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Emergency project paper on a proposed grant in the amount of SDR 12.3 million (US$20 million equivalent) to the Republic of Cote d'Ivoire for an emergency multi-sector HIV/AIDS project.


Summary of Financial Management Capacity Assessment

As part of the Emergency Multi-Sector HIV/AIDS project preparation, a full financial management assessment was carried out in accordance with the Financial Management Practices Manual issued by the Financial Management Sector Board on November 3, 2005. The main objectives of the assessment were to determine whether: (a) the PIU has adequate financial management arrangements to ensure that project funds will be used for purposes intended in an efficient and economical way; (b) the PIU's financial reports will be prepared in an accurate, reliable and timely manner; and (c) entities' assets will be safeguarded.

The conclusion of the financial management assessment is that financial management arrangements have an overall risk rating of high and do not satisfy all the requirements under OP/BP10.2. At the same, as this project will be executed under OP/BP 8.00 ("Rapid Response to Crises and Emergency Operations"), proposed FM arrangements are streamlined and simplified during preparation, with emphasis on increased and reinforced ex-post requirements during execution, particularly in the early stages of implementation.

To mitigate country and project risk, a Fiduciary Management Team (FMT) will be put in place to ensure that sound financial management and procurement will be maintained throughout the life of the project, both at the central and regional levels. This FMT will be staffed by experienced and qualified personnel with relevant backgrounds in donor-funded projects.

Financial Management Risks

The financial management risks are expected to be high for the following reasons: (i) Governance and transparency indicators are considered among the worst in the world; (ii) the control environment is generally weak, internal audits are not fully effective despite the extensive audit system in place, and external audit bodies are not functioning adequately; (iii) lack of accountability and experience of some key Administrative and Financial Directors has resulted in delays in the execution of public expenditures; (iv) disbursement of external assistance has been slow, and World Bank-financed projects in particular have experienced low disbursement rates compared to other projects in the subregion; (v) project implementation requires the careful coordination of multiple actors within a complex organization.

Financial management risks will be mitigated by enhancing the control environment. This will include:

* Recruitment of an independent individual consultants (FMT) that will report directly to the Project Coordinator;

* Disbursements contingent on Bank-approved detailed disbursement plans prepared every trimester during the first year of implementation, every semester during the second year of implementation, and annually thereafter (unless otherwise agreed); and

* Semi-annual technical and financial audits, including an opinion on the project's performance during the first year, which will provide early feedback on the project and on each consultants performance.

Addressing Project Weaknesses. Safeguards will be built into the program to ensure that funds are utilized for the purposes intended:

(a) Disbursements will be linked to project implementation progress;

(b) A fiduciary management Team comprised of individual consultants will be recruited for all financial transactions, accounting, and procurement;

(c) An assessment of each consultant of the FMT performance will be conducted annually by the World Bank;

(d) Two External audits (technical and financial) will be undertaken at least annually to verify the appropriate use of funds and how the project is being implemented, and every six months for the first year;

(e) A computerized accounting system, TOMPRO, will be established to allow for close monitoring of project FM implementation at central and local levels;

(f) Regular surveys of a representative subset of beneficiaries will track program delivery and effectiveness;

(g) Regular supervision missions will be carried out in collaboration with national authorities and other donors, including UNAIDS, UNICEF, UNFPA, UNDP, WHO, Global Fund, and PEPFAR; and

(h) Joint annual reviews of the NSP will be organized each year by the MLS to assess project performance and develop recommendations.

Overall Fiduciary Implementation Arrangements. A FMT will have overall responsibility for Project accounting and reporting. Thus, while the NACC will be responsible for the physical implementation of the program, the FMT will be responsible for financial management, procurement and disbursement. The FMT will be represented at the regional offices (one accountant in each office)

Accounting and Financial Software. An existing computerized and integrated financial management system already purchased will be used; The system is appropriate to the scale and nature of the program and capable of recording and reporting in a timely manner the program operations by origin of funds, region, component, and activity. The computerized financial management system is multi-currency, multi-location, and multi-donor, and it includes, among others, the following modules: general accounting; cost accounting; budgeting; assets management; contract management; preparation of withdrawal applications and tracking of disbursements by donors; and report generation, including quarterly financial monitoring reports and semi-annual financial statements.

Project Financial and accounting manual. As part of the PIM, a Financial and Accounting Procedures Manual has been developed by an audit firm. It includes a description of salient features of the financial management system as well as financial policies and procedures. This Financial and Accounting Procedures Manual will have to be updated in order to reflect the new organization of the program and the new activities; among others, it will now need to include an organizational diagram and job description of the accounting and financial staff. It already comprises: (i) the accounting system to be used--chart of accounts, budget coding, and accounting standards; (ii) the main transaction cycles; (iii) internal control procedures; and (iv) a summary of the various operational procedures related to budget management (planning, execution and monitoring) and management of assets, procurement of works, goods and services, and disbursements, which are detailed in the PIM.

In addition, other project manuals have been developed for use by civil society, community-based organizations, the private sector, and the public sector. These manuals will be updated as necessary throughout project life.

Reporting. At least two sets of financial reports will be prepared by the FMT: (i) the quarterly Interim Financial Reports (IFR), as required by the Bank; and (ii) the annual project financial statements, including the project's consolidated financial statements. The quarterly LFRs, as agreed during appraisal, will be prepared and submitted to the Bank 45 days after the close of the each quarter. It was agreed by the project FMT and the NACC that LFRs will be based on the format developed in the Bank's Guidelines on Financial Monitoring Reports, with some adjustments. The LFRs will include a table of Source and Use of funds and a table of Use of Funds by activities or by components. A copy of Financial Monitoring Report Guidelines will be provided to the team for reference.

External Auditing. Terms of Reference for the external audit of the Project's financial statements must be developed and agreed with LDA within six months of Grant effectiveness. During the first year, financial and technical (performance) audits will be conducted in parallel semi-annually to ensure consistency between the physical and the financial implementation of the Program and provide an opinion on the Project's performance and thereafter annually. Audits will be conducted by independent auditors acceptable to the Bank in accordance with international auditing standards. Audit reports of such scope and detail agreed by LDA would be submitted to the Bank within 3 months after the end of the audit for the first year and 6 months there after. The auditor will provide a unique opinion on: (i) the Project's financial statements; (ii) the statement of expenditure; and (iii) the Designated Account. The auditor will also provide a management letter on the internal control procedures, outlining recommendations for improving the control system and the accounting and financial procedures.

In addition, technical audits carried out in parallel to financial audits will provide opinions on Project performance; that is, project progress and timeliness in relation to progress milestones and objectives stated in the Emergency Project Paper, as well as the economy and efficiency with which the project is being implemented.

Funds Flows. A Designated Account will be located in the Central Bank of West African States (BCEAO) and a Project Account in a commercial bank. The Project Account will be managed jointly by the FMT and a Public Accountant assigned to the project by the MoF. Sub-accounts in each of the four regions will be managed by the FMT's regional representatives and the Regional AIDS Committee.(RAC).

All accounts will be managed in accordance with Bank guidelines. To facilitate quick disbursements, the Bank has agreed with the Government on a special procedure for emergency projects that allow project funds to by-pass the cumbersome regular national procedures.


Disbursement Arrangements: Use of Statement of Expenditures (SOEs). Disbursements for all expenditures would be against full documentation, except in the following cases, for which disbursements would be based on statement of expenditures (SOEs): for items o f expenditure under contracts and purchase orders below US$500,000 equivalent each for goods, below US$200,000 equivalent each for consulting firms, and below US$50,000 each for consultant services (individuals), training, and works and incremental costs. Supporting documentation for SOEs would be retained by the FMT for review by IDA missions and external auditors.

Supervision Plan. At least three supervision missions are proposed per year, based on the risk assessment of the project. The mission's objectives will include ensuring that strong financial management systems are maintained for the project throughout its life. An SOE review will be carried out regularly to ensure that expenditures incurred by the project remain eligible for LDA funding. The Implementation Status Report will include a financial management rating for the project.
The FM assessment has identified the following risk rating:

Type of Risk Risk Risk Mitigating Measures Residual
 Rating Risk

INHERENT RISKS (risk that arises from environment in which project is

Country Level

--With the post-conflict H --The Country is S
situation, budgets are progressing (albeit at
being prepared to an uneven pace) toward
address emergency issues normalization.
with no clear link Elections have been
between policies and scheduled for November
resources. 2008 and preparations
 are proceeding at a
 pace that would make
 it possible to respect
 this deadline.
 --A PEMFAR was
 conducted in early
 2008. The conclusion
 is that significant
 progress has been made
 in the PFM system.

--Budget execution is --A Governance and
delayed. Institutional
 Development Grant will
 be implemented in
 parallel with the
 proposed project and
 support a more
 rigorous and
 transparent use of
 public resources.
--Internal and external
controls are not

Entity Level S --The FMT will have
 overall responsibility M
The PIU team and project for the project's
coordinator have been Fiduciary aspects,
involved in the Project including procurement,
preparation and will be financial management
transferred to the new and disbursement.
implementing unit.
 --Both at the central
However, the new and decentralized
implementation level, adequately
structures do not have a qualified and
sufficient track record experienced project
in managing Bank fiduciary staff will
projects. be on board.
 --The project staff
 will be trained
 continuously during
 the life of project;
 the project software
 and procedure manual
 are in place and will
 be updated or upgraded
 as necessary.

