Documentof The WorldBank FOROFFICIALUSEONLY ReportNo: 29846-AFR PROJECTAPPRAISAL DOCUMENT ONA PROPOSEDGRANT n THEAMOUNT OF SDR6.90 MILLIOP (USD 10.0MILLIONEQUIVALENT) TO THE GOVERNMENTOF THE UNITED REPUBLICOF TANZANIA FORTHE AFRICANREGIONAL CAPACITY BUILDING NETWORKFORHIV/AIDS PREVENTION, TREATMENT, AND CARE AUGUST 19,2004 HumanDevelopment 1 IAfricadocument Regional Office I This has a restricteddistributionandmay beusedby recipients only inthe performance of their official duties. Its contentsmay not otherwise be disclosedwithoutWorld Bank authorization. CURRENCYEQUIVALENTS (ExchangeRateEffectiveMay 5,2004) Currency Unit = TanzanianShilling Tshs1:OO = US$O.O0898 US$l:OO = Tshs 1113.5 FISCALYEAR July 1 -- June 30 ABBREVIATIONSAND ACRONYMS AIDS Acquired Immune Deficiency Syndrome ART Antiretroviral Therapy CAS Country Assistance Strategy CBO Community-Based Organization FMA Financial Management (and Procurement) Agent FMR Financial MonitoringReport HIV HumanImmunodeficiency Virus IBRD International Bank for Reconstruction andDevelopment IDA International Development Association IEC Information, Education and Communication MAP Multi-Country HIV/AIDSProgram for Africa MODEP MinistryofDevelopment andEconomic Planning NACC National HIV/AIDSCouncil NACP National HIV/AIDSControl Program (Ministry o f Health) NAS National HIV/AIDSSecretariat NGO Non-Governmental Organization PIP Project Implementation Plan PLWHA People Livingwith HIV/AIDS STI Sexually TransmittedInfections TB Tuberculosis TOR Terms o fReference FOROFFICIAL USEONLY UNAIDS Joint UnitedNations Program onHIV/AIDS UNICEF UnitedNation's ChildrenFund VCT Voluntary Counselingand Testing WHO World Health Organization Vice President: Callisto Madavo Country Managermirector: Judy O'Connor Sector ManagerAIirector: Dzingai Mutumbuka Task Team Leader/Task Manager: Sheila Dutta This document hasa restricteddistribution and may be used by recipients only in the performance of their official duties. I t s contents may not be otherwise disclosed without World Bank authorization. AFRICA AFRICAN REGIONAL CAPACITY BUILDING NETWORK FOR HIVIAIDS PREVENTION, TREATMENT, AND CARE CONTENTS A. Project DevelopmentObjective Page 1. Project development objective 2 2. Key performance indicators 2 B. Strategic Context 1. Sector-related Country Assistance Strategy (CAS) goal supported bythe project 3 2. Main sector issues andGovernment strategy 4 3. Sector issuesto be addressedby the project andstrategic choices 6 C. Project Description Summary 1. Projectcomponents 2. Key policy andinstitutional reforms supported by the project 3. Benefits andtarget population 4. Institutionaland implementationarrangements D.ProjectRationale 1. Project alternatives considered andreasonsfor rejection 11 2. Major relatedprojects financed by the Bank andor other development agencies 12 3. Lessonslearned andreflectedinthe project design 13 4. Indicationso f recipient commitment andownership 14 5. Value added o f Bank support inthis project 14 E. Summary ProjectAnalysis 1. Economic 14 2. Financial 14 3. Technical 14 4. Institutional 15 5. Environmental 18 6. Social 19 7. Safeguard Policies 19 F. Sustainability andRisks 1. Sustainability 20 2. Critical risks 20 3. Possible controversial aspects 21 G. Main Grant Conditions 1. Effectiveness Condition 21 2. Other 22 H. Readinessfor Implementation 22 I.CompliancewithBankPolicies 22 Annexes Annex 1: Project Design Summary 23 Annex 2: Detailed Project Description 26 Annex 3: EstimatedProject Costs 27 Annex 4: Cost Benefit Analysis Summary, or Cost-Effectiveness Analysis Summary 28 Annex 5: Financial Summary for Revenue-Earning Project Entities, or Financial Summary 29 Annex 6: (A) Procurement Arrangements 30 (B)FinancialManagement andDisbursement Arrangements 36 Annex 7: Project Processing Schedule 43 Annex 8: Documents inthe Project File 45 Annex 9: Statement ofLoans and Credits 46 Annex 10: Country at a Glance 50 Annex 11: Selection and EligibilityCriteria for Training Institutions and Students 56 Annex 12: Project Supervision Strategy 61 Annex 13: MonitoringandEvaluation 64 Annex 14: Training Institutions 70 MAP(S) IBRD33082 AFRICA African Regional Capacity BuildingNetwork for HIV/AIDSPrevention, Treatment, and Care Project AppraisalDocument Africa RegionalOfice AFTH1 Date: August 19,2004 Team Leader: Sheila Dutta Sector ManagerElirector: Dzingai Mutumbuka Sector(s): Health(100%) Country ManagerElirector: Judy M.O'Connor Theme(s): HIV/AIDS(P) Project ID: PO80406 Lending Instrument: Specific InvestmentLoan (SIL) For LoanslCreditslOthers: IFinancingPlan Amount (US$m): 10.0 (UStm): Source Local Foreign Total 0WEWRECIPIENT Address: P.O. Box 3021, Dar es Salaam, Tanzania ContactPerson: ARCAN Project Coordinator A. Project DevelopmentObjective 2. Project development objective: (see Annex 1) The development objective o f the ARCAN project i s to expand access to comprehensive and evidence-based HIV/AIDSprevention, care and treatment programs by supporting a network o f subregional "learning sites" to expand training o f health care practitioners. The project will support HIV/AIDS-related health sector human resource capacity building in Kenya, Ethiopia, and Tanzania using a "training-of-trainers" (TOT) model. It i s expected that, as a result o f increased capacity among health care practitioners inthe subregion, this project will contribute to the enhanced delivery o f HIV/AIDS-related services, stronger linkages between prevention and care interventions, and expanded South-South partnerships. 3. Key performance indicators: (see Annex 1) The envisioned long-term impact of this project would involve both country-specific and subregional improvements in the quality of HIV/AIDS-related service delivery and consequently reductions inAIDS-related morbidity and mortality. However, given that such impact measures would neither be quantifiable (nor attributable) during the four-year implementation period, impact indicators will not be included among the key performance indicators for the ARCAN project. Instead, the major focus will be on monitoring a core set o f outcome, output andprocess indicators. The proposed key performance indicators are noted below and expanded in Annex 1. Further delineation o f these indicators, inaddition to ARCAN's overall monitoring and evaluation (M&E) framework, are presentedinthe project's M&EManual (summarized inAdditional Annex 13). Outcomeindicators: The major outcome indicatorsfor thisproject willfocus on identijjing specijic individual-level factors enabling more effective health sector human capacity development in the context of HIUAIDS. Theseindicators will be measured annually. Increase inthe percenthumber o f successfulARCAN "graduates" (Le. those who conduct at least the minimumrequired levelo fcascade training inthe first six months after their preliminary training) whose effectivenesswas predicted onthe basiso fthe project's student selection criteria ratings, pre- and post-course tests/evaluations, andor rating o f trainingwork plan quality. Increase inpercent o f service deliverypoints inARCAN countries with one (or more) primaryrecipients ofproject-supported TOT training. Increase inlevel o fjob satisfaction reportedby ARCAN graduatesone year after course completion. Output indicators: The major output indicators will examineprojectfeatures relating to knowledge, skills, resource mobilization, andpractice, among ARCANgraduates. These indicators will be measured annually. - 2 - Increase inthe percent o fARCAN graduateswho conduct one training sessioninthe first six months after their primary training(i.e. number o f "successfhl" graduates inany given course dividedby the total number o f graduates from the same course), as measured annually through trainingreports submitted to the Project Coordination Unit. Total amount o f financial resourcesmobilizedby ARCAN graduates (from national MAPS and other sources) to conduct their TOT-model training, as measuredat 12month intervals o fthe project. Qualitative reviewo fthe support providedto ARCAN graduates after completion of their primary TOT course, including resourcemobilization, access to training materials, contact withrelevantnational andor intemational technicalhaining entities, participation in "refresher" courses and conferences, etc. (measured at project mid-termreview and completion). Process indicators: Theprimary process indicatorsfor thisproject will address the actual training process by the regional training institutions involved inproject implementation,in addition to the continuing TOT-model training conducted by ARCAN graduates. Increase inthe total number o ftraining hours conducted as a result o fthe ARCAN Project (Le. total number of individuals trained [sumo fthe work o fbothARCAN training institutions andthe ARCAN course graduates] multipliedby the number o ftraininghours conducted). Increaseinthe numbedpercent o f individuals trained by ARCAN graduatesper number o f people initially targeted, according to work plans (i.e. "actual" versus "planned" training targets). B. Strategic Context 1.Sector-relatedCountry AssistanceStrategy(CAS) goalsupportedby the project: (see Annex 1) Documentnumber: (Indicated below) Date of latestCAS discussion:(Indicated below) Ethiopia: The Country Assistance Strategy (CAS) for Ethiopia (Report'25591-ET) was issued on March 24, 2003. This CAS focuses on improving human development outcomes, enhancing pro-poor growth, and reducing vulnerability, and also places emphasis on the need for capacity bpilding. This document indicates that constraints to improvinghealth services lie primarilyinthe shortage o f skilled human resources and identifies HIV/AIDS as the foremost threat to national poverty andvulnerability reduction efforts. Kenya: The CAS for Kenya (Report'29038-KE), issued on May 19,2004, identifies support for an improved understanding o f poverty, the health sector, the education sector, and the national response to HIVIAIDS as among it basic areas o f support. The CAS notes that HIV/AIDS i s a top priority for the government. - 3 - Tanzania: The CAS for Tanzania (Report#20728-TA), issued on June 30, 2000, highlights the need for improved service delivery, indicates that the Bank will retain its significant focus on health sector development, and supports the national Poverty Reduction Strategy. The CAS also notes the emergence o f HIV/AIDS as a multi-sectoral development issue posing a severe constraint to poverty alleviationefforts. 2. Main sector issues and Government strategy: Background Despite increased levels o f political commitment and financial investment at both national and international levels inrecent years, there still exists substantialdeficiencies inthe development and provision o f relevant and comprehensive training for health care practitioners involved in the design and implementation of HIV/AIDS-related prevention, care, and treatment interventions. Experience has demonstrated that the impact of such intensified investment and advocacy efforts will be constrained, however, without improved capacity and training among health care practitioners, particularly among those already heavily engaged in HIV/AIDS-related service delivery. There is a consequent need to develop human resource development/management strategies that take into account the impact o fthe epidemic on national health systems. Basic pre- andin-service training, as well as continuing education, will be necessary to produce qualified health personnel in sufficient numbers to effectively respond to HIV/AIDS. Given maturing epidemics and increasing demands on the health sector across the African continent, the development and/or sharing o f high quality and regionally-relevant curricula, training materials and programs (including distance learning modules) for health care practitioners at all levels can be viewed as a public good. The development o f ARCAN as a subregional project enables the potential harmonization o f approaches, with respect to improvedHIV/AIDS-related capacity development, and greater knowledge-sharing across countries. The ARCAN Project will place particular emphasis on ensuring that its training programs are delivered by recognized subregional institutions, working in close partnership with the public and private sectors, civil society organizations, intersectoral programs, and with a wide range o ftechnical partners. Health Sector Capacity Gaps Countries receiving support under the MAP program, including Ethiopia, Kenya, and Tanzania, currently possess limited ability to provide prevention, care and treatment services for people living with HIV/AIDS, including the management of simple opportunistic infections. Issues surrounding the ability to provide comprehensive HIV/AIDS-related services in resource-limited settings require substantial capacity enhancementamong health care practitioners at all levels. Part of this capacity gap results from the fact that an effective response to HIV/AIDS requires additional skills and approaches that have not always been characteristic o f traditional health systems. Additionally, in most developing countries, health systems were relatively weak and under-resourced prior to the advent o f AIDS, which has since served to exacerbate these institutional and financial vulnerabilities. Maturing epidemics are now placing greater strains on - 4 - these already over-stretched systems, as the demand for health services continues to grow in parallel with increasing morbidity and mortality. HIV/AIDS also has led to a resurgence in tuberculosis, a lethal synergy which urgently requires additional efforts and resources to redress. The combined impact at country-level generally includes a dramatically increasedworkload for health care practitioners, over-crowding o f health facilities at all levels, high hospital bed occupancy rates, and more frequent shortageshtock-outs o f medical commodities and basic pharmaceuticals. In addition to the above complexities, the output of health care providers in high prevalence countries can be substantially reduced due to attritionhum-out, morbidity and mortality among co-workers, personal illness, illness among family membedrelatives, frequent absences to attend funerals, and perceived risk o f occupational transmission o f HIV infection. Two decades o f experience with HIV/AIDS have clearly indicated that the "business as usual" approach to addressing such health sector challenges will not suffice. A more comprehensive, coordinated, and inter-sectoral responseto health sector capacity development will require greater government stewardship, particularly with respect to Ministries o f Health and National HIV/AIDS Councils/Commissions, inclosepartnership with private sector and civil society entities. TrainingNeeds Assessmentfor Eastern and Southern Africa The report o f a recent series o f assessments supported by USAID (Regional Economic Development Services Office for East and Southern Africa), to examine the needs for HIV/AIDS-related training in 12 Eastern and Southern African countries, including Ethiopia, Kenya, and Tanzania, serves to highlight these gaps. The major findings o f this assessment indicate that although counties have developed national strategies that clearly indicate priorities in the prevention and control of HIV/AIDS, these plans provide limited attention to human capacity development. In essentially all counties included in this assessment, there was a significant disconnect betweentraining gaps reported by key informants andnational-level training programs/opportunities. Interestingly, the report notes that the degree to which this limited national focus on capacity development stems from resource constraints, versus the presumption that the neededtraining would "somehowl' occur, remains unclear. The most critical training gaps identified in the country-specific reports for this assessment included: management skills for program administrators and/or coordinators; clinical management o f HIV/AIDS for health care practitioners at all levels; counseling and communication skills for health care practitioners at all levels; and community-based service delivery. Importantly, these assessments identified the need to also address specific training needs in non-health sectors in order to strengthen the requisite multisectoral and multi-partner response to HIV/AIDS. The results o f this series o f country assessments emphasize both the enormity o f the existing HIV/AIDS-related training gaps and the critical need to enhance capacities o f regional training institutions so that they are more effectively and proactively able to respond to these long-term needs (Source: USAID/REDSO, 2003). Epidemic Status in ARCAN Countries Ethiopia, Kenya, and Tanzania are among the most heavily affected countries by the HIV/AIDS - 5 - epidemic. UNAIDS estimates that as o f December 2003, the national adult prevalence rate in Ethiopia was 4.4 percent indicating that 1.5 million Ethiopians (adults and children) were living with HIV/AIDS. There were also estimated to be 720,000 AIDS orphans (under the age of 17 years) inEthiopia at this point. The national adult prevalence rate inKenya was estimated to be 6.7 percent in December 2003, with 1.2 million individuals living with HIV/AIDS and 650,000 orphans. InTanzania, the corresponding adult prevalence rate was estimated to be 8.8 percent, with 1.6 million individuals living with HIV/AIDS andover 980,000 orphans, to date (UNAIDS Epidemic Report, July 2004). 3. Sector issuesto be addressed by the project and strategic choices: Relationship to National MAP and Health Sector Projects The proposed subregional MAPproject will serve a complementary and catalytic role to boththe national MAP and health sector projects currently effective in each o f the three ARCAN countries. Indiscussionsheldwith country counterparts duringpreparation, the Bank emphasized that although the ARCAN project would fully finance the development and delivery o f this subregional training program, participating countries would need to commit to supporting the continuation o f the "training-of-trainers" model at country level, using national IDA or other explicitly identifiedfinancial resources. Countries' willingness to commit to the provision o f this support (in the form o f a letter submitted to IDA from the respective National HIV/AIDS CounciVCommission andor Ministry of Health) was a prerequisite for consideration under this grant. Guidelines for Eligibility and Selection Criteria for Training Institutions and Training Participants The training institutions forming the ARCAN network (i.e. the project "implementers"), will be selected on the basis o f a proven track-record in implementingtraining programs inthe different areas prioritized under the ARCAN project. Consequently, ARCAN-supported training programs will be deliveredby aneligible group oftraining institutions inacademia, the public sector, private sector, civil society, to a qualified group o f training participants. During project pre-appraisal, eligibility and selection criteria for training entities and TOT participants were approved by the ARCAN Steering Committee following a two-phased process, which is detailed in Additional Annex 11. The final selection o fthe ARCAN training institutions was conducted by the Steering Committee duringproject appraisal. Eligibilityfor MAP Subregional Projects As presentedinthe Memorandum and Recommendation of the President for MAP2, subregional HIV/AIDSprojects will be eligible for support under the MAP ifthey meet the following access criteria: -The project addresses a subregional or cross-border HIV/AIDS issue,promotes apublic good of multinational scope, provides services to populations beyond the reach of national programs, or realizes economies of scale that would not be practical to attain through cooperative country-level action. The establishment o f a subregional training network for HIV/AIDSpractitioners, such as ARCAN, would realize economies o f scale - 6 - and leadto increasedquality andconsistencyinsubregional service delivery. -No other alternative for achieving the project goals would be as practicable or economic. The harnessing o f technical and human resources from the multiple sites o f excellence required for this program would not be feasible to achieve solely through a national program o f any givenIDA country inthe subregion. -The project has been endorsed by the governments of the countries concerned or a relevant public international or regional organization. Strong endorsement by the national HIV/AIDS authorities (National HIV/AIDS Councils/Commissions, Ministries o f Health, and Ministries o f Finance) o f ARCAN countries has been received. Senior officials from the NACCs, MOWNACPs, and MOF also will be serving on the project's Steering Committee, inaddition to NGO representativesfrom each country. -The project is consistent with the HIV/AIDS strategies, policies, and programs o f the affected countries andwith any relevant subregional and intemational strategy and policy. This project complements national HIV/AIDS strategies, MAP operations, and health sector programs in each o f the ARCAN countries, and also follows the priorities establishedbynational health sector capacity buildingplans. -A high-level coordinating body has been established to oversee the implementation of the project. The ARCAN Steering Committee includes the heads o f National HIV/AIDS Councils and Ministryof HealthNationalAIDS Control Programs. It also includes senior representation from Ministries o f Finance andnationalNGOs. -Appropriate institutions, policies, procedures, and regulations are in place to enable concerned subregional and national stakeholders to participate effectively in project implementation. The training institutions involved inthe implementation o f the ARCAN project will be derived from the public sector, private sector, and civil society training institutions, primarily onthe basis o f implementation experience. -The implementing body has an adequatefiduciaryframework in place to comply with all IDA requirements and safeguards. These issues have been addressedand detailedin the project's Financial Management Manual, in addition to the financial management sections o fthe appraisal document. -The implementing body has agreed to use exceptional implementation arrangements to accelerate project implementation. The ARCAN Project Coordination Unit will subcontractmost key implementation tasks, including financial management, procurement, monitoring and