The World Bank Report No: ISR11331 Implementation Status & Results Madagascar Second Multisectoral STI/HIV/AIDS Prevention project (P090615) Public Disclosure Copy Operation Name: Second Multisectoral STI/HIV/AIDS Prevention project Project Stage: Implementation Seq.No: 19 Status: ARCHIVED Archive Date: 31-Dec-2013 (P090615) Country: Madagascar Approval FY: 2006 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 12-Jul-2005 Original Closing Date 31-Dec-2009 Planned Mid Term Review Date 15-Dec-2008 Last Archived ISR Date 24-Jun-2013 Effectiveness Date 05-Jan-2006 Revised Closing Date 30-Sep-2014 Actual Mid Term Review Date 15-Dec-2008 Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase utilization of STI/HIV/AIDS, maternal and child health and nutrition services in the project area. Has the Project Development Objective been changed since Board Approval of the Project? ● Yes No Component(s) Component Name Component Cost Harmonization, donor coordination, and strategies 1.50 Support to Health Sector Response 12.50 Funds for STI/HIV/AIDS prevention and care-taking activities (FAP) 7.40 Monitoring and evaluation 4.70 Project management and capacity building 4.40 Public Disclosure Copy Health, Nutrition, and HIV/AIDS Services 5.20 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status Overview From November 18th to November 22nd, a World Bank mission conducted an implementation support mission for the additional financing project in the amount of US$6 million Page 1 of 11 The World Bank Report No: ISR11331 approved on June 14, 2012 and effective February 22, 2013. The project development objective (PDO) is rated Satisfactory based on the performance of some of the PDO level and intermediate level indicators. Overall, the implementation progress is also rated Satisfactory based on fast tracked implementation of several activities due to the delay in effectiveness. Public Disclosure Copy Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Decrease in Syphilis prevalence among SW Percentage Value 16.60 15.80 15.00 (%) Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 Comments Source: Biological Source: Combined Biological Original Financing Ending Surveillance Survey and Behavioral Surveillance 2012 Survey Target reached at 95 percent. Syphilis prevalence rate is stable. Result representative of sentinels sites Pregnant Women tested positive and treated Number Value 179.00 1750.00 1913.00 for syphilis during prenatal consultations in Date 31-Dec-2010 30-Sep-2013 30-Sep-2014 project areas (number) Comments Source: MOH Report Source: MoH Reports ADDITIONAL FINANCING Percentage of targeted groups who can cite Percentage Value 66.80 64.30 68.00 three methods of HIV/AIDS prevention Date 31-Dec-2012 31-Dec-2012 31-Dec-2012 Comments Source: Independent Source: Biological M: 68% Verification Agency report Surveillance Survey (ESBC F: 67% M: 66.8% 2012) _____________ F: 65.8% M: 64.3% SW: 61% _______________ F: 64.4% Military: 57% Public Disclosure Copy SW: 60% _______________ Original financing ending Military: 53% SW: 74.0% 2012; Military: 62.9% Target achieved at 95% for young men and women. Source: Combined Biological Target achieved at 110% for and Behavioral Surveillance military and 121% for SW. Survey; 2012 % Page 2 of 11 The World Bank Report No: ISR11331 Percentage of targeted groups who can cite Percentage Value 48.30 68.00 54.00 three methods of HIV/AIDS prevention IN Date 31-Dec-2010 31-Dec-2010 30-Sep-2014 PROJECT AREAS (%) Comments Source: Independent Source: Independent ADDITIONAL FINANCING Public Disclosure Copy Verification Agency report; Verification Agency report; M: 54% M: 48.3% Above is average of the F: 56% F: 49.8% following: SW: 67% SW: 63.6% M: 61% Military: 78% Military: 74.6% F: 62% SW: 73% Military: 75% Percentage of men and women aged 15-49 Text Value M : 38.1% M : 20% who report having sex with a non-regular F : 16.8% F : 