Project Level --The FMT will have one
Project implementation focal point at all
arrangement is complex H project levels (PIU S
and may change during and regional)
implementation. The PIU --All staff will be
will be represented at trained in the use of
the regional level, project tools
along with the FMT. (software, procedure
 manual) and Bank
 fiduciary procedures.
 --Resource transfers to
 the regional level
 will be well
 documented and
 supervision missions
 will be conducted

CONTROL RISKS (risk that the project's financial management system is
inadequate to ensure funds used economically and efficiently for
intended purpose)

Budgeting S --The Bank team and M
Budget preparation is a project staff will
relatively strong part work closely to put in
of the place comprehensive
 cost tables for the
 project as well as
 detailed work programs
 and quarterly
 budgeting for the
 first 12 months of the
CI budget process, but --The budget for the
improvements are needed project will provide
regarding the additional training
consistency among for project staff (at
projections used by both the central and
various ministries and regional level) in
agencies. preparing realistic
 budgets consistent
 with their
 disbursement plans.
 --Training, mentoring
 and hands-on
Funds may be delayed. experience will be
 provided to regional
 staff as well as FMT
 staff in financial
 planning and budget

Accounting M --The accounting system L
SIGFIP does not provide will be supported by
all information required specialized software.
by the Bank for The project has
financial reporting and already acquired the
auditing. TOMPRO. This software
 will have to be
 updated as necessary
 to accommodate project
 --The financial
The FMT and NACC may not management procedures
be familiar with project outlined in the PIM
software (TOMPRO). during early project
 preparation in 2003
 were adequate, and
 this manual will be
 updated as necessary
 during implementation.
 --Training will be
 provided to all
 project staff at
 central and
 decentralized levels

Internai Control H S
National internal --The project does not
control systems do not have an internal
have enough capacity to control department.
cover project However, the
activities. administrative manual
 outlines approval and
 procedures that should
 work relatively well.
The NACC does not have --The project will be
its own internal control supervised closely and
unit. recruitment of
 internal control staff
 will have to be
 considered as an
 option to mitigate
 this risk

Funds Flow S --The arrangements for M
Disbursement of external the flow of funds as
assistance has been detailed in the PIM
slow; in particular, are acceptable to the
Bank-financed projects Bank.
have experienced low --There will be one
disbursement rates transit account which
compared to other Bank will be located at
projects in the sub- BCEAO and managed by
region. This was mainly the treasurer.
due to the misuse of the --One Designated Account
Financial Management will be located at a
Integrated System reliable commercial
(SIGFIP). Bank and will be
 managed by the public
 accountant in
 coordination with the
 FMT and project
 --Staff at the regional
 level will be trained
 in the use of the
 simplified procedures
 manual that will be
 prepared. The project
 will use the
 "transfert en capital'
 procedures for all

Financial Reporting S --The IFR guidelines M
 will be provided to
The project team does the project management
not have experience in team and IFR will be
producing interim un- used over the life of
audited financial the project. However,
reports. the project is not
 expected to be
 eligible to
 disbursement under IFR
 due to the weaknesses/
 complexity of the M&E
 --Training will be
 provided to financial,
 accounting and M&E
 staff and the M&E
 system will be
 simplified The format,
 content, and
 periodicity of IFR
 will be discussed
 during negotiation and
 will be agreed upon.

Auditing M --The process to recruit M
 an auditor is underway
The audit TORs will be and will be completed
developed to cover the within the next three
Project's fiduciary months.
risks, and external --The FMT will be
auditors will be responsible for
appointed. producing action plans
 addressing audit
 recommendations with
 clear deadlines.
 --A technical audit will
 be conducted after the
 first semester of
 implementation and
 repeated if an update
 of the project risk
 assessment warrants


H-High S-Substantial M-Modest L-Low

 Allocation of Credit Proceeds

 Disbursement Category Amount of the Amount of the
 financing allocated financing
 (US$) allocated(SDR)

1. All Goods, Works and
 Services Eligible for 17 494 390 10 750 000
 Financing through the

 2. Project start-up
 activities, including
 purchase of office
equipment and supplies, 2 505 610 1 550 000
purchase of vehicles and
 other transport
expenditures, consultant

 Disbursement Category Percentage of
 expenditures to
 be financed

1. All Goods, Works and
 Services Eligible for 100 percent
 Financing through the

 2. Project start-up
 activities, including
 purchase of office
equipment and supplies, 100 percent
purchase of vehicles and
 other transport
expenditures, consultant

Action Tasks

1- Appointment of Fiduciary Appoint/recruit reliable FMT to
Agency undertake overall fiduciary
 aspects of the program,

2- Designated Accounts Open a Transit Account at
 Open one Designated Account
 in a commercial bank
 acceptable to IDA.

3- Accounting procedures Update the existing Project
manual to be provided Administrative, Financial and
 Accountant Manual and other
 simplified manuals.

4- Recruitment of external Appropriate terms of reference
auditor (TOR) for the external auditor
 to be developed and agreed.
 Prepare a shortlist of firms of
 qualified auditors to be invited
 to submit proposals for
 conducting the external audit
 based on approved TOR
 acceptable to the Bank.

5- Reporting Agree on format for IFRs, and
 ensure that ability to prepare
 IFRs is demonstrated

6- Installation of the Update the existing software
integrated financial and installation and configuration,
accounting system and ensure testing and training
 of staff

Action Target Responsible
 completion institution

1- Appointment of Fiduciary 06/30/2008 NACC(MLS)/IDA

2- Designated Accounts 07/31/2008 NACC(MLS)/FMT

3- Accounting procedures 07/31/2008 NACC(MLS)/FMT
manual to be provided

4- Recruitment of external 07/31/2008 NACC(MLS)

 05/31/2008 NACC(MLS)

5- Reporting 07/31/2008 FMT/IDA

6- Installation of the 06/30/2008 NACC(MLS)/FMT
integrated financial and
accounting system



A) General

The procurement environment in Cote d'Ivoire is currently under reform, further to recommendations of the 2004 Country Procurement Assessment Report (CPAR) and its action plan under implementation. Unfortunately due to the socio-political instability and the conflict started since September 2002 (the country is now considered in post-conflict situation) no major progress has been made. However a new procurement code ("Decret" No. 2005-110) has been adopted in February 2005 and entered into force in April 2006. Most of the new procurement code provisions are in line with international standards and being updated to comply with the recent WAEMU Directives. However, even though the new procurement code brought some good progress, there are still major issues were identified during the recent PEMFAR done in 2007 and need to be addressed : (i) the non separation of the regulatory body and execution body (both are currently undertaken by the National procurement directorate); (ii) the non compliance with international standard for sole source use (sole source is currently about 30 percent of national public procurement); (iii) the non existence of a national training strategy to develop the capacity of government and private sector; (iv) the lack of dialogue between the private and public sector; (v) the non functionality of the control framework (no external control and audit) which does not allow the identification of irregularities linked to fraud and corruption; (vi) the non functioning appeals mechanism in place and a very weak means to fight corruption. This review, which used the OECD/DAC baseline indicators, concluded to an average score (1.5 out of 3) of the quality of the system with major weaknesses on pillar 4 (transparency and system integrity) which was scored at 26 percent.

This current HIV/AIDS project has been declared an emergency project by Bank Management according to operations rules. As a consequence, the procurement arrangement and procedures have been devised to be commensurate with the emergency nature according to OP/BP8.0 for rapid response. Therefore, the arrangements envisaged all strategies and necessary flexibility for a quick and efficient procurement.

Use of Bank's Guidelines

Under the Project, the procurement of civil works, goods and consultants will be carried out in accordance with the World Bank's "Guidelines: Procurement under IBRD Loans and IDA Grants" dated May 2004 and revised in October 2006, and with the "Guidelines: Selection and Employment of Consultants by World Bank's Recipients" also dated May 2004 and revised in October 2006. For ICB and Major assignments, Bank's Standard Bidding Document, Standard Request for Proposals and evaluation forms will be used. In Ivory Coast, National standard bidding document is available (not for medical goods) but not yet adopted. Due to that and in case of NCB, Bank's standard document will be used with necessary adaptation. Given the high shopping level (US$70,000 for current goods and US$400,000 for ARVs, reagents, laboratory equipment and others ARV related goods) commanded by the emergency nature of the project, request for shopping solicitation will specify that bids should be submitted sealed and bids opening will be public.


Upon Board Approval, a General Procurement Notice (GPN) will be prepared and published in the UN Development Business (UNDB) online, Development Gateway's Dgmarket online, and in a national newspaper of wide circulation to advertise for major consulting assignments (above US$200,000 equivalent) and ICB for which specific contracts are expected. The Borrower will keep a roster of the responses received from the potential bidders interested in the contracts. Specific Procurement Notices (SPN) for goods and works to be procured under ICB and NCB and for consultant services will be published in a national newspaper of wide circulation and may also be advertised in the UNDB and Development Gateway's Dgmarket online in order to get the broadest interest possible from eligible bidders. Request for Expression of Interest (EOI) for other consulting services (below US$200,000) will be advertised in a national newspaper of wide circulation. At least two weeks will be allowed for submission of EOIs.

Procurement of Works: (US$69,000)

Civil works contracts will be very limited in number and in value. Hence, no international competitive bidding (ICB) or national competitive bidding (NCB) is foreseen under the Project. Small refection and rehabilitation of health centers such as HIV testing centers and rehabilitation of facilities for line ministries and institutions that will be selected based on their work programs estimated at less than US$70,000 equivalent per contract may be procured through price quotations obtained from not less than three (3) qualified domestic contractors (preferably more in order to obtain at least three comparable offers) invited in writing to bid. A sufficient bid submission period will be allowed and bids will be opened in public. In all cases, the award shall be made to the contractor who offers the lowest price evaluated for the required work, and who has the experience and resources to complete the contract successfully. The bidding document (request of quotations) will be very simple but will include, among other things, at least a detailed description of the works, including basic specifications, relevant drawings and bill of quantities where applicable, the required completion date and a basic form of agreement acceptable to the Bank.

Procurement of Goods (US$5,946,100)

The total cost of non medical and medical goods including drugs is estimated at US$5,946,100 equivalent for the Project. The items will include: office equipment, furniture and materials, audio-visual equipment, vehicles, HIV/AIDS-related health commodities, ARVs, reagents, laboratory equipment, drugs, condoms, tests equipment, blood-taking/giving sets, LEC materials, and other project related supplies. Procurement of goods will be bulked where feasible into bid packages (of at least US$500,000) valued and procured through suitable methods.

Non Medical Goods (US$2,153,000)

(a) Goods estimated to cost more than US$500,000 would be procured through ICB;

(b) Goods estimated to cost less than US$500,000 and more than US$70,000 would be procured through NCB; and

(c) Goods estimated to cost US$70,000 equivalent or less per contract may be procured through Shopping procedures. Contracts will be awarded on the basis of written solicitation issued to at least three (3) qualified suppliers (but preferably more--six (6) recommended to ensure full competition and to anticipate possibly limited responses).

Following the evaluation of bids received in writing from such qualified suppliers, the award would be made to the supplier with the lowest price quotation for the required goods, provided it has the experience and resources to execute the contract successfully.

Medical equipment and HIV related Goods (US$3,973,100)

Regarding the procurement of ARVs or specifics medicals goods, the market situation of each product, the nature of the medicines and medical supplies, and the critical dates for delivery are all major factors that will determine the choice of suitable procurement method. The majority of ARVs and some other HIV/AIDS related drugs are either single source or limited-source products or proprietary items. Consequently, ICB or NCB without pre-qualification typically cannot be the preferred method of procurement. Instead, limited international bidding, direct contracting (with UN agencies or others) or shopping may be the most suitable methods.

