Senegal - Community Nutrition Project

Document of The World Bank Report No. 14004-SE STAFF APPRAISAL REPORT REPUBLIC OF SENEGAL COMMUNITY NUTRITION PROJECT APRIL 26, 1995 Population and Human Resources Division Western Africa Department Africa Region  CURRENCY EOUIVALENTS Currency Unit: CFA Franc (CFAF) USSI = CFAF 580 (October 1994) ABBREVIATIONS AND ACRONYMS ADMUR Association for Urban and Rural Development (Association pour le Developpement en filieu Urbain et Rural) AEP Sanitation and Potable Water (Assainissement et Eau Potable) AGETIP Public works Executing Agency (Agence d'Excution des Travaux d'Interet Public contre le Sous-Emploi) BASICS Basic Support for Institutionalizing Child Survival Project CAS Country Assistance Strategy CNC Comnunity Nutrition Center (Comit National de Concerrations Rurales, CVCR) CPSP Fund for Price Equalization and Stabilization (Caisse de Perequation et de Stabilisation des Prix) CRS Catholic Relief services CSA Food Security Commission (Commissariat a la Secunte Alimentaire) DHS Demographic and Health Survev DSSP Division of Primary Health Care (division des soins de sante prirnaire) ENDA Environment and Development in Africa (Environnement et Developpement en Afnique) EPS Health Education Division (Division Education pour la Santi) ESP Priority Survey (Enqudte Sur les Priorites) FONGS Federation of Non-Governmental Organizations (Feddration des Organisanons Non -Gouvernementales) GIE Small Economic Interest Groups (Groupement d'intdrdt economique) GPF Women's Promotion Groups (Groupements de Promonon Feminine) GTZ German Technical Cooperation ICB International Competitive Bidding ICR Implementation Completion Report IDA International Development Association IEC Information, Education and Communication ITA Food Technology Institute (Institut de Technologie Alimentaire) KAP Knowledge, Attitudc, Practice KIW Kreditanstalt fur Wiederaufbau LCB Local Competitive Bidding M+E Monitoring and Evaluation MIC Micro-entreprcneur MIS Management Information System MOC Local NGO supervisor (Maitre doeuvre communautaire) MOH Ministry of Health and Social Action NWO Non-Governmental Organization NMD Nutrition Management Division ORSTOM French Scientific Research Institute for Development and Cooperation (Institut Fran,ais de Recherche Scientifique pour le Developpement en Cooperation) ORT Oral Rehydration Therapy PNVA National Agricultural Extension Program (Programme National de Vulgarisation Agricole) PPF Project Preparation Facility PPNS Health and Nutrition Project (Programme de Protection Nutritionnelle et Sanitaire) SANAS Senegal's Food and Applied Nutrition Service (Service d'Alimentation et de Nutriiaon Appliqude au Scnegal) SDA Social Dimensions of Adjustment SM Social Mobilization SOE Statement of Expenses SONES National Water Company of Senegal (Societi Nationale des Eaux du Sin'gal) TA Technical Assistance UNDP United National Development Program UNICEF United Nations Children Fund UNFPA United Nations Fund for Population Activities USAID United States Agency for International Development WFP World Food Program WHO World Health Organization ZOPP Objectives-oriented project planning (Ziel-orientierte Projekt-Pkamng) FISCAL YEAR January I - December 31  REPUBLIC OF SENEGAL COMMUNITY NUTRITION PROJECT CONTENTS Page Credit and Project Summary ..i.iii.........................................................) 1. INTRODUCTION .1 II. SECTORAL CONTEXT .1 A. Background . .. B. Economic Situation of Vulnerable Groups . . 2 C. Nutrition and Food Security. 2 D. Government Policies and Actions and the Bank's Experience.. 5 E. Rationale for IDA Involvement.. 7 Ill. THE PROPOSED PROJECT. 8 A. Project Objective and Design. 8 B. Project Description . 9 C. Status of Project Preparation .19 D. Project Costs and Financing .22 IV. PROJECT IMPLEMENTATION .23 A. Project Management .23 B. Project Monitoring and Evaluation .25 C. Procurement .26 D. Disbursement 28 E. Accounting, Auditing and Reporting 29 F. Supervision Plan 30 G. Environmental Impact .30 H. Project Objective Categories .30 V. BENEFITS AND RISKS .30 A. Benefits .30 B. Risks .31 VI. AGREEMENTS, ASSURANCES AND RECOMMENDATION 32 This report is based on the findings of an appraial mission carried out in Senegal in January/February 1995, consisting of Mr. Lalie Pean (Sr. Project Officer, mission leader), Mr. Enmmerich Schebeck (Departmental Project Advisor), Ms. Tonia Marek (Nutritionist), Ms. Adnana De Leva (Economist), Mr. Richard Seifinan (Nutritionist), Mr. Uwe Kracht (Consultant, United Nations), Mr. Gonzalo Ribt- Dieguez (Chief Desk Officer, WFP/Rome), Mr. Ibrahim Sharifa (Director WFP/Senegal), Mr. Paul Crowley (Consultant, Food Tecbnologist) Mr. Manfred Dittmar (Director, Africa, KfW), Mr. Christophe Twerenbold (Econoniist, KfW), Ms. Lioba Wenigautner (Nutritionist/Consultant, KfW), Mr. Magaue Wade (Director General, AGETIP), Mr. Ibnou Gaye (Director of Development, AGETIP). Ma Judith McOuire (PHN) is the Lad Advisor. Ms. Maryse Pierre-Louis (Sr. PHN Specialist) and Mr. Bemard Abei16 (Sr. Procuremat Specialist) are the peer reviewes. Mr. Jea-Louis Sarbib is the Departmet Director. Mr. Ok Pannenborg (Chief, Population and Hum Resources Division), and Mr. Alberto Harth (Chief, Infrastrucue Division) share responsibility for the project Technical support wa provided by Ma. Song Li.  ANNEXES Paze 1. Lessons from nutrition projects in Senegal and other countries 34 II. Community nutrition program 36 III. Targeting 45 IV. Water program 48 V. Rural household food security (Terms of Reference) 56 VI. Social Mobilization and Information, Education, and Communication (IEC) 58 VII. Training 65 VIII. Momntoring and evaluation 69 LX. Detailed cost tables 82 X. Disbursements Profile 90 XI. Supervision plan 91 XII. Project implementation structure 92 XIII. List of documents in project files 93 Map: IBRD 26962  REPUBLIC OF SENEGAL COMMUNITY NUTRITION PROJECT CREDIT AND PROJECT SUMMARY Borrower: Republic of Senegal Beneficiaries: 1.2 mnillion persons for the nutrition and water programs Credit Amount: SDR 11.7 million (US$18.2 million equivalent) Staff of MOH, SONES, AGETIP, and municipalities Terms: Standard, with 40 years maturity Project The project's development objectives are to (a) halt a fuirther deterioration in the Objectives: nutritional status of the most vulnerable groups (malnourished children under 3 years of age and pregnant and nursing mothers) in targeted poor urban neighborhoods; (b) provide potable water to unserviced neighborhoods of the nutrition program; and (c) enhance household food security in poor rural and urban areas during critical periods of vulnerability. Its implementation objectives are to (a) demonstrate the feasibility of targeted, efficient and cost-effective delivery of community nutrition interventions; and (b) execute a poverty-oriented program through a privately operated agency. Project The project consists of three major components: (a) a nutrition program, Description: consisting of Information, Education and Communication (IEC) interlocutors, supported by supplementary feeding for the target population in urban areas and a small fund for research and development; (b) a water program in the targeted neighborhoods of the nutrition program; and (c) a pilot rural household food security program. As an integral part of these components, there will be (i) a package of social mobilization and IEC, (ii) a package of managerial and technical assistance and training to build local capacity for nutrition/health services delivery; and (iii) a management information system for monitoring and evaluation, supported by systematic client consultation throughout project execution to ensure necessary program adjustments reflecting participants' views. Project The project will have two main benefits. Fir the immediate impact of the Benefits: nutrition program is intended to halt a further deterioration in the nutritional status of the most vulnerable groups in the poorest urban areas, estimated at a total target population of 469,000 (about 230,000 malnourished children under 3 and 120,000 nursing and pregnant women receiving food as well as growth-monitoring and IEC services, and 119,000 mothers and children receiving only growth-monitoring and [EC services). The project's nutrition education activities should set in motion behavioral changes and adoption of better child-feeding practices, leading to long-lasting nutritional improvement in children under 3. Through the water program increased access to safe drinking water should reduce the incidence of diarrhea and water-borne diseases affecting the nutritional status of 174,000 residents in the targeted neighborhoods for the first year of operation, and 522,000 beneficiaries for the subsequent years, totaling 696,000 over the life of the project for this program. Thus, about 1.2 mullion people will benefit from both programs. As demnonstrated during the pilot phase in neighborhoods where the Community Nutrition Center is close to a health facility, the proposed project will also lead to an increased demand for and use of health services. An additional benefit of the household food security and water programs will be the provision of development-oriented infrastructure  ii in targeted rural and urban areas. Second, the project will establish for the first time a local capacity to deliver community-managed nutrition services with private sector efficiency, both in terms of management and administrative cost containment. It will also contribute to the capacity building of NGOs by providing training in the supervision of community nutrition centers and IEC methods to pre-selected local NGOs. Finally, closer collaboration between NGOs and public health services will improve the delivery of social programs geared to the most vulnerable households and the capacity-building of local groups to manage their social/poverty problems. Project Risks: As the nutrition program will be carried out in the urban low-income areas and among some of its poorest people, many of them illiterate and innumerate, its implementation will not be easy. The project will involvefive specific risks. The first concems the production of the food supplement, since the enterprise selected by WFP for production enjoys a virtual monopoly. The second risk is linked to the strong coordination required among the many stakeholders associated with project implementation, which could impose a logistical problem that might undernine the private agency's (AGETIP) efforts to meet project objectives efficiently and effectively. The third risk is that implementation might be delayed by community mobilization, organization and training shortfalls. The fourth risk is that the necessary nutrition-health coordination arrangements between AGETIP and the Ministry of Health fall short of expectations. Finally, the project's administrative costs might be higher than estimated, thus jeopardizing the program's sustainability. To reduce the risk related to the sole source of food production, WFP will attempt to identify through local competitive bidding alternative production sources during the first year of operation. To mitigate implementation risks, the project will be implemented on the basis of a detailed Manual of Procedures and under a strictly organized schedule of supervision procedures, thus ensuring attention to quality issues by all implementing bodies. In addition, starting from the pilot phase, the program will expand towards full coverage only after organizational, management, and technical program details have been sufficiently tested and adjusted to account for absorptive capacity conditions in the field. The National Commission for the Fight Against Malnutrition, created at the Presidency in June 1994, constitutes the strongest possible Government commitment in supporting AGETIP's community mobilization efforts. Training and in-service training of large numbers of community private entrepreneurs and beneficiaries are recognized as key elements for project success. Moreover, improved coordination with the health system will be ensured by clearly defined contractual arrangements between AGETIP and the Ministry of Health. Finally, AGETIP's contract management capabilities, supported by its strong management information system, have proven to be guarantor for cost containment and will ensure sustainability. Through this approach to social services provision, the traditional role of Govemment as a provider of public services will be replaced by one in which the Govenmment provides those services in terms of planning, programming and budgeting, but leaves delivery to the more efficient and cost-effective agents of the private sector. Environmental No environmental risks are foreseen. Risks: Poverty Program of targeted interventions to halt a further deterioration in the nutritional Category: status of the most vulnerable groups in specific poor neighborhoods selected on the basis of a poverty assessment, to reduce their food insecurity, and to generate employment and income for community groups through small-scale activities. Economic Rate Not applicable. of Return  Lo0o317 lelblull UU EA ulJy LI1JU caL vtlwUU iii SUMMARY OF PROJECT COST ESTIMATES (Net of taxes and duties) Local Foreign Total -(in USS million)- 1. Nutrition Program 14.6 0.7 15.3 2. Water Program 0.6 2.2 2.8 3. Rural Household Food Security 1.1 0.1 1.2 4. Social Mobilization and EEC 1.3 0.3 1.6 5. Training 1.1 0.4 1.5 6. Monitoring and Evaluation 0.8 0.7 1.5 7. AGETIP Management 0.7 0.3 1.0 8. Pilot Operations and Project Preparation 0.4 0.1 0.5 Total Base Costs 20.6 4.8 25.4 Physical Contingencies 0.3 0.2 0.5 Price Contingencies 2.0 0.1 2.1 TOTAL PROJECT COSTS 22.9 5.1 28.0 FINANCING PLAN (in USS million) IDA 18.2 WFP 5.2 KfW 3.0 Govermment 1.6 TOTAL 28.0 Estimated IDA Credit Disbursements (in USS million) IDA Fiscal Year 1996 1997 1998 1999 Annual 3.6 5.6 5.4 3.6 Cumulative 3.6 9.2 14.6 18.2  iv REPUBLIC OF SENEGAL COMMUNITY NUTRITION PROJECT SOCIO-ECONOMIC INDICATORS Most Same Region/ Recent Income Group Next Higher Unit of Estimate /I sub-Sah. Lower- Income Measure (mre) Africa Income Group Total Population (mre u 1992) thousands 7,841 546,390 942,547 477.960 Urban % 40.8 29.5 57 71.7 Income Indicators GNP per capita (mre =1994) USS 470 - - Social Indicators Public Expenditures on Basic Social Services % of GDP - - - Gross Enrollment Ratio: % school age group Primary Total 59 66 - 107 Male 70 79 - Female 49 62 - Secondary: Total 16 - - - F;emale I1 - - - Mortality per 000 live births Infant Mortality Rate a8 99 45 40 Undwr-5 Mortality Rate 105.8 169 59 51 Chronic child malnutrition (-5 years old) 29 - - Life Expectancy years Overall 49 52 68 69 Female advantage 2 3.4 8.4 6.3 Total Fertility Rate births per woman 5.9 6.1 3.1 2.9 /1 Except for GNP/capita mrs, all other mres are for the periods 1987-92. The malnutrition rates are obtained from the 1991 Priority Survey. Souans Social Indicators of Development, 1994, The World Bank, 1994. World Development Report 1993: Investing in Heatth, the World Bank, 1993.  SENEGAL COMMUNITY NUTRITION PROJECT STAFF APPRAISAL REPORT I. INTRODUCTION 1.01 The Govemrnment of Senegal has requested IDA's assistance in financing a conununity nutrition project. The principal objectives of the proposed project are to halt a further deterioration in the nutritional status of the most vulnerable groups in poor urban neighborhoods, provide those households with potable water, and enhance food security in targeted poor urban and rural areas during critical periods of vulnerability. 1.02 The proposed project will be IDA's first free-standing nutrition project in Senegal and the first project of this kind in sub-Sahara Africa. It is not an emergency intervention, but an experimental one that attempts to demonstrate an innovative approach, i.e., the delivery of targeted and cost-effective nutrition interventions, designed in close collaboration with all stakeholders and executed not by the Government but by agents of the private sector. Total project costs are estimated at about US$28.0 mnillion equivalent, net of taxes and duties, of which IDA would finance about USS18.2 million. The Gernan Government (KfW) would finance in parallel about US$3.0 million equivalent, WFP would finance in parallel USS5.2 million, and the Government of Senegal would contribute USS1.6 million equivalent. 11. SECTORAL CONTEXT A. Background 2.01 Senegal is a low income country with a population of 7.8 million, growing at ?.7% per year, with an average per capita income of US$470 distributed unequally. Although better off than some of its Sahelian neighbors, Senegal faces many similar constraints, such as dry arid land, low rainfall, rapid population growth, dependence on one agricultural commodity, groundnuts, that accounts for 60% of farm cash income, and economic stagnation. It ranks 150 out of 173 countries on the poverty index developed in the 1993 Human Development Report by UNDP. Senegal is, however, more urbanized than its neighbors (40% of the population). The health and education status of the population improved over the past decade, but primary enrollment is starting to decrease. However, life expectancy is only 49 years of age; children under five in urban areas suffer a chronic malnutrition rate of 23%; onchocerciasis in rural areas is prevalent. Widescale malaria, diarrhea, and respiratory diseases indicate that Senegal's living standards remain below those of other lower-middle income countries. 2.02 Over the past decade, dramatic declines in formal sector activity have combined with longer-term trends (population growth, land degradation, declining world commodity prices) to plunge the country into a severe and prolonged economic recession. The Government launched adjustment and stabilization programs in the early 1980s, resulting in the partial liberaiiztion of agriculture, fiscal stabilization through austere expenditure contraction, and financial reform. But, this internal adjustment was insufficient to improve the competitiveness of the economy and achieve the type of economic growth that would have a large impact on poverty. The January 1994 devaluation of the CFA franc offered an opportunity to regain competitiveness and to reverse economic performance by improving rural incomes through higher prices for the most important  2 revenue source of the poor (groundnuts) and by encouraging other export-oriented industries, such as fishing, tourism, agro-processing, and small manufacturing. B. Economic Situation of Vulnerable Groups 2.03 The economic crisis has particularly affected vulnerable groups in Senegal. While the devaluation is expected to promote long-term economic growth in Senegal, it has led to a deterioration of incomes and food access for vulnerable groups in the short term. For example, food expenditures, which represent 70% of the household budget of the poor increased nearly 40 percent during 1994. The urban poor are particularly affected by increases in the prices of irnported food. In early 1994, the Government of Senegal introduced accompanying measures aimed at passing the benefits of the parity change on to rural producers; limiting the wage bill; reducing regressive levels of taxation, while balancing fiscal and credit measures to control inflation; and improving the availability of social services in health and education by increasing budgetary appropriations to these sectors. In the short term, temporary measures to minimize increases in the prices of certain basic food and non-food goods (bread, rice, edible oils, kerosene, medicines, and basic health care) were adopted. The Bank-financed 1992 household priority survey found that 33% of the entire population, about 2.4 million individuals, did not spend enough money on food to assure a minimum daily caloric intake of 2,400 calories per adult equivalent. Rural poverty (86% of total) far exceeds urban poverty. Yet, poverty in urban areas is intensifying, as highlighted by the fact that Dakar, with over one-fifth of the total population, houses 12% of the total poor. Poor households in Dakar have on average 12 persons, more than half of whom are children and elderly; nearly half of the heads of these households have more than one wife, two out of three households use some type of standpipe to access water, four out of five heads of households have no education, and less than 10% have any assets (land, hoe, carts): Despite better average living conditions in urban areas, a substantial number of poor live in squatter areas in peri-urban Dakar, which serves as a magnet for the handicapped, orphans, and destitute who seek services, special care or income from begging. Increasing migration to urban areas is contributing to the problems of these squatter neighborhoods which have poor or nonexistent sanitation, house up to eight people in a room measuring less than two square meters, lack water or electricity, and are characterized by housing made of discarded metal and cardboard. These living conditions are breeding grounds for disease. 