The World Bank Report No: ISR6535 Implementation Status & Results Brazil AIDS-SUS (National AIDS Program - National Health Service) (P113540) Public Disclosure Copy Operation Name: AIDS-SUS (National AIDS Program - National Health Project Stage: Implementation Seq.No: 4 Status: ARCHIVED Archive Date: 21-Aug-2012 Service) (P113540) Country: Brazil Approval FY: 2010 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 18-May-2010 Original Closing Date 31-Dec-2014 Planned Mid Term Review Date 26-Nov-2012 Last Archived ISR Date 30-Jan-2012 Effectiveness Date 01-Dec-2010 Revised Closing Date 31-Dec-2014 Actual Mid Term Review Date 04-Mar-2013 Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed project development objectives are the following: (i) Increase access and utilization of HIV/AIDS and Sexually-Transmitted Diseases (STD) prevention, care and treatment services by Groups Most at Risk; and, (ii) Improve the performance of the National HIV/AIDS and STD Program through decentralized implementation, improved governance and results-based management. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Improving Surveillance, Prevention and Control of HIV/AIDS and STD 192.00 Building Decentralized Governance and Innovation Capacity 7.83 Overall Ratings Public Disclosure Copy Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Low Implementation Status Overview The AIDS-SUS Project is a Specific Investment Loan (SIL) with a Sector Wide Approach (SWAp), in which disbursements are triggered by the execution of agreed programs and achievement of specific results targets (Disbursement-Linked Indicators - DLI). The 3rd supervision mission (SPM) was held from March 26 - 30, 2012, and the Bank's main counterparts were officials from the Department of Surveillance, Prevention and Control of STD and AIDS, and Viral Hepatitis (DST/AIDS) at the Ministry of Health (MoH). During the mission, all Project monitoring indicators were updated; the teams discussed three out of four studies on allocative, technical and economic efficiency of the Brazil's National HIV/ Page 1 of 7 The World Bank Report No: ISR6535 AIDS Response (with the participation of the representative of the Public Health Institute of Mexico ­ INSP/Mexico); and discussed activities and studies to be conducted under the governance and innovation capacity component (Component 2). Fiduciary issues were also addressed. Since the last SPM, the Borrower has complied, totally or partially, with the commitments agreed with the World Bank. Public Disclosure Copy In terms of results, the Project is progressing towards the PDO as measured by eight out of 11 PDO indicators. In fact, as of December 2011, the 2012 target (42%) and 2013 target (49%) for the indicator on People Living with HIV/AIDS (PLHA) accessing condoms (indicator #4) had already been surpassed at 50.6%. On the other hand, some challenges persist, especially regarding the achievement of indicators that do not depend upon the MoH, but on the states and municipalities. The three PDO indicators that did not achieve their targets for December 2011 were: (i) prisoners accessing condoms (indicator #5); (ii) State Secretariats of Health (SES) reaching at least 70% of Results-based Action Plans (PAM) targets (indicator #6); and (iii) Municipal Secretariats of Health (SMS) reaching at least 70% of PAM targets (indicator #7). From an operational point of view, important challenges in 2011 were resolved, and DST/AIDS was able to (i) present three disbursement requests (1 advance and 2 reimbursements) totaling US$8.5 million; (ii) hire the independent verification agency (IVA), which completed the technical audit of indicators in April 2012; (iii) have the Interim Financial Reports (IFR) vetted by the World Bank and generated through the system; (iv) agree on a revised terms of reference (TOR) for the Project audit, including procurement; and (v) submit a revised procurement plan vetted by the Program Director. The total disbursed amount as of July 3, 2012 was US$8.7 million (13% of loan proceeds). A safeguards mission was held on May 31 and June 1, 2012 to verify compliance with safeguards policy OP/BP 4.10 (Indigenous Peoples), and Project performance has been considered satisfactory. