders consultation the M&E manual for applied use by all executing agencies in the project is in preparation. This simple and common framework will permit standardized monitoring of project financed activities and will be available for CNLS discussion with a view to establishing a nationally common set of HIV/AIDS reporting indicators. Following completion of the Clinical Waste Management Assessment, it will be possible to identify an appropriate category of simple monitoring indicators, for inclusion in the appropriate category (i.e. social mobilization, care and support, policy) in the common M&E project manual. The project already makes provision for any additional research studies that may be required. 6. Social: 6.1 Summarize key social issues relevant to the project objectives, and specify the project's social development outcomes. Experience in other countries confirms that special measures should be taken to protect the rights of PLWHA. From the outset, the Benin HIV/AIDS project team has included consultation with PLWHA in the preparation and design of the project, so that they themselves could flag critical issues and identify appropriate actions and modalities. Representation of the PLWHAs at every level of the CNLS is now ensured, and project implementation now provides for support to PLWHAs as an association or within their community HIV/AIDS subprojects, or from NGO/private sector executing agencies of the project. Increased coverage and improved quality of care services for PLWHAs, and consequently improved quality of life for them, is the anticipated social development outcome. Neither in formal law, nor in practice, do women have equal rights with men in Benin, and in cultural practice, especially in the countryside, women often have no public voice in social or sexual matters. In Benin, the virus is transmitted predominantly through heterosexual contact, and while women, children, and commercial sex workers are the key groups with increasing rates of infection, or at very high risk, men play a predominant role in the continued transmission of the HIV virus in their regular/seasonal trading and social migrations. As a consequence, the second and increasingly significant way in which the virus is spread is through mother to child transmission. In both scenarios the socially disempowered status of women is a powerful underlying factor. - 29 - The project provides for increased coverage of HIV/AIDS testing/counseling /treatment for prenatal mothers, and increased availability of quality services for treatment of STIs. A reduction in the number of HIV/AIDS infected children and reduction in the STI transmission rates, (resulting in improved quality of life for the implicated children, women and men) are the anticipated health/social development outcomes. The project also provides for advocacy and technical assistance to continue the necessary legal and regulatory reforms required to legally and socially empower women and children, social issues which are brought into high profile by the HIV/AIDS epidemic. The National HIV/AIDS Strategy identifies the following legal domains and regulatory measures for action: new laws and regulations to establish the rights of women in divorce, and in polygamous marriages; and in inheritance; regulations to effect the already approved decree abolishing the charge required of "apprentices" for their release from employment; regulations to apply existing legislation to ensure the full protection of the law for children in "difficult circumstances"(i.e. orphans; children placed with families under the "vidomegon" system). 6.2 Participatory Approach: How are key stakeholders participating in the project? Stakeholders Participation in the program Project design and preparation: involvement of The project is the product of a series of government stakeholders actions, followed by participatory work done by the key stakeholders at the national level with leadership from the World Bank. The working group included representatives from the key ministries, PNLS, PLWHA associations, and NGOs already active in fighting HIV/AIDS. Consultations have also been held with UNAIDS partners at the various stages of project preparation. A consultative workshop for key stakeholders to review and validate the project operational manual was held before negotiations and stakeholders were also involved in the preparation of the monitoring and evaluation framework Project Implementation: Communities and other eligible groups will Rural, urban, and special communities participate by drawing up priority action plans in participatory exercises. Their Subprojects will be financed by the project under rules to be discussed with the beneficiary groups, and such groups will be assisted to design and implement a permanent process of social monitoring. People living with HIV/AIDS People living with HIV/AIDS will be represented in the CNLS committees at all levels (national, regional, and communal) and are eligible for care services and support by communities and private sector groups whose action plans are financed by the project. Sector organizations To ensure full involvement of all organizations in the sector, priority ministries and private organizations will participate on the CNLS coordination committees and will help develop and implement sector-specific HIV/AIDS strategies. NGOs, civil society, religious groups Civil society organizations will be sub-contracted to - 30 - develop and implement the "support to civil society's response" (Component 1) and "support to the public sector response" (Component Two) within specific terms of reference and budgetary envelopes. The field activities of and the use of funds by these organizations will be subject to routine supervision. UNAIDS Partners Collaboration will continue in 3 specific ways: (1) UNAIDS partner agencies along with the Bank will be members of the CNLS "consultative group" advising the CNLS secretariat on program plans and financing for the execution of the National IHIV/AIDS strategy; (2) As consultative members of CNLS and financing and executing partners, UNAIDS agencies will also participate in the application of the common M&E framework; (3)UNAIDS partners will be invited to participate in project supervision missions. 6.3 How does the project involve consultations or collaboration with NGOs or other civil society organizations? NGOs will be involved as implementing agencies, especially in the community-managed response component. The role of NGOs will be to sensitize and assist communities in the participatory process of preparing and implementing their HIV/AIDS action plans. The OM spells out the procedures and criteria for identification, selection and contracting of NGOs. During project launching, workshops will be organized to discuss and agree with the potential implementing agencies on the methodologies, work organization, budgets, supervision mechanisms, and procedures for financial control. 6.4 What institutional arrangements have been provided to ensure the project achieves its social development outcomes? The Technical Secretariat of the CNLS will have on staff a community development specialist who in collaboration with the M&E specialist of the PMU would monitor the changes regarding women and marginalized groups in society. 6.5 How will the project monitor performance in terms of social development outcomes? The key project indicators (Annex 1 and the M&E Annex) include gender responsive indicators (discrete health status; community activities indicators, and behavior change indicators). These indicators have been developed in line with the UNAIDS recommended indicators for M&E of HIV/AIDS programs, and: (a) compliance with reporting within the project M&E framework will be required of all project executing agencies including communities; (b) this M&E framework and format has already been agreed to at a post appraisal stakeholders workshop and at negotiations; it will be proposed to the CNLS as the standard format for validation and adoption by all CNLS executing agencies at credit effectiveness. Conmmunities will carry out their situation analysis, following the model of a participatory diagnostic, and they will include simple social indicators, consistent with the project M&E framework as part of their action plans, and as a means of self monitoring their activities. - 31 - 7. Safeguard Policies: 7.1 Do any of the following safeguard policies apply to the project? Policy Applicability Environmental Assessment (OP 4.01, BP 4.01, GP 4.01) 0 Yes 0 No Natural Habitats (OP 4.04, BP 4.04, GP 4.04) 0 Yes 0 No Forestry (OP 4.36, GP 4.36) 0 Yes * No Pest Management (OP 4.09) 0 Yes 0 No Cultural Property (OPN 11.03) 0 Yes * No Indigenous Peoples (OD 4.20) 0 Yes 0 No Involuntary Resettlement (OD 4.30) 0 Yes 0 No Safety of Dams (OP 4.37, BP 4.37) 0 Yes * No Projects in International Waters (OP 7.50, BP 7.50, GP 7.50) 0 Yes 0 No Projects in Disputed Areas (OP 7.60, BP 7.60, GP 7.60)* 0 Yes 0 No 7.2 Describe provisions made by the project to ensure compliance with applicable safeguard policies. Systematic training and capacity building (on the subject of HIV/AIDS waste management) of all Health personnel responsible for managing existing Incineration and Waste Management Units in medical facilities. Consequent to the categorization of all MAP projects as Category B, (8/2001) the following additional provisions have been made: Using available PHRD funds, the appropriate international expertise has been contracted to initiate the process of assisting the Borrower to prepare a comprehensive Clinical Waste Management Plan. The Borrower agreed during negotiations that completion with full costing of this Clinical Waste Management Plan is a condition of effectiveness; the draft plan is already being circulated for technical comments. F. Sustainability and Risks 1. Sustainability: The risk factors that may affect sustainability are primarily those of lack of adequate capacity at a sufficient scale: whether it be required of NGO's and CBO's in their role of supporting and empowering the country villages and urban communities; or of the Ministry of Health, in its role of assuring basic national coverage and quality of key preventive and care services related to the transmission and treatment of HIV/AIDS; or of the CNLS technical secretariat and CNLS partners in their role of organizing and consolidating the national studies, detailed facilities monitoring, data collection and analysis needed to inform the management of the implementation and forward planning of the National HIV/AIDS Strategy. Other risk factors relate to the reality that dealing with HIV/AIDS involves working publicly in the sensitive areas of sexual health and 'behavior; in Benin the social stigma associated with HIV/AIDS is directed at PLWHA's rather than CSW's. Politically, the project is expected to be sustainable because its point of departure is the leadership and commitment shown by government, and the current strong ownership of the Ministries of Finance, and of Plan, of the MOH and the five Sectoral Ministries which have already developed and launched the execution of their own Sectoral HIV/AIDS Action Plans in the past 3 years. To tackle the issue of organizational and technical capacity, the Project support for strengthening the capacity of the CNLS to - 32 - oversee the national program, and for reinforcing, extending and consolidating this government ownership among the remaining 16 sectoral ministries, is expected to establish a sound and broad basis for sustaining such activities. The Project also privileges institutional capacity building in the public, private and NGO sectors, and in the fornation of public/private partnerships in all activities, at the national, regional and local levels, at all stages of implementation, as a key mechanism for building sustainable social capacity to manage the country's response to the epidemic. The project mechanisms, designed on the basis of the established successful in-country experience with extensive subcontracting and direct financing to empower innovative development approaches by village and urban communities, are expected to bring early successes in the scaling up and replication of existing HIV/AIDS preventive activities and care services for PLWHA's, which will both help generate sustained support, and stimulate further replication. 