2.04 To compensate for the hardships of the poorest population groups, particularly in urban areas, resulting from declining purchasing power, the Government plans to provide direct assistance to certain vulnerable groups by facilitating the establishment of family- or community-oriented projects aimed at halting further deterioration of already high malnutrition rates. It is in this vein that the Presidency created a National Commission for the Fight Against Malnutrition and requested IDA's support. The proposed project, which will complement other ongoing employment/food security efforts, such as a food-for-work project managed by the Public Works Executing Agency (AGETiP) and supported by food from the World Food Program (WFP), is a response to this request. Yet, the proposed project also presents a challenge and an opportunity to lay the basis for a long-term program to address the country's entrenched nutrition problems, an objective towards which the proposed project hopes to contribute. C. Nutrition and Food Security 2.05 The main nutrition problem and the effect of food insecurity in Senegal remains chronic protein-calorie malnutrition, which results in visible stunting and wasting of children. Average levels of caloric intake have been barely adequate in both rural and urban areas for many years. All urban zones in Senegal show caloric inadequacy, estimated to be 80% of normal consumption below which  3 households are considered in a state of nutritional risk. Throughout Senegal, but particularly in the urban areas, rice consunption has become an important part of the cereal diet. In urban areas, more than 98% of noon meals, 50% of evening meals, and 20-50% of morning meals use rice as the staple. The phasing-out of subsidies for rice is likely to cause particular hardship for low-income groups, particularly because in the short-run, the supply response is not expected to provide large stocks of low-cost coarse grains to substitute for the more expensive rice. This food availability and access problem is undoubtedly most acute among urban poor households, who are mainly employed in the service sector or in petty trade. They are, therefore, not likely to realize any compensatory production benefits in the short run, and have, therefore, confronted significant loss of purchasing power parity. Unless the urban poor households are able to reduce their non-food expenditures by the amount of real income loss, and transfer these amounts to food expenditures, the result will be further nutritional deterioration. 2.06 Rural Senegalese confront a somewhat different problem. They annually face a hungry period (June-September) prior to the harvest. Villagers who ordinarily eat three meals a day reduce the number of meals to two at the end of the dry season (Benefice and Simondon, 1993). Even in rice-producing areas, where rice constitutes 48% of the total energy intake in January (during the harvest period), villagers purchase 50% or more of their energy requirements, i.e., 50% in January rising to 61% in June (Benefice and Simondon, 1993). This seasonal availability problem spills over into the major peri-urban poverty areas as well. 2.07 Infant malnutrition rates have remained relatively constant during the past decade. The 1992 Priority survey found that 29% of children under five years of age were chronically malnourished, with rural child malnutrition estimated at about 34% and urban at 23%. Malnutrition begins before birth, and in Senegal about 10% of children are low birthweight babies. Iron deficiency anemia is a severe public health problem with 63% of children estimated to be anemic. Significant regional and seasonal vitamin A deficiency was found among children 1-5 years of age (7.4%) in a survey completed in 1993 (Rankins). Iodine deficiency is also considered a problem, but mainly in inland areas. 2.08 The urban malnutrition problem is growing more severe because the urban population is growing much faster (4.0% per year in Dakar) than the national growth rate of 2.7%. Urban chronic child malnutrition at 23% is more pronounced in Dakar than in other cities of West Africa (22% in Accra, 18% in Conakry, and 11% in Abidjan). Large differences in malnutrition rates have been found depending on the socio-economic profile of the community. For instance in the poor area of Guediawaye the proportion of children with chronic malnutrition is 1.6 times higher than in Medina (Guiro, June 1994). Even in the same suburb, there are great disparities, depending mainly on whether the area is a squatter or a planned area. In the Pikine area, chronic malnutrition rates were higher in the squatter areas of Yeumbel and Medina Gounass than in the planned neighborhoods of Pikine Extension and Pikine Ancien (Guiro, 1994). 2.09 In addition to poverty, often being both one of the causes and one of the consequences of child malnutrition, food insecurity, lack of knowledge of good feeding practices, endemic diseases, inadequacy of potable water, and poor sanitation remain significant factors towards child malnutrition. They are discussed individually below. a) Food insecurity: In the past, supplies of coarse grains and rice on a national level did not translate into adequate food for families, principally because of weaknesses in Senegal's food distribution system and limited access to income. Even in years of normal rainfall with adequate production and adequate imports of rice, a substantial portion of the population  4 was chronically food insecure. With the establishment of a more stable food structure and other measures taken under the Bank's proposed Agriculture Sectoral Adjustment Lending, stable food availability - and therefore one crucial aspect of the food security situation in general - should improve, particularly for the poor. Nonetheless, many households still have inadequate income or other resources to obtain needed levels of appropriate foods on a regular basis. The evidence suggests a strong positive correlation between low-income families and high levels of stunting and other forms of malnutrition in children under five, and poor nutritional status of women of reproductive age. The 1992-93 Demographic and Health Survey (DHS) showed that 15% of women of reproductive age had a low Body Mass Index (less than 18.5 kg/m2), indicating chronic energy deficiency in this cohort, which is often a good marker of household food insecurity. Simply put, household income remains one of the main factors affecting food insecurity in Senegal. b) Feeding practices: With regard to poor feeding practices, both the 1986 DHS and a more recent study in Guediawaye confirm that this is a critical area in infant feeding. In Senegal only 6% of children under three months are exclusively breastfed, and in Guediawaye 40% of the children began receiving complementary feeding earlier than four months (the recommendation is to exclusively breastfeed a child up to four months). In addition, children over four to six months usually require complementary feeding, but the 1986 DHS survey (latest data available) found that a large percentage (29%) received only breastnilk or breastmilk plus water or low nutrition liquids. The low caloric density of weaning food is also a problem: the most common weaning food is millet porridge (rouye). A child being weaned does not eat more than 200 mi of the porridge per meal and thus absorbs only 70 calories and two grams of proteins at each seating, which is largely insufficient, especially since a child only has two to three meals a day (the ideal is five meals a day). c) Endemic diseases: A sick child has a 30% higher chance of being underweight than a healthy child. The most critical age in terms of nutritional status is between 12 and 23 months when children in Senegal are abruptly stopped being breastfed. By the age of 20 months, about one in three children suffers from insufficient weight. Health problems contribute in part to the deficiency in weight, diarrhea being one of the major problems among small children. The prevalence of diarrhea among young infants is high and increases rapidly among infants under nine months of age. In the 1986 DHS survey, it was found that one in two Senegalese children under 24 months had diarrhea in the two weeks preceding the survey. This level is the highest among nine sub-Saharan countries where similar data were collected. Malaria, acute respiratory illnesses, parasite-related diseases, and measles are widespread childhood illnesses. Other major diseases found in Senegal have a direct or indirect impact on the care for children. Of particular note is maternal anemia, and onchocerciasis which alone affects some 57,000 people (or 1 in 130 Senegalese). d) Water and Sanitation: The inadequacy of potable water and the lack of sanitary services are major causes of morbidity in the poor neighborhoods of the peri-urban areas. Among the most widespread illnesses are diarrhea, intestinal parasites, amoebiasis, typhoid and conjunctivitis. A significant part of the population in the neighborhoods of the proposed Community Nutrition Project (20% in Dakar and over 30% in the secondary towns) get their water from traditional wells which exploit shallow pools of water polluted by waste water. In the neighborhoods without drinking water networks, the conditions of water storage and informal resale add considerably to water pollution for the populations not served by the network.  5 D. Government Policies and Actions and the Bank's Experience Policies 2.10 In an effort to increase cereal self-sufficiency, the Governnent has pursued a policy supporting domestic rice production. Producers in the North River regions have benefitted from heavy Government investment in irrigated perimeters. For these producers, inputs and water rates were highly subsidized. The poorer region of Casamance benefitted less (less marketing of rice and competition from fraudulent rice imports from the Gambia) from Government support in the development of irrigated perimeters for rice production. As a result of these policies, until January 1994, consumers paid a high price for the protected local rice. However, since June 1994, the Government abandoned its rice production strategy within the context of the preparation of the proposed Agriculture Sector Adjustment Lending. Although the expansion of irrigated rice is possible, the abandonment of the protectionist measures will doubtlessly slow down the artificial expansion of paddy rice production in the north river valley. As a result, the likelihood of Senegal achieving rice self-sufficiency in the near future is considered very slim. However, the practice of artificial flooding of the Senegal River Valley, which was begun last year, has had a beneficial effect by enabling large flood recession areas to be planted with millet, which is increasingly becoming a substitute for rice among poor households. Further, it is Government policy, supported by the Bank, to improve the effectiveness of research and extension services for women farmers. This policy is being implemented through a series of agreed-upon measures and is supported by the National Agricultural Extension Program (PNVA) (Cr. 2108-SN). 2.11 A coherent five-year National Nutrition Program (1991-1996) was announced in the early 1990s, but little has materialized. Ongoing efforts to identify and treat malnutrition rely mainly on health education by health post personnel. This not only places an extra burden on already overworked staff, but is not the most effective way of dealing with malnutrition among the poor as they are the least likely to seek modem medical care. 2.12 The Food Security Commission (CSA) is responsible for food security issues. It maintains a minimal stock of cereals in storage facilities throughout the country and seeks to stabilize market prices for cereals. The CSA monitors food security (stocks and prices) on a pilot basis in four zones identified as food insecure and monitors food prices nationwide. The pilot zones, located in the northem part of Senegal, have been identified based on levels of cereal deficits and rainfall pattems rather than on indicators of net income. Recent evidence suggests that in poor harvest years, farmers in the more fertile zones could actually be more vulnerable to malnutrition and food insecurity because of lack of off-farm sources of income. Actions 2.13 The Government incorporated nutrition under the USAID-financed Health and Nutrition Project (PPNS) which lasted from 1973-88. This program, carried out with the assistance of Catholic Relief Services, established about 400 centers around the nation providing pre- and post-natal visits, growth monitoring and food supplements to children under five. As of 1984, 10.3% of children under age three were covered by these supplemental programs, which were not targeted either by season or by qualifying rural regions. In fact, distribution depended on the location of the health center. Had the program been better targeted to lower-income children, the impact (and cost-effectiveness) might have been greater. An additional problem revealed by project evaluations was that only 6-11% of the calories were actually consumed by the beneficiaries. Take-home rations lasted fifteen days instead of the whole month: in 1981 each child received 5.53 kg per month, while in 1982 each child received only 3.84 kg, comnpared to a theoretical objective of 7.5 kg (Echenber et. al., 1984). In 1987, supplemental food was discontinued,  6 thus leaving only growth monitoring in the PPNS. Many mothers stopped participating because of the high opportunity cost of their time, especially since the small fee mothers had to pay to the PPNS (about $0.67/mooth) was mandatory. The drop in attendance might also have been due to the quality of health services provided by the health centers, which was inadequate to provide an incentive for mothers to bring, their children. The PPNS has not been replaced by a similar program, thus leaving a gap in the detection and prevention of malnutrition on a national basis. 2.14 The Ministry of Health and Social Action (MOH) recommended that the PPNS be restructured by redefining the role of the mothers' committee vis-a-vis the health committee. It also introduced the idea that growth monitoring should be decentralized to the community and that nutrition activities be carried out by women groups (Diene, 1989), but no follow-up took place. 2.15 The MOH has been able to achieve a 37% vaccination coverage among children less than one year old, and 55% for children between 12 and 23 months old. Despite this relatively low coverage, it seems that a large part of the population in the target areas ask advice from health personnel, as shown by the beneficiary assessment carried out during preparation of this project. But health service delivery is generally weak, as health centers/posts tend to be understaffed and underequipped. A study undertaken during project preparation (Sal, 1994) concluded that among the 10 health posts visited in five of the target areas, only one could assure satisfactory delivery of curative, preventive and educational services and offer nutrition rehabilitation facilities; two had almost no activities, and several among the others did not even have a weighing scale. IDA's Experience in Senegal 2.16 IDA has been involved in both the health and infrastructure sectors in Senegal. In health, IDA prepared a nutrition project in the late 1970s, but the project was dropped for a rural health project, which has been satisfactorily completed (PCR Report No. 12319). The ongoing human resources project supports the extension of primary health care services in three regions through the construction/renovation of health posts, the training of medical and paramedical personnel, the decentralization of health planning and management, and a small nutrition sub-component in the Maternal and Child Health component. Ia infrastructure, IDA's involvement includes four urban projects; two are complete, one ongoing and another under preparation. 2.17 In addition, IDA has supported two Public Works and Employment Projects in promoting the delivery of public services through simplified contracting procedures. The first project was successfully completed in September 1993 and the second is in its second year of implementation. To help mitigate the potentially negative effects of the country's macro-economic adjustment program, particularly on youth and the urban poor, the first Public Works and Employment Project (Cr. 2075-SE) was approved in December 1989: (i) to create temporary new employment in urban areas as rapidly as possible; (ii) to improve individual skills of those employed under the project and the competitiveness of the firms that would carry out works, so as to develop their capacity to respond to increased opportunities for sustained employment after project completion; (iii) to demonstrate the feasibility of labor-intensive projects and test the procedures that would enable the public sector to commission such projects; and (iv) to undertake sub- projects that are economically and socially useful. Key associated objectives were to maximize the benefits of implementation methodologies that feature low cost, high visibility and conspicuous impact; use transparent but expeditious and flexible procedures for sub-project proposals, appraisal, contracting and disbursements; and provide sustainable technical and managerial assistance.  7 2.18 A special agency with private legal status, the Agence d'XEcution des Travaux d'Interet Public contre le Sous-Emploi (AGETIP), was created to implement the project. AGETIP as an NGO is an independent institution with a Board consisting of a Director from the private sector and representatives from the National Council of Employers of Senegal, the Union of Construction and Public Works Workers, and the Association of Mayors of Senegal. The director of AGETIP is assisted by technical and financial directors and an internal auditor. Administrative costs have been kept below 5% of the total program amount. Project management is govemed by a Manual of Procedures, which is an integral part of the Convention signed with the Govenmment of Senegal. 2.19 AGETIP has successfully met many of its objectives. In its first three years, AGETIP created 11,103 temporary jobs through public works execution with an average duration of 30 days each. Seventy-eight enterprises won contracts to execute 119 sub-projects, including 15 youth groups (103 youth groups had in fact been pre-qualified). The AGETIP agency has successfully addressed poverty and household food security problems, particularly in the cities of Kaolack and Saint Louis, through food for work initiatives supported by the World Food Programme (WFP). It has set up easy and transparent bidding procedures which facilitated the participation of a large number of small- and medium-scale enterprises in the program, who respected the agreed-upon time framework for the execution of works. Moreover, the project disbursement profiles indicate that AGETIP has demonstrated an absorptive capacity greater than the average IDA-financed project. Most important, AGETIP has shown how managerial autonomy and private sector orientation lead to strong results, as indicated in bidding and procurement procedures - AGETIP completes the process in two months, while the public administration takes six months, and at lower cost than force account. 2.20 Lessons learned from the first AGETEP project indicate that (i) in the appraisal of social sub-projects, quantifiable indicators be used to rank them; (ii) a strong covenant be included in the Development Credit Agreement to link the review of sub-project batches to the disbursement of counterpart funding; (iii) training for contractors should be available upon credit effectiveness; (iv) a grassroots participation program be an essential part of the project; and (v) a phased approach be adopted. E. Rationale for IDA Involvement 2.21 The objectives of the proposed project are fully in accordance with the development strategy of the World Bank Country Assistance Strategy (CAS) for Senegal, presented to the Board on February 16, 1995. The proposed Community Nutrition Project is considered as one of the key projects in meeting these objectives. IDA's strategy to assist Senegal is to achieve sustainable economic growth with equity and targeted poverty reduction. Its central focus is: (a) to promote competitiveness in order to make the economy more responsive and to create more opportunities for the private sector; (b) to complete structural reforms in agriculture; and (c) to deliver essential services efficiently and effectively. Moreover, a central aspect of the Bank's partnership with Senegal is the strengthening of the quality of the dialogue with Government and civil society to enhance participation and to facilitate internalization and ownership. IDA's strategy rests on the approach developed in the 1990 World Development Report, which is based on a two-pronged approach: (i) increasing economic growth and incomes mainly through labor-intensive methods and (ii) improving access to basic social services. A complement to this approach is assuring adequate social safety nets for the truly vulnerable (pregnant and nursing women and children below the age of three years). A key element in this strategy is the strengthening of anti-poverty programs, particularly those which contain a safety net for the poor that promote human resource development and increased access to social services. IDA's main nutrition objective is to assist the Government in  8 adopting strategies and cost-effective programs to deal with the malnutrition problems of the most vulnerable groups. While considerable external support is needed for this project, IDA is best equipped to play the important catalytic role required to mobilize the needed assistance from the donor's community and to influence government's strategy. The proposed project, consistent with IDA's human resources development and poverty alleviation objectives in Senegal, has drawn from other nutrition-related studies, particularly from the IDA-funded Tamil Nadu Nutrition Project in India and the 15-year nutrition project implemented by USAID/Catholic Relief Services in Senegal, regarding food targeting and the composition of a food supplement, i.e, that cannot be sold on the market (Annex 1). Best practices from nutrition projects have indicated the importance of communication and community mobilization in targeted interventions; the need to establish program sustainability through clearly defined nutritional entry and exit criteria; and the need for regular on-the-job training and supportive supervision systems with clearly defined accountabilities. These lessons form the overriding principles for the design of the proposed operation. These lessons have been taken into account for the proposed project orientation, design, funding, and implementation. III. THE PROPOSED PROJECT A. Project Objectives and Design 3.01 The project's development objectives are: (i) to halt a deterioration in the nutritional status of the most vulnerable groups (malnourished children under three years of age and pregnant and nursing women) in targeted poor urban neighborhoods; (ii) to provide potable water to unserviced neighborhoods targeted under the nutrition program; and (iii) to enhance household food security among poor urban populations and households "at risk" in targeted poor rural areas during critical periods of vulnerability. 