Argentina - Integrated Drug Prevention Pilot Project

Document of The World Bank ReportNo: 19153-AR PROJECT APPRAISAL DOCUMENT ON A PROPOSED LEARNING AND INNOVATION LOAN IN THE AMOUNT OF US$4.75 MILLION TO THE ARGENTINE REPUBLIC FOR AN INTEGRATED DRUG PREVENTION PILOT PROJECT April 30, 1999 Human and Social Development Group Argentina, Chile and Uruguay Country Management Unit Latin America and Caribbean Region  CURRENCY EQUIVALENTS (Exchange Rate Effective January 28, 1999) Currency Unit = Argentine Peso (AR$) AR$1.00= US$ 1.00 US$ 1.00 =AR$ 1.00 FISCAL YEAR January I December 31 ABBREVIATIONS AND ACRONYMS CAS Country Assistance Strategy CCM Consejo Consultivo Municipal CCP Consejo Consultivo Provincial CENARESO Centro iVacional de Reeducacion Social CIDI Composite international Diagnostic Interview DALYs Disability-Adjusted Life Years DICA-R-A Diagnostic Interview for Children and Adolescents DIS Diacnostic Interview Schedule EDS Encuesta de Desarrollo Social EMCDDA European Monitoring Center for Drugs and Drug Addiction FOPAR (Argentina) Participatory Social Investment Fund EPINFO Statistical Processing and Internet-based Communications of Survey-based Data GDP Gross Domestic Product GNP Gross National Product GoA Government of Argentina HIV/AIDS Human Immuno-Defficiency Virus/Acquired Immune Defficiency Syndrome IDB Inter-American Development Bank INPA Interv encion Participativa (Participatory Approaches to Drug Prevention) IV Intravenous LACI Loan Administration Change Initiative LIL Learning and Innovation Loan LUSIDA (Argentina) AIDS and STD Control Project NBI Basic Needs Indicators NGO Non-Govemmental Organization PIU Project Implementation Unit PTS Provincial Technical Supervisor (Supervisores Tecnicos Provinciales) QBS Selection Based on Consultants Qualifications QCBS Quality and Cost-based Selection SCAN Schedule for Clinical Assessment Neuropsychiatry SDS Secretaria de Desarrollo Social SEDRONAR Secretariat for Programming for Prevention of Drug Abuse and the Fight Against Narco-Trafficking SIDUC Uniformed Information System on Drugs SIEMPRO Social Information, and Monitoring and Evaluation of Targeted Social Programs) SIME Sistema de Informacion Monitoreo y Evaluacion de Adicciones STP Supervisor Tecnico Provincial TORs Terms of Reference UNDCP United Nations Drug Control Program UNDP United Nations Development Program VIGI-A (Argentina) Disease Surveillance and Control Project WHO World Health Organization Vice President: Shahid Javed Burki Country Manager/Director: Myrna L. Alexander Sector Manager/Director: Xavier E. Coll Task Team Leader/Task Manager: Hideki Mori  ARGENTINA INTEGRATED DRUG-ADDICTION PREVENTION PILOT 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 3 2. Main sector issues and Government strategy 3 3. Sector issues to be addressed by the project and strategic choices 5 C. Project Description Summary 1. Project components 6 2. Key policy and institutional reforms supported by the project 7 3. Benefits and target population 7 4. Institutional and implementation arrangements 8 D. Project Rationale 1. Project alternatives considered and reasons for rejection 8 2. Major related projects financed by the Bank and other development agencies 9 3. Lessons learned and reflected in proposed project design 9 4. Indications of borrower commitment and ownership I 1 5. Value added of Bank support in this project 1 1 E. Summary Project Analyses I. Economic 1 1 2. Financial 11 3. Technical 12 4. Institutional 12 5. Social 12 6. Environmental assessment 12 7. Participatory approach 12 F. Sustainability and Risks 1. Sustainability 13 2. Critical risks 13 3. Possible controversial aspects 13  G. Main Loan conditionl4 1. Effectiveness conditions 14 2. Other 14 H. Readiness for Implementation 15 I. Compliance with Bank Policies 15 Annexes Annex 1: Project Design Summary 16 Annex 2: Detailed Project Description 18 Annex 3: Estimated Project Costs 26 Annex 4: Cost Benefit Analysis Summary, or Cost-Effectiveness Analysis Summary 27 Annex 5: Financial Summary for Revenue-Earning Project Entities, or Financial Summary 29 Annex 6: Procurement and Disbursement Arrangements-Table A 30 Annex 7: Project Processing Schedule 36 Annex 8: Documents in Project File 37 Annex 9: Statement of Loans and Credits 38 Annex 10: Country at a Glance 41 MAP(S)  ARGENTINA Integrated Drug Prevention Pilot Project Project Appraisal Document Latin America and Caribbean Region Country Management Unit for Argentina, Chile and Uruguay Date: April 30, 1999 Team Leader: Hideki Mori Country Manager/Director: Myrna L. Alexander Sector Manager/Director: Xavier E. Coll Project ID: 58526 Sector(s): SA - Social Assistance Lending Instrument: Learning and Innovation Loan (LIL) Theme(s): Social Development, Social Protection Poverty Targeted Intervention: Yes Project Financing Data L Loan Ei Credit E Grant El Guarantee O Other (Specify) For LoanslCredits/Others: Amount (US$m) 4.75 Proposed Terms: Li To be defined EX Multicurrency li Single currency USD EL Standard Variable EL Fixed Li LIBOR-based Grace period (years): 3 Years to maturity: 15 Commitment fee: 0.75% Front end fee on Bank loan 1.00% fFinancing Plan: [iTo be defined Source Local ForeTsn Total Government 2.14 0.01 2.15 IBRD 4.30 0.45 4.75 IDA 0.00 0.00 0.00 Total: 6.44 0.46 6.90 Borrower: The Argentine Republic Guarantor: Responsible agency: Secretaria de Programacion para la Prevenci6n de Drogadicci6n y Lucha contra el Narcotrafico (SEDRONAR) Implementing agency(ies): Secretaria de Programaci6n para la Prevenci6n de Drogadicci6n y Lucha contra el Narcotrafico (SEDRONAR) Address: Sarmiento 564, Buenos Aires, Argentina Contact Person: Tel: (54-11) 4320-1250 Fax: (54-11) 4320-1168 Email: Estimated disbursements ( Bank FYWUS$M): 2500 2001 Annual 3.54 21_ Cumulative 3.54 4.75 Project implementation period: 2 years Expected effectiveness date: 07/01/99 Expected closing date: 12/31/2001 OCS PAD Form: October 9, 1998  A: Project Development Objective 1. Project development objective: (see Annex 1) The primary objective of the proposed LIL Project is to test the applicability of a multisectoral drug prevention strategy in the Argentine context. Drugs and drug-related problems are complex and often controversial. However, the nature and degree of drug abuse in Argentina do not appear to be as serious as in other countries. Consequently, the Government's primary interests are: (i) obtaining a more accurate picture of drug use in Argentina; and (ii) preventing its citizens from becoming drug users. Successful drug prevention strategies are contingent on the existence and strengthening of social capital, particularly the enhancement of social skills and assertiveness among young people. In addition, providing alternatives to drug use, such as opportunities for recognition and personal achievement via community activities, has been proven to be effective for populations that are most vulnerable to drug use. Furthermore, international experiences indicate that inclusion of group interaction mechanisms, trained mental-health professionals, and counselors make a positive impact on potential drug users. Could such a set of strategies be effective, in the Argentine context? The country already has significant experience in demand-driven economic and social development through local and community participation that could be combined with specific drug prevention strategies from other countries to double the impact of this drug prevention effort. In this context, the LIL mechanism has been selected because of: * Incomplete information on conditions in the country; 9 A new and relatively unknown area for Bank activities; and o The need to develop and test the most appropriate intervention package. The project is expected to help the Government of Argentina (GoA) determine the need and the framework for a larger drug-prevention project. More specifically, the project would: * Elaborate the epidemiological profile of drug-addiction and estimate the consumption levels of psychoactive substances through the development of decentralized information systems; * Identify and develop technologies for integrated drug-prevention, and transfer them to municipalities and community organizations; * Mobilize and strengthen local solidarity networks to prevent primary drug use in local youth; and * Assist selected municipalities in developing and implementing a municipal plan, which would in turn, strengthen the capacity of local communities in preventing drug use. The project would not support supply-reduction activities or drug treatment facilities for secondary drug users. Nor would it support supply-reduction-related activities including (i) the control of production, and transportation of illicit drugs; and (ii) investigation and prosecution of drug dealers and users. 