Mozambique - HIV/AIDS response Project

ISDS THE WORLD BANK GROUP AWorld Frec of Poverty 4 fQS hop sThc ViW "iL Integrated Safeguards Data Sheet (Initial) Date ISDS Prepared/Updated: 08/28/2002 24763 Section I-Basic Informnation August 28, 2002 A. Basic Project Data Country: MOZAMBIQUE Project iD: P078053 Project: HNV/AIDS Response Project Task Team Leader: James H. Coates Authorized to Appraise Date: September 5, 2002 IBRD Amount ($m): Bank Approval: December 10, 2002 IDA Amount ($m): 55.00 Managing Unit: AFTR1 Sector: Health (100%) Lending Instrument: Specific Investment Loan (SIL) Theme: Other human development (P) Status: Lending I.A.2. Project Objectives: The project will assist the Government of Mozambique to finance the implementation of its National Strategic Plan to Combat STD and HIV/AIDS. The strategy is designed to slow the spread of Ifv/AIDS infection and mitigate the effects of the epidemic, through prevention, support and care activities. The national plan is multisectoral in nature, bringing together the efforts of Government, civil society and communities in a national campaign to slow the rate of infection and provide care for those who suffer from the disease, and for those who depend on them. The effort is led by a National Council to Combat AIDS, chaired by the Prime Minister, which includes key Ministers and leaders in civil society in its membership. The strategy is funded from the National Budget and various local and international contributois, including the United Nations agencies and potentially the Global Fund to Fight AIDS, Tuberculosis and Malaria. The design of the Mozambique strategy is well suited for support by the Bank under its Multicountry HIV/AIDS Program for the Africa Region (MAP II), as it matches all of the criteria for inclusion (see Section D4). The Bank's MAP n for US $ 500 million was approved at the Board on February 7, 2002 (Doc No. IDA/R2002-4). The project will (i) improve institutional capacity for planning, delivery and monitoring of H-V/AIDS response interventions through all levels of Government and its line ministries, civil society and the private sector; (ii) strengthen the a national network of health centers to provide testing, counselling, treatment of opportunistic infections and care related to HWV/AlDS; (iii) enable Government at the national level and regions, as well as through its line ministries, to carry out programs advocating prevention and providing care for its own staff and communities; and (iv) fund a variety of projects led by civil society and carried out in urban and rural communities, which cover HIV/AIDS related prevention, advocacy, public awareness creation and care for orphans and PLWHA. I.A.3. Project Description: The objective of the project is to slow the spread of HIV infection in Mozambique, and mitigate the  2 ISDS effects of AIDS, through prevention and care activities. The project is expected (at this early stage in the design process) to have five components as described briefly below. (i) Civil Society Initiatives (- US$ 23 million) -- The battle against the HIV virus is waged ultimately in the community, and with each individual. This component would empower communities to respond effectively to the HIV/AIDS epidemic. A Civil Society Facility would be created to finance appropriate HIV/AIDS related activities carried out by community based organizations, NGOs, the private sector, associations and other organizations. The management of the facility would be decentralized to the provincial level, in support of a provincial program to combat HIV/AIDS. Criteria and procedures for project preparation and approval would be specified in the Operational Manual, and would cover: (i) inclusion of HTV/AIDS related prevention and care activities; (ii) participatory preparation; (iii) responsiveness to target community needs and development of target community AIDS competence; (iv) implementation sponsored by organization capable of accounting.for fund use and monitoring for satisfactory implementation. Preparation of proposals would be decentralized and participatory. Intermediary organizations, many of them NGOs, would have their capacity strengthened to enable them to foster program identification at the community level, and the preparation of project proposals to be funded by the Civil Society Facility. It is expected that these community, private sector and NGO projects will support independent civil society efforts to increase awareness (the movement of local Mozambican Artists Against HIV/A1DS is one such action), seeking support from traditional healers in the campaign, and ensuring that the community based approach is fostered across the country, contravening the current deficit of attention and awareness in rural areas. (ii) Capacity Building for the Civil Society HIV/AIDS Response (- US$ 6 million) -- this would include (i) training of 'facilitating institutions' in community mobilization and capacity