Page 1 PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No: AB178 Project Name Great Lakes Initiative on HIV/AIDS (GLIA) Region Africa Sector Social Services (70%) and Health (30%) Project ID P080413 Borrower(s) GREAT LAKES INITIATIVE ON HIV/AIDS COUNTRIES Implementing Agency Environment Category [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) Safeguard Classification [ ] S 1 [X] S 2 [ ] S 3 [ ] S F [ ] TBD (to be determined) Date PID Prepared July 16, 2003 Estimated Date of Appraisal Authorization January, 2004 Estimated Date of Board Approval June, 2004 1. Key development issues and rationale for Bank involvement The countries in the Great Lakes Region, which were hard hit by the HIV/AIDS epidemic, established national AIDS control programs in the 1980s, created the “Great Lakes Initiative on HIV/AIDS” (GLIA) at a consultative meeting of Health ministers in 1998 to: i) complement national plans to fight against AIDS and ii) promote networking among key actors in the region. In May 2003 the GLIA countries (Burundi, DRC, Kenya, Rwanda, Tanzania, Uganda) met in Nairobi and formalized their commitment to “a) develop and coordinate our policies and strategies at our respective borders with respect to HIV/AIDS prevention, care and treatment by intensifying our response, and b) to develop multisectoral programs targeting specifically vulnerable groups namely mobile populations and interacting communities in the six GLIA countries.” A secretariat has been functioning for nearly five years with funding from the Rwanda Government; UNAIDS has provided resources for pilot testing of interventions, and there have been workshops and consultations among the partners. Five GLIA countries have MAP projects while the sixth (DRC) is in the process of preparing a MAP project. Participating countries have or are developing national HIV/AIDS policies, strategies, programs and plans of action. The proposed operation is fully consistent with the specific sub-regional grant criteria contained in the Multi-country HIV/AIDS (MAP2) Program for the Africa Region, in that it: · Addresses a sub-regional or cross-border HIV/AIDS issue, promotes a public good of multinational scope, provides services to populations beyond the reach of national programs, and realizes economies of scale that would not be practical to attain through cooperative country-level action; Page 2 · Has been endorsed by the governments of the countries concerned and a relevant public regional organization; · Is consistent with the HIV/AIDS strategies, policies, and programs of the affected countries and with any relevant sub-regional and international strategy and policy; · A high-level coordinating body has been established to oversee implementation of the project; · Appropriate institutions, policies, procedures and regulations will be in place to enable the concerned sub-regional and national stakeholders to effectively participate; · The implementing body will use exceptional implementation arrangements to accelerate project implementation, including subcontracting key implementation tasks and channel funds to communities, civil society, institutions and the private sector. The principal partner support in the GLIA effort has been UNAIDS, a multi-donor partnership which includes the Bank. Since 1998 UNAIDS has provided resources for the GLIA secretariat, funds to pilot test transport corridor activities, consultancies to assist the GLIA secretariat in defining health, surveillance and refugee activities and with inter-country workshops and consultations. UNHCR has provided HIV/AIDS health and community services in refugee camps, through its implementing partners. USAID has recently written the GLIA secretariat expressing its readiness to assist in strengthening the secretariat in the short term. Both the GLIA countries and development partners have actively sought World Bank involvement. Bank support to this effort brings: i) a broad developmental perspective and how HIV/AIDS fits into this agenda; ii) experience in over 22 countries in Sub-Saharan Africa in designing and implementing programs under the MAP; iii) experience in preparing a sub-regional multi-country HIV/AIDS-focused effort with the Abidjan/Lagos Transport Corridor Project; iv) experience in dialoguing with countries which may be in de facto conflict with one another, at highest political and economic levels; and v) IDA’s role in sub-regional multi-donor disarmament, demobilization and reintegration efforts. Each of the GLIA countries separately and jointly submitted commitment letters to the Bank stating their readiness to support and participate in the preparatory process, that such an effort would fill critical gaps left by individual country projects, and specifically requesting the Bank to provide technical and financial assistance. Rwanda has provided approximately $200,000 over the last two years in support of GLIA activities, including funds for the secretariat. 