2. Key performance indicators: (see Annex I) The project would test an operational model and an implementation mechanism for reducing potential and actual demand for drugs and alcohol. As a LIL, project performance would be assessed based on the quantity and quality of information generated by the project and the sustainability of the systems and approaches established. Key performance indicators would include: * Performance of municipal councils as measured by the number and types of subprojects sponsored; * Nature and degree of participation by various actors as measured by numbers of participants -2-  disaggregated by gender, age range, and other relevant indicators; * Number, quality, and attendance of courses completed by the youth and municipal councils; * Types and quality of data generated; * Functionality of the information network; * Indications of behavior and attitude changes of at-risk groups as measured by surveys; and * Quality of municipal plans and their sustainability implications as measured by post-project budgetary outlays, as well as average cost per beneficiary by the type of subproject implemented. B: Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported by the project: (see Annex 1) Document number: CAS Progress Report No. R-98-266; IFC/R98-233 Date of latestCAS discussion: 11/10/98 Social sector assistance has played a lead role in the Country Assistance Strategy for Argentina, both because of its contribution to poverty reduction, as well as the need to have in place a well-functioning social safety net to underpin Argentina's Convertibility Plan. Most notably, health, education and social protection programs, such as the temporary employment creation and public works program (TRABAJAR) account for the bulk of that support, and have been addressing some of the systemic problems facing the financing and delivery of quality basic services, particularly for the poor. More recently, as set out in the latest CAS update, this program of basic services is being complemented with innovative, small scale learning interventions to support social programs which target particular vulnerable groups and address specific social problems that Argentina is encountering. This is the case, for example, in the Bank's ongoing support for AIDS prevention, the proposed support for indigenous peoples, as well as this proposed program for drug prevention. 2. Main sector issues and Government strategy: The social costs of drug abuse are serious public health concerns in both developed and developing countries. Whether legal or illegal, a wide range of substances cause harmful effects. The World Health Organization (WHO) estimates that substance abuse accounts for about 4% of the entire global burden of disease and injury from all causes, as measured in disability-adjusted life years (DALYs). Substance abuse is the also the major risk factor in road, traffic, and other injuries (8.8%); suicides (2.2%); sexually transmitted diseases with HIV (1.7%); liver cirrhosis (1.6%); and violence (1%). In countries that are going through an epidemiological transition, such as Argentina, substance abuse may account for an even higher proportion of disease and injury burden (about 25%), with alcohol accounting for 10-11% of illness and death each year. For Latin America alone, significant mortality rates (8.7 per 100,000) of liver cirrhosis indicate the gravity of the problem. These figures represent the loss of human capital, as well as the loss of irreplaceable cumulative knowledge and skills that undermine national productivity. The estimated gross national product lost or not earned, may amount to 5-6% of country GNP as a result of reduced productivity from drug/alcohol consumption at work, premature deaths, and medical and social expenses. The costs of providing health care to a drug addict are thought to be around 80% higher than for an average citizen in the same age group (International Narcotics Control Board, 1996). Successful drug prevention efforts depend on the etiology of beginning, continuing, and stopping drug use, which vary widely among cultures and socio-economic groups. For example, in developed countries, youth with troubled histories of emotional or physical abuse seem to have different reasons for using drugs than do youth from stable backgrounds, and reasons for continuing use may be very different from reasons that -3-  started the use. A teenager may begin drug use because of peer pressure, but continue to use it due to the addiction developed. It is important to note that different prevention strategies are necessary to apply to these different patterns affecting drug use, which is why it is imperative to involve local communities in prevention efforts. A yet untouched issue in many countries is the deliberate inhalation of volatile solvents, which is an increasing problem worldwide. These substances, such as glue, petrol, paint thinners, domestic polish and aerosol sprays are particularly attractive to marginalized and vulnerable young people because of their ready availability, low cost, and the rapidity of mood alteration following inhalation. Hazards associated with their use range from sudden death to various neuropsychological and physical harms. Government Strategy: The GoA is committed to preventing potential substance abuse among the at-risk population, whether the substance is legal or illegal. This includes the more commonly abused 'hard drugs' of cocaine, ecstasy, heroine, and crack, as well as alcohol and other legally obtained volatile solvents that are consumed by the youth in Argentina. The GoA first tackled drug abuse issues formally in 1974 when it passed a law on drug possession for personal use. The Centro Nacional de Reeducacion Social (CENARESO) was the first public organization responsible for rehabilitation and treatment of drug users. During the mid-1981)s, many governmental and non-governmental organizations (NGOs) were created to address the same issues, and provide similar services. In 1985, the first national organization for drug prevention strategies and policies, the Comision Nacional para el Control del Narcotrafico y el Abuso de Drogas, was created. Drug prevention activities were augmented when Argentina became a party to the 1988 U1N Convention Against Illicit Traffic in Narcotic Drugs & Psychotropic Substances, joining the international community's efforts against drug abuse. In 1989, major anti-narcotics legislation was passed to activate the commitments of community-based alternatives to prison. The Comision Nacional was replaced in 1989 by the Secretaria de Programacion para la Prevencion de la Drogadiccion y la Lucha contra el Narcotrafico (SEDRONAR), which is responsible for coordinating all counter-narcotics activities, including drug prevention and treatment programs, as well as participation in international meetings on global anti-drug efforts. Activities have taken place with coordination between the federal and provincial levels. SEDRONAR's annual budget is approximately $17.5 million (1998). Drue Use: One of the main challenges is the lack of information on the nature and extent of substance abuse in Argentina. Through studies conducted to date, it appears that the rate of drug abuse is not significant (it is estimated that one percent of the population uses drugs), but that without proper attention, the situation may worsen. In addition, although Argentine-specific data are not available, studies prove that the abuse of alcohol is a major problem in the Latin America region. Prevalence rates of excessive drinking in the region, estimated at 15-34%, are high compared with other regions. The incidence rate of liver cirrhosis is 20.6 per 100,000 people, much higher than in the Middle East (14 per 100,000) and Sub-Saharan Africa (10.5 per 100,000). Moreover, anecdotal evidence from field visits to the provinces indicates that excessive alcohol abuse is growing among young girls. Using information available, it is possible to identify some trends in drug abuse in Argentina. Research in 1996 in the Province of Buenos Aires shows that in two poor neighborhoods, 14% of the population uses cocaine via inhalation. If youths fifteen years old and above are included in the sample, the rate of cocaine use rises to 22%. Cocaine is the drug of choice for about 81% of Argentina's drug users, and one study found that about three percent of students in the Province of Buenos Aires had tried cocaine. Intravenous (IV) drug use continues to be a problem in Argentina, where the number of registered IV drug users has not -4-  decreased substantially (900 to 831 cases) from 1994 to 1996. The association between IV drug use and the spread of HIV/AIDS adds to the urgency. Although national data are scarce, most experts agree that the group with the highest prevalence of drug use is young people from 10-30 years old. According to the 1991 census, 25% of the total population is between 14 and 29 years old, indicating that a significant portion of the population is a high-risk group. Between 1995 and 1996, the average age of initiating cocaine use dropped from 16 to 14. Prompt and appropriate action is necessary to ensure that this trend does not continue. Drug users in the 15-20 year age range often use drugs on an irregular, non-intensive basis; regular or intensive use is evident in the 20-30 age bracket. Since the average age for beginning treatment is 23 years of age, early intervention is desirable to prevent progression to the stages at which there is more intense use of drugs. Data also show that there is increased vulnerability for the unemployed and the poor. The unemployment rate for those between 15 and 19 years of age is three times higher than the national average. 