creation for local organizations, as well as (ii) awareness development and capacity building for leadership in the public sector, civil society and the private sector, (iii) and the formulation of training modules in HIV/AIDS awareness for use in public and private sector enterprises. Specialized packages of Information, Education and Communications (IEC) materials would be developed and distributed through this effort. (iii) Government Multisector Response (- US$ 7 million) -- this component would support the activities developed by line ministries to (i) put in place HIV/AIDS response plans for Ministry staff, targeting vulnerable groups (such as soldiers, police, extension workers, teachers) and putting in place mechanisms for awareness creation, protection, mitigation and care and (ii) design ways of mainstreaming HTV/AIDS response concepts into the services the Ministry delivers to its clients. The Government is a the largest single institution in the country, with a series of broad networks which cover the country. The Ministries of Education, Health, Agriculture, Women and Social Action and State Administration (including Local Government) each have a network of staff and infrastructure which reaches out across Mozambique's 10 provinces and 128 districts. The objective is to mobilize the Government to reach out into the communities of its staff and clients, to in-crease national awareness of the existence, nature and measures for preventing the extension of the disease, and information and guidance on treatment and care to its own staff. The intention is also to mobilize the staff and ensure that the ministries' programs include appropriate messages from the HIV/AIDS campaign. These programs are already well underway in some institutions (such as the Ministry of Health) and will have to be fostered in Education, State Administration, Agriculture and Youth and Sports and key additional ministries. Under guidance from the National Secretariat to the CNCS, plans have been prepared by line Ministry and by each Province, for actions to be undertaken in support of the national AIDS campaign. The project would continue to develop ownership in each institution, and provide funding (within limits to be detennined) and training and guidance to enhance the development of feasible workplans and the outreach and effectiveness of the programs run through Government networks.  3 ISDS (iv) Stren2thening and Scaling Up Health Sector Services for HIV/AIDS (- US$18 million) -- this could include (i) the strengthening of the Integrated Health Network and HIV/AIDS related services; (ii) increasing the supply of HIV/AIDS related drugs and materials, such as the supply of condoms, drugs to treat opportunistic infections, anti-retrovirals for the reduction of MTCT and post exposure prophylaxis; (iii) measures to enhance bio-safety; (iv) measures to enhance blood safety; (v) improved management of HIV/AIDS related interventions for health sector workers; (vi) improved management of opportunistic infections, focussing on their prevention via prophylaxis, as well as their treatment as mentioned; (vii) monitoring of nutrition levels in HIV/AIDS patients and provision of micronutrients where appropriate, and (viii) improved management monitoring and evaluation of health sector inputs and outcomes. With the objective of increasing access to the services which are key to the success of the AIDS campaign, the project would support the strengthening of a network of 50 health centers across the country, located in order to respond to the current prevalence rates and density of vulnerable groups. These centers would be specialized in providing voluntary counselling and testing for HIV, treatment for STDs (and treatment under HAART in a limited number of pilot cases), guidance and training for individuals and associations in ARV treatment, and guidance in Home Based Care for PLWHA and their families, and orphans. A chart depicting the nature of the services to be offered by these centers is shown below. They would be established under the guidelines and with overall supervision and monitoring from the Ministry of Health. However, due to current capacity limitations in the Ministry, operations would be contracted out initially to NGOs and other partners. These contracts are costed under the Civil Society Initiatives component, as they will be administered from the Civil Society Facility.  4 ISDS rLUX OF BENEFICIARIES WITHIN AN INTEGRATED NETWORK TO COMBAT HIVAIDS INFORMATION, EDUCATION AND p. Encouraement COMMUNICATION ([EC) a Inrormn Referal * Raise awareness Normal influx * Encourage VCT Cooperaiion ~~~~~~~~~~~FLAT (TB-PROGRLAM) Cooperation __ VOLUNTARY COUNSELING AND & E (prove OD tReatment for TESTING CENTER (VCT) hospitalized TB patients , Pre-test counseling * Continue TB tmratment for BLOODTRANSFUSION UNIT * HIV-test (Determine + Uni-Gold) Day Clinic Patients * Improve pre-test counseling * Post-tcat counseling a Encourage VCT * &* Improve post-test counseling . Referral to Day Clinic * Referral to Day Clinic PRE- AND POSTNATAL CAREt MATERNITY * Reduce vertical : transrnission s t fl r , .