losure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized The World Bank Implementation Status & Results Central African Republic Multisectoral HIV/AIDS Project (P073525) Operation Name: Multisectoral HIV/AIDS Project (P073525) Project Stage: Implementation Seq.No: 24 Status: ARCHIVED Archive : 17-Dec-2011 Country: Central African Republic Approval FY: 2002 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Adaptable Program Loan Implementing Agency(ies): CSLP, CMO Key s Board Approval 14-Dec-2001 Original Closing 30-Jun-2006 Planned Mid Term Review Last Archived ISR 17-Dec-2011 Effectiveness 19-Sep-2007 Revised Closing 31-Mar-2012 Actual Mid Term Review Project Development Objectives Project Development Objective (from Project Appraisal Document) The objectives of the Project are to assist the Recipient to contribute to: (a) urgent needs in the fight against HIV, such as access to prevention, treatment, and impact mitigation services; (b) urgent social needs, such as prevention of malaria, increased access to water supply and improved primary education. The Project consists of the following Components: Component 1: Support to the National Program against HIV-AIDS Component 2: Support to Emergency Health Needs Component 3: Support to Emergency Needs in the Education Sector Component 4: Support to Financial Management and Procurement. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost 1. STRENGTHENING PUBLIC SECTOR RESPONSE 0.00 2. STRENGTHENING CIVIL SOCIETY RESPONSES 0.00 3. COORDINATION, FINANCIAL MANAGEMENT,AND MONITORINGAND EVALUATION 0.00 Component 1 : Support to the National Program against HIV-AIDS 6.86 Component 2 : Support to emergency health needs 6.98 Component 3 : Support to emergency education needs 2.87 Component 4: Support to a Financial Management and Procurement Unit (FMPU) 0.29 Overall Ratings Previous Rating Current Rating Page 1 of 7
Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview The project was approved on December 14, 2001. Soon after the approval (February 2002), CAR went into arrears which were cleared in November 2006. After the Bank s reengagement, the closing date was extended in two stages: (i) for one year (from June 30, 2006 to June 30, 2007) to allow for a restructuring of the project, and (ii) for three years (from June 30, 2007 to September 30, 2010) once the project was restructured and the PDO was revised in June 2007. The project only became effective in September 2007 and the closing date was set to September 30, 2010. The restructuring changed the project s exclusive focus on HIV/AIDS to enable it to also respond to new emergencies resulting from civil disturbances and other developments since the original project was designed and approved. Between 2007 and 2010, project implementation improved and the closing date was extended a third time from September 30, 2010 to March 31, 2012 in order to allow for: (i) the health component activities to be completed, (ii) the extension of HIV/AIDS activities to rural areas, and (iii) the identification and implementation of community sub-projects, which were proved to be more complex and time-consuming than planned. Between 2007 and 2012, disbursement increased from close to 0% to almost 95%, and the majority of indicators that remain (many have been dropped during the two restructurings) are close to, or have even surpassed, 100% of their target objectives. Despite the specific context of CAR and its status as a fragile state, the project has made substantial progress. Contributions to positive impacts in education and health: The project has contributed to strengthening primary education in rural areas through increasing the number and quality of school teachers, as well as improving access to school textbooks. Within the health sector, the project has contributing substantially to mitigating the impact of HIV/AIDS through providing support to 7,513 people living with HIV/AIDS, improving access and utilization of voluntary counseling and testing (118,862 pregnant women), expanding coverage of antiretroviral combination therapy to 3,616 persons, and significantly expanding coverage for prevention of mother to child transmission in the last 12 months at targeted health centers (27,355). The project has also contributed to increasing coverage of insecticide treated bed nets (100,000 bed nets distributed) and access to potable water to 28,500 individuals. Finally, the project has contributed to additional technical assistance through support to the production of the Health Sector Country Status Report and two large-scale health facility surveys. Most of the project s objectives were achieved efficiently and were responsive to the country s urgent needs within the health (in particular HIV/AIDS) and education sectors. After restructuring in 2007, disbursement increased substantially and even surpassed the revised disbursement estimates. The project remains particularly relevant to the country s development priorities and the Bank s HNP Africa strategy as it has significantly contributed to expanding coverage and utilization of high impact health services through pro-poor policies, as well as supporting multi-sectoral approaches that contribute to health outcomes. By improving access to and quality of primary education in CAR, the project has also contributed to preserving the potential of rural children for future competitiveness and employment. Locations No Location data has been entered Results Project Development Objective Indicators Page 2 of 7