2. Critical Risks (reflecting the failure of critical assumptions found in the fourth column of Annex 1): Risk Risk Rating Risk Mitigation Measure From Outputs to Objective Govermment reverses or fails to follow-up M Detailed discussion of sub-contracting on the strategy to implement HIV/AIDS arrangements with stakeholders in Government program through multitude of and among civil society to ensure ownership of sub-contracting organizations the proposed implementation arrangements. Severity of their condition, social S National IEC Launch and iterative awareness rejection, and personal reluctance of campaigns to support village and urban PLWHA prevents their self-organisation community recognition of their role in the care as an association for access to project of PLWHA. support. Proactive outreach by national and decentralised Project staff. In the interests of patient privacy and confidentiality, established village level committees will be eligible to develop proposals with and manage financial resources for Associations of PLWHA. Committment by the 21 Sectoral M Technical and financial resources are available Ministries, key state organisations and to the Ministries for the preparation and pfivate sector employers is not sustained execution of their HIVAIDS Action Plans; those 5 Ministries which have already successfully drafted and launched the execution of their first plans will advise others on the basis of this experience. Adequate capacity in the Ministry of S The design of each of the three project Health and CNLS technical secretariat components privileges capacity building for and among CNLS partners to organise the both the Borrower and civil society; one of the required training, studies, detailed specific roles of the PMU is to ensure timely facilities monitoring, data collection and and sustainable technical resources in capacity analysis is not available building are available to both the CNLS technical secretariat and to the Ministry of Health. - 33 - From Components to Outputs Sufficient capacity to ensure the S Iterative organization of national level and implementation of the project is not found decentralized workshops by PMU and among NGOs, CBOs, etc. decentralized Project technical staff to mobilize existing capacities in private sector and civil society, and to ensure capacity building when needed. PCU and decentralized technical staff to annually evaluate NGO and CBO contract performance. The Borrower fails to organize the related S The project provides for sustained international staff training, and the purchase / technical assistance to support the Borrower's distribution of supplies of HIV/AIDS test Ministry of Health in this complex but urgent equipment and medical treatment in a task; the project also provides for "punctual" timely manner. TA from Benin's UNAIDS development partners. In addition, the project will be managed by a PMU that will be established within the Technical Secretariat of the CNLS The Borrower fails to ensure timely S The project provides for technical support for deposit of funds, nominally allocated for the formulation and financing of the execution the support of the execution of these plans of the Ministries initial Plans; with the increased in the Annual National Budget. number and improved quality of such sectoral (Authorized by Decree 8/2000) plans, and their experience in execution, the integration of these plans in the annual budget will be more feasible. The national IEC and mobilization M The project provides for the mobilization of the campaign, over the 4 years of the project, extensive coverage of the existing 55 Rural will not reach Benin's remote Radios network; complemented in follow-up by communities i.e. ("lake conrmunities" the enlistment of the traditional leaders of "river migrant communities" and remote villages and kingdoms as the local "animators" villages.) of CNLS. The PMU does not launch nor sustain M An existing IDA funded project (Health & appropriate capacity building for the Population Project) provides for both the CNLS technical secretariat of the CNLS, in a technical secretariat and the PMU to be timely manner. established and to launch preparatory activities for the first year before project effectiveness. Mechanisms to organize efficient and N Program will sub-contract financial effective provision of technical and management and transfer of resources to private financial resources directly to the sector, with decentralized technical staff communities are not set in place in a providing continuous monitoring and follow-up. timely manner, leading to delays in Iterative study to identify and alleviate transfer of funds between financial constraints and causes for any delays in the institutions from the national to the transfer of financial resources to the decentralized level; from the decentralized communities. level to the communities resulting in delays for communities in accessing project resources. Overall Risk Rating - 34 - Risk Rating - H (High Risk), S (Substantial Risk), M (Modest Risk), N(Negligible or Low Risk) 3. Possible Controversial Aspects: Public discussion of sexual matters and sexual behavior remains taboo and there is an associated very high level of stigma associated with HIV/AIDS and towards PLWHAs. The social marketing of condoms, in the context of advocacy for responsible and safe sexual behavior remains contrary to certain belief systems and compounds the level of social stigma associated with HIV/AIDS.As one means of empowering PLWHAs and launching a change in the public perception of them, the project provides for: (1) participation of PLWHAs in all levels of the CNLS, (2) support for PLWHAs either indirectly and anonymously through the financing of community Subprojects; or indirectly through project financed support from NGOs and faith based agencies; or directly through financing of a Subproject of an association of PLWHAs. G. Main Loan Conditions 1. Effectiveness Condition (a) the Borrower has issued the new CNLS Decree, in form and substance satisfactory to the Association, and the several units or committees to be established under the new CNLS Decree, including a technical secretariat at CNLS and the Decentralized Committees of CNLS, have been established each in a form and with functions, staffing and resources satisfactory to the Association; (b) the Project Account has been opened and the initial contribution of the Government has been deposited; (c) the Borrower has adopted the Project Implementation Manual, the Administrative, Accounting and Financing Manual, and the Monitoring and Evaluation Manual, all in form and substance satisfactory to the Association; (d) the Borrower has adopted a procurement plan for the implementation of the Project during the First Project Year; (e) the Borrower has established the PMU in a manner and with functions and resources satisfactory to the Association, and with the following staff: a Project coordinator, a HIIV/AIDS specialist, a financial management specialist, a monitoring and evaluation specialist and a procurement specialist, (f) the Borrower has established an accounting and financial management system for the Project satisfactory to the Association; (g) the Borrower has employed the Financial Management Agency under conditions and terms satisfactory to the Association; (h) the Borrower has adopted a Clinical Waste Management Plan (CWMP) in form and substance satisfactory to the Association. 2. Other [classify according to covenant types used in the Legal Agreements.] Project covenants would include: (a) The Borrower shall implement the CWMP, in a manner and according to a timing satisfactory to the Association. - 35 - (b) By the end of the First Project Year, the Borrower shall adopt a master plan for the development of a comprehensive monitoring and information system to monitor the HIV/AIDS epidemic in its territory on an ongoing basis, in form and substance satisfactory to the Association. (c) By the end of the First Project Year, the Borrower shall adopt a comprehensive baseline study to allow evaluation of key performance indicators related to HIV/AIDS issues, including epidemiological and behavioral aspects of the HIV/AIDS epidemic, in form and substance acceptable to the Association. (d) By November 15 of each year during the implementation of the Project, commencing on November 15, 2002, the Borrower shall submit to the Association for its review and comments its draft of: (i) the program of activities to be carried out under the Project during the following year; and (ii) the related budget and procurement schedule. The Borrower shall, in preparing the final version of such program, budget and procurement schedule, take into account the comments made by the Association. By each calendar year during the implementation of the Project, commencing on December 31, 2002, the Borrower shall adopt the program of activities to be carried out under the Project during the following calendar year, and the annual related budget and procurement plan, in form and substance satisfactory to the Association. (e) The Borrower shall by April 30, 2002, employ the independent auditors. H. Readiness for Implementation [ 1. a) The engineering design documents for the first year's activities are complete and ready for the start of project implementation. 1 I. b) Not applicable. a 2. The procurement documents for the first year's activities are complete and ready for the start of project implementation. I 3. The Project Implementation Plan has been appraised and found to be realistic and of satisfactory quality. X 4. The following items are lacking and are discussed under loan conditions (Section G): Under the Japanese PHRD Grant, consultants prepared an Implementation and M&E Manuals which were reviewed at a national workshop held in August after the appraisal and prior to the negotiations. Within two months after Board presentation, these Manuals will be completed and validated by the CNLS since this is a conditionality for effectiveness. A consulting finn was hired to prepare the Administrative, Accounting and Financial Management. The manual will be completed within two months after Board presentation since this is a conditionality for effectiveness. 1. Compliance with Bank Policies El 1. This project complies with all applicable Bank policies. 1 2. The following exceptions to Bank policies are recommended for approval. The project complies with all other applicable Bank policies. - 36 - OP/BP 10.02 requires that when audit costs are financed by the Bank, (a) the audit firn should be selected in accordance with the Bank's Guidelines for Selection and Employment of Consultants and (b) disbursed under the operating costs category. As an outcome of consultations between the client and the Task Team, it was decided that the costs of the annual independent audit would instead be allocated to and disbursed from the "Constants services" category, instead of the "operating costs" category. issoussi Joseph B -Dwomoh Antoinette M. Sayeh * /TeatLeader Sector Manager/Director Country ManagerlDirector - 37 - Annex 1: Project Design Summary BENIN: Multi-Sectoral HIVWAIDS Project Key Performance Data Collection Strategy Hierarchy of Objectives Indicators i: _:;_:::: _______;: ___: Critical Assumptions Sector-related CAS Goal: Sector Indicators: Sectorl country reports: (from Goal to Bank Mission) Sector related CAS Goal Contribute to poverty Poverty indicators in samples Documents on socio-economic The country does not record alleviation by promoting of urban and rural surveys any major economic, social or human development communities political crisis Project Development Outcome / Impact Project reports: (from Objective to Goal) Objective: Indicators: Build capacity in both civil (i) HIV prevalence rate MOH sentinel surveys No unexpected massive society and the public sector to among pregnant women aged migratory phenomena scale up and diversify their 15-24 seeking prenatal efforts to stabilize the consultation at sentinel sites No significant sociopolitical transmission of HIV/AIDS by would be reduced by at least unrest empowering active community 5% in reference to the participation and multi- baseline study by the end of sectoral govemment the Project initiatives. (ii) HIV prevalence rate MOH sentinel surveys Adequate political among people seeking commitment treatment for sexually transmitted infections (STIs) would be reduced by at least 8% in reference to the baseline study by the end of the project (iii) Percentage of pregnant Special sentinel surveys, GTZ women aged 15-24 attending survey, SIDA-2 Project antenatal clinics who test positive for syphilis would be reduced by at least 2% in reference to the baseline by the end of the Project. (iv) HIV prevalence among MOH sentinel surveys core transmitters groups (Commercial sex workers, truck driver, youths, etc.) would decrease by 20% in reference to baseline survey by the end of the Project (v) Percentage of households DHS, UNAIDS population with a chronically ill adult survey aged 15-49 who have in the last twelve months received free extemal help in caring for the patient or replacing lost income would increase by 20% in reference to baseline survey by the end of the Project. - 38 - Key Performance Data Collection Strategy Hierarchy of Objectives Indicators Critical Assumptions Output from each Output Indicators: Project reports: (from Outputs to Objective) Component: Component I Increased knowledge, 1.1. Number of community -Progress reports from - Agreement from organizational capacities and organizations intermediaries decentralized authorities and resources in communities (villages/specific groups) -Progress reports from opinion leaders. and/or associations to established, trained and regional coordination units Government commitment to effectively implement elaborated their subproject implementation of national activities for the fight against through the participatory and HIV/AIDS program by AIDS planning exercise would partnerships with civil society/ range between 1300 and 2000 private sector and NGO's. in at least 50% of the villages by the end of the Project. 