3. Sector issues to be addressed by the project and strategic choices: As a Learning and Innovation Loan (LIL), the project's main purpose is to assess the existing situation, while setting the stage for more comprehensive drug prevention activities in Argentina. Although law enforcement and treatment programs have traditionally been dominant components of prevention, the proposed project would see if it would be feasible to promote this community prevention approach as an alternative to punitive actions. To better determine the drug use situation in Argentina, an information system would be supported, in conjunction with a municipal focus and a participatory approach. Such activities, along with institutional strengthening, would provide the necessary background and initiative for further efforts, and are fully consistent with client demand. Coordination of Efforts and Capacity Building: A health-focused network for substance abuse exists, which provides services to addicts. However, coordination is lacking in prevention programs, where levels of organization differ, strategies are not clearly defined, and responses to the question of prevention are varied. Prevention activities in Argentina are still in a state of development, working toward improvements in the technical tools, and analytical and planning strategies used. In line with the GoA's strategy, this project would bridge that gap. In addition, the project would strengthen the current capacity of communities and government by nurturing their collaboration and communication in drug prevention efforts. Multisectoral Approach: Drug prevention activities require the input of various sectors, including education, private sector, social assistance, health, and judicial systems. Therefore, effective programs require strong coordination between the sectors to address different dimensions of the issue. The project would use such a multisectoral approach to address the social costs of substance abuse in Argentina. Local Municipal Focus: The project would use a municipal focus to extend prevention activities, while ensuring that activities are appropriate for specific situations in municipalities. The information system would also operate in a decentralized manner, in which information would be collected on a local level and included in a national network. Participatory Approach: In order to meet the needs of specific communities, the project would adopt a participatory approach consistent with the GoA's past successes in community-based economic and social programs. Such an approach would direct attention to the needs of specific at-risk groups such as the unemployed, the poor, youths, etc., and tailor programs, such as media campaigns. This participatory -5-  approach would encourage attention to the "micro" levels at which specific populations would be supported, including their training and inclusion in drug prevention campaigns. Information System: As statistical data are currently lacking on both national and local levels, the project would collect information regarding the current situation, as well as develop a permanent information system to continue monitoring drug abuse trends. The information generated (national prevalence, factors associated with drug use, etc., disaggregated by categories such as age, gender, economic status, etc.) is essential to design improved drug prevention programs. Young People: Considering the prevalence of drug use among young people, the project would direct attention to this high-risk group, and sensitize its activities accordingly. Educational campaigns encouraging dialogue among young people, and promoting and strengthening youth-related, and youth-led initiatives would be supported by the project. HIV/AIDS: Given the association between IV drug use and the spread of HIV/AIDS, the project would assess and collect more information on the situation, and advance strategies for cooperation with other programs which are already implementing such initiatives, such as the Bank's AIDS and STD Control Project (LUSIDA). C. Project Description Summary 1. Project components (see Annex 2 for a detailed description and Annex 3 for a detailed cost breakdown): The proposed project has two major components and a small project management component. Further discussion can be found in Annex 2. Component A: Participatory Approaches to Drug Prevention (INPA - Intervencion Participativa) This component is designed to promote local solutions to drug use in selected municipalities on a pilot basis via: (i) Training local community members and sector professionals; (ii) Training youth leaders; and (iii) Financing the implementation of the municipal plans for drug prevention. Reflecting the pilot nature of the project, only five provinces--expected to be Salta, Misiones, Santa Fe, Mendoza, and La Pampa--would be identified based on demographics, estimated levels of drug consumption, proximity to known drug trafficking routes and regional representation. Within each province, four municipalities would be identified, two of which would be selected as the pilot municipalities by SEDRONAR in accordance with the criteria established in the Operational Manual (OM) of the project. The criteria would include population (i.e. 10,000 or less), proximity to known drug trafficking routes, estimated levels of drug consumption, sequestration, commitment of local authorities, presence of NGOs capable of conducting training and other relevant social indicators. Component B: Information Systems. Monitoring. and Evaluation (SIME - Sistema de Informacion Monitoreo y Evaluacion de Adicciones) This component is designed to establish the network that would facilitate generation and exchange of information relevant to drug prevention, as well as to carry out the monitoring and evaluation of the project itself via: (i) a survey-based epidemiological study to obtain information on drug consumption patterns; (ii) development of prevention methods and training modules that would be disseminated via -6-  national, regional and provincial workshops; (iii) creation of a network of monitoring centers to strengthen existing institutions focused on drug prevention; and (iv) monitoring and evaluation of overall project implementation processes. Component C: Proiect ManaLyement A small project implementation unit (PIU), expected to consist of four technical staff, would be responsible for overall project management. Indicative B-ank- % of Component Sector ost d% of financing Bank- _______i:_______________A--_____;. (US$My) - - Total E (U$$ fi nancing A. Participatory Approaches to Drug BI - Institutional 5.42 78.6 4.28 90.1 Prevention (INPA - Intervenci6n Development Participativa) B. Information Systems, Monitoring BI - Industrial 1.13 16.4 0.17 3.6 and Evaluation (SIME - Sistema de Development Informaci6n, Monitoreo y Evaluaci6n de Adicciones) C. Project Management 0.30 4.3 0.25 5.3 Total Project Costs 6.85 99.3 4.70 98.9 Front-end fee 0.05 0.7 0.05 1.1 Total Financing Required 6.90 100.0 4.75 100.0 (figures above are only for indicative purposes, and rounded to the order of 0.01 million). 2. Key policy and institutional reforms supported by the project: The proposed project seeks to deepen and extend the existing policy and institutional framework. In particular, the project would amplify the prevention focus in dealing with drug-related problems, while the existing policies and strategies are mostly related to the control of drug trafficking. If the project were to be successful, it could trigger a significant shift in the policies and strategies. 3. Benefits and target population: The primary benefits of the project would be: (i) the knowledge and experience gained through the implementation of the project; and (ii) increased institutional capacity of SEDRONAR, municipalities, and local actors in addressing and handling drug prevention issues. The project targets local community members, including municipal authorities and local institutions, such as schools, hospitals/clinics and youth groups. The indirect benefits would be future generations of Argentines potentially free from substance abuse. Ultimately, if the project is successful, and is replicated, the intended target population would be high risk groups nation-wide which will cut across all income levels. Nevertheless, for the LIL, the target population is limited to the five participating provinces which all have per capita incomes below the national average, and the target populations will more than likely be among the poorer segments of the population. -7-  4. Institutional and implementation arrangements: The project would be managed by a small project implementation unit (PIU), the Subsecretariat for Prevention and Assistance (Subsecretaria de Prevencion y Asistencia), one of the two subsecretariats under the Secretariat for the Programming for the Prevention of Drug-Addiction and Fight against Drug Trafficking (SEDRONAR - Secretaria de Programacion para la Prevencion de la Drogadicci6n y la Lucha contra el Narcotrcfico; see Chart 2 in Annex 2). The key staff to be hired for the PIU would include a General Coordinator, an INPA Technical Supervisor, a SIME Technical Supervisor and an Administrative Supervisor. (see Annex 2; Annex 6). As described under "C.1. Project Components", SEDRONAR would work with five provinces, and two municipalities in each province. The municipalities are required to form a consultative council (Consejo Consultivo Municipal - CCM to ensure participatory processes. For further detail, see Institutional framework and flow of funds in Annex 2. Cooperation between SEDRONAR and the provinces/municipalities would be governed by the