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3. Implementation and costs.

Implementation Experience

3.1 After an initial three-month delay in effectiveness, (28) the project was implemented over six years and three months (including a six-month extension (29)) and closed on December 31, 2001, with the credit fully disbursed.

3.2 Counterpart Financing. At the start of the project Government made its counterpart funds available, although frequently later than the agreed schedule. However, Government's failure to budget the 20 percent counterpart funding for key sectoral ministries in 1998 caused their activities to come to a halt. (30) Chronic unavailability of counterpart financing during the second half of the project life caused the working relationship and trust between the project and its suppliers to deteriorate seriously, because the latter were being paid only 80 percent of their invoices (the Bank's share). Support staff were only receiving 80 percent of their salaries and telephone and electricity were cut. The Bank was persistent in raising this issue with Ministers of Finance and of Plan, Development and Cooperation, but this issue was not resolved prior to the project's closing. (31)

3.3 Population. The two major studies started with some delays but were eventually completed. The Demographic and Health Survey was delayed by elections and the initial unavailability of logistics to support field work. The Migration and Urbanization Survey was delayed because UNFPA was unable to provide all of the funds it had initially committed and CERPOD restructuring caused a disruption in its technical support. IDA agreed to finance the gap and cost overruns given the importance of this study.

3.4 Lack of government commitment and heavy bureaucratic processes caused major delays in key project activities. The Government decree creating three key population entities--the HCPRH, CNPRH and CPPRH (32)--was signed on November 23, 1995, and the legal texts defining the composition and operations of these entities were signed on April 10, 1996. The preparation and approval of the Program for Priority Actions and Investments (Programme d'Action et d'Investissements Prioritaire, PAIP), which was the framework for population policy implementation, was delayed as a consequence. It was transmitted to the HCPRH for its review and approval on January 23, 1998, nearly three years later than planned. Furthermore, the HCPRH met for the first and only time on November 17, 2000 to approve the PAIP almost three years after it was received. A draft decree was prepared in 1998 proposing that the HCPRH be chaired by the Prime Minister, rather than the Head of State, to make it more operational, but the decree was never signed. In a meeting of September 7, 2001, the CNPRH insisted that the President continue to chair the HCPRH.

3.5 Six seminars for journalists, NGOs, opinion leaders, and leaders of women's organizations were carried out as planned. Some 140 union leaders (against 100 planned) were trained in population information workshops and the majority of prefects and subprefects were trained in population, as planned. The messages of these seminars and training sessions were tailored to the specific target groups, but by and large included dissemination of the Declaration of Population Policy and the social and economic consequences of rapid population growth and high fertility for the country at large, the local level, the family, as well as individuals. Themes discussed included: poverty, allocation of scarce resources, the status and role of women in development, and maternal and child health and the benefits of child spacing.

3.6 While the Population Unit was given a higher profile in MoPC--promoted first to the level of a division and subsequently to the level of a full directorate--the number of population professionals was diminishing due to death and attrition. (33) Some of them were replaced with contractual staff and others not at all. Capacity-building efforts were also undermined by the reorganization of CERPOD in 2000, with whom the Division of Population had signed a contract for technical assistance and capacity building. With many staff leaving CERPOD after the reorganization, the quality and quantity of support fell short of levels provided in the initial years of the project.

3.7 HIV/AIDS. Implementation of this component was constrained by weak capacity within the PNLS in the MoPH throughout the life of the project. Attempts to strengthen PNLS were made in the early years of the project with the appointment of a new coordinator and a few other qualified staff. However, inadequacies in numbers and skills of staff have persisted. Difficulties in eliminating shortages of qualified personnel were due both to paucity of available qualified staff and to the reluctance of decision-makers to dismiss weak, non-performing staff.

3.8 There were tensions between the PNLS coordinator and the long-term technical assistant, hired to build PNLS capacity in epidemiology and program management. One source of tension was the extent to which the technical assistant was perceived to have substituted for PNLS skills gaps instead of developing the capacity of PNLS. Interviews revealed many strong and divergent opinions, some expressing that the technical assistant encroached on the responsibilities of the PNLS coordinator, while others noting that management and technical skills were so scarce and demands so great on PNLS that there was no other alternative and that support at the technical level was appreciated. Additionally, the terms of reference of this technical assistant included significant, additional responsibilities that extended beyond the support to PNLS: technical assistance and guidance to the PCT in project management and in the set-up, launch and oversight of the social fund. These responsibilities, (34) combined with the fact that his office was located with the PCT, reduced his availability to the PNLS. A final evaluation of this technical assistance was not undertaken by the Borrower.

3.9 Despite these constraints, most planned activities were implemented. Progressively, AIDS plans were developed and implemented at the prefecture level by prefectoral health councils. By project close, prevention activities were being undertaken in all 14 prefectures, as planned. Two hundred eighty three health personnel (against 300 planned) were given HIV/STD-related training. The project provided technical and financial support to five existing sentinel surveillance sites already existing at the project's outset and established four additional sentinel sites (versus two planned) bringing the total of fully functional sites to nine (versus seven planned). (35) Five HIV sero-prevalence studies focusing on specific groups were carried out as planned; (36) and two population-based HIV sero-prevalence studies were carried out in 1997 (37) (versus none planned). In addition, three KAP studies were carried out (versus two planned); and a planned study on the socio-economic impact of HIV/AIDS was also carried out. However, of the five planned operational studies to improve health services quality, only one was carried out. (38)

3.10 Social Marketing. At the project design stage KfW cofinancing was slated to cover the costs of the first three years of implementation of this component (including the cost of condoms), and IDA the remaining two. However, during implementation KfW decided to extend its support, including the social marketing technical assistance, through 2001 (the end of the project). (39)

3.11 Despite initial delays in start-up activities, implementation of this component was highly successful. Earlier activities focused on the setting up of MASACOT (the project social marketing unit), promotional activities, professional training, and networking.