~~~~~ Nutritional suppon LABORATORY DAY CLrNIC * HItV.Testing for * Treatment of opportunistic diseases bloodtransfusion unit (OD) INTERNAL MEDICINE/ (including confirmation test) * IIAART (in pilot scttings) PEDIATRIC WARDS * Improve diagnostic capacity * Coordination I intcgration of * Improve OD treatment DayClinic network _ o Encourage VCT * CD4 count (Pilot settings) n E STI I HV CONSULTATIONS * Improve STI treatnent HOME BASED CARE * Include treatment of minor * Palliative care (medical-nutritional OD's support) * Encourage VCT Each center, located in an area of high vulnerability, would have a catchment of about 100,000 persons. Of these, it is estimated he VCT center would test 3,600 persons (of whom 1,200 are likely to be pregnant women). Those who tested positive for HIV would have access to the services of the clinic for treatment of opportunistic disease, and to the facilities providing guidance and counselling on care. It is estimated that the clinic would have a capacity for 1000 regular users. (v) Institutional Development for Program Management (- US$ 6 million) -- The project would target the Secretariat of the National Council, strengthening its capacity to lead the country in the campaign. Efforts would include: (i) creation of a supportive regulatory environment; (ii) strengthening organizational arrangements and financial management; (iii) strengthening monitoring and evaluation; (iv) formulation and monitoring of a communications strategy; and (v) capacity building for the Secretariat and the CNCS, designed to complement other CNCS capacity building initiatives underway or soon to start (such as the proposed UNDP HIV/AIDS Capacity Building Project). The program would help build up systems to manage the fund for community projects. This would include a decentralized capability for financial management and supervision, for review and decision  5 ISDS making on proposals. Under the project, systems would be put in place to track the activities of the various partners in the campaign, to enable lessons to be learned and shared across programs, and to avoid contradictory approaches to similar topics in the same locations. The project would also foster the intellectual capacity and methodology to assess the effectiveness and progress in different aspects of the campaign, build on what works, and identify and encourage innovation. The project would enable the Secretariat to build a commonality of purpose across the many different stakeholders in the program, with a particular emphasis on developing a sense of 'AIDS competence' amongst urban and rural communities dealing with the epidemic. Indicative Project Costs are listed below: Components: Community and Social Initiatives Capacity Building for Civil Society HIV/AIDS Response Government Multisectoral Response Strengthening and Scaling Up Health Sector HIIV/AIDS Institutional Development for Program Management l.A.4. Project Location: (Geographic location, information about the key environmental and social characteristics of the area and population likely to be affected, and proximity to any protected areas, or sites or critical natural habitats, or any other culturally or socially sensitive areas.) The project is national in scope, and would target those areas of greatest HTV prevalence. B. Clheck Environmental Classification: B (Partial Assessment) Comments: C. Safeguard Policies Triggered Policy Applicability Environmental Assessment (OP/BP/GP 4.01) * Yes 0 No 0 TBD Forestry (OP/GP 4.36) O Yes * No O TBD Natural Habitats (OP/BP 4.04) O Yes * No O TBD Safety of Dams (OP/BP 4.37) O Yes * No O TBD Pest Management (OP 4.09) O Yes * No O TBD Involuntary Resettlement (OP/BP 4.12) 0 Yes * No 0 TBD Indigenous Peoples (OD 4.20) O Yes * No O TBD Cultural Property (OP 4.1 1) O Yes * No O TBD  6 ISDS |Projects in Disputed Territories (OP/BP/GP 7.60)* | 0 Yes * No 0 TBD Projects in International Waterways (OP/BP/GP 7.50) | 0 Yes * No 0 TBD| *By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties' claims on the disputed areas Section II - Key Safeguard Issues and Their Management D. Summary of Key Safeguard Issues. Please fill in all relevant questions. If information is not available, describe steps to be taken to obtain necessary data II.D. la. Describe any safeguard issues and impacts associated with the proposed project. Identify and describe any potential large scale, significant and/or irreversible impacts. The key safeguard issue relates to the management of health care waste -- and its safe disposal. Current procedures are weak . The presence of waste which is potentially infected with the HIV virus exacerbates the health risks of mismanagement, and prompt a renewed concem with safe management and disposal procedures II.D. I b. Describe any potential