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Annex 4: Detailed project description.

BOTSWANA: Botswana National HIV/AIDS Prevention Support Project

Component 1: Support to NACA:

1. With NACA as the institutional home of the Project, the NACA component will provide very focused and strategic attention to build internal capacity to coordinate HIV/AIDS activities effectively, both for the Project and the program more generally. This is in line with the third goal of the Botswana National Strategic Framework (NSF) for the National Response to HIV/AIDS, which is "Strengthening the Management of the Response".

2. NACA was established by a Presidential decree on December 8, 1999 and went through a major reorganization in the early 2000s. More recently, based on recommendations from institutional assessments carried out especially by the Government in its NACA joint planning report, the O&M study, the NACA Mid-Term Review, and the World Bank team, the Government at very senior levels has recently concluded a review of the organization of NACA. Some decisions remain pending, but the revised structure of NACA was approved. NACA will continue to have a National Coordinator (at Permanent Secretary level), but with a new structure comprising four Departments--(a) Program Planning, Coordination and Support; (b) Policy, Strategy, Research, Monitoring and Evaluation; (c) Education, Communication and Advocacy; and (d) Corporate Services. Each Department is headed by a Director. This structure is based on a thematic allocation of responsibilities - and then within each Department functional responsibilities have been allocated. For a small organization such as NACA, this is a complex matrix management system--but this is unavoidable given the range and depth of the multisectoral issues that NACA is required to address.

3. The agreement on this new structure will in turn permit the recruitment of a significant number of additional staff including the filling of some long-standing vacancies particularly at the middle management levels. This recruitment process has already begun. Thus, within the next 6-9 months these positions will be filled and for the first time for some years, NACA will have a clear organizational structure which is adequately staffed.

4. To complement these Government's initiatives in reorganizing and re-building NACA, one important focus of the Project inputs will therefore be on capacity building within NACA, in key areas that complement support being provided by other partners. Particular attention will be paid to systems building. The ultimate aim is to ensure that NACA evolves into a viable, credible and efficient organization.

5. The role of NACA as primarily a program coordinator would continue to be emphasized. In addition to its program coordination responsibilities at the central level, it also has decentralized responsibilities especially at the district level. The Project will support central and district activities, with the district activities implemented through a combination of the Ministry of Local Government (the DACs office and the District Council) and the CSOs.

6. With the results focus of the Project, importantly, this component would also provide support for the improved design and strengthening of the National M&E Framework. This would complement other partner inputs, both centrally and in the districts, and would include technical assistance, efforts to improve data use by management, and support for database development and surveys.

7. As part of the building of capacity in NACA, a central part of the Project is long-term technical support for NACA. There are 8 positions planned, which would be senior experienced consultants working in NACA Headquarters. Terms of reference (TORs) for all positions are agreed. These TORs focus on achieving results in capacitating NACA and skills transfer, combined with strict progress reviews, rather than only providing technical inputs. These positions will phase out over the Project and are as follows:

(a) Management and planning

-- Senior Management and Implementation Specialist (and de facto technical assistance team leader)

-- Senior Capacity Building Specialist

-- Senior Strategic Planning and Partnerships Specialist

(b) Fiduciary

-- Two Senior Financial Management specialists

-- Two Senior Procurement specialists

-- Senior Monitoring and Evaluation specialist

8. Recruitment for these positions has started and the Government has agreed, if necessary, to finance these positions initially from its own resources until Project funds are available. To complement these inputs which will be centrally based (but not solely centrally focused), technical assistance at the district level will be available through a variety of arrangements with partners including volunteers from the UN, JICA and the US Peace Corps. Specifically, NACA has agreed to pre-finance the recruitment of mid-level TA (Grant officers), that would primarily be responsible for strengthening the DACs office to implement Project, as well as program activities. Recruitment of these has also commenced.

9. The above assumes that this will continue to be from the Ministry of Finance to NACA and then on. Both NACA and the Bank team would prefer not to have NACA as an intermediary, but this issue remains under discussion, and the status quo prevails.

10. As an important part of NACA's systems strengthening, both the external and internal coordinating structures were reviewed by the Government and partners. The resulting revised arrangements, and particularly the coordinating committee structures, have recently been implemented. The Project implementation arrangements are designed to fit within these structures (see Annex 6).

11. Training, particularly long-term training, and development for NACA's own staff is already well planned and generously financed through existing Government programs. But the Project will finance capacity training, to be implemented by NACA, for CSOs at the national and district levels and associated annual CSO capacity assessments. NACA will also contract an important series of studies focusing on the social aspects of the HIV/AIDS epidemic.