9% partner in the last 12 months. Date 05-Jan-2006 31-Dec-2010 31-Dec-2012 Comments Source: EDS 2003/2004 Source: EDS 2008/2009; Original Financing Ending Update: Indicator achieved in 2012 EDS 2008/2009 Target achieved and surpassed Percentage of target population reporting the Text Value M: 28.3% M:35% M: 35% use of a condom in their last act of sexual F: 25% F: 29% F: 30% intercourse with a non-regular partner inthe last Military: 61.2% Military: 66% Military: 70% 12 months in project areas. Date 31-Dec-2010 30-Sep-2013 30-Sep-2014 Comments Source: Independent Source: Independent ADDITIONAL FINANCING Verification Agency report Verification Agency report Source: Independent Verification Agency report Percentage of SW reporting the use of a Text Value 79.4% 86% condom in their last act of sexual intercourse Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 with a client. Comments Source: ESC 2006 Source: ESC 2012 Original financing ending 2012 Percentage of youth aged 15-24 that have Text Value M: 7.7% M: 15.7% M: 20% received an HIV test in the last 12 months and F: 8.7% F: 15.8% F: 22% who know their results (by age and by gender) Public Disclosure Copy Date 05-Jan-2006 24-May-2013 30-Dec-2012 Comments Source: ESC 2006 Source: ESBC 2012 Original financing ending 2012 Target achieved at 79% for young men and 72% for young women Page 3 of 11 The World Bank Report No: ISR11331 Percentage of SW that have received an HIV Percentage Value 49.10 49.20 64.00 test in the last 12 months and who kow their Date 05-Jan-2006 24-May-2013 31-Dec-2012 results (by gender) (%) Comments Source: ESC 2006 Source: ESBC 2012 Original financing ending Public Disclosure Copy 2012 Target achieved at 77%. Pregnant women receiving antenatal care Number Value 60381.00 60381.00 127547.00 during a visit to a health provider (number) Date 31-Dec-2010 31-Dec-2010 30-Sep-2014 Comments Source: MoH reports Source: MoH Reports ADDITIONAL FINANCING Progress and Targets will be updated after completion of restructuring in January 2014 during next supervision mission. Children 0-24 months obtaining monthly Number Value 47704.00 47704.00 50215.00 adequate minimum weight in project areas Date 31-Jul-2011 31-Jul-2011 30-Sep-2014 (number) Comments Source: NGO and Nutrition Source: NGOs & Nutrition ADDITIONAL FINANCING sites reports sites reports Progress and Targets will be updated after completion of restructuring in January 2014 during next supervision mission. Children immunized (number) Number Value 52810.00 52810.00 113941.00 Date 31-Dec-2010 31-Dec-2010 30-Sep-2014 Comments Source: MoH reports Source: MoH reports ADDITIONAL FINANCING (Full immunization) (Full immunization) Progress and Targets will be updated after completion of restructuring in January 2014 during next supervision mission. Public Disclosure Copy Children immunized - under 5 years against Number Value 0.00 52810.00 113941.00 Polio (number) Sub Type Date 31-Dec-2010 30-Sep-2014 Breakdown Comments Not Yet Available. Will be This is part of the full ADDITIONAL FINANCING updated in next ISR. immunization package above. This is part of the full Source: MoH reports immunization package above. (Full immunization) Source: MoH reports Progress and Targets will be (Full immunization) updated after completion of Progress and Targets will be restructuring in January 2014 updated after completion of restructuring in January 2014 Page 4 of 11 The World Bank Report No: ISR11331 during next supervision during next supervision mission. mission. Direct project beneficiaries Number Value 234069.00 1960856.00 1929774.00 Public Disclosure Copy Date 05-Jan-2006 31-Dec-2010 31-Dec-2012 Comments of which Female: 63%; of which Female: 71%; of which Female: 64%; Source: Project data 2006 Source: Project data Dec Original financing ending 2012. End target surpassed in 2012 terms of % female Female beneficiaries Percentage Value 15163.00 1299963.00 