3.02 The specific project implementation objectives are: (i) to demonstrate the feasibility of targeted, efficient and cost-effective delivery of community nutrition interventions; and (ii) to execute a poverty-oriented program through AGETIP, a privately operated agency, rather than a ministry, applying delegated contract management to local entrepreneurs, such as women and youth groups, community associations, and local NGOs. 3.03 Realization of the last objective will demonstrate the potential for replacing the traditional role of Government in delivering public services by one where Government would provide those services in terms of planning, programming and budgeting, but leave their delivery and partial cost recovery to the more efficient agents of the private sector. Moreover, the project's urban nutrition and rural household food security programs have been designed so as to complement each other in contributing to both nutrition and household food security by: ensuring a food supplement to malnourished children and pregnant and nursing women, as weli as to the siblings aged 6-36 months of the malnourished children, and by generating household income through labor-intensive employment activities in the neighborhoods or villages of the target population. Progress in achieving these objectives will be assessed against monitoring and evaluation indicators that have  9 been developed and agreed upon with the Government, AGETIP, and key stakeholders during an "Objectives-oriented project planning" (ZOPP) workshop held in July 1994. In the long term, the development objectives of the project will be to strengthen management capacity in the area of nutrition, according to replicable and sustainable mechanisms and to assist the Government of Senegal in the preparation of a national strategy to fight malnutrition. B. Project Description 3.04 The project will consist of three major components: (a) a nutrition program, consisting of Infornation, Education and Communication (IEC) interlocutors, supported by supplementary feeding which includes micronutrients, growth monitoring, and referral to basic health services for the target population in urban areas, and a small fund for research and development; (b) a water program that would meet the water needs of poor households in many of the samne households in the targeted neighborhoods of the nutrition program; and (c) a pilot household food security program in targeted rural poor areas. As an integral part of these three components, there will be (i) a package of social mobilization and IEC; (ii) a package of training to build local capacity for nutrition/health service delivery; and (iii) a management information system for monitoring and evaluation, supported by systematic client consultation throughout project execution to ensure necessary program adjustments reflecting participants' views. These elements are mutually supportive and establish the basis for a longer term strategy to deal with nutrition and household food security problems. 3.05 The proposed project will be IDA's first free-standing nutrition project in Senegal and one of the first projects of this kind in Africa. It is not an emergency intervention, but an experimental one that attempts to test an innovative approach, i.e., a private delivery mechanism to assist targeted vulnerable groups in the area of nutrition. Important lessons provided by IDA's experience in the nutrition sector in other regions of the world and with health projects in Africa are that strong political commitment by government, community ownership and involvement of all stakeholders in the decision-making process are crucial for successful implementation. The creation of the National Commission for the Fight Against Malnutrition, with the strong support from the President of the Republic of Senegal, is an encouraging example of Govenmment commitment to address the problem of malnutrition among the most vulnerable groups, and offers an unprecedented opportunity for engaging all national and international partners to join forces in addressing malnutrition. The preparation of the proposed project has addressed ownership aspects. A rapid beneficiary assessment and a ZOPP workshop were carried out to identify project objectives and target groups, to understand where coping strategies are inadequate to ensure household food security and good nutritional status of segments of the target population, to define jointly with the targeted population appropriate nutrition interventions, and to determine the willingness and mechanisms by which the target group would participate in the implementation of the nutrition component. This project will complement ongoing donor-assisted nutrition projects which provide IEC on nutrition rehabilitation of malnourished children through the health system. Nutrition Program 3.06 The objectives of the nutrition program are: (i) to halt a deterioration of the nutritional status of the vulnerable groups (pregnant and nursing women and children below the age of three years) in targeted poor communities; and (ii) to bring about a change in nutritional behavior of mothers, particularly in terms of breastfeeding, child weaning and diarrheal treatment.  10 3.07 The nutrition program will involve three sub-components: (i) an IEC intervention aimed at changing nutrition behavioral patterns, supported by supplementary feeding and child growth monitoring; (6) some basic preventive health care, through a referral service of severely malnourished children to nutrition rehabilitation centers, and health posts and centers, in particular for sick and malnourished children and for family planning (Annex I, paras. 9-10); and (iii) a fund for research and development so as to encourage development of small entrepreneurs in the food supply and processing business and to contribute policy and program improvements in the nutrition sector. A weekly take-home supplement will be provided to pregnant and nursing women and malnourished children aged 6 to 36 months (including siblings of malnourished children below 3 years) in the target areas. A monthly growth-monitoring session will be held by specially trained community nutrition centers (CNCs) staff. The age and weight of all children enrolled in the nutrition program will be registered on growth charts, and mothers will receive counselling on how well their children are doing. The nutrition program will be operated by a variety of specially trained micro-entrepreneurs (MICs), such as women groups, community associations, and youth groups, in community nutrition centers (CNCs). They will be supervised by NGOs and Groupements d'Interet Economique (GIEs), which will be contracted and trained specifically for this purpose and report to AGETIP. Local Steering Committees (Comites de pilorage) made up of local religious leaders, neighborhood chiefs, opinion leaders and various local groups and associations will provide the means towards local ownership and communty commitment and, as such, participatory advice and overall oversight. 3.08 The food supplement serves a dual purpose: to partially fill the food gap in poor peri- urban households which have had to reduce their food consumption due to lower purchasing power, and to serve as an instrument for behavioral change towards better breastfeeding and weaning practices. It is for this reason that the food supplement, growth monitoring and the [EC interventions are inseparable and will be treated in an integrated way. The project is designed to ensure that CNCs will not be regarded as food handout centers by the target population. Moreover, on-site feeding of children has been ruled out because of its heavy demands on the time of mothers and on project management capacity. 3.09 The relationship between the MOH and the CNCs will be constant and mutually beneficial. For example, when clinically indicated a child will be referred to health facilities operated by the MOH to receive preventive or curative health services. A referral person in charge of receiving any referred child will be identified. When no health infrastructure exists near a CNC, the ongoing IDA-supported Human Resources Development Project (Cr. 2255-SE) will assist in the rehabilitation or construction of new health facilities on a priority basis in targeted areas. AGETIP and the primary health care division of the MOH have mapped out for each existing health center its zone of intervention and the location of the CNCs and the district hospitals for secondary referrals of severe malnutrition cases. CNCs will provide an "outreach" base into the communities for the MOH, including extending its mother and child health care and family planning activities. To formalize relationships between MOH and AGETIP, a Convention has been signed between these two entities. The signing of the Convention was a condinon ofnegotiations (para. 6.01). This agreement requires at least monthly visits to the CNCs by medical personnel, to deal with health facility referrals, choice and coordination of IEC messages, and mobilization of the community for health events. The District Medical Officer, who is a member of the District Nutrition Committee (Annex II, para. 10), will receive monthly monitoring reports on project progress, which will enable the health service to improve its targeting. The MOH-AGET[P agreement also spells out the mechanism by which the Community Health Committees will ensure that monthly check-ups and an essential drug package (oral rehydration salt, vitamin A, iron and folic acid, deworniing and malaria tablets)  I1 will be available to CNC participants, consistent with the cost-recovery approach being implemented by MOH. 3.10 To address micronutrient deficiencies, the project will implement a three-pronged approach: the food supplement will contain a multi-vitamin and mineral mix; micronutrient supplements (iron and folic acid tablets to pregnant women and children, and vitamin A capsules) will be distributed by the Community Health Committee; and finally, periodic distribution of deworming tablets will help decrease the problems of anemia among children. 3.11 With regard to the educational and behavioral aspects of the IEC program, existing research findings suggest that the strategy should focus on three principal themes: (i) exclusive breast feeding for the first five months and the timely introduction of appropriate weaning food thereafter, providing five meals a day for children under 3 years, in addition to breast milk; (ii) proper growth monitoring; and (iii) prevention of diarrheal diseases and of dehydration. Promotion of these themes will utilize messages, communication materials and approaches already developed and to various degrees successfully tested in projects supported by Senegal's Food and Applied Nutrition Service (SANAS), the United Nations Children Fund (UNICEF). Other existing material will also be adapted. A multi-faceted strategy for promoting the central themes will be pursued. This includes the use of mass-media, group approaches, traditional media, counseling, and training of community collaborators. 3.12 The services offered by the CNCs will be provided to the target population according to strict entry and exit criteria, especially for the food supplement in order not to create a dependency on this food. The entry and exit criteria for the target population are as follows: - Children aged 6-36 months: moderately to severely malnourished children, siblings of the moderately to severely malnourished children in the same age group, and children who have failed to gain weight for two consecutive months will be those who can enter the program. The children will receive a weekly food supplement and monthly growth monitoring for six months. It is anticipated that after that period an average of 80% of the children will exit the food supplementation program; they will have gained weight and their mothers will have received significant EEC sessions. The remaining 200/o, however, will probably re-enter because of lack of weight gain, needing an additional six months of the food supplement. - Pregnant Women: Entering the program will be women in the last three months of their first pregnancy. They will receive the food supplement and benefit from IEC activities on a weekly basis for three months. - Nursing women: nursing women who have a child in the program (less than 24 months old) or with a non-programn child less than six months old will receive food supplementation and EEC on a weekly basis for six months. - WeDl-nourished children and their mothers: mothers of children who are not malnourished wil also be strongly encouraged to participate in the IEC program and to have their children's growth monitored. All women and children entering the program will be referred to health facilities for other services that they might need, thus strengthening the links between the CNCs and the public health system and virtuaDy making the CNCs catchpoints for the provision of basic health and family planning services and the distribution of micro- nutrients.  12 3.13 The total number of beneficiaries of the nutrition program for the four-year project is estimated at 350,000 women and children receiving the food supplement and other CNC services, plus an additional 119,000 receiving CNC services without the supplement, resulting in a total number of beneficiaries of 469,000 persons (based on a staff of four persons per CNC). The four principal targeting criteria are: site selection (peri-urban poverty districts); demographics (pregnant and nursing women, children aged 6 to 36 months); nutritional status (malnourished and/or no weight gain); and food characteristics (sweet porridge is generally unappealing to adult males because of traditional eating habits thus, it is self-targeting). The target locations for the first year of the project (based on the ESP) are 21 neighborhoods in the cities of Pikine, Dakar, Diourbel, Kaolack, and Ziguinchor (Annex III, Attachment A), covering a total of 50,000 persons, plus an additional 17,000 persons, resulting in a total number of beneficiaries of 67,000. Table I presents the target population and the number of centers broken down by year. Assurances were given during negotiations that the specific neighborhoods for the creation of CNCs for the second, third and fourth year of the project will be presented by AGETIP to IDA no later than March 1996, March 1997, and March 1998. (para. 6.02e). Moreover, a large share of the country's total population will receive nutrition/health messages through mass media campaigns. About one third of the targeted population is estimated to consist of pregnant and nursing women. The project aims at reaching some 30% of all malnourished children 0-3 years in the selected urban areas. These targets will be reviewed at the time of project effectiveness, annually thereafter. The project will respond to beneficiary-led demands. Further details on the Nutrition Program and on targeting are provided in Annexes II and HI Table 1: Nutriltion Program - Beneficiaries and Centers by Year Beneficiaries Year 1 Year 2 Year 3 Year 4 Total Receive Food Supp & Services/wk Children 31 000 59 000 67 000 73 000 230 000 Nursing mothers and First Pregnancy Women 19 000 31 000 33 000 37 000 120 000 Sub-total 50 000 90 000 100 000 110 000 350 000 Receive Monthly Services Onlv Children 8 500 15 300 17 000 18 700 59 500 Mothers 8 500 15 300 17 000 18 700 59 500 TOTAL BENEFICIARIES 67 000 120 600 134 000 147 400 469 000 Number of new centers 72 107 104 114 397 Number of old centers 72 179 283 Total number of opened centers 72 179 283 397 The assumptions underlying the above estimates are found in Annex M. 3.14 Beneficiaries who receive full service (i.e., food supplement, growth monitoring, and IEC) will be charged a fee of CFAF 50/week for their participation, in keeping with the Ministry of Health's current practice of partial cost recovery for drugs. This fee will be reviewed annually in light of project objectives. The fees collected will be managed by the Local Steering Cdmmittees in collaboration with the MICs, and will be used exclusively for the CNC's upkeep and for emergency situations, such as a severely malnourished child whose mother does not have the transport money to go to the nearest health center. Transparency will be ensured by making the beneficiaries well aware  13 of the fee and by showing the accounts and use of the money to the CNC's Local Steering Comnuittee. 3.15 The food supplement will be produced locally, using only local foodstuffs (pearl millet, roasted cowpeas, roasted peanuts), except for sugar and a multi-vitamin/mineral mix which will be imported. The addition of sugar is intended both to increase the energy contents of the product and to enhance its self-targeting characteristics, making it less appealing as an all-family food. One hundred grams of the dry supplement, to be prepared as a pap similar to the local millet porridge (rouye), provide 370400 kcal and some 15 grams of protein, in addition to the energy and nutrients derived from breastmilk and regular food. An infant/small child can consume 100 grams of the product in about two meals. The product's characteristics are in line with international guidelines for weaning foods established by the Codex Alimnentarius Comrnission in 1991 and with product specifications for locally manufactured fortified blended foods suggested by WFPIUNICEF. 3.16 A simple, inexpensive process will be used for the manufacture of the supplement. A group of Senegalese food processors have been identified who collectively have the capacity to produce the food. The cost of the blended food is expected to be within the normal range of this type of food produced in other countries. WFP will finance the local production of the food supplement through monetization of imported food aid and will co-ordinate the activities of the entire food chain from local procurement to processing, packaging, storage (CSA), distribution to the CNCs and quality control (ITA) at all levels. WFP will use a competitive bidding process for procurement to attempt to stimulate interest by other manufacturers in addition to those already identified. It will also identify one or more alternative formulations for the product which will enable it to substitute ingredients which might not be available at competitive prices in a given season. Moreover, WFP will reserve a portion (up to 25%) of total food-supplement requirements for possible production by small producers or micro-entrepreneurs, with a view to laying the basis for potential future small/micro-enterprise production for ensuring project sustainability. As further insurance on the sustainability of these micro-enterprises, some training in management will be provided by the project to these micro-entrepreneurs to ensure that they acquire skills for eventual diversification of their business. As a condition ofproject effectiveness, WFP will confirm to the Government and IDA the availability offiunds to purchase the local ingredients for the purposes of the supplemen- tary feeding program (para. 6.04a). Details on the food-supplement are given in Annex II. 3.17 The Nutrition Program has been tested during a six-month pilot phase. This procedure was prompted by the unusual approach for the Bank of executing a nutrition program through a privately operated entity, involving large numbers of local NGOs and micro-entrepreneurs made up of a large variety of community groups. The pilot phase has shown that AGETIP is able to handle this additional activity, without jeopardizing its ongoing work program. The strong emphasis on social mobilization was an additional factor calling for particularly careful preparation and the pre- testing of many innovative features, which potentially lay the basis for a longer term food and nutrition program in Senegal. 3.18 The experience of the pilot phase has demonstrated the need to make provisions to allow AGETEP to have some flexibility over the delivery mechanism but also over the composition of the food supplement and packaging, over a future diversification of supply sources, and over ways of addressing technical issues as they arise. Therefore, a Special Fund of US$1 milion will be created and managed by AGETIP. The Fund is principally designed to encourage development of small entrepreneurs in the food supply and processing business in selected peri-urban and rural areas in the vicinity of CNCs; and to contribute policy and program improvements in the nutrition sector.  