Provincial/Municipal Framework Agreements (Carta de Adhesi6n Provincial/Municipal). The model framework agreements are included in the Operational Manual. Financial management arrangements for the project were reviewed by the Bank's financial management specialist, and found acceptable (see Annex 8: Documents in the Project File). D: Project Rationale 1. Project alternatives considered and reasons for rejection: The most likely alternative would have been a full-fledged drug-prevention project, larger in size and broader in geographic coverage and scope. This alternative was rejected because such a project would be: (i) riskier given lack of information and experience in participatory drug prevention; and (ii) far more controversial as it would include not only demand reduction measures, but also supply reduction measures, including regulatory and legislative reforms as well as criminal investigation and prosecution. As a large part of this project involves the generation and dissemination of drug prevention information, a public good, it has been determined that the public sector is the best vehicle to target drug prevention activities. In many cases, treatment and rehabilitation of substance abusers has been successful via the private sector, but the public nature of prevention activities indicates a strong case for the public sector. Nonetheless, the private sector, via local NGOs, will be involved in designing the municipal training programs, as well as the youth training programs. The decision to focus on primary rather than secondary prevention was made based on the estimates of use and resource availability. Primary prevention consists of delaying or preventing initial use or stopping the use of drugs before an individual is actually addicted to the drug. Secondary prevention focuses on early intervention and treatment referral for those already diagnosed as having a substance abuse disorder. Argentina already has a strong referral system of drug and alcohol treatment centers, and from an economic perspective, treatment of dependency disorders is not as cost-effective as prevention. A broad-based prevention strategy has been selected versus a more targeted approach due to the multisectoral nature of the drug problem. Since drug use involves several dimensions of community life from health to education to social capital and religious institutions, it was agreed that each sector should be included in the preliminary approach. An approach commonly chosen by the UN and other organizations to reduce drug supply is alternative development projects which promote the development of specific crops to substitute for coca production -8-  and offer farmers economic alternatives. This would be a questionable approach, as very little evidence indicates the 'existence of a significant level of drug production in Argentina. Moreover, the Bank's experience ha shown that interventions in support of producing single agricultural commodities rarely succeed. In addition, country experiences demonstrate that even with reduced cultivation of drugs, the slack is taken up in neighboring countries, where cultivation is unfettered by projects or authorities. 2. Major related projects financed by the Bank and/or other development agencies (completed, ongoing and planned). I I . Latest Supervision Sector Issue Project (PSR) Ratings I . ~~~~~~~(Bank-financed proJects only) Implementation Development Bank-financed Progress (IP) Objective (DO) Public Health AIDS and STD Control HS HS (LUSIDA), AR-PE 43418 Community Mobilization Social Protection 1, AR-PE S HS 35495 Social Protection IV, AR-PE HS HS 6058 Epidemiological Surveillance Disease Surveillance and NA NA Control (VIGI-A), AR-PE 55482 (not yet effective) Social Protection Jamaica Social Fund S S Social Protection Colombia Peace and Development Social Protection Colombia Youth Development S S Other development agencies IDB Youth Productivity and Employability Support Program (Loan 1031) Project for Attention to Children and Adolescents at Risk (Loan 1008 and 1 1 11) P/DO Ratings: HS (Highly Satisfactory), S (Satisfactory), U (Unsatisfactory), HU (Highly Unsatisfactory) 3. Lessons learned and reflected in the project design: The Bank has little direct experience in drug prevention programs, and the proposed project would be the Bank's first stand-alone operation. Past support has been primarily of wider social programs, including social funds, community development projects, community health projects, and others involving educational programs. As a result, the experience drawn upon to design the proposed project has been principally that of the OECD countries. Experience and research on drug-prevention in Europe and the US suggests the following. First, the complexity of the paths that lead towards drug use and abuse indicate the necessity for broad-based prevention strategies towards: (i) increasing knowledge about drugs and their effects; (ii) changing attitudes towards drugs and other deviant behaviors; (iii) decreasing or stopping the use of drugs; (iv) enhancing refusal, social and life skills; and (v) decreasing negative behaviors. Various studies appear -9-  to indicate that the enhancement of social skills and assertiveness tends to discourage (or prevent initiation into) drug use. Provision of alternatives to drug use - providing opportunities for recognition and personal achievement through involvement in community or 'self-help' activities - is often found to be very effective for those most vulnerable to drug abuse. Furthermore, inclusion of group interaction mechanisms and trained mental-health professionals and counselors appear to make a positive impact. Second, it is essential to include not only illicit drugs but also other substances such as alcohol and tobacco in any discussion of prevention for the following reasons: (a) the use of any psychoactive substance enhances the risk of using others (for example, early alcohol and tobacco consumption increases the risk of illicit drug use); (b) many factors known to be responsible for the onset of drug use (such as family or peer-group influences) are largely independent of the specific substance used; (c) different substances appear to have biological similarities (for example, cannabis, opiates and alcohol); (d) it is more efficient for prevention activities to address all substances, rather than to develop different programs for different drugs; and (e) if a prevention intervention is to be credible to the young, it must include licit substances which young people see adults abusing on a daily basis. For these reasons, most primary drug-prevention programs do not differentiate between substances. Information on specific drugs is clearly necessary, but providing such information does not play a major role in many preventive activities. Third, OECD experience also has shown that different age groups appear to benefit from different strategies. Most effective for children aged 12-14 seem to be strategies that stress interpersonal and refusal skills, and allow them to have the necessary time to practice using these skills. Also effective would be the provision of information about the peer/social pressures to use drugs. For older children, successful programs appear to include more structured, drug-focused sessions. More precisely, successful prevention programs for children and adolescents appear to: v be designed to enhance protective factors and attempt to reverse or reduce known risk factors; 3 target all forms of drug abuse, including tobacco, alcohol, cannabis and solvents; * include skills to resist drugs when offered, strengthen personal commitments not to use drugs, and increase social competency (for example, in communication, peer relationships, self-efficacy and assertiveness); _ when targeted at adolescents, include interactive methods, such as peer discussion groups, rather than didactic teaching techniques alone; * include a component for parents or care-givers which reinforces what the children are learning and provides opportunities for family discussion since family-focused prevention has a greater impact than strategies that focus solely on parents or children; * be long term, taking place throughout the school career with repeat interventions to reinforce the original prevention goals - schools offer opportunities to reach all populations and are also important settings for specific 'at-risk' groups; * strengthen norms against drug use in all drug-abuse prevention settings, including the family, school and the community - as with family interventions, community programs are more effective when accompanied by school and family components; * be adapted to address the specific nature of the drug-abuse problem in the local community; * be more intensive, and begin earlier the higher the level of risk experienced by the target population; and * be age-specific, developmentally appropriate and culturally sensitive. Argentina has successfully implemented a number of participatory community based projects in recent years (e.g. FOPAR - Participatory Social Investment Fund; Programa Juvenil; TITSIDA - AIDS/STD Prevention Project, etc.). Many of the design features of those projects, including the -10-  establishment of municipal/provincial council, local action plans and funding of small-scale, demand-driven community subprojects are incorporated into the proposed project. 