(a) Drugs and HIV/AIDS-related health commodities, such as ARV and reagents, medical supplies, tests equipment, blood-taking/giving sets, milk substitutes, antiseptics and anti-TB drugs, may be procured through WHO, UNICEF, UNFPA and other specialized agencies of the United Nations (provided the ongoing different between UN agencies and Bank on audit, fraud and anticorruption clauses to be included in contracts have been solved on a satisfactory manner to the Bank), in accordance with the Bank Guidelines for Procurement under IBRD Loans and IDA Grants (paragraph 3.9). In such cases, these Agencies can be contracted under sole source provision;

(b) ARVs, reagents, and other HIV/AIDS related drugs to cost US$400,000 equivalent or less per contract may be procured through International Shopping procedures. Contracts will be awarded on the basis of written solicitation issued to at least three qualified suppliers, following evaluation of bids received in writing from such qualified suppliers. The award would be made to the supplier with the

lowest price quotation for the required goods, provided it has the experience and resources to execute the contract successfully. This method will be used in the cases where there are only a few known suppliers and provided it will have been indicated in the annual procurement plan reviewed by the Bank;

(c) Laboratory and other medical equipments estimated to cost less than US$500,000 and more than US$70,000 would be procured through NCB; and

(d) Procurement of reagents for HIV/AIDS testing and for blood transfusion security considered as proprietary items may be procured directly with prior approval of LDA from manufacturers and authorized local distributors in view of the requirements of existing laboratory/testing equipment in Cote d'Ivoire.

Consulting Services (US$3,432,900)

Consultant services, financed by LDA would be for the following types of activities: studies and surveys related to the monitoring and evaluation activities, trainers, community development specialists, public relations firms (LEC campaigns), PIU core staff, FMT, procurement, financial and technical audits, organization with specialized expertise (i.e. capacities to work with vulnerable groups), NGOs and other technical assistance provided to communities . These consulting services will be procured with the most appropriate procurement method allowed by the Bank's Guidelines and included in the Procurement Plan approved by the Association: (a) Quality and Cost Based Selection (QCBS); (b) Least Cost Selection (LCS); (c) selection based on the Consultant's Qualification (CQ) if contract amount is less than US$ 200,000; (d) Single Source (SS) Selection shall be used with agreement of the Bank. All terms of reference will be subject to the Bank's prior review.

Short-lists for contracts estimated at or less than US$200,000 equivalent may be comprised entirely of national consultants (in accordance with the provisions of paragraph 2.7 of the Guidelines on "Selection and Employment of Consultants by World Bank Recipients"), provided that a sufficient number of qualified individual or firms are available. However, if foreign firms have expressed interest, they would not be excluded from consideration. Consultant for services meeting the requirements of section V of the Consultants' Guidelines will be selected under the provisions for the Selection of Individual Consultants, i.e., through the comparison of the curriculum vitae of at least 3 qualified individuals. The use of civil servants as individual consultant or as a team member of Consultants firms will strictly follow the provisions of Article 1.9 to 1.11 of the Consultants' Guidelines.

Training, Workshops, Study Tours, and Conferences

All training and workshops under the Project will be conducted on the basis of programs, which should be approved by the Bank on a quarterly basis, and which shall, inter alia, identify: (a) the training and workshops envisaged; (b) the personnel to be trained; (c) the institutions which will conduct the training; (d) the duration of the proposed training and (e) an estimate of the cost.

Operational costs

Operational costs to be financed by the Project would be procured following the Project's Financial and Administrative Procedures Manual (FAM) approved by the Bank. For efficiency purpose, operational supplies will be packaged on the basis of six to 12 months needs and will be procured competitively. For services (such as car maintenance, computers maintenance, etc.), the Project will proceed by service contracting for a defined period.

B) Procurement Arrangement & Assessment of the Agency's Capacity to implement procurement

A quick assessment has revealed that there is no procurement specialist within the Project Implementation Unit (PIU). Due to the country situation (post conflict and fragile state) and the project nature (multisectoral, covering several regions with a multiple small transactions, need of capacity building), it has been agreed that the Project's fiduciary management (procurement and financial Management activities) will be implemented by a team of individual consultants. These consultants should have a relevant and international experience in similar operation and will be selected on a Bank's acceptable competitive basis. The procurement team within the Fiduciary management Team will be comprised of: (i) a senior procurement specialist with an international experience who will be at the central level within the PIU; and (ii) a procurement agent located at the regional level within each RCU. The Fiduciary management Team will manage procurement under the administrative responsibility of the PIU. It will be responsible of all procurement issues at different level. During the Project life and specially the first year, the Procurement Team will build the required procurement capacity at different levels. More specifically, the Procurement team's tasks will include: (i) maintaining a detailed list of technical specifications of goods and services to be financed by the project; (ii) maintaining registers of all interested bidders; (iii) preparing and updating procurement plans; (iv) preparing bidding documents, request for quotations and requests for proposals; (v) preparing bid evaluation reports for approving; (vi) receiving of goods and services and dispatching; (vii) monitoring of contracts implementation; (xiii) building required capacity where needed (at different level and in line ministries); and (ix) giving input for PIU which should submit quarterly reports describing the program already executed and the updated schedule for remaining activities. In order to ensure quality and timely procurement of this project, all of the procurement officers (seniors and analysts) will sign a performance-based contract to take fully responsibility of what they have supposed to undertake.

For ownership purpose, small shopping (for IEC materials, workshops, training, operations etc.) included in an entity's work program may be procured by the specific entity (line ministries, Private sector and civil society) if the procurement capacity has been assessed enough by the Procurement Team. If the entity's capacity is estimated as weak, the Procurement Team will work to reinforced it after a year.

The Procurement Team's capacity assessment cannot be done at this time since it has not yet been selected. However, these international recruited consultants are supposed to have relevant experience with this type of operations, and familiar with the Bank's procurement procedures, at the central and decentralized levels. Taking into account: (i) the current situation with a PIU without any procurement staff; (ii) the country's current socio-political situation; and (iii) the delays with the procurement reform, the procurement risk rating has been set as 'High' for the first year, and prior review thresholds fixed consequently. The Situation will be monitored and updated if needed after one year project implementation.

C) Procurement Plan

Taking into account OP/BP 8.00 provision, a Simplified Procurement Plan (SPP) containing all procurement to be carried out at national level for at least the first 6 months of project implementation will be drafted, finalized by the Government and submitted to the Bank before negotiations. Information required in the SPP will be limited to the following: object of contract, estimated costs, procurement method, estimated date of bid submission and Bank review status (Prior or Post). As a management tool, the procurement plan (PP) will be updated on annual basis or as required (to reflect implementation needs) in agreement with the PIU and the Bank. The PP will be available in the Project's database (and in the Bank external website). During project implementation, all procurement will be carried out in accordance with the formally agreed PP (original and formally updated). In light of the difficulties in planning the number of contracts and packages and coming up with precise figures for the value of each contract, no aggregate amount for any procurement method is required for the EPP or for the Grant Agreement. The PP described above excludes sub-projects and microprojects to be implemented by NGOs, and private sector entities. Their demand-driven nature makes it difficult to finalize a PP at this moment.

D) Financial and Administrative Manual (FAM): Procurement

A FAM containing a well drafted procurement section has been prepared and approved by the Bank in year 2005. This manual needs to be updated to integrate new project implementation aspects (reduction of actors and project zone) that shouldn't normally affect sensitively the procurement section. The updated FAM will be submitted to the Bank's review before disbursement.

E) Frequency of Procurement Supervision

The Bank's Country Office in Cote d'Ivoire will carry out a prior review for all contracts requiring the Bank's non-objection. A mandatory post-review mission is planned to take place on a yearly basis. It is also recommended that a supervision mission/field visit take place every six months, to address all pending procurement issues faced by the Project.

Prior Review: (i) Consultancy services estimated to cost above US$200,000 for firm, 2 First consultant firms selection with contract estimated to costs less than US$200,000, Single Source selection of consultants (regardless of contract amount), contract for consultants' services provided by an individual estimated to cost a substantial amount to be determined on a case by case basis and reflected in the Procurement plan, will be subject to prior review by the Bank.

(ii) Short lists composed entirely of national consultants: Short lists of consultants for services estimated to cost less than US$200.000 equivalent per contract may be composed entirely of national consultants in accordance with the provisions of paragraph 2.7 of the Consultant Guidelines.
Attachment 1
Details of the Procurement Arrangement involving international

1. Goods and Works and non consulting services.

(a) List of contract Packages which will be procured following
ICB and Direct contracting:

1 2 3 4 5

Ref. Contract Estimated Procurement P-Q
No. (Description) Cost Method

 Vehicles 4 * 4 898.1 ICB/IAPSO
 Purchase of 703.46 ICB/Direct
 'ARV (Year 1) contracting
 with UN
 Purchase of 82.76 ICB/Direct
 Nevirapine for shopping
 PTME (Year 1) SNU

1 6 7 8 9

Ref. Domestic Review Expected Comments
No. Preference by Bid-
 (yes/no) Bank Opening
 (Prior/ Date

 NO Prior 31 AUG 08
 NO Prior 4 DEC 08

 NO Prior 4 DEC 08

Prior Review: All ICB Contracts for works, all ICB, all ILB contracts
for Goods, 2 first Goods NCB and all Direct contracting will be
subject to prior review by the Bank.

2. Consulting Services.

(b) List of Consulting Assignments with short-list of international

1 2 3 4

Ref. No. Description of Estimated Selection
 Assignment Cost Method

 FGF 367,8 QCBS

1 5 6 7

Ref. No. Review Expected Comments
 by Bank Proposals
 (Prior / Submission
 Post) Date
 Prior 21 JUIN 08


a) Status of National Monitoring and Evaluation System

Cote d'Ivoire has developed a national Monitoring and Evaluation System, guided by a national monitoring and evaluation framework and operational plan which documents the processes for tracking the evolution of the HIV epidemic and monitoring the results and performance of the national response to HIV/AIDS. The objective of the ME Sub-Component is to ensure the establishment of a Monitoring-Evaluation sub-system for the Project to help ensure the monitoring and evaluation of all the other components of the Project but also support the National Monitoring-Evaluation. The project will complement PEPFAR in further strengthening of the health information and surveillance systems, including the use of information for decision making particularly in the four regions. The project will provide support for periodic behavioral and biological surveillance among general population and high risk groups; periodic surveys on service quality, and analytical work/impact evaluations at midterm and the end of the project. In order to ensure effective targeting of high risk groups, the project will conduct vulnerability mapping and special research to a) appropriately define and stratify high risk groups and their locations and other operational research to ensure appropriateness of behavior change messages and increased awareness on how to access services. The national M&E indicators will be reviewed annually in national M&E meetings of all partners, donors and stakeholders and the indicators for the project may be further realigned based on the outcomes of national M&E reviews.