evaluation, and technical service consultancies in the interest o f reducing bureaucracyand streamlining project efficiency. C. Project DescriptionSummary 1. Projectcomponents(see Annex 2 for adetailed description andAnnex 3 for adetailed costbreakdown): The ARCAN program aims to achieve an optimal balance between addressing prevention, treatment, care, and support issues. In the development of the project sub-components, prevention and care have been explicitly treated as part of a continuum, versus as competing or discrete entities. The proposedARCAN project components include the following: - 7 - (a) Health care practitioner training. The project will support the implementation o f short-term (non-diploma) training courses for health care practitioners at various levels, including physicians, nurses, counselor supervisors, laboratory technicians, and HIV/AIDS program managers. All programs financed under ARCAN will follow the training-of trainers (TOT) approach inorder to maximize the impact o fthis capacity-building project. (b) Monitoring and evaluation and knowledge sharing. The proposedproject will prioritize the establishment o f a system of monitoring and evaluation (M&E) that would enable the rapid synthesis and sharing o f lessons and also their application to the continued strengthening o f the program. Routine dissemination o f HIV/AIDS-related program information would also be financed underthis component to ensure greaterknowledge sharing betweenandwithincounties. As part of its continuing education emphasis, ARCAN will explore options for distance learning to maximize resources and to ensure a broader regional approach for sharing experiences and enhancingskills. (c) Program coordination. This component would support the development o f strong coordination and capacity building between ARCAN counties and their implementing, coordinating, andgoverning agencies. A major focus o f this component would involve providing the ARCAN Project Coordination Unit with support to conduct its administrative, fiduciary, and technical responsibilities. Indicative Bank- %of Component costs %of financing Bank- (US$M) Total (US$M) financing 1. Healthcare practitioner training 7.72 77.2 7.72 77.2 2. Monitoringandevaluationandknowledge sharing II 0.38 3.8 0.38 3.8 II 3. Programcoordination 1.50 II1 15.0 III 1.50 II1 15.0 Unallocated 0.40 4.0 0.40 4.0 Total FinancingRequiredI 10.00 1 100.0 I 10.00 I 100.0 I 2. Key policy and institutionalreforms supported by the project: This project will support subregional capacity building, with respect to the training of HIV/AIDS practitioners, in addition to strengthening South-South learning networks. The project will indirectly support national decentralization policies inthe ARCAN countries by building capacity among health care practitioners at various levels to better respond to the demands and impacts of the epidemic. - 8 - 3. Benefits and target population: The major direct and indirect benefits stemming from this project will include improvedtraining o f health professionals inthe management of HIV/AIDS, improved quality and coverage o f national prevention, treatment, care and support programs, and a stronger subregional response. Although much o f this project will focus on health care practitioners, the project will follow a multisectoral approach inthat students for ARCAN training, particularly the program management courses, will bedeliberately drawn from all relevant sectors. 4. Institutional and implementation arrangements: The multi-country nature o f this "learning" project necessitates the development o f institutional andimplementation arrangementsthat are simplified and flexible to as large anextent as possible. a) Structure of the Steering Committee: The Steering Committee (SC) represents the highest policy and governancebody for the ARCAN network. Key features o f the SC include: i)Acompositionoffourteenmembers,foureachfromofEthiopiaandKenya, andsix from Tanzania (four from the Mainland and two from Zanzibar); further details regarding the SC composition are presentedbelow; ii)TheheadoftheARCANProjectCoordinationUnit(PCU)toserveasSCsecretary; iii)Thepositionof SCchairpersonandvice-chairpersonSC,aswellas,meetinglocations to be rotated between ARCAN countries; iv) SC meetings to be held twice each year; the first meetingto specifically review and approve the annual work plan and budget, and provide overall policy guidance; the second meeting, at mid-year, to review and discuss progress with implementation, M&E, financial and other technical reports, as required. b) Sub-Committees: The SC will be aided by two sub-committees: a Technical Sub-committee dealing with all content issues and an Audit Sub-committee responsible for all fiduciary issues. The four members o feach subcommittee, includingthe SC Chair, will be derived from the overall SC membership. With respect to the Audit Sub-Committee, it was agreed that this group would be primarily constituted by the Ministry of Finance representatives on the SC. The two sub-committees will meet no more than twice a year. c) Composition of the Steering Committee: Given the above roles and responsibilities, it was agreedthat the SC composition from eachARCAN country would be constituted by: (i) the head o f the Ministry o f Health's national AIDS program; (ii) the head o f the National HIV/AIDS CounciVCommission; (iii) a senior representative from the Ministry o f Finance; and (iv) an NGO/CBO representative with strong experience in the field. The overall Steering Committee nomination process was jointly ledby heads o f the National HIV/AIDSCouncils and Ministry o f Health National HIV/AIDS Control Programs. Details regarding the overall institutional arrangementsare presentedinthe Project Operations Manual. d) Project Coordination Unit: A small Project Coordination Unit (PCU), o f five full-time professional staff, will have the responsibility for the coordination o f all ARCAN activities. The - 9 - PCU will report to the Steering Committee and will be responsible for the daily management and coordination o f the overall program. It will operate as an autonomous body. The ARCAN Project Coordinator (i.e. the PCU head) will act ex-&io as Secretary o f the Steering Committee. The Steering Committee will select the head o f the PCU and the four PCU Program Officers based on a competitive process to which candidates from all ARCAN countries will be invited to apply. Inorder to maximize efficiency, the project will adopt afaire-faire philosophy, contracting-out services when possible, rather than cultivating in-house expertise. As a result, a number o f key project management functions will be contracted out by the PCU (to independent firms, agencies andor independent consultants) on the basis o f one-year, renewable, performance-based contracts, in accordance with Bank guidelines. This out-sourcing will include financial management, procurement, monitoring andevaluation, travel arrangements, the annual audit, and specific technical assessments. Office o f the ARCAN Steering Committee (NACC, MOH, MOF, NGO representatives from Ethiopia, Kenya, & Tanzania) Project Coordination Unit (PCU) Training Institutions Financial Monitoring & Technical (Project "Implementers") Management & Evaluation Service Procurement Agent Agent Agent Operations Manual The ARCAN Project Operations Manual (including the Project Implementation Plan and the Financial Procedures Manual) and M&E Manual were prepared during the course o f project preparation. Preparation o fthe Procurement Manual beganduringprojectpreparation andwill be completed before project effectiveness. Linkages withNational HIV/AIDSCoordination Bodies and Ministries o fHealth Ineachofthe countries participatinginthe ARCANproject, HIV/AIDSefforts arecoordinatedat the national level by a high-level multisectoral body, the responsibilities o f which include (in addition to the broad mandate o f coordination): advocacy; providing leadership and stimulus for -10- an enhanced national response; and monitoring and evaluation. Coordinating bodies in each o f the ARCAN participating countries are: (i) in Ethiopia, National HIV/AIDS Control Council (HAPCO), located in the Office o f the Prime Minister; (ii) inKenya: National AIDS Control Council (NACC), located in the Office o f the President; and (iii) in Tanzania (Mainland and Zanzibar): Tanzania Commission for AIDS (TACAIDS), located in the Prime Minister's Office; andthe Zanzibar AIDS Commission (ZAC), locatedinthe ChiefMinister's Office. Given that they are responsible for overall coordination o f the national response, the national coordinating bodies can be expected to maintain up-to-date knowledge o f the HIV/AIDS-related initiatives o f the key training institutions intheir respective countries. As such, these coordinating bodies will play a key role inthe coordination and oversight o f any preliminaryneeds assessment activity that might be necessary prior to project implementation. Similarly, they will serve as the primary repository of information related to training and capacity development throughout ARCAN implementation. The national coordinating bodies will therefore be a primary link for ARCAN at the country level, as consistent with their roles in the national responses and MAP programs. Since priority will be placed on health-related training needs, each country's Ministry o f Health (primarily through the National AIDS Control Programs) will serve as an additional crucial ARCAN link, with respect to technical input and leadership, incorporation o f ARCAN activities within national training plans, in addition to ensuring the follow-up of trainees, Due to the importance o f maintaining these institutional links over time, and to provide country-level leadership, oversight and ownership, it was agreedthat the heads o fboth the National HIV/AIDS CounciVCommission and the Ministry o f Health National AIDS Control Program from each country will serve as members o f the ARCAN Steering Committee, in addition to senior representativesfrom Ministries o f Finance and civil society organizations. D. Project Rationale 1. Projectalternatives consideredandreasonsfor rejection: The following project alternatives were considered: -Multiple individual country projects: The initiation o f an ARCAN-like structure in each interested country, using traditional lending instruments, would not be able to achieve the programmatic synergies, the multi-country and multi-level partnerships, nor the economies o f scale that can potentiallybe reachedusinga multi-country approach. N o single country possesses training programs with the requisite proven implementation capacity and expertise in all priority areas. -Singletrainingsite: SupporttoasingletrainingsitetoaddresstheHIV/AIDSrelatedhuman resource capacity needs for the subregion was assessed as non-viable due to the wide range o f training needs incountries. N o single training institution possesses the requisite multi-level and multi-sectoral implementation experience, much less the technical capacity to undertake such an effort. Moreover, there was also no interest in this "single-source" model from country - 11- counterparts. -Subregionaltrainingnetworkcomposedof multiple learningsitesof excellence:Theproposed project would enable the creation o f a subregional network o f ''best practice" institutions already involved in the training o f health care practitioners. This model has been assessed by IDA and national counterparts as the most effective and flexible mechanism to respond to health sector capacity gaps. 2. Major relatedprojects financed by the Bank and/or other development agencies(completed, ongoing and planned). Sector Issue Project mplementation Development Bank-financed Progress(IP) Objective(DO) HIV/AIDS Kenya HIV/AIDS Disaster - v S Response Project (MAP) Health Kenya - Decentralized U U HIV/AIDS andReproductive HealthProject PublicAdministratiodEducation Kenya - DevelopmentLearning S S Centre Project HIV/AIDS Ethiopia - Multi-Sectoral S S HIV/AIDS Project (MAP) Health Ethiopia - Health Sector S S DevelopmentProgram HIV/AIDS Tanzania: Multi-Sectoral AIDS S S Project (MAP) Health Tanzania: SecondHealth S S Sector DevelopmentProject 3ther developmentagencies USAID Program Support (Ethiopia, Kenya, Tanzania) Netherlands Program Support (Ethiopia, Kenya, Tanzania) EuropeanUnion Program Support (Ethiopia, Kenya, Tanzania) WHO Program Support (Ethiopia, Kenya, Tanzania) UNAIDS Program Support (Ethiopia, Kenya, Tanzania) DfID Program Support (Ethiopia, Kenya, Tanzania) GTZ Program Support (Ethiopia, Kenya, Tanzania) UNICEF Program Support - 12- (Ethiopia, Kenya, Tanzania) UNDP Program Support (Ethiopia, Kenya, Tanzania) 3. Lessonslearned and reflected inthe project design: Some o f the key lessons learned over the past three years of M A P implementation, include the following: -Capacity building at all levels is critical to the development of a long-term and sustained response to HIV/AIDS. The ARCAN project i s focusing its efforts on the expansion of capacity within various levels o fthe health sector. -Management of HIV/AIDS programs calls for exceptional measures. The initial response to the MAP program in many countries has been to treat these projects as any other, when the urgency o f the problem and its devastation call for unconventional responses. Implementation o f key aspects, including financial management, procurement, monitoring and evaluation and selected service delivery, have usually been more effective when they are "contracted" rather than done "in house." This out-sourcing principle has been kept foremost in mind in designing the project coordination mechanisms for ARCAN. -Scaling up existing programs and building capacityfor HIV/AIDS activities have been more dificult than originally expected. Capacity building needed for scaling up has two distinct components: enhancing skills; and increasing the quantity o f existing skills and institutional infrastructure. Through its explicit focus onhumanresource capacity building and the use of a "training of trainers" model, the ARCAN project will address these constraints to the best o f its ability. -Monitoring and evaluation (M&E) systems are the key to effective implementation. In an experimental and learning process, a good M&E system is absolutely essential. The ARCAN project has focused on ensuring that strong andflexible M&E arrangementswere developed duringthe projectpreparation period. -Partnerships matter. Addressing HIVIAIDS effectively can only be done by genuine collaboration-within government, between the public and private sectors and civil society, among donors, and specialized technical agencies. Effective partnership involves sharing power and responsibility during program design and implementation. The ARCAN project has already established strong partnerships with a number o f partners from the private sector, academia, civil society, in addition to a regional and international technical entities. This process will be actively continued and the potential for other strategic partnerships, particularly with respect to distance learning and telemedicine will beexamined, duringimplementation. - 1 3 - 4. Indications of recipient commitment and ownership As was previously discussed, willingness of counties to utilize existing MAPhealth credit resources to support the continuation of the ARCAN training-of-trainers model at country-level was among the eligibilityrequirements for this project. Early inpreparation, letters to this effect were submitted to IDA by the respective National HIV/AIDS Councils/Commissions and/or Ministries o fHealth. 5. Value added of Bank support inthis project: The Bank's support to this project brings a broad development perspective to addressing HIV/AIDS,experience indesigning andimplementingnational HIV/AIDSproject inmore than26 African countries, partnerships with numerous regional and international technical bodies (including UNAIDS, WHO, and the GFATM), and the potential to address HIV/AIDS-related resource gaps at both the national and subregional levels. The development o f new means o f sharingknowledge andbuildingcapacity inclient counties is also a core fictionofthe Bank. E. Summary ProjectAnalysis (Detailed assessmentsare inthe projectfile, seeAnnex 8) 1. Economic(see Annex 4): 0Costbenefit NPV=US$million; ERR= % (see Annex 4) 0 Costeffectiveness 0 Other(specify) The economic analysis contained inthe PAD for the MAP1(Report# 20727 AFR) contains the overall economicjustification andunderpinningsfor the ARCAN project. Giventhat the proposed project would be supporting training and capacity buildingefforts utilizing establishing African training entities, a separate economic analysis will not berequired. 2. Financial (see Annex 4 and Annex 5): NPV=US$ million; FRR= % (see Annex 4) Fiscal Impact: The fiscal impact o fthis project is expectedto be negligible. 3. Technical: The ARCAN project will follow internationally acceptedbestpractice with respectto training o f health care practitioners inHIVIAIDSprevention, treatment, care and support services, as validated by UNAIDSandWHO, inaddition to other key technical partners. -14 - 4. Institutional: The Governments of Ethiopia, Kenya, and Tanzania all expressed interest in serving as signatory/recipient o f the proposed subregional IDA grant. During the course o f project preparation, various options with respect to the housing o f the project and the consequent locationo f the Project Coordination Unitwere assessed, with the respective Ministries o f Finance (MOF), Ministries o f Health NOH), and National HIV/AIDS CounciVCommission (NAC) in Ethiopia, Kenya, and Tanzania. In Kenya and Ethiopia, the Bank was informed that the possibilities to house ARCAN would be within the M O H or N A C structures. In Tanzania, however, the Prime Minister's Office (PMO) indicated its willingness to house the project under its own ministry. For reasons outlined below, the Tanzanian PMO was assessed as the most viable anddesirable option for the ARCAN project: National AIDS CounciZs/Commissions: Although initially suggestedby most countries, housing a subregional project within the structure o f one o f the National AIDS Councils/Commissions (NACs), would be in conflict with the existing legal frameworks o f these national entities. The proposed by-laws o f ARCAN are conceived for a subregional program andare not amenable with those o f NACs. Capacity and administrative constraints would likely also present a serious challenge for these generally overextended national bodies to coordinate/support a multi-country program. Moreover, the selection o f one NAC from among those involved inthis project would likely create undesirable rivalry among the other countries. These circumstances would not afford ARCAN the necessaryimpartiality. Ministries of Health: The second option raised by most countries involved the potential housing o f the ARCAN within the structure o f Ministries of Health. However, this option is also viewed by IDA as problematic. First, placing a MAP project within the confines of any MOHwould be contrary to the basic principle o f a multisectoral response, the cornerstone o f the Bank's regional response to HIV/AIDS. Moreover, housing ARCAN within the challenging and over-stretched environment o f a M O H would likely lead to significant difficulties in the implementation of this regional project. The fact that ARCAN i s being explicitly designed with a very light coordination structure, requiringa highdegree o f autonomy and flexibility to achieve its goals, emphasizesthis point. Finally, in discussions with Governments, there was general acknowledgement that if one Ministry of Health were to be selected to house ARCAN over the others, it would likely be "difficult" to obtain requisite support from the other countries, in a timely manner, due to intra-sectoral pressures. Ofices of the Prime Minister or President: Based on the overall institutional assessment and the lessons learned from MAP projects under implementation, the mission supported the positioning o f ARCAN as an autonomous entity within either the Prime Minister's Office (PMO) or President's Office (OP) o f one o f the partner countries. In conformity with the multisectoral approach o f MAPS,placing ARCAN within PMO or OP (and explicitly outside any NAC structure), was determined to be the most viable option to safeguard the autonomy, integrity, subregional nature, and subsequentimplementation effectiveness o fthis subregional project. 4.1 Executingagencies: The ARCAN Project will be executed through a number o f highly qualified and established -15- training institutions based inthe subregion. As discussed earlier, these implementing institutions will be selectedon the basis on agreedeligibility requirements by the Steering Committee. h e x 11 details the selection and eligibility criteria for the project training institutions and Annex 14 outlines the background and content o f selectedtraining programs. 4.2 Project management: Given that Tanzania will serve as signatory for this multi-country project, the ARCAN Project Coordination Unit (PCU) will be based in Dar-Es-Salaam. It has been established that the PCU will be an autonomous entity andthat itwill liaise with the Office o fthe Prime Minister through a government-appointed senior official. The PMO will serve as the institutional home of the project, although the PCUwill retainits autonomy. 