4. Indications of borrower commitment and ownership: The borrower has already made significant progress in the project design and implementation arrangement, using its own resources. The operational manual has been already drafted and reviewed by the Bank during the appraisal and the negotiations. In addition, the project has already identified five provinces for the INPA component. The Bank team's field visits during project preparation confirmed their strong interest. 5. Value added of Bank support in this project: The Bank has supported a wide range of projects and analytical work in Argentina and the rest of the world in health, education and social development. Some of them have small components or lines of actions geared toward drug-prevention. Although this would be the first time the Bank has financed a comprehensive drug-prevention project, the Bank is strategically situated to transfer useful knowledge and experience to Argentina. Also the Bank's involvement in the project has already mobilized the support of the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), and is likely to catalyze the support of other international organizltions such as the United Nations Drug Control Programme (UNDCP). E. Summary Project Analysis (Detailed assessments are in the project file, see Annex 8) 1. Economic (supported by Annex 4): O Cost-Benefit Analysis: NPV=US$ million; ERR= % * Cost Effectiveness Analysis O Other Per LIL procedures, design and execution of detailed economic analysis would be carried out during project implementation, and will assess the cost-effectiveness of various interventions and their impacts. While interest in judging the cost-effectiveness of different prevention initiatives has grown, very few published studies are available - although a number of general guides to economic evaluations do exist (for example, Tolley, 1992; Gold et al., 1996; Drummond et al., 1997). The costs of prevention activities fall into four main groups: (i) direct costs to the agency delivering the intervention; (ii) direct costs to other agencies involved in the intervention; (iii) direct costs to the individuals participating in the intervention; and (iv) indirect productivity costs. On the other hand, the potential benefits of drug-prevention programs can also be divided into a number of different categories: (i) health benefits to the individuals targeted by the intervention; (ii) consumption benefits of the intervention; (iii) other non-health benefits; (iv) social diffusion effects; and (v) effects on future resource use. 2. Financial (see Annex 5): NPV=US$ million; FRR= % Not applicable. This would not be a revenue-generating project. Fiscal Impact: Per aforementioned LIL procedures, a detailed fiscal analysis including financial sustainability implications would be carried out during project implementation. -11-  3. Technical: The proposed LIL would assess whether the participatory approach with strong emphasis on municipal and local levels is a viable option in effective drug prevention, and would identify necessary modifications and alternative mechanisms for wider-scale adoption. The basic design of the potential interventions has been carried out with the assistance of the Bank's health specialists and a specialist of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), and was carefully reviewed. 4. Institutional: a. Executing agencies: This would be SEDRONAR's first externally-financed operation. Thus, their institutional capacity for implementing projects is untested. However, the overall approach is to build on strong local participation, and SEDRONAR could benefit from knowledge / technology transfer from programs like FOPAR and SIEMPRO, which are successfully being implemented using similar community-based approaches and data gathering techniques. b. Project management: The PIU would be headed by a General Coordinator acceptable to the Bank. In order to ensure the success of a project that cuts across multiple sectors, it is preferable that this person has knowledge and experience in social development, and in dealing with international institutions. The PIU would be also staffed with an INPA Technical Supervisor, a SIME Technical Supervisor and an Administrative Supervisor whose terms of reference and experience are acceptable to the Bank. 5. Social: Per aforementioned LIL procedures, social impact assessment would be carried out during project implementation based on terms of reference acceptable to the Bank. The assessment would utilize commonly used techniques, including focus group meetings and sample-based interviews stratified based on gender, age and other relevant factors. Under the INPA component, gender/age breakdown of municipal council members, training participants and their attendance to council meetings/training sessions would be closely monitored. Survey questionnaires used for the Survey-based Epidemiological Study and those used by the monitoring centers under the SIME component would include additional data elements like education background, type of employment, marital status and the number of children. 6. Environmental assessment: Environment Category O A 1 C O B El FL No negative environmental impact is expected. There will be no resettlement nor bias against indigenous populations. 7. Participatory Approach (key stakeholders, how involved, and what they have influenced or may influence; if participatory approach not used, describe why not applicable): a. Primary beneficiaries and other affected groups: Drug prevention is a multi-sector issue, and the participatory approach is central to the project's design. Relevant sector institutions (education, health, etc.), municipal and provincial governments and civil society organizations would be represented in the municipal councils. Participation of local youth groups would be ensured through the support of training projects. b. Other key stakeholders: N/A -12-  F: Sustainability and Risks 1. Sustainability: Per LIL procedures, sustainability of learning would be tracked through the monitoring of performance indicators described under "D.2 Key Performance Indicators." Fiscal sustainability would be analyzed during project implementation. 2. Critical Risks (reflecting assumptions in the fourth column of Annex 1): Risk Risk Rating Risk Minimization Measure From Outputs to Objective * Institutional and financial M This is one of the criteria to select commitment of sponsoring provinces provinces and municipalities. and participating municipalities * Communication and leadership skills S Adequate selection criteria and training of the leaders * Sustained interest and commitment of S Skilled leaders and adequate types of youth group members subprojects; confidentiality of information * Active exchange of information S Utilization of user-friendly technology; between network node organizations adequate information exchange protocols * Studies provide useful knowledge and M Consultations with potential information information users. From Components to Outputs * Adequate commitment of sponsoring M This is one of the criteria to select provinces, participating municipalities provinces and municipalities. and council members * Existence of demand for drug related M Network nodes would be selected from information the institutions that have specific roles to play in drug prevention Overall Risk Rating M Risk Rating - H (High Risk), S (Substantial Risk), M (Modest Risk), N(Negligible or Low Risk) 3. Possible Controversial Aspects A potentially controversial aspect of the project is not what it will attempt to do, but what it will not do. It does not deal with the production, distribution, or sale of illicit drugs; it does not deal with treatment and rehabilitation, nor with prosecution of any crimes related to the use and abuse of drugs. It does not attempt to deal with supply reduction, including price controls and taxation, limiting access, or public safety. It also does not deal with the issue of the "right to take drugs" as a matter of personal choice and civil liberty. Instead, the focus of the project is on primary preventative actions, before drug use becomes a problem, within the broader area of demand reduction. Another potentially controversial area is the availability of personal data which cou'd be used -13-  outside the project's scope. For the project to be effective in building trust and securing the participation of high-risk groups, particularly youths, it is important that participation in any project-sponsered activities is not compromised by the involvement of police in any law enforcement matter, or in the availability of information on individuals. Thus, measures will be taken to ensure the confidentiality of data collected under the project on individuals, and to limit the direct participation of police to community development officials with the agreement of the participating communities. Data would be collected on a voluntary basis. G: Main Loan Conditions 1. Effectiveness Condition * Approval of the project's Operational Manual by the Bank and adoption of the Manual by SEDRONAR; * Establishment of the Project Implementation Unit (PIU) with the appointment of key staff, namely a General Coordinator, an 1NPA Technical Supervisor, a SIME Technical Supervisor and an Administrative Supervisor, with terms of reference and qualifications satisfactory to the Bank (see Annex 2; Annex 6). 