1.2. Number of Community -Subproject proposals and HlV/AlDS Committees completion reports receiving support to -Progress reports from implement their Subprojects intermediaries would be: Yl: 100/150; Y2: -Progress reports from 150/225; Y3: 200/300; Y4: regional coordination units 200/325; Total: 750/1000. 1.3. By the end of the Project, -Subproject proposals and at least 2500 community completion reports Subprojects would be -Progress reports from successfully completed intermediaries 1.4 Number of self-sufficient -Progress reports from -Reluctance of PLWHA to and functioning PLWHA regional coordination units reveal their identity and support groups and -Beneficiary Assessment organize themselves into associations will be at least: Studies associations Y I: National Association with at least 25 members. Y2: 6 Regional Associations with at least 25 members; Y3 20 Communal Associations with at least 10 members; Y4: 40 Communal Associations with at least 10 members and networked with the National Association. Component 2 2.1 Strengthened and 2.1.1. By the end of the Sector Action Plans Sustained commitment by the expanded response of Project at least 15 ministries 21 Sectoral Ministries, key non-health public sector and 30 public sector state organizations and private organizations and significant organizations would have sector employers. private sector agencies to the formulated their action plans. impact of HIV/AIDS on their - 39 - staff and the implications of the epidemic for the orientation of their Sectoral programs and business plans 2.1.2.Percentage of public Number of sector organization sector education institutions HIV/AIDS Action Plans with HIV/AIDS integrated into their curriculum would increase by 100%. 2.2. Enhanced quality of care 2.2.1. Percentage of women Special Studies (Health Adequate capacity in Ministry and availability of health care testing for HIV positive at Facility Surveys), Training of Health and CNLS services and information for antenatal clinics who are Reports secretariat and partners to the prevention, care and provided with a complete organize the training, studies, treatment of HIV/AIDS/STI. course of ARV therapy to detailed facilities monitoring, prevent mother to child data collection and analysis transmission will be at least required. 50% by end of the Project. 2.2.2. In those facilities where Special Studies (Health blood units are transfused the Facility Surveys), Annual percentage that have been Health Study. screened for HIV according to national guidelines will be 100% by the end of the Project. Component 3 Reliable data on the evolution Effective 2nd generation Quarterly reports to CNLS. The secondment by of the epidemic surveillance system, linking Government of appropriately (HIV/STI/knowledge/attitudes/ epidemiological and behavioral skilled staff to the Technical behaviors) and program results surveillance established by end Secretariat of the CNLS is are regularly disseminated and of first 18 months for CNLS effected in a timely manner. used by decision-makers in reporting. formulating policy decisions and strategic interventions. -40 - Key Perfornance Data Collection Strategy Hierarchy of Objectives Indicators Crtical Assumptions Project Components / Inputs: (budget for each Project reports: (from Components to Sub-components: component) Outputs) Component I Increased knowledge, 1.1 By the completion of the Progress reports from - Sufficiency of competent organizational capacities and Project, number of people in intermediaries. NGOs and other executing resources in communities implementing agencies -Progress reports from agencies. mediated by support from mobilized to implement the regional coordination units. associations, NGOs and Support to Civil Society decentralized Response Component would structures competent to be at least 200 women and accompany them in the fight 200 men i 50% of the against AIDS. communities at least. 1.2 Number of NGOs/civil society organizations or Progress reports from associations implementing intermediaries AIDS activities funded by -Progress reports from program would be: Yl: 10; national/regional coordination Y2: 20; Y3: 30; Y4: 40; Total units. 100. 1.3 By the completion of the Project, grants provide to community to finance subprojects will amount to $6,000,000. Component 2. 2.1. Mobilization of 2.1.1. Number of non-health Focal Point Reports Appropriate choices for non-health public ministries ministries and public sector Project Reports. ministerial and agency focal and private sector agencies with appointed focal points. organizations to respond points to animate and catalyze proactively to the HIV/AIDS their Action Plans would be at epidemic. least 50 by the end of the Project. 2.1.2. National Budget (2.9 Annual National Budget Increased mobilization of million in Budget Year 2001) Quarterly reports to CNLS. Ministries and private sector to sectoral ministries for agencies by project and other HIV/AIDS action Plans to be CNLS Partners is fully at least US$ 5 million by year effective. 4. Ministry of Finance makes timely deposit of funds nominally allocated to sectoral Ministries and the CNLS in the Annual National Budget. - 41 - 2.2. Significant increase in 2.2.1 Percentage of (public Training report Adequate capacity in Ministry relevance and quality of and private) health agents Special Studies (Health of Health and CNLS training of public and private trained and retrained in Facility Surveys), Annual secretariat and partners to sector health agents, in the techniques of prevention of Health Study. implement the training, and use of equipment, medicine HIV/AIDS/STI's transmission sustain the and preventive techniques, in health /care facilities . purchase/distribution of and in the application of that medical supplies in a timely training for the accurate and coordinated manner. identification and appropriate care of HIV/AIDS patients. 2.2.2 In those health facilities that are stocked with drugs to Health Facility Survey and treat common opportunistic clinic stock records. infections the percentage of those which will also provide palliative care and report no stock-outs in the past twelve months would be 100% by the end of the Project. 2.2.3 Percentage of antenatal clinics that offer counseling and voluntary testing for HIV Special Studies (Health staff, or that refer clients to Facility Surveys), Annual VCT services would be 50% Health Study. by the end of the Project. 2.2.4 Number of traditional healer and TBA's trained and equipped with the correct Annual Traditional Healer information on the prevention Evaluation, Special Study. of HIV/AIDS/STI would be 192 by the end of the Project. Component 3 1. National IEC and capacity 3. .Existence of an Quarterly reports of the PMU The national IEC campaign building for mobilization operational computerized MIS and the annual reviews of the will reach even Benin's "lake campaign is launched by system containing information CNLS. communities", "river migrant PMU in the context of the on evaluated effective communities" and remote National HIV/AIDS Strategy intermediaries for the IEC villages. and is effectively sustained in campaign and those involved reaching decentralized levels in follow-up support for of all 12 Departments through communities the first year. by the end of Year 1; with annual revision. 3.2. Existence of an Quarterly reports of the PMU operational computerize and the annual review and system containing information report of the CNLS. on community, subgroup projects and key indicators be established by the end of 18 months. - 42 - 3.3 Airtime allotted on Radio Centralized and decentralized Stations covering the fight monitoring of Radio Station against HIV/AIDS would emissions by decentralized increase by 100% in reference PMU staff and CNLS actors. to baseline study. 2. Effective organization of 3.2.1. Sectoral Ministries will Quarterly reports of the PMU The 16 Sectoral Ministries and timely provision of the have prepared and begun and the annual review and and significant private Technical support and execution of their 2 nod report of the CNLS. agencies respond fully to the capacity building required by HIV/AIDS Action Plan by end opportunities provided by the the remaining 16 Sectoral of Year 2. Technical assistance and Ministries and significant financial resources available private sector agencies to 3.2.2. The remaining Sectoral Quarterly progress reports under the project. formulate and implement Ministries will have prepared their Action Plans against and begun execution of their Quarterly progress reports, HIV/AIDS. HIV/AIDS Action Plans by supervision reports the end of Year 1. 3.2.3. Minimum of 5 significant sector Quarterly progress reports, organizations will have Annual evaluation reports, prepared and begun execution Supervision reports of their HIV/AIDS Action Annual strategic action plans, Plans by end of 18 months. Meeting reports 3. At Project outset, a prompt 3.3.1. Number and coverage MOH sentinel sites The PMU launches and launch of capacity building of sentinel surveillance sites sustains appropriate capacity for the Technical Secretariat (II sites currently) would be building for the technical of the CNLS, Department of at least 17 (of which 4 are secretariat of the CNLS, in a Health and partner agencies, rural) by Year 4. timely manner. in the establishment and management of sustainable 3.3.2. Number of special Research reports data systems for the analysis, studies conducted and monitoring and reported on HIV prevention, communication of the knowledge behaviors care and findings on the evolution of support would be 12 by Year the HIV/AIDS pandemic in 4. Benin. 3.3.3 Percent of annual Annual evaluation reports evaluations disseminated according to schedule outlined in the M&E manual (annual evaluations for the health sector, traditional healers, finance and ptocurement, community response, sector response) would be 100%. - 43 - 3.3.4. Percentage of Quarterly progress reports, operational and annual review. research/evaluation studies where results are discussed, adopted/applied in subsequent program design and implementation strategies by the CNLS would be 100% by year 4. 4. Provision of appropriate 4.4.1. Before start of Project, Report by recruited staff prior Mechanisms to organize technical support and timely the technical and financial to effectiveness efficient and effective financial support for management staff for the provision of technical and community level planning and PMU and the 5 local outreach financial resources directly to execution of HIV/AIDS units are contracted. the communities are set in activities, consequent to the place in a timely manner. mass national mobilization 4.4.2. Before the start of the campaign. project, qualified auditors are The first two quarterly contracted to ensure ex-post progress reports in Year 1 control of resources by communities, sub-contracting agencies and HIV/AIDS Subprojects at various levels. 4.4.3. All of the necessary equipment for the functioning of the Project Management Annual and quarterly budgets Unit and the Local Units is and action plans procured and put in place within the first six months of the project. 4.4.3. Within the first 6 months, the PMU program staff at all levels are trained in Quarterly progress reports management, monitoring and evaluation procedures for the project. 