4.3 Procurement issues: Contracts for goods, such as office equipment and furniture for the PCU office would beprocured inaccordance with the Bank's "Guidelines: Procurement under IBRD Loans and IDA Credits" published in May 2004. Consultants' services shall be procured in accordance with the Bank's "Guidelines: Selection andEmployment of Consultants by World Bank Borrowers" publishedby the Bank inMay 2004. Procurement inthe proposed project will mainly involve contracting-out specific services, minor rehabilitation works for the PCU offices and some minor procurement o f goods (for the PCU). Procurement arrangements are based on those established for MAP operations and specifically will follow simplified procurement guidelines. Details regarding Procurement Arrangements are presentedinAnnex 6(A). - 16- 4.4 Financialmanagement issues: a) Flow of funds and Disbursements The United Republic o f Tanzania has beenmandatedby the ARCAN countries to be the recipient country and consequently signatory for this multi-country IDA grant. The Government o f Tanzania has inturndelegatedthe oversight role to the Office o f the Prime Minister. The Project Coordination Unit (PCU) will be assisted in managing the project finances by a Financial Management and Procurement Agent (FMA) to be contracted for that purpose and undertake procurement under the project. The project Grant Account will be maintained at the World Bank Headquarters. The PCU will establish a US Dollar Special Account in a commercial bank satisfactory to IDA, preferably inthe host country (Tanzania), into which advances will be made periodically from the GrantAccount. A Project Account inlocal currency will be establishedina commercial bank satisfactory to IDA which will be financed with b d s drawn from the Special Account on a need basis from time to time, to ensure the Grant value i s protected from exposure risk oferratic foreignexchangerates. Disbursements against eligible project expenditures will be made following the report-based disbursement approach, where Financial Monitoring Reports (FMRs) and used to trigger flow o f funds from the GrantAccount to the Special Account. Expenditures paidunderthe project will be subject to ex-post review for eligibility and reasonableness and economy. FMRs have the advantage o f facilitating matching o f financial, procurement and physical progress in a project. FMRs for this project will be submitted on quarterly, within 45 days after end o f each quarter. FMR formats to be used in this project are illustrated in the Financial Management and Procurement Procedures Manual (FPPM) presentlybeing finalized by including the procurement section. Supporting documentation for expenditures reported inFMRwill be retained at the PCU office, from where they will be subsequently reviewed by supervision missions and availed for audit. IDA will arrange for capacity buildingclinics for the FMA and the PCU staff on FMRs and how these are prepared inview o fthe fact that the staff may be handlingFMRsfor the first time. b) Counterpart Funding The governments o fthe three ARCAN countries have all providedtax exemption for expenditures under the project where goods and services are procured from these countries. Inview ofthis the governments will not provide counterpart contribution in cash, but will support the project by makinga contribution in-kindthrough the staff time by public servants who will provide support to the project. Inparticular, staff-time o f trainees who are nominated from the public service will take time off from work to attend the courses and in addition to this they will spend staff-time whenthey return to implementtheir training. Use o f existingtraining facilities, andnational-level coordination and dissemination o f information within the M O H and NACC structures also add to the non-monetray counterpart contributionto the project. During project preparation, the Bank discussed with the respective Ministries of Finance the -17- subject o ftaxes and duties on expenditures to be incurred underthe grant (Note: Taxes envisaged for Kenya and Ethiopia refer to taxes imposed on ARCAN contracts with training institutions only; while taxes envisaged for Tanzania, where the PCU is physically located, refer to taxes imposed on the purchase o f goods and services for the PCU, in addition to ARCAN contracts to Tanzanian training institutions). The Government o f Tanzania has clearly indicated that ARCAN expenditures for goods and services, as well as for oil and lubricants, would be tax exempted. Similarly, both the Governments o f Ethiopia and Kenya indicated that, as in the case o f the national MAP projects, contracts with training institutions will be tax exempted. Based on the above, the grant agreement would indicate that the project would be tax exempted and that the Schedule I(disbursement schedule) should be articulated to reflect 100percent Bank financing. c) Resource Allocation Project resources will not be allocated separately to each o f the ARCAN counties but will be allocated to components and the trainees drawn equitably from these counties will benefit for the training on offer. d) Financial Reporting and Audit Financial statements for the project will be prepared annually by the FMA in collaboration with PCU. The FMA will maintain an adequate accounting system that will facilitate proper management o f project finances and generate correct and reliable financial statements in a timely manner. The responsibility to prepare and submit audited annual financial statements to IDA in time is vested inthe SC with support from the PCU. Auditedreports for the project will be due to IDA not later than six months after end of the financial year to which they relate incompliance with Financial Covenants on the Development Grant Agreement (DGA) and fulfilment o f the fiduciary requirement under OP/BP 10.02. 5. Environmental: Environmental Category: C (Not Required) 5.1 Summarize the steps undertaken for environmental assessment andEMPpreparation (including consultation and disclosure) andthe significant issues andtheir treatment emerging from this analysis. Giventhat the project content will consist o ftraining which will take place inpre-existing training institutions, the ARCAN project is not anticipated to have adverse environment effects. The project has beenclassified as Category C by the Africa SafeguardPolicies EnhancementTeam (ASPEN), as per OD 4.0 1. 5.2 What are the mainfeatures o f the EMP and are they adequate? NIA 5.3 For Category A andBprojects, timeline andstatus of EA: Date o freceipt o f final draft: NIA 5.4 How have stakeholdersbeenconsulted at the stage o f (a) environmental screening and (b) draft EA report on the environmental impacts andproposed environment managementplan? Describe mechanisms o f consultation that were usedandwhich groups were consulted? -18- N/A 5.5 What mechanisms have been establishedto monitor and evaluate the impact ofthe project on the environment? Do the indicators reflect the objectives andresults ofthe EMP? N/A 6. Social: 6.1 Summarize key social issuesrelevant to the project objectives, andspecify the project's social development outcomes. The project is expected to have a positive social impact by improving the capacity level of health care practitioners involved inthe designand delivery o f HIV/AIDS-related prevention, care, and treatment services. The provision o f on-going professional support to health care providers i s also likely to reduce staff attrition, which i s correlated with improved quality o f care and the sustainability o fHIV/AIDS service delivery programs. 6.2 Participatory Approach: How are key stakeholders participating inthe project? Key stakeholders ineachcountry have beendirectly involved inthe design andimplementation of this project, Implementingpartners are anticipatedto include government healthcenters, NGO/CBOprograms, andprivate sector entities, onthe basis o fclear eligibility and selection criteria. 6.3 How does the project involve consultations or collaboration with NGOs or other civil society organizations? NGOsare among the project's implementingpartners andhave beeninvolvedinthe overall design o fthe program, as well on the Steering Committee. 6.4 What institutional arrangements have beenprovided to ensure the project achieves its social development outcomes? A Steering Committee constituted withbroadrepresentativeso fparticipatingcountries has been formed and will serve as the overall governancebody for the proposed project. 6.5 How will the project monitor performance interms of social development outcomes? This will be assessedthrough on-going beneficiary assessments at various service delivery sites, exit surveys onclient satisfaction inhealthcentersbeingsupported bythe project, andthrough feedback from NGO/CBO technical andimplementing partners. 7. Safeguard Policies: I - 19- PestManagement(OP 4.09) 0Yes 0No CulturalProperty (OPN 11.03) 0Yes 0No IndigenousPeoples(OD 4.20) 0Yes 0No InvoluntaryResettlement(OP/BP4.12) 0Yes 0 No SafetyofDams (OP 4.37, BP4.37) 0 Yes 0 No ProjectsinInternationalWaters(OP 7.50, BP7.50, GP 7.50) 0 Yes 0 No ProjectsinDisputedAreas (OP 7.60,BP7.60, GP 7.60)* 0Yes 0No 7.2 Describeprovisions made by the project to ensurecompliance with applicable safeguardpolicies. NIA F. Sustainability and Risks 1. Sustainability: The project is likely to be sustainedto the extent that there is strong ownership, participation and commitment from ARCAN countries. Iti s unlikelythat the Governments o fpartner countries would be able to fully finance ARCAN inthe medium-term,and consequently it is expectedthat multilateral, bilateral, andor private sector financing will be required for program continuation andexpansionbeyondthe four-year implementationperiodo fthe project. The overallproject risk i s considered to be substantial becauseo fthe multi-country nature of this project and its innovative nature. 2. CriticalRisks (reflecting the failure o f critical assumptions found inthe fourth column o fAnnex 1): Risk Rating I Risk Mitigation Measure S The PCUwill provide regular updates o fthe weak duringproject implementation. program andprogress, throughout the project implementationperiod. Preventionactivities are not effectively M Continuedtechnical review ofthe linked to care, treatment, andsupport appropriateness andcontent o fprogram vided through ARCAN curricula andfollow-up support and information to ARCAN "graduates" S Close monitoring ofprogram implementationin order to identify challenges early Transparency not maintainedinthe M Development o f clear eligibility andselection selection of training institutions and criteria studentsbetweenandwithin participating countries Insufficient program coordinationbythe M Development o fjointly agreedproject ARCAN Secretariat. responsibilities, operating guidelines, and benchmarks. - 20 - Content o f training programs not routinely M Creationof a Technical Subcommittee to advise updatedto reflect recent developments in the Steering Committee ofrelevant HIV/AIDS prevention, treatment andcare. developments. Highloss o fARCANgraduatesdue to S Provisiono f continuing education andgreater "brain-drain" recognition o fthe importance o f "master trainers" innational capacity development efforts ARCAN graduates experience continued S Active monitoring o f graduate activitiesby the delays/refusals from national authorities PCUandhaving this included inthe TOR for uponthe submission of well-prepared one o f the Program Officers. continuing TOT plans Overall Risk Rating S Intensiveimplementation support, inaddition to regular monitoringand supervision activities. 3. PossibleControversialAspects: The proposedproject hasbeen explicitly designedto complement, andnot substitute for, national programs andinvestments inhealth sector humanresourcecapacity building. Giventhat Bank support to ARCAN will be financed through an IDA grant, and the Kenya andEthiopia country-specific MAP projects are financed through IDA credits, this raisesthe potential for deliberate leakage and/or requeststhat purely national activities be integrated into this subregional project. The Tanzania MAP, givenits relative recency, is fundedusing an IDA grant. However, similar "leakage" concernscouldapply. Earlyandrepeatedclarificationto all concernedpartners regarding the envisioned complementary nature o f the ARCAN project to these country-specific MAP projects, should serve to limitthis possible challenge. G. Main Grant Conditions 1. EffectivenessCondition The ARCAN Project'seffectiveness conditions include the following: a) The PCUhas beenestablishedwith the PCU Coordinator inplace. b) The Project Operations Manual, includingthe Project Implementation Plan, the Financial ProceduresManual, andthe Procurement Manual o fthe project, hasbeen adopted and is acceptableto IDA. (Note: the preparation o fthe Procurement Planfor Year One o f implementation was met as a condition for Negotiations). c) The Financial Management andProcurement Agency has been contracted following standardIDAprocedures. d) Terms ofReferencefor the ExternalAuditors havebeenfinalizedandare satisfactory to IDA. - 21 - 2. Other [classify according to covenant types used inthe LegalAgreements.] NIA H. Readinessfor Implementation 0 1.a) Theengineeringdesigndocumentsforthefirstyear's activitiesarecompleteandreadyforthestart o fproject implementation. iXI 1.b)Not applicable. [XI 2. The procurement documents for the first year's activities are complete andready for the start o f project implementation. [XI 3. The Project Implementation Planhas beenappraisedandfound to be realistic ando f satisfactory quality. [XI 4. The following items are lacking and are discussedunder loanconditions (Section G): Final Project Implementation PlanandOperations Manual (draft reviewed during Appraisal) 1. Compliance with Bank Policies [XI 1. This project complies with all applicable Bank policies. 02.ThefollowingexceptionstoBankpoliciesarerecommendedforapproval. Theprojectcomplieswith all other applicable Bankpolicies. Sheila Dutta Dzingai Mutumbuka Team Leader Sector ManagedDirector - 22 - Annex 1: Project Design Summary AFRICA African Regional Capacity Building Network for HIWAIDS Prevention,Treatment, and Care KeyPerformance Data CollectionStrategy Indicators CriticalAssumptions iector Indicators: iectorlcountry reports: from Goalto Bank Mission) Ensure access to basic health i f e expectancy h u a l UNDP Development "tained Government andsocial servicesbythe report ommitment poor. World BankReports luccessfulimplementation of lublic sector, private sector, ndcivil society development trategies ProjectDevelopment 3utcomeI Impact 'roject reports: FromObjectiveto Purpose) Objective: ndicators: Expandaccess to increase inthe ?rojectProgressreports; itrong public-private-civil comprehensive and iercenthumber of successful ociety partnership in evidence-basedHIV/AIDS 4RCAN "graduates" (i.e. rraining Reports from 1IV/AIDS-related human prevention, care, and hose who conduct at least the Winistries o f Health; esourcecapacity developmenl treatment programs by ninimumrequired level of :fforts supporting a network o f :ascade training inthe first rraining Reports from "leaming sites" for health care six months after their Yational HIV/AIDS practitioners preliminary training) whose Zouncils/Commissions zffectiveness was predicted on the basis of the project's student selection criteria ratings, pre- andpost-course testdevaluations, and/or rating of training work plan quality Percentof service delivery Project ProgressReports points intrainee's country with one (or more) primary recipients o fARCAN supported TOT training. Increaseinlevel o fjob satisfaction reportedby ARCAN graduatesone year after course completion. (Note: Each o fthe above outcome indicators will be measuredannually) Outputfrom each Output Indicators: Projectreports: [fromOutputsto Objective) Component: 1) Health Care Practitioner Increase inthe percent of Project ProgressReports; National commitment to - 23- iRCAN graduateswho ipport training under onduct one training session pecial Surveys RCANand its country-level nthe first six months after intinuation heir primary training (Le. umberof "successful" raduates inany given course lividedbythe total number of yaduates from the same :ourse), as measuredannually hrough training reports ,ubmittedto the Project Zoordination Unit. rota1amount o f financial 'roject ProgressReports imitedattrition among esourcesmobilizedby .RCAN graduates \RCAN graduates (from iational MAPSandlor other iources) to conduct their rOT-model training, as neasured at 12 month ntervals o fthe project. 2ualitative review o f the ipecial Surveys (imitedturn-over oftraining support provided to ARCAN taff within ARCAN training naster trainers after istitutions :ompletion o f their primary TOT course, including resource mobilization, access to training materials, contact with relevant national andlor intemational technicaytraining entities, participationin"refresher" courses and conferences, etc. 2) Monitoring and Evaluation Increasesinthe number of ?rogressReports; LRCAN graduates remain and Knowledge Sharing training monitoring reports ommitted to continued submitted to the PCUby 4nnual Work Plans eaming and training ARCAN graduates (compiled ipportunities annually) Overall ARCAN Project ProgressReports %e presenceof effective adjustments or fine-tuning d&Efeedback loops due to M&Einput SpecialStudies 3) Program Coordination Project disbursements will Project FinancialReports - 24 - ncreaseafter Year One o f iroject implementation Note: Eacho fthe above iutputindicators will be neasuredannually) 'roject ComponentsI nputs: (budgetfor each sroject reports: from Componentsto iub-components: :omponent) htputs) )HealthCarePractitioner JS$ 7.72 million Llanagement information Strongpolitical commitment 'raining iystem; ?om authorities inARCAN :ountries Reportsto ARCAN Steering Zommittee :)MonitoringandEvaluation JS$O.38 million Management information Strongand flexible ndKnowledge Sharing system; nulti-country and nulti-sectoralpartnerships Reportsto ARCAN Steering ire established, as well as Committee .egular M&Eactivities I)Program Coordination JS$1.50million Management information Provision of intensive system; implementation support and :oordination Reportsto ARCAN Steering Committee Jnallocated JS$0.40 million - 25 - Annex 2: Detailed Project Description AFRICA: African RegionalCapacity BuildingNetworkfor HlVlAlDS Prevention,Treatment, and Care The ARCAN project componentswill consist o fthe following: By Component: ProjectComponent 1 US$7.72million - Health carepractitioner training. The projectwill support the development o f short-term, non-diploma, training courses for health care professionals at various levels, includingphysicians, nurses, counselor supervisors, laboratory technicians, and HIV/AIDSprogram managers. All programs will follow the training-oftrainers (TOT) approachinorder to maximize the impact o f this capacity-building project. As part o f its continuing education emphasis, ARCAN will explore options for distance learning to maximize resourcesand to ensure a broader regional approach for sharing experiences and enhancing skills. Details regardingthe training institutions proposed to be contracted as part of ARCAN's Year One ImplementationPlan are presentedinAdditional Annex 14. The Project Operations Manual delineates all other aspectso fthe Year One Training Program. Importantly, while the mission team anticipates a significant demand for capacity buildinginthe areaof antiretroviral treatment, especially duringthe first year o fthe project, itwas acknowledged that the project would also specifically address capacity needs inthe area o f prevention. It is consequently agreedthat the ARCAN Steering Committee would take responsibility o fmaintaining a balance betweentraining opportunities inpreventive, treatment, andprogrammanagement areas to ensure that this project addressesgaps, as deemed appropriate, across the prevention and care continuum. A similar approach will be adoptedto obtain an appropriate balance betweentraining opportunities inmedical areas andthose courses that offer HIV/AIDS-related training from the perspective o f other sectors/areas. ProjectComponent2 US$0.38million - Monitoring and evaluation and knowledgesharing. The proposedproject will prioritize the establishment of a system o fmonitoring and evaluation (M&E) that would enablethe rapid synthesis andsharing o f lessons and also their application to the continued strengthening o fthe program. HIV/AIDScare i s a rapidly changing area o fclinical practice. Routine dissemination o f information and linkages to experts inthe field o f HIV/AIDS are needed. Ifsuch efforts are not afforded a highpriority, efforts to provide training andeducation to health care providers are largely ineffective as individuals are limitedfrom acquiring new information ina fieldundergoing rapid change. ProjectComponent3 US$1.50 million - Program coordination. This component would support the development o f strong coordination betweenARCAN'S institutional and implementing entities, inaddition to the out-sourced project contractors. The major focus o fthis component would involve providingthe PCUwith support to conduct its administrative, fiduciary, and technical responsibilities. - 26 - Annex 3: Estimated Project Costs AFRICA. African Regional Capacity Building Networkfor HlVlAlDS Prevention, Treatment, and Care 2. M&E/ KnowledgeSharing 0.38 0.00 0.38 3. ProjectCoordinatingUnit 1.32 0.17 1.49 Total BaselineCost 8.15 1.45 9.60 PhysicalContingencies 0.00 0.00 0.00 Price Contingencies 0.36 0.04 0.40 Total Proiect Cost: 8.51 1.49 10.00 Total Financing Required ~~ 8.51 1.49 10.00 - Local Foreign Total ProjectCost By Category US$million US$million US$million Goods 0.00 0.07 0.07 Works 0.03 0.00 0.03 Services 2.17 1.46 3.63 Training 5.82 0.00 5.82 Incrementalsalaries 0.06 0.00 0.06 Operatingcosts 0.39 0.00 0.39 Total Project Cost: 8.47 1.53 10.00 Total Financing Required 8.47 1.53 10.00 I Identifiable taxes and duties are 0 (US%m)andthe totalproject cost, netoftaxes, is 10(US$m). Therefore, the project cost sharingratiois 100%oftotal project costnetoftaxes. - 27 - Annex 4: IncrementalCost Analysis AFRICA African Regional Capacity Building Network for HlVlAlDS Prevention, Treatment, and Care NotApplicable Annex 5: Financial Summary AFRICA African Regional Capacity Building Network for HlVlAlDS Prevention, Treatment, and Care Years Ending 2008 (in US$ Millions) [ Year1 1 Year2 I Year3 IYear4 I Year5 1 Year6 IYear 7 Total Financing Required ProjectCosts Investment Costs 1.7 2.4 2.3 3.1 0.0 0.0 0.0 RecurrentCosts 0.1 0.1 0.1 0.1 0.0 0.0 0.0 Total ProjectCosts 1.8 2.5 2.4 3.2 0.0 0.0 0.0 Total Financing 1.8 2.5 2.4 3.2 0.0 0.0 0.0 Financing IBRDllDA 1.8 2.5 2.4 3.2 0.0 0.0 0.0 Government 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Central 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Provincial 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Co-financiers 0.0 0.0 0.0 0.0 0.0 0.0 0.0 User FeeslBeneficiaries 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total ProjectFinancing 1.8 2.5 2.4 3.2 0.0 0.0 -0.0 Mainassumptions: - 29 - Annex 6(A): Procurement Arrangements AFRICA. African Regional Capacity Building Networkfor HlVlAlDS Prevention,Treatment, and Care Procurement General 1. The three participating countries are inthe processo fimplementingprocurement reforms intended to make their national procurement systems more economic, efficient, transparent and accountable. ProcurementProcedures 2. All civil works and goods would be procured in accordance with "Guidelines: Procurement under IBRD Loans and IDA Credits, "May 2004" and the provisions stipulated in the Development GrantAgreement (DGA). All procurement o f consultant services would be done in accordance with "Guidelines: Selection and Employment of Consultants by World Bank Recipients, "May 2004 and the provisions inthe DGA." Bank's Standard Requests for Proposals and evaluation forms would be used where practicable. The general description of various items under differentexpenditure category are describedbelow. For eachcontract to be financedby the Grant, the different procurement methods or consultant selection methods, the need for prequalification, estimated costs, prior review requirements, and time frame are agreed between the Recipient and the Bank project team inthe Procurement Plan. The Procurement Plan will be updated at least semi-annually or as required to reflect the actual project implementation needs and improvements in institutional capacity. These updates will be approved by the Steering Committee. 