2. Other [classify according to covenant types used in the Legal Agreements.] * SEDRONAR will submit to the Bank, semi-annual progress reports no later than May 31 and November 3 0 each year, starting November 3 0, 1999, in accordance with the format acceptable to the Bank; a The mid-term review of the project will be held no later than December 15, 2000; SEDRONAR will, no later than September 30, 2000, prepare and submit a summary report to the Bank as an input to the mid-term review; * No later than December 31, 1999, SEDRONAR will contract an independent auditor with terms of reference and qualifications acceptable to the Bank to carry out annual procurement and financial audits of the Municipal Plans by June 30 of each year (see Annex 6); * The Bank will review and approve the first Municipal Plan. Prior to this approval, no disbursement will be made under the disbursement category, Grants (see Annex 6); * Following the review and approval of the first Municipal Plan by the Bank, SEDRONAR will not transfer funds to be disbursed under the loan to a municipality unless SEDRONAR has furnished to the Bank evidence satisfactory to the Bank that: (a) the CCM has been established within the corresponding municipality; (b) the Provincial Framework Agreement (Carta de Adhesion Provincial) has been entered into between SEDRONAR and the Province in which the municipality is located; (c) the Mujnicipal Framework Agreement (Carta de Adhesi6n Municipal) has been entered into between SEDRONAR and the municipality; (d) the Municipal Plan for the municipality has been approved by SEDRONAR; and (e) the Subsidiary Agreement (Convenio de Transferencia) has been entered between SEDRONAR and the municipality (see Annex 2); * SEDRONAR will complete the selection of the participating provinces and municipalities by December 31, 1999 in accordance with the criteria and procedures specified in the Operational Manual (see Annex 2); * SEDRONAR will complete the review and approval of Municipal Plans by March 1, 2000 (see Annex -14-  2); * SEDRONAR will furnish the draft terms of reference for the Survey-based Epidemiological Studv (see Annex 2) for the Banks review and comments by January 1, 2000, and complete the survey, including review by the Bank, by March 31, 2000. H. Readiness for Implementation d 1. a) The engineering design documents for the first year's activities are complete and ready for the start of project implementation. l 1. b) Not applicable. 1 2. The procurement documents for the first year's activities are complete and ready for the start of project implementation. O 3. The Project Implementation Plan has been appraised and found to be realistic and of satisfactory quality. O 4. The following items are lacking and are discussed under loan conditions (Section G): 1. Compliance with Bank Policies D 1. This project complies with all applicable Bank policies. O 2. The following exceptions to Bank policies are recommended for approval. The project complies with all other applicable Bank policies. Hideki Mox Xgler E. Coll Myrna L. Alexander Team Leader Sector Manager/Director Country Manager/Director -15-  Annex 1: Project Design Summary ARGENTINA: Integrated Drug Prevention Pilot Project iW g Sector-related CAS Goal: Sector Indicators: Sector/ country reports: (from Goal to Bank Mission) * Reduce demand for illicit * Effective and efficient *ESW/CAS * Economic and social drugs, and reduce abuse of strategies and institutional stability or improvement other licit substances settings * Improved social services and * Availability of resources to longer-term human resource support above development Project Development Outcome I Impact Project reports: (from Objective to Goal) Objective: Indicators: *To test the applicability of * Changes in behaviors and * Periodic reports from PIU * Adequate political a multi-sectoral drug attitudes of at-risk groups, in * Pre- and post-results of commitment and public prevention strategy in the particular youth groups survey (Estuidio) support Argentine context via: (i) obtaining a more *Types and quality of data * Data are consistent with * Existing community-based accurate picture of drug use generated requirements of survey actors willing to participate on in Argentina; and (ii) (Estudio) and SIME a voluntary basis in councils preventing its citizens from parameters to prevent drug use becoming drug users *Number and quality of local through local community networks created/strengthened * Ex-post evaluation reports activities to prevent primary drug use in by SIEMPRO youth Output from each Output Indicators: Project reports: (from Outputs to Objective) component: * Improved municipal local * Number of councils *Semi-annual progress * Political and financial capacity to address established; council reports; annual audit reports commitment of sponsoring drug-prevention membership; provinces and participating training/workshops conducted municipalities * Municipal Plans * Quality and outcomes of the plan * Youth group leaders * Number of leaders identified * Communication and and trained leadership skills of the leaders * Youth training projects * Number and types of * Sustained interest and training projects approved commitment of youth group members to the subprojects * Functional information * Number of network nodes * Active exchange of network installed; data traffic patterns information between network node organizations -16-  * Specific studies * Number and quality of * Publications; workshops * Studies provide useful studies completed knowledge and information * Development of prevention * Quality and breadth of * Training materials and * Trainings build capacity in methods and training modules prevention methods developed resulting media tools community members and educate youth groups Project Components I Inputs: (budget for each Project reports: (from Components to Sub-components: component) Outputs) A: Participatory $ 5.4 million * Municipal Plans * Adequate commitment of Approaches to Drug sponsoring provinces, Prevention (INPA - participating municipalities Intervenci6n Participativa) and council members B: Information Systems, $ 1.1 million * Results of surveys from * Existence of demand for Monitoring and SIME component drug-related information Evaluation (SIME - Sistema de Informaci6n Monitoreo y Evaluaci6n) C: Proiect Management $ 0.3 million * Coordination of project activities -17-  Annex 2: Project Description ARGENTINA: Integrated Drug Prevention Pilot Project By Component: Project Component I - US$5.4 million Component A: Participatory Approaches to Druz Prevention (INPA - Intervenci6n Participativa) For the illustration of the INPA component, see Chart 1: INPA Institutional Arrangements below. The component is designed to promote local solutions to drug use and to strengthen the institutional capacity of selected municipalities and provinces via: (a) Training local community members and sector professionals; (b) Training youth leaders; and (c) Financing the implementation of the municipal plans for drug prevention. Reflecting the pilot nature of the project, only five provinces--expected to be Salta, Misiones, Santa Fe, Mendoza, and La Pampa--would be identified based on demographics, estimated levels of drug consumption, and proximity to known drug trafficking routes and regional representation. Within each province, four municipalities would be identified, two of which would be selected as the pilot municipalities by SEDRONAR in accordance with the criteria established in the Operational Manual (OM) of the project. The criteria would include population (i.e. 10,000 or less), proximity to known drug trafficking routes, estimated levels of drug consumption, sequestration, commitment of local authorities, presence of NGOs capable of conducting training and other relevant social indicators. SEDRONAR would complete the selection of the participating provinces and municipalities by December 31, 1999 [see G. Main Loan Conditions]. As a first step, based on procedures and selection criteria described in the project Operational Manual, the mayor of each municipality would establish a Consultative Municipal Council (Consejo Consultivo Municipal-CCM) for drug prevention as an advisory panel. The Council would consist of key members of the community from various sectors including education, health, religion, gender, and relevant social development NGOs. Of these 8 appointees, 3 of them would be from the municipal government. The Council members would establish internal regulations in accordance with the project Operational Manual (Consejo Consultivo Municipal: Reglamento Interno). To support the CCMs during the pilot phase under the project, technical assistance would be provided to each of the CCMs through SEDRONAR-hired consultants. Special considerations would be made with respect to the participation of local police forces in the CCMs of the INPA component. All CCMs would be initially created without any representative from police forces. A member of the municipal department of the provincial police force could be on the CCM if: (i) the municipal department has a specific division/unit designated to community development, including the support of the victims and families of violence against women, youth and other vulnerable groups; (ii) the CCM unanimously approves the participation of a member of the police force on the council; and (iii) the police force