Internal Streamlining of activities:

12. In order to suitably tailor its internal processes to adequately address the demands of the national response, NACA will re-calibrate these three existing committees which will expectedly become more potent with the additional human resources mentioned above:

a) Programs Committee: Main tasks will include:

* Reviewing, assessing and recommending all the programs, projects and plans submitted to the Technical and Policy Steering Committees;

* Promote Programs coordination and collaboration between the appropriate organizations, agencies and individuals;

* Monitor and evaluate all Program activities and effect dissemination of information.

b) Finance, Administration and Audit Committee: Main tasks will include:

* Preparation of estimates of expenditure and prospective budgets;

* Administer and keep under review the rules and regulations governing financial management of NACA's funds;

* Ensure prudent management of Financial resources;

* Provide a framework for coordination, disbursements, review and advice accordingly of manpower requirements of the committee;

* Liaise and coordinate all matters related to internal and external funding;

* Serve as staff appointments and review committee for NACA;

* Function as a disciplinary committee for the staff of NACA.

* The Committee is tasked with oversight, governance, accountability, and transparency at NACA. The committee shall provide a forum for private and direct communication between committee members and the external auditors, internal auditors, and senior staff. In addition, the committee will establish procedures to receive retain and treat complaints received by NACA regarding accounting, internal accounting controls, or audit matters and for the confidential, anonymous submissions by NACA staff of concerns regarding questionable accounting or audit matters.

c) Procurement Committee: Main tasks will include:

* Review and verify that all the procurement procedures and processes including tender opening, and

* Ensure that technical and commercial evaluations have been undertaken in accordance with the Government of Botswana and the World Bank's procurement guidelines.

External streamlining of activities:

13. These processes will govern how NACA coordinates Project specific activities with its other development partners. These are pertinent, especially towards further defining NACA's deliverables.

Project Steering Committee (PSC):

14. This committee with broad based and multi-sectoral membership will ensure that the Calls for Proposals (CFP), and public sector ministerial annual HIV-specific work plans are in-line with the priority areas of the NSF and address the most needed areas of deficiency. Membership will be at Permanent Secretary level for public sector ministries, and director level for the other development partners. The PSC will include key implementing partners at the national level, specifically from the MFDP, MOH, MLG, NACA, MOE, the UN technical agencies and CSO/private sector. Under BNAPS, the PSC will be strengthened in its oversight role, and in holding implementers accountable to work programs that are integrated and targeted towards results. To this end, the type and quality of reporting to the PSC will need to be standardized and with an emphasis on performance. The PSC will meet at least twice a year and share the minutes of key issues discussed and agreed to all implementers and IBRD.

15. The committee will agree on the annual scope of the Project activities, based on the CFP taking into account priorities and gaps identified in the annual review process and will forward their recommendations to the NACA. Once these recommendations have been agreed on, the secretariat proceeds to make the CFP for CSOs, as well as approve or amend the work plans for the public sector ministries. Detailed terms of reference for the ad-hoc committee are to be found in the annex to the manual.

HIV/AIDS Technical Sub-Committee (TSC):

16. The committee is already in existence and was used for GFATM reviews as well as the PEPFAR programs. It will be tasked with reviewing, assessing, and awarding proposals developed by CSOs and the Private Sector at the National level (proposals ranging from 30,000-600,000BWP) as well as technical reviews for the public sector ministerial HIV/AIDS specific work-plans. Apart from the technical and financial viability of the proposals and work-plans the committee will also look for areas of synergy as well as maximize any imminent complementarities.

17. The members of the committee will be appointed by NACA and will then be vetted by the PSC. Under BNAPS, the Technical Steering Committee (TSC) will include key implementing partners at the national level, specifically from the MOH, MLG, NACA, MOE, the UN technical agencies and CSO/private sector. Representatives to the TSC from the Public Sector Ministries will be at least at Director- level. The TSC will meet at least twice a year and share the minutes of key issues discussed and agreed to all implementers and IBRD.

18. Members will have technical expertise in the issue proposed by the CFP and will have no conflict of interest with institutions or organizations submitting proposals. Membership will be multi-sectoral.

Component 2: Public Sector Ministries:

19. This component will support public sector line ministries focusing on initiatives in line with the National Strategic Framework (NSF). In consultation with partners and as indicated in the NSF, the Project will commence with the following ministries: (i) Health; (ii) Works and Transport; (iii) Labour and Home Affairs; (iv) Education; (v) Local Government; and (vi) Youth, Sports and Culture.