3. A GeneralProcurement Notice (GPN) is mandatory andmustbepublishedinthe UN Development Business andthe dg Market, and ina national newspaper o fwide circulation as providedunderthe Guidelines, immediately after negotiations. Expressions o f Interest for consultancy services estimated to cost the equivalent o f US$200,000 and above will also be publishedinthe Development Business anddgMarket. Details ofproject costsbyprocurement arrangements are presentedinTable A. 4. Monitoring and evaluation o fprocurement performance will be carried out through annual ex-post procurement audits and regular ad-hoc reviews. Such audits would: (a) verify that the procurement and contracting procedures and processes followed were in accordance with the DGA; (b) review and comment on contract administration and management issues as dealt with by the PCU; (c) review PCU capacity in handling procurement efficiently; and (d) identify improvements inthe procurement process inthe light o fany identifieddeficiencies. - 30 - InstitutionalArrangements 5. A small Project CoordinationUnit(PCU), offive full-timeprofessional staff, will havethe responsibility for the coordination o f all ARCAN activities. Itwill be located inthe Prime Minister's Office. Since the financiallprocurement managementagency (FMA) will be out-sourced, a full time procurement specialist may not be requiredbutthe Projector Coordinator will needto have adequateexperience inprocurement to coordinate the work o fthe FMA. The PCUreports to the Steering Committee, and is responsible for the daily management and coordination o fthe overall program. The PCUwill operate as an autonomous body. The ARCAN Project Coordinator (i.e. the PCUhead) will act ex-officio as Secretary o fthe Steering Committee. The Steering Committee will select the head o f the PCUand the four PCUProgram Officers basedon a competitive process to which candidates from all ARCAN countries are invitedto apply. Whenever possible, the project will contract-out tasksrather than building in-house capacity. As a result, a numbero fkey project management functions will be contracted out by the PCUto independent firms, agencies and/or independent consultants onthe basiso f one-year, renewable, performance-basedcontracts except for the FMAwhich will initially be for two years, inaccordancewith Bank guidelines. This out-sourcing will include financial management, procurement, monitoring and evaluation, the annual audit, and specific technical assessments. The role o fthe Steering Committee inthe procurement process would be to approve the procurement plan. Contract awards will be done by a management committee in accordancewith the Procurement Manual. The Procurement Manual would be approvedby IDA as part o fthe Operational Manual. The Manualwould beready by GrantEffectiveness. ProcurementCapacityAssessment 6. The PCUhas yet to be establishedandhenceits procurement capacity cannot beassessed at the moment. However, procurement o fthe Facilitatorand the Project Coordinator will require some procurement experience on the part o fthe PrimeMinister's staff charged with recruiting these consultants. The two consultants will be employed under the Project PreparationFacility which is beingexecutedby the PMO's Office. There is currently a Senior Supplies Officer (SSO) inthe PMOwho isthe headofthe ProcurementUnitand Secretaryto the MinisterialTender Board. The SSO i s familiar with the Tanzania Procurement Regulations but he has not been involved inBank financed projects before. The SSO will be responsible for carrying out the day-to-day procurement process inaccordance with Bankprocedures. Given his experiencewith the Tanzania Government Regulations which are basedonthe Bank Guidelines, he should be able to managethe process but he may need some assistance from procurement specialist inBank financed projects withinthe PMO's Office suchas TACAIDS. The process o frecruiting the FMA andthe other PCUstaff will start immediately after the Project Coordinator is recruited. Once recruited, the FMA will be responsible for carrying out procurement inaccordance with the Procurement Manual. The FMA would therefore have at least one procurement specialist with qualifications and experience acceptable to the Association. Since some procurement will be done evenbefore the FMA is inplace, the procurement risk inthe project is beingassessed as highand the thresholds for prior review have been set onthe basis o fthis. The risk factor is expectedto decline to mediumafter the appointment o f an FMA. This risk situation will be reassessedafter one year. - 31 - 7. A review ofthe procurement recordkeeping system was made. Althoughthe SSO is familiar with the principles o fprocurement filing there are no filing facilities such as space; cabinets andfolders. These facilities will have to be made available and separate files have to be opened for this project. All the files will be passedto the PCU upon its establishment. ProcurementMethodsfor Works, Goods, and ConsultingAssignments CivilWorks 8. The civil works to be includedinthis project would be small andgenerally o frehabilitation nature such as rehabilitation o fthe PCU office. These works may be procuredunderlump-sum, fixed-price contracts awarded on the basis o f quotations obtained from at least three qualified domestic contractors invitedinwriting to bid. The invitation shall include a detaileddescription o fthe works, including basic specifications, the required completion date, abasic form o f agreementacceptableto IDA, andrelevant drawings where applicable. The awards will be made to the contractors who offer the lowest price quotation for the requiredwork, provided they demonstrate they have the experience andresourcesto complete the contract successfully. Goods 9. The project will finance one vehicle, office equipment and furniture for the PCU. Contracts for these goods and other small quantities o f office supplies and consumable materials which are available locally at economical prices would beprocured through national shopping procedures based onprice quotations from at least three reliable suppliers. Consultancy Services 10. The total cost o fconsultant services andtraining is estimated at US$9.2 million equivalent. The consultancy services requiredwould cover financial managementagency, travel bureau, technical services agency, monitoringand evaluation, PCU staffand audit. All consulting service contracts costing more than US$lOO,OOO equivalent for f m s will be awarded through Quality and Cost Based Selection (QCBS) method. Consulting service contracts estimatedto cost less than US$lOO,OOO for firms may be awarded through the Consultants' Qualifications Selection (CQS) method. For contracts o f a routine nature estimatedto cost less than US$lOO,OOO and where well establishedpractices andstandards exist suchas financial audits, Least-Cost Selection (LCS) methodmay be used. All services o f individual consultantswill be procuredunder individual contracts inaccordance with the provisions o fparagraphs5.1 to 5.3 o f the Guidelines. Although the service contracts will be renewed on annualbasis, depending onthe satisfactory performance o fthe consulting fm,the selection method would be basedon the estimated contract value of the assignmentover the four year period. Most o fthe assignments are therefore expected to bephased. Inexceptional cases, Single-Source selection would be used in accordance with the provisions o fparagraphs3.9 to 3.13. To this effect, services o fthe technical services agency estimated to cost US$330,000 equivalent may, with the Association's prior - 32 - agreement, be procured on single-source basis. 11. To ensure that priority i s givento the identificationo f suitable andqualified national consultants, short-lists for contracts estimated to cost less than US$200,000 or equivalent may be comprised entirely o fnational consultants from the three participating countries providedthat a maximum o ftwo firms come from one country. However, if foreign f m s outside these three countries have expressedinterest, they will not be excluded from consideration. Training 12. Training, the core activity of this project, estimated to cost US$5.8 million (58% o ftotal project cost), will be carried out by carefully selectedinstitutions inthe three countries. The Quality Based Selection (QBS) method will be used for the selection process. OperatingCosts 13. Operating costs which would be financed under the project would beprocured usingthe Government's Procurement Regulations which have beenreviewedand found acceptable to IDA. ProcurementPlanning 14. The Recipient, at appraisal, developed a Procurement Plan for project implementation which provides the basis for the procurement methods. This planhas been agreedbetweenthe Recipient and the Project Team on May 11,2004 and is available at PMO's Office. Itwill also be available inthe Project's database. The Procurement Planwill be updatedinagreementwith the Project Team annually or as required to reflect the actual project implementation needs and improvements ininstitutional capacity. Prior Review 15. Table B provides the prior review thresholds. There will be no contracts subject to prior review for works and goods. All consulting contracts costing US$lOO,OOO equivalent or more for f m s will be subject to IDAprior review. With respect to eachcontract for employment o f individual consultants estimatedto cost the equivalent o f US$50,000 or more, the qualifications, experience, terms o freference and terms o f employment o fthe consultants shall be fknished to IDA for its priorreview.Inaddition, all single-source selectionofconsultantsandany exceptional extensions to non-prior review contracts raising their values to levels equivalent or above the prior review thresholds will be subject to prior review. - 33 - Procurementmethods(TableA) Table A: Project Costs by ProcurementArrangements (US$ millionequivalent) Figures inparenthesesare the amounts to be financed by the Bank Grant. All costs include contingencies. 21Includes civil works and goods to be procuredthrough national shopping, consulting services, training, technical assistanceservices, and incremental operating costs. Note: Figures above are the amounts to be financed by the IDA grant at 100percent. Not Applicable Table B: Thresholds for ProcurementMethodsand Prior Review ExpenditureCategory ContractValue Threshold(US$) 1. Works (small All rehabilitationworks) IFirms US$100,000 andover Lessthan us$100,000 Less than us$100,000 LCS None(Ex-Post) LCSto beusedfor contractso f aroutine naturewhere well establishedpracticesand I standards exist suchas fmancial US$50,000 andover audits - 34 - I /*u I I I Individuals p IICs thanus$so,ooo I II ICs None(Ex-Post) 1All Single-Source All Firmsfindividuals -4. Single-Source Training USS100,OOO andover QBS All Less than us.$100,000 QBS None (EX-Post) Table C OVERALLRISKASSESSMENT - H I G H Referto Paragraphs6 above. PriorReview Thresholds: Works No contracts Goods No contracts Consultancy Services (Firms) US$lOO,OOO equivalent Consultancy Services (Individuals) US$50,000 equivalent Frequencyof procurementsupervisionmissionproposed:Once every 6 months. Inaddition ad-hoc reviewdaudits will be carried out. TableD ActionPlanfor Mitigatingthe HighProcurementRisk - - 35 - Annex 6(B): FinancialManagementand DisbursementArrangements AFRICA: African Regional Capacity Building Network for HIVIAIDS Prevention,Treatment, and Care Financial Manapement 1. Summary ofthe FinancialManagementAssessment Financial management arrangement The project's financial managementcapacity assessmentfor the project was not necessaryfor this project inview o fthe fact that its implementation will be coordinated by a newly established Project Coordinating Unit(PCU), which will out source the financial managementand procurement service to a Financial Management and Procurement Agent (FMA). Beinga sub-regional project involving three countries, it is prudent for the management o fthe project to be free o f any direct or indirect o f government financialprocedures and control. The financial managementpolicies, regulations andprocedures governing project finances have been documented inthe Project Financial and Procurement ProceduresManual (PFPPM) specifically prepared(prior to effectiveness) to meet the operational needs ofthe project. The Project Coordinator (PC) as the chief executive officer o f the project will be assistedto manage the financial andprocurement affairs o fthe project by one o fthe Program Offices (PO-F) with appropriate financial management qualification, competence and experience, as detailedinthe Terms o f Reference (TOR). The PO-F will be the technical officer inthe PCUresponsible for supervising the FMA andadvising the PC on all financial andprocurement mattersunderthe project. The detailed structure o fthe PCUi s documented inthe PFPPM. Similarly, the TOR will also contain detailed areas o f responsibilities for the FMA.An annual performance basedcontract will be enteredinto betweenthe PCUandthe FMA, which will spell out the obligations and deliverables o fthe FMA as well as the consideration (cost) for the service. The TOR for the FMA will specify the numberofkey staff andtheir required qualification, periodo frelevant experience andareas ofcompetence. There will regular interaction betweenPCU andFMAinthe normal course o fproject implementation. The primaryresponsibility ofthe FMA will be disbursement o f project fhds to approved institutions deliveringthe courses inthe sub-region, contracted service providers, selectedtrainee from the member countries attending courses and other suppliers o f miscellaneous goods for use by PCU. The FMA will be reporting to the PCU on the financial and procurement status as well the physical implementation progress o fthe project on a quarterly basis, usingthe Financial MonitoringReporting (FMR) formats illustrated inthe PFPPM Flow of Funds: The project will be financed with the IDA funds from the Multi-Country AIDS Program (MAP) Grant. The grant funds will be maintained inWorld Bank, Washington DC inthe Grant Account for the project. The project will have the necessary capacity to disburse Grant proceedsusingthe report based disbursement approach (Financial Monitoring Reports) from the outset on becoming effective. To facilitate the first withdrawal o f Grant proceeds to support project implementation, the PCU will open a Special Account to be maintained in U S Dollars in a commercial bank satisfactory to IDA and preferably inthe host country (Tanzania). Soon after Grant effectiveness, PCU will submit to IDA a withdrawal application (Form 1903-B) for the initial deposit o f the - 36 - authorized Special Account advance, based on the projected plan o f activities (work plan and budget) and a cash forecast for the initial six months period. All subsequent withdrawal o f Grant proceeds shall be triggered by approved projected plan o f activities and cash forecast constituting the FMR to be submitted to IDA within 45 days after the end o f each quarter. Inaddition to the PCU accessing the Grant proceeds through the Special Account, PCU will also have the opportunity to used Direct Payment method o f disbursement where appropriate. However, this method will be rarely usedunderthis project inview o fthe nature o fthe project. To facilitate smooth implementation o f the project, the project will have a Project Account maintained inlocal currency (Tanzanian Shilling) ina commercial bank acceptable to IDA which will be managed by the FMA and used for the purpose o f meeting local eligible project expenditures, mainly relating to operating costs. Inthis regard, the PCU will transfer funds on a need basis from the Special Account to the Project Account in accordance with agreed procedures, and cashforecast for a givenperiod. This will ensure that the value o f project funds i s not exposed to the risk o f exchange loss due to erratic exchange rates for the U S Dollar. Project funds neededto settle any eligibleexpenditures incurredunder the projectwill be disbursedbythe FMA either from the Special Account ifthe payment is to a foreign provider of services or goods or from the Project Account in local currency to national supplier or provider o f services in compliance with business practice and laws o f the host country. The FMA will periodically (quarterly) compile all the expenditure data and information under the project and prepare FMRs at end o f each quarter and submit the FMRto the PCU to review and authorize the FMR and the accompanying withdrawal application supported by the relevant cash forecast for the next period o f six months all o f which are submitted to IDA to trigger further flow o f funds to the project, The low chart below illustrates the channel funds will follow as well as the information flow. The implementation responsibility of the ARCAN project is vested in the Steering Committee (SC) with the support o f the PCU which has contracted the FMA to provide the technical support inthe managementof ARCAN project finances. Based on this framework, the PCU will work closely and in collaboration with the FMA to ensure the FMA maintains an adequate accounting system that will provide reliable and correct financial information on the project in a timely manner. This services of the FMA meeting this requirement is therefore a critical element inthe financial management arrangement infblfilment o f the fiduciary requirement under OP/BP 10.02. The FMA will therefore use a suitable accounting software for the project that will facilitate timely reporting of project activities at end of each quarter. To this end, the system will be designedwith a view to being capable o f managing the project data and information and generate the FMRs and any other reports required. Indesigningthe accounting system for the project, care will be takento ensure it remains simple and practical and will be expected to interface with the informationmanagementsystem inthe PCU. Extra effort will also be made by the PCUto linkthe financial information management system with the Monitoring and Evaluation system to draw synergy in the two systems which will be o f tremendous value to the PC and SC for decision making. The PCU will also be responsible for overseeing the work o f the FMA and in collaboration with the FMA, ensure project annual financial statements are prepared andpresented before the Audit Sub-committee, for review and sanctioning inreadiness for audit. The PCU will with the support - 37 - of the Audit Sub-committee ensure the SC complies with its fiduciary responsibility of submitting the audited annual project financial statements to the IDA in a timely manner l l f i l m e n t o f the Financial Covenant on audit set out in Article IV of the Development Grant Agreement (DGA) for the project. AdministrativeandFinancialFlows \G IDA Disbursements I Division IDADisbursements Division aoolication statements [SpecialAccount 1 replenishments Ministry L Submission o f Finance I O f )I 1 PCU Special Account a FMAProject 623 withdrawal Institutions (consultants, overheads, etc.) 2. Audit Arrangements The SC with the assistance of PCU shall appoint a qualified andcompetent Auditor for the project, who shall be engagedannually to undertake the audit ofthe project inaccordancewith the Intemational StandardsonAudit. The PCUwill prepare TOR satisfactory to IDA for the auditor prior to effectiveness. -38 - The SC with the supportof the PCUwill ensure that audited annual project financial statementsto the IDAnot later thansix months after the endofthe financial year to which theyrelate incompliance with the FinancialCovenant on audit set out inArticle IV o fthe Development Grant Agreement (DGA) for the project. 