14 3.19 It is envisioned by the mid-term review that at least some of the blended food will be produced by women's groups or other micro-entrepreneurs at or near the CNCs as an alternative to centralized large scale manufacturers. This concept entails producing a cereal-based product sinilar in composition and nutritional quality to the current product, but made with simple inexpensive equipment under supervised conditions. The concept also requires that the product meet the safety and health standards required of the current product, and that the local producers obtain a reasonable profit margin. The Special Fund will provide the financial resources to undertake these research and development activities with the assistance of the Senegal Food Technology Institute (ITA). The ITA will be contracted to make tests and provide analyses of costs, benefits and technical requirements to develop supply responses for the production of the food supplement at the grassroot level. 3.20 The Special Fund will provide funds, up to US$800,000, to purchase services from micro and small producers that meet the production requirements of the project. It will neither finance start-up capital costs, nor the purchase of equipment. If the product is found satisfactory, i.e., its quality is certified by ITA to meet the recommended nutritional value, its price is competitive, its quantity is estimated by WFP to be sufficient for project needs, and the logistics for its distribution is ensured by WFP, AGETIP will be able to enter into a contractual arrangement to purchase the food supplement from this producer. The bidding documents and the sample contract detailing the obligations of the two parntes are an integral part of the Manual of Procedures that were reviewed and agreed upon during negotiations (para. 6.02b). The number of small and artisanal firms selected by AGETIP to supply alternative food supplements to the project will be a function of the size of the fund and of the capacity of the firms that will have won participation in the project. This component will be discontinued as soon as the funds allocated to it are spent. 3.21 The experience gained in the first year of implementation of this project will be valuable for any broader national effort to address Senegal's nutrition problems, particularly its extension to the rural areas. Therefore, the Special Fund will finance (up to US$200,000) the revision of the 1991-1996 national nutrition program action plan, undertaken by the MOH. These efforts will be carried out in light of the project's experience in terms of identifying nutritional problems and solutions, success in utilizing NGOs to carry out nutrition interventions for vulnerable groups, development of a domestic food supplement industry, behavioral change and social mobilization aspects which lead to improved knowledge and nutrition outcomes. Assurances were given during negotiationsfrom Government that under the aegis of the National Commissionfor the Fight Against Malnutrition, the technical advisory committee will draft appropriate terms of reference of a studyfor updating the national nutrition action plan that will be presented to IDA for review no later than July 31, 1996 (para. 6.02rn). The Commission will oversee the execution of any studies and review the results in light of project activities and experience, and will ensure their implication in a broader, longer-term rural and urban national nutrition strategy and program. Water Program 3.22 The water component, which has been designed in line with the Third National Water Project, which is proposed for FY96 Bank support, aims at assuring adequate drinking water supplies (extension of networks to increase home supplies, installation of new standpipes) and improving general health conditions of the population concerned,.during and af*r the lifetime of the project. This component will also ensure that the current water supply deficit in Dakar will not become a constraint in the implementation of the nutrition progranm, in view of the requirements for safe drinking water for the preparation of the food supplement to be distributed by the program. Studies have shown that most of the project's targeted communities do not have connections to public services and do not have ready access to potable water, both essential elements for a community's  15 health status and its level of environmental hygiene. KfW financed a feasibility study on all technical, socio-economic, financial and institutional aspects of the water component, with a view to ensuring the provision of safe water to the target population. In Dakar, despite the overall drinking water deficit (15-30% of requirements), it is still possible to improve the supply situation in poor peri-urban areas, because of their proximity to large water-pipe conduits and the low water demand of the poor population (40 liters per person/day for households linked up with the water supply network, and 25 liters per person/day for stand-pipe users). In the provincial capitals targeted for the first project year (Kaolack, Diourbel and Ziguinchor), the production capacity of the National Water Company of Senegal (SONES) is sufficient, so that the water supply network can be extended to the peri-urban areas. 3.23 During the first year, the water component will cover 12 poor neighborhoods that have poor water services, of which five are in Dakar and seven in the provincial towns (Diourbel one, Kaolack three, Ziguinchor three). For the first year of operation, these neighborhoods will have a total population of around 174,000 inhabitants (est. for 1995). In these areas, standpipes are to be installed and managed by private entrepreneurs. A study on the willingness of the poor to pay for the water showed that they can pay for this improved water service. For the users of standpipes, the study revealed that the poor can allocate up to 10% of their incomes for water purchases. The beneficiaries of private connections will be able to meet their bills which generally fall within the limits of the "social category" of SONES's tariff structure. Moreover, SONES has become more flexible with regard to cost recovery, offering the possibility of paying water bills in installments; this allows households not to have to pay a major amount ($8-1 0 every two months) in a single payment. The "drinking water" component envisages a network extension of 11.2 km and the construction of 30 public standpipes. Assurances were given during negotiations that the proposed areas for intervenhon for the three subsequent years of the project will be agreed upon by AGETUP and Government and presented to IDA no later than March 1996, March 1997, and March 1998 (para. 6.02e). The prograrn will be implemented under the supervision of AGETIP, which will sub-contract the works to local enterprises according to a schedule of charges established by SONES. For the purpose of greater involvement of the beneficiary population, the contracted enterprises will have to recruit workers and unskilled laborers from the population of the neighborhoods concemed. The procedures and practices necessary for this approach are well known and widely applied in the framework of highly labor-intensive community works already undertaken by AGETIP. 3.24 Sensitization and sanitation education are key factors for the success of the water program. For this reason, it is envisaged that a member of each CNC will be responsible for and trained in sensitizing and educating beneficiaries in the field of water. Issues to be discussed include the links between water and health, the cost of access to potable water, the hygiene aspects of water conservation, and the organization of the collection and disposal of household garbage. The [EC agents will be selected by the micro-enterprises from the population of the concemed neighborhoods, according to their qualifications and ability to influence people. Moreover, the organizational structure and management of the Nutrition Management Division (NMD) will be strengthened with the inclusion of a sanitary engineer on its staff for the entire duration of the program. The sanitary engineer will be in charge of: (i) adapting the water program to the operational framework of AGETIP, SONES and the services of the Ministry of Hydraulics, and (ii) detemining the sites for the extension of the networks and the standpipes, which are to be in the same areas as the nutrition prograrn. The details of the Water Program are presented in Annex IV.  16 Rural Household Food Security Program 3.25 Rural malnutrition is a very significant problem in Senegal. While benefits from the January 1994 devaluation have improved the situation for those working in agriculture, rural household food insecuity among the poor remains a very senous and continuing concern. The Bank's Agriculture Sectoral Adjustment Loan is expected to result in further improvemeu in the livelihoods of those active in agriculture, and enhance food security, particularly for the poor living in rural areas. Nevertheless, for those who are chronically food insecure, a more targeted effort is required. This component, therefore, will formulate and test targeted approaches to assist chronically food insecure and malnourished rural women and children living below the poverty line. It will do so by making available food security and nutrition information and advice, food supplements, food, cash or cash equivalents, principally through labor-intensive infrastructure and income-generating activities. 3.26 The intention is to learn from the first phase of project operations in the ten priority urban centers. It is also the intention to gain a better understanding of where and how to improve conditions for rural women and children through behavioral change, greater access to food, diet diversity, clean water, food production and income-generating programs. Further, this will be an opportunity to look more closely at time allocation patterns of rural mothers, and ways to enhance women's control over household income. A useful starting point in identifying and tracking vulnerable groups in rural communities is the CSA 's Suivi des zones et groupes d risques alimentaires, a monthly bulletin identifying trends in food insecure regions and groups which is done in cooperation with the MOH. 3.27 AGETIP's rural partners will be principally those rural organizations which are similar to the MOCs and MICs in peri-urban areas. These would include some of the existing 3,600 rural and urban women groups in Senegal. In addition, the Federation of Non-Governmental Organizations in Senegal (FONGS) and the associated Comite National de Concertation Rurale (CNCR) provide technical and administrative support to member farmer organizations, and could perform MOC-like functions. Similarly, traditional women's associations have social and safety net functions, with some taking up regular collections which go to members in need. Many of these groups have been further organized by rural Government agents (Monitrices Rurales) to become Women Promotion Groups (GPF) retaining traditional functions while expanding into economic activities. Small economic interest groups (GIEs) function in rural areas, as they do in urban settings, with the added feature that agricultural extension activities for women are channeled through such groups. 3.28 The rural household food security program will be developed in collaboration with other donors, such as WFP. While experimentation is foreseen, the initial approach will be to develop labor-intensive community micro-projects, such as wells, village health posts, classrooms, school canteens, conmmunity gardens, food storage facilities, and maintenance of communal roads which are of principal benefit to the poorest households. Targeting in the ruml areas will be done through pre- qualified NGOs and other active rural entities such as the PNVA and the Monifrces Rurales, who will inform village groups of the program and mobilize these groups to be able to carry them out. These organizing entities will be trained in reaching poor village households, in order to be able to assist them in forming MIC-like groups for infrastructure construction activities and to identify promising income-generating activities.  17 3.29 In determining sub-project selection, food security concems of poor households will take precedence over strictly investrnent objectives. Details on the selection criteria, institutional arrangemets for micro-project implementation and supervision will be developed by a working group composed of AGETIP, technical representatives from the National Commission members, NGOs, and representatives of the Consultative Group. By June 1997, a proposal. satisfactory to IDA, will have been prepared and presented for approval to the National Commission for the Fight Against Malnutrition (see terms of reference in Annex V). Assurances were given during negotiations (hat the action plan to implement the householdfood security program will be completed two months prior to the mid-term review by WEP and IDA (para 6.02n). Disbursements for the rural householdfood security program will be conditoned on an approved plan of action, acceptable to IDA during the mid-term review (para 6.05). The first set of activities will commence during the June-September 1997 hungry period and be fully underway by Februarv-Apnrl 1998, the period of low rural labor demand. Social Mobilization and IEC Programs 3.30 The social mobilization and IEC Programs, central to all the components of the project, will be used to encourage the participation of all those involved in the project and to stimulate positive behavior change arnong the target populations. The project is based on a premise of broad and sustained political support, good communications between all levels of stakeholders and community participation. The social mobilization objectives are: (i) to mobilize political support and collaboration for the project at the national, regional and community level; (ii) to ensure that the community has a sense of ownership of the project and participates in its planning and execution; and (iii) to improve the capacity of communuities to provide and broaden access to nutrition and related health services. 3.31 Critical elements in the mobilization strategy at the national level mclude the political support provided by the National Commission for the Fight Against Malnutrition, as well as national planning meetings, such as ZOPP workshops. Mass media campaigns will aim at sensitizing the public at-large to the problems addressed by the project and their solutions. A key factor in mobilization efforts at the commrunity level is the establishment of local steering committees, composed of local leaders, GlEs and associations, and representatives of local authorities. These committees will serve as a mechanism for communication and coordination among all local stake- holders in the project, and as an instrument for community supervision, problem identification and problem-solving. The social mobilization strategy at the community level also includes a variety of public meetings tailored to local traditions (including local language theater, grbot or public speakers). The social mobilization component will be directed by community supervisors (MOC) in conjunction with agents of the CNC and will be supervised by AGETIP. 3.32 The objectives of the IEC program are: (i) to stimulate positive behavioral change among the target population and strengthen their capacity to manage their nutrition, health and relaied problems; and (ii) to increase awareness of nutrition, health and sanitation conditions and ways of addressing them among the public at-large, including the leaders responsible for the provision of social services. [EC strategies, messages and materials are being developed and pre- tested in collaboration with Government ministries including the MOH and the Ministry of Family, Women and Children; NGOs; international organizations such as UNICEF and USAID; and private sector consulting finns. Their primary target groups are pregnant and nursing women in the case of the nutrition program, and households and communities in the targeted poverty areas of the water program. This difference in target groups within the overall target population will require distinct IEC strtegies for each program. The nutrition program will rely heavily on client consultation at the  18 CNC in the form of individual counseling (through the CNC's Commnunity Health Agent), group meetings (organized by the CNC's IEC agent), household visits of CNC agents to targeted women, and community-level activities. In the case of the water program, emphasis will be given to household- and community-level approaches. The latter would-as in the case of social mobilization- -include traditional media such as foilkore theater. 3.33 The mass media will play a complementary role in the delivery of IEC messages for both programs. Particular emphasis will be placed on broadcasts in national languages on regional radio stations. Initially, IEC messages would focus on growth monitoring; breast feeding and good weaning practices; oral rehydration; and good water and hygiene practices, as well as prudent use and continuing maintenance of the infrastructure constructed in the water program. Other themes will be identified and messages and materials developed during project implementation. The effectiveness of these messages in the project context wiDl be ascertained through annual beneficiary assessments and Knowledge, Attitude and Practice (KAP) studies. There will be a need to develop new messages and materials where none exist and in response to obstacles identified through client consultation. 3.34 Major emphasis will be placed on client consultation and research to guide and improve the quality and efficiency of project interventions. Behavioral and operational research wiDl be integrated in the development of strategies, messages and materials. This will require research: (i) to gain insights into the target population's behavior; (ii) to identify obstacles to changes in behavior and misinformation; (iii) to pre-test strategies and materials with target populations; and (iv) to monitor and evaluate the program to measure IEC-induced behavioral change. This work will be mainly conducted by private consultants recruited by AGETIP. Further details are given in Annex VI. Training 3.35 The training component will include: (i) a package of on-the-job training services related to work organization, management, and technical and nutritional training for micro-entrepreneurs who are awarded contracts for delivery of nutrition services; (ii) a training program for supervisory services to be carried out through contracted NGOs; and (iii) training in how to plan and conduct IEC, including strategy and materials development, use of materials, and inter-personal comnunications techniques. EEC training wil be provided to small and micro-entrepreneurs and local NGOs, and to participants involved in social mobilization. Training of those implementing the social mobilization and EEC programs wiDl be done through the training of trainer model. The training program will be contracted out to private pre-selected firms who have been training entrepreneurs and supervisors of existing social mobilization aspect in projects managed by AGETIP. Training modules have already been developed and adapted from existing materials. Agreement on a detailed training program for entrepreneurs and supervisors and the IEC program for beneficiaries will be submitted to IDA for review no later than July 1, 1995. (para. 6.02g). 3.36 During project preparation, training was provided to some 120 micro-entrepreneurs and their staff, as well as to a number of supervisors (NGOs) in order to implement the pilot phase. Young medical doctors, formerly unemployed, have been trained to perform training and special supervising functions in the nutrition program. It is expected that during the life of the project nearly 4000 persons, including micro-entrepreneurs, supervisors, and AGETIP staff, will benefit from training. Further articulation of the length and content of the training program will be developed, based on continuing information generated during the pilot phase. At present, an initial training program is envisaged for CNC staff prior to the start-up of a CNC, to be followed by a second  19 training session after approximately six months of operation, and a third session after one year. Annex VII describes the Training program. Monitoring and Evaluation 3.37 A monitoring and evaluation system will be set up: (i) to permit the continuous review and calibration of the prograrn design; (ii) to strengthen the Government's monitoring and evaluation capacity in nutrition in order to analyze the cost-effectiveness and appropriateness of various intervention strategies; (iii) to determine the progress of project activities according to planned targets and schedule, and to propose appropriate corrective actions; (iv) to verify and update existing information on the extent, severity and location of various forms of malnutrition; (v) to establish the impact of project activities on nutritional status and to relate these changes to other socio-economic and behavioral variables; and (vi) to provide a basis for ongoing evaluation of the project effectiveness by local, district and national level government. The monitoring system will allow for quick analysis and availability of information at all levels of project management through a simple, computerized reporting systen, with warning thresholds. A baseline census for each geographic area of project intervention will provide the information base to identify malnourished children and to monitor project progress. The evaluation system will consist of baseline and impact studies in cross- sectional samples of target and control populations. Agreement was reached on the annual monitoring indicators, supervision guides, and the terms of reference for the base-line and impact evaluation studies to be submitted to IDA no later than July 1, 1995 (paras. 