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target National HIV/AIDS Strategic Plan 2014-2019 Text Value Strategic Agenda (2011-2015) Available on the web. based on project-generated evidence available with indicators and targets on the web (DLI #11) prepared Date 31-Dec-2010 31-Dec-2011 31-Dec-2014 Comments Not applicable Aligned with MOH's instruments. Civil Society Organizations (CSO) with results- Percentage Value 2.50 63.50 85.00 based contracts (DLI #10) Public Disclosure Copy Date 31-Dec-2008 31-Dec-2011 31-Dec-2014 Comments Numerator: Total number of SIMOP. 75 out of 118 CSO projects funded by the subprojects. DST/AIDS with disbursements linked to the achievement of results. Denominator: Total number of CSO projects funded by the DST/AIDS. Page 2 of 7 The World Bank Report No: ISR6535 Increase in SMS with information on STD and Percentage Value 15.00 69.23 20.10 HIV/AIDS in institutional sites - epidemiological Date 31-Dec-2010 31-Dec-2011 31-Dec-2014 and financial (DLI #9) Comments Financial information is >20%. Public Disclosure Copy available at the national program website, complying with the objective of transparency. Increase in SES with information on STD and Percentage Value 19.00 92.59 20.10 HIV/AIDS in institutional sites- epidemiological Date 31-Dec-2010 31-Dec-2011 31-Dec-2014 and financial (DLI #8) Comments Financial information is >20%. available at the national program website, complying with the objective of transparency. 26 Municipal (Capital City) Secretariats of Percentage Value 39.00 42.00 66.00 Health (SMS) reaching at least 70% of PAM Date 31-Dec-2008 31-Dec-2011 31-Dec-2014 targets (DLI #7) Comments SIS 27 State Secretariats of Health (SES) reaching Percentage Value 50.00 37.00 85.00 at least 70% of Results-based Action Plans Date 31-Dec-2008 31-Dec-2011 31-Dec-2014 (PAM) targets (DLI #6) Comments SIS Prisoners accessing condoms (DLI #5) Percentage Value 50.50 45.10 70.00 Date 31-Dec-2008 31-Dec-2011 31-Dec-2014 Comments The method of calculation of Plan of needs of prevention the indicator was revised and inputs the baseline changed from 58% to 50.50%. The Department would like to revise the targets for this indicator. People Living with HIV/AIDS (PLHA) accessing Percentage Value 37.00 50.60 49.00 Public Disclosure Copy condoms (DLI #4) Date 31-Dec-2007 31-Dec-2011 31-Dec-2014 Comments The method of calculation of Plan of needs of prevention the indicator has been revised inputs and the baseline changed from 35% to 37%. Increase of Drug Users (DU) who report the Percentage Value 40.70 40.70 46.80 use of a condom at last sexual intercourse (DLI Date 31-Dec-2010 31-Dec-2011 31-Dec-2013 #3) Comments RDS-DU 2010 +15%. Value to be defined Next RDS in 2013 once the baseline is available. Page 3 of 7 The World Bank Report No: ISR6535 Increase of sex workers (SW) reporting the use Percentage Value 90.10 90.10 99.10 of a condom with their most recent client (DLI Date 31-Dec-2008 31-Dec-2011 31-Dec-2013 #2). Comments RDS-SW 2010 +10%. Public Disclosure Copy Next RDS in 2013 Increase of Men who Have Sex with Men Percentage Value 63.00 63.00 72.50 (MSM) reporting the use of a condom the last Date 31-Dec-2010 31-Dec-2011 31-Dec-2013 time they had sex in the last year (DLI #1) Comments RDS-MSM 2010 +15%. Next RDS in 2013 At least 70% execution of project Eligible Percentage Value 89.60 70.00 Expenditure Programs (EEPs) - DLI (Global Date 31-Dec-2008 21-Oct-2011 31-Dec-2013 Indicator) Comments Not applicable Budget allocation to EEPs was updated to reflect LOA 2011. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increase in DSEI with Plan STD and HIV/AIDS Number Value 26.00 30.00 34.00 implemented Date 31-Dec-2009 31-Dec-2011 31-Dec-2014 Comments Impact evaluation carried out Text Value 3 designed To be discussed 3 carried out Date 31-Dec-2009 31-Dec-2011 31-Dec-2014 Comments The team proposes to interpret this obligation broadly, and consider this will be complied through the studies supported by HNPVP SES qualified for performance award Percentage Value 0.00 0.00 50.00 Date 31-Dec-2010 31-Dec-2011 31-Dec-2014 Public Disclosure Copy Comments Mechanisms for performance award not developed yet - under discussion with the National Health Fund (FNS). SMS Capital city executing at least 70% of Percentage Value 54.00 53.80 76.00 Incentive Policy resources transferred each Date 31-Dec-2008 31-Dec-2011 31-Dec-2014 year (DLI #20) Comments SIS SES executing at least 70% of Incentive Policy Percentage Value 59.00 48.10 83.00 resources transferred each year (DLI #19) Date 31-Dec-2008 31-Dec-2011 31-Dec-2014 Page 4 of 7 The World Bank Report No: ISR6535 Comments SIS. States have been facing difficulties to transfer funds to CSO, accumulating resources in their accounts. Public Disclosure Copy MSM accessing services which provide Percentage Value 25.80 30.10 49.00 condoms (DLI #18) Date 31-Dec-2008 31-Dec-2011 31-Dec-2014 Comments The method of calculation of Plan of needs of prevention the indicator was revised and inputs the baseline data was changed from 35% in 2008 to 25.80% in 2009. DU reporting having been tested for HIV in the Percentage Value 44.40 14.70 51.00 last 12 months (DLI #17) Date 31-Dec-2010 31-Dec-2011 31-Dec-2013 Comments RDS-DU 2010. Tested for HIV RDS-DU 2010. Tested for HIV +15%. RDS-DU 2013 will some time in their life, not in some time in their life, not in include both questions - some the last 12 months. PCAP the last 12 months. time in their life and in the last 2008 provides data for the Next RDS in 2013 12 months. last 12 months - 16.7% Baseline was revised and changedfrom 44.40% to 14.70%. SW reporting having been tested for HIV in the Percentage Value 30.40 19.80 35.00 last 12 months (DLI #16) Date 31-Dec-2010 31-Dec-2011 31-Dec-2013 Comments RDS-SW 2010 +15% Next RDS in 2013 Baseline was revised and changed from 30.40% to 19.8% because the denominator was incorrect. MSM reporting having been tested for HIV in Percentage Value 23.50 23.50 27.00 the last 12 months (DLI #15) Date 31-Dec-2010 31-Dec-2011 31-Dec-2013 Comments RDS-MSM 2010 +15% Public Disclosure Copy Next RDS in 2013 DU reporting access to free condoms in the Percentage Value 71.40 71.40 82.10 last 12 months (DLI #14) Date 31-Dec-2010 31-Dec-2011 31-Dec-2013 Comments RDS-DU 2010 +15% Next RDS in 2013 SW reporting access to free condoms in the Percentage Value 77.20 77.20 88.80 last 12 months (DLI #13). Date 31-Dec-2010 31-Dec-2011 31-Dec-2013 Page 5 of 7 The World Bank Report No: ISR6535 Comments RDS-SW 2010 +15% Next RDS in 2013 MSM reporting access to free condoms in the Percentage Value 70.80 70.80 81.40 Public Disclosure Copy last 12 months (DLI #12) Date 31-Dec-2010 31-Dec-2011 31-Dec-2013 Comments RDS-MSM 2010 +15% Next RDS in 2013 Data on Financial Performance (as of 09-Apr-2012) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P113540 IBRD-79010 Effective 18-May-2010 05-Oct-2010 01-Dec-2010 31-Dec-2014 31-Dec-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P113540 IBRD-79010 Effective USD 67.00 67.00 0.00 8.72 58.28 13.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation - A 3rd request of disbursement (reimbursement), estimated at US$5,150 million, is expected to be submitted to the World Bank by July 30, 2012. - A revised procurement plan for 2012 was approved by the World Bank on May 3rd, 2012, and a General Procurement Notice was published on June 28, 2012. Page 6 of 7 The World Bank Report No: ISR6535 - The Bank team has requested the Borrower to prepare a technical note, accompanied by an action plan when applicable, on the indicators (i) that did not achieve the targets and/or (ii) for which the DST/AIDS would like to revise the calculation method. Restructuring History Public Disclosure Copy There has been no restructuring to date. Related Projects There are no related projects. Public Disclosure Copy Page 7 of 7