3. DisbursementArrangements Use of Financial Management Reports (FMRs) This beinga sub-regional project, inwhich case most o fthe transactionswill be inrelationto training o ftrainers courses mounted by selectedinstitutions inthe three ARCAN countries, majority o fpayments will be disbursed inforeign currency against contracts enteredinto by the institutions and the PCU. Iti s therefore envisagedthat funds inthe Special Account will largely be used to pay cost o ftraining deliveredfrom outside the UnitedRepublic o f Tanzania. Payment o f local suppliers for general services and few goods as well as minor civil work costs, will be in local currency, through the Project Account. Iti s highlyunlikely that use o f Direct Payment methodandor Special Commitments will beneededunder the project. The use o f FMRsunder the project will require the FMA andthe PCU staff to be trained on the concept and nature o f FMRs. To this end, IDA will organize anddeliver the training as soon as the PCU staff and the FMA staff are inplace, preferably at a time close to Grant effectiveness, to facilitate immediate application o fthe acquired skills. Capacity buildingsupport from IDA will continue as neededeven after effectiveness, to help FMA and PCUperfect their skills. FMR relateddisbursementutilizes h d s inthe Special Account. The authorized amount o fthe Special Account advance will bebasedonthe projected planned activities and cashforecast for the initial six months ofproject implementation after the Grantbecomes effective. However, the authorized amount o fthe advance will be subject to a maximum o f 20 percent o fthe Grant amount in accordance with DisbursementPolicy governing use o f FMRsfor disbursement. Allocation of grant proceeds(Table C) The projectwill disburse Grant processunderthe reportbased approach, FMR as stated above. The disbursementprofile is basedon estimated levelof funds requiredeachyear to meetproject needs duringthe implementation periodo f four years. The profile hasbeen estimatedwithin the expectation that the Grant will be declared effective inthe second quarter o fFY 2005 andthat the implementation will follow the planned schedule andend intime after the four year period. A table showing the allocation o fthe IDA grant is provided below. - 39 - Table C: Allocation of Grant Proceeds ExpenditureCategory IAmount in US$milllon 1 FinancingPercentage 1 1. Goods 0.06 100 2. Works 0.03 100 3. Services 3.30 100 4. Training 5.24 100 5. IncrementalSalaries 0.06 100 6. ODeratinP Cost 0.35 100 7. PPFRefinancing 0.00 100 8. Unallocated 0.96 Total ProjectCostswith Bank 10.00 Financing Total 10.00 All countries have providedletters indicating that ARCAN Project expenditures would be tax-exemptinaccordancewithnational laws. Withregard to fuel and lubricants under category 6 (operating costs), the Government o f Tanzania advised that there would also be a tax exemption. The project would pay the full 100percent cost o ffuel and lubricants andwould bereimbursedby the Ministryo fFinance upon submission o fthe relevant documentation The Government o fTanzania advised that the PCUstaffwould beregarded as consultants to the project as per standardTanzania protocol. Therefore, there would be no tax implications on salaries. Resource Management Project resources will not be allocated separately to each of the countries (i.e. no separate Kenya subcomponent, Ethiopia subcomponent, etc.). However, it i s envisaged that benefits from the project will accrue equitably to nominated students coming from the member countries, who will attend the courses and learningeventsunderthe project. Counterpart Funding The design o f this project does not call for cash contributions from the different governments. However, as per Bank standard procedures, the governments are providing in-kindcontributions to the project in the provision o f staff time (of the involved public sector health professionals involved as trainees), the use o f existing training facilities, and national-level coordination and dissemination o f informationwithinthe M O HandNACC structures. During project preparation, the Bank discussed with the respective Ministries of Finance the subject o ftaxes and duties on expendituresto be incurred under the grant (Note: Taxes envisaged for Kenya and Ethiopia refer to taxes imposed on ARCAN contracts with training institutions - 4 0 - only; while taxes envisaged for Tanzania, where the PCU is physically located, refer to taxes imposed on the purchase o f goods and services for the PCU, inaddition to ARCAN contracts to Tanzanian training institutions). The Government o f Tanzania has clearly indicated that ARCAN expenditures for goods and services, as well as for oil and lubricants, would be tax exempted. Similarly, both the Governments o f Ethiopia and Kenya indicated that, as in the case o f the national M A P projects, contracts with training institutions will be tax exempted. Based on the above, the grant agreement would indicate that the project would be tax exempted and that the Schedule I(disbursement schedule) should be articulated to reflect 100 percent Bank financing throughout. Financial Risks Risk Rating I MitigatinpMeasures VIA selectedfails to deliver i.FMAwill have anannual rvices effectively and L performancebased 'fciently as expected contract which provides an exit strategy inthe event performance i s unsatisfactory. A new FMA will be selected. Meanwhile, the Program Officer for finance inthe PCUwill play stop-gap role. ii.FMA andPCU staffwill receive training on FMRs in clinics to be facilitated by IDA iii.Projectlaunchworkshopwill helpclarify roles andhelp to clarify issues specific to funding o fIDA supported projects Use o f Grant proceeds for L i.Quality o f PCUi s o fhigh ineligibleexpenditures integrity and solid qualification andexperience. All PCUstaff will have annualperformance basedcontract, which allow for termination where performance i s unsatisfactory or inappropriate. ii.Use o f FMAwill substantially minimize opportunity for misusc o f funds iii.Review o fFMRson quarter11 basis willhelp flash out any misuse o fproject funds and - 4 1- ineligible expendituresandallow corrective measuresto be taken at an early stage at anearly stage. Audit Reports are delayed L i.Private independent and competent auditor will be engaged ii.AuditSub-committee will be inplace andactive from inceptionofthe project to supervisefinancial affairs o fthe project andoversee the audit process andimplementation of auditor's recommendations in the management letter - 42 - Annex 7: Project Processing Schedule AFRICA African Regional Capacity Building Networkfor HlVlAlDS Prevention,Treatment, and Care ProjectSchedule Planned Actual ITimetaken to preparethe project(months) II 12 1I 10 I ~ First Bank mission (identification) 0611112003 0611112003 Appraisal mission departure 04/19/2004 04/19/2004 INegotiations I 05/07/2004 I 05/07/2004 I Planned Date of Effectiveness 12131I2004 Prepared by: Representatives from the NationalHIV/AIDSCouncildCommissions of Tanzania, Kenya, and Ethiopia Representatives from the Ministry of Health, National HIV/AIDSControl Programs of Tanzania, Kenya, and Ethiopia Representatives from the Ministry o f Finance of Tanzania, Kenya, andEthiopia Representatives from National HIV/AIDSCivil Society Organizations of Tanzania, Kenya, and Ethiopia Office ofthe Prime Minister, United Republic of Tanzania Preparationassistance: UNAIDS (Technical assistance); WHO (Technical assistance); USAID (Technical assistance); CDC/GAP (Technical assistance) FI Bank staff who worked on the projecl included: Name Sheila Dutta Senior Health SpecialistlTask Team Leader (AFTHl) LuigideFelice Financial Management Specialist (Consultant) JohnNyaga Senior Financial Management Specialist (AFTHV) A. Waafas Ofosu-Amaah Senior Gender Specialist (PRMGE) Susan stout LeadMonitoring& Evaluation Specialist (HDNGA) DirkPrevoo Operations Officer (AFTR2) Elizabeth Lule Adviser (HDNHE) Albertus Voetberg Lead Health Specialist (AFTHl) & TTL, Kenya M A P Project Emmanuel Malangalila Senior Health Specialist (AFTHl) & TTL, Tanzania M A P Project Anwar Bach-Baouab Lead Operations Officer (AFTH3) & TTL, Ethiopia M A P Project GebreselassieOkubagzhi Senior Health Specialist (AFTH3) Karen Hudes Senior Counsel (LEGAF) -43- Pascale Dubois Senior Counsel (LEGAF) Elizabeth Adu Ieputy General Counsel, Operations (LEGVP) JohnCameron ?inancia1Management Specialist (Consultant) Abbas Kesseba hstitutionalArrangement Specialist (Consultant) Steve Gaginis Finance Officer (LOAG2) Rogati Kayani LeadProcurementSpecialist(AFTPC) Mercy Sabai Senior Financial ManagementSpecialist (AFTFM) DonaldMneney Procurement Analyst (AFTPC) KelvinBillinghurst Monitoring& Evaluation Specialist (Consultant) Keith Hansen Manager, ACTafiica (AFTHV) Shiyan Chao Senior Health Economist (ECSHD) Cassandrade Souza OperationsAnalyst (AFTHV) Therese Cruz ProgramAssistant (AFTHV) Nadege Thadey ProgramAssistant (AFTTR) EvelyneKapya ProgramAssistant (AFC04) Peer Reviewers: Chris Walker Lead Specialist (AFTH1) Bachir Souhlal LeadSocial Development Specialist (MNSRE) Debrework Zewdie Director, GlobalAIDS Unit(HDNGA) JonathanBrown Operations Adviser (AFTQK) Developmentpartners involved inproject preparation: Jacob Gayle (Senior Technical Adviser, CDC/GAP on secondmentto UNAIDS, Geneva) KristanSchoultz (UNAIDS Country Coordinator, Kenya) Bruce Waring (Technical Network Development Adviser, UNAIDS,Geneva) Bernadette Olowo-Freers (UNAIDS Country Coordinator, Tanzania) Matshidiso Moeti(Regional HIV/AIDS Adviser, WHO/AFRO, Harare) Catherine McGnney (Team Leader, Training Activities, CDC/GAP, Atlanta) MaryPatKieffer (Regional PMTCT Adviser, USAIDREDSO, Nairobi). - 44 - Annex 8: Documents in the Project File* AFRICA African Regional Capacity Building Network for HlVlAlDS Prevention, Treatment, and Care A. ProjectImplementationPlan Draft datedApril 30,2004 B. Bank Staff Assessments Economic Assessment of MAP Projects August 2000 Project Integrated Safeguards Data Sheet January 2003 - - C. Other World Bank ProjectConcept Document June 2003 - World Bank PreparationMissionBack-to-Office Report World Bank PreparationMissionBack-to-Office Report October 2003 -- June2003 World BankPre-Appraisal MissionBack-to-Office Report - December2003 World BankPreparationMissionBack-to-Office Report - March2003 World Bank Appraisal MissionAide-Mkmoire - May 2004 ProjectFinancial ManagementManual - draft - April 2003 Project Monitoringand Evaluation Manual - draft - April 2003 TanzaniaNationalMulti-Sectoral Strategic Framework for HIV/AIDS Tanzania Ministryof Health, NationalHIV/AIDS Strategic Plan Zanzibar HIV/AIDS StrategicPlan KenyaNationalMulti-Sectoral Strategic Framework for HIV/AIDS Ethiopia National Multi-Sectoral Strategic Framework for HIV/AIDS TechnicalNote on the Use of Antiretrovirals inTanzania Guidelinesonthe Use ofAntiretrovirals inKenya *Including electronic files -45- Annex 9: Statementof Loans and Credits AFRICA: African RegionalCapacity BuildingNetworkfor HlVlAlDSPrevention,Treatment, and Care 19-Jul-2004 Differencebetween expected and actual OriginalAmount in US$ Millions disbursements' Project ID FY Purpose IBRD IDA GEF Cancel. Undisb. Orig Frm Rev'd PO74020 2004 PublicSectorCapacityBuildingProgram 0.00 100.00 0.00 0.00 96.33 0.00 0.00 PO76735 2004 Water Supplyand SanitationProject 0.00 75.00 0.00 0.00 96.05 0.00 0.00 PO44613 2003 ET RoadSector DevelopmentProgramII 0.00 0.00 0.00 0.00 131.61 1.68 0.00 PO49395 2003 ETHIOPIA-ENERGY ACCESS 0.00 132.70 0.00 0.00 145.40 49.72 0.00 PO50938 2003 CapacityBuildingfor Dec.Serv.Del. 0.00 26.20 0.00 0.00 28.87 15.45 0.00 PO75915 2003 ET PastoralCommunityDevelopment 0.00 0.00 0.00 0.00 29.44 0.23 0.00 PO81773 2003 EMERGENCYDROUGHTRECOVERYPROJECT 0.00 0.00 0.00 0.00 15.95 1.48 0.00 PO57770 2002 ET CULTURALHERITAGE 0.00 5.00 0.00 0.00 5.38 1.56 0.00 PO50383 2002 Ethiopia:FOODSECURITYPROJECT 0.00 85.00 0.00 0.00 91.77 *7.98 0.00 PO73196 2001 ET:Demobilizationand ReintegrationProj 0.00 170.60 0.00 0.00 34.14 27.34 0.00 PO69686 2001 MultisectoralHIV/AIDS 0.00 59.70 0.00 0.00 29.42 44.09 0.00 PO69063 2001 AFTKL: ETGLOBALDISTANCELEARNING 0.00 4.90 0.00 3.14 2.13 5.24 -0.02 PO67084 2001 EMERGENCYRECOVERYAND REHAB. PROJECl 0.00 230.00 0.00 0.00 90.21 70.07 0.00 PO35147 2001 ET C0NSERV.a SUSTAIN. USE MEDIC.PLAN 0.00 0.00 1.a0 0.02 1.55 1.20 0.00 PO50342 2001 Women Dev. Initiatives 0.00 5.00 0.00 0.00 3.42 1.71 0.91 PO52315 2001 ET:CONSERVATIONOF MEDICINALPLANTS 0.00 2.60 0.00 0.00 1.90 -0.95 0.00 PO00756 1999 HealthSector Dev. 0.00 100.00 0.00 0.00 21.61 19.22 0.00 PO00755 1998 ETHIOPIAROADSEC. DEV. PROG. 0.00 309.20 0.00 0.00 47.27 48.71 42.32 PO00736 1998 ET ENERGYII 0.00 200.00 0.00 0.00 16.72 20.44 0.00 PO00733 1998 ET:AG. RESEARCH TRAINING a 0.00 60.00 0.00 0.00 16.55 14.77 0.00 PO00771 1996 Social Rehab.(ESRDFI) 0.00 120.00 0.00 11.48 27.63 20.04 28.18 Total: 0.00 1685.90 1.80 14.64 935.77 334.02 71.39 ETHIOPIA STATEMENT OF IFC's HeldandDisbursedPortfolio MU 2004 - InMillionsUS Dollars Committed Disbursed IFC IFC FYApproval Company Loan Equity Quasi Partic Loan Equity Quasi Partic TotalPortfolio: 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Approvals Pending Commitment FY Approval Company Loan Equity Quasi Partic Total Pending Commitment: 0.00 0.00 0.00 0.00 -46- Kenya: Statement of Loans and Credits 30-Mar-2004 Difference between exDected and actual Original Amount in US$ Millions disbursements' Project ID FY Purpose IBRD IDA SF GEF Cancel. Undisb. Orig Frm Rev'd PO78209 2004 DevelopmentLearningCentre LIL - 0.00 0.00 0.00 0.00 0.00 2.95 0.00 0.00 PO78058 2003 KenyaArid LandsII 0.00 60.00 0.00 0.00 0.00 56.99 1.43 0.00 PO82376 2003 Free PrimaryEduc.Support 0.00 0.00 0.00 0.00 0.00 22.83 4.43 0.00 PO66490 2002 PUB.SEC.MGMT.TA 0.00 15.00 0.00 0.00 0.00 9.11 9.98 0.00 PO69501 2001 Kenya Economic8 PublicSector Reform 0.00 150.00 0.00 0.00 0.00 55.40 39.94 28.65 PO66486 2001 Decentr. Reprcd.Health8 HIWAIDS 0.00 50.00 0.00 0.00 0.00 35.63 19.97 7.16 PO70718 7.001 RegionalTrade Fac. Proj.-Kenya 0.00 25.00 0.00 0.00 0.00 14.78 4.06 0.00 PO70920 2001 HIV/AIDSDisasterResp.(Umbrella) 0.00 50.00 0.00 0.00 0.00 29.74 13.99 0.00 PO46871 1997 KE-LakeVictoriaEnv. (GEF) 0.00 9.80 0.00 9.80 0.00 5.45 5.61 0.00 PO34180 1997 EarlyChildhwdDev. 0.00 27.60 0.00 0.00 0.00 8.67 10.05 9.32 PO01344 1997 KE ENERGYSECTORREFORM 0.00 125.00 0.00 0.00 0.00 24.82 32.98 0.00 PO01319 1996 URBANTRANSPORT 0.00 115.00 0.00 0.00 0.00 25.54 35.28 0.00 PO35691 1996 KENYA NAIROBIMOMBASAROAD - 0.00 50.00 0.00 0.00 0.00 5.61 9.60 8.78 Total: 0.00 677.60 0.00 9.80 0.00 297.53 187.33 53.93 STATEMENT OF IFC's HeldandDisbursedPortfolio Feb29 2004 - InMillionsUS Dollars Committed Disbursed IFC IFC FY Approval Company Loan Equity Quasi Partic Loan Equity Quasi Partic 1972 TPS (Kenya) 0.00 0.04 0.00 0.00 0.00 0.04 0.00 0.00 2000 Tsavo Power 17.04 0.83 1.17 19.25 17.04 0.83 1.17 19.25 2001 AEF 2000 Indust 1.53 0.00 0.00 0.00 1.53 0.00 0.00 0.00 2000 AEF AAA Growers 0.54 0.00 0.00 0.00 0.54 0.00 0.00 0.00 1998 AEF AAR Clinic 0.00 0.50 0.00 0.00 0.00 0.50 0.00 0.00 1997 AEF Ceres 0.93 0.00 0.00 0.00 0.93 0.00 0.00 0.00 1997 AEF DerasLtd. 1.oo 0.00 0.00 0.00 1.oo 0.00 0.00 0.00 1996 AEF Equitea 0.3 1 0.12 0.00 0.00 0.3 1 0.12 0.00 0.00 2000 AEF Lesiolo 2.50 0.00 0.00 0.00 2.50 0.00 0.00 0.00 1998 AEF Locland 0.28 0.00 0.00 0.00 0.28 0.00 0.00 0.00 2000 AEF Magana 1.26 0.00 0.00 0.00 1.26 0.00 0.00 0.00 1997 AEF Makini 0.18 0.00 0.00 0.00 0.18 0.00 0.00 0.00 1997 AEF Redhill Flrs 0.28 0.00 0.00 0.00 0.28 0.00 0.00 0.00 1999 ANSPAR 1.41 0.67 0.00 0.00 1.41 0.67 0.00 0.00 1980 DBK 0.00 1.31 0.00 0.00 0.00 1.31 0.00 0.00 1982 DiamondTrust 0.00 0.80 0.00 0.00 0.00 0.80 0.00 0.00 1998 GBHL 2.33 0.00 3.00 0.00 2.33 0.00 3.00 0.00 2001 GapcoKenya 15.00 0.00 0.00 0.00 10.00 0.00 0.00 0.00 1982101103 IPSO() 0.00 4.50 0.00 0.00 0.00 0.69 0.00 0.00 1994 IPSO()-Allpack 0.00 0.36 0.00 0.00 0.00 0.36 0.00 0.00 1996199 IPS(K)-Fngoken 0.00 0.06 0.00 0.00 0.00 0.06 0.00 0.00 2003 IPSO()-PremFood 0.00 0.11 0.00 0.00 0.00 0.11 0.00 0.00 1983191 IntlHotels-Ken 4.29 0.00 0.00 0.00 4.29 0.00 0.00 0.00 2000 K-RepBank 0.00 0.43 0.00 0.00 0.00 0.12 0.00 0.00 1994196 Kenair 15.00 0.00 0.00 0.00 6.41 0.00 0.00 0.00 47 - LIK 0.00 0.03 0.00 0.00 0.00 0.03 0.00 0.00 Mabati 5.00 0.00 4.50 0.00 5.00 0.00 4.50 0.00 Panafrican 12.64 0.00 0.00 0.00 12.64 0.00 0.00 0.00 Total Portfolio: 81.52 9.76 8.67 19.25 67.93 5.64 8.67 19.25 Approvals PendingCommitment FYApproval Company Loan Equity Quasi Partic 2003 Kenair 0.00 0.00 0.00 0.00 2004 Magadi Soda Co. 0.02 0.00 0.00 0.00 Total PendingCommitment: 0.02 0.00 0.00 0.00 Tanzania: Statement of Loans and Credits 30-Mar-2004 Differencebetweenexpected and actual OriginalAmount in US$ Millions disbursements' Project ID FY Purpose IBRD IDA SF GEF Cancel. Undisb. Orig Frm Rev'd PO71014 2004 HWAIDS 0.00 0.00 0.00 0.00 0.00 72.65 -1.59 0.00 PO82335 2004 SecondHealthSector Dev. 0.00 40.00 0.00 0.00 0.00 67.60 4.78 0.00 PO59073 2003 DARWATERSUP 8SANITATION 0.00 61.50 0.00 0.00 0.00 58.27 2.72 0.00 PO67103 2003 Partic.Agr. Dev. and EmpowermentPro]. 0.00 56.58 0.00 0.00 0.00 59.14 2.15 0.00 PO47762 2002 RURALWATER SUPPLY 0.00 26.00 0.00 0.00 0.00 27.89 7.69 0.00 PO58706 2002 TZ ForestConservationand Management 0.00 31.10 0.00 0.00 0.00 34.02 7.57 0.00 PO71012 2002 PrimaryEduc. Dev. Program 0.00 150.00 0.00 0.00 0.00 55.65 27.37 0.00 PO73397 2002 LowerKihansiEnvironmentalManagement 0.00 6.30 0.00 0.00 0.00 5.20 1.68 0.00 PO02797 2002 TZ SONGOSONGO GAS DEV. 8 POWER GEN. 0.00 183.00 0.00 0.00 0.00 123.44 86.88 0.00 PO65372 2001 SocialActionFund 0.00 60.00 0.00 0.00 0.00 9.40 -11.83 0.00 PO69982 2001 RegionalTrade Fac. Proj. -Tanzania 0.00 15.00 0.00 0.00 0.00 9.04 2.35 0.00 PO60833 2000 PUBLICSERV REF PROG 0.00 412 0 0.00 0.00 0.00 26.07 -14.79 0.00 PO49838 2000 PRIVATIZATION 0.00 45.90 0.00 0.00 0.00 30.73 24.60 0.00 PO50441 2000 RURAL8MICROFINSVC 0.00 2.00 0.00 0.00 0.00 1.oo 0.93 0.13 PO02822 2000 TANZANiAPSAC i 0.00 190.00 0.00 0.00 0.00 43.74 -151.60 0.00 PO57187 2000 FIDPII 0.00 27.50 0.00 0.00 0.00 13.85 12.28 0.81 PO47761 1999 TAX ADMiNiSTRATlON 0.00 40.00 0.00 0.00 0.00 21.16 17.15 3.04 PO02804 1998 AGRlC RESEARCH 0.00 21.80 0.00 0.00 0.00 0.87 1.20 0.00 PO02789 1998 HumanRes. Dev. I 0.00 20.90 0.00 0.00 0.00 0.91 -0.02 0.00 PO46837 1997 TZLAKE VICTORIA ENV. (IDA) 0.00 10.10 0.00 0.00 0.00 1.49 -3.31 0.00 PO38570 1997 TZ:RIVERBASINMGM.SMAL 0.00 26.30 0.00 0.00 0.00 I.74 3.46 0.00 PO02758 1996 URBANSECTOR REHAB 0.00 105.00 0.00 0.00 0.00 8.21 14.39 0.00 PO02770 1994 TZ ROADSII 0.00 170.20 0.00 0.00 63.53 25.10 93.46 34.56 Total: 0.00 1,330.38 0.00 0.00 63.53 699.18 127.53 38 - 48 - STATEMENT OF IFC's HeldandDisbursedPortfolio Feb 29 - 2004 InMillionsUS Dollars Committed Disbursed IFC IFC FYApproval Company Loan Equity Quasi Partic Loan Equity Quasi Partic 1997 AEF Aquva Ginner 0.68 0.00 0.00 0.00 0.68 0.00 0.00 0.00 1998 AEF Blue Bay 1.24 0.00 0.00 0.00 1.24 0.00 0.00 0.00 2001 AEF BoundaryHi1 0.20 0.00 0.00 0.00 0.20 0.00 0.00 0.00 1996 AEF Contiflora 0.07 0.00 0.00 0.00 0.07 0.00 0.00 0.00 1998 AEF Maji Masafi 0.18 0.00 0.00 0.00 0.18 0.00 0.00 0.00 1994 AEF Moshi Lthr 0.00 0.19 0.00 0.00 0.00 0.19 0.00 0.00 2000 AEF Zan Safari 0.52 0.00 0.00 0.00 0.52 0.00 0.00 0.00 2002 Exim Bank 2.50 0.00 1.00 0.00 1.50 0.00 1.00 0.00 1996 IHP 0.35 0.60 0.00 0.00 0.35 0.60 0.00 0.00 2000 IOH 2.50 0.00 0.00 0.00 2.50 0.00 0.00 0.00 2000 NBC 0.00 10.00 0.00 0.00 0.00 3.44 0.00 0.00 1993 TPS (Tanzania) 4.38 0.87 1.04 0.00 4.38 0.87 1.04 0.00 1991/97 TPS Zanzibar 0.00 0.03 0.00 0.00 0.00 0.03 0.00 0.00 1994 Tanzania Brewery 0.00 6.00 0.00 0.00 0.00 6.00 0.00 0.00 Total Portfolio: 12.62 17.69 2.04 0.00 11.62 11.13 2.04 0.00 Approvals Pending Commitment ~~ FYApproval Company Loan Equity Quasi Partic Total PendingCommitment: 0.00 0.00 0.00 0.00 -49- Annex IO: Country at a Glance AFRICA African Regional Capacity Building Network for HlVlAlDS Prevention,Treatment, and Care Kenya Sub- POVERTYand SOCIAL Saharan Low- Kenya Africa Income Developmentdiamond' 2002 Population,mid-year (millions) 31.3 686 2,495 Lfe expectancy GNI percapita (Atlas method,US$) 360 450 430 GNI (Atlas method, US5billions) 11.3 306 1,072 T Population(%) 2.3 2.4 1.9 Laborforce I%) 2.9 2.5 2.3 Gross primary Mostrecent estimate(latestyear available,1996-02) enrollment Poverty(% ofpopulationbelownationalpovertyline) Urbanpopulation(% oftotalpopulation) 35 33 30 Lifeexpectancyat birth (years) 46 46 59 I Infantmortality (per 1.000 livebirthsJ 80 105 61 Childmalnutrition(% ofchildmnunder5J 22 Accessto improvedwatersource Accessto an improvedwatersource (% ofpopulation) 57 58 76 Illiteracy(% ofpopulationage 15+) 16 37 37 Gross primalyenrollment (% ofschool-agepopulationJ 94 86 95 Male 95 92 103 -Kenya Low-incomegroup Female 93 60 87 1982 1992 2001 002 Esonomlcratios. GDP (US5 billions) 6.4 8.0 GrossdomesticInvestmentiGDP 16.2 137 Exportsof goodsand serviceslGDP 25.0 26.9 Trade GrossdomesticsavingslGDP 14.5 13.7 Gross nationalsavingslGDP 11.6 9.7 Currentaccount balancelGDP -4.7 -2.3 .. Domestic Interestpavrnents/GDP 1.3 2.5 0.7 0.5 savlngs l+l Investment TotaldebVGDP 10.0 68.2 49.5 51.1 Totaldebt servicelexports 14.5 31.1 13.9 9.8 Presentvalue of debtiGDP .. 36.1 Presentvalue of debtiexports .. 146.6 Indebtedness 1982-92 1992.02 2001 2002 2002-06 (average annualgrowth) GDP 4.4 2.1 1.1 1.8 3.5 -Kenya -Low-incomegroup GDP percapita 1.0 -0.4 -1.0 -0.2 1.6 Privateconsumption 67.1 70.2 79.0 61.1 .in1 Generalgovernmentconsumption 18.4 16.1 16.6 10.2 Importsof goods and services -OD1 b G D P (average annualgrowth) Agriculture 2.7 1.6 1.2 1.0 2o Indusby 4.3 1.6 0.7 1.4 IO Manufacturing 5.1 1.8 0.6 3.5 Services 4.9 2.9 1.3 3.6 I PrivateconsumDtion 5.1 2.2 -4.4 0.0 -'O Generalgovernmentconsumption 3.6 8.6 4.3 Grossdomestic investment 1.5 4.3 2.3 3.8 -Exports b l m p o r i s Importsof goods and services 5.7 5.5 -1.2 2.9 *The diamonds show four kev indicatorsin the countw lin bold) comoaredwith its income-amuoaveraae. If data are missina.the diamondwill be inmmolete - 50 - PRICESand GOVERNMENT FINANCE 1982 1992 2001 2002 Domestlcprlces lnflatlon(%) I (% change) T Consumerprices 27.3 3.9 5.0 Implicit GDP deflator 11.7 17.5 11.3 4.9 Governmentflnance I (% of GDP, includescumnfgrants) Currentrevenue 25.1 27.5 22.5 22.4 97 98 99 00 01 Current budgetbalance -1.5 1.3 1.5 2.4 Overall surplus/deficit -10.2 -3.3 4 . 9 4.9 W G D P d e f l a t o r ' I O I C P I TRADE I 1982 1992 2001 2002 (US$ millions) Exportand import levels(US$mill.) Total exports(fob) 894 1,013 1,732 1,742 Fuel 223 69 115 101 Coffee 227 128 88 97 Manufactures 107 144 274 310 Total imports (cif) 1,415 1.866 3,182 3,137 Food 83 156 290 300 Fuel and enemy 523 412 810 809 Capital goods 250 411 756 803 Export priceindex (1995=100) 77 76 74 74 98 97 98 89 00 01 lmporipriceindex (1995=100) 112 91 100 104 mExpotts .Imports I Terms of trade (1995=100) 69 84 74 71 O2 BALANCEof PAYMENTS 1982 1992 2001 2002 (US$ millions) Currentaccountbalanceto GDP (%) Exportsof goods and services 1,715 2,149 2,966 3,001 lmporisof goods and services 2,030 2,152 3,939 3,850 Resourcebalance -315 -3 -973 -848 Net income -254 -355 -80 -70 Net current transfers 83 68 781 576 Currentaccountbalance -305 -180 -318 Financing items (net) 139 255 509 Changes in net reserves 167 -75 -191 256 Memo: Reservesincludinggold (US$ millions) 248 182 1,097 1,174 Conversion rate (DEC, /ocal/US$) 10.9 32.2 76.6 78.7 EXTERNALDEBT and RESOURCEFLOWS 1982 1992 2001 2002 (US$ millions) Compoaltlonof2002 debt (US$ mill.) Total debt outstanding and disbursed 641 6,898 5,644 6,207 IBRD 0 656 24 13 A: 13 IDA 0 1,411 2,263 2,447 I 0:863 Total debt service 256 670 417 299 IBRD 1 159 26 13 IDA 0 16 51 60 Compositionof net resourceflows Officialgrants 143 378 252 Oflicialcreditors -15 155 62 1 Privatecreditors -136 20 -103 -18 Foreigndirect investment 13 6 5 Portfolioequity 0 0 0 D:526 World Bank program Commitments 0 176 93 2 A IBRD , E Bilateral Disbursements 0 92 116 66 B IDA D -Other mulslateral F Private Principal repaymenk 0 104 58 54 C IMF --- 0 Short-terr --- Netflows 0 -12 58 12 Interestpayments 1 71 20 19 Net transfers -1 -83 39 -7 Rote: Inistable was proauceatrom tne uevelopmenttconomics centralaatabase. -51 - Tanzania Sub- POVERTYand SOCIAL Developmentdiamond' 2002 Population,mid-year(millions) Lifeexpectancy GNI per capita (ANasmefhod,US$) GNI (Atlas method, US$billions) 9.9 306 1,072 Averageannualgrowth, 1996-02 T Population(%) 2.4 2.4 1.9 Laborforce (%) 2.5 2.5 2.3 Most recent estimate (latestyear available,1996-02) enrollment Poverty(% ofpopulationbelownationalpovertyline) Urbanpopulation(% of totalpopulation) 34 30 Lifeexpectancyat bitlh(years) 43 46 59 - Infantmortality (per 1,000livebirths) 107 105 81 Childmalnutrition(% ofchi/drenunder5) 29 Accessto improvedwater source Accessto an improvedwatersource(% ofpopulation) 68 56 76 Illiteracy (% ofpopulafionage 15+) 23 37 37 - Grossprimaryenrollment (% ofschool-agepopulation) 63 86 95 Tanzania Male 63 92 103 Low-incomeamup Female 63 80 67 1982 1992 2001 2002 GDP (US$billions) 4.6 9.3 9.4 Economicratios' GrossdomesticinvestmenVGDP 27.2 17 17.4 Exportsof goodsand ServicesIGDP 12.4 15 16.7 Trade GrossdomesticsavingsIGDP 0.3 10.5 Gross nationalsavingslGDP .......... 