1235055.00 Sub Type Supplemental HIV Interventions - Direct Project Beneficiaries Text Value 58061 150325 135210 Date 31-Dec-2010 30-Sep-2013 30-Sep-2014 Comments Source: Project reports Source: Project reports SW: 12,000; Military: 9,500; Youth: 113,660 ; of which female: 50.5% ADDITIONAL FINANCING of which Female (HIV Interventions - direct Text Value 50% 61% 51% project beneficiaries) Sub Type Date 31-Dec-2010 30-Sep-2013 30-Sep-2014 Breakdown Comments Source: Project report Source: Project report ADDITIONAL FINANCING Health and Nutrition Interventions - Direct Text Value 0 0 420584 Project Beneficiaries Date 31-Dec-2010 30-Sep-2014 Comments Progress and Targets will be ADDITIONAL FINANCING updated after completion of restructuring in January 2014 during next supervision mission. of which Female (Health and Nutrition Text Value 61% 61% Inteventions - Direct Project Beneficiairies) Public Disclosure Copy Sub Type Date 31-Dec-2010 30-Sep-2014 Breakdown Comments Pregnant Women and Progress and Targets will be ADDITIONAL FINANCING; Children Under Five; updated after completion of Pregnant Women and Source: Project reports restructuring in January 2014 Children Under Five; during next supervision mission. People with access to a basic package of Number Value 0.00 395349.00 health, nutrition, or reproductive health services Date 31-Dec-2010 30-Sep-2014 (number) Comments Source: Project reports Progress and Targets will be 94% updated after completion of (percent increase based on Page 5 of 11 The World Bank Report No: ISR11331 restructuring in January 2014 number of people); Pregnant during next supervision Women and children Under mission. Five; AF Public Disclosure Copy Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target The National Strategic Plan for HIV/AIDS is Text Value NSP 2001-2006 NSP updated and revised and disseminated by the end of 2006 disseminated by end 2010; Original Financing Ending 2012 Date 05-Jan-2006 31-Dec-2012 31-Dec-2010 Comments Source: 2006 ES/CNLS Source: 2009 ES/CNLS Source: Annual reports from reports reports ES/CNLS. End target achieved. Original Financing Ending 2012 Annual Reporting allows identifying each donor Number Value 0.00 6.00 6.00 contribution to the program in a coherent Date 05-Jan-2006 31-Dec-2010 31-Dec-2012 manner Comments Source: Reports ES/CNLS Source: 2012 ES/CNLS Source: 2012 ES/CNLS 4 by Dec. 2010 reports; End target achieved reports; End target achieved; Original Financing Ending 2012 The national communication plan is updated Text Value National communication National Communication according to recommendatins of midterm stategy developped in 2004 Strategy updated for evaluation 2009-1012; Original Financing Ending 2012 Date 05-Jan-2006 31-Dec-2010 31-Dec-2012 Comments Source: 2006 ES/CNLS report Source: 2009 ES/CNLS report Source: 2012 reports from ES/CNLS Revised National Communication strategy. End target achieved. Public Disclosure Copy Original Financing Ending 2012; Number of STI treatment kits sold in public and Number Value 81750.00 3536000.00 249350.00 private sectors (number) Date 05-Jan-2006 16-Mar-2011 31-Dec-2012 Comments Source: Project reports Source: Project Reports; Original Financing Ending End target surpassed. 2012 ARV Treatment Guidelines are adequate and Text Value n/a ARV Protocol revised in 2008 implemented Date 05-Jan-2006 31-Dec-2010 31-Dec-2010 Page 6 of 11 The World Bank Report No: ISR11331 Comments Source: PNLS reports Source: PNLS; End target achieved; Indicator achieved Original Financing Ending 2012 Public Disclosure Copy Number of condoms distributed and sold Number Value 5000000.00 25000000.00 25000000.00 through the public sector and NGO programs Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 per year Comments Source: project report Source: Project reports Original Financing Ending 2012 Number and percentage of pregnant women Number Value 54806.00 