Monitoring and evaluation of progress toward project objectives will rely on a combination of routine health services data, monitoring data on HIV/AIDS program activities, periodical behavioral and biological surveillance surveys and periodic surveys on the coverage and quality of services. Local research institutes will be subcontracted to conduct evaluations and operational research. The Bank will also undertake linked impact analysis/evaluation studies to further generate evidence of project outcomes and impact. The project will support efforts to further improve reporting at the decentralized levels and the use of data for improved decision making both for health sector and multi-sectoral HIV/AIDS activities. Technical capacity and oversight for monitoring and evaluation at the decentralized levels will be further strengthened.

Routine Program Monitoring at the national and decentralized levels: of the national HIV/AIDS program is the ultimate responsibility of the MLS. The MLS, through its strengthened M&E unit and the decentralized structures (CTAIL), will be responsible for implementing and coordinating the national M&E system. Coordination activities (data analysis and sharing) and supervision will be covered by the CTAIL) action plans. The M&E Unit will be in charge of implementing a system for reporting data and using information for managing the national program in the context of the "Three Ones" principles, and also for specific monitoring of the MAP II project. Financial monitoring, will be done by the FMT under the supervision of the PIU, through its central and decentralized units. Technical and financial monitoring will be linked, and the decentralized FMT units will therefore need to work closely with the CTAIL. Data processing and logistics; recruitment of competent human resources; technical assistance, training and workshops, and supervisory missions, coordination activities, and M&E operating expenses.

Epidemiological Surveillance (Biological, Behavioral, and Combined) and Operations Research

The project will support epidemiologic surveillance and operations research for tracking of epidemic drivers and trends in order to ensure effective targeting of HIV prevention efforts.

Because the epidemic is currently generalized in Cote d'Ivoire, epidemiological surveillance will cover the general population as well as "bridge" populations and high-risk groups. The project will support expansion of the populations for surveillance through a vulnerability mapping exercise to identify additional groups to include in surveillance, and to refine the targeting of intervention groups and geographic hot spots; (iii) operational research based on a priority agenda and coordinated activities, to produce a database of research outcomes.

The Epidemiological Surveillance component is well supported through PEPFAR. The LDA grant will provide funding for (i) biological surveillance of SW; (ii) second-generation surveillance: (iii) dissemination of epidemiological reports.
Brief Description of the Project Monitoring Procedures

1. Selection of Sub-beneficiaries of the Project, using an
 objective, transparent and pre-defined procedure
2. Selection of Sub-beneficiaries of the Project, using an
 objective, transparent and pre-defined procedure
3. Development and approval of budgeted operational plans of M-E
 of Beneficiaries
4. Signing of Service Contracts or Agreements (public sector)
5. Implementation by the operational actors of the quarter
6. Supervision of the implementation of the operational plans
7. Developing and submission of monthly monitoring sheets by the
 selected sub-beneficiaries and contract workers
8. Monthly input of the monthly monitoring sheets into the
 computerized system, which will be decentralized at the level
 of each region for the reporting of data from the sub-system
 of the MAP project (technical and financial data)
9. Editing and analysis of the technical and financial monitoring
10. Submission of the quarterly financial reports by the
 beneficiaries and contractual workers at the Project
 Management Unit
11. Quarterly disbursement of the operational plans of the
 beneficiaries and processing of operations at the level of the
 computerized information system of the Pro ject
12. Sharing of reports from beneficiaries at the level of the CTAL
 and RACC of the 4 Regions, the Ministries concerned and Civil
 Society networks of the MLS
13. Development and Transmission of the quarterly Project
 Financial Monitoring Report to IDA, the Government and UN
 Theme Group

Description of Implementation of the ME Sub-System of the Project in
the 4 Intervention Regions

Level M&E Activities Description

 Data collection Filling in the tools for
 collecting primary data on
 standardized tools

Departmental Centralization and The operational data will
 Transfer of data be centralized by the data
 administrator at the
 departmental level, who
 will be identified

 Monitoring of activities The activities funded
 should be monitored

 Sharing and Validation of Validation by a select
 Monitoring Sheets group of the DACC on the
 basis of the supervisions

 Data input Each monitoring sheet is
 fed into the computerized
 database established at
 the regional level after
 validation at the level of
 the Regional project Unit

Regional Sharing of information at Preparation of the
 the level of the RACC Regional Project Report
 according to the
 standardized framework
 with the presentation of
 project monitoring tables
 and Sharing of data at the
 level of the Regional CTAL

 Centralization of the data Data from the 4 regions
 at the level of the should be transferred
 national database centralized in the
 database installed at the
 Project Management Unit

 Monitoring the Analysis of the technical
 performance of the and financial reports to
 beneficiaries come up with monitoring

Central Development and Each quarter, the PMU
 transmission of RSF to prepared the RSF,
 IDA including the Technical
 Monitoring part developed
 by the ME Unit

 Request for Refund and Each quarter, the PMU
 Disbursement for the develops the RSF,
 subsequent Quarter to including Technical
 beneficiaries in order, Monitoring part developed
 according to the by the ME Unit
 procedures defined

Level Responsibility Frequency

 -Community actors Monthly
 -Health service actors

 ME focal point appointed
 by the DACC Monthly

 DACC Monthly
 Contract workers
 Ministries concerned

 Validation structure of Monthly
 the DACC

 ME focal point of the Monthly
 Project at the Regional

Regional Regional Project Quarterly

 Project Data Monthly

 Financial Management Quarterly
 Unit and the Monitoring-
 Evaluation Unit of the

Central Coordination of the Quarterly

 Coordination of the Quarterly


 Planned Actual

Appraisal February 28, 2008 February 28,2008
RCC Review April 17, 2008 May 13, 2008
PLD to PIC April 23, 2008
ISDS to PIC April 23, 2008
Board Approval June 12, 2008
Planned Effectiveness September 12, 2008
Mid-term Review January 31, 2010
Closing Date June 30, 2012

Key institutions responsible for preparation of the Project:

Minister in Charge of HIV/ALDS (MLS)

Bank staff and consultants who worked on the Project included:

Name Title Unit

Management Team
Antonella Bassani Acting Country Director AFTP4
Bernard Harborne Country Coordinator AFTCS
Eva Jarawan Sector Manager AFTH2

Technical Team
Ibrahim Magazi Task Team Leader AFTH2
Maurizia Tovo Lead Social Protection Specialist AFTH2
Daniele A-G. P. Jaekel Operations Analyst AFTH2
Zainab Mambo-Cisse Program Assistant AFMCI
Nicole Hamon Language Program Assistant AFTH2
Cassandra De Souza Operations Analyst AFTHV
Rene Bonnel Consultant HDNGA
Nilufar Egamberdi Consultant
Shilpa Challa Consultant
Aoua Paul Diawara Country Coordinator CI/ONUSIDA
Bella Diallo Sr Financial Management AFTFM
William Dakpo Procurement Specialist. AFTPC
Juliana Victor Monitoring and evaluation HDNGA
 Ahuchogu specialist
Assiata Houedanou Soro Disbursements Assistant AFMCI
Adjaratou Ndiaye Consultant (Evaluation/ HDNGA


A grant in the amount of US$20 million is being sought to finance an Emergency Multi-Sector HIV/AIDS Project for the Republic of Cote d'Ivoire. This Environmental and Social Screening Assessment Framework (ESSAF) aims to describe the approach and principles to be followed to ensure due diligence in managing the potential adverse environmental and social impacts and risks associated with the project.


For many years, Cote d'Ivoire had the second largest economy in the West African sub-region and stood as a beacon of extraordinary per capita growth, dynamism and political stability. However, since December 1999, Cote d'Ivoire has been in politico-military crisis, culminating in a brief civil war that has left the country divided in two. The situation has become progressively calmer since then and most agencies now consider that life is almost back to normal. Whilst the direct impact of the conflict was limited, the socio-economic and governance deterioration and ongoing human rights abuse have had a significant impact on the population.

Cote d'Ivoire has been so far the country most affected by the HIV/AIDS epidemic in West Africa. Within an overall adult HIV prevalence of four point seven percent, available the data describes a generalized epidemic marked by striking gender and geographic differences, early sexual debut, intergenerational and multiple concurrent sexual partnerships, weak knowledge about HIV transmission and prevention, and low condom use. In all age groups, females are far more likely than males to have HIV (overall six point four percent vs. two point nine percent; among ages 20-24, four point five percent vs. zero point three percent). Prevalence rates peak among women ages 30-34 at 14.9 percent, vs. five point six percent of men of the same age; male prevalence peaks among ages 40-44 at seven percent, vs. eight point six percent of women of that age. Male prevalence may be mitigated by near-universal (96 percent) circumcision.

The project will finance condoms, drugs, reagents, syringes and needles for VCT and treatment which will be distributed in the four targeted regions. The associated environmental risks are in the area of medical waste management.

The project

The development objectives of the proposed project are derived from the country's strategic plan for fighting HIV/AIDS 2006-2010 and its effects and for preventing the further spread of HIV/AIDS by means of a multisectoral program approach. Thus, complementing the activities financed by other sources, the purpose is to help Cote d'Ivoire. Government implement its 2006-2010 National Strategic Framework for boosting its national response to HIV/AIDS by contributing to increasing and improving the coverage and utilization of prevention services, treatment and care for specific high-risk and vulnerable groups. More specifically, the project will contribute to (a) strengthening access to and increasing utilization of prevention services for vulnerable groups (women, youth, etc.) and the high-risk groups such as the commercial sex workers and staffs of some key ministries; (b) improve access and utilization of treatment and care services for HIV/AIDS infected and affected persons, notably the persons living with HIV/AIDS (PLWHA), and orphans and vulnerable children (OVC).

The project consists of four components:

1. Social mobilization and HIV/AIDS Prevention Services (US$6.4 million)

This component will help scale-up field activities already being implemented by an assortment of private bodies (national and international NGOs, primarily) under the responsibility of different line ministries. Most of the activities to be financed will take place in the four focus regions and aim at providing targeted service packages, including prevention, treatment and care, for a period of three years. The regions will establish their respective action plan, which will specify targeting and delivery mechanisms that are in line with project objectives and with the National Strategic Plan for HIV/AIDS. In particular, the project will support the following high-risk groups:

* Commercial sex workers (male and female): The project will support activities that promote safer behaviors, including through: (a) provision of condoms and lubricants, (b) campaigns aimed at raising awareness and eliciting changes in behavior, (c) improving access to STD treatment services and ARV. These activities will be backed by limited action-oriented research aiming to yield a better understanding of the situation and of the factors at play, as well as to (i) identify appropriate targeting and delivery mechanisms, and (ii) develop effective communication strategies.

