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III. Implementation.

A. Partnership Arrangements

28. The Jamaica NSP is funded by the Government and a number of external agencies. The GFATM and the Bank provide the most significant levels of funding. Other partners, especially the United Nations Agencies and bilateral donors also provide technical support and some funding for specific interventions. All the agencies provide their funding through the NHP. The project will not have specific co-financing from any other partner. The expanded HIV/AIDS theme group provides a regular forum for coordination. In addition, partnerships have been strengthened around key thematic areas. Section IB. above describes how the two main external financing sources (Bank and GFATM) will complement each other as well as the contributions being made by the other bilateral and multilateral development partners. The project design supports the strengthening of partnership between the key stakeholders: the MOH, non-health line ministries, civil society organizations, the private sector, and external funding agencies. Partnerships with the GFATM, bilateral donors and UN agencies will include: implementation based on one annual work plan of the NHP; regular information exchange/updates, harmonized technical assistance on specific thematic areas e.g. education and coordinated implementation reviews/supervision missions whenever possible, though this may present logistical challenges.

B. Institutional and Implementation Arrangements

29. Institutional Arrangements. The following institutions will be key to the successful implementation of the project: The Council for Health and Social Development (COHSOD) reporting to the Cabinet will be responsible for setting policy, overall coordination, and monitoring and evaluating the performance of the national HIV/AIDS program. The Ministry of Health (MOH) will be the Executing Agency through The Project Coordination Unit (PCU) of the National HIV/STI Program. The PCU will coordinate activities and provide technical and fiduciary support to the implementing entities. Execution of project activities will be handled by divisions of the MOH, the four Regional Health Authorities, four non-health line ministries, CSOs and the private sector.

30. Implementation Arrangements. The project will be coordinated by the PCU within the National HIV/STI Program (NHP) of MOH. The PCU consists of an experienced team of professionals that have coordinated the technical and fiduciary activities of the first HIV/AIDS project. The staff has been trained in World Bank procedures, has performed satisfactorily under the first project and is expected to continue performing well under the follow on project. The Unit is headed by a Senior Medical Officer, who manages a core staff that includes the coordinators for the project components and subcomponents, an M&E officer, a financial manager and a procurement manager and their supporting administrative staff. The fiduciary unit also manages the grant funds from the GFATM. Most of the PCU staff has been paid out of donor funds, including the first World Bank loan. The process to convert some of these positions into permanent establishment posts has been initiated with the intended outcome of creating an institutionalized and sustainable core group of professionals to coordinate and support the implementation of the national HIV/AIDS Program.

31. Implementing Entities. Four types of entities will implement project activities: The MOH through its centralized departments and the four decentralized RHAs; Four key non-health line ministries: Education, Tourism, Entertainment and Culture, Labour and Social Security, and National Security, Civil Society entities including the NGO sector with Community Based Organizations (CBOs), churches and other Faith Based Organizations (FBOs); and the private sector through the Jamaica Business Council, private companies and the media.

32. The implementation strategy is detailed in the Project Operations Manual and is summarized in Annex 6. Implementation of project activities will be preceded by the elaboration of annual work plans for the public sector entities and by proposals for the civil society entities. The Government Ministries will prepare annual work plans which are aligned with the Government annual budgets. CSOs will be funded through a demand-driven process based on the system that has been put in place under the ongoing Bank-financed project. A consolidated annual work plan will be prepared by the PCU and reflected in the MOH's annual budget for submission to the Ministry of Finance and the Public Service (MOFPS). The work plan will include the MOH's own work plan, plans of other Line Ministries and a budget line for subprojects of civil society groups and the private sector. Annex 6 contains a fuller description of the institutional and implementation arrangements including eligibility criteria, selection procedures and funding mechanisms for civil society and the private sector. The Project Operations Manual will contain a detailed description of implementation strategies for line ministries, CSOs and the private sector.

33. Financial Management and Procurement Arrangements. The PCU financed under the first HIV/AIDS project is familiar with the Bank procedures. It will be responsible for financial management and procurement. Latest financial management and procurement procedures will be applied now that there is more capacity within the PCU and within the public administration in general. Detailed guidelines on the financial and procurement management including accountability and transparency provisions are contained in Annexes 7 and 8.

C. Monitoring and Evaluation of Outcomes/Results

34. A full time M&E officer with a supporting staff within the PCU will be responsible for: (i) maintaining the overall M&E plan including manuals, implementation procedures, tools, data flowcharts and a budget; (ii) strengthening the monitoring systems to ensure sound output and process monitoring; and (iii) validating data by random sampling recording and aggregating processes and by examining large variations in historical trends. Evaluation of the outcome and the impact of project performance on achieving the development objectives will be done through periodic behavioral surveys of high-risk groups, household surveys of the general population, workplace surveys of a random sample of companies, and health facility surveys and specific research. Baseline markers and targets will be established for measuring progress. Outcome/impact indicators are listed in Annex 3. Most of the indicators are drawn from the country's national M&E plan and are the basis for the country's regular reporting to UNGASS. Monitoring program performance and productivity of service providers will be done on an ongoing basis using management reporting mechanisms. Service statistics will be collected regularly at the points of service and reported on a monthly basis to document progress being made and to show variations that occur. Input and process indicators are listed in Annex 3.