Condom sales soon exceeded project targets and increased during the first years of the project until the year 2000. In that year it was decided to replace the technical assistant for this component, who was not considered by the Bank, KfW, or the borrower to be fulfilling capacity building responsibilities specified in the terms of reference. The time and disruption of replacing this expert had a negative effect on condom sales. Also, at the end of 1999 the Government and its partners decided to transform MASACOT, which had a temporary (or project) legal status, into a permanent NGO, the Association for Social Marketing of Chad (I'Association pour le Marketing Social au Tchad, AMASOT). Time and effort were thus spent on the preparation and discussion of draft legal texts. The first General Assembly for this new entity met on October 17, 2001. AMASOT was formally recognized by the Ministry of Interior and Security in January 2002 and the following month regional branches of AMASOT were established in Abeche, Mongo, Moundou, N'Djamena, Pala, and Sarh. The dip in the sale of condoms was only temporary and continued to climb thereafter.

3.12 Around the time of the MTR it was decided to diversify social marketing efforts to include oral rehydration salts for home treatment of diarrhea and dehydration. The rationale for this decision was to contribute to reductions in child mortality, which is recognized to be a strong determinant of fertility. The financing of this initiative under the project was made possible after KfW financing of socially marketed condoms was extended to the end of the project, thus liberating IDA funds for this new commodity. The first packets were ordered and marketed in 2000 with great success and increasing sales over time.

3.13 Social Fund. This component was slow to start because of: (a) the weakness of civil society organizations; (b) Government mistrust of civil society organizations in the wake of civil conflicts; and (c) a general lack of information and discomfort about population issues and HIV/AIDS across civil society. The preparation and approval of a social fund procedures manual having been a condition of effectiveness, the first two years of activity were devoted primarily to information and outreach with potential partners (NGOs, associations, key sector ministries) to inform them of the availability of funds and the project preparation and approval cycle.

3.14 Early efforts also focused, as planned, on the recruitment of experienced NGOs to carry out capacity building and outreach with civil society groups to guide them in subproject preparation and implementation, incite the development of new subprojects and contribute to the strengthening of public-private partnerships at decentralized levels. The social fund financed six NGOs to carry out these technical support capacity-building initiatives, two more than planned.

3.15 In response to a call during the MTR for micro finance for women as a means of fighting HIV/AIDS and addressing determinants of reproductive behavior and family well-being, the Development Credit Agreement was amended and funds reallocated to support this initiative. During the second half of the project this new subcomponent provided US$800,000 to 12 field-based agencies, (40) which provided microcredit to women's groups throughout the country.

3.16 Despite successes in exceeding implementation targets, lack of FOSAP capacity in microfmance caused a differentiation in the quality and appropriateness of approaches and results across the 12 field-based agencies. Implementation of the population and HIV/AIDS subprojects was constrained both by slow disbursements (caused in part by failure to replenish the Special Account due to delays in statements of expenses submission) and by the fact that some NGOs responsible for capacity building and outreach had a growing clientele that was exceeding their budgets and staff capacity.

3.17 FOS AP carried out independent evaluations and audits of all subprojects. Many of the local associations interviewed during field visits noted that FOS AP and PCT staff and senior NGOs (under the capacity building projects) provided critical technical guidance and support.

3.18 Originally FOSAP was conceived as an organ of the project with no life anticipated after the project's closing. However, it was later acknowledged that an important dynamic had been initiated that should continue beyond the project's closing. In 1998, the legal status of FOSAP was revised to give it a permanent legal status. As such, its management was detached from the project and given full autonomy. Two management committees, each made up of public sector and civil society representatives, oversee, respectively, the subproject grant and microfinance components. Since FOSAP achieved this autonomy, co-signature of projects by PCT was no longer necessary; and FOSAP acquired its own Special Account, which greatly facilitated disbursements.

Planned Versus Actual Costs and Financing

3.19 The total project cost was US$26.1 million equivalent, or 96 percent of the cost estimated at appraisal (US$27.2 million, see Annex D). While the IDA credit of 13.9 million SDR was fully disbursed, its dollar value decreased over the life of the project from US$20.4 million to US$18.7 million at closing (see Annex D). KfW financing was greater than initially planned because of its decision to extend its support of the social marketing component. Government counterpart financing fell short of its commitments and the actual contribution by civil society (under the social fund) was in line with appraisal estimates.

3.20 Annex D presents planned versus actual disbursements. While grants under the social fund were initially estimated at 2.70 million SDR or 19 percent of the total credit amount, actual disbursements under the social fund amounted to 3.55 million SDR or 25 percent of the total credit. An additional 5 percent of the credit (0.8 million SDR) was disbursed to support microcredit for women.
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Publication:Chad - Population and AIDS Control Project
Date:Mar 7, 2005
Previous Article:2. Objectives and design.
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