* Orphans and vulnerable children (OVC): Project activities will ensue from the strategy designed in the context of the National OVC Program. The latter was validated and endorsed by a wide range of public and private stakeholders on March 25, 2008. Under the Program, each department would feature a Platform comprising representatives of public and private entities involved in child protection at the departmental level. The Platform defines the specific services to be provided (in conformity with national program parameters), and contracts these NGOs that are best suited to deliver said services. Orphans and other children made vulnerable by HIV/AIDS within the focus regions for example, will benefit over time from a package enhancing access to education and health services, nutritional assistance, clothing and counseling.

* PLWHA: The project will finance all national and international NGOs, associations or religious entities that provide assistance to PLWHA in the four focus regions. The goal is to help these agencies widen their coverage or offer more comprehensive services. Financing will focus mainly on activities related to counseling, ARV treatment, provision of condoms and re-agents, and other prevention-oriented operations.

* Mobile populations: This target group includes migrants, internally-displaced persons, refugees and long-distance drivers. The project will support communication campaigns tailored to such groups, as well as peer education programs, in order to heighten awareness, promote safe behavior and encourage testing. At the same time, access to testing services, counseling and treatment will be facilitated.

* Particularly vulnerable youth and women: This target group will include youth and women living in low-income urban neighborhoods in the four focus regions, where access to such services is typically low, as it is in rural areas, but with the added aggravation of a lesser protection afforded by the strong social control and more conservative behaviors which tend to prevail in the countryside. In addition, particular attention will be paid to sexual violence against women, as this is becoming an increasingly worrisome trend nationwide. The project will support, namely: peer education programs and Information-Education and Communication (IEC) campaigns targeting youth clubs, students and women groups; provision of condoms; easier access to voluntary testing and STD treatment; MTCT services; ARV treatment; and assistance to victims of sexual violence including access to emergency ARV treatment (PEP kits).

While the high-risk and highly vulnerable groups above will benefit from the bulk of the financing available for the four focus regions, this component will also collaborate with the private sector in these regions by helping set up HIV/AIDS committees in the various agro-industrial enterprises and by supporting various activities for the fight against HIV/AIDS in the workplace. In particular, the project will finance the establishment of a committee and the training material, while the enterprises will be responsible for the cost of organizing training and sensitization sessions.

Over and above the activities in the four focus regions, this component will finance a few interventions with country-wide coverage to strengthen the national prevention effort (it will be recalled that prevention is the most under-funded aspect of the national strategy). Thus, the instruments and mechanisms developed for the intensive IEC campaigns targeting commercial sex workers and vulnerable youth will be piloted in the four focus regions but later expanded to other areas of the country. This will be done in close collaboration with the Ministry to Fight HIV/AIDS (for commercial sex workers) and with the General Directorate for Youth (for vulnerable youth). At the same time, the project will support a mass campaign for the general public to improve common knowledge about HIV/AIDS and reduce the stigmatization of PLWHA and other high risk groups. It is expected that, in addition to using the mass media (primarily the radio, which is accessible to most rural areas and to illiterate people), this sub-component will work in synergy with the community-driven initiatives financed by two World Bank projects, the PNGTR and the PCAP, by piggy-backing on these projects to deliver messages concerning HIV/AIDS to rural communities.

2. Public Sector Interventions (US$7.8 million)

This component is divided into two sub-components, one in support of the Ministry of Health and the other in support of three other key Ministries.

Sub-component 2.1: Health Sector (US$5.4 million)

Support to the Ministry of Health will complement whatever assistance is already available from other sources. The following activities will be financed: (i) medical treatment of HIV/AIDS through ARV; (ii) medical treatment of opportunistic infections; (iii) medical treatment of tuberculosis patients; (iv) medical treatment of STD; (v) strengthening of testing and biological follow-up in a limited number of laboratories; (vi) development of centers providing MTCT services and provision of reproductive health supplies; (vii) risk management in the workplace by providing PEP kits to health centers that can also be used for rape victims and other victims of gender-based violence (e.g., female circumcision); (viii) quality control by the National Public Health Laboratory; (ix) epidemiological surveillance; and (x) reinforcement of VCT centers in the four regions.

The Ministry is also responsible for the implementation of a plan for medical waste management. As part of the preparation process for this project, a plan for medical waste management was developed in 2002. This plan was approved by the Bank, adopted by the Government and then sent to the Bank for publication. The analysis carried out to prepare the plan establishes that the project is unlikely to have significant negative impacts on the environment. The environmental risks identified include: (i) insufficient means to destroy biomedical waste; (ii) poor management of the sites where are stocked both biomedical and household waste; (iii) inappropriate means to collect and transport waste toward disposal sites; (iv) largely insufficient training of health personnel for the safe management of medical waste. The project, therefore, will finance part of the equipment needed to collect, transport and incinerate medical waste as well as related staff training. These activities will be carried out in the four focus regions of the project but also in selected police and army infrastructures.

Sub-component 2.2: Support to the action plans of key Ministries (US$2.4 million)

The project will support the three key Ministries with the mandate to cover the target groups that cannot be easily reached by NGOs, such as youth who are in school, the armed forces and the police. This support will complement assistance already available from other partners for the implementation of the Ministries' action plans, in particular UNFPA, PSI and FHI (the latter two are international NGOs). Activities for the Ministry of Defense and the Ministry of Interior will be very similar, as they will both target members of the national defense and security forces; implementation will be done on a national scale. Concerning support for the Ministry of Education, implementation of the action plan will take place through the regional representations of the Ministry giving priority to the four focus regions of the project (of course, materials and approaches developed for the four focus regions will then be used in other parts of the country).

The action plans of the Ministries of Defense and Interior include: information and sensitization activities, efforts to reduce stigmatizing and discrimination, promotion of voluntary testing and condom use, provision of services to limit the impact of the disease and of opportunistic infections, and support to PLWHA associations within the army and the police. The sub-component will help set up Regional Committees for the Fight against AIDS. The project will provide assistance to the army and police health services in the four regions so as to strengthen their capacity to offer MTCT services. The project will contribute to information and sensitization activities in the workplace, encourage voluntary testing, provide treatment for STD, and support proper handling of bio-medical waste. In addition, the sub-component will support the introduction of modules on HIV/AIDS in the programs of army and police academies.

Concerning support to the Ministry of Education, the sub-component will complement the important effort already underway thanks to financing from other partners. In particular, as most of the sector action plan is financed by PEPFAR, the project will concentrate on filling a strategic gap through the introduction of HIV/AIDS modules for pre-teenagers. A curriculum has already been developed for both students and teachers, and the project will support its dissemination. The sub-component will also finance the activities of associations of PLWHA who are teachers.

3. Capacity Building Component (US$3.3 million)

This component will finance all capacity building activities necessary for the successful implementation of the other three components. As the appraisal mission concluded that the NGO sector was better prepared for the fight against HIV/AIDS than the public sector, emphasis will be put on helping the administration to develop national strategies/ approaches and develop national guidelines to improve the efficiency and effectiveness of various initiatives as well as facilitate scaling up . Activities to be financed include the following:

* Support key technical Ministries (Education, Health, Social affairs, Youth, HIV/AIDS): For the education sector the following activities will be financed to increase the capacity of the Ministry to fight the pandemic: (a) training of trainers, (b) training in counseling (for psychosocial counseling and palliative treatment), and (c) equipments needed for implementation of the sector action plan, such as mobile projection unit, computers and slide projectors; at the regional level, the project will finance activities to strengthen the capacity of the Regional Coordinating Units and of the focal points for the education sector in the four focus regions. Other key technical Ministries will be helped define their strategies and update their action plans, produce reference guides and operating manuals to ensure a consistent approach nationwide, and set up monitoring and evaluation systems to track their activities. Assistance will be in the form of training sessions and equipment provision.

* Strengthen the capacity of civil society: For civil society actors, most of the assistance will go umbrella organizations, as this will facilitate coordination and hopefully have a multiplier effect. Organizations to be supported include the network of local radios (REPMACI), the network of civil society organizations dealing with HIV/AIDS (COSCI), the network of people living with HIV (RLP+), the network of faith-based organizations (ARCI), the Youth Network of Cote d'Ivoire (FENUJECI) and the Business Coalition of Cote d'Ivoire (CECI). These organizations will be helped develop training guides and tools, as well as communication materials to be used by their members. In addition, they will be assisted in improving their planning, networking and coordinating skills, and will be provided with the equipment necessary to carry out missions to monitor the quality of their members' activities and offer technical assistance when needed.

* Ensure competent project implementation: This sub-component will finance activities within the four focus regions of the project aiming at ensuring the good performance of the four regional project coordination units.

4. Coordination, Management, Monitoring and Evaluation (USS2.5 million)

The coordination mechanism under the Ministry to Fight HIV/AIDS has had insufficient staff and resources to lead the nationwide fight against the pandemic particularly at the decentralized levels (region and department). Throughout the country only two regions (San Pedro and Abengourou) out of 19 have their coordination body (CRLS) working. The project would provide funds to help the Ministry to Fight HIV/AIDS carry out its role in implementing the "Three Ones" principles--"one national coordinating body, one monitoring and evaluation system, one National strategy:"

* In support of the first principle, funding will be provided to help set up and operationalize the CRLS in the remaining 17 regions of the country, as well as establish the accompanying Technical Units to Support Local Initiatives (CTAIL). PEPFAR is taking care of the organization of the NACC meetings at the central level.

* In support of the second principle, a monitoring and evaluation (M&E) sub-component will fund the establishment of an M&E system for the project that will track the achievements of all project components but also support the national M&E framework that was completed in March, 2005 thanks to UNAIDS and PEPFAR financing. In particular, the sub-component will (a) complement existing mechanisms by strengthening of the health information and surveillance systems, including the use of information for decision making in the four focus regions; (b) provide support for periodic behavioral and biological surveillance among the general population and high-risk groups; (c) finance periodic surveys on service quality, and (d) fund impact evaluations at mid-term and the end of the project.

In order to ensure the effective targeting of high-risk groups, the project will support vulnerability mapping and other ad hoc research needed to produce an operational definition of these groups, determine their profile and stratification, and identify their locations. Additional action-research will be financed to identify appropriate behavior change messages and communication strategies.

Compliance with Safeguards Policies

The environment category of the project is B because the project is not expected to have substantial adverse environmental effects. The Bank Safeguard Policy requires a separate environment plan for category B projects that has to be disclosed in country and in the Bank Infoshop. Because the project is being processed under OP/BP 8.0, the environment plan does not have to be ready prior to project approval, but will have to be completed within six months of effectiveness. Besides, the appropriate safeguards instrument is the Medical Waste Management Plan (MWMP).