986682.00 500000.00 test for syphilis during prenatal consultations Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 Comments % n.a 36% 80% Source: PNLS 2007 report Source: 2012 PNLS report; Original financing ending End-target surpassed for the 2012 numbers. The percentage decreased as health service providers were replaced. The new ones had not yet received training on the provision of care for STDs. Number of syphilis treatments distributed in Number Value 3280.00 6641.00 5740.00 public health centers in project areas (number) Date 31-Dec-2010 30-Sep-2013 30-Sep-2014 Comments Source: Project reports Progress and Targets will be ADDITIONAL FINANCING updated after completion of (AF) restructuring in January 2014 during next supervision mission. Number of condoms distributed through the Number Value 0.00 10744319.00 10000000.00 public sector and NGO programs per year in Date 31-Dec-2010 30-Sep-2013 30-Sep-2014 project areas Comments Source: Project reports Progress and Targets will be ADDITIONAL FINANCING updated after completion of (AF) restructuring in January 2014 during next supervision Public Disclosure Copy mission. Number of SW, Youth aged 15-24 (by gender) Number Value 0.00 97379.00 76760.00 and Military tested for HIV in the last 12 months Date 31-Dec-2010 30-Sep-2013 30-Sep-2014 and received their test results in project areas Comments SW: 0 Source: Independent Source: Independent ----------------- Verification Agency reports. Verification Agency reports. M: 0 Above is total of the following: Above is total of the following: F: 0 M: 38090 SW:18,480 ----------------- F: 39644 ---------------- Military: 0 M: 21,900 Page 7 of 11 The World Bank Report No: ISR11331 Source: Independent Military: 6569 F: 22,200 verification reports SW: 13076 ---------------- Military: 14,180; AF Public Disclosure Copy Number of pregnant women receiving iron folic Number Value 5943.00 114792.00 acid in project areas Date 31-Dec-2010 09-Dec-2013 30-Sep-2014 Comments Source: MoH reports Progress and Targets will be AF updated after completion of restructuring in January 2014 and next supervision mission. Number of children under five receiving Vitamin Number Value 332808.00 587774.00 A supplementation in project areas Date 31-Dec-2010 09-Dec-2013 30-Sep-2014 Comments Source: MoH reports Progress and Targets will be AF updated after completion of restructuring in January 2014 and next supervision mission. Number of Pregnant women attended their first Number Value 13925.00 63774.00 antenatal visit before the end of the first quarter Date 31-Dec-2010 09-Dec-2013 30-Sep-2014 (<4 months) of pregnancy in project areas Comments Source: MoH reports Progress and Targets will be AF updated after completion of restructuring in January 2014 and next supervision mission. Number of births attended by skilled personnel Number Value 14348.00 47654.00 in project areas Date 31-Dec-2010 09-Dec-2013 30-Sep-2014 Comments Source: MoH Reports Progress and Targets will be AF updated after completion of restructuring in January 2014 and next supervision mission. Number of children under five treated with Zinc/ Number Value 12374.00 28000.00 SRO for diarrhea in project areas Date 31-Dec-2010 09-Dec-2013 30-Sep-2014 Public Disclosure Copy Comments Source: MoH Reports Progress and Targets will be AF updated after completion of restructuring in January 2014 and next supervision mission. Number of children under five enrolled in the Number Value 189717.00 189717.00 growth monitoring and promotion program in Date 31-Dec-2010 09-Dec-2013 30-Sep-2014 project areas Comments Source: Nutrition Site reports Progress and Targets will be AF updated after completion of Page 8 of 11 The World Bank Report No: ISR11331 restructuring in January 2014 and next supervision mission. Health personnel receiving training (number) Number Value 0.00 166.00 282.00 Public Disclosure Copy Date 31-Dec-2010 30-Sep-2013 