6.02 k and 1). It should be kept in mind that measurement of project impact will be affected by the considerable mobility (in- and out-migration) of the population in the targeted areas. Several operations research studies will be undertaken to gather information that neither the monitoring nor the evaluation system will reveal concerning ways to improve project effectiveness (Annex VIII). Finally, in order to improve the monitoring of the overall situation of vulnerable groups in Senegal, the project will finance short- term technical assistance in the Ministry of Economy, Finance and Planning. C. Status of Project Preparation 3.38 During project preparation a number of studies, financed under the Second Public Works and Employment Project (Cr. No. 2369-SE), were conducted to deepen the understanding of poverty and malnutrition in Senegal and ensure greater client consultation and participation. These studies included: a. a beneficiary assessment of poor urban households to examine changes in household food consumption behavior following the devaluation and to solicit these households' views on a supplernental feeding program; b. a targeting study to identify poor neighborhoods in regional capitals and other main urban centers, as well as the project's target population in these areas; c. a study of eating habits of the target population in urban areas to identify breastfeeding practices, weaning foods and food habits of women, so as to help define an appropriate composition of the food supplement; d. a study on social mobilization to determine the most effective methods of encouraging conmmunity participation and ownership;  20 e. a census of comnuniuty groups, NGOs and women associations; and f. a study on existing health/nutrition services and facilities in the targeted areas. 3.39 In addition, the prospective co-financiers, the World Food Program (WFP) and Germany (KfW), have been intensivel) involved in project preparation, since identification started in March 1994. WFP-financed a study ("Local Production of a Blended Food in Senegal for Use in the Community Nutrition Project") to determine the most appropriate composition of the food supplement. The recommendations of the study were reviewed by WFP, AGETIP, KfW and the World Bank in July 1994. Following this meeting, a supplementary study (Etude relative a la production d'un aliment de complement pour le Projet de Nutrition Communautaire au Senegal) was conducted in August 1994 by a local consultant under WFP and AGETIP supervision. These studies prompted the following pilot activities: (i) a trial run for the production of the food supplement; (ii) a test of the acceptability of the food supplement with a sample of the target population; (iii) the selection of targeted neighborhoods; (iv) a census and nutritional screening of the population in the targeted areas; and (v) a workshop of project stakeholders on the LEC and social mobilization strategy. The studies have also contributed to the preparation of the pilot phase, which was launched in three neighborhoods in November 1994 in order to field test project approaches and procedures and to fine-tune them prior to actual project implementation, thus ensuring effective project implementation. 3.40 On the uistitutional side, a National Commission for the Fight Against Malnutrition was created at the Presidency in June 1994 to ensure that a social safety net for poor households be available. The Commission, chaired by the President of Senegal, is composed of representatives of the Prime Minister's Office, of the ministries of Economy, Finance and Plan, Health and Social Action, and Women, Children and Farmily Affairs, AGETIP, and NGOs. The Commission is playing a strong role in supporting AGETIP's community mobilization efforts and in ensuring coordination among ministries involved in project implementation. A Technical Committee, chaired by the MOH and composed of the ministries of Women, Children and the Family, of the Economy, Finance and Plan, and AGETIP, was formed to assist in project design. This Committee is supported by a Consultative Committee which includes representatives of UNICEF, WFP, USAID, GTZ, ORSTOM, SANAS, DSSP, EPS, ENDA, and the BASICS Project, so as to allow an exchange of views on a number of technical, nutritional and institutional issues and to ensure that best practice is followed. 3.41 A ZOPP workshop was held during project preparation for key stakeholders involved in the planning of the project. The week-long planning workshop was organized and financed with GTZ's assistance. The workshop brought together representatives of Governmnent Ministries, the Presidency, NGOs and donors. The following Ministries were represented: Health and Social Action; Family, Women and Children; Agriculture; Finance; and Interior. The Secretary General of the Presidency also attended. The workshop identified nutrition-related health problems and obstacles in dealing with them. The objectives of the project were then clarified, project activities and intended results identified, and indicators to monitor results defined. The ZOPP was useful in developing a framework for the project and a consensus between the Government, the financial partners and NGOs. 3.42 UNICEF has also provided advice throughout project preparation. It has contributed extensively to the planning of the IEC component by: (i) providing pedagogical materials on key areas, especially breastfeeding, diarrhea, anemia and deworming; (ii) supplying SANAS with relevant leaflets; and (iii) holding a seminar/workshop in September 1994 to review and further  21 develop nutrition/IEC modules and medias (audio-visual spots, posters, flip charts and root medias) used in Senegal. AGETIP attended the September seminar which was held with key partners, SANAS, EPS, the BASICS Project, and selected NGOs (e. g. ENDA). In addition, AGETIP held another seminar with these key partners and UNICEF in December 1994. The IEC strategy and the yearly planning of EEC activities for the project were finalized during the seminar. 3.43 In the process of project planning, an examination of the issue of potable water in the poor neighborhoods indicated the need for further review of water sources. The Government requested an advance under the Project Preparation Facility to finance such a study during the pilot phase. A PPF of USS500,000 was granted for this purpose, as well as to fund the activities of the pilot phase up to project effectiveness. The water study was completed in December 1994. 3.44 For the pilot phase of the project, one neighborhood was selected in Dakar (Grand Yoff Arafat), one in Pikine (Guinaw Rail) and one in Diourbel (Keur Cheikh Ibra). In order to validate the data base used for the targeting and to verify the prevalence of malnutrition amnong children, a baseline survey of all households in the three urban districts targeted was undertaken, during which all children aged 6 to 36 months were screened for malnutrition. The survey indicated that roughly 30% of the children suffered from moderate to severe malnutrition. It was estimated that about 6,800 persons (children 6-36 months and pregnant and nursing women) constituted the target group for the pilot phase under the orginal eligibility criteria. 3.45 AGETIP initiated the pilot phase with the support of two NGOs (ENDA, ADMUR), and one GEE (Touba Boustane) as supervisors, and 23 micro-enterprises. In planning the pilot, AGETIP involved the Govemors of the two regions concemed, and the Aide-Memoire of the July preparatory mission was distributed to the regional authorities, the municipalities, the servces of the MOKL SONES, and neighborhood leaders (chefs de quartier). In addition, AGETIP organized community meetings that were attended by neighborhood leaders and representatives, community group leaders (youth, women, and economic groups), and local NGOs. Based on these meetings, Steering Commies (Comites de Pilotage) were forned and given official status by the Prefet or the Govemor of the region. These committees have been expanded to include local health and hygiene personnel of the MOK as well as community development and SONES representatives. 3.46 In February 1995, 58% of Guinaw Rail's malnourished children were receiving food supplementation and growth monitoring at the CNCs. In Diourbel and Araft, however, the number of beneficiary children registered at the CNCs significantly exceeded the number registered in the baseline survey - by some 30% and nearly 100%, respectively. Limited comparability of the data from the baseline survey (using the arm-circumference indicator) and the CNC data (based on the weight-for-height indicator) and possible flaws in the baseline survey and CNC records can only partially explain the significantly higher pilot phase numbers of malnourished children. There is reason to believe, confinned by informal information provided by local NGOs, that child malnutrition has increased in these neighborhoods. The issue will be kept under review and will be further evaluated after project effectiveness. The high influx of people to CNCs has demonstat (a) the very high demand for the food supplement and the services provided by the CNCs; (b) the right targeting of neighborhoods; and (c) the need for more restrictive and fine-tuned eligibility criteria as already reflected in paragraph 3.12. Focus groups have revealed that women appreciate the food supplement, the EEC (notably group EEC) and growth monitoring services. Women mentioned that the supplement was generally prepared as porridge in addition to other meals, but was also given to other family children. They also expressed the desirability of associating some other health- and development-related activities with the CNCs. Problems encountered regarding production, quality control and packaging of the food supplement have been resolved in collaboration  22 with WFP and ITA. In addition, the pilot phase experience has indicated that the weekly ration size could be reduced (from I kg to 700g/beneficiary/week) because intra-family leakage is taken into account by allowing the siblings of malnourished children to benefit from the food supplement and since the reduced ration provides the required daily caloric intake of 370400 kcal. D. Project Costs and Financing Costs 3.47 Total costs for the proposed project, excluding direct and indirect taxes and duties, are estimated at US$28.0 million. AGETIP is a not-for-profit enterprise that has tax-exempt status. Base costs are estimated at US$25.4 million equivalent, and total contingencies amount to US$2.6 rnillion equivalent (9.3% of total project costs). Foreign exchange would account for USS5.1 million, or 18.2% of total project costs. Detailed cost tables are presented in Annex LXK 3.48 Physical contingencies have been calculated at 5% for equipment, vehicles and materials. The following price contingencies have been included: (i) on foreign exchange expenditures 2.4% per annun, and (ii) on local cost expenditures 7.8% in 1995 and 2.5% per annum thereafter. Estimates for equipment, training, studies, and vehicles are based on the experience of AGETIP. 3.49 Project costs are based on January 1995 prices. Project costs by component, free of taxes and duties, are shown in Table 2 below. The nutrition program would account for 60.2% of base costs, the water program 11%, the rural household food security program 4.7%, social mobilization and IEC activities 6.3%, the package of training 5.9%, monitoring and evaluation 5.9%/o, and AGETIP's management fee 3.9%. Table 2: Project Cost Summary (net of taxes and duties) (TJSS million) Local Foreig Total Nutrition Program 14.6 0.7 15.3 Water Program 0.6 2.2 2.8 Rural Household Food Security Program 1.1 0.1 1.2 Social Mobilization and IEC 1.3 0.3 1.6 Training 1.1 0.4 1.5 Monitoring and Evaluation 0.8 0.7 1.5 AGETIP Management 0.7 0.3 1.0 Pilot Operations and Project Preparation 0.4 0.1 0.5 Total BASE COSTS 20.6 4.8 25.4 Physical and price contingencies 2.3 0.3 2.6 Total PROJECT COSTS 22.9 5.1 28.0  23 Financing 3.50 Of the US$28.0 million total project costs, IDA would finance US$18.2 million equivalent, or 65% of total project costs, for the delivery services of the nutrition program, the rural household food security program, the social mobilization and IEC program, the training package, the monitoring and evaluation system, and project management (Table 3). Through parallel co- financing, WFP would contribute US$5.2 million, or 18.6% of total project costs, for the nutrition program (funding food, processing and logistics of distribution). Through parallel co-financing, KfW would fund US$3.0 million equivalent, or 10.7% of total project costs, to finance the water program. UNICEF has contributed extensively to the planning of the social mobilization and IEC component. The Government is expected to contribute US$ 1.6 million equivalent, or 5.7% of total project costs. Table 3: Financing Plan by Disbursement Category* (USS million) IDA WFP Germany Govt. Total Amt % Amt % Amt % Amt % Amt % Water Programi 2.8 10.0 2.8 10.0 Nutrition services 9.2 32.8 5.2 18.6 1.6 5.7 16.0 57.1 Training 1.5 54 1.5 5.4 AGETIP Mgint Fee 0.8 2.9 0.2 0.7 1.0 3.6 Consultant Serces 3.6 12.9 3.6 12.9 PPF Advance 0.5 1.8 0.5 1.8 Unallocated 2.6 9.2 2.6 9.2 Total Disbursements 18.2 65.0 S.2 18.6 3.0 10.7 1.6 5.7 28.0 100.0 Costs are net of taxe and duties I IV. PROJECT IMPLEMENTATION A. Project Management 4.01 The Government of Senegal has designated AGETIP as the executing agency for this project, as AGETIP has proven its ability to execute a broad range of projects successfully and expeditiously, mainly because of its strong managerial and operational capacity. To that effect, an amendmnent to the Convention between AGETIP and the Government of Senegal was agreed upon during negotiations, and its signing will be the condition of Board Presentation (para. 6.03). To ensure that AGETIP can effectively expand this capacity to the broader nandate of executing community-based nutrition programs, the newly-created Nutrition Management Division will include a small technical staff specialized in the areas of nutrition and health, water, IEC and social mobilization, and monitorng and evaluation, under the guidance of a manager. During negotiations, IDA received official notification of the nomination of the divisional director of AGET7P to manage this new division (para. 6.01). The appointment of the key staff of the Nutrition Management Division by AGETIP is a condition ofproject effectiveness (para. 6.04c). During negotiations, assurances were given that the Government of Senegal will agree that at all times  24 the management of this Division will be handled by a person acceptable to IDA (para. 6.02d). AGETIP will execute the project under the established procedures of "delegated contract management", with extensive use of short-term consultants. Assurances were given at negotiations that at the mid-term review an assessment will be carried out to determine the feasibility of separating the NMD from AGETIP to make it a stand-alone agency (para. 6.02j). There will also be a review as to whether other entities could execute delegated contract management responsibilities similar to those performed by AGETIP. In view of the growing role of AGETIP in delegated project contracting, this action aims at lessening the monopoly risk that may otherwise be created. Moreover, starting with a pilot, the project will proceed in a phased manner, so as to ensure that organizational, management and technical details have been sufficiently tested and adjusted to account for absorptive capacity conditions in the field. Project implementation will be guided by a detailed Manual of Procedures which, among others things, stipulates entry and exit criteria for program participation to avoid food dependency, and establishes linkages with the health system to ensure referral health services. The Manual clearly spells out objective criteria for cost-effective targeting and specific indicators to monitor project implementation. In order to improve coordination with the health system, clear contractual arrangements between AGETIP and the MOH are defined in the Manual of Procedures. A draft of the Manual of Procedures was sent to IDA and agreement on it was reached during negotiations (paras. 6.01 and 6.02b). 4.02 In order to ensure greater ownership of the project, District Steering Committees (Comites de Pilotage) will be created in each district to play an advisory role and will be given official status by decree of the Governor of the region. Members of the committees will be representatives of the Govemor, Prefet or Sous-Pr6fet, the District medical officer, the mayor, and neighborhood leaders, as well as agents from technical services involved in the project. Local commnittees (Comites de Pilotage de quartiers) will be organized in each target neighborhood, in order to participate in the elaboration of the social mobilization strategy pertinent to the neighborhood and to provide periodic feedback to AGETIP on the overall project impact and performance. 4.03 Nutrition program. Local groups-including GIEs, women groups, community associations, and youth groups--will be the small and micro-entrepreneurs for the nutrition service program. These groups will be instrumental to the success of this project since they will be the entry point to communities and will provide the link between the planners at the national level and the beneficiaries. They will be responsible for identifying and motivating beneficiaries, ensuring greater community participation, and for delivering nutrition services. Supervisors of the nutrition centers (NGOs and consultants), defined as organized groups with a technical capacity and legal status, will be instrumental in the training and supervision of small and micro-entrepreneurs responsible for managing the supplementary feeding program at the community level. A roster ofpre-qualified small and micro-entrepreneurs and supervisors will be submitted to IDA no later than July 1, 1995. (para. 6.02h). The selection of the entrepreneurs and supervisors will be based on competitive bidding, as spelled out in the Manual of Procedures. Local health structures will participate in the project and provide primary care to pregnant and nursing women and children referred by the CNC for periodic clinical exams and other basic health services. AGETIP has entered into an agreenent with the MOH to ensure the collaboration of the local health structures in this endeavor. 4.04 Water Program. This component will be implernented under the supervision of AGETIP, which will sub-contract the technical execution to local enterprises according to a schedule of charges established by SONES. For the purpose of greater involvement of the beneficiary population, the contracted enterprises will recruit workers and unskilled laborers from the targeted neighborhoods. Procedures and practices known and widely applied in the framework of highly  25 labor-intensive community works previously undertaken by AGETIP will be applied. AGETIP will enter into an agreement with SONES to ensure the respect of technical standards by the local contractors. The signing of this agreement, under terms and conditions acceptable to IDA, is a condition ofproject effectiveness (para. 6.04d). In order to ensure proper coordination of activities with the water sector, the Ministry of Hydraulics will be part of the National Commission for the Fight against Malnutrition. 4.05 Rural Household Food Security. Local community personnel will be recruited to implement and supervise this program, as done under the peri-urban component. However, more detailed preparation of this component will be undertaken during the first and second year of project implementation in order to target the rural areas where the project will intervene, in line with the findings of the Senegal Poverty Assessment, to deternine the type of works, and to specify the most appropriate time for this intervention. It is envisaged that this component will become fully operational in the third year of project implementation. Disbursement on this component will be conditional upon the approval by IDA of a plan of action and an investment program that will be presented by AGETIP at the medium-term review of the project (para. 6.05). 4.06 Social Mobilization and IEC. NGOs or other private sector organizations will be responsible for developing training modules and IEC materials (building on existing materials) and for conducting the training of the small and micro-entrepreneurs and supervisors for the nutrition centers. The Manual of Procedures provides detailed criteria for pre-qualification and selection of these groups. Similar groups will also be hired to conduct: (i) IEC and certain monitoring and evaluation functions; and (ii) research, including beneficiary studies to identify nutrition and food security needs, which would serve as a basis for adjusting project planning and strategy development during project implementation. 