6.2 7.3 10.1 Currentaccount balancelGDP -15.5 -7.9 .. Domestic InterestpaymenWGDP i2 0.4 0.6 savings Investment Total debUGDP ..... 145.1 71.5 77.2 Total debt servicelexports 23.6 42.2 10.3 7.8 Presentvalue of debVGDP .. 14.4 1 Presentvalue of debVexports .. 89.9 Indebtedness 1982-92 1992-02 2001 2002 2002-06 (average annualgrowth) ,, -Tanzania GDP 4.0 6.1 6.3 GDP percapita .... 1.3 3.8 4.1 Low-income STRUCTUREof the ECONOMY 1 Growth (56ofGDP) Iga2 1992 2o01 2002 of investmentand GDP (X) I Agriculture ........ 48.0 44.8 44.4 Is- Industry 16.2 16.0 16.3 Io-- Manufacturing 8.2 7.4 Services 35.8 39.2 3 Privateconsumption 80.0 79.9 77.1 .s Generalgovemmentconsumption .... 19.6 11.7 12.5 Importsof goodsand services -GDI d G D P 1982-92 1gg2-02 (average annualgrowth) Growthof export8and lmporh (Oh) Agriculture ...... .. 3.6 5.4 5.0 Industry 5.3 6.9 9.3 40 Manufacturing 4.3 5.0 7.8 .?a Services 3.7 5.5 6.2 0 Privateconsumption 3.9 24.0 2.3 -20 Generalgovemmentconsumption 1.9 -32.6 13.6 -40 Grossdomesticinvestment 0.7 5.8 6.7 -Exports -O'lmportp Importsof goodsand services ........ 2.3 19.5 -3.3 . - 52 - Tanzania PRICESand GOVERNMENTFINANCE 1982 1992 2001 2002 Domesticorlces (% change) 30 Consumerprices 28.9 21.8 5.2 4.6 25 20 ImplicitGDP deflator 25.4 6.2 4.2 15 Governmentfinance 10 5 (% of GDP, includescurrentgrants) 0 Currentrevenue 12.7 11.4 11.5 Currentbudgetbalance 0.8 -0.7 -1.4 I -GDPdeflator -CPI 1 Overallsurplusldeficit -1.6 -5.0 -5.7 TRADE 1982 1992 2001 2002 (US$ milljons) Exportandimportlevels(US$ mill.) Total exports(fob) 411 414 772 737 I 2.000 - Coffee 134 60 57 70 Cotton 56 98 33 41 Manufactures 43 64 56 38 Totalimports(cif) 1,128 1,357 1,726 1,889 Food 106 25 169 Fuel and energy 256 142 106 I Capital goods 527 639 755 813 Export priceindex(1995=100) 86 75 151 156 88 97 98 99 00 01 Importprice index(1995=100) 77 101 102 110 mExports .Imports Termsof trade (1995=100J 112 74 148 141 BALANCEof PAYMENTS 1982 I992 2001 2002 1 Currentaccount (US$millions) balanceto GDP(%) I Exportsof goods and sewices 645 548 1,430 1,569 0 Importsof goodsand services 1,201 1,885 2,232 2,224 1 Resourcebalance -556 -1,337 -802 -656 2 3 Netincome -85 -187 -85 -45 -4 Netcurrenttransfers 24 456 -19 10 5 6 Currentaccountbalance -523 -714 -738 7 Financingitems (net) 524 817 909 8 9 Changesin netreserves 0 -102 -171 -347 -10 Memo: Reservesincludinggold (US$milljOnS) Conversionrate (DEC,locallUS$) 9.3 297.7 876.4 966.6 EXTERNALDEBT and RESOURCEFLOWS 1982 I992 2001 2002 (US$ millions) Compositionof 2002debt (US$ mill.) Totaldebt outstanding and disbursed 6,202 6,675 6,679 7,238 IBRD 211 171 8 6 IDA 414 1,618 2,588 2,869 I G:606 Total debt service 152 235 154 128 IBRD 25 45 4 3 IDA 4 19 35 22 Compositionof net resourceflows Officialgrants 309 697 927 Officialcreditors 231 263 93 179 Privatecreditors 31 -45 -21 -21 Foreigndirect investment 17 12 224 Portfolio equity 0 0 0 ~ 7-7 C400 1 World Bank program Commitments 71 60 355 57 A IBRD - E Bilateral Disbursements 107 235 119 148 6 . IDA D -Other mulllateral F Private Principalrepayments 10 39 23 8 C- IMF G Short-tern --- Netflows 97 196 96 140 Interestpayments 18 25 17 17 Nettransfers 79 171 80 123 %mote. InlstaDle was producedfrom tne uevelopmenttconomics centrald a t a D a s e . b - 53 - Ethlopla ~ f r l income ~ ~ Developmentdiamond 2002 I Population,mid-year(millions) 67.3 688 2,495 Lifeexpectancy GNI percapita (Atlas method, US$) 100 450 430 GNI (Atlas method, US$billions) 6.7 306 1,072 Averageannualgrowth,199642 Population(%) 2.4 2.4 1.9 Laborforce f%J 2.2 2.5 2.3 Gross per primary Mostrecentestlmate(latestyear avallable,199642) capita `\ enrollment Poverty(% ofpopulationbelownationalpovertyline) 44 Urbanpopulation(% oftotalpopulation) 16 33 30 Lifeexpectancyat birth (years) 42 46 59 Infantmortality (per 1,000livebirths) 116 105 81 Childmalnutrition(% ofchildrenunder5) 47 Accessto improvedwatersource Access to an improvedwater source I%ofpopulation) 24 58 76 Illiteracy(% ofpopulationage IS+) 56 37 37 Gross primaryenrollment (% ofschool-agepopulation) 64 86 95 -Ethiopia Male 76 92 103 Female 52 80 87 KEY ECONOMICRATIOSand LONG-TERMTRENDS 1 1982 1992 2001 2002 Economicratios. GDP (US$ billions) 5.4 10.0 6.2 6.0 I Grossdomestic investmenffGDP 13.4 9.2 18.0 20.2 Exportsof qoods and services/GDP 9.5 4.5 15.4 15.2 Trade GrossdomesticsavingdGDP 5.6 3.0 2.2 1.9 Grossnationalsavings/GDP 6.6 7.2 13.8 T Currentaccount balancelGDP -6.8 -3.3 -4.2 .. Domestic Interestpayments/GDP 0.4 0.4 1.o 0.7 savings Investment Total debVGDP 60.2 93.0 91.3 108.9 I Totaldebt service/exports 13.8 23.1 16.5 11.6 Presentvalue of debffGDP 46.7 Presentvalue of debffexports 295.5 :: Indebtedness 1982-92 1992-02 2001 2002 2002-06 (average annualgrowth) -Ethiopia GDP 0.7 5.5 7.7 5.0 1992-02 2o01 2o02 (average annualgrowth) Growthof exportsandImports(K) Agriculture 1.3 2.8 11.5 ;- Industry -2.9 6.1 5.8 Manufacturing -4.4 6.6 7.9 "s Sewices 1.6 6.3 4.6 5.5 Privateconsumption 1.5 2.5 11.4 -4.0 -10 Generalgovernmentconsumption -1.0 16.4 -16.5 26.8 -20 Grossdomesticinvestment -1.8 10.3 27.4 17.4 -Exports &Imports - 54 - Ethiopia ~~~~~ ~ ~ ~~ PRICES and GOVERNMENT FINANCE I 1982 1992 2001 2002 Inflation(%) Domestlcprlces (% change) "T Consumerprices 5.9 21.o -7.2 -7.2 Implicit GDP deflator 4.2 11.3 -7.0 -6.3 Governmentfinance ("A of GDP,includescurrentgrants) Currentrevenue 16.6 10.6 19.6 22.1 Current budgetbalance -1.7 -5.0 -0.3 -0.1 I -GDP deflator e C P I 1 Overallsurplus/deficit -8.0 -9.6 -10.0 TRADE 1982 1992 2001 2002 (US$millions) ExportandImportlevels(US$mill.) Totalexports(fob) 376 154 441 467 Coffee 81 175 166 2'ooo T Leatherand leatherproducts 28 38 44 1.500 Manufactures Totalimports(cio 848 875 1,558 1,598 1,000 Food 131 241 177 Fueland energv 120 265 244 500 I I Capitalgoods 320 589 624 0 Exportpriceindex (1995=100) 84 83 59 86 97 98 99 00 01 Importpriceindex(1995=100) 110 96 116 .Exports .Imports O2 Termsof trade (1995=100) 77 86 50 BALANCE of PAYMENTS 1982 1992 2001 2002 (US$mi//ionsj I Currentaccountbalanceto GDP(%) Exportsof goods and sewices 512 453 957 909 Importsof goods andservices 946 1,074 1,945 2,004 Resourcebalance 435 -621 -987 -1,095 0 Net income -9 -86 -59 -50 Netcurrenttransfers 73 372 774 5 Currentaccountbalance -371 -335 -264 -10 Financingitems(net) 431 381 251 Changesin netresewes -60 -46 13 -136 1.151 Memo: Reserves including gold (US$millions) 277 172 Conversionrate (DEC,local/US$I 2.1 2.1 8.3 8.5 EXTERNAL DEBT and RESOURCE FLOWS 1982 1992 2001 2002 (US$millions) Compositionof 2002 debt (US$ mill.) Total debt outstanding and disbursed 3,280 9,341 5,697 6,523 IBRD 48 12 0 0 IDA 302 964 2,151 2,756 I F 9 8 G 6 6 Totaldebt senke 76 109 182 108 IBRD 8 8 0 0 IDA 3 13 36 17 Compositionof net resourceflows Officialgrants 107 886 413 Officialcreditors 1,345 184 434 548 Privatecreditors 98 80 -10 -4 Foreigndirectinvestment 2 0 20 Portfolioequity 0 0 0 World Bank program Commitments 30 150 202 343 A- IBRD E Bilateral - Disbursements 28 112 455 465 B IDA D Other multilateral - F Private - Principalrepayments 5 13 22 5 C IMF -- G Short-tern ~ Netflows 23 99 433 460 Interestpayments 6 8 14 12 Net transfers 17 92 419 447 " - 55 - AdditionalAnnex 11: Selection and EligibilityCriteria for Training Institutions,Implementing Partners, and Trainees AFRICA African RegionalCapacity Building Network for HlVlAlDS Prevention,Treatment, and Care EligibilityCriteriafor TrainingInstitutionsandImplementingPartners ARCAN-supported training o ftrainers will be delivered by an eligible group o ftraining institutions to a qualifiedgroup o ftrainingparticipants. Final selection and subsequent hding will go directly to training institutions and implementingpartnersthat are contracted under ARCAN onthe basis o fhavingmet certain pre-determined requirements for possible participation inthe ARCAN network. The final selection oftrainingparticipantswill bemadeonthe basisof candidateshavingmet certain pre-determined criteria for participation. Guidelines for boththe selection o ftraining entities andtrainingparticipants willbe developed and approvedby the InterimSteeringCommittee following a two-phased process: Phase 1will involvethe development o f Core EligibilityCriteria for the institutions and entities that will participate inthe ARCAN network as trainers; and Phase2 will comprise the development o f Selection Criteria for candidateswho will participate as trainees. Participation inthe networkwould not be limitedto entities characterized solely as "training institutions." Indeedit is envisagedthat the ARCAN network would be open to participation by a broadrange o f institutions inacademia, public sector, private sector, civil society, andfaith based community inthe countries, providedthey meet the establishedeligibility criteria. During pre-appraisal andprior to appraisal, an indicative list o f institutions that are eligible for participation inARCAN'S first year operations would beprepared. The list would be put together by Steering Committee inconsultation with the World Bank andpartners, following the overall principles guidingthe establishmento f eligibility criteria. These guidingprinciples include assessingthe likelihood o fthe prospective institutionor entity to provide training that inprograms inthe various HIV/AIDS capacity buildingcategories that are prioritized by the project. This assessmentwould inquire the extent to which the institution's activities are: strategic, Le., support implementation o fnational HIV/AIDS strategies; incremental, inthat they add to, and do not replace existing b d s for training by MAPSor related partner programs; comprehensive, inthat they contribute to creating a regional public good in areas o ftraining that have the potential for yielding rapid andvisible impacts either upstream (in terms o fpolicy, for example) or downstream, interms o fhow it cascadesdown to provide a multipliereffect; is basedonresults inthat it incorporates a strong M& Efocus; andis sustainable inthat it focuses on networking, knowledge sharing, practical application o facquired skills. Phase 1: Development of CoreEligibilityCriteriafor ARCANTrainingInstitutions Phase Iwould involve the development o f core eligibility criteria for the training institutions. It would be guided by a set of guiding principles, including assessing the experience o f a prospective institution in providing training in the HIV/AIDS capacity building categories - 56 - prioritized by the project and that are deemed to be: strategic; comprehensive, incremental, sustainable; and likely to contribute to networking, knowledge sharing, and the practical application o f acquired skills. Based on these principles, five sets o f core eligibility criteria have beendeveloped inclose consultation with national counterparts: (a) Implementation experience and proven track record in HIV/AIDS-related capacity building; (b) Technical capacity in the comprehensive range of training areas and thematic issues prioritizedby ARCAN; (c) Country ownership interms of national accreditation and recognition; (d) Relevance of the institution's capacity building initiatives and proposals to the core training needs, including an explicit focus on regional capacity building (including full-utilization o f African teaching and administrative stafo and the prioritized expansion o f South-Southpartnerships; and (e) Likelihood o f sustainability in terms the mechanisms proposed by the institutions to contribute to an enabling environment for post-training support, networking and knowledge sharing, and to addressthe retention andrapid turnover o f trainees. ImplementationExperience/TechnicalCapacity:This criterionwould bemeasuredprimarily bythe institution's proventrack recordinprioritizedareas-especially, its previous multi-year experience. Iti s recommended that this be a minimumo f three years experience. However, recognizing the capacity limitations insome areas o fHIV/AIDS training needs, consideration would be givento institutions proposing to embark on new areas o ftraining, providedthey meet other criteria, such as the hctional governance, administrative and financial managementtrack record andthe relevance o f HIV/AIDSto its overall mission and strategic plans. Where circumstanceswarrant, the possibility o ftwinningarrangementswithtraining institutions within or outside the ARCAN sub-region, butwithinAfrica, will be considered. Additional indicators o f implementation experience that would have to be satisfied comprise: adequatetechnical staff and advisors -to include both full- or part-time faculty or adjunct faculty inthe subject areas to be determinedby the Steering Committee; commitment to quality assurance, for example through certification, selection o ftrainees andtrainers, quality o f curriculum, etc.; and the quality and comprehensivenesso fthe institution's internal strategic plan for capacity buildingo fmultiple HIV/AIDSstakeholders, includingmedical professionals, HIV/AIDS groups, legalaid professionals, PLWHA Associations CountryOwnership:This eligibility criterionis designed to assessthe extent to which the institutionadopts an institutionalapproach to training that is supportive o fmulti-sectoral, multi-partner approaches -that is one that does not only target medical and health sector personnel, butthat supports the country-driven responsesto strengthening overall capacity inthe areas o fprogrammanagement, financial managementandmonitoring and evaluation of HIV/AIDSinitiatives at all levels. Consequently, factors suchas national recognition and accreditation, e.g., by the Ministries o f Healthas a leader, keyplayer andcontributor to the national responseto HIV/AIDSwould be an important indicator o f country ownership. Also important would be the complementarity o fthe prospective institution's overall approachwith national AIDS coordinating structures, MAPS,donor initiatives, etc.; andincorporation and/or - 57 - integration innational HIV/AIDS capacity buildingpolicies, plans & initiatives. Relevance to Core Capacity Needs: Relevanceto ARCAN Steering Committee's annual training guidelines andpriorities; Balance inthe integration o f core competenciesinHIV/AIDS prevention, treatment andcare, with emphasis onthe poverty focus o f such interventions, their gender sensitivity intargeting boththe content of trainingprograms as well as the beneficiaries o f suchtraining; Commitment to south-south capacity building,networking andknowledge sharing, for example as demonstratedby a strategy for such capacity buildingandprevious experiencein these areas. This would also include the demonstratedcommitment inbuildingcapacity among African teaching and administrative staff. Potential for Sustainability: Financial independence andstability, as demonstratedby sound financial accountability andcontrol mechanismsand institutionalmaturity (interms o f governance structure, management andaccountability procedures, permanent staffing) would provide evidence o fthe potential for sustainability. The Steering Committee would also examine the extent to which the institutionprovides a comprehensive sector focus (government, non-governmental, academia, research, private sector, etc.). Additionally, the institution's specific plans for post-training networking & support; its commitment to sub-regional and national knowledge sharing; and its ability o fARCAN to complement existing work program, without overburdening or weakeningthe institutionwould be examined. This i s inkeepingwith the main purpose o fARCAN support -to buildcapacity that would filter through the countries' HIV/AIDS response. Iti s not intendedto bethe main source o f support for the institution's operations -merely to infuse some resources to it to expandinto neededareas. Finally, for this criterion, the strengtho fthe institution's focus on M& E, as demonstratedby systems and tools inplace for monitoring andevaluation, the experience withevaluation initsprevious courses, application o flessons into curriculumdevelopment would be relevant. Phase 2: Development of SelectionCriteria for ARCAN TOT Participants Phase I1would involve development o f selection criteriafor training candidates, and would be completed after final selection o f institutions. These selection criteria will include, among other priorities, requirements relating to the candidates' educational background andprofessional experience andpreparation for the TOT program; inter- andintra-country diversity (especially geographic, sector andgender balance); andthe equitable distributiono ftrainingparticipants among the ARCAN partner countries. Prospective trainees will be selectedto participate inARCAN TOT programs on the basis o f selection criteria establishedby the SC. These selection criteria have been developedby the SC on the basis o f a set o f guidingprinciples derived from: The special nature and intendedobjectives o fARCAN training as set forth inthe ARCAN program guidelines; The stated outcome indicators for ARCAN training; The anticipated processindicators; and The needto provide a solidbasis for transparent selection o fprospective candidates - sa - Because o fthe TOT focus o f all ARCAN training, these selection criteria emphasizeboththe qualifications (and therefore technical preparation and readinessfor participationinthe proposed ARCAN training) as well as the opportunity(ies) available to the candidatesupontheir returnto the home countries andwork places that will enable and support them indesigning, planning and implementing training or mentoring programs that apply the knowledge acquired duringARCAN training. To enhance the likelihood o fmeeting the major outcome indicators o fARCAN (increase inthe percentageofARCAN graduateswho conductthe minimumrequiredlevels ofcascade training) bothpersonal attributes andskills, as well as the workplace environment and support that would enable candidates to follow through on such training are targeted as important criteria. Finally, the infrastructure for in-service and on-the-job training, professional networking (for example as representedby flexibility inwork scheduling; guaranteesprovidedby employers; and accessto information andtelecommunications technologies and facilities to enablethe ARCAN graduate to consult and interact with other ARCAN alumni within the country andinter-regionally andto makeuse o fvirtual distance learningmaterial). Thus, the criteria incorporate elements o f candidates' previous demonstrated experience (and seniority) interms o fprofessionaltraining andpreparation for the ARCAN training, as well as a forward-looking assessmento f candidates' potential as a future trainer, mentor and networking colleague inHIVIAIDS training, capacity building, networking andpeer support programs, initiatives and activities intheir home countries and within the ARCAN region. Based on these guidingprinciples, the following sets o fessentialanddesirablecriteria highlightingthe knowledge, skills, attributes, educational background andprofessional experience o fpotential ARCAN traineeswill guide the nomination and selection o fpotential trainees. These criteria will bebased onthe following: a) Educational background and qualifications Holdat least a certification (undergraduate degree, diploma, professional license (or its equivalent ina discipline relevant to the health sector) and an indicatedminimumyears o f work experience. Have excellent written andverbal Englishlanguage skills. Be computer-proficient and familiarwith the Internet, to facilitate the candidates contribution and participation inARCAN alumni networking and knowledge sharingactivities. b) Professional background and experience Demonstrated strong interest andbackground inhealth services, healthsystems management, HIV/AIDSresearch, programming, management andproject/programme implementation or any other fieldrelated to HIV/AIDS program implementation. Have a strong interest indevelopment issues, includingunderstanding o fhow the changing HIV/AIDSenvironment andprogression ofthe epidemic affects development. Demonstrated professional leadership inone or more dimensions o f HIV/AIDSprevention, treatment and care as evidenced by multi-year experience inanHIV/AIDS setting. Proven track record o f designing, planning, delivering or contributing to HIV/AIDSrelated services ina local or national setting inanARCAN country. - 59 - c) Employer authorization and documentedreturn guarantee by candidates'employers. Ability to integrate knowledge acquired duringARCAN training withthe broader strategic, policy, andprogramobjectives o fthe candidates' National HIV/AIDS strategy, especially its humancapacity objectives andneeds. Ability to identifl HIV/AIDSconceptsinhealthsystems analysis to targetpolicies, strategies and interventions to improve HIV/AIDSto improve outcomes. Willingness and ability to develop strategies and action plansto apply the information, knowledge and tools acquired duringthe ARCAN training intheir work place settings so that they canplan, budgetfor, deliverand evaluate HIV/AIDSprevention, treatment and control courses to address needs. Ability to engageinparticipatory learningby sharing experiences, andbuildingonexperiences to address andshare issues faced at work ina participatory learningenvironment. d) Post-ARCAN training workplace support and cascade learningpotential Ability to use the knowledge and skills to deliver HIV/AIDStraining intheir institutions and intheir countries inamore efficient andequitableways Resourcemobilization skill -ability to develop fundingproposals for capacity building programs on HIV/AIDSfor submission to HIV/AIDSfunding opportunities intheir country (including the ability to design programs that would tap