30-Sep-2014 Comments Source: Project reports Project reports AF Above represents new personnel trained (not cumulative number) Number of women involved in growth Number Value 103146.00 104451.00 monitoring and promotion activities in project Date 31-Dec-2010 09-Dec-2013 30-Sep-2014 areas Comments Source: PNCC site reports Progress and Targets will be AF updated after completion of restructuring in January 2014 and next supervision mission. Annual Operation Plan reflects Number Value 4.00 6.00 6.00 recommendations of Consolidated Annual Date 31-Dec-2010 16-Mar-2012 31-Dec-2012 Report Comments Source: PNLS reports Source: UGP report; Original Financing Ending Indicator achieved each year. 2012 Number of national surveys and studies Number Value 4.00 13.00 13.00 undertaken in accordance with agreed Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 timetable Comments Source: Project reports Source: Project reports Original Financing Ending 2012 Number of health personnel trained in Number Value 0.00 166.00 100.00 monitoring and evaluation Date 31-Dec-2006 31-Dec-2012 31-Dec-2012 Comments Source: Project reports Source: Project reports Original Financing Ending 2012. End target achieved. Percentage of PLWHA reference centers Percentage Value 96.00 97.00 98.00 having submitted monthly reports within 15 Date 30-Dec-2011 30-Sep-2013 30-Sep-2014 days of the end of the month Comments Source: PNLS report Source: PNLS report AF Public Disclosure Copy 97.00 (target Y1 & Y2 vs 95%) Quaterly Independant Verification Agency Number Value 5.00 4.00 7.00 Reports submitted within 45 days of the end of Date 31-Dec-2012 30-Sep-2013 30-Sep-2014 the quarter Comments Quarterly AF Source: Independent Verification Agency Reports Page 9 of 11 The World Bank Report No: ISR11331 Monitoring committee meetings held within 2 Number Value 5.00 4.00 7.00 weeks of submission of quarterly Independent Date 31-Dec-2012 30-Sep-2013 30-Sep-2014 verification Agency Report Comments Source: Project reports AF Public Disclosure Copy Percentage of capacity-building plan Percentage Value 33.00 100.00 100.00 implemented by year Date 05-Jan-2006 30-Nov-2012 31-Dec-2012 Comments Annually; Source: Project reports Annually Source: Copy of capacity- confirm that this indicator has Original Financing Ending building plan; Project reports been achieved each year. 2012 Percentage of PIU audits without reserves Percentage Value 100.00 100.00 Date 31-Dec-2010 01-Jun-2012 30-Sep-2014 Comments Source: Audit reports Not yet due AF Percentage of IFRs submitted by deadline Percentage Value 100.00 100.00 100.00 Date 31-Dec-2010 30-Sep-2013 31-Dec-2012 Comments Source: IFRs; PIU Source: Project data reports Original Financing Ending that this indicator is achieved 2012 each quarter. Data on Financial Performance (as of 28-Aug-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P090615 IDA-41040 Closed 12-Jul-2005 13-Jul-2005 05-Jan-2006 31-Dec-2009 31-Dec-2012 P090615 IDA-51240 Effective 14-Jun-2012 27-Jul-2012 22-Feb-2013 30-Sep-2014 30-Sep-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P090615 IDA-41040 Closed XDR 20.20 19.60 0.60 19.60 0.00 100.00 P090615 IDA-51240 Effective XDR 3.90 3.90 0.00 2.23 1.67 57.00 Public Disclosure Copy Disbursement Graph Page 10 of 11 The World Bank Report No: ISR11331 Public Disclosure Copy Key Decisions Regarding Implementation The project development objective (PDO) is rated Satisfactory based on the performance of the PDO level indicators (Parent Project) as assessed through the Combined Biological and Behavioral Surveillance Study which was validated on May 24, 2013. Detailed progress on indicators will be measured and recorded during the next supervision/implementation support mission. Restructuring History Level two Approved on 28-Dec-2011 Related Projects P128169-Second Multisectoral STI/HIV/AIDS Prev II Additional Financing Project Public Disclosure Copy Page 11 of 11