4.4.4. Number of meetings held by CNLS would be at least 8 by end of Year 4. Quarterly progress report 4.4.5. Percentage of time spent in the field by all Project Management Unit staff (including two "open" multi-sectoral Bank supervision missions per year) would be about 50%. - 44 - Annex 2: Detailed Project Description BENIN: Multi-Sectoral HIV/AIDS Project Project Approach A number of general points are worthwhile highlighting. First, the Project has been designed in line with the MAP framework, to the extent that it aims at expanding the national response by improving access to funds for all stakeholders and by broadening the range of interventions to be supported. Second, the proposed operation aims to build on Benin's decentralization process and existing structures (whenever possible) rather than to set up new structures and procedures. Third, capacity building is a central and critical element of the Project and has thus been integrated in each Project component. Fourth, a special effort has been made to involve People Living with HIV/AIDS (PLWHA) and their associations in the design and implementation of program activities. Finally, particular attention has been given to gender issues in the design and execution of program interventions. Given the above points, the Project will support the implementation of the National HIV/AIDS- Strategy (published 12/2000 on the basis of a 2-year broadly consultative process) and expects to tackle the prevalence and impact of the HIV/AIDS epidemic, through mobilizing and supporting responses developed by local communities and by each key sector of the governnent and eligible institutions. The main focus will be on scaling up existing prevention activities and on the treatment, care, and mitigation support provided to people infected or affected by HIV/AIDS. No organization nor sector in the country has the capacity or resources to take on the HIV/AIDS challenge alone. To meet this challenge, the government has chosen to work through a multitude of implementing agencies. The fight against HIV/AIDS has been started on many fronts, explicitly by attempting to draw on all available capacity (in private and public sectors, among NGOs, civil society, religious groups, traditional practitioners, community-based organizations). In addition, to complement other resources (the national budget and the technical and financial resources comnmitted by UNAIDS partner agencies), the Project will help establish and strengthen the institutions and mechanisms needed to sustain the effort against HIV/AIDS over the next ten to fifteen years. The Project will support the implementation of the National HlV/AIDS Strategy through three core components: support to the (1) response of civil society; (2) response of the public sector (including the health sector) and (3) coordination, management, monitoring, and evaluation. By Component: Project Component I - US$11.31 million Component 1: Support to the Response of Civil Society The principles of community-based participatory development and the financial mechanisrns for providing support to communities, which underpin this component, have benefited from the experience gained from the implementation of several IDA-financed credits in Benin involving such community-based execution and management of activities (the Social Fund, the Pilot Rural Development Support Program of Borgou, the Pilot Community-based Forestry Management Project, the Food Security Project). The Project will provide technical assistance and financial support to three broad types of activities: (1) social mobilization, training, and Subproject preparation; (2) execution of the community Subprojects by the communities themselves; and (3) execution of community-based HIV/AIDS preventive and provision of care activities by private sector organizations, NGOs, and associations of civil society. The Project will support the civil -45 - society response through three subcomponents. Subcomponent 1: Strengthening the institutional capacities of the community-based organizations and the civil society organizations, carrying out awareness-raising campaigns, training, and community Subprojects preparation The point of departure and sustained stimulus of the two broad types of activities to be implemented under this component will be the strengthening of the institutional capacities of the community-based organizations and the civil society organizations, the awareness-raising campaign, followed by the training of trainers at the national level and thereafter at all other levels of decentralization ,which will be launched and facilitated by the Project Management Unit (PMU) and the unit's regionally based staff, at the outset of the Project. This IEC campaign and training cycle will be repeated annually, following evaluation and feedback on the results and obstacles for the program to date from the decentralized departmental level HIV/AIDS Committee's (CDLS) provided for by CNLS. The Project provides for the local PMU teams to subcontract NGOs and private agencies possessing the required expertise to support communities in the planning, executing, and monitoring of their HIV/AIDS Subprojects, and for collaboration with field staff of the core Ministries of Rural Development, Social Protection, and Health, thus ensuring the empowerment of about 35 percent of Benin's communities in their fight against the epidemic by the end of the Project. Subcomponent 2: Community grant for executing Subprojects The concept of community is used here in a generic sense. By convention, a rural community is a village or group of small villages and hamlets that share a common cultural history and social identity. In urban areas, the term can designate people sharing a common identity who live in a specific area of the town. In both urban and rural areas, the term also designates a group of people with common occupational, professional or social interests, such as women's groups, youth groups, and workers' groups. On the basis of the participatory training, and follow-up support/capacity building for their community-based analysis and planning process, the communities will develop their gender-responsive HIV/AlDS Subprojects, with particular attention to ensuring inclusion of the concerns of those social groups who traditionally have less voice (the young, women, pastoral nomads). Simple criteria, including a limited negative list and a wide range of indicative examples of possible activities, are available to guide this community in selecting its priority activities (Cf Operational Manual). These tools are intended to support the community's careful analysis of the behavioral and socioeconomic factors that, in their local society, could contribute to the spread of the HIV/AlDS virus and to recognize any as-yet-unmet needs for support required by any community groups at high risk for HIV/AIDS, or by any PLWHA, their orphans, or affected families. Experience elsewhere confirms that the preventive effectiveness of the community Subprojects will depend in great part on the community's successful identification of these contributing factors. A focus on such factors of transmission such as "razor blades" (used for cutting hair, umbilical cords, and female genital mutilation), and scarring ceremonies is important essentially in that these provide entry points for developing commnunity reflection on the underlying dynamic of social relations, attitudes and behaviors that may place community members and their community at risk. The daily and seasonal mobility of different age/sex and occupational groups of Benin's communities is a classic example of such socio economic "potential risk" factors, taken together with social attitudes and expectations influencing behavior and relationships between men and women. The examples of community Subprojects activities to address such factors are provided in the OM for illustration only. They can be usefully considered under three headings: (i) media and cultural event communication activities to promote and valorize appropriate behavior change (such as dance/song groups - 46 - at village ceremonies); (ii) incentive mechanisms to ensure follow-up on such behavioral change possibilities (collaborative training of tradipractictioners with local health personnel); and (iii) specific support activities for PLWHAs and their affected families (village pharmacies' supplies). The community HIV/AIDS Subproject proposals will be forwarded to the local "arrondissement" level approval committee (CCLS or CALS) for review. Following successful approval, the Subproject proposal will be forwarded to the relevant regional office of the Project, for prompt transfer of funds to the account opened by the designated members of the community's HINV/AIDS committee (CVLS), following their signature of a grant agreement with the relevant CDLS, the Financial Management Firm(FMF) and the relevant community-based organization. Using the base formula (US$1 x number of population x year) gives an average of US$1000 (with a ceiling of US$3000) per annum per community, encouraging communities to plan and finance their activities on an iterative yearly basis. Of the 6000 communities in Benin, (both urban and rural) that the Project is intended to reach with awareness raising campaigns over its life, the Project is anticipated to finance an average of 100 community HIV/AIDS Subprojects per year per department. Subcomponent 3: Financial support to civil society organizations for executing prevention and care activities for communities This category of activities ensures both the fullest possible engagement of all civil society actors in supporting and scaling up the response of urban and rural communities to the HIV/AIDS epidemic, and provides for attention to those needs that may well lie beyond the capacity of any single community to organize. Therefore, private sector organizations, NGO and associations of civil society that are already engaged in HIV/AIDS preventive or provision of care activities, or that have a particular expertise relevant to the HIV/AIDS campaign, may also submit proposals. Those requesting financing to support the expansion of effective existing initiatives that address the specific objectives of the Project will be given priority. Examples of such proposals include activities such as Centers of Care for PLWHA, facilitation of community-based support for HIV/AIDS orphans and affected families, promotion of collaboration with the national and decentralized associations of traditional practictioners (TP's); support for HIV/AIDS transmissions on Community Radio networks; and programs of anonymous voluntary testing and counseling for HIV/AIDS in high risk/high prevalence zones, programs facilitating "peer group" counseling among youth groups, and commercial sex workers. It is anticipated that such proposals would be prepared in consultation with other relevant actors, such as the respective government Ministry or decentralized administration, or the commnunities concerned. Furthermore, depending on the geographic coverage of the activities in such proposals, the review/approval process will be with the decentralized approval HIVt/AIDS committees (CCLS, CALS, or CDLS ). The grant agreement will be entered into among the relevant CDLS, the FMF, and the relevant civil society organization, or among the CNLS, the PMU, and the relevant civil society organization, as the case may be. For Subprojects estirnated to cost less than the equivalent of US$15,000, the relevant civil society organization will enter into a grant agreement with the relevant CDLS, and the local FMF; the Subproject will be approved at the CDLS level. Subprojects that are estimated to cost more than the equivalent of US$15,000 and are to be implemented by a civil society organization will be approved by CNLS based on criteria specified in the Operational Manual. The related grant agreement will be entered into among the PMU, the CNLS, and the civil society organization. In any case, Subprojects to be implemented by a civil society organization cannot exceed the equivalent of US$35,000. NGO and private sector stakeholders' participation in the consultative workshop on the OM held in August 01 has provided a timely basis for these potential executing agencies of the Project to become familiar with the implementation guidelines and generic criteria, and to identify how they might contribute, in the - 47 - framework of the Project, to the implementation of the National HIV/AIDS strategy. Project Component 2 - US$9.25 million Component 2: Support to the Public Sector Response (including the health sector) Consequent to the Project launch and annual nationwide awareness raising campaign, this Project component provides for follow-up support for two categories of public sector activities: (i) non-health sector line Ministries and public and private institutions at the national level to build their capacity to elaborate and execute short- and medium-term HIV/AIDS action plans, and (ii) the Ministry of Health to contribute to the expansion of the coverage and improvement of the efficacy of 4 specific interventions in its program of activities to prevent the spread of HIV/AIDS. Subcomponent 1: Non-health sector Action Plans Among the non-health sector line Ministries, the Project will mobilize the 16 of 21 Ministries that have yet to launch their first HIV/AIDS initiatives; and will provide support to the Ministries of Rural Development, Defense, Education, and Youth and Tourism to deepen and expand their current action plans. Of the 50 or so other public sector organizations or agencies, the National Assembly, both the universities, the Port Authority, and various associations of the judicial system are examples of key actors. The sectoral Action Plans will detail how the Ministries and eligible agencies would initiate or strengthen their fight against HIVIAIDS, indicating collaborating partnerships with their related decentralized entities wherever possible. Sectoral Action Plans could be organized (not restrictive) around two core themes: (1) awareness raising /advocacy and counseling