4.07 Monitoring and Evaluation System. An elaborate, yet simple, monitoring system has been developed to check performance and efficiency of micro-entrepreneurs and supervisors. This system will provide readily understandable information on project coverage and on the evolution of the nutritional situation of children who come to the CNC (para. 4.08). B. Project Monitoring and Evaluation 4.08 Monitoring will be implemented through (i) a management information system (MIS) that provides feedback to each level; and, (ii) operations research. The MIS has already been designed and builds upon a successful system in use by AGETIP for its public works activities. The system operates as follows: (i) the CNCs will use a simple reporting form that is presented in the Manual of Procedures to record their activities; (ii) the MOCs will input the records kept manually by the CNCs and send them electronically via modem to AGETIP; (iii) selected performance information on the centers will be transmitted to AGETIP's NMD by the supervisors (MOCs) of the CNC on a monthly basis; (iv) the monitoring agent at AGETIP headquarters will process the information received and submit all performance statistics to the NMD's manager, on a monthly basis; (v) the performance of each CNC will then be compared to pre-established performance norms and fed back by AGETIP to the CNC and the MOCs; and (vi) corrective measures will be recommended for CNCs that show low perfornance. The norm for a CNC is determined in terms of general attendance, coverage of children, number of children receiving the food supplement and key growth monitoring, nutritional improvements of children (children grailuating after three months, children graduating after six months, total children graduating); number of pregnant women entering the program, number of pregnant and nursing women receiving supplement, number of clients referred to health services, and coverage of relapses for past six months. Operations research will be  26 triggered, as needed, by questions raised throughout the supervision system. The system is set up so as to facilitate impact evaluation and longitudinal performance studies of changing indicators on nutritional status, on knowledge, attitudes and practices concerning nutrition, on hygiene and health, and on the satisfaction of the population. In addition, the system will also allow the measuring of the cost-effectiveness of the program at national and local levels. A series of ZOPP workshops will be held during project implementation to assess progress, build consensus, and agree on the next course of action with all concerned stakeholders from government to community leaders. The monitoring system is described in detail in Annex VIII. 4.09 To ensure sustainability, the beneficiary population will continue to be involved in project implementation. This will be done through (i) a yearly beneficiary assessment, the results of which will be taken into account in relevant project components; and (ii) a monitoring system that requires supervisors to visit beneficiaries and non-beneficiaries in order to identify potential problems and offer suggestions. Every six months, the CNC's Local Steering Committee will be given information on project progress and problems encountered, so that constraints can be assessed locally, and local solutions sought. The District Steering Conmmittee will also be informed and will be asked to find solutions that could not be found at the local level. Project sustainability is closely linked to macroeconomic performance, namely that only through economic growth and cost-effective public expenditures will the Government be able to take over the nutrition activities started under the project. 4.10 Evaluation indicators will consist of impact measures on both the beneficiaries and the overall target population (Annex VIII). Sample cross-sectional surveys of project beneficiaries and non- beneficiaries will be carried out yearly in three out of the ten cities to analyze the evolution of malnutrition rates, household food insecurity, and access to water, and thus to estimate project impact and opportunities for project improvement. C. Procurement 4.11 The procurement procedures according to which AGETEP will select small contractors and micro-entrepreneurs and award contracts are simplified procedures designed under the Bank's Public Works and Employment projects and outlined in the current Manual of Procedures of AGETIP for small contractors and the supplementary manual developed by AGETIP for micro-entrepreneurs under the project. It is anticipated that al contracts for nutrition services wil be below CFAF 2.8 million (US$5,000) annually and those for supervisory services for CFAF 4.8 million (US$10,000). AGETIP will pre-qualify and maintain a roster of entrepreneurs eligible for National Competitive Bidding (LCB), established according to procedures acceptable to IDA and detailed in the Manual of Procedures of the roster will stay open during project execution so as to allow additional applications at any time. Large firms are not likely to be interested in the tye and size of most activities proposed, but they will not be excluded from participating in the process. The purpose of pre-qualification wil be to detennine the micro-entrepreneurs who can demonstrate their ability to carry out the proposed nutrition programs effectively and would, therefore, be eligible to bid.  27 Table 4: Summary of Proposed Procurement Arrangements* (USS Million) Procurement Method Project Element ICB LCB Other NB.F. TOTAL WateT Program 2.8 2.8 Equipment 1.2 0.4 0.1 1.7 (1.2) (0.4) (0.1) (1.7) Service Contracts at 7.8 1.8 9.6 ____________________________ ~~~~~~(7.8) _ _ _ _ (7.8) Consultant Services bl 6.1 6.1 _________________________ _________ ~~~(6.1) (6.1) Miscellaneous Operating Costs 2.1 2.1 (2.1) (2.1) Food 5.2 PPF Advance 0.5 5.2 0.5 _____________________________ ~(0.5) (0.5) TOTAL 1.2 0.9 16.1 9.8 28.0 DA financed (1.2) (0. 9) (16.1) (18.2) Cos are not of taxes and duties Notus: Totals may na add up due to rounding;. Figures in parent show IDA amoud and are fie oftax and duties. N.BRF. = Not Bank-Financed Nutrition activities will be procured in accordance with AGETIPs Pwcedural Manual (acceptable to IDA). Consulting sevices wiUl be procured according to IDA guidelineL a/ For swvices provided by micro-a neur. b/ For superviy servicas provided by NGOO and for ucdies and toeunical aiance by pivate fien or individuals. 4.12 For the delivery of nutrition services (including IEC services, referral services for severely malnourished children, distribution of iron folate and ORT), procurement procedures will be consistent with those acceptable for service contracts. These services will be contracted out to micro- entrepreneurs. The core of the procurement procedure for micro-entrepreneurs expected to participate in the nutrition program will be local advertisement of a proposed contract to service a community nutrition center. All micro-entrepreneurs registered in the roster will be invited to bid and deliver services under the supervision of NGOs. Those expected to participate comprise primarily small community groups (such as women groups, community associations, GlEs and youth groups). Qualification criteria for micro-entrepreneurs include formal registration as a legal entity and a proven record of relevant community activity. 4.13 Procurement arrangements for the water works and rehabilitation of CNCs are designed to address poverty alleviation objectives. These works will be sized so that they can be implemented by small contractors, using simple, labor-intensive techniques already demonstrated by AGETIP. The quality of the works performed will be ensured through technical supervision by qualified engineering bureaus or individuals registered with AGETIP and under successfully tested AGETIP procedures. 4.14 Contracts for equipment, vehicles and materials will be grouped into bid packages and those in excess of USS200,000 will be awarded on the basis of international competitive bidding (ICB). AGETIP will use World Bank standard bidding documents. For such ICB, local  28 manufacturers will enjoy a preference margin of 15% or applicable custom duties, whichever is lower. National competitive bidding (LCB), using procedures which have been found acceptable to IDA, will be used for procurement involving contracts lower than US$200,000 but greater than US$ 30,000, up to a total of US$0.4 million over the life of the project. Contracts below US$30,000 for vehicles, small items of equipment and office supplies will be procured by local and/or international shopping procedures acceptable to IDA with a minimum of 3 price quotations up to an aggregate amount not to exceed US$0.1 million. 4.15 Consultant services for training, technical assistance, and project monitoring will be procured according to IDA guidelines outlined in the "Use of Consultants by World Bank Borrower and by the World Bank as Executing Agency". This includes audits and accounting services, capacity building, contract management by AGETIP and training of NGOs providing technical advice and supervision to micro-entrepreneurs, nutrition monitoring and evaluation activities, and implementation of a nutrition IEC program. Given the specific nature of these activities, contracts will be awarded to institutions or consultants satisfactory to IDA on the basis of work programs and terms of reference or in a competitive way from established pre-qualified rosters. 4.16 As the designated executing agency for the project, AGETIP will charge the project a 5% overhead-cost fee for the provision of overall management services. These services include project management (preparation, scheduling, and implementation), supervision, legal counsel, administration and office space. The project will benefit from AGETIP's umbrella, which will ensure its independence and autonomy. The AGETIP management system has established a proven record of low cost service (contract) delivery and independence of action in critical areas such as project review and approval, disbursement of funds and implementation. Specifically, since its creation in 1989, AGETIP has proven its capacity to manage large numbers of contracts with small enterprises in the building and public works sector, using social mobilization as a major instrument for project implementation at the community level. To extend this capacity to the management of the activities envisaged under the project, AGETIP will set up a Nutrition Management Division, comprising of a Coordinating Director and one technical staff for each of the following areas: nutrition/health services; water; training; IEC and social mobilization; and monitoring and evaluation. 4.17 Prior Bank review will be required for all contracts valued at more than US $200,000 equivalent. Prior Bank review will not apply to consultant services estimated to cost less than US$ 100,000 for firms and US$50,000 for individuals. However, this exception to prior review will not apply to the terms of references of such contracts, to single-source hiring of firms, to assignment of a critical nature as determined by IDA, and to amendment of contracts raising the contract value to US$100,000 or more for firms and US$50,000 or more for individuals. D. Disbursement 4.18 The project is expected to be implemented over a four-year period, with the closing date set at lune 30, 2000, and the IDA credit disbursed over four years, according to the categories shown in table 5. The estimated disbursement profile is shown in Annex X. The Credit is expected to disburse ahead of the regional disbursement profile for population, health, and nutrition projects because the project will be implemented through agents of the private sector. Disbursements will be made on the basis of 100% of total expenditures free of direct and indirect taxes and duties for IDA's share of the services linked to the nutrition program, the rural household food security program, social mobilization and IEC program, training, and project management The Government's deposit of an aggregate initial amount of not less than US$0.4 million equivalent in CFA Francs in AGETIP 's account as its contribution for the firstyear is a condition ofproject effectiveness (para.  29 6.04b). In addition, assurances were given during negotiations that the Government deposit its counterpartfunds at the beginning of each year ofproject implementation, i. e., July 1, 1996, July 1, 1997, and July 1, 1998 (para. 6.02i). It is understood that the percentages in Table 5 have been calculated on the basis of the provisions 309 and 1091 of the Law 92-40 of July 9, 1992 of the Government of Senegal, which exempt the goods and works to be financed from taxes and customs duties levied by the Government of Senegal. If any change is made to this Law which has the effect of levying taxes or customs duties on such goods or works, the percentages referred to above shall be decreased in accordance with the provisions of Section 5.08 of the General Conditions. Table 5: Allocation and Disbursement of the IDA Credit CATEGORY OF EXPENDITURES AMOUNT PERCENTAGE FINANCED I (USS Million) (free of duties and taxes) EquipmneTt 1.4 100% Consultant Services (TA, training, studies) 13.7 100% I PPF Advance 0.5 100% |Unallocated | 2.6 _l TOTAL 18.2 4.19 To expedite project implementation, a Special Account denominated in CFAF will be opened at a commercial bank and operated on terms and conditions acceptable to IDA. The authorized allocation will be CFAF 600 million, representing anticipated eligible expenditures financed by IDA for a 4-month period. IDA will make an initial deposit of those amounts from the proposed credit iunmediately upon credit effectiveness. Replenishment of the Special Account will be made on the basis of full documentation, except for contracts valued at less than USS 100,000 equivalent, for which disbursements will be made on the basis of Statements of Expenses (SOE). In such cases the relevant documentation will be retained by AGETIP for review by IDA supervision missions and the project's external auditors. E. Accounting, Auditing and Reporting 4.20 The terms of reference and a list offirmsfor the selection of an external accounting/auditingfirm andfor the design and implementation of accounting andfinancial management system was presented to IDA prior to negotiations (para. 6.01). The arrangements were reviewed and agreed upon during negotiations (para. 6.02c). The accounting system of AGETIP will be revised to take into account the diversification of its operations. The adoption and implementation of the accounting andfinancial management system and the employment of an independent auditor to audit project records, accounts andfinancial statements will be conditions of effectiveness (paras. 6.04e and f). Consolidated project accounts will be maintained by the Agency. These accounts will be audited every six months by independent auditors acceptable to IDA according to terms of reference agreed by IDA. The auditors will be appointed for a period of four years. Auditors will express separate opinions on statements of expenditures and special accounts. Audits will be carried out semi-annually and auditors' reports will be submitted to IDA within three months of the close of each semester. During negotiations, assurances were given that AGET7P will also submit every six months management and financial audits, and a technical audit will be undertaken annually (6.02t). It will submit monthly progress reports and prepare an implementation completion report (ICR) within six months of the closing date.  30 F. Supervision Plan 4.21 The project will be supervised every four months. The necessary staff inputs for supervision will be as follows: 5 staffweeks in FY95, 18 in FY96, 18 in FY97, 18 in FY98, and 18 in FY99 for a total of 77 staffweeks. A detailed supervision plan is shown in Annex XI. Given the need for close monitoring of the operation, there will be a mid-term evaluation during which ZOPP workshops would be held in order to assess, inter alia, the targeting mechanism, cost-effectiveness, and beneficiary participation, and the actions for the nutrition strategy. This mid-term evaluation will also serve to make any necessary modifications to project implementation in close coordination with all concerned stakeholders. Other ZOPP workshops will be held at the end of the project for purposes of evaluation and design of future operations. G. Environmental Impact 4.22 The overall environmental impact of the project is expected to be neutral to positive. The environmental category is C. The impact of the small public works to be financed under the project, such as the rehabilitation of community infrastructure, will be neutral on the environment. Components such as the water program will have a positive impact on the environment by providing potable water to the beneficianres. H. Project Objective Categories 4.23 The proposed project is a poverty-targeted intervention, geared to halting a deterioration in the nutritional status of the most vulnerable groups in targeted poor neighborhoods of Senegal, selected on the basis of a poverty assessment. As such, it expects to reduce food insecurity in these neighborhoods, and generate employment and income for community groups through the promotion of small-scale activities. The project promotes the development of small and micro-entrepreneurs, community participation, and the involvement of NGOs and local consultants in implementation, thus placing key implementation into the hands of the target group population and thereby insuring long- term sustainability. The project responds to the Government's objectives of human resource development and poverty alleviation. V. BENEFITS AND RISKS A. Benefits 5.01 The project will have two main benefits. First, the imrnediate irnpact of the nutrition program is intended to halt a deterioration in the nutritional status of the most vulnerable groups in the poorest urban areas, estimated at a total target population of 469,000 (about 230,000 malnourished children under three years of age and 120,000 nursing and pregnant women receiving food, growth monitoring and IEC services, and 1 19,000 mothers and children receiving only growth monitoring and IEC services). Based on preliminary estimates the project is expected to reach about 30% of urban malnourished children in targeted areas. The project's nutrition education activities should set in motion behavioral changes and adoption of better child-feeding practices, leading to long-lasting nutritional improvement in children under three years. Through the water program, increased access to safe drinking water should reduce the incidence of diarrhea and water-bome diseases affecting the nutritional status of 174,000 residents in the targeted neighborhoods for the first year of operation, and 522,000 beneficiaries for the subsequent years, totaling 696,000 over the life of the project for this program. Thus, about 1.2 million persons will benefit from both programs.  31 As demonstrated during the pilot phase in neighborhoods where the CNC is close to a health facility, the proposed project will also lead to an increased demand for and use of health services. An additional benefit of the household food security and water programs will be the provision of growth and development-oriented infrastructure in targeted rural and urban areas. 5.02 Second, the project will establish, for the first time, a local capacity to deliver community-managed nutrition services with private sector efficiency, both in terms of management and administrative cost containment. It will also contribute to the capacity building of NGOs by providing training in the supervision of comrnunity nutrition centers and IEC methods to pre-selected local NGOs. Finally, closer collaboration between NGOs and public health services will improve the delivery of social programs geared to the most vulnerable households, and the capacity of local groups to manage their social/poverty problems. B. Risks 5.03 As the nutrition program will be carried out in the urban low-income areas of Senegal and among some of its poorest people, many of them illiterate and innumerate, its implementation will not be easy. The project will involve five specific risks. The first concerns the production of the food supplement, since the enterprise selected by WFP for production enjoys a virtual monopoly. Tlhe second risk is linked to the strong coordination required among the many stakeholders associated with project implementation, which could impose a logistical problem that might undermine AGETIP's efforts to meet project objectives efficiently and effectively. The third risk is that implementation might be delayed by community mobilization, organization and training shortfalls. The fourth risk is that the necessary nutrition-health coordination arrangements between AGETIP and the Ministry of Health fall short of expectations. Finally, the project's administrative costs might be higher than estimated thus endangering the program's sustainability. 