A Medical Waste Management Plan was originally prepared by the Ministry of Health and the Ministry of Environment for the project and cleared by IDA, and it was disclosed in the country and in the Info shop in November 01, 2002. The main environmental issue deserving attention is the disposal of medical waste related to testing and treatment. In particular, environmental risks include: (i) the inappropriate handling and disposal of medical waste by untrained staff, (ii) the inadequate management of the respective disposal sites in urban or peri-urban areas where domestic and medical waste are often mixed; (iii) the use of untrained staff to handle medical waste; (iv) the disposal of waste on open sites to which anyone can easily have access and manipulate waste with no safe precautions. As the Medical waste Management Plan is more than five years old, the Plan will be updated and disclosed in country and at the Info shop by the Ministry of Health. The plan will contain measures to mitigate the potential risks identified above. The project will finance the following: incinerators, waste collection equipment, training on how to safely dispose of contaminated blood and other materials, and information on the hazards of contamination for all health facilities including those for the army and police in the four Regions covered by the project.

Impact of the project on the environment and the implementation of the Medical Waste Management Plan will be monitored during supervision missions. The project management unit will have to recruit a medical waste management specialist that will responsible for following up the recommendations of the MWMP; especially those that has to do with training and the installation of incinerators.

Implementation Support

Regular reviews will be carried out every 12 months after effectiveness to assess progress, achievements of overall objectives, as well as the role of the different partners, and to eventually reorient the project if needed to ensure achievement of objectives. Supervision missions will take place quarterly in the first and half years of project implementation. The reviews and mission will involve visits by specialists to selected sites to first-hand assessment of progress of executing entities performance. The ASPEN field representative in West Africa based in Abidjan will provided the much needed guidance as and when they arise during project implementation.


Economic Analysis

Since 1999 Cote d'Ivoire has been affected by a protracted politico-military crisis, which has led to substantial population displacement increased poverty, insecurity and sexual violence. Although the conflict has not resulted in a significant degradation of health facilities, it has significantly widened existing disparities. These circumstances provide for a reversal of the accomplishments of the last few years. For the immediate future, the most pressing needs are to address the main gaps in the current AIDS response.

Regional disparities in the AIDS response

In the areas under control by the New Forces (currently called Center-North-West or CNW), as well as in the ex-buffer zone, the emigration of a large number of nurses and doctors has reduced the availability of health services, especially as concerns VCT, PMTCT and antiretroviral treatment (3). To help restore medical services, health facilities located in the towns controlled by the New Forces recently started hiring health professionals. Due to the shortage of doctors and nurses in these areas, however, the increase in staff was made up mostly of additional health assistants, who lack training in prevention and care of HIV/AIDS. Some civil society organizations provide advocacy and information and communication services, but few prevention services are available to population groups that are at high risk of infection such as sex workers and combatants. Overall, despite recent efforts, access to care, treatment and support for PLWH remains quite limited (Figure 1).

In the south, health facilities had to confront a sudden hike in demand for services resulting from the concentration of displaced people in a few towns. However, as the displaced population also came with a large number of health professionals, health facilities did not experience the same staff imbalance and shortages of qualified medical personnel as in the towns controlled by the New Forces. This allowed clinics, civil society organizations and NGOs to increase prevention services, treatment and care and support (Figure 1). Nonetheless, these organizations face substantial funding gaps to meet the service needs of the displaced population.

In both zones, health facilities have not been overwhelmingly affected by the political and military crisis, even though some rehabilitation of equipment, stolen or destroyed, will be necessary in the CNW zone. For health facilities in the CNW zone to become fully operational, the priority is to go ahead with the planned redeployment health personnel, and to provide this personnel with adequate training. While nearly all categories of health professionals have benefited from training in DSC, the percentage of medical staff trained in the prevention, treatment and care of HIV/AIDS remains low. This is especially the case of health assistants in the towns controlled by the New Forces and that of nurses. In towns where the displaced population has been resettled, about 60 percent of the doctors had received training in antiretroviral treatment, according to the 2005 survey of health facilities in the area affected by the crisis. In view of the large number of armed forces along the demarcation zones, increased prevention services that target groups who have a high risk of infection, and in particular women, is especially important.


AIDS Response and Funding Gaps

Among Western African countries, Cote d'Ivoire has the most generalized HIV epidemic; furthermore the latter is characterized by striking gender differences (average HIV prevalence rate among females was 2.2 times higher than among males), weak HIV knowledge and low condom use (UNGASS, 2008). (4) Partly as a result of the conflict, existing disparities in the AIDS response have worsened across the country. At the same time, the economic crisis experienced by the country has severely limited the available government resources. In total, about 1 percent of GDP only was spent by government on health expenditures.

Provided that the current improvement in the political situation is sustained, economic prospects for economic recovery are good. Most of the reduction in output witnessed since 2000 is due mainly to lack of demand--not to a loss of physical capital. As a result, an economic recovery could be achieved quite rapidly over the medium term. In the short-term, however, the government faces substantial funding gaps, resulting from the need to address the immediate post-conflict needs while setting the stage for reversing the deterioration in the AIDS response.

Estimates of the amounts needed for funding the implementation of the National AIDS Plan (2006-10) were recently prepared by the AIDS Ministry. Since two years of implementation have now elapsed, the funding gaps were recalculated by focusing on the remaining three years (2008-2010). In total, the financing needs would amount to FCFA 211 billion, equivalent to approximately US$469 million (Table 1). Prevention expenditures would represent 21 percent of the total, while care and treatment would account for about 61 percent. However, it is likely that care and treatment expenditures are overestimated. Following the recent revision of epidemiological estimates (December 2008), the estimated number of people living with HIV in Cote d'Ivoire has declined from 750,000 to 475,813, which would translate into a significant reduction of funding needs.

In comparison, the available funding would amount to FCFA172 billion (US$380 million) for the years 2008-2010. These estimates represent the amounts that donors have indicated they would provide to Cote d'Ivoire. The largest share would come from PEPFAR (US$315 million), followed by the government (US$35 million), and others donors (US$30 million). These amounts exclude any contribution from the Global Fund as so far there was no indication of additional funding. They also do not include the financing that the present project would provide (US$20 million).

Overall, the difference between the estimated financial requirements and the available resources amounts to US$89 million for the period 2008-2010. However, this figure may underestimate substantially the funding needs of the country, as it implicitly assumes that funds are fungible across categories or, to put it differently, that donors would be able to shift funds from the areas currently showing large surpluses to under-funded areas. Currently, PEPFAR is the largest funding contributor of the AIDS response, accounting for close to 80 percent of the available financing. In many essential areas, PEFAR is already providing substantial support and it seems unlikely that funds could be further increased to fill gaps in other areas.

Funding gaps for each program intervention were estimated by comparing the amounts needed and the funds provided by donors. Adding up the resulting gaps indicates that US$188 million remain to be funded during the period 2008-2010 (Table 2). Key areas that remain to be fully funded include important activities such as: (i) prevention, especially IEC and activities targeting groups at high risk of infection; (ii) institutional strengthening and coordination of the AIDS response; and (iii) development of an evidence base for strategic policy formulation. In total, the additional funding for these three areas amounts to US$99 million. In addition, there are remaining funding gaps for treatment, but as previously mentioned, needs are likely to be much less than expected thanks to the substantial downward revision in the number of people estimated to be living with HIV.

Expected Impact of the Emergency Multi-Sector HIV/AIDS Project

The HIV epidemic has now reached a stage where its economic and social impact has become noticeable in Cote d'Ivoire. This is contributing to a reduction in GDP growth and a reversal of some of the gains previously achieved in terms of human development. The choice now facing the government is either to finance the cost of the AIDS response or to delay its financing and end up paying much more in a few years not only to finance the treatment and care of a larger group of AIDS patients but also to offset the loss of human capital that the AIDS epidemic entails.

Earlier estimates had already provided an indication of the some of the short and medium-term costs of the epidemic. In 1998, some 64 percent of primary teachers' deaths were found to be due to AIDS, thereby depriving a large number of students of education. (5) In agriculture, prevalence rates of 17 percent were found in large agro-industrial complexes providing some of the main agricultural exports. And in the health sector, AIDS patients greatly increased the occupation of hospital beds. Overall, the economic cost of the HIV epidemic of Cote d'Ivoire is likely to be substantial. For example, a model simulating the impact of the epidemic through its effect on human capital and savings suggests that by 2010 GDP would be about 13 percent lower than in the absence of the epidemic. (6) However, the same model also indicates that the loss in GDP could be reduced by providing access to antiretroviral treatment. On one hand, treatment prevents the loss of adults in their prime productive years, thus increasing the ratio of the active population to the total population; on the other hand, treatment increases the productivity of the labor force by reducing losses in human capital. The net effect of antiretroviral treatment is estimated to offset about 32 percent of the potential loss of GDP in the case of the Cote d'Ivoire. (7)


Over the long term, the number of people under treatment will continue to increase in the Cote d'Ivoire unless the current prevention efforts are further strengthened. While it is difficult to measure the effects of past prevention efforts, the steady decline of the HIV prevalence rate in Cote d'Ivoire from a peak of around 6 percent in the late 1999 to an estimated 3.9 percent in 2007 indicates relative success. Given the limited budgetary resources of the government, priority should therefore be given to closing some of the funding gaps, especially as concerns prevention, institutional strengthening and coordination of the AIDS response.
Table 1: Estimated Financial Requirements for 2008-2010 (Millions of

 2008 2009 2010 Total

Prevention 13,545 15,009 15,547 44,101
Care and treatment 34,812 43,338 50,011 128,161
Coordination 2,863 3,418 3,996 10,277
Institutional strengthening 4,770 4,913 5,086 14,769
Monitoring and Evaluation 2,213 2,486 3,633 8,332
Research 1,562 1,865 2,180 5,607
Sub-total 59,764 71,029 80,454 211,247

Source: Plan Strategique National de Lutte contre le VIH/SIDA.
Document des couts financiers et financements du PSN.