2. Proposed objectives The Project will: - Support the mission of the Great Lakes Initiative on HIV/AIDS (GLIA) in building capacity and implementing program activities within the Great Lakes countries to effectively combat HIV/AIDS by increasing and improving access to HIV/AIDS prevention, care, and treatment for mobile and vulnerable groups such as refugees, transport sector workers, highly affected/infected populations. - Implement a sub-regional approach that complements national programs, reduces the negative impact on individuals, families and communities from HIV/AIDS to create a Page 3 more positive environment for social and economic development in the Region, promoting prospects for more lasting peace and security. 3. Preliminary description Four components are under consideration, over a 3-4 year period, namely: Component 1: Refugee camps and affected areas surrounding the camps represent an underserved sub-catchment population which will receive assistance covering the full range of prevention, care and treatment. Internally displaced people who have returned from refugee camps would constitute another potential target population. Initially two (2) such sub-catchment areas would be identified in each GLIA country, preferably of different types. UNHCR would be responsible for the programs in the refugee camps, while affected areas and IDPs would be administered by the national HIV/AIDS Secretariats within the national HIV/AIDS framework, utilizing the national MAP approach. A tripartite agreement would be developed between the GLIA secretariat, UNHCR, and the national AIDS program which described the activities and types of services provided. (UNHCR currently operates principally through tripartite agreements with the Government and UNHCR Implementing Partners who are usually NGOs). Criteria for interventions will be developed but conceivably based on general principles of “transportability” by the refugee community to their future destination, and of “enduring value” to the affected area should the refugee camp no longer exist. This implies possibly no new physical infrastructure, and/or modest renovation, rehabilitation or reconstruction of existing facilities to accommodate expanded activities. Component 2: Transport sector workers and cross border populations, as well as partnership networks, including PLWHAs, would be supported through capacity building and interventions. Pilot programs such as the Safari Safi program with trucker federations offering IEC/BCC materials and condom distribution, have been piloted. Women’s networks, the embryonic early child development network (Tanzania, Kenya, Uganda), sub-regional faith-based organizations, and similar potential GLIA networks would be supported and expanded through technical assistance, and funding for interventions. Component 3: Sub-regional health sector collaboration would take as its basic premise that common policies and approaches for key health sector stakeholders (public health specialists, doctors, nurses, health assistants, health program implementers, pharmacists, laboratory technicians, and drug manufacturers and distributors), can overcome barriers to better care and treatment in the Region, and is a means to more efficiently utilize scarce human and financial resources. Component 4: Program management, policy and capacity development would provide overarching support for GLIA. Sub-components would include: i) project administration and operational support, emphasizing outsourcing wherever possible; ii) sub-regional advocacy, strategy, policy and program capacity building, and oversight; iii) civil society, especially mobile populations and highly affected group capacity development; iv) assessment, monitoring and evaluation, including epidemiological and behavioral surveillance and mapping, operational research and pilot testing. In addition to a core secretariat, also envisioned is the designation of a Page 4 GLIA Focal Point within each national HIV/AIDS secretariat. This GLIA Focal Point would be provided with an annual budget which includes travel, workshop and operational research funds to cover GLIA advocacy, activity oversight, and participation in sub-regional meetings and discussions. 4. Safeguard policies that might apply Environment and resettlement (as it relates to movement of people resulting from construction). 5. Tentative financing Source: ($m.) BORROWER/RECEPIENT 1.0 IDA GRANT FOR HIV/AIDS 15.0 IDA GUARANTEE 0 Total 16.0 6. Contact point Contact: Pamphile Kantabaze Title: Task Team Leader Tel: (257) 22 2443 – 5399231 Fax: (257) 22 6005 - 5399228 Email: Pkantabaze@worldbank.org Location: Bujumbura, Burundi (IBRD)