5.04 To reduce the risk related to the sole source of food production,, WFP will attempt to identify through local competitive bidding, alternative sources during the first year of operation. Implementation risks will be mitigated by several measures. The project will be implemented on the basis of a detailed Manual of Procedures and under a strictly organized schedule of supervision procedures, thus ensuring attention to quality issues by all implementing bodies. In addition, starting from the pilot phase, the program will expand towards full coverage only after organizational, management, and technical program details have been sufficiently tested and adjusted to account for absorptive capacity conditions in the field. The National Commission for the Fight Against Malnutrition constitutes the strongest possible Government commitment in supporting AGETIP's community mobilization efforts. Training and in-service training of large numbers of community private entrepreneurs and beneficiaries are recognized as key elements for project success. Moreover, improved coordination with the health system will be ensured by clearly defined contractual arrangements between AGETIP and the MOH. Finally, AGETIP's contract management capabilities, supported by its strong management information system, have proven to be guarantor for cost containment and will ensure sustaunability. Through this approach to social services provision, the traditional role of Government as a provider of public services will be replaced by one by in which Government provides those services in terms of planning, programmning and budgeting, but leaves delivery to the more efficient and cost-effective agents of the private sector.  32 VI. AGREEMENTS, ASSURANCES AND RECOMMENDATION 6.01 Before negotiations, the Government provided evidence of (i) a draft of the amendment to the Convenhon to be signed with AGETIP to include the new services to be provided by the Nutrition Management Division (para. 4.01); (ii) a draft of the Manual of Procedures (para. 4.01); (iii) the terms of reference and a short list of firms for the selection of an external accounting/audit firm and for the design and implementation of accounting and financial management systems (para. 4.20); (iv) a signed Convention between the Ministry of Health and AGETIP (para. 3.09); and (v) the nomination of the director for the Nutrition Management Division (para 4.01). 6.02 During negotiations, agreements were reached on: a. the amendment to the Convention between AGETIP and Government to include the new services to be provided by the Nutrition Management Division (para. 4.01); b. the draft of the Manual of Procedures, including bidding document and sample contracts for the Special Fund (para. 3.20 and 4.01); c. the terms of reference and a short list of firms for the selection of an external accounting/audit firm and for the design and implementation of accounting and financial management systems (para. 4.20); d. the management of the Nutrition Management Division to be the responsibility of a person acceptable to IDA at all times (para. 4.01); e. the submission by AGETIP to IDA of the proposed areas of intervention for the second, third and fourth year of the project for the nutrition and water components, no later than March 1996, March 1997 and March 1998 (paras. 3.13 and 3.23); f. the submission of audit reports (management and financial every six months and technical audit annually) and of annual review reports (para. 4.20); g. the submission of a detailed training program for entrepreneurs and supervisors and the EEC program for beneficiaries to IDA for review no later than July 1, 1995 (pam. 3.35); h. the submission to IDA of a roster of pre-qualified small and micro-entrepreneurs and supervisors no later than July 1, 1995 (para. 4.03); payment of Government counterpart funds by July 1, 1996 for the second year, by July 1, 1997 for the third year, and by July 1, 1998 for the fourth year (para. 4.18); j. an assessment will be carried out during the mid-term review to deternine the feasibility of separating the NMD from AGETIP to make it a stand-alone agency (pam. 4.01); k. the terms of reference for base-line and impact evaluation studies on measuring the impact of the project to be submitted to IDA no later than July 1, 1995 (para. 3.37); 1. annual monitoring indicators and supervision guides to be subritted to IDA no later than July 1, 1995 (pam 3.37);  33 m. terms of reference of a study for updating the national nutrition action plan to be submitted to IDA no later than July 31, 1996 (para. 3.21); and n. the action plan to implement the rural household food security program two months prior to the mid-term review by WFP and IDA (para. 3.29). 6.03 The condition for Board presentation is signing of the amendment to the Convention between the Government of Senegal and AGETIP (para. 4.01). 6.04 The conditions of project effectiveness are: a. WFP's confirmation in terms and conditions satisfactory to IDA, and reflected in WFP's Grant Agreement, of the availablity of funds to purchase the local ingredients for the purposes of the supplementary feeding program (para. 3.16); b. Government's deposit of an aggregate initial amount of not less than US$0.4 million equivalent in CFA Francs in AGETIP's account as its contribution for the first year of project implementation (para. 4.18); c. appointment of the key staff of the Nutrition Management Division by AGETIP (para. 4.01); d. signing of an agreement between AGETIP and SONES for the purposes of implementing the water program, under terms and conditions acceptable to IDA (para. 4.04); e. adoption and implementation by AGETIP of accounting and financial management system acceptable to IDA (para. 4.20); and f. employment of independent auditors acceptable to IDA for the audit of the project records, accounts, and financial statements (para. 4.20). 6.05 The conditions of disbursements on the rural food security program component will be IDA's approval of a plan of action (para. 3.29) and an investment program to be presented by AGETIP (para. 4.05) at the mid-term review of the project. 6.06 Recommendation. Subject to the above terms and conditions, the proposed project would be suitable for an IDA credit of SDR 11.7 million (US$18.2 million equivalent) to the Republic of Senegal on standard IDA terms, with 40 years maturity.  34 ANNEX I Page I of 2 LESSONS FROM NUTRITION PROJECTS IN SENEGAL AND OTHER COUNTRIES Senegal 1 . From 1973 to 1988, a supplementarv feeding program, the Programme de Protection Nutrntonnelle et Sanitaire (PPNS), was carried out with the assistance of Catholic Relief Services (CRS). The PPNS established nutnrtion centers throughout the country, mainly in rural areas (less than 10% in cities). The number of centers increased dramatically from 37 in 1973 to 430 in 1984. The CRS/Senegal was responsible for food procurement, the collection of fees from mothers and the general administration of the program. The SANAS (Food and Applied Nutrition Service of Senegal of the Ministry of Health) supervised the program, and Cathwel/Senegal supervised the program and food distribution and inspection of feeding centers. The health posts and feeding centers were managed locally by health committees, comprised of men only. The centers were usually run by medical technicians, nurses, nurses aides, community health workers, and mothers' committees. Most workers of the centers were Government employees. 2. The services provided by the centers were pre- and post-natal supplementary feeding, growth monitoring, nutrition education and food supplementation for children under 5 years of age. In 1987, the supplementary feeding was discontinued, thus leaving simply growth monitoring, resulting in a drop of beneficiaries from 152,200 mothers and children in 1985 to 100,000 in 1987, and to 97,800 between January and September 1988. The reasons for this drop in attendance are in part linked to the high opportunity cost of mothers' time, especially since the small fee that mothers were asked to contribute to the PPNS (about USS0.67/month) was mandatory, and to the quality of health services provided by the health centers, was inadequate as an incentive for mothers to bring their children. According to a 1983 evaluation, the successes of the program were (i) a high coverage of inmmunization for children in the program; (ii) better use of health services by children in the program; (iii) lower infant and child mortality rates for participating communities; (iv) a large number of paramedical personnel trained in the use of growth cards; (v) lower incidence of malaria armong children enrolled in the program due to higher usage of prophylactics; and (vi) and increase in the use of oral rehydration salts in the participating areas. Some of these results, however, may have been due to the fact that children in the program had better access to health care services than non- participants. The program was not renewed also because of the following poor performance indicators: only 6-1 1% of the calories were actually consumed by the beneficiaries; take-home rations lasted fifteen days rather than one month; the monthly food supplement received was much lower than the planned one (in 1981, each child received 5.5 kg and in 1982, 3.8 kg, instead of the planned 7.5 kg) either due to management or distribution problems; 10% of the most at-risk households were unaware of the program or did not participate in it; although 90% of the children under 2 years of age entered the program, 20% stayed until 3 years of age or more, thus diminishing the chances for younger at-risk children to enter the program.  35 ANNEX I Page 2 of 2 The causes identified for this poor performance include: the non-targeting of lower-income groups, since distribution depended on the location of the health center (90% were located at a health facility), the take-home rations could be easily sold on the market, thus allowing large leakages (the ration was composed of 3.75 kg of corn-soy-milk and 3.75 kg of soy-fortified cornmeal or soy-fortified sorghum); and the perception of the food as a new source of income (the food represented an income transfer of about 18% of household income) than a way of promoting changes in children's feeding patterns. Conclusions 3. These conclusions are based on lessons learned from past supplementary feeding projects (the IDA-financed Tanil Nadu project in India, an emergency feeding program in Zimbabwe, a national program of food distribution and feeding in Botswana, a supplementary feeding program in the Gambia, the IDA-financed Applied Nutrition Education Project in the Dominican Republic, the PROSALUD - health - project in Bolivia, and the PANFAR project - project for Food and Family Nutrition - in Peru): targeting of children under two years of age is necessary to prevent malnutrition in poor areas; while malnourished children should be targeted individually to provide therapeutic care; supplementary feeding of children: food supplements should not replace the meals prepared by the family; nutrition education should accompany the supplementation program; and health follow-up should be provided simultaneously with the feeding program; supplementary feeding of pregnant women: has an effect among rural women (urban women having less of a caloric deficit and less energy expenditures), especially if provided during the rainy season; should cover the last trimester of pregnancy; should be accompanied by ironlfolate supplements as well as anti-malaria prophylaxis; and should include nutrition and family planning messages; supplementary feeding of nursing women: target all poor nursing mothers; should be accompanied by iron/folate supplements and anti-malaria prophylaxis; should provide nutrition and family planning messages; and IEC and community participation are crucial: mothers need to undentand and accept the principle of targeted supplementation in order to reduce the risk of the re-sale of the food supplement, its leakage to other family members, and its substitution for the customary food ration. Local committees need to be involved in the food supplement program from the inception, thus ensuring that the program is managed at the community level. The committee should be kept informed of the program's progress at regular intervals so that it understands fully any changes made.  36 ANNEX II Page 1 of 9 COMMUNITY NUTRITION PROGRAM 1. The nutrition program will be implemented by micro-entrepreneurs (MICs), organized in local associations, such as GIEs. However, only those communities showing a willingness to have this program will benefit. The MCIs will be supervised by NGOs which will report directly to AGETIP. Contracts will be provided to NGOs for carrying out the training, supervision and evaluation of the program. Modules and guidelines for training, supervision and evaluation have been developed by AGETIP and tested during the pilot phase. Community Nutrition Centres (CNC): 2. Community micro-entrepreneurs will be trained to provide the following services: 1) Identification of malnoursihed children 2) Child growth monitoring and promotion 3) Referral of acute cases of malnutrition and of women for family planning to health centers 4) Distribution of a food supplement 5) IEC 6) Basic record keeping 7) Home visits Each MIC will have a staff of four who will be trained to carry out these activities and who will handle a maximum of 350 persons per week. This workload will also allow the MIC to undertake home visits to malnourished children. After one to two years of operation, it is expected that MICs will have more time for home visits and could also engage in other community services, such as literacy or farnily planning. 3. AGETIP developed "Guidelines for the Model Community Nutrition Center", training manuals, a "Supervision Guide" and a "Home Visits Guide". These documents will be given to each MIC. Any entrepreneur will be able to apply for training as long as it satisfies the selection criteria and accepts to work under the standard contract conditions that will be presented. Standard and simple registration and accounting forms are included in the Manual of Procedures. 4. Growth of children will be monitored based on weight-for-age, and plotted on the growth curve to complement what is already being done by the health structures. Salter scales will be used to measure the weight. 5. A model contract between AGETIP and the MIC has been drafted. This contract specifies that the CNC should not be used for other purposes than nutrition activities of the project, unless specifically authorized by AGETIP. The Terms of Reference of the MIC include weekly home visits to children who have been identified as children with nutrition problems (criteria for this are in the "Home Visit Guide for the CNC staff'), and periodic meetings with local steering committee.  37 ANNEX 11 Page 2 of 9 Selection of Beneficiaries 6. The following are entry and exit criteria to be applied arnong the population in the target areas: - for pregnant women: any pregnant woman who lives in the target area can enter the prograrn during the last trimester of her pregnancy until birth. Initially the program will be available to women who are pregnant for the first time. (services received: IEC, referral to health center and food). - for nursing women: a womnan can enter the prograrn if she has a malnourished child between 6 and 24 months of age (thereafter a woman cannot be considered lactating) or if she has a child less than 6 months old (services received: [EC and food). - for children: a child aged 6 to 36 months can enter the program for 6 months if it is malnourished (in the yellow or red zones); if it is a sibling 6-36 months old of a malnourished child; or if it is well nourished (in the green zone) but has not gained weight for two consecutive months. The child will exit after six months if it has achieved normal weight, or has gained weight during the last three weighings. If a child fails to gain weight between three weight monitoring sessions, he will continue the program but be referred to a health center (services received: growth monitoring, food (if malnourished), referral to health center). - siblings of malnourished children will also be admitted as long as they are 6-36 months old (services received: growth monitoring, food, referral to health center). Children will not be eligible to receive the food supplement if they are not accompanied by their care- taker who must attend the EEC session. 7. For the first year of the project, the AGETIP nutritionists will be responsible, at the end of the 6 months, to identify and advise beneficiaries who can continue in the program and those who cannot. For the years thereafter, MOCs will be identified and trained to do this work. 8., A census of the target population in selected locations will be undertaken (i) to validate the data base used for targeting, and (ii) to screen under-three year old children for malnutrition, using age, weight and height indicators. Malnourished children will receive the food supplement, and will be monitored by the MOC's if they fail to continue the program. The census will be undertaken by a private company which will be requested to use the CNC members as surveyors for the census. A technical consultant will be asked to do the quality control of this census, so as to ensure that the data can be used for evaluation purposes. Data on each family of the target area will be computerized and families "at risk" of malnutrition will be identified. Malnourished children who do not come to the CNC will receive home visits from the CNC staff to enourage the mother to participate in the nutrition program. Each child who is identified by the census group as a malnourished child or who is less dtan three years and belongs to a fiunily with a malnourished child will receive a "program card" valid for 6 months. Each time the child goes to the CNC, this card will be stamped with the date and the name of CNC.  38 ANNEX n Page 3 of 9 Link with the Health System 9. An agreement between the MOH and AGETIP has been signed which spells out the role of each institution. This Agreement states that at least once a month medical personnel will visit the CNCs to carry out the following activities: discuss any problems, especially concerning referrals to health facilities (referral will mainly be for sick or severely mnalnourished children and women for family planning services); coordinate the choice of IEC messages; social mobilization for health events that will occur in the community. 10. The MOH/AGETIP agreement also defines how the local Health Comminttee will ensure that a minimum drug package will be made available to the target group through the CNC, following the MOH cost-recovery system and standard treatment. The drugs concerned are part of the national essential drug list, namely: vitamin A, iron and folate, deworming drug, and chloroquine. *At the local level, the Health Committee will be involved in distributing certain drugs to the beneficiaries through the CNC. In addition, the CNC will systematically refer beneficiaries to the nearest health infrastructure. The health personnel from the closest health infrastructure will visit the CNC at least once a month. The local steering committee will have a sunmmary of the Agreement between AGETIP and the MOH in order to understand the role of each organization. *At the district level: the District-Medical Officer is part of the District Steering Committee. At the national level: the MOH is part of the National Commission. The SANAS will be constantly informed of the nutrition program progress and will receive a copy of data base. Supervisory NGO (MOC) 11. An NGO (MOC) will be selected according to criteria spelled out in the Manual of Procedures and will supervise about 10 CNCs. A training program has been developed for these MOCs and a Supervision Guide as well as a Home Visit Guide will be developed before project effectiveness. The MOC will undertake a weekly supervision of each CNC. A contract between AGETIP and the MOC has been designed along with specific terms of reference. The MOC will receive the same training as the MICs, plus additional training on supervision. Home visits will be undertaken weekly by the MOC to at least two households selected at random among the families whose names appear in the beneficiary file to check if they received the services, and to at least two households who have abandoned the program to find out the causes of cessation. Periodic meetings of all NGOs with AGETIP will be organized. Training in Nutrition 12. Each MOC and CNC staff will receive the sarne training, provided by training consultants. This will ensure that each of the four CNC staff can serve as back-up, ifnecessary. The MOH will be involved in the quality control of training. 13. The training modules which have been developed during the pilot phase will be revised and for project implementation the following modules will be printed:  39 ANNEX II Page 4 of 9 General presentation of the project: with project objectives, target population, the different actors and their contracts; * Techniques for welcoming the population; * Nutrition: basic nutrition, breastfeeding promotion, weaning practices and frequency of feeding, prevention and treatment of diarrhea, growth monitoring and promotion (using weight for age and how to use the growth chart); food demonstration in the CNC, referral of children to the health system and how to coordinate with the health system; * Inter-personal communication techniques: social mobilization and nutrition education; * The management information system: monitoring and supervision of a CNC data collection and analysis; techniques for; supervision by the MOC; home visits by MIC and MOC; the computer system used; feedback to the mother and to the community; * Stock management: general concepts; quality control; record keeping; safety. Training will be practical and will include role plays. Yearly refresher course will be provided to both MIC and MOC. Food Supplement 14. The food will: (i) serve as a supplement to malnourished infants aged 6-36 months and their siblings 6-36 months old and to pregnant and lactating women selected from the poorest neighborhoods; (ii) act as income transfer to the households enabling them to improve their food security during critical periods; (iii) induce those in need of assistance to attend the CNCs; and (iv) demonstrate to the recipients that use of nutritional supplements will accelerate recovery from malnutrition and thereby reinforce the nutrition education component (an activity which will attempt to alter the behavior of mothers in term of weaning food preparation and child feeding). 