Table 2: Funding Gaps in US$ Million

 2008 2009 2010 Total

IEC 8 11 13 32
Condoms 4 6 5 15
1ST 1 1 1 3
Universal precautions 0 0 1 1
Prevention PLWH 1 1 1 2
Subtotal 14 19 20 53
Treatment 1 28 46 76
Socio-economic support 0 0 1 1
OVC 4 4 4 12
Subtotal 5 33 51 89
Coordination 6 8 9 23
Institutional strengthening 3 4 4 11
Research 3 4 5 12
Subtotal 12 16 18 46

TOTAL 32 67 89 188


Cote d'Ivoire at a glance

Key Development Indicators CSte Saharan Low
 d'Ivoire Africa income
Population, mid-year (millions) 16.1 770 2,403
Surface area (thousand sq. km) 322 24,265 29,215
Population growth (%) 2.0 2.3 1,8
Urban population (% or total population) 36 30
GNI (Adas method, USS billions) 16.6 646 1,562
GNI per capita (Atlas method, US$) 920 642 650
GNI per capita (PPP, international $) 1,550 2.032 2,698
GDP growth (%) 0.9 5.6 8.0
GDP per capita growth (%) -1.1 3.2 6.1
(most recent estimate, 2OO0-20O6)
Poverty headcount ratio at $1 a day 41
 (PPP, %)
Poverty headcount ratio at $2 a day 49 72
 (PPP, %)
Life expectancy at birth (years) 45 47 59
Infant mortality (per 1,000 live births) 117 96 75
Child malnutrition 22 29
 (% of children under 5)
Adult literacy, male (% of ages 15 61 69 72
 and older)
Adult literacy, female 39 50 50
 (% of ages 15 and older)
Gross primary enrollment, male 78 96 108
 (% of age group)
Gross primary enrollment, female 65 86 96
 (% of age group)
Access to an Improved water source 51 56 75
 (% of population)
Access to improved sanitation facilities 37 38
 (% of population)

Net Aid Flows 1980 1990

(USS rallions)
Net ODA and official aid 210 686
Top 3 donors (in 2005):
 France 118 416
 United States 1 17
 Germany 12 19

Aid (% of GNI) 2.2 6.9
Aid per capita (USS) 26 59

Long-Term Economic Trends

Consumer prices (annual % change) 17,9 -0.7
GDP implicit deflator (annual % change) 35,5 -7.3

Exchange rate (annual average, local per US$) 211,3 272.3
Terms of trade index (2000 = 100) 36 94

Population, mid-year (millions) 8,2 11.5
GDP (US$ millions) 10,175 11,467
 (% of GDP)
Agriculture 25,9 30.6
Industry 19,7 24.7
 Manufacturing 12,8 22.6
Services 54,4 44.8

Household final consumption expenditure 62.8 67.6
General gov't final consumption expenditure 16,9 21.4
Gross capital formation 26,5 6.7

Exports of goods and services 35,0 29.8
Imports of goods and services 41,2 25.5
Gross savings 5,2 -5.2

Net Aid Flows 2000 2006

(USS rallions)
Net ODA and official aid 351 119
Top 3 donors (in 2005):
 France 156 66
 United States 10 33
 Germany 16 13

Aid (% of GNI) 3.6 0.8
Aid per capita (USS) 22 7

Long-Term Economic Trends

Consumer prices (annual % change) 2.5 2.5
GDP implicit deflator (annual % change) -0.4 5.6

Exchange rate (annual average, local per US$) 709.9 522.4
Terms of trade index (2000 = 100) 100 69

Population, mid-year (millions) 16.0 18.1
GDP (US$ millions) 10,448 17,568
 (% of GDP)
Agriculture 24.2 22.7
Industry 24.9 26.3
 Manufacturing 21.7 16.3
Services 50.9 51.0

Household final consumption expenditure 74.9 71.7
General gov't final consumption expenditure 7.2 8.2
Gross capital formation 10.8 9.7

Exports of goods and services 40.4 51,3
Imports of goods and services 33.3 41,0
Gross savings 6.0 12.7

1960-90 1990-2000 2000-06
(average annual growth %)
3.4 3.3 2.1
2.7 8.1 0.1
0.3 4.1 1.1
4.4 8.2 -1.3
3.0 7.6 -3.0
3.6 11.1 0.1
3.3 10.4 0.4
0.2 1.2 2.7
-12.2 19.6 -1.4
1.9 9.5 3.7
-2.5 18.3 5.1

Note: Figures in italics are for years other than those specified.
2006 data are preliminary. .. indicates data are not available,

a. Aid data are for 2005.

Development Economics, Development Data Group (DECDG),

Balance of Payments and Trade 2000 2006

(US$ millions)
Total merchandise exports (fob) 3,740 8,144
Total merchandise imports (cif) 2,788 6,067
Net trade in goods and services 742 1,817

Current account balance -293 524
 as a % of GDP -2.8 3.0

Workers' remittances and
 compensation of employees (receipts) 119 160

Reserves, including gold 566 1,732

Central Government Finance

(% of GDP)
Current revenue (including grants) 17.2 18.8
 Tax revenue 14.6 15.3
Current expenditure 15.5 17.0

Overall surplus/deficit -0.6 -0.3

Highest marginal tax rate (%)
 Individual 10 10
 Corporate 35 35

External Debt and Resource Flows

(US$ millions)
Total debt outstanding and disbursed 16,876 16,407
Total debt service 820 667
Debt relief (HIPC, MDRI) -- --

Total debt (% of GDP) 161.5 93.4
Total debt service (% of exports) 18,3 7.7

Foreign direct investment (net inflows) 134 246
Portfolio equity (net inflows) 81 117

Private Sector Development 2000 2006

Time required to start a business (days) -- 45
Cost to start a business (% of GNI per capita) -- 134.1
Time required to register property (days) -- 32
Ranked as a major constraint to business
 (% of managers surveyed who agreed)
 n.a. .. ..
 n.a. .. ..

Stock market capitalization (% of GDP) 11.3 23.7
Bank capital to asset ratio (%) .. ..

Technology and Infrastructure 2000 2005

Paved roads (% of total) 9.7 8.1
Fixed line and mobile phone
 subscribers (per 1,000 people) .. ..
High technology exports
 (% of manufactured exports) 2.0 8.4


Agricultural land (% of land area) 62 63
Forest area (% of land area) .. ..
Nationally protected areas (% of land area) .. ..

Freshwater resources per capita (cu. meters) .. 4,231
Freshwater withdrawal (% of Internal resources) 1.2 ..

C02 emissions per capita (mt) 0.35 0.32

GDP per unit of energy use
 (2000 PPP $ per kg of oil equivalent) 3.9 3.8

Energy use per capita (kg of oil equivalent) 410 388

World Bank Group portfolio 2000 2006

(US$ millions)

 Total debt outstanding and disbursed 1,557 1,734
 Disbursements 0 0
 Principal repayments 57 84
 Interest payments 32 12

 Total debt outstanding and disbursed 290 366
 Disbursements 76 -1
 Total debt service 8 43

IFC (fiscal year)
 Total disbursed and outstanding portfolio 125 45
 of which IFC own account 98 34
 Disbursements for IFC own account 6 0
 Portfolio sales, prepayments and
 repayments for IFC own account 3 5

 Gross exposure 15 20
 New auarantees 0 0

Note: Figures in italics are for years other than those specified.
2006 data are preliminary. .. indicates data are not available.--
indicates observation is not applicable.

Millennium Development Goals

With selected targets to achieve between 1990 and 2015
(estimate closest to date shown, +/- 2 years)

 Cote d'Ivoire

Goal 1: halve the rates for $1 a day 1990 1995 2000 2005
poverty and malnutrition
 Poverty headcount ratio at $1 a day (PPP, .. .. .. ..
 % of population)
 Poverty headcount ratio at national .. 36.8 38.4 ..
 poverty line (% of population)
 Share of income or consumption to the 7.3 7.2 .. ..
 poorest qunitile (%)
 Prevalence of malnutrition (% of children .. 24.0 21.7 ..
 under 5)

Goal 2: ensure that children are able to
complete primary schooling
 Primary school enrollment (net, %) .. .. .. ..
 Primary completion rate (% of relevant 41 37 40 ..
 age group)
 Secondary school enrollment (gross, %) 21 .. 22 ..
 Youth literacy rate (% of people ages 15- .. .. .. ..

Goal 3: eliminate gender disparity In
education and empower women
 Ratio of girls to boys in primary and .. .. .. ..
 secondary education (%)
 Women employed in the nonagricultural .. .. .. ..
 sector (% of nonagricultural employment)
 Proportion of seats held by women in .. .. .. ..
 national parliament (%)

Goal 4: reduce under-5 mortality by two-
 Under-5 mortality rate (per 1,000) 157 .. 112 192
 Infant mortality rate (per 1,000 live 103 .. 180 117
 Measles immunization (proportion of one- .. .. .. ..
 year olds immunized, %)

Goal 5: reduce maternal mortality by three-
 Maternal mortality ratio (modeled .. .. .. ..
 estimate, per 100,000 live births)
 Births attended by skilled health staff .. .. .. ..
 (% of total)

Goal 6: halt and begin to reverse the
spread of HIV/AIDS and other major diseases
 Prevalence of HIV (% of population ages .. .. .. 7.1
 Contraceptive prevalence (% of women ages .. .. .. ..
 Incidence of tuberculosis (per 100,000 .. .. .. ..
 Tuberculosis cases detected under DOTS .. .. .. ..

Goal 7: halve the proportion of people
without sustainable access to basic needs
 Access to an improved water source (% of 69 50 51 ..
 Access to improved sanitation facilities .. .. .. ..
 (% of population)
 Forest area (% of total land area) .. .. .. ..
 Nationally protected areas (% of total .. .. .. ..
 land area)
 C02 emissions (metric tons per capita) 0.4 0.5 0.4 0.3
 GDP per unit of energy use (constant 2000 4.8 4.4 3.9 3.8
 PPP $ per kg of oil equivalent)

Goal 8: develop a global partnership for
 Fixed line and mobile phone subscribers .. .. .. ..
 (per 1,000 people)
 Internet users (per 1,000 people) 0 0 2 11
 Personal computers (per 1,000 people) .. .. .. ..
 Youth unemployment (% of total labor .. .. .. ..
 force ages 15-24)


CAS Annex B3-IBRD/IDA Program Summary Cote d'Ivoire
As of Date 04/14/2008
Proposed IBRD/IDA Base-Case Lending Program

Fiscal Proj ID US$ Strategic Implementation
 (M) Rewards
Year (H/M/L) Risks (H/M/L)

2008 Post-Conflict Assistance 120.0 H H
 Program (PCAP)
 Economic Governance and 308.0 H H
 Recovery Grant (EGRG)
 Emergency Urban 94.0 H H
 Institutions and 13.0 H H
 Governance TA
 Reactivation of Existing 104.0 H M

 Result 659.0

2009 Economic Governance and TBD H M
 Recovery Grant II
 Emergency Investments in TBD H M
 Energy & Infrastructure

 Result 100.0

 Overall Result 759.0

CAS Annex B4
Summary of Non-lending Services
As of Date 03/25/2008

Product Completion Cost

Recent completions
Poverty Diagnostic/Capacity Bldg. FY07 70
Post Conflict Recovery Planning FY07 46

Country Social Analysis FY08 30
Interim Strategy Note FY08 50
Cocoa & Coffee Study FY09 55
TA on Energy FY09 75

Planned (c)
CEM FY09 200
Support for PRSP FY09 75
Support to PRIS and M&E FY09 65
W-Africa Post Conflict Env. Analysis FY09 60
Multi-donor Assessment/CG FY09 135
Health CSR FY10 40
Post Conflict ICA FY10 40
Education CSR FY10 60
Poverty Assessment FY10 120
CAS FY10 50
Support for PRSP Progress Report FY10 35

Product Audience Objective
 (a) (b)

Recent completions
Poverty Diagnostic/Capacity Bldg. G,D,B,PD PD, KG
Post Conflict Recovery Planning G,D,B,PD PD, KG

Country Social Analysis G,B KG
Interim Strategy Note G.D.B KG
Cocoa & Coffee Study G,B KG
TA on Energy G,B KG

Planned (c)
Support for PRSP G,D,B KG
Support to PRIS and M&E G, B KG, PS
W-Africa Post Conflict Env. Analysis G,D,B,PD KG
Multi-donor Assessment/CG G,D,B KG, PS
Health CSR G,D,B KG, PS
Post Conflict ICA G,D,B KG, PS
Education CSR G,D,B KG
Poverty Assessment G,D,B,PD PD, KG
Support for PRSP Progress Report G,D,B KG

(a.) Government, donor, Bank, public dissemination.