into existing MAP funds). N o quota system exists for participants from the three ARCAN countries. However, promising candidates from all ARCAN member countries are encouragedto apply inorder to meet the ARCAN program guideline for equitabledistribution among participatingcountries. Promising female candidatesand candidates working at the urban, provincial, district, rural and community-based settings are also encouragedto apply, inorder to meet the ARCAN program guidelinefor gender andintra-country diversity. Duringimplementation, the Steering Committee would reviewthe approved eligibility and selection criteria on a periodic basis to assesstheir continued relevance, basedon the experiencefrom ARCAN training, andfeedback from multiple sources (including TOT candidates, M&Ereports and HIVIAIDS programpartners). Subsequent revisions andupdates o fthese criteria would be informedby the findings o f future training needs assessments, andthe results o fperformance-based contracts with the selected institutions. - 60 - Additional Annex 12 : Project Supervision Strategy AFRICA: African RegionalCapacity BuildingNetworkfor HIWAIDS Prevention,Treatment, and Care The ARCAN Project will require intensive supervision, givenits multi-country andmulti-partner nature. Additionally, the Project Coordination UnitandSteering Committee will benew entities with some individuals ineachlikelyto possesslimitedexperiencewith Bankoperations. As a result, this project will require a heavier thannormal supervision effort. Objectives and Strategic Focus The first year of implementation for the project is expected to be FY05.Althoughthe project preparation hasbeen extensive, it is anticipatedthat there will be considerable needfor close supervision during the initialyears o fproject implementation. The main objectives ofthe supervision inthe first year are to (a) ensure that there i s adequate implementation capacity within selectedtraining institutions; (b) ensurethat the Project Coordination Unithas adequatecapacity and support to begincarrying out their mandate o f coordination; and (c) ensure adherenceto appropriate fiduciary responsibilities. The supervision strategy will focus on the following critical areas inthe first year. However, as is the case with the overall project design, flexibility infocus for support supervision will be required inorder to be responsive to evolving priorities or emergingproblems. Institutional arrangementsfor the implementation The supervision will focus onthe essentialinstitutionalarrangementsinorder for the project to carry out the plannedproject activities. Duringthe initial stages o fthe project there will be a strategic focus on the strengtheningand creation o fpartnerships - between andwithin countries, and with civil society organizations, private sector organizations andwithinthe public sector. Such partnerships are seen as the mainvehicle to address concerns about the absorptive capacity neededto intensify the nationalresponsesto HIV/AIDSas critical to the complementary and catalytic nature o fthis project. Monitoring and Evaluation Inamulti-sectoral project withdiverse implementing agenciessuchasthis, itwillbeimportant to have a sound M&E system inplace early duringproject implementation. Duringthe first year, the supervision activities will focus on achieving an adequatelevel o f functioning for M&E. - Coordination The core function o fthe PCU is the coordination o f a large range o f activities and initiatives implemented by a host of agencies from the public sector, the private sector and civil society organizations. The supervision strategy will concentrate on supporting the PCU and Steering Committee inthis formidable task. Procurement Supervision will provide support onprocurement andevaluate whether requisite capacity and procedures for the project procurement are inplace. -61 - Financial Management Duringthe first year the project, supervisionwill focus onthe establishment andmanagemento f the Special Account andfacilitate timely flow o f h d s directly to implementation entities. Partnerships ManyUNandbilateral agencies havemadeusefulcontributions duringprojectpreparation. These contributions resulted inthe proposition for establishingjoint coordination mechanisms. The supervision o fthe project will continue to buildthis partnershipandcollaboration. Three methods are identifiedto further develop the partnership and collaboration: (i) Joint-missions. The IDA team will invitemultiplepartners to participate insupervision missions andreviews o fthe project. Donor agencieswith experts inan areawhere they may have comparative advantageswill be invitedto be part o fthe IDAsupervision missionteam; (ii) international experiences and Sharing best practices through supervision. Invitingpeople with experiences o fimplementingsuccessful HIV/AIDSrelatedprograms outside Africa or the regiontojoin the missionto sharetheir expertise andexperiences. Such support canbe provided and financed by the donor community; and(iii) evaluation ofthe partnerships with a view to (a) strengthenthe relations; (b) Periodic achieve our common goals inthe East Africa subregion; and (c) improving coordination. During the project launch workshop, the IDA team will discuss the options described above with various partners to confirm possible arrangementsandsupport. Supervision The project will need intensive supervision giventhe large spano f activities, its blend o fpublic andprivate sector interventions, andits multi-sectoral as well as its multi-agency nature. In addition, concems about a limited capacity will require intensive support to develop partnerships for the implementation o fthe national program. The project will be implemented by entities only recently established and whose capacity will need strengthening. A budget o f US$200,000 has been allocatedto supervisethe project duringthe first 12months o fproject implementation. Some o fthe skills required for the supervision o f the project will be neededon a regular basis while otherswill berequiredon an ad hoc basis. It i s therefore proposed to establish a project team, which will emphasize financial, procurement andoperational basic needs, complemented by technical specialists, inparticular those covering M&E, civil society and private sector participation, specific technical concems and sub-regional policy issues. A muchmore intensive than normal supervision program should be carried out duringthe first year o fthe project to put inplaceasoundinstitutional baseandproperly begininterventionstobeundertakenbythis operation. The core supervision team would be comprised o fthe following experts from headquartersand the involvedcountry offices: i)TaskTeamLeaderwithexperienceinhealthandMAPprojects; ii)OperationsSpecialistwhowouldsuperviseimplementationprogressinspecific sub-components and issues relatedto institutionaldesign iii)FinancialManagementSpecialistwhowouldreviewBankprocedureswithrespecttofiduciary responsibilities and assess managementtraining needs iv) Procurement Specialist who would review progress ofoverall procurement arrangements iv) Monitoringand Evaluation Specialist who would reviewthe relevant systems and - 62 - methodology put inplace v) HealthSpecialist and Gender Specialist to review progress of specific project sub-components. The core team would be complemented with additional technical experts via consultanciesand from technical partners, as needed. As hasbeenthe case duringprojectpreparation, key technical partners would also be actively encouragedto participate insupervision missions. - 63 - AdditionalAnnex 13: Monitoringand Evaluation AFRICA. African Regional Capacity Building Networkfor HIWAIDS Prevention,Treatment, and Care Background Monitoring and evaluation (M&E) is an essentialcomponent o f any development project. This holds particularly true with respectto the context o fHIV/AIDS, where the rapid expansion o f successfulinitiatives is essential inreducing the expanding morbidity, mortality and socioeconomic consequences o fthe epidemic. Suchprogram expansion, however, needsto be basedon clear, rational reasoning("evidence-based decision making"). An appropriate, flexible, and effective M&Esystemenhances this reasoningthrough "learning by doing," especially when implementing programs with a relatively new approach, and inturnfeeds into management decision making.An effective monitoringandevaluation system requires boldnessinredesigning, improving andkeepingon supporting target objectives. The ARCAN Project will concentrateon expandinghealthsector humancapacity, with respectto HIV/AIDSprevention, treatment andcareprograms. Between the projectcountries involved certain principles o f M&Eshould apply. These include: Reporting systems shouldbe simple, applicable to eachtraining institution, eachprogram area o f focus, and specializationhector o fparticipants Sharing o fknowledge betweenandwithin ARCAN countries is an intricate component of the project. The project design explicitly seeks for promote cross-border learning at both national andregional levels Monitoring and evaluation should feed to the National AIDS CounciVCommission Secretariat and to the National Ministryof Healthto augment their specific roles (coordination verses health sector program implementation) Project monitoring is the routine, daily assessmento f ongoing activities andprogress. Monitoring looks at what i s beingdone. InARCAN monitoring will record activities undertakenby boththe training institutions and recipients o fthis training (Le. the "master trainers). Evaluation i s periodic assessment considersoverall achievements and impact by anintervention. While typical M&E systems use a matrix o f input,process, output, outcome and impact, the focused nature o fthe ARCAN project onhuman resourcecapacity building excludes impact measurement. These are covered inother M&E strategies such as those o fthe Ministry o fHealthand or NAC. The overall impact o fARCAN would be enhancedservice delivery with reduction inthe morbidity and mortality o fHIV AIDS. As indicatedinthe appraisal document, however, measuremento fthese impact i s beyond o fthe scope o fthis project. The Concept of Training of Trainers The concept ofTrainer ofTrainers usestraining organizations (called, Training Institutions or Training Institution's) to train an ongoing number o f trainers duringthe course o fthe project. Success o fthe project i s dependent on Training Institution's & TOT'Straining early into the programand consistently keepingwiththese plans. It should be emphasizedthat more regular training with less people i s far better thanthe infrequent training conducted with many people (i.e. - 64 - "less more often, than more less often"). TOT Outcomesor Consequences Consequencesor longer term results o f the project are envisioned to include: Increasedcapacity among healthcare practitioners with respect to training inselected program areas; Enhanceddeliveryof HIV/AIDS related services inboth quality andthe expansion o f coverage; Stronger linkages between key thematic areas o f HIV/AIDS programcomponents; and Promotiono fthe interchange o fknowledge andideasbetweedandwithin countries. Indicators Indicators are essentialto measure the implementation andprogress of any project, andneedto be kept simple and be appropriately reported on. The key performance indicators for ARCAN are measuredandcollected at different levels o fmanagementwithin the project. These include: Overall Coordination Structure (Project Coordinating Unit) Training Institutions Trainer o fTrainers - 65 - Keyprogram indicators for the project are shown inthe following table. Level Key Program Indicators Input rhe inputfor theproject 1. Total number o fpartner training institutions s the existing Training 2. Finances made available through ARCAN to Training Institutions `nstitutions with their 3. Increasedcapacity to train by partner organizations becauseofARCAN Project as paining programs and measuredby the number o fARCAN fundedtraining to non ARCAN fundedtraining by the 'esource materials along partner training institutions uith thefinances and 4. Quantitylquality o f trainers inARCAN-financed Training Institutions eesourcesfiom the WorldBank Process TrainingInstitutionLevel Theactual training wocess by the Training 5. Number of first time I follow up training sessionsheldfor Trainer of Trainers lnstitutions and 6. Number oftraining coursesheldinwhich participants were vettedprior to the description of the course andpre & post course evaluations undertaken. garticipants'own TOT 7. Numberoftrainees attending first time I follow uptraining session work. Process indicators 8. Number, geographical distribution o fARCAN trainees [map according to zim to describe this country andhealth district, villageltown] and sector representedat the time o f primary wimary level of training. training 9. NumberI percentageofpeople trained per number ofpeople initially targeted [according to work plan] 10. Number ofhours oftraining conducted 11. Number ofpeople training hours [numbero fpeople trainedmultipliedby the number ofhours oftraining conducted] output TrainingofTrainersLevel Knowledge, skills, resources andpractice 12. NumberI percentageoftrainees who conduct one training sessioninthe first As a result of the TOT six months after primary training occurred I total of those attending an ARCAN training training sessionsheld, course (as measuredby the number o f training reports submitted to the PCU) ARCANgraduates will be 13. Numberoftraining monitoring reports submittedto the Training Institutionby capacitated to undertake the TOT'S after trainees have returnedto their posts OR their own training to 14. Number of first time I follow uptraining sessionsheld(reported at the endof expand their knowledge eachyear) and skills. 15. Numberoftraineesattending first timeI follow uptraining sessionbyTOT's (compiled for eachyear) 16. Geographical distribution o fTOT trainees [map according to country and health district I institution] and sector 17. NumberI percentageofpeople trained per number ofpeople initially targeted [according to work plan] 18. Number of hours of training conducted 19. Numberofpeople training hours [number ofpeople trained X the number of hours o f training conducted [TOT training only] 20. Description of the resources [financial + other] obtained by TOT's inorder to conduct training as measured at 12 month intervals 21. "Loss to follow up" measure for TOT graduates. - 66 - 'CU Level 12. Total people training hours conducted becauseof ARCAN [number ofpeople rained multiplied by the number of hours o f training conducted, sum ofbothTraining nstitution's & TOT's], as measured at 12month intervals ofthe project, midtermand roject end Outcome Improvements in the 23. Number of successfulTOT's (graduates who conduct the minimumrequired expansion, coverage and training) who can be identified through selection criterion I pre andpost course evaluations I quality of HIV /AIDS work planor special surveys) related service delivery. 24. Percentof service delivery points intrainee's country with a primary recipient of ARCAN supported TOT training Major Types of Project M&EData Primary data collected by partners Numberoftrainingepisodes Hours o ftraining episodes Numberofparticipants Calculated data People training hours conducted Number or percentageo ftraineeswho conduct one training sessioninthe first six months after primary training occurred (as measuredby the numbero f trainingreports submitted to the PCU)/ total o fthose attending an ARCAN training course) Total people training hours conducted becauseo f ARCAN [number o fpeople trained multipliedbythe numberofhours oftraining conducted, sum ofbothTraining Institution's & TOT's], as measuredat 12monthintervals o fthe project Program and Financial MonitoringData Cost per TOT trained by Training Institution's Cost per people training hours Cost per total number o fpeople trained (both TOT's and their trainees) Data Sources: A number o f data sources are required for these indicators to be collected, including the following: Afer each training (both theprimary ARCAN TrainingInstitute courses & TOTgraduate courses) TrainingInstitution's and ARCAN TOTSwill submit to the PCU: ARCAN Training Monitoring Form List o f trainees & signatures Pre course evaluation forms Post course evaluation forms Student work plans (Training Institution's only) - 67 - Informationonresources accessedandusedduringtraining (TOT's only) Project Annual Reports will include: The number o fARCAN project training courses comparedto the numbero fnonARCAN trainings held Compilation o fprogram monitoring data o fthe previous 12months o fthe project Mid TermReview/Endof Project ReviewKey Components: Survey o f TOT's either by phone, post or e-mail contacts Assessment o fplacement and currentjobs o fthe TOT's trainees (at least on a special survey basis) Linkingprogram andfinancial monitoring, as deemedfeasible within the context ofARCAN. (For example, examination o fwhether ARCAN TOT graduates access national-level resources differentially depending upontheir performance. Such an indicator would needto focus on a) definition o fperformance, and b) how allocations will relate to performance (e.g. will it rewardhighperformance or low performance or both? ) Multi-LeveYMulti-Partner Roles and Responsibilities ARCAN TOT Graduates Preparework plans including resourcerequirements at the time o fprimary training Conduct training and submit timely reports following eachtraining sessionto the PCU Participate and support special evaluation survey's or reviews [such as midand at the endo f the project] Training Institutions Submit timely reports following eachtraining sessionto the PCU Submitannualreports concerning activities Participate and support special evaluation survey's or reviews (such as mid-and end-project reviews] Project Coordination Unit Central collection point for training report forms from Training Institution's and TOT's Refer on Financial Monitoring informationto the M&EAgency M&E Agency (out-sourced) Linkedproposedtraining work planbyTOT's to that actually conducted Linkprogramreportingto financial managementsystem Forward ona monthly basis the updateddata base o fprogram information Conduct operational or programresearch/ evaluation Submission on the details of the vetting system o fpotential candidates [submitted to PCU Year1Yl TechnicalServiceAgency (out-sourced) - 68 - Review or vet potential candidates for TOT training courses & submission o freport to PCU Guidelines for pre andpost course evaluations & submission to PCU Steering Committee Approve TOR for the M&EAgency Approve reports before dissemination Steering Committee Members Support the M&Econcepts o fthe ARCAN Project with respect to their constituencies Provide input to the program on the basis o fM&Edata gathered and relevant information from their own organizations Assist infilling inthe M&Egaps which are not part o f the Project. MinistryofHealth (i.e. impact measurementsthat couldresult as a consequenceofthis and many other nationaVregiona1HIV/AIDSinitiatives) NationalAIDS Council Civil Society Organizations Topics for Evaluation Effective selection criterion for effective TOT's (linkingthe selection processwith the TOT's who trained or didnot train others at the end o f six months) Development o f appropriate implementation tools or training tools to be used by the TOTS Support for TOT's, such as: Monthly contact Financial support Development o fnew materials for use (printmaterials, manuals, guidelines) Evaluation o fthe quality of training by TOT's Descriptiono f the cause o f drop out o f TOT's Before and afier documentation o f training conducted by implementingpartners To what extent has ARCAN expandedtraining capacity To what extent has ARCAN redirected activities New scope New scope and/or Changed training methods Changedmonitoring and evaluation o fprograms What i s the cost o ftraining? Direct costs -finances and other inputs provided through ARCAN Indirect costs -loss o f services, reduced service delivery (especially with respectto health care workers) - 69 - Additional Annex 14:ARCAN Training Institutions AFRICA. African RegionalCapacity Building Networkfor HIVIAIDS Prevention,Treatment, and Care Duringthe course ofproject preparation, a very detailed, nine-month, processwas followedbythe preparation team inensuring transparency andequity inthe selection o f training institutions to serve as implementingpartners for the ARCAN Project. The final selection o f training entities was conductedby the ARCAN Steering Committee duringproject appraisal, onthe basis of the agreed selection and eligibility criteria. The a summary ofthe selectedtraining institutions andrelevant programs is presented below: Course: NurseTraining Institution: Advanced NursingStudies Program,Aga KhanSchoolofNursing CourseLocation: Nairobi,Kenya Duration: 2 weeks Background: The Aga KhanDevelopment Network i s a group o fprivate, international, non-denominational agencies and institutions that seek to empower communities and individuals, often indisadvantagedcircumstances, to improve living conditions and opportunities. The Aga KhanFoundationis aprivate, international, non-profit, non-denominational development agency that i s now working in20 countries. The missiono f AKU inEast Africa is to become the premier center o f learningandto provide quality programs o f continuing professional education that increasecompetenceand leadto the acquisition o f higher-level academic awards and degrees. The missionwill be achievedbyusinginnovative curricula, adult teaching learning strategies and by developing the capacity to utilize andconduct relevant research, especially inrelation to monitoring the quality o f care andservice providedby graduates and inmeasuringthe impact o f changesthat occur inthe country as a result o fthe educational contribution providedby the university. The AKU School o fNursing(AKU-SON), which beganoperations in 1980educatesnurses to provide exemplary nursing care and demonstratesleadership innursingeducation, practice, administration and research. The School offers programs inGeneral NursingDiploma, Post R N BScN, BScN andMScN. In2001, AKU-SON introduced anAdvanced NursingStudiesprogram inKenya, UgandaandTanzania. Developedatthe request ofnursing leadersandthe respective governments o fthe three EastAfrican countries, the programoffers continuing and higher education up to BScN level to working nurses, allowing them to remainat their workplaces as they pursueprofessional