member would be from the division/unit described in (i). The internal regulations established by the CCM would provide further details of the terms and conditions of the participation of local police forces. (i) Training of local municipal actors. It is currently planned that 20-25 participants, including the members of the CCMs, as well as other relevant community members and sector professionals, would attend 5 training modules of 3 weeks each, divided into drug prevention methodology; organizational and communications skills; and strategic planning. Each module would be split into 1 week of theory and 2 weeks of practical applications. The graduates of these workshops would then write the Municipal Plans -18-  that are described in sub-component (iii) below, thus designing and owning their own local drug prevention strategies. In each INPA-participating municipality, all training activities would be carried out by a single consulting firm contracted by SEDRONAR (hereafter, Training Consultant). Due to the nature of the assignment, such a consulting firm is likely to be an NGO that is familiar with the local conditions of the corresponding municipality. (ii) Youth, culture and solidaritv. The youth of 14-25 years are considered to be most vulnerable to various temptations and other social as well as family conditions that are known to be conducive to the use of psychoactive substances, and for this reason, require special attention and approaches different from those for adult populations. The project would train approximately 30 youths in each municipality, selected by the CCM based on the criteria specified in the Operational Manual. The selection would be largely based on each candidate's potential to become a leader among their age group in their respective communities and a role model for younger children. Training is planned to consist of 5-module workshops of 3 weeks each, focusing on the consequences of drugs and alcohol consumption, effective communications skills, as well as other related topics, and would be carried out by the same Training Consultant for (i) Training of local municipal actors above. As part of the training, selected potential youth leaders would be encouraged to develop small training projects to prevent drug use in their communities. In each INPA-participating municipality, the CCM would review proposals and approve up to 5 training projects for funding of approximately US$1,000 or less each, based on selection criteria described in the Operational Manual. The funds to support such training projects would be included in the fee for the Training Consultants. (iii) Municipal plan for drug prevention. The CCM is expected to assume the central coordination role in developing and monitoring the implementation of a municipal plan for drug prevention, fully utilizing the training provided to the council members as well as other key members of the community. The plan would be submitted to SEDRONAR through the mayor of the municipality as a sub-project proposal. The municipal plans would include at least one activity designed by the youths in their workshops. SEDRONAR would review the proposals, and if acceptable, provide sub-project grants of up to US$150,000 each to support the pilot-implementation of the plans. This demand-driven and community-executed sub-project approach is essentially the same as what is known as the social investment fund approach. The sub-project grant would support the procurement of small goods and the contracting of consultant services, and both are carried out by the municipalities themselves in accordance with the procedures specified in the Operational Manual. SEDRONAR would complete the review and approval of the Municipal Plans by March 1, 2000 [see G. Main Loan Conditions]. Each municipal plan would be a holistic solution developed and executed by local actors and youths to deal with the drug problem that would otherwise be threatening their community. The sub-project grant would be provided only in the second (and the last) year of the project, to support the first year of each municipal plan. However, INPA-participating municipalities would be encouraged to extend the municipal plan schemes beyond the project completion, and to explore possible source of financing, including municipal and provincial sources, to support the plan's extension. Ultimately, one of the indicators of project sustainability would be municipal and provincial budget allocation for continued prevention efforts, submitted for the year following the project completion. (iv) Strengthening provincial links. Because the primary partner of the municipalities is the province, rather than the National Government (i.e., SEDRONAR), it would be essential to start establishing a link between the municipalities and provinces. In addition, in the future, provinces would require a focal point for coordinating drug prevention efforts. However, at present, provinces have little incentive to commit substantial resources for such purposes given the lack of effective prevention models. The project would -19-  provide for a provincial technical supervisor position (PTS; supervisor tecnico provincial) to facilitate and coordinate activities between SEDRONAR, the provinces, and the municipalities. By the end of the project, the participating provinces hopefully would see the value of such roles, and eventually would invest their own resources in future drug prevention activities. The aforementioned PTS would participate in the CCMs, but would not have voting powers on official decisions. In addition, he/she would communicate closely with the monitoring centers established in the SIME component in the province, and advise the provincial authorities and other relevant actors as appropriate. Institutional framework and flow of funds. In order to ensure the smooth execution of the INPA Component, SEDRONAR would enter into two types of framework agreements ("Carta de Adhesi6n Provincial" and "Carta de Adhesion Municipal"). In addition, to support the implementation of the Municipal Plans, SEDRONAR would enter into a subsidiary agreement (Convenio de Transferencia). The models of each type of framework and subsidiary agreement are included in the Operational Manual. The first framework agreement (Carta de Adhesi6n Provincial), made with each of the five participating provinces, would: (a) specify criteria and procedures to select municipalities; (b) allow SEDRONAR and the selected municipalities in the province to enter into the second framework agreement and the subsidiary agreement; (c) allow SEDRONAR to carry out training activities in the selected municipalities in the province; and (d) specify the terms and conditions of placing a provincial technical supervisor (i.e. PTS; see the subcomponent (iv) Strengthening provincial links above). The second framework agreement (Carta de Adhesion Municipal), made with each of the participating municipalities, would: (a) specify the terms and conditions for establishing the CCM; and (b) allow SEDRONAR-hired Training Consultant (see below) to carry out the aforementioned training activities in the municipality. Once SEDRONAR approves the Municipal Plan, developed by the Municipal Council and submitted through the municipality, SEDRONAR and the municipality would sign a subsidiary agreement, which specifies the terms and conditions of the provision and the use of grants for the Municipal Plan. The Bank will review and approve the first Municipal Plan. In addition, a Municipal Plan would be financed unless SEDRONAR submit to the Bank evidences of the establishment of the corresponding CCM, the effectiveness of the two framework agreements, SEDRONAR's approval of the Municipal Plan, and the effectiveness of the subsidiary agreement [see G. Main Loan Conditions]. All training activities in each of the INPA-participating municipalities would be carried out by consultants (i.e. Training Consultants) contracted by SEDRONAR using TORs and procedures acceptable to the Bank. The consultant contract would include the administration and management of the funds ear-marked for the small training projects to be implemented by youth groups (see (ii) Youth, culture and solidaritv in the above). Project Component 2 US$1.1 million Component B: Information Systems, Monitoring and Evaluation (SIME - Sistema de Informaci6n Monitoreo y Evaluaci6n de Adicciones) (i) Survey-based Epidemiological Studv. Lack of systematic information on the drug consumption pattern is a major bottle-neck in formulating and implementing effective policies and strategies. The project would carry out a nation-wide survey of drug consumption pattern through interviews of a representative sample of the Argentine population. Survey questions are based on internationally accepted standards, including -20-  CIDI (Composite International Diagnostic Interview/CIE-10/WHO), DIS (Diagnostic Interview Schedule version III-A, based on the American Psychiatric InstitutionlDSM-III), DICA-R-A (Diagnostic Interview for Children and Adolescents/Washington University Division of Child Psychiatry), SCAN (Schedule for clinical assessment in neuropsychiatry/WHO), and Argentina's SIDUC (Uniformed Information System on Drugs; Sistema de Informacion uniforme sobre drogas). The survey manual (including survey design and questionnaire) was reviewed during the appraisal and found acceptable (available in the