to encourage appropriate behavioral change or sociopsychological support needed among ministerial staff themselves, and (2) initiatives related to the specific technical or sectoral policy mandate of the Ministry, or the public sector organization or agency and its constituencies. Proposals for the limited provision of equipment (such as audio-visual tools) are anticipated within such plans. Examples of eligible activities related to the first theme might include: - Capacity building: training of focal points at all levels of decentralization, in their role as a catalyst, to enable line Ministries and institutions to initiate, coordinate, and sustain these activities - Initial staff IEC program backed up by regular staff updates of information on the HIV/AIDS epidemic in Benin (CNLS reports) * Review of any necessary statutory reform or related change in regulatory practices, in light of the patient! employees' and affected families' right to confidentiality of their health status and privacy. Examples of eligible activities related to the second theme might include: * Study of the current and Projected impact of WHV/AIDS on the respective ministerial sector of the economy (as per the 8/2000 decision of the Council of Ministers) for discussion at CNLS * Nationwide initiatives to be undertaken by decentralized field staff in support of local communities * Gender-responsive sector-specific HIV/AIDS communication plans in Ministries responsible for public service facilities. Once approved by the technical secretariat of the CNLS, these activities will be funded through direct transfers of funds to the respective line Ministries or public sector organizations or agencies, on the basis of a financial agreement to be signed between the CNLS, the PMU, and the relevant public sector organization. The financial agreement will include specified program and financial performance indicators (combined monitoring and evaluation) with continued support being contingent on satisfactory annual - 48 - performance. The cost of these activities or action plans will range from US$15,000 to US$50,000. With the evolution of Project execution, Ministries will be encouraged to consolidate their Action Plans with other related sectors, and to seek additional financing through partnering shared program activities with private sector organizations. Participation by sector Ministries in the consultative workshop on the OM in August 2001 has provided a timely basis for the advance preparation of their Action Plans. Subcomponent 2: Health sector interventions/activities Regarding the Ministry of Health(MOH), the Project subcomponent provision for technical assistance and financial resources for the PNLS will complement the government's annual budget allocation and resources from external partners, and will support HIV/AIDS-related health activities and initiatives of both the public and the private sector. The four areas of intervention are: (1) Improved accessibility to HIV testing and counseling in 6 departrnental hospitals by (a) providing equipment and financial accessibility to testing and counseling including subsidizing the HIV Elisa and rapid tests, in sufficient quantity to cover the basic needs of transfusion, sentinel surveillance, and VCT (including testing prenatal women); (b) improving the quality of pre- and post-test counseling; (c) further expanding the prevention of mother to child transmission by helping MOH to put in place the conditions for the introduction and expansion of access to HIV antiretroviral therapy (HART); and (d) developing the safety of the related blood transfusions services, injections, and medical as well as surgical practices, by establishing associated training programs including training on clinical waste management. Staff training on prevention of mother-to-child transmission will include the use of the guidelines already defined for Benin by the Pretrame Project. (2) Improved prevention of HIV transmission by making STI treatments more accessible and affordable. The Project will subsidize the supply of kits for STDs treatments and will finance a training program on the syndromic approach of STDs. (3) Improved quality and scale of provision of health care to persons living with HIV/AIDS by (a) improving the physical and financial accessibility to the prevention and treatment of opportunistic diseases as well as other treatments (anti-pain treatments, palliative care) for PLWHAs. In this regard, the Project will finance a training program for health staff and will supply drugs to prevent and treat opportunistic diseases. The International Union against Tuberculosis is largely supporting Benin in the provision of TB drugs and related staff training. Thus, the Project will complement this by (b) supplying equipment for the referral laboratory of the national program against TB and (c)by supporting the development of initiatives and Action Plans from both public and private health institutions aiming at improving the provision of health care to PLWHAs, including developing collaboration between health staff and traditional healers. (4) Initiation of a systematic program of collaboration with the National Association of Traditional Medicine Practitioners (NATMP) to improve the (a) qualifications and competence of TPs to fully participate in the fight against HIV/AIDS, especially in the rural areas; (b) identification of effective traditional treatments of STIs and opportunistic diseases (ODs); (c) scientific validation of selected traditional treatments; and (d) collaboration between TPs/TBAs and government clinics. (5) Support HIV/AIDS prevention and control activities for its staff. This set of innovative activities will include developing an inventory of treatments used by healers to treat sexually transmitted diseases and provide for the scientific validation of plant-based remedies used to treat - 49 - STDs and selected opportunistic diseases through field testing in departmental botanical gardens. The Project provides for the possibility of a census of the TBAs and TPs in Benin, and the formalization of their local associational networks as part of mobilizing their efforts to support communities' activities against HIV/AIDS. Joint MOH staff and TP/TBA training will increase the level of understanding by TPs of the causes and transmission of HIV/AIDS, the prevention of associated diseases, the value of condoms, and the care and counseling of infected and affected persons. It is also intended to develop collaboration between TPs and health staff in clinics and hospitals and in their communities to improve the provision of care to PLWHAs. The Project will finance the above activities as follows: (1) acquiring essential laboratory equipment and reagents and other consumables, including the laboratory infrastructure needed to develop HART; (2) acquiring tests and drugs for the prevention of the mother-child transmission of HIV/AIDS and for the management of related opportunistic diseases; and (3) sustaining skills training and capacity building for all decentralized levels of health professionals and their traditional counterparts, in particular for the implementation of the CWMP; and (4) providing technical advisory services. Project Component 3 - US$ 4.87 million Component 3: Support to Project Coordination, Management, and Monitoring and Evaluation This component will finance the following activities: (1) strengthening the capacity of CNLS and PMU to implement a coordination, management, monitoring, and evaluation framework for the Project through the provision of technical advisory services and training, and the acquisition of goods, equipment, and vehicles; (2) strengthening the capacity of CDLSs, CALSs, CCLSs, and CVLSs to carry out the coordination, monitoring, and evaluation of Subprojects, through the provision of training; (3) carrying out monitoring and evaluation activities through the provision of technical advisory services; (4) carrying out accounting, financial reporting, and disbursement functions related to the Subprojects to be implemented by a community-based organization or civil society organization at a decentralized level, through the provision of technical advisory services and training, the renovation and equipment of office space, and the acquisition of vehicles; and (5) carrying out financial audits of the Project and of the FMF through subcontracting. Project oversight context The institutional and implementation arrangements for the Project, together with the Project management arrangements, are specified in the OM, which was finalized during appraisal and validated by a national consultative workshop with stakeholders in August 2001. The Project will be placed under the management oversight of the CNLS, which is chaired by the president of Benin, whose members are drawn equally from govemment and civil society. As proposed in the new decree regarding the CNLS, the CNLS will be composed of three complementary for: (1) the decision making plenary assembly of all members of CNLS, which will annually identify national program priorities and approve programs and global budgets of the various executing agencies/financing partners; (2) the CNLS technical secretariat, a multisectoral unit of 6 seconded public sector professionals with no program execution functions, but tasked with reviewing the program plans and results reports of different executing agencies and partners, analyzing and consolidating these documents for review /approval of the biannual plenary CNLS, and updating the CNLS on the results of the national monitoring/evaluation program and related research); (c) a consultative group. composed of the vice presidents of CNLS, its technical secretariat, with financing partners and donors to be invited, in an observer status, to collaborate on advocacy initiatives and to clarify available financial resources and proposed programs in support of the National HIV/AIDS Strategy. The activation of the CNLS committees at the decentralized departmental, district, and arrondissement levels before the credit's date of - 50 - effectiveness, will help provide the framework for the implementation of the National HIV/AIDS Strategy as even the current CNLS decree has made provision for these committees. Overall Project management and implementation arrangements In this institutional context, the PMU, with a staff of 6 private sector professionals subcontracted by the Borrower's Ministry of Planning, will function alongside and in a support role vis a vis the CNLS technical secretariat. Like the CNLS, the PMU technical secretariat has no program execution function. Its role is to subcontract with a full range of actors in the private and public sector to facilitate the effective and efficient execution of the Project, as specified in the annual Project plans and budgets approved by CNLS and the Bank, and to ensure technical assistance and capacity building for the CNLS technical secretariat (Component 3). The PMU will establish an independent ad hoc procurement evaluation commission to process in a transparent manner, and in compliance with the Operational Manual, all the national-level Project-related bids, proposals, contracts, and financial management agreements. No member of organizations eligible for Project financing can be a member of this commission. For the institutional implementation and management arrangements to support the response of civil society to the HIV/AIDS epidemic, it is envisaged that the PMU will subcontract with the already referenced FMF to handle support for program development/execution, and accounting, financial reporting, and disbursement functions for the community-level activities. This subcontract will require the agency to have regional offices in the 6 departments of the country, each with 2 staff dedicated to the financial management and programmatic support of the communities planning and executing their HIV/AIDS Subprojects. The FMF will manage the 6 Second Generation Special Accounts (SGSAs) to be opened in 6 departments to finance activities to be implemented under two subcomponents of Component 1 (Community grant for executing Subprojects; and financial support to civil society organizations for executing prevention and care activities for communities). The various decentralized levels of the CNLS, all of which draw on existing multisectoral public/private sector fora, reach as far as the Village H1V/AIDS Committees (CVLS). These decentralized CNLS structures will provide a network of collaborators to be mobilized by the communities with facilitation support of the FMF regional staff. The members of the CNLS at the level of the "arrondissement" will make up the "approval committee" for the community HIV/AIDS action plans. Regionally experienced NGOs, confessional agencies, traditional associations, and private sector organizations will also be subcontracted by the PMU to provide technical assistance and support to communities and particular community groups, as well as to contribute