15. AGETIP will execute the project under the established procedures of delegated authority involving NGOs, women groups, economic interest groups, youth associations, etc. The implementation will be guided by a Manual of Procedures which will cover all the necessary topics including the contractual arrangements between AGETIP and the MOH. 16. WFP will provide a dry-blended food which will be produced locally based on local cereals, cowpeas, and groundnuts. The mix will be fortified with imported vitamins and minerals to contribute to the alleviation of some of the existing micronutrient and food deficiencies and sweetened with sugar in order to increase self-targeting (so that the blended food cannot be used as a family food but only as a porridge). Each beneficiary attending the centers will receive 700 granis of supplementary food per week during six months. Requirements for Supplementary Food 17. The international food and nutrition community has considered the basic requirements for foods for older infants (6-12 months) and young children (1-3 years) and through exensive deliberation arrived at guidelines regarding raw mnaterials, processing, formulation, hygiene,  40 ANNEX 11 Page 5 of 9 packaging and labeling. While the guidelines generated by various groups have differed somewhat, and all the guidelines provide flexibility to account for variations in local conditions and local regulations, these intemational guidelines provide a basis for identification of a suitable supplement for use in the nutrition program. 18. The guidelines offered by the Codex Alimentarius Commission in 1991 and those suggested by WFP/UNICEF product specifications for locally manufactured fortified blended foods were used to select ingredients, develop a formula, and suggest a manufacturing process for the product which will be used in the program. In addition, it was concluded that a single product should be used in the program which will be suitable for use as a food supplement by all beneficiaries (in&nts, children, and pregnant and lactating women). 19. The food should be based on locally available ingredients to the maximum extent possible and should utilize millet as the cereal base for the product and cowpeas/groundnuts as the principal sources of supplementary protein and energy. 20. The groundnuts and cowpeas will be roasted to reduce the amount of antinutritional fctors (trypsin inhibitors and other heat sensitive factors normal present in legumes). Roasting equipment suitable for treating groundnuts and cowpeas are available in Senegal and WFP consultants have identified conditions suitable for operating these roasters to treat the products. 21. The cereal component (millet) will not need to be precooked. Precooking for cereals is generally undertaken when it is necessary to increase the caloric density of porridge (by disrupting the starch so that less water is needed to prepare the food) or reduce the time necessary to cook the product. However precooking can be expensive in terms of capital costs (e.g., up to USS 1.0 million for an extrusion cooking system to produce 2000/3000 tons per year). Operating costs are also expensive (USS50-100 per ton). Furthermore, precooking changes the textural characteristics of the prepared food to some extent and therefore could result in diminished acceptability among persons accustomed to consuming products made from unprecooked flours, such as those in the project. Based on these factors, particularly the high capital costs and the lack of need for improved caloric density and shortened cooking time, it was recommended not to precook the cereal. 22. Because vitamin and mineral deficiencies are expected to be prevalent among the beneficiaries, available research and studies suggest that imported vitamins and minerals be used in the product to provide about 2/3 of the recommended daily allowance. 23. The supplement should be suitable for consumption by infants and children during two (2) supplementary feedings when prepared with a traditional recipe used for that age group, specifically a porridge. 24. The food should be suitable for manufacture at low cost by existing Senegalese food processors with little or no additional investment. Preferably, the product should also be suitable for manufacture by small enterprises at the local level, should be processed, packaged and distributed in such a way as to minimize insect infestation and avoid hardous contaminants including pathogenic microorganisms such as E. coli and toxic substances such as aflatoxin.  41 ANNEX I Page 6 of 9 Ingredients and Formulation of the Supplement 25. Based on the general requirements outlined above, in September 1994 a WFP nutrition consultant selected a set of ingredients, a formulation and a manufacturing procedure which provided a basis for producing a food supplement suitable for use in the project. The ingredients and formulation were: Ingredient Proportion (%) Pearled millet flour 55.0 Roasted, dehuUed cowpeas 23.6 Roasted, deskinned peanuts 11.0 Sugar 10.0 Vitamins (A, C, B 1, B2, B 12, 0.1 Niacin, Folic acid) Minerals (calcium, zinc, iron) 0.3 100.0 26. The millet, cowpeas and groundnuts are all produced in Senegal and in amounts sufficient to supply blended food for the nutrition prograrn. Sugar is also produced in the country but costs substantially more than imported sugar. Consequently, WFP will import the sugar. Likewise, if the prices of millet and cowpeas reach unaffordable limits, WFP will import them from neighboring countries thus also promoting triangular transactions. The vitamin and mineral pre-mix is not produced locally and will be imported. 27. The blended food will provide the following amounts of protein, fat, fiber and energy per 100 grams: Property Amount As is (7% moisture) Dra basis (0%) Protein (g.) 15.0 16.2 Fat (g.) 7.5 8.2 Fiber (g.) 1.9 2.1 Energy (kcal.) 370.0 401.0 28. Based on linited tests, the caloric density of porridge made from the product is in the range of 80-90 kcal per 100 ml of cooked food. While this caloric density is somewhat lower than the 100 kcal value recomunended in the guidelines, it is deemed sufficient. The caloric density can be raised by increasing the proportion of groundnut or sugar or by decreasing the amnount of millet. However, these changes would either increase cost, lead to excessive fat level or increase the need for inports. Based on the above facts, it has been decided that the benefits do not merit the negative consequences.  42 ANNEX II Page 7 of 9 29. The 100 gram per day ration will then provide each beneficiary 15 grams of protein and 370 kcal. per day through two supplementary feedings of about 220 ml each (7.7 ounces). This supplement will provide 25-40 percent of the recommended daily allowance of energy and 65-75 percent of the allowance of proteins for older infants and young children. These levels are deemed appropriate for malnourished children selected as beneficiaries of the project. 30. With respect to processing, it has been decided that the groundnuts and cowpeas should be roasted to inactivate the antinutritional factors and it was also recommended that the groundnuts be selected and processed to avoid contamination with aflatoxin (product of mold growth that is carcinogenic and which has an upper limit of 10 parts per billion in groundnuts in Senegal). 31. Tests undertaken with a local groundnut processor demonstrated that hand sorted and de-skinned groundnuts should contain less than 3 ppb of aflatoxin. Therefore, the contribution of aflatoxin to the product by the groundnuts should be less than I ppb. 32. The amount of product required for distribution in the CNCs varies throughout the course of the project depending on the number of beneficiaries being served. A total of 350,000 beneficiaries will be served during the project, thus the total requirement for food during the four year project life is estimated at 6,370 tons. Likewise, because the maximum number of beneficiaries is 110,000 during the fourth year, the maximum annual requirement for food supplement is 2002 tons and this will occur during the last year of the project's life. Consequently, the maximun manufacturing capacity needed is 2002 tons per year or about 167 tons per month. Manufacturing Procedure for the Food Supplement 33. A sirnple, inexpensive process for manufacturing the food supplement will be used during which the dry ingredients listed above will be mixed, ground to a powder with a particle size less than one millimeter, then re-mixed with the vitamins and minerals, and finally packaged in 40 kg. bags for distribution to the CNCs. 34. A group of Senegalese food processors have been identified who collectively have the capacity to manufacture the product. Agrifa SA of Fatick was found to be a potential supplier of low-aflatoxin roasted groundnut and roasted, dehulled cow peas, while Moulins Sentenac/Dakar could supply the pearl millet, the final mix, and bag the product. 35. Sentenac reported to WFP that it believes it can provide the amount of product required for the pilot phase of the project (24 tons per month), but will require additional equipment to increase the capacity to manufacture at the maximum rate required during project implementation (167 tons per month). However, Sentenac apparently requires a definite, long-term commitment for procurement of product from the project before it will invest in changes in its processing system. 36. The cost of the blended food is expected to be within the normal range of this type of food produced in other countries and within the availability of WFP fiuds that could be committed for this purpose.  43 ANNEX 11 Page 8 of 9 37. In sununary, the basic process recommended should be suitable for the manufacturing of the product and local manufacturers should be capable of resolving their technical problems when they are assured that they will be productive participants in the project. Procurement of the Food Supplement 38. WFP will procure the required amounts of product for the project from local manufacturers. Several local food processors have participated in manufacturing the food supplement during the pilot phase of the project and it is expected that they will maintain interest as production increases to a total of 6,370 metric tons over the life of the project. However, of the participating processors no single one is currently capable of undertaking all of the processing steps. Furthermore, no manufacturer outside the present group has as yet been identified as potential participant in manufacture. Accordingly, the present small number of processors represents a potential risk in the supply of product for the project. 39. WFP intends to take several steps to minimize this risk during procurement. First WFP wili use a competitive bidding process for procurement to attempt to stimnulate interest by other manufacturers. Call for bids will include requests not only for the complete product but also for individual components. Second, WFP will identify one or more alternative formulations for the product which will enable it to substitute ingredients which might not be available at competitive prices in a given season (e.g. it might be possible to replace groundnuts with a combination of groundnut oil and millet). And thirdly, WFP will reserve a portion (up to 25%) of the amount of product required for procurement from small producers or micro-entrepreneurs who might initially be partially mobilized as an alternative source of supply but be completely mobilized to supply the full requirements, if the principal suppliers fail. These options will be explored and developed with a view not only to reduce current procurement risks but also to lay the basis for potential future smaWmicro-enterprise production for ensuring project sustainability. 40. WFP in collaboration with AGETIP and ITA will develop product and production standards, procurment terms and issue requests for bids for the product to be delivered after the pilot phase is completed. Packaging and Distribution of the Food Supplement 41. The blended food will be packed and transported by WFP to CSA stores and, as needed, distributed in small quantities to CNCs where stocks will be maintained in secure store rooms. Each recipient will receive a 700 gr. ration of blended food weeldy. Distribution will be carried out by CNC personnel using measuring cups designed to deliver 700 gr. of product. 42. Each recipient or recipient group (eligible family members) will be issued a 2 or 5 liter plastic canister with a tight fitting lid in which to store the blended food. The 2-liter container will be used for one ration and the 5-liter one for two or more rations. Separate canisters for women and children will be identified by color and printed logos as having been issued by the project, and will also bear printed messages to help mothers use the product effectively. The canisters will be given to  44 ANNEX II Page 9 of 9 the mothers the first day of distribution and are durable enough to be used continuously throughout their participation in the project to receive the weekly food rations. 43. If the canisters are lost or destroyed, the beneficiaries are expected to buy replacements from the center at cost. The use of this type of containers is expected to reduce packaging costs substantially, as compared with delivery of the product in 700 gr. plastic bags. Furthermore, the canisters should provide an effective barrier against insect infestation and against moisture and spillage. Quality Assurance for the Food Supplement 44. A specific plan of action for quality assurance of the food supplement will be required to guarantee the manufacture and distribution of the supplement according to the specifications outlined above. To meet this need, a Hazard Analysis Critical Control Point (HACCP) system according to Codex Alimentarius guidelines has been developed by ITA. This system will then be incorporated by WFP into the procurement specifications and production operations. NUMBER OF BENEFICIARIES AND TONS PER YEAR TIME CHILDREN MOTHERS TOTAL RATnONS ' METONS YEAR I 31,000 19,000 50,000 1,300,000 910 YEAR 2 59,000 31,000 90,000 2,340,000 1,638 YEAR 3 67,000 33,000 100,000 2,600,000 1,320 YEAR 4 73,S00 37,000 110,000 2,860,000 2,002 TOTAL 230,800 120,000 350.000 9,1000 ,70  45 ANNEX III Page I of 3 TARCETING 1. The project has incorporated the recommendations of the Bank's Assessment of Living Conditions (World Bank, 1994) on improving the targeting of the poor, namely (i) taking a census of the beneficiaries in the target neighborhoods by the community-based groups under the supervision of a survey specialist; (ii) using beneficiary assessments to monitor the impact of the project, so that appropriate adjustments can be introduced in a timely fashion; (iii) intervening in the poorest areas which often do not benefit from public services; and (iv) increasing the involvement of local conmuunity groups and NGOs to carry out and supervise activities. The project will adopt the principles of AGETIP in contracting out all activities to community-based groups. 2. The project has adopted four types of targeting and food-eligibility criteria: site selection/geographic targets; (peri-urban poverty districts); demographics (pregnant and nursing women, children aged 6-36 months); nutritional status of children (malnourished, no weight gain, "at risk" children/siblings of malnourished children); and food characteristics (choice of a "self-targeting" food generally unappealing to adult males because of traditional food habits). As to demographic and nutritional targeting of the nutrition program, see Annex II for details on entry and exit criteria. ln terms of geographic targeting, the nutrition and water programs will intervene in the poorest neighborhoods of urban centers. This targeting will be based on the results of the 1992 household budget survey (ESP), which defined poor households as those whose average per capita monthly expenditure level was below the cost of a food basket equivalent to 2400 calories per day. Based on this definition, 33% of the Senegalese population are poor, of which roughly one-fourth are in the urban areas (nearly 550,000). Given the recent iznpact of the parity change, the high vulnerability of most urban households to poverty, and the growing urban population, however, it is most likely that these figures are now low - a hypothesis which appears to be supported by pilot-phase findings concerning the prevalence of child malnutrition. The ESP breaks down the population into 8000 "census districts", thus permitting a detailed poverty profile of all neighborhoods. In this project, the targeting of the poorest urban neighborhoods will be generally based on the following criteria: the poverty level (at least 20% of the population is poor) and the population density (the population totals at least 2000 persons if at least 10% of the population is poor), but will vary slightly by region. For demographic targeting, a census will be conducted within the targeted neighborhoods before the opening of the CNC in order to arrive at a list of potential beneficiaries (Table 1). 3. For the first year of the project, the criteria for the selection of the zones are the poverty level and the presence of an AGETIP office. Accordingly, three regions have been targeted - - Dakar, Kaolack and Ziguinchor (Attachmnent A). More specifically, the following urban areas will be covered: Pikine and Guediawaye in the region of Dakar, Kaolack and Diourbel in the region of Kaolack, aznd the city of Ziguinchor in the region of Ziguinchor. The criteria for selecting the neighborhoods of Pikine and Gu6diawaye are: a poverty level of at least 25% and a total targeted population of at least 2000 persons. For the less populated region of Kaolack, the criteria are: a poverty level of 18% and a total targeted population of at least 1500 persons. For Ziguinchor which recorded high levels of poverty, the criteria are a poverty level of at least 30% and a total targeted population of minimum 1500 persons. In order to respect the number of beneficiaries estimated for the first year, certain neighborhoods of the region of Dakar with a poverty level of 25% will benefit from the project as of the second year. On the other hand, one neighborhood of Diourbel with a poverty level of less than 15% will be retained in the first year so as to continue the program begun under the pilot phase. It should be noted that the water prograrn will intervene in these neighborhoods  46 ANNEX m Page 2 of 3 over the first year of the project. The selection of targeted areas for the second, third and fourth year of the project will be determined annually since project activities will be phased in gradually. Based on these criteria, it is estimnated that the targeted population in the 21 selected neighborhoods will total 50,000 persons in the first year, who will be eligible for supplemental feeding growth monitoring and IEC activities. It is assumed that the centers will also offer monthly growth monitoring for children that are not malnourished and EEC activities for their mothers, estimated at 17,000 persons (based on the capacity of the CNCs to handle extra IEC activities). Over the life of the project, the number of beneficiaries receiving weekly services (food supplement, growth monitoring, and [EC activities) is 350,000 persons and an additional 119,000 persons will receive growth monitoring and IEC activities on a monthly basis, totalling 469,000 beneficiaries, and nearly 400 CNCs will operate (Table 1). Table 1: Nutrition Progrm - Beneflciaries and Centen by Year Beneficiaries Year I Year 2 Year 3 Year 4 Total Receive Food SuDO. & Services/wk Children 31 000 59 000 67 000 73 000 230 000 Nursing mothers and First Pregnancy Women 19 000 31 000 33 000 37 000 120 000 Sub-total so0000 90 000 100 000 110 000 350 000 Receive Monthly Services Onld Children - 8 500 15 300 17 000 18 700 59 500 Mothers 8 500 15 300 17 000 18 700 59 500 TOTAL BENEFICIARES 67 000 120 600 134 000 147 400 469 000 Number of new centers 72 107 104 114 397 Number of old centers 72 179 283 Total number of opened centers 72 179 283 397 Aimmptiom: . The urban population covered by the project is expected to rie by 4% per year, refleding Sealas urban pSth rate. . The pilot phae indicated an infant maluition rate of 30% in the rgted popultioL 15% of the total project popultion is bdweu 0-3 yean of ae and another 15% ae prpant women (each woman estimated to have 6 children) Women eligible only becaa of their pregancy Aabi will receive thee mont of ration (one4half the nomal period) 20% of the childrin who aer the propam will require an additional six month of food sppleme. . Not all malnourished chiddrena in the progam are seae either because some ar over 24 months ad unlikely to be breaded, or because a mother dao not to breaueed. . Moben wi chdilden und 6 moa of ag will receive the food suppleme. if tbey ae breafeeding . Sice the avage bth pingis 22.4 month in uwea, it isimated tt tere will bea sibling foreac malnourideild. 4. The project aims at increasing its coverage of malnourished children in urban areas from 16% in Year I to 58% in Year 4. According to the 1992 EPS, malnutrition among urban children was 22.4% (stunting)-and 16.9% (wasting); the corresponding values for rural areas were 33.6% and 24.8%. The pilot-phase results, based on the arn-circumference indicator and the weight-for-height indicator put moderate to severe malnutrition at 30-31