20. Annual work plans for funding under the project will be submitted for the Project Steering as well as the HIV/ALDS Technical Sub-Committee's review. Upon approval, funding will be channeled through NACA for further disbursement to the relevant ministries. Monitoring and evaluation of activities will be coordinated by NACA. The key thematic areas of support would focus on programs and activities in the three priority areas reflected in the NSF. The public sector support will emphasize external and internal mainstreaming and indicative activities under this component include the following:

a) Ministry of Education (MOE): MOE activities will seek to prioritize prevention for in and out of school programs.

Research: (a) A survey will be carried out ("Voice of the affected and infected") in partnership with Baylor University using an amalgam of standard survey tools to extract and clearly identify the effects of HIV/AIDS on infected and affected children. The cohorts will be children aged 6-18 years of age who either attend or are registered at a health facility. The objective of this will be to utilize the realized information to modify training instruments geared towards children and their guardians; influence the design of IEC/BCC materials and activities; and to influence policy formulation regarding school curricula, social worker services etc.; and (b) A cost-effectiveness study to critically assess the cost-effectiveness of all internal MOE programmatic activities focused on primary and secondary learners and recommend more efficient and strategic mechanisms.

Training: (a) in partnership with Baylor University, the MOE will organize a phased Training of Trainers program aimed at increasing and updating the knowledge of primary and secondary school teachers. The team will have 11 regional sessions with 20 teachers per team. The overarching target is to reach the 23,300 primary and secondary school teachers (b) 6 Training of Trainers workshops per annum for the regional Guidance and Counseling teams attached to school districts. The aim will be to streamline the ways to effectively pass impart HIV/AIDS prevention messages to learners who are affected, infected or neither. Initial plans are to commence with teams in three regions, with 25 teachers per region.

Program Implementation: (a) development of HIV/AIDS guidelines for the MOE. This will involve streamlining the individual guidelines for each of the 9 departments into a coherent and comprehensive and well articulated ministerial guideline which is aligned to the NSF, national HIV/AIDS policy, public service code of conduct on HIV/AIDS on workplace and the DPSM wellness policy, primarily for the purposes of effective intra-ministerial planning; (b) Establishment of multi-disciplinary counseling centers, which will act as one-stop shops for learner support. It will cater to in and out of school learners and will be staffed by psychologists, social workers and nurses serving school clusters. It will serve as a referral center for learners who have HIV/AIDS related psychosocial needs as well as a resource center for in and out of school learners as well as teachers. This initiative is clearly in line with the multi-sectoral thrust of the MOE-MOH school health policy; and (c) The Project will support a consultancy aimed at updating and strengthening the pre-service and teaching curricula by infusing relevant HIV/AIDS materials.

Program Support: (a) Support for the "Silent Shout" program which is a television periodical that focuses on youth discussing HIV related issues with their peers and professionals. The Project will support transport, room and board for children who live in the rural areas as they have been logistically excluded from previous editions; (b) Purchase of airtime on regional radio stations towards providing a forum for youth and teachers to discuss HIV/AIDS related issues The aim is to weaken stigma and increase knowledge of HIV/AIDS; and (c) other programs include: support for youth outreach forums, toll-free counseling facility to ensure a safe and private environment to seek and receive counseling, and strengthening the HIV/AIDS resource centers in the 47 vocational colleges nationwide.

b) Ministry of Labour and Home Affairs (MLHA): Priorities for the Department of Prisons focused on providing mobile antiretroviral clinics for the largest prisons (4 in Gaborone and 1 in Francistown) to complement the weekly VCT services, as well as in-service training for its staff on HIV prevention methods. Specific activities for the first year will include complementing the VCT and antiretroviral administration capacities at two of the biggest prisons, and training on IEC knowledge and dissemination methods to prisons staff as well as the dissemination of educational materials to inmates.

c) Ministry of Local Government (MLG):

Department of Social Services (DSS): The DSS will focus on rehabilitating street children by facilitating vocational training as well as educating them on HIV/AIDS. Also specialty training on HIV/AIDS will be given to social workers posted to hospitals, specifically focusing on the psychosocial complications of HIV/AIDS as they affect marital relationships.

Department of Primary Health Care (PHC): (a) The Project will support the conversion of 7 recently acquired warehouses to regional medical stores to complement the activities of the central medical store and the pharmaceutical supply chain with the overall objective of reducing stock-outs and re-stocking times of satellite clinics; and (b) the Project will support the upgrades of 26 clinics to become HAART compliant in line with the new government's policy of dispensing HAART in the ART and PMTCT program.

d) Ministry of Works and Transport (MWT): Priorities focused on strengthening existing district programs that focus on mobile populations. Palapye, Selebi-Phikwe, and Francistown were some of the areas highlighted.