to the monitoring and evaluation of their activities. Four categories of activities The PMU will be responsible for facilitating Project implementation within the framework of the National HIV/AIDS Strategy and the CNLS. The objectives and related responsibilities for the PMU under the Project can be usefully grouped in four categories: (1) Communications; (2) Capacity Building; (3) Monitoring and Evaluation; and (4) Financial Management. Category 1. Communications: The point of departure for the activities foreseen for all three Project components will be the organization of the launch of the mass communications campaign by the president of Benin and chairman of the CNLS, with multimedia for involving ministers of the core sectors of the economy, sustained by the nationwide network of state, comrnmunity and private radio networks, awareness-raising workshops at all levels of CNLS, and community-level cultural events. The PMU will ensure annual mass communications initiatives through the life of the Project, executed by subcontracted international and national communications specialists, whose task will equally include strengthening the - 51 - capacity of the CNLS technical secretariat and the CNLS forum to actively sustain comnmitrnent and capacity in HIV/AIDS advocacy and awareness raising. A particular characteristic of this task will be the challenge of standardizing the content and presentation of messages, given the diverse cultural traditions and languages of Benin, and the need to coordinate with the Abidjan/Lagos corridor subregional MAP Project in preparation. Category 2. Capacity Building: At the national level, the focus will be on ensuring capacity building of the newly established multisectoral technical secretariat of the CNLS, and of the sectoral line Ministries and public sector organizations in the execution of their HIV/AIDS Action Plans. The PMU, together with its local outreach staff, will focus on empowering communities through capacity building efforts targeted to support their efforts to limit the spread of HIV/AIDS. Category 3. Monitoring and Evaluation: As per the Gap Analysis, the core of the capacity building to be facilitated by the PMU for the multisectoral technical secretariat to the CNLS will be to ensure the secretariat's competence to focus on the strategic program implications of the results of the common monitoring and evaluation framework and manual, which are being prepared in consultation with, and for use by, CNLS executing agencies and partners. The Project indicators (Section 2.1-2.4 Annex I and the M&E Annex) are structured according to the categorization of interventions and indicators established by UNAIDS. These categories include behavioral change, social capacity for support to PLWHA, counseling/care services for STIs, security of blood transfusion services, mother-child transmission of HIV and voluntary testing and counseling. This single, simple, and standardized M&E tool will meet a key need identified by the Gap Analysis and will make it feasible for meaningful data to be aggregated from different executing agencies and different levels of decentralization of execution. It is also recognized that it will be necessary for the PMU, in collaboration with the CNLS secretariat, to sustain stakeholders' ownership and involvement by ensuring regular dissemination of findings and enlisting their feedback on their experience with the manual. All M&E activities will be contracted out to external agencies/consulting groups to ensure an independent analysis that tracks program performance against targets and variations in performance rate in compliance with the established protocols. Similarly, the Project provides for the contracting out of surveillance and research, as the evolving status of the epidemic indicates, to complement research initiatives undertaken by other CNLS partners. It is also anticipated that Project finances may support capacity building in some of the national institutions carrying out data collection and synthesis for the CNLS, such as the Center for Population, Training and Research, (CEFORP), that have expertise in regular studies of HIV/AIDS-related behavioral change and the system of departmental and national data collection on STIs (SNIGS). The Project will also strengthen the technical secretariat of the CNLS in its role as the designated mechanism to cornpile for the plenary meetings of the CNLS the biannual reports of all executing agencies and partners working within the framework of the National HIV/AIDS Strategy. The first annual meeting (April-May 2002) would focus on the implications of the M&E-based results of the past year's program of work and the second annual meeting (October 2002) would prepare/discuss/endorse the next annual work plan. Over the life of the Project, the PMU, with CNLS permanent secretariat, will review the options for meeting a more extensive need identified in the Gap analysis, namely, the organization and dissemination to implementing agencies of up-to-date information on AIDS prevention and care, best practices of existing Projects, research results, and any relevant reports. Category 4. Financial Management: The PMU will be responsible for Project financial management, based on the Administrative, Accounting and Financial Manual prepared for the Project. The first step will be to carry out a time-bound action plan for the sound establishment of the Project financial management system to ensure preparation of quarterly Project management reports acceptable to IDA. The PMU will monitor Project disbursements and ensure that they are in conformity with IDA requirements and will consolidate and prepare the annmal financial statements, in accordance with internationally accepted accounting - 52 - principles, at the end of each fiscal year. The PMU will also be responsible for making arrangements for the certification of these annual financial statements by a competent and experienced auditing firm under terms and conditions acceptable to IDA. The recruitment of auditors acceptable to IDA will be completed by April 30, 2002. To ensure timely, efficient disbursement and support for responsible management of funds by the communities, a Financial Management Firm (FMF) will be subcontracted to handle accounting, financial reporting, and disbursement functions for two subcomponents (community grant for executing Subprojects, and financial support to civil society organization for executing prevention and care activities for communities) for the community-level activities in Component 1. This financial management firm should have offices in the 6 departments of the country and have established a sound reputation for responsible and adaptive management for facilitating direct financing to communities. Each local bureau of the FMF will have 2 staff dedicated to the financial management and programmatic support of the Benin MAP Project. Financial management and M&E Again on the basis of past experience, the Project provides for the possibility ofjoining program M&E with financial management. The FMF should be already doing this in its management and its staffing. The grant agreements to be entered into with communities and with civil society organizations, respectively, and the associated reporting requirements on financial management performance and program results will continue this practice in the implementation of Component 1. At the national level, it is also established that the financial agreements and contracts that will facilitate the scaling up of the public sector response, similarly will combine reporting on financial management performance and program results, allowing for an independent analysis and cross verification. At the CNLS-wide level, the first challenge for the PMU is to support the technical secretariat in establishing the wide and routine use of the common M&E indicator protocols. The August 2001 consultative workshop with stakeholders on the Operational Manual provided an opportunity to explain Bank guidelines regarding joint and parallel financing, as a first step toward the possibility of combining financial and M&E monitoring at the CNLS. - 53 - Annex 3: Estimated Project Costs BENIN: Multi-Sectoral HIV/AIDS Project Local Foreign Total Project Cost By Component US $million US $million US $million Support to Civil Society Response 10.80 0.50 11.30 Support to Public Sector Response (including the Health Sector) 4.04 5.20 9.24 Support to Project Coordination, Management, Monitoring & 3.58 1.28 4.86 Evaluation Total Baseline Cost 18.42 6.98 25.40 Physical Contingencies 0.00 0.00 0.00 Price Contingencies 0.01 0.02 0.03 Total Project Costs 18.43 7.00 25.43 Total Financing Required 18.43 7.00 25.43 Local Foreign Total Project Cost By Category US $million US $million US $million Goods: Vehicles, Motorcycles and Equipement 0.44 2.16 2.60 Works 0.09 0.00 0.09 Consultant Services, Traning & Audit 2.36 2.08 4.44 Drugs, Tests and Reagent 0.49 2.76 3.25 Subprojects 10.00 0.00 10.00 Operating costs 4.75 0.00 4.75 Beneficiairies Contributions 0.30 0.00 0.30 Total Pro = 18.43 7.00 25.43 Toa rject Costs Total Financing Required 18.43 7.00 25.43 Identifiable taxes and duties are 0 (US$m) and the total project cost, net of taxes, is 25.43 (US$m). Therefore, the project cost sharing ratio is 90.44% of total project cost net of taxes. - 54 - Annex 4 Benefit Analysis Summary BENIN: Multi-Sectoral HIV/AIDS Project An economic analysis of the impact of HIV/AIDS and a cost-benefit analysis of the Multi-sectoral HIV/AIDS project prepared under the Multi-Country AIDS Program was discussed in Annex 5 of the Project Appraisal Document of the Multi-Country AIDS Program for the Africa Region. In addition to this economic analysis it may be mentioned that the proposed project will benefit the population of Benin in numerous ways: * It will directly benefit highly vulnerable groups such as commercial sex workers, men and women in unifonn, truckers, university students, who will be able to protect themselves as well as their partners thanks to accessible and affordable means of prevention. * It will also highly benefit pregnant women and young people, by enhancing reproductive health education and raising access to prevention and treatments of sexually transmitted infections. * It will benefit Benin society overall by reducing the risk of acquiring HIV of the general population, beyond these vulnerable groups and avoiding or reducing new infections among adults. * It will contribute to decreasing the HIV infection rates of children, and contributing to increase life expectancy. * It will reduce the impoverishing impact of AIDS on households by reducing the loss of income due to illness and deaths of breadwinners as well as by providing affordable care and transfers. * Communities' capacities will be strengthened and empowerment structures supported and reinforced. * The social capital of Benin will be protected by supporting solidarity mechanisms and care to orphans. - 55 - Annex 5: Financial Summary BENIN: Multi-Sectoral HIViAIDS Project Years Ending Financial Management 1. General It is proposed that, within the CNLS' s technical secretariat and under the responsibility of its Permanent Secretary, the Project be coordinated and managed by a small Project Management Unit (PMU), whose staff, for the purposes of financial management of the MAP Project will include a Project Coordinator, with responsibility for overall management, an HIV/AIDS Specialist, a Financial Management Specialist (FMS), a Procurement Specialist, an M&E Specialist, and support staff. The financial management, procurement, and financing of the activities foreseen within the MAP Project will be the responsibility of the Financial Management Specialist. An assessment of the Project Financial Management System will be conducted by the Bank Country Office Financial Management Specialist as soon as the system and the PMU staff are in place. This activity should include: * Assessment of the adequacy of the financial management system within the PMU: accounting and reporting systems, internal control system, financial report format, and competence of financial and accounting staff * Explicit opinions on the status of the financial management system in place at the time of assessment, including any financial management risks. An agreed action plan to strengthen the financial management system to improve capabilities and a satisfactory system must also be provided prior to the date of Project effectiveness 2. Flow of Funds The disbursement arrangements must be supple, combining adequate but simple requirements with efficient procedures, to ensure the timely flow of funds to finance the different categories of activities foreseen for the different components of the Project. To this end, as the Borrower does not have the financial means for advancing funds to finance the Project activities, two Special Accounts A and B will be opened in a commercial bank, under the responsibility of the Project Coordinator