D. Sustainability

35. The following factors will contribute to program sustainability after project completion:

(a) An enabling policy and legal environment with strong political support and leadership for dealing with HIV/AIDS;

(b) Government's willingness and ability to sustain public awareness of HIV/AIDS issues;

(c) Implementation sustainability: development of broad ownership and a strong institutional coordination mechanism for the expanded response to the pandemic and the involvement of other key stakeholders (line ministries, NGOs, FBOs, local communities, etc.);

(d) Converting some of the PCU positions into permanent establishment posts to create an institutionalized and sustainable core group of professionals to coordinate and support the implementation of the national HIV/AIDS Program;

(e) Financial sustainability will include Government budget allocations to finance the national HIV/AIDS program and continued support from external sources especially the Global Fund; and,

(f) Allocating resources available for HIV/AIDS to the highest priority interventions.

E. Critical Risks and Possible Controversial Aspects for the Proposed Project
 Risk Description of risk Rating
 Factors of risk

Project * Expenditures during the first S
design project for non-health line
 ministries and for CSOs accounted
 for only 8% of total project

 * The first project has been
 criticized for its centralized
 approach and has been perceived
 outside the MOH as a MOH
 project rather than a multi-sectoral

Stigma and * The country's legal framework S
Discrimination remains inadequate. However,
and Human several reforms have been
Rights launched over the past years.
 Major achievements include the
 National HIV/AIDS Policy
 approved by Cabinet (2004) &
 Parliament (2005) and the National
 HIV/AIDS Workplace Policy
 submitted in 2003 to and approved
 by Cabinet in March 2007.

 * An Amendment to the Public
 Health Act based on a review of
 existing legislation and for the
 purpose of repealing outdated
 legislation is being drafted.

Implementation The first HIV/AIDS project invested S
capacity in the skills development of a project
sustainability unit to coordinate the national
 response. The challenge is to retain
 this staff.

Financial * Until now a significant share of S
sustainability the Jamaica HIV/AIDS program
 has been financed mostly with
 external funds. The GOJ may not
 be able to assume full financial
 responsibility utilizing its own
 resources for the national
 HIV/AIDS program at the end of
 this project

Financial * The Regional Health Authorities M
management may not have robust financial
 management and accounting
 practices, specifically,
 maintenance of appropriation
 accounts, financial reporting and
 internal auditing.

Procurement * Compliance with both Bank and S
 national procurement procedures
 could potentially delay project

Social and The bio-medical waste S
environmental management program may not be
safeguards upgraded fully to cope with the
 current challenges.

Overall Risk:

 Rating of
 Risk Mitigation measures residual
 Factors risk

Project * The new project defines ex ante four M
design key non-health ministries that will
 develop their strategy, annual work
 plans and budgets. CSOs will be funded
 by the GFATM grant. The project will
 provide technical support to ensure
 the participation by the business
 sector and CSO community through
 demand-driven subprojects and
 disbursements against approved plans
 and contracts.

 * The four decentralized Regional
 Health Authorities will be responsible
 for execution of most of the project

Stigma and A strong emphasis on IECBCC will S
Discrimination mitigate the level of stigma and
and Human discrimination.
 * Under the Project's third component,
 the project will provide technical
 assistance for reviewing for drafting
 a new Public Health Act that will
 include the rights of people living
 with HIV/AIDS and other vulnerable
 populations, including children
 affected by HIV/AIDS, giving them full
 equality and dignity under the law,
 without stigma or discrimination.

Implementation * The Government has already initiated M
capacity a process of institutionalizing the
sustainability program by establishing the requisite
 posts and other activities in the
 Government's establishment in a phased
 manner over the medium-term to ensure
 sustainability of the national

Financial * Continuing efforts to secure S
sustainability external funding for sustaining the

Financial * A complete financial management M
management assessment of the financial management
 capacity at the RHA level has been
 conducted. Strengthening of the RHA
 financial management will be included
 in the project.

Procurement * The Government has indicated that it M
 will review its own procurement
 thresholds within the next fiscal year
 to address some of the current
 bottlenecks. The Bank team will guide
 the Government team in taking
 advantage of flexibilities in Bank
 procurement procedures

Social and * The current HIV/AIDS project is M
environmental supporting the installation of a
safeguards biomedical waste plant to serve the
 south-east region (accounts for 60% of
 the medical waste generated on the
 island). The medical waste management
 plan has been updated in preparation
 for this project and an action plan
 has been agreed with priority actions
 identified for financing. Despite
 these actions, additional investments
 will still be needed by the Government
 to fully address the needs of the

Overall Risk: M

Risk Rating--H (High Risk), S (Substantial Risk), M (Moderate Risk), N
(Negligible or Low Risk).

F. Loan/Credit Conditions and Covenants

Conditions of effectiveness:


Conditions of disbursement:

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Publication:Jamaica - Second HIV/AIDS Project
Date:Apr 1, 2008
Previous Article:II. Project description.
Next Article:IV. Appraisal summary.

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