development. The regional nursingleadershipplayed akey role inpromoting the establishmentofthe ANS PrograminEast Africa. Their input andparticipationwas sought at eachlevel o fplanning, from the conduct o f a feasibility study, through the formation o f a steering committee, to the development o fthe curriculumand the planningo f course content. Principal aim:AKU, through the A N S program aims to become a premier center o f learning for practicing nurses andmidwivesinEastAfrica. This will be achieved by: Providing quality programs inadvancedand continuing education; - 70 - Utilizing innovative curriculum andprogram delivery strategies; Developing an international level capacity to conduct relevant nursingandhealth related research Educating nurses to provide exemplary nursingcare Providingleadership innursingeducation, practice, administration and research. Developingthe ability of graduate nursedmidwivesto pursue further higher education programs at tertiary education institutions Providingcontinuing education opportunities that will meet the needs o f nursesand midwives intheregion inthe specific, aswell ashealthsystems ingeneral. Expectedresults o f the AKU-ANS include: Improved quality o fpatient care and health status o fcommunities throughout the region. Linkages with the Aga Khan Health Services and other hospital facilities enablesthe nursesto develop clinical competence inhospital settings; Enhanced status o f female professionals; Increasedmanagerial andclinical skills o fnurses at all levels o f service inboththe public and private sectors; The development o f a regional approachto nurse credentialing for healthmanagement and care while safeguarding essentialcountry specific traditions. Recent Developments in Distance Learning Initiatives: InKenya, AKU-SONhasbeen identified as one of six pilot institutions to introduce the distance learning (DL)programfor EN-RNconversion onbehalfofthe NursingCouncilandthe MinistryofHealthinKenyain2004. This program was introducedinresponseto the desperateneedto get a critical masso f adequately equipped nurses inKenya to assist instrengthening the health system o fthe country. The DLprogram is the idealway o f achieving the ultimate objective ofthe ANS Programto reach nurses inall parts o f the country. Similar programs are also expectedto commence inUganda andTanzania. CourseModulesfor ARCAN-financed Training-of-Trainers NurseProgram (course duration: 2 weeks) Unit I:Fundamentals of HIV/AIDS ExplainHIV/AIDSorigins and effects. Describe transmission o fHIV/AIDS. Describe HIV/AIDSrelated symptoms anddiseases (including T.B. and STD's and other opportunistic infections). Discuss diagnosis o fHIV infectionandAIDS. Describe the managemento fHIV infectione.g. anti-retroviral therapy inline with the National Guideline, strengthening the immune system andtreatment o fopportunistic infections. Unit 11: HIV/AIDSPrevention Discuss principles and strategies o fbehavioral change. Discuss the gender dimensions to HIV/AIDS - 71 - Explainprinciples o f adult education. Discuss HIV/AIDSprevention ina traditional African context. Explore changing of unsafe sexual anddrugusebehavior. Discuss sexuality, education andlife skills trainingfor youth. Unit 111: HIV/AIDS Counseling Explaincounselingprinciples and skills. Discuss counseling indiverse context (e.g. cross-cultural counseling) and systemic counseling. Explain the process and importance o fpre andpost HIV test counseling. Discuss the principles andfactors involvedincounseling HIV infected individuals, their caregivers andsignificant others. Discuss spiritual, emotional andbereavement counseling processesto include importance o f disclosure to significant others andpossibly the wider community, makingreferenceto the memory book. Unit IV: Care and Supportfor theperson living with HIUAIDS Explore the extent o f family and community involvement inthe care and support o fpersons livingwith HIV/AIDS. Explore strategieso fhow to involve PeopleLivingwith AIDS (PLWAs) inprevention, care andsupport o finfected andaffected. Discuss issuesrelated to home-basedcare andAIDS orphan care. Explaininfection control inhospitals/clinics/homes. Discuss issuesrelated to strengthening the immune system e.g. nutrition (balanced diet, food safety and clean water) andpositive living. Describe the nursingprinciples inhospital andhome-basedcare o fpersonslivingwith HIV/AIDS. Unit V: Legal ethical and management issues Discuss legal ethical and managementissues o fpersons affected and infected by HIV/AIDS. Identify available guidelines on confidentiality o fHIV/AIDS anddiscussthe importance of informedconsent. Identifyand discussexistingHIV/AIDSpolicies inboth government andprivate sector. Explainthe process o fpolicy development on HIV/AIDSat work place, schools, and other institutions Discuss the impact o f HIV/AIDSon development - 72 - Course: Counselor Supervisor Training Institution: Kenya Associationof Professional Counselors Course Location: Nairobi, Kenya Duration: 4 weeks Background KAPC was registered in 1991andprovided assistance, inthe first instance, by conducting counselor-training courses. Ithas subsequentlyfocused upon a numberof activities including: counselor supervision, training counselor supervisors, counselor research, adolescent studies, reproductive health education, counseling services and an adolescentnewspaper, Straight Talk. KAPC is now seen as an authority figure inProfessional Counseling not only inKenyabut also in the Easternand Southern Africa region. Many organizations and countries consult KAPC on counseling andcounseling supervision services andtraining. KAPC is famous for its annual International Counseling Conference, which hosts participants from as many as 15 countries every year. Currently KAPC i s chairing the committee inKenya that is developing the schemeo f service for the cadre o fProfessional Counselors inthe Ministry o fHealth. KAPC has intemational recognitionandinMay 2004 KAPC will be co-hosts o fthe BritishAssociation o f Counseling and Psychotherapy (BACP) on their ResearchConference inLondon. KAPC i s provingto be an authority inthe area o fAdolescent Reproductive HealthinKenya through its 'Strength Talk' project. Currently KAPC is amember o fthe RATNand the Africa Regional Sexuality Resource Center. KAPC has a staff establishmento f 34 full time members and about 65 parttime consultants. KAPC was registered as a Non- Governmental Organization (NGO) in 1991. The core missiono f the organization has beenthe promotiono f counselling as illustrated through its mission statement, "to facilitate the creation o f a social climate where society, communities, organizations, families or individuals can consider the opportunities o f change". This hasbeendone over the past fourteen years through: Counsellor training courses- Skills levels, Certificate, Higher Diploma and a Masters Degree. Counsellor researchon areas o f sexuality, reproductive health, STD's, HIV/AIDS and Voluntary Counselling andTesting Adolescent studies peer education, reproductive healtheducation, counselling services and an adolescentnewspaper, Straight Talk. Annual International Counselling Conference andProfessional Development Programs ExperienceinTraining KAPC's core programs inrelation to training have included; Training counsellors, counsellor supervisors, andpeer education, on area o f sexuality and counsellor supervision. As KAPC have developed, programs have been addedand strengthened interms o f quality. KAPC i s regarded as both a national and international organization with a structure that is inkeepingwith its diversified activities. From 1994 - KAPC offered a 4-week certificate course incounselling to the general public. This coursehas attracted over 3000 participants drawn from Kenya and 18 other countries inthe sub-SaharanAfrica region(fromNigeriato SouthAfrica). Majority oftheparticipants from other countries didthe course inNairobi while KAPC transferred the training to particular - 73 - countries in- Uganda, Tanzania, Eritrea, Rwanda, Somali and Sudan. The participants have came from: NGO's; religious denominations; government departments; local councils; businesses; UN agencies and some students registered as private individuals. The range o f courses offered since 1994has increasedandnow includes Peer education, HIV/AIDSTOT Counsellor Training Courses, a HigherDiplomainCounselling Studies anda Master's Degree inCounselling Studies taught incollaboration with University o f Durham.In addition a number o f short courseshave beendeveloped on Stressmanagement, child - counselling, loss and grief, marriage and guidance counselling andretrenchment. Although the geographical distribution o f students centersonNairobi an increasingnumberhave come from other parts o fKenya. KAPC courses have also attracted a number o f international students and these have come from 14 countries ineasternandsouthern Africa, also from Nigeria. KAPC has a history as well as experience incounsellor training, Peer Education, Adolescent Reproductive HealthPrograms and supervision. Currently the Association holds; A series of peer education programs, counselling certificate courses for participants from Kenya and the Eastern and SouthernAfrica Region. Others are a HigherDiploma incounselling studies, a Masters Degree Program incollaboration with DurhamUniversity, UK. KAPC has successhlly been involvedinthe following range ofprograms over the years: 1994to date runninga regular counsellor's trainingprogramme bimonthly at certificate level inNairobi, KisumuandMombasa. 1997 initiated and since then conduct a HigherDiploma inCounselling trainingprogramme in Nairobi, KisumuandMombasa 1998 to date hosts a Masters degree programme incollaboration with DurhamUniversity 1992 - 96 conducted adolescentresearchesandbehavior change programs with support and collaboration with the Ford foundation and Rockefeller Foundation 1995 to date - Publishes an adolescent sexuality and reproductive health newspaper 'Straight Talk' anddistribute360,000 copies to young people nationally every month. Have been supported inthe initiatives by, the FordFoundation, DSW, UNICEF, Pop Council, Futures Group International andEquality Now 1998 to date - Initiated andrunning'Straight Talk Clubs' inschools incollaboration with the Ministry o f education. Currently about 700 clubs with an average o f 35 students. 1996to date - conducting a two weeks (10 day) peer education programme inwork place, schools and on a regular calendar over the school holidays. Trained peer education counsellors for UNICEF staff, UNDP, World Bank staff, World Vision, FamilyPlanning Association o f Kenya, KenyaPorts Authority, Kenya Revenue Authority, various churches supported programs etc. From 1999 - holding an annual trainingprogramme for self-select counsellors interested in developing a career as counsellor supervisors. From 1995 - conducting a monthly support supervision programme for the association members inNairobi, KisumuandMombasa 1995-98 - a three year AIDSCAP Counselling andTesting multi-sitestudy, the Nairobi site that KAPC hosted and offered regular supervision to all its counsellors 1997 to date supervision and evaluation o fMSF-Belgium HIV/AIDScare and support - 74 - programme inNairobi; 1998 - 2001 - Supervision o fthe City Council o fNairobi, University of Gent and Washington university counsellors inthe City council clinics 1999-2001 Establishment o fa by-weekly support supervision for Liverpool University (HAPAC Project) counsellors inThika andNairobi. 2001 -2003 Training of support supervisorsand establishment of support supervision for KAPC Futures Group International supported HIV/AIDS counsellor's programme inthe 12 districts inNyanza province, Kenya. A total o f24 counsellor supervisors were trained. 2001 -2003 Training o f support supervisorsand establishment of support supervision for the Family HealthInternational (FHI), HIV/AIDS,VCT supported programs inNairobi, Thika, Mombasa and Western Kenya. A total o f24 counsellor supervisors were trained. 2003-2005 - Training and establishment o f support supervision programme in5 countries in Eastern and South African Regionincollaboration with the Regional AIDS Training Network (RATN). A total of 12 students are currently beingtrained. - 75 - Course: Physician Training Institution: Kenya MedicalAssociation Course Location: Nairobi, Kenya Duration: 2 weeks Background Kenya Medical Association is a voluntary membership organization open to all medical practitioners registered in the Republic o f Kenya. It is organized into 14 Divisions around the country. Founded in 1968, K M A ' s main objectives include promoting the practice o f medicine in Kenya; upholdinghighstandards o fmedical ethics and conduct; to advise the Government and the general public on matters related to health; fighting for the welfare o f doctors; and to support continuing medical education (CME) through its periodic publications, seminars and scientific conferences. The day-to-day running o f KMA is vested under a National Executive Committee (NEC) which consists o f the Chairman, Vice - Chairman, Secretary, Assistant Secretary and Treasurer, all elected biannually by its registered members. The Association runs most o f its activities through thematic standing committees such as Reproductive Health, HIV/AIDS, Social Welfare and Responsibility, East African MedicalJournal (EAMJ), HumanRights, DrugPolicy and Continuing Medical Education (CME) among others. All these Committees report to NEC through their chairmen. The members o f NEC, chairmen o f standing Committees and elected representatives from all 14 Divisions form the National Governing Council (NGC), the decision makingorgan o f KMA. Inline with its objectives, KMA has implemented several donor hdedprojects. Currently, it is involved in the training o f health workers on the rational use o f anti-retroviral drugs (ARVs), a project h d e d by World Health Organization through the Ministry o f Health (MoH). Negotiations are underway to expand the scope o f this program to cover all cadres o f health workers in a self-inclusive ARV Training Program. KMA i s implementing a GTZ financed measure to promote the role o f ProfessionalAssociations inEast Africa to strengthen civil society inEastAfrican Community (EAC). As an Association, KMA hasjoined the sister organizations inthe East African regionto forge a cooperation inthe HealthSector together with the medical regulatory bodies and the Ministries o f Health. It is under this initiative that the three East African Associations formed the Federation o f East African Medical and Dental Associations (FEMDA) which was launched during the 2004 KMA Annual Conference. KMA works closely with the Medical Practitioners and Dentists Board (MP&DB), the statutory body that regulates the practice o f medicine inKenya. One o f the major achievements o f this was the development o f Fee Guidelines by members o f KMA for use by the Boardto govern the fees chargedby providers (doctors). Recognizing the pivotal role of continuing education in the profession, KMA i s working to develop a National Continuing Professional Development (CPD) Structure that will ultimately make Continuing Medical Education (CME) mandatory for all health workers. - 76 - Physician Training Course Modules (course duration: 2 weeks) Module 1: History andEpidemiologyo f HIV/AIDS Module 2: Preventive Interventions against HIV/AIDS Module 3: HIV/AIDSImmunobiology and the Laboratory Use inDiagnosis andFollow up o fPatients with HIV/AIDSincluding ARV Treatment Module 4: Medical Management o f HIV/AIDS Module 5: Surgery inthe HIV/AIDSEra Module 6: ARV Drugs andtheir Characteristics Module 7: Guidelines on ARV DrugUse Module 8: Pharmacy andDispensing o fARV Module 9: PMTCT Transmission o fHIV/AIDSand support Module 10: The Use o fARV drugs inChildhood-HIV/AIDS Module 11:Clinical PackagesandARV inHome BasedCare Module 12: Legal Framework inHIVIAIDSandinARV DrugRational Use inSpecial Circumstances 2. Modules to be developed are: Vaccine Development for fight against HIV/AIDSTransmission and infection HIV/AIDS:ClinicalFeaturesandDiagnosis Opportunistic Infections, Clinical FeaturesandManagement ARV DrugChemistries, PharmaceuticsandDrugReactions HIV/AIDSAdvocacy, Behavior Change Communications (BCC) andVoluntary Counseling. - 77 - Course: LaboratoryTechnicianTraining Institution: EthiopianHealthandNutritionResearchInstitute CourseLocation: Addis Ababa, Ethiopia Duration: 2 weeks Background: The EthiopianHealthandNutrition ResearchInstitute (EHNRI), established in 1950, i s a unique researchinstitutionwithinEthiopia, recognized nationally and internationally as a center o f excellence. The breadth andrelevance ofthe institute's researchagenda, andthe ability o fthe institute to work closely with government ingetting researchinto policy, have all contributed to this reputation. The institute i s staffedby nearly400 employees rangingfrom scientific, technical, administrative and supportive personnel, involvedwith numerous projects that are at the cutting edge of HIV/AIDS, STD, TB, traditional medicine, andnutritional healthresearch. Currently, there are 10 Senior Researchers, 15 Researchersgrade 11,8 Researcher grade -I, 35 Associate Researcher grade 11, 10Associate Researchergrade I,35 ResearchTechnologists (rangingfrom grade I1to VII) and20 ResearchAssistants. The senior staff are recognizednationally for their expertise, andtherefore serveonmanycritical national structures. Inaddition, they are consultedby and support the government inthe development o fhealth policies andprograms. Currently, the institute i s governedby Boardo f Directors (BOD) andthe Minister o f Healthi s the Chair o f the BOD, the institute's director serving as its secretary. The institute collaborates with Ministry ofHealth, HIV/AIDSPrevention andControl Office, the EthiopianScience andTechnology Commission, Regional Health Bureaus, the EthiopianRedCross Blood Banks, Addis Ababa University, Non-Governmental Organizations, WHO, UNAIDS, and other groups which aim to combat the HIV/AIDSepidemic inthe country. The institute hasreceivedvarious awardsandhonors for its contribution bothfrom national and international organizations. The institute hasthe following objectives: Enhancing the capacity o fthe EHNRIto support surveillance o f HIV/AIDS/STI/TB, VCT andprovide referral servicesfor diagnostic andother diseasesrelatedto HIV infectionand transmission inEthiopia. To strengthen development o f a national quality assurance program for HIV/STI/TB. EHNRI, incollaboration with others, also hasthe objective ofenhancing its capacity to support and strengthen HIV/AIDS/TB/STI surveillance andprogrammatic services including: - validate HIV/STI/TBalgorithms to support sentinel surveillance andprogrammatic services (VCT, MTCT) develop standardized operation procedures (SOP) provide quality assurance provide continuing diagnostic training establish drugresistancesurveillance for TB and STI - 78 - establish laboratory referral diagnostic and monitoring facility for HIV/AIDS/TB/STI and other opportunistic infections The institute provides short-term training inthe following: - -Training o f laboratory technicians on HIV testingalgorithms inEthiopiafor the purposes o f surveillance [two weeks] and. VCT programs, including PMTCT programs -Screening for bloodsafety -Training on Good Laboratory Practices (GLP) -Integrated Laboratory Training on HIV/STI/TB/malaria -Training on laboratory aspectso f antiretroviral monitoring, including CD4 cell counting and viral loaddetermination methodologies -Introduction to epidemiology and statistics - 79 - Course: Program Managers Training Institution: Eastern and Southern ManagementInstitute Course Location: Arusha, Tanzania Duration: 3 weeks Course Objectives HIV/AIDS progrdproject managers face a number of constraints in their day-to-day duties including limited financial resources, lack o f political will to support programs at national and decentralized levels, stigma and denial, corruption, misuse o f resources among others in addition to general inadequate technical and managerial skills. The overall objectives o f the course are to enable HIV/AIDS program managersto perform effectively intheirjobs. Participants o f this course offered by the Eastern and Southern Management Institute (ESAMI) willbe able to: Explainthe generalmanagementandtechnical issues inHIV/AIDS programs andequip participants with such skills Develop programs and projects to combat HIV/AIDS Describe the role of InformationManagement inHIV/AIDSprograms Provide anoverview o f change management Appraise HIV/AIDSprograms and projects Plan and implement HIV/AIDSprograms andprojects Share national andparticipants' experience inthe managemento f HIV/AIDS programs and activities and Prepare action plans to resolve programs/project managementproblems and for integration of learnedprinciples back to work Monitor and evaluate HIV/AIDSprograms andprojects The coursewill cover the following modules: Modulel: Foundation Module Introductionto ProjectProgram Management Introduction to HIV/AIDS Socio-cultural aspects o f HIV/AIDS HIV/AIDSProject/Program Management Module 2 -Program/Project Formulation and Planning ProgradProject Planning Data collection analysis Project design HIV/AIDSPrevention, Mitigation Care andSupport Module 3 -Program/Project Appraisal Introductionto appraisals - 80 - Assessmento f financial feasibility Assessment o f Socio-economic Impact Assessment o f Institutional and Organizational Impact HIV/AIDSandFinancing Module 4 -Program/Project Implementation and Management Introduction to implementation Project planningandimplementation techniques Recruitment and selection of staff Leadership and team building Financial resourcesmanagement Procurement and supplies management Changemanagement Module 5 -Program/Project Evaluation Introduction to monitoring and evaluation Monitoring and Evaluation Planning ImplementingEvaluationPlan Module 6-Integration and Transfer of Learning Country profile andpersonal experiencewith HIV/AIDSprograms Action Plans Transfer of learning The target candidatesfor this course include HIV/AIDS program leadedmanagers ingovernment, private sector, parastatals and civil society at local, national andregional level Politicians, policy makers andmiddleto senior level decision makers ingovernment and civil society to create an enabling environment for program and PLWHA Trainers inHIV/AIDSandmanagementprograms Program Officers of Donor funded HIV/AIDSprograms -81 - - 82 - MAP SECTION