and the Financial Management Specialist. Special Account A: Finances for the Support to Civil Society Response Component (1) The resources of Special Account A will be used exclusively to finance Subprojects initiated by communities, registered associations (social, occupational, professional, religious), NGOs, and private sector unions. To this end, the Project could use the financial management services of a Financial Management Firm (FMF) that has the full capacity to manage Second Generation Special Accounts (SGSA) such as AGeFIB, to effect the transfer of funds required by this component. As the FMF will not have the financial means for advancing funds to finance the community level activities, it envisaged that six MAP Project Second Generation Special Accounts (SGSA) will be opened in each of the 6 departments in which this FMF will have bureaux. As soon as the decision to finance a Subproject has been taken by the - 56 - local-level review and selection committee (an entity completely independent of the FMF), the approved Subproject proposal will be forwarded to the appropriate departmental office for financing. After having promptly completed the necessary checks for compliance with financial management procedures, a grant agreement will be signed by the Financial Management Firm with the relevant CDLS, and the community-based organization or the civil society organization that will implement the relevant Subproject. Simultaneously, the first tranche of funds will be released, the release of additional tranches being subject to the Subproject's compliance with the reporting requirements specified in the grant or financial agreement. The first payment to each of the 6 MAP Project subaccounts managed by the local FMF will be calculated on the basis of an estimated 90 days of expenses. The total sum for this first payment will be applied for by the Cotonou-based FMS and will then be transferred to the respective Project subaccounts managed by the local FMFs. Replenishment of these subaccounts will be on the basis of disbursements effected within the framework of the local Subproject financial agreements. As it might already be established practice, each local bureau would be required to provide justifying documentation in the form of SOEs to ensure replenishment of their respective MAP Project subaccounts from Special Account A. Detailed discussion of the modalities for financing the activities foreseen in the Civil Society Response component of the MAP Project by means of the six local bureaux will appear in the Operational Manual. Special Account B: Finances for Components 2 and 3. B 1: Finances for public sector activities -- Action plans of sector Ministries and public sector organizations The Action Plans of the sectoral Ministries and public organizations will be reviewed and, following approval of the Plans, provision for 2 different categories of disbursement modalities is required. (1) Arrangements for the financing of the purchase of medical equipment, medical supplies, laboratory reagents, condoms, IEC equipment, and consultant services for various studies and for the formulation of the Sectoral Strategies and Action Plans fall in this first category. In this first instance, for the purposes of efficiency and economies of scale, the established procedures for financing activities with IDA resources will be applied, following the related established procurement requirements, resulting in either direct payment or payment from the Cotonou-based Special Account B, (managed by the MAP PMU), with the justifying documentation to be held centrally by the PMU. The responsibility for implementation and monitoring of the specific activity so financed will be held by the respective sectoral Ministry, whereas the PMU will merely execute the relevant payments, as per the instruction of the given Ministry, within the context of the approved Ministry or public sector organization Action Plan. (2) Interventions and initiatives (foreseen within the Ministry or public sector organization Action Plan), but requiring small-scale funding, such as discrete training or awareness-raising activities, or a work program of a series of related small-scale initiatives, fall in this second category. To avoid the impact of the slow rate of mobilization of human and financial resources usually associated with the public sector, following the approval of the Ministry or public sector organization Action Plan, the given sectoral Ministry or public sector organization will sign the related financial agreement and open an account in a commercial bank. The Administrative Director (DA) and the H1V/AIDS focal point of the Ministry or public sector organization will be the only signatories. Just as in the case of the local-level Subproject proposals financed under Component 1, a first advance payment will then be deposited to the Ministry's or public sector organization's account. B.2: Finances for Project Coordination, Management, and Monitoring and Evaluation (Component 3) - 57 - These finances will cover consultant services, audits, and recurrent costs (as specified in the DCA). On the basis of their joint signatures, and in compliance with established procurement and replenishment procedures, the Project Coordinator and the FMS are able to withdraw and replenish funds as needed. Access to and disbursement of funds for financing the activities foreseen in Component 3 will follow the procedures established by IDA for such coordinating units. 3. Management/Maintenance of the Special Accounts A computerized accounting system will be put in place within the Project Management Unit. The manual of accounting procedures is under preparation. The recruitment of key personnel and their training will be initiated soon. (a) The overall consolidated accounts will be held at the PMU. The Project Accounting system will be required to comply with the norms of private sector accounting generally accepted for IDA-financed credits. As implementation of the Project proceeds, all of the Project financial information will incrementally be available at the MAP PMU. (b) At the level of the 6 departmental FMA sites, the accounting will be simplified and limited to the essentials, namely, a summary of the expenditures incurred in the context of the respective financial agreements, the SOEs, and associated justifying documentation. (c) At the level of the local Subprojects, as is already the established practice under the Social Fund and the PAMR Projects, a summary table of the funds received and expended is largely adequate. It will also continue to be required that the associated justifying documentation, such as the invoices, will be kept by the responsible representatives of the Subprojects to comply with the requirements of random sample post-procurement spot audits. (d) For the small-scale initiatives undertaken within the framework of the approved Ministry Action Plans, as with (c) above, a summary table specifying the resources used (funds received and expended) with related justifying documentation will also be required. - 58 - Autononous Amortizing Coffer A l Project Management Unit Public Officer Special Account Special Account Counterpart A R Funds rA ~~~Ministries! *8* cJ , * 8 Institutions for small 0 ........ Action Plans 015 * ° Financial Management (Conventions) Firm (FW) . u u Second Generation Account * \ C . E Ministries 8 * \ ° . z Institutions; important 8 . expenditures in C \ m ........ ... equipment & * \ consultations NGOs, Associaions CVLS Accounts j o, s Conununties - 59 - 4. Audit An auditing firm acceptable to IDA will be retained to audit the MAP Project. The firm's mandate will cover all the resources mobilized in the context of the Project. The TOR will be reviewed by the Bank to ensure that the auditing firm has the required competencies and that the TOR covers all of the Project areas of activity that require auditing. To complement the financial audit, a technical audit of goods/equipment purchased and any structures/infrastructure financed by the Project will be undertaken to assess their quality and efficiency. 5. Financial Management Capacity Assessment During the appraisal mission, the Project team had thorough discussions with the consultant in charge of preparing the Administrative, Accounting and Financial Management Manual on the main points and scope of the manual, and made recommendations for its timely preparation. Because the PMU and the financial management system are not yet in place, the Project team could not make a full assessment of the financial management of the PMU. However, an assessment of one of the possible Financial Management Finns that would handle the financial management of the Project at the community level was conducted by the Country Office Financial Management Specialist, and the firm was found satisfactory. This assessment was confirmed by the recent mid-term review of this agency carried out in July 2001. Regarding the PMU, it was agreed with the government that the PMU would be in place as soon as possible to allow the PMIU's staff to become familiar with the financial management aspects of the Project, preferably prior to the negotiations or at the latest before the Project becomes effective (namely 90 days after approval of the Credit by IDA. Recruitment has started, and a draft of the Administrative, Accounting and Financial Management Manual was available for review and discussion during negotiations. Although substantial at this stage, the financial management risks will be dealt with adequately before Project implementation. A condition of effectiveness is the establishment of a satisfactory financial management system, both in terms of personnel and management procedures. As part of the assessment, an action plan to timely put in place and strengthen the PMU's capacities to meet the requirements of a satisfactory financial management system was prepared and agreed during appraisal. The detailed plan is presented in annex 13. Year 1 | Year 2 | Year 3 | Year 4 Year 5 | Year 6 | Year 7 Total Financing Required Project Costs Investment Costs 5.1 5.1 5.1 5.4 0.0 0.0 0.0 Recurrent Costs 1.2 1.2 1.2 1.1 0.0 0.0 0.0 Total Project Costs 6.3 6.3 6.3 6.5 0.0 0.0 0.0 Total Financing 6.3 6.3 6.3 6.5 0.0 0.0 0.0 Financing IBRDIIDA 5.7 5.7 5.7 5.9 0.0 0.0 0.0 Government 0.5 0.5 0.5 0.5 0.0 0.0 0.0 Central 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Provincial 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Co-financiers 0.0 0.0 0.0 0.0 0.0 0.0 0.0 User Fees/Beneficiaries 0.1 0.1 0.1 0.1 0.0 0.0 0.0 Others 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total Project Financing 6.3 6.3 6.3 6.5 0.0 0.0 0.0 Main assumptions: - 60 - Annex 6: Procurement and Disbursement Arrangements BENIN: Multi-Sectoral HIVIAIDS Project Procurement General The Country Procurement Assessment Report (CPAR) for Benin was completed in April 1999. Despite the findings of some discrepancies, inconsistencies, and delays reported in the procurement process, no special exceptions, permits, or licenses need to be specified in the Credit Documents for Intemational Competitive Bidding (ICB), because the Republic of Benin's procurement practices allow IDA procedures to take precedence over any contrary provisions in local regulations. Guidelines Goods and works financed by IDA would be procured in accordance with World Bank's Guidelines for Procurement under IBRD Loans and IDA Credits (January 1995, revised in January and August 1996, September 1997, and January 1999). The Bank's Standard Bidding Documents and Standard Evaluation Report would be used for ICB. National Competitive Bidding (NCB), advertised locally, would be carried out in accordance with the Republic of Benin's procurement laws and regulations, acceptable to IDA, provided that the principles of economy, efficiency, transparency, and fair competition in line with the Bank Guidelines are respected. For NCB procedures, the following conditions have to be met: (a) bids would be advertised in national newspapers with wide circulation; (b) any bidder is given adequate response time (4 weeks) for preparation and submission of bids; (c) bid evaluation and bidder qualification are clearly specified in the bidding documents and applied without discrimination; (d) no preference margin is granted to domestic manufacturers; (e) eligible firms, including foreign firms, are not precluded from participation; (f) award would be made to the lowest evaluated bidder in accordance with the criteria specified in the bidding documents; and (g) bid evaluation reports would clearly state the reasons to reject any non-responsive bid. The Standard Bidding Documents to be used for NCB would be reviewed by IDA before Credit effectiveness. Consultant Services contracts financed by IDA would be procured in accordance with the Bank's Guidelines for the Selection of Consultants by World Bank Borrowers (January 1997, revised in September 1997, and January 1999). The standard Request for Proposal, as developed