Mobile Staff: Outreach and educational activities will focus on the ministry staff that are mobile and rotate between construction and repair sites as well as transporters/truck drivers across the border. Activities here will also focus on increasing STI diagnostic and treatment facilities at the border areas using mobile clinics and EEC/BCC outreach activities.

Stationary Staff: Training activities will be strengthened for the ministerial peer educators who will focus primarily on the stationary ministerial staff.

Commercial Sex Workers: This sub-component will focus on educating and rehabilitating commercial sex workers by engaging them in income generating activities as their predominant clientele are the mobile population at the border regions.

e) Ministry of Youth, Sports, and Culture (MYSC): Priorities are focused on strengthening existing ministerial programs that target youth. Interventions will be nationwide, with the first year focusing on sport facilities along the eastern corridor. Specific activities outlined for the first year will include outreach activities that will target youth, using sport facilities and sporting events as IEC platforms. This sub-component will also focus on Sexual and Reproductive rights as they affect preventative behaviors in youth by preparing an information package on sexual and reproductive health and HTV/AIDS integration. Focus will be on legislation, policy implications.

f) Ministry of Health (MOH): The Health Sector component is being developed around an already strong national treatment and care program. It was agreed that, within the context of the proposed operation, efforts would be focused on providing technical assistance to the prevention activities of the civil society and the public sector components, as well as increasing the technical and financial efficiencies of the PMTCT and ART program.

TB/HIV activities: (a) The Project will support the conversion of wards in three hospitals to regional TB/HIV isolation and referral centers. This will serve to contain the proliferation of the dual epidemic; and (b) Recruitment of two regional TB/HIV coordinators (North and South). These will be charged with coordinating the planning, implementation and evaluation activities of the regional TB and HIV coordinators to promote synergies.

Treatment Program: (a) In partnership with the Botswana Harvard partnership, the Project will support a cost-effectiveness study to review the current treatment program. This is in line with one of the Projects core objectives of increasing the technical and financial efficiency of the treatment program. Currently, treatment commences at CD4 levels of 250 and below. The study will observe two-three cohorts of different higher ranges of CD4 cell counts, observing for the duration and frequency of hospitalizations, occurrence of opportunistic infections and conversion of primary to second-line drugs. This study is currently under-going review by the research and ethics committee and is tentatively planned for the second year of the Project; and (b) The Project will also train pharmacists and pharmacy technicians to strengthen the HR capacity needed to effectively implement the new HAART regimen.

Component 3: Civil Society Organizations (CSO)/Private Sector:

21. This component has been allocated the majority of the Project funds, reflecting the importance of the civil society organizations (CSOs) in the achievement of Project activities. CSO activities will be focused at both the district and national levels and will operate via the call for proposal mechanism. Disbursements will be quarterly and performance based.

22. This component would make financial resources available to civil society, private sector, focusing on initiatives in line with the NSF. In terms of implementation of this component, the process could be described in four interlinked processes: developing calls for proposals; receiving, evaluating, and awarding proposals; financial flows monitoring outputs. Awarding proposals to civil society and private sector agencies is proposed to be done at two levels: (i) DAC-level (awarding proposals below 30,000BWP); (ii) National-level (awarding proposals in a range of 30,001-600,000BWP) and proposals over 600,000 BWP per year requiring a prior review by the IBRD.

23. The Project preparation team interviewed relevant players in the CSO component as well as collateral counterparts within NACA, the public and private sector as well as other development partners. Findings revealed that CSO dysfunction gravitated around inadequate and inconsistent funding, low capacity and weak capacity development planning strategies, and organizational misalignments within the CSO sub-sector. Project design has emphasized results-based support and targeted community level activities.

24. This sub-component will focus on proposals and activities that prioritize specific HIV/AIDS prevention results and target vulnerable populations including: commercial sex workers, orphans and vulnerable children, migrant workers, women (including widows), youth, workers in small and medium-sized enterprises, micro-enterprises, and the informal sector, and people living with HIV/AIDS. Vulnerable population groups eligible for BNAPS financing will be decided through the agreed processes involving both the HIV/AIDS Technical Sub-Committee and Project Steering Committee, as outlined in the draft Operations Manual. It is expected that this process will streamline funding procedures, agreeable to all stakeholders while focusing on specific thematic areas based on comparative strengths and regional needs.
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Publication:Botswana - National HIV/AIDS Prevention Support Project
Date:Jan 1, 2008
Previous Article:Annex 3: results framework and monitoring.
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