(b.) Knowledge generation, public debate, problem-solving.

(c.) Tasks planned currently being reviewed/consolidated for greater
strategic focus.

CAS Annex B8-Cote d'Ivoire
Operations Portfolio (IBRD/IDA and Grants)
As of Date 05/28/08

Closed Projects 88

Total Disbursed (Active) 4.49
 of which has been repaid 0.00
Total Disbursed (Closed) 4,497.29
 of which has been repaid 2,667.39
Total Disbursed (Active + Closed) 4,501.78
 of which has been repaid 2,667.39
Total Undisbursed (Active) 135.96
Total Undisbursed (Closed) 0.00
Total Undisbursed (Active + Closed) 135.96

Active Projects
 Last PSR
 Supervision Rating

Project ID Project Name Development Implementation
 Objectives Progress

P083583 CI-EGRG-Econ. Governances # #
 Recovery Grant
P082817 Cl-Post-Conflict MU U
 Assistance (FY08)

Overall Result

Active Projects

 Original Amount in USS Millions

Project ID Fiscal IBRD IDA GRANT Cancel. Undisb.

P083583 2008 308 10.05

P082817 2008 120 125.92

Overall Result 428 135.96

Active Projects Difference Between
 Expected and Actual
 Disbursements (a/)

Project ID Orig. Frm Rev'd


P082817 10.25

Overall Result -298.48

(1.) Children (0-15 years), AIDS orphans (0-18 years), youth (15-24 years), women and girls, policemen and soldiers, sex workers, migrants and truck drivers, teachers, people living with HIV/AIDS, injection drug users (IDUs), men who have sex with men, sero-discordant couples, the work force (in both the public and private sectors), rural population, and prisoners.

(2.) Of course, the standard legal conditions of effectiveness will apply, i.e., due authorization or ratification of the legal agreement by the government and submission of a satisfactory legal opinion confirming this.

(3.) Evaluation des consequences de la crise sociopolitique sur la prevention et la prise en charge du VIH/SIDA en Cote d'Ivoire, 2005-2006". Ministere de la Sante et de l'Hygiene Publique.

(4.) Suivi sur la declaration d'engagement sur le VIH/SIDA (UNGASS). Rapport National de la Cote d'Ivoire 2008. Janvier 2008.

(5.) Le VIH/SIDA et le corps des enseignants. Project Impact du VIH/SIDAS sur le systeme educatif des pays de la region de l'Afrique de l'Ouest et Centrale et suivi des objectifs de l'education pour tous. Bulletin No. 3, deuxieme trimestre 1998.

(6.) Ventelou B., Moatti J.P., Videau Y, and Kazatchkine M. Time is costly: modeling the macroeconomic impact of scaling-up antiretroviral treatment in sub-Saharan Africa. 2008. AIDS 2008, 22:107-113.

(7.) Simulations were also done for other countries. Gains ranged from 25 percent (Central African Republic) to 83 percent Angola.
EMAP Results Framework

Project Development Project Outcome Indicators

(i) Strengthened access to Percentage of female sex workers
and increased utilization of reporting the use of a condom
prevention services among with their most recent client
vulnerable and high risk [disaggregated by age (<25,
groups (such as women, 25+>)] (UNGASS, AAP).
youth, and commercial sex
workers). Percentage of women and men aged
 15-49 who have had more than one
 sexual partner in the last 12
 months reporting the use of a
 condom during their last sexual
 intercourse [disaggregated by sex
 and age (15-19, 20-24, 25-49)].

 Percentage and number of HIV-
 infected pregnant women who
ii) Improved access and received a completed
utilization of treatment and care antiretroviral treatment to
services for HIV/AIDS infected reduce the risk of mother-to-
and affected persons, notably the child transmission (UNGASS, UA,
persons living with HIV/AIDS AAP).
(including OVC).
 Percentage and number of adults
 and children with advanced HIV
 infection receiving
 antiretroviral therapy
 [disaggregated by sex and age
 (<15, 15+) -(UNGASS, UA, AAP).

Project Development Use of Project Outcome
Outcomes Information

(i) Strengthened access to Asses risk reduction among female
and increased utilization of sex workers.
prevention services among
vulnerable and high risk
groups (such as women,
youth, and commercial sex
workers). Assess risk reduction among
 population with multiple

 Assess and improve progress
 towards VCT and PMTCT treatment
ii) Improved access and program.
utilization of treatment and care
services for HIV/AIDS infected
and affected persons, notably the
persons living with HIV/AIDS
(including OVC).

 Intermediate Intermediate Outcomes Use of intermediate
 Outcomes Indicators Outcome Information

 1. Percentage of Assess coverage of
 people from at-risk interventions among high
 groups who both risk and vulnerable
 correctly identify groups and strengthen
Components 1, 2 ways of preventing program reach.
 the sexual
 transmission of HIV
 and who reject major
 misconceptions about
 HIV transmission
 [disaggregated by sex
 and age (15-19, 20-
 24)] (UNGASS, IDA

Social 2. Percentage and Assess VCT service
mobilization number high risk uptake among high risk
and HIV groups (FSW) who groups.
Prevention received an HIV test
Services for in the last 12 months
vulnerable and and who came back for
high risk their test results
groups Public [disaggregated by sex
Sector and age (<25, 25+)]
Prevention and (UNGASS).

 3. Percentage of Assess improvement in
 women and men aged risk reduction behavior.
 15-49 who received an
 HIV test in the last
 12 months and who
 came back for their
 test results
 [disaggregated by sex
 and age (<25, 25+)]

 4. Number of condoms Assess condom
 distributed (male & availability and
 female) among the CSW distribution.
 in the 4 target
 Project regions.

 5. Number of sub- Monitoring of sub-
 contracts awarded for contracts.
 High Risk Group and

Component 3 6. Number of Assess the public sector
 decentralized effort to implement
Capacity (department) plans project activities.
Building developed and
 implemented in the
 four regions for
 Health and Education.

Component 4 7. Joint annual Assess data availability
 report of the and use for program
 Multisectoral HIV/ improvement.
 AIDS Program,
 disseminated during
 the annual Meeting of
 the CNLS;

Coordination, 8. Percentage of Assess reporting
Management, executing agencies compliance by sub
Monitoring and (public sector and projects and
Evaluation civil society) that implementing agencies.
 submit programmatic
 and financial three-
 monthly reports
 completed and on

 9. Percentage and Assess the Government
 number of technical coordination effort
 committees to support
 local initiatives
 (CTAIL) put in place
 and operational.

Table 1: Costs by Activity

Component A Social mobilization and HIV US$6.4 million
 prevention services
Component B Public Sector US$7.8 million
Component C Capacity Building US$3.3 million
Component D Coordination, Management, US$2.5 million
 Monitoring and evaluation

Type f Risk Risk Risk Mitigating Measures Residual
 Rating Risk
I. INHERENT RISKS (risk that arises from environment in which project
is situated)

Country Level

Insecurity, political * The current Peace
instability, and H Agreement is being H
uncertainty about implemented, with
holding of elections delays but with
 political will and
 significant political
 steps. The Bank with
 IMF and other donors
 is closely supporting
 the peace process.

Major changes in all * A PIU be in place
government institutions H for the three years of S
are expected to follow project implementation
upcoming Presidential so as to avoid
elections disruption.

Project Level

Both public and private * The project will
sector capacity in Cote H select staff and S
d'Ivoire have been implementing partners
weakened by the crises on a competitive basis
and governance problems and will support them
 with technical
 assistance if needed.
 * The project includes
 a Capacity Building
 Component to support
 NGOs and sectoral
 focal points or
 * The use of a
 Fiduciary Management
 Team (FMT) will ensure
 competent financial
 management and
 procurement functions.
 * The monitoring and
 evaluation system will
 allow for early
 identification of

Cote d'Ivoire has been * A Team comprised
categorized by the Bank H with individual S
as a high-risk country consultants (FMT) will
in terms of systemic have overall
corruption responsibility for
 fiduciary aspects of
 * The project will be
 subject to regular
 independent audits.

Reduced or delayed * The project team and
funding from partners S counterparts are M
(UNFPA, PSI and FHI) maintaining open
could jeopardize communication with all
implementation partners to ensure
 good coordination and
 national leadership on
 how to reallocate
 funding if necessary.

The Public Health * The Project will
Pharmacy is facing H carry out M
shortages of drugs and international
medical equipment procurement through
 UNOPS or other UN
 agencies (UNICEF,
 UNFPA), thus avoiding
 reliance on the Public
 Health Pharmacy.

MLS institutions * The project will
responsible for regional H fund some of the S
coordination are weak. initial institutional
 set-up costs to assist
 government in
 developing Technical
 Committees to Support
 Local Initiatives at
 the regional level


 H-High S - Substantial M-Modest L-Low

Composition of total external debt, 2005

Short-term 53
IDA 353
IMF 282
IBRD 1,687
Other multilateral 2,030
Bilateral 3,827
Private 288

US$ millions

Note: Table made from pie chart
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Title Annotation:Annex 4. Financial Management and Disbursement Arragements-Annex 12. Map
Publication:Cote D'ivoire - Emergency Multi-Sector HIV/AIDS Project
Date:May 1, 2008
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