project file; see Annex 8, SEDRONAR 2). Survey samples would be approximately 3,000, stratified based on age group, gender, poverty level (using basic needs indicators, NBI) and urban-rural conditions. Data from EDS ( Encuesta de Desarrollo Social; Social Development Survey) would also be utilized for further analysis, once SIEMPRO completes its processing. The TORs for the survey would be submitted for the Bank's review and comments by January 1, 2000, and the survey would be completed and reviewed with the Bank by March 31, 2000 [see G. Main Loan Conditions]. (ii) Development of Prevention Methods and Training Modules. The project would assist SEDRONAR in developing effective community-based prevention methods based on international and domestic experience. These methods would be disseminated through national, regional and provincial workshops. Based on the methods developed, SEDRONAR would further develop training modules to be used under the INPA Component for municipal level training (see the paragraphs for (i) Training of Local Municipal Actors and (ii) Youth, Culture and Solidarity under the INPA Component in the above). Consultants hired to provide municipal level training would be properly trained in the use of the training modules in advance. (iii) Network of monitoring centers. In Argentina, a number of hospitals, health clinics, education institutions, youth support centers, NGOs, religious institutions and other social-sector organizations are already active in the areas of education for drug prevention, support of drug users and their families in dealing with addictions and related problems, and emergency and long-term treatment of drug users. The project would attempt to: (a) strengthen those institutions' capacity in systematically assessing the drug use pattern and related problems in its locality; and (b) organize them into a network for voluntary information exchange. If successful, the network would become a network of monitoring centers, analogous to the network of seismic monitoring centers. Individually, each center would monitor drug-related problems in their locality. Collectively in the network, the centers would generate information critical to promote drug prevention more effectively. For the purposes described in the above, SEDRONAR would select approximately 60 institutions across the country as monitoring centers in accordance with the criteria detailed in the Operational Manual. The institutions would be locally-based, and running specific programs closely related to drug prevention and treatment. The selection process would consider geographic location (i.e. urban-rural combinations, areas that are considered to be in the route of drug-trafficking, etc.) and the quality and size (i.e. the number of beneficiaries) of the program run by the institutions. At least one institution would be selected as a center in each of the municipalities participating in INPA. In addition, in each of INPA-participating provinces, the provincial technical supervisor would assemble and systematically organize the data made available from the centers in the provinces for the use of policy makers, the general public and other concerned parties. The project would provide each monitoring center with: (i) a PC-based public domain (i.e. free distribution) database management software called EPINFO designed for easy data entry, statistical processing and Internet-based communications of survey-based data; (ii) standardized survey question set and application manual; (iii) training for the use of the software and the survey applications, and data analysis techniques; and (iv) other necessary technical assistance. Training would also include how to create and maintain WEB-pages on free WEB-sites. -21-  The project would assist SEDRONAR in developing and disseminating a set of standard survey questions, mentioned in (ii) in the previous paragraph. The set would consist of four modules tailored for each one of the following four types of populations: (a) children; (b) adolescents; (c) patients of emergency care; and (d) patients of non-emergency care. All modules would be based on internationally accepted standards, described previously under "(i) Survey-based Epidemiological Study" in the above. In addition, survey questions would not include any personal identification element, such as name or any type of personal identification codes. The monitoring centers would be encouraged to interview the beneficiaries of their services using an appropriate module, process obtained data using the provided software, periodically submit the data sets to SEDRONAR, and make the sets available on their WEB-sites. In addition, in INPA-participating provinces, the centers would also be encouraged to submit the data sets to the Provincial Technical Supervisor (see the INPA description under Component A in the above), who would assemble and organize the data sets to facilitate consciousness raising, policy formulation and other public use at the provincial level. Data submission to SEDRONAR and WEB-based publications mentioned in the above would be on a strictly voluntary-basis, and the centers would be under no oblization to do so. However, SEDRONAR would create an honor-based incentive mechanism to encourage active data exchange. SEDRONAR would validate and verify the quality and the integrity of each data set submitted, and the centers that submit scientifically valid data sets would be given the status of "Certified Monitoring Center". Special considerations would be made with respect to the participation of police forces in the Monitoring Network. No police force would form a part of the network outside the INPA-participating municipalities. In the case of INPA-participating municipalities, the municipal department of the provincial police force could be a monitoring center if: (i) the municipal department has a specific division/unit designated to community development, including the support of the victims and families of violence against women, youth and other vulnerable groups; (ii) the INPA-CCM unanimously approves the participation of police force as a monitoring center; and (iii) the monitoring center would be established within the division/unit described in (i). The internal regulations established by the CCM would provide further details of the terms and conditions of the participation of local police forces. (iv) Monitoring and Evaluation. Due to the complexity of drug issues, comprehensive evaluation of the proposed project would not be feasible before project completion. However, the project would monitor the capacity level and performance of CCMs, the nature and the degree of participation by various actors, the number and the quality of training and technical assistance, the types and quality of information generated, and the functionality of the information network, indications of behavioral and attitude changes of at-risk groups, quality of municipal plans and their sustainability implications. Once the project is completed, SEDRONAR plans to carry out an ex-post impact evaluation of the project through SIEMPRO. More specifically, the questionnaire to be used for the nation-wide survey under the aforementioned subcomponent (i) Survey-based Epidemiological Study would include the same set of questions to be used by each of the monitoring centers. Data sets submitted from monitoring centers, at least 10 of which are located in INPA-participating municipalities, would be constantly compared to the data obtained from the nation-wide survey. This way, SEDRONAR hopes to capture some of the impact generated by the INPA Component. Institution-building at the INPA-participating municipalities would be monitored and evaluated based on the quality and implementation progress of the municipal plan, based on the periodic progress reports submitted by the CCMs as well as consultants contracted for municipal level training. -22-  Sustainability impact would be evaluated based on the municipal / provincial budget submission for the year after project completion. Finally, development of SIME Monitoring Network would be monitored based on the number of Certified Monitoring Centers (see above) during the given period, and frequency of access to monitoring center WEB-pages by general public. Project Component 3 - US$ 0.3 million Component C: Proiect Management A small Project Implementation Unit (PIU), consisting of a General Coordinator, an INPA Technical Supervisor, a SIME Technical Supervisor and an Administrative Supervisor would be established to manage and coordinate. Hiring of these four senior PIU staff, with terms of reference and qualifications satisfactory to the Bank, would be a condition of loan effectiveness. The PIU would be established under the Subsecretariat for Prevention and Assistance (Subsecretaria de Prevencion y Asistencia), one of SEDRONAR's two subsecretariats (see Chart 2: Project Management Arrangements in SEDRONAR below), and assisted by SEDRONAR's administrative unit. -23-  Chart 1: INPA Institutional Arrangements "Carta de Adhesi6h "Carta de Adhesi6h Between the Municipality and SEDRONAR Between the Province and SEDRONA (a) specifies the terms and conditions for ! F (a) specifies criteria and procedures to select establishing the Municipal Council; (b) allows j DIXNTA n municipalities; (b) allows SEDRONAR to enter into SEDRONAR-hired Training Consultant to carry D.RONAJR1