Tanzania - Multi-Sectoral AIDS Project

Page 1 Revised Project Information Document (PID) R eport No: AB3097 Project Name TANZANIA-Multi-Sectoral AIDS Project Region Africa Regional Office Sector Other social services (75%); Health (25%) Theme Fighting communicable diseases (P); Civic engagement, participation and community driven development (P); Health system performance (S); Population and reproductive health (S); Vulnerability assessment and monitoring (S) Project P071014 Borrower(s) GOVERNMENT OF TANZANIA Implementing Agency(ies) GOT Address: Prime Minister's Office Magogoni Street,.P.O. Box 3021, Dar es Salaam, Tanzania Contact Person: Mr. Vincent Mrisho, Permanent Secretary Tel: 2135076, 2117249 Fax: +255-22-2121981 Email: PS@PMO.GO.TZ Environment Category B (Partial Assessment) Date PID Prepared June 18, 2003 Auth Appr/Negs Date April 28, 2003 Bank Approval Date July 7, 2003 Original Closing Date September 30, 2008 New Closing Date September 30, 2009 The Government of the United Republic of Tanzania requests and the Bank agrees to: (i) change the project development objective to: PDO 1: increased HIV preventive knowledge and behavior:. PDO2: increased coverage and utilization of preventive, treatment and support services; and PDO3: support a multisectoral response by enabling sectors to coordinate, implement, monitor and evaluate aspects of the HIV response; (ii) revise all KPIs within the Generic Results Framework and to make them consistent in the PAD, Legal Agreement and in the ISR; (iii) add a new activity for capacity building in surveying to improve monitoring of the new national HIV/AIDS framework; and (iv) reallocate funds among the components and expenditure categories to accommodate the changes in PDO/KPI and the new range of activities for the national HIV M&E Road Maps. 1. Country and Sector Background The first AIDS cases in Tanzania were recorded in 1983. Since then the epidemic has increased to a level where I NAIDS estimates that at the end of 1999 about 8.1% of the adults in the country were infected with HIV and about 1.3 million people were estimated to be living with HIV/AIDS. About 140,000 people are estimated to have died due to AIDS in 1999 alone. The number of orphans created by the AIDS epidemic was estimated to be 1.1 million (cumulative), 700, 000 of whom were estimated to be alive in 1999. HIV/AIDS has also had an impact on the occurrence of tuberculosis which is having a significant resurgence with unusual presentation and a tendency to emergence of multidrug resistance strains. The HIV epidemic in Tanzania has affected both urban and rural areas. The peak age group of infected females is the 25-29 year old group, while amongst males it is the 30-34 year old group. Generally females acquire HIV infection at an earlier age compared to males. A survey in 1999 found that the under-five mortality rate, including child and infant mortality rate, has not decreased over the past three years, this is attributed to the HIV/AIDS epidemic. Widespread illness and deaths due to HIV/AIDS are projected to lead to a reduction in GDP. Presently, some of the most productive age-groups in society are thought to be infected by HIV and the productive sectors are experiencing a loss of skilled labor, increasing costs for recruitment and benefits, and reduced productivity. Government response In Tanzania, the presence of HIV/AIDS was recognized quite early on, primarily as a health issue. The response to HIV/AIDS underestimated the extent to which it would spread and the devastating Page 2 impact it would have on social and economic development. Institutional efforts to control the spread of HIV in Tanzania date back to 1985 when a Short Term Plan was prepared by the Ministry of H ealth for 1985 and 1986. Since 1985, three national plans have been formulated Page 3 2 PID to guide the Tanzanian National AIDS Control Program. The First Medium Term Plan (MTP-I) covered 1987 - 1991, the Second Medium Term Plan (MTP-II) covered 1992 - 1996, and the Third Medium Term Plan (MTP-III) covers 1998 - 2002. Significant progress has been made by government over the past year aimed at putting in place the institutional framework required to effectively scale-up the response against HIV/AIDS in Tanzania. Several important accomplishments are worth mentioning. First, there is growing commitment among national and local leaders - political, religious and commercial - to encourage all members of society to play a role in stopping the spread of HIV and care for those affected. Secondly, the President established the Tanzania Commission for AIDS ( TACAIDS ). This body is expected to provide the strategic leadership necessary to galvanize the national social movement to effectively reduce the spread of HIV/AIDS. Thirdly, the Poverty Reduction Strategy includes HIV/AIDS as a central development challenge requiring that all sector and district plans address this issue. And finally, there is a draft national policy on HIV/AIDS that cuts across disciplinary and institutional sectors to provide the framework for a national response. The Government has been implementing the National HIV/AIDS program guided by the first National Multisectoral Strategic Framework (2003/2007). Currently the Government is preparing the 2 n d National Multisectoral Framework (2008/2012). The Government of Tanzania has requested access to IDA resources within the framework of the umbrella Multi-Country HIV/AIDS Program (MAP) for the Africa Region approved by the Board of Directors of the World Bank Group on September 12, 2000. Tanzania would be eligible for MAP funding if it satisfies the following four MAP criteria: a) 6DWLVIDFWRU\\03HYLGHQFH\03RI\03D\03VWUDWHJLF\03DSSURDFK\03WR\03+,9\12$,'6\11\03 Tanzania should have a coherent national, multisectoral strategy and action plan for HIV/AIDS prevention, care and treatment that has been developed through a participatory approach. Tanzania has draft HIV Policy and Strategy documents for a multi sectoral response. b) A KLJK\03OHYHO\03+,9\12$,'6\03FRRUGLQDWLQJ\03ERG\\11\03 Tanzania should have a national AIDS Commission which will have broad representation of key stakeholders from all sectors, to oversee and coordinate the implementation of the National HIV/AIDS policy. The creation of TACAIDS has been announced by the President and is in the late stages of being formalized as a semi autonomous body under the Prime Minister's Office. c) *RYHUQPHQW\03DJUHHPHQW\03WR\03XVH\03DSSURSULDWH\03LPSOHPHQWDWLRQ\03DUUDQJHPHQWV\11\03 Government has to agree to accelerate project implementation by channeling funds directly to civil society organizations, communities and decentralized sub-national levels of project implementation. The Government is committed to channeling funds to civil society and to use whatever is the most effective means to do this, across the whole country. d) *RYHUQPHQW\03DJUHHPHQW\03WR\03XVH\03DQG\03IXQG\03PXOWLSOH\03LPSOHPHQWDWLRQ\03DJHQFLHV\11\03 Government has to agree within the public sector to expand HIV/AIDS activities to a broad range of ministries, departments and parastatals, as well as to fund activities undertaken by the private sector, the civil society organizations including non-government and community-based organizations, and AIDS service providers. Government has to agree to further expand HIV/AIDS activities to community level and to support community initiated HIV/AIDS activities. . Page 4 P1D 2. Objectives (Revised)