Indicator Name Core Unit of Measure Baseline Current End Target Improved primary education: Students/Teacher Text Value 95:1 71:1 (2007-2008) 81:1 ratio in targeted areas 80:1 (2008-2009) 100% of target achieved. Since 2010, the new education project supported by the Bank has taken over the support to the sector, including contracting and paying the apprentice teachers. Improved primary education: (vi) Number of teachers meeting minimum teaching qualifications in targeted areas. Increased adoption of preventive measures against malaria (vi) Additional number of households using ITBNs (iii) Number of PLWHA receiving support through their associations or their national federation of associations. Text Value 3666 4516 Target was surpassed. All 809 qualified apprentice teachers expected to be in place through the project were there in January 2009. An additional 193 apprentice teachers were deployed since December 2009. Text Value Basse Kotto - 0 Mbomou - 0 Haut Mbomou - 0 100,000 Basse Kotto - 100,000 Mbomou - 100,000 Haut Mbomou - 100,000 260,000 ITBNs received in Bangui did not meet the quality criteria and therefore cannot be distributed. Those bed nets should be returned, but have not been returned by the closing of the project. Only 33% of the objective is met. Source: MoH Report Text Value 0 7513 8000 94 % of end of project objective is achieved (cumulative since beginning) Source: CNLS Report Page 3 of 7
(ii) Number of PLWA receiving ARV in targeted health centers. Increased adoption of HIV/AIDS prevention measures and increased access to treatment: (i) Number of men and women who accepted VCTand received test results in targeted health centers Adults and children with HIV receiving antiretroviral combination therapy Text Value 0 3,616 1,300 01-Jun-2007 278 % of end of project objective is achieved (cumulative since beginning) Source: CNLS Report Text Value 0 118,862 200,000 01-Jun-2007 : Only 59% of the objective was achieved due to the fact that in 2011 there was an extended stock-out by the provider supplier in the distribution of HIV tests. In recent months the supply issue was resolved and access to testing has improved, hence the increase from 48% to 59%. Source: CNLS Reports Number Value 0.00 3616.00 1300.00 Sub Type Supplemental Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target NEW - Number of textbooks in targeted sites Text Value 66310 155560 01-Oct-2008 19-Jan-2011 89,000 textbooks were distributed by the end of May 2009. Source: Ministry of Education In addition, 47,000 student tables and 130book cases were distributed to schools. Student/books ratio in targeted areas Text Value 6.7 1.85 2.8 by end 2008. This ratio was reached more than a year ago. The distribution of 90,000 Page 4 of 7
m2 area drained (through project) of (previous) standing water and marshlands identified by population as major cause of malaria transmission in communities Number of people having access to water points provided by the project in targeted areas Number of youth HIV action plans developed and implemented textbooks to schools was completed. Source: Ministry of Education Text Value 0 N.A. 01-Jun-2007 19-Jan-2011 1) Drainage was not selected Indicator is dropped. by the population as a priority micro project. 2)- During project implementation it became clear that the maximum amount available per microproject is insufficient to carry out this type of activity. Indicator dropped at restructuring of the project in Sept. 2010 Text Value 0 28500 Will be determined at project sites. For the period until December 2008, the target was 19,800 (Forages : 11,400 ; sources amenagees : 7,600 ; puits : 800) 01-Jun-2007 151 % of target achieved. Thanks to the finalization of many micro-projects that were still being implemented (Forages: 10,800; sources amenagées: 14,700, puits: 3,000) Source: Report from Directorate of Hydraulic Text Value 0 83 40 01-Jun-2007 19-Nov-2011 Total of 83 action plans (from 35 Associations) developed and implemented against the target of 40 action plans by the end of project. Source: CNLS Report Page 5 of 7
Number of pub sector HIV action plan developed and implemented Number of blood transfusion pockets tested for HIV and other blood borne infections in targeted health centers Number of pregnant women reached by PMTCT during the last 12 months in targeted Health centers Text Value 0 4 4 01-Jun-2007 Objective achieved. Source: CNLS report Text Value 0 27944 32,000 30-Sep-2007 87% of (end of project) targeted number of tested transfusions was achieved. Source: National Transfusion Center Text Value 0 27355 9000 01-Sep-2007 304% of target achieved. Source: CNLS report Data on Financial Performance (as of 27-Feb-2012) Financial Agreement(s) Key s Project Loan No. Status Approval Signing Effectiveness Closing P073525 IDA-35840 Effective 14-Dec-2001 14-Dec-2001 19-Sep-2007 31-Mar-2012 P073525 TF-50111 Closed 31-Oct-2001 31-Oct-2001 31-Oct-2004 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P073525 IDA-35840 Effective USD 17.00 17.00 0.00 18.32 2.25 108.00 P073525 TF-50111 Closed USD 0.60 0.60 0.00 0.60 0.00 100.00 Disbursement Graph Page 6 of 7
Key Decisions Regarding Implementation The closing date of the project was extended for 18 months (closing date is March 31, 2012). Restructuring History Board Approved on 30-May-2007, Board Approved on 25-Jun-2007 Related Projects There are no related projects. Page 7 of 7