cumulative impacts due to application of more than one safeguard policy or due to multiple project component. Il.D.Ic Describe any potential long term impacts due to anticipated future activities in the project area. Il.D.2. In light of 1, describe the proposed treatment of alternatives (if required) II.D.3. Describe arrangement for the borrower to address safeguard issues An Environmental Assessment (for hazardous medical waste) has been completed and an Environmental Action Plan has been formulated. Both will be released to the public, and discussed with Government. An effort will be made to contribute to the fulfillment of the Action Plan from the resources from this project, as well as from resources mobilized from other donors. II.D.4. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The preparation of the National Strategic Plan in 1999 brought in a wide variety of people and institutions from all walks of life, and all areas of the country. This has created broadbased acceptance and agreement with the approach and goals of the Plan. There have been a large number of small, somewhat disjointed initiatives, from a large number of separate institutions willing to try an approach, or to develop a message, but unable to increase to scale for lack of resources. The project follows the strategy as outlined in the plan. During the preparation of the project, the team participated in the annual National consultation and assessment of the HI1IV/AIDS campaign, and there is broad awareness of the Bank's involvement (and questioning of whether the country should borrow to finance the AIDS campaign). The Bank's resources will enable this broad based involvement to be scaled up. In the design of the project, the Government/Bank team has engaged formally with the National AIDS Council, the NGOs (both international and local), the associations of People Living With HIV/AIDS, the donors, the private sector, the media and social communication, and many of the Ministries. By following the design and priorities in the National Strategic Plan, the project can complement and  7 ISDS support the momentum which is already being created. All players are aware of the opportunity which the presence of the Bank offers, and appear willing to work with the CNCS to take advantage of it. The key piece, which is still missing and is necessary for the campaign to really take off, (and which the Bank project is unable to affect) is the presence of a dynamic and committed public figure of high stature, preferably someone who is HIV positive, to take on the Campaign, and give it the fire necessary to break down the cultural and social barriers it still faces. E. Safeguards Classif 4cation. Category is determined by the highest impact in any policy. Or on basis of cumulative impacts from multiple safeguards. Whenever an individual safeguard policy is triggered the provisions of that policy apply. ] SI. - Significant, cumulative and/or irreversible impacts; or significant technical and institutional risks in management of one or more safeguard areas [X] S2. - One or more safeguard policies-are triggered, but effects are limited in their impact and are technically and institutionally manageable S3. - No safeguard issues [ ] SF. - Financial intermediary projects, social development funds, community driven development or similar projects which require a safeguard framework or programmatic approach to address safeguard issues. F. Disclosure Requirements Environmental Assessment/Analysis/Management Plan: Expected Actual Date of receipt by the Bank 7/1/2002 7/1/2002 Date of "in-country" disclosure 9/13/2002 Date of submission to InfoShop 9/13/2002 Date of distributing the Exec. Summary of the EA to the ED (For category A projects) Resettlement Action Plan/Framework: Expected Actual Date of receipt by the Bank Not Applicable Not Applicable Date of "in-country" disclosure Date of submission to InfoShop Indigenous Peoples Development Plan/Framework: Expected Actual Date of receipt by the Bank Not Applicable Not Applicable Date of "in-country" disclosure Date of submission to InfoShop Pest Management Plan. Expected Actual Date of receipt by the Bank Not Applicable Not Applicable Date of "in-country" disclosure Date of submission to InfoShop Dam Safety Management Plan: Expected Actual Date of receipt by the Bank Not Applicable Not Applicable Date of "in-country" disclosure Date of submission to InfoShop If in-country disclosure of any of the above documents is not expected, please explain why. Si2ned and submitted by Name Date  8 ISDS Task Team Leader: James H. Coates 8/28/02 Project Safeguards Specialists 1: Serigne Omar Fye/Person/World Bank Project Safeguards Specialists 2: Project Safeguards Specialists 3: Approved by: Name Date Regional Safeguards Coordinator: Charlotte S. Bingham 8/28/02 Sector Manager/Director: Karen Brooks 8/28/02 For a list of World Bank news releases on projects and reports, click here 1 4 _ EYMWRA _WowAs lo