by the Bank, would be used for appointment of consultants and the Sample Form of Evaluation Report for the Selection of Consultants. Simplified contracts would be used for short-term assignments, that is, those not exceeding 6 months, and carried out by firms or individual consultants. The government was briefed during the appraisal mission about the features of the new Consultant Guidelines, in particular with regard to advertisement, bid opening, and steps of IDA reviews. Essentially, communities would receive and manage small grants. Participation by communities in procurement would be based on Simplified Procurement and Disbursement Procedures for Community-Based Projects (February 1998). Advertising Given the urgency of the Project, a General Procurement Notice (GPN) would be prepared and issued in the United Nations Development Business (UNDB) web site without the need for hard-copy publication, as - 61 - well as in the local newspapers to advertise for major consulting assignments and ICB (above US$200,000 equivalent). The RPA Office has waived the requirement for printed publication of GPN. The detailed GPN for the subsequent years would be prepared for the Project and published in UNDB. It would be updated annually for any outstanding procurement. Specific procurement notices for goods and works would be advertised in the national press with wide distribution and internationally for ICB contracts. Request for expression of interest would be published in local newspapers. Answers to these expressions would be used to establish list of NGOs and service providers that would help communities. Sufficient time would be allowed (minimum of 30 days) before preparing the short list. The related bidding documents, as applicable, would not be released -- or the short list for consultant services would not be prepared -- until 8 weeks after the GPN had been published. Specific procurement notices (SPNs) for goods and works would be advertised in national press with wide circulation and internationally for large contracts (ICB). Sufficient time would be allowed to obtain the bid documents. Procurement Methods Civil Works. With the exception of civil works for office rehabilitation (US$0.09 million, of which US$0.08 million is financed by IDA), all other small works are included in SubProjects. Contracts for works estimated to cost the equivalent of US$20,000 or more per contract up to an aggregate of US$40,000, would be awarded through NCB. The procurement of works, such as electricity, painting, plumbing, and decoration, estimated to cost less than the equivalent of US$20,000 per contract up to an aggregate of US$40,000, would be procured on the basis of quotations obtained in writing from at least 3 qualified local contractors. Goods. Financed under Components 2 and 3, goods are estimated at US$5.84 million, of which US$5.54 miillion would be financed by IDA. Goods include vehicles, computer equipment, furniture, and equipment including laboratory materials and drugs. To the extent practicable, these contracts shall be grouped into bid packages estimated to cost the equivalent of US$100,000 or more and would be procured through ICB. Procurement of items available locally that cannot be grouped into bid packages up to at least US$ 100,000 equivalent per contract and up to an aggregate amount of US$640,000 would be procured through NCB procedures acceptable to IDA. The above aggregate values for NCB and other non-ICB procurement methods for goods and works are limitative and cannot be exceeded. The PMU would maintain a tracking system to monitor such procurement. SubProjects (US$10.0 million financed by IDA) under Component I would comprise a broad spectrum of activities to be undertaken with the direct participation and financial contribution of the beneficiaries. Due to their demand-driven nature, it is not possible to deternine the exact mix of goods, small works, and services to be procured under these activities. Funding for these activities would be in the form of grants. Therefore, the types of activities to be financed under SubProjects and their procurement details would depend on the needs identified by community-based organizations and civil society organizations. The Bank Guidelines for Simplified Procurement and Disbursement for Community-Based Investments would be used for procurement under these components of the Project. The PMU would be responsible for ensuring compliance with these guidelines. Ex-post reviews of random SubProjects would be conducted periodically by IDA and independent consultants appointed by the Govemment. Simplified procurement and disbursement procedures for community-based programs, including the list of items qualifying under this component, would be developed and included in the Project Implementation Manual (PIM). The PIM would also include procedures for IDA prior review thresholds -62 - for community initiatives. Consultant Services Consulting services would be primarily in the areas of HIV/AIDS training, information, education, communication (IEC), applied research, financial management, monitoring and evaluation, information dissemination, and auditing and accounting. They also would be used to strengthen the institutional and technical capacities of communities under Component 1 of the Project (facilitation of community participation processes such as community development, participative diagnostic, and subProject preparation). These contracts, which are for applied research, epidemiological study, monitoring and evaluation, and financial management services are estimated to cost the equivalent of US$50,000 or more per contraLt, will be procured through Quality- and Cost-Based Selection (QCBS). The contracts for services estimated to cost less than the equivalent of US$50,000 per contract will be procured under contracts based on Consultants' Qualifications in accordance with the provisions of paragraphs 3.1 and 3.7 of the Consultant Guidelines. Least Cost Selection (LCS), in accordance with paragraphs 3.1 and 3.6 of the Consultant Guidelines, would be used for financial and technical audit contracts costing less than US$100,000; the firm with the lowest price would be selected, provided its technical proposal received the minimum marks. The selection of Individual Consultant Services such as (1) high- and mid-level staff of the PMU and the regional offices of the FMF, (2) specialized activities (implementation, community development, organization, participation, counseling), (3) workshop and seminar facilitation, small studies and other assignments would be on the basis of comparison of curriculum vitae in accordance with paragraphs 5.1 through 5.3 of the Consultant Guidelines. Single-Source Selection (SSS) would be used exceptionally for (a) information, education, and communication training, and (b) consulting assignments costing less than US$10,000 per contract in accordance with paragraphs 3.8 - 3.11 of the Consultant Guidelines. To ensure that priority is given to the identification of suitable and qualified national consultants, short lists for contracts estimated under US$20,000 or the equivalent may be comprised entirely of national consultants (in accordance with the provisions of paragraph 2.7 of the Consultant Guidelines), provided that a sufficient number of qualified individuals or firms (at least three) are available at competitive costs. The Bank's Standard Request for Proposal (RFP) would be used to request proposals and to select and appoint consultants. Simplified contracts would be used for short-term assignments or simple missions of standard nature, that is, not exceeding six months, carried out by individual consultants or firms. Training, workshops, conference attendance, and study tours would be carried out on the basis of approved annual work programs that would identify the general framework of training or similar activities for the year, including the nature of training/study tours/workshops, number of participants, and cost estimates. IDA Reviews Works. Prior IDA review would apply to each work contract estimated to cost the equivalent of US$20,000 or more and to the first 2 contracts estimated to cost less than the equivalent of US$20,000 awarded on basis of quotation. Goods. IDA-financed contracts for goods costing the equivalent of US$100,000 or more to be procured through ICB would be subject to IDA' s prior review procedures in accordance with Appendix 1 of the Guidelines. Contracts for goods costing less than the equivalent of US$100,000 would be procured through NCB. The first 3 of such contracts would be subject to prior review. - 63 - Consultants. IDA prior review would apply to contracts for the recruitment of consulting firms and individuals estimated to cost the equivalent of US$50,000 or more and the equivalent of US$25,000 or more, respectively. The prior review would also apply to all Terms of Reference, regardless the estimated cost. In addition, the first 2 contracts for strengthening of the institutional and technical capacities of communities under Component 1 of the Project would be submitted to IDA for prior review. For consultant contracts estimated to cost the equivalent of US$50,000 or more, opening the financial envelopes would not take place prior to receiving the Bank's non-objection to the technical evaluation. For contracts estimated to cost less than US$50,000 and the equivalent of US$25,000 or more, the Borrower would notify IDA of the results of the technical evaluation prior to opening the financial proposals. Documents related to procurement below the prior review thresholds would be maintained by PMU for ex-post review by auditors and IDA supervision missions. All thresholds stated in this section shall be reviewed annually by the Borrower and IDA. Modifications may be agreed, based on performances and actual values of procurement implemented. Amendments to the Credit Development Agreement may be prepared as necessary. Frequency of procurement supervision missions proposed: One every 12 months (includes special procurement supervision for post-review/audits). -64 - Procurement methods (Table A) Expenditure Category Method 1 Total Costs ICB Procurement Other 2 N.B.F. NCB 1. Works 0.00 0.05 0.04 0.00 0.09 (0.00) (0.04) (0.04) (0.00) (0.08) 2. Vehicles, 0.9 1.69 0.00 0.00 2.59 Motorcycles, and Equipment (0.87) (1.49) (0.00) (0.00) (2.36) 3. Drugs, Tests, and 3.25 0.00 0.00 0.00 3.25 Reagent (3.18) (0.00) (0.00) (0.00) (3.18) 4. Consultant Services 0.00 0.00 4.45 0.00 4.45 and Training ________________ i(0.00) (0.00) (4.45) (0.00) (4.45) 5.Subprojects 0.00 0.00 10.00 0.00 10.00 (0.00) (0.00) (10.00) (0.00) (10.00) 6. Operating Costs 0.00 0.00 3.08 1.67 4.75 (0.00) (0.00) (2.93) (0.00) (2.93) 7. Beneficiaries' 0.00 0.00 0.3 0.00 0.3 Contribution (0.00) (0.00) (0.00) (0.00) (0.00) Total 4.15 1.74 17.87 1.67 25.43 (4.05) (1.53) (17.42) (0.00) (23.00) " Figures in parenthesis are the amounts to be financed by the IDA Credit. All costs include contingencies. 2] Includes consulting services, services of contracted staff of the Project management office, training, technical assistance services, grants to communities, contribution of beneficiaries, and incremental operating costs. - 65 - Table Al: Consultant Selection Arrangements (optional) (US$ million equivalent) Selection Method Consultant Services Expenditure Category QCBS QBS SFB LCS CQ Other N.B.F. Total Cost A. Firms 1.50 0.00 0.00 0.25 0.50 0.00 0.00 2.25 (1.50) (0.00) (0.00) (0.25) (0.50) (0.00) (0.00) (2.25) B. Individuals 0.00 0.00 0.00 0.00 0.00 2.20 0.00 2.20 (0.00) (0.00) (0.00) (0.00) (0.00) (2.20) (0.00) (2.20) Total 1.50 0.00 0.00 0.25 0.50 2.20 0.00 4.45 (1.50) (0.00) (0.00) (0.25) (0.50) (2.20) (0.00) (4.45) 1\ Including contingencies Note: QCBS = Quality- and Cost-Based Selection QBS = Quality-based Selection SFB Selection under a Fixed Budget LCS = Least-Cost Selection CQ = Selection Based on Consultants' Qualifications Other = Selection of individual consultants (per Section V of Consultants Guidelines), Commercial Practices N.B.F. = Not Bank-financed Figures in parenthesis are the amounts to be financed by the Bank Credit. Prior review thresholds (Table B) Contract Value Contracts Subject to Expenditure Threshold Procurement Prior Review Category (US$ thousands) Method (US$ millions) l. Works >or = US$20,000 NCB Equal to or more than US$20,000 equivalent or = US$100,000 equivalent ICB All '' G'CN *Mo 4 iee-ecj~B-il DEPARTMENTS-- BENIN ; \ . NA- / ~~~~~~NAIOALCATA ZOLJ SECONDARY ROADSDoI PLTAURUT RICPAEDEPATCSI)E EMANT \~~ J Q PAEBAROU PAEDCOAD MO GO RoAILROADS DEARTMENTSQU o LIUR -*O-e RBVENRE N LITTORAL ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~/CHFLIEU GES 501U5 PREFECTURE BQRGOU I N~~~~~~~~~~~~~~~~~~~~~~~~EARTMNAT CAUNTAL JE DONGA CH~~~~~~~~~~~~~~~~~~~~~~~~~~~~UrE LIEUS DEPARTEAIENTS oI 1 C 4L E 60ENAINL ONDRE 'CC,~~eC/ Sack ROtUMTES DRINTAIEEFAICRSEPEhAE KILOMFERS A f~~~~~~~~~~~~~~~~ RIROD IT K © ATLANTIGUE j~~~~~LO A ~ U 2H AUN A wghl -/c - - IENTT nA RONDRES