33806 THE WORLD BANK GROUP WASHINGTON, D.C. URBAN PAPERS UP-1 SEPTEMBER 2005 Lessons and Experiences from Mainstreaming HIV/AIDS into Urban/Water (AFTU1 & 2) Projects Nina Schuler in collaboration with Alicia Casalis, Sylvie Debomy, Christianna Johnnides and Kate Kuper URBAN SECTOR BOARD © 2005 The International Bank for Reconstruction and Development/The World Bank 1818 H Street NW Washington, DC 20433 Telephone 202-473-1000 Internet www/worldbank.org The findings, interpretations, and conclusions expressed here are those of the author and do not necessarily reflect the views of the Board of Executive Directors of the World Bank or the governments they represent. To order additional copies of this publication, please send an e-mail to the Urban Help Desk, urbanhelp@worldbank.org Urban publications are available on-line at http://www.worldbank.org/urban/. LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS i CONTENTS KEY ISSUES AND FINDINGS............................................................................................1 Introduction ....................................................................................................... 1 Process.............................................................................................................. 1 HIV/AIDS interventions in the African Urban portfolio............................................... 2 What are the drivers behind mainstreaming HIV/AIDS interventions in the African Urban portfolio?.................................................................................................. 3 What are the lessons learned from Urban/Water projects? ........................................ 4 Lessons Learned from HIV/AIDS (MAP) Projects.................................................................... 5 Addressing challenges ......................................................................................... 5 Conclusion: Starting a dialogue............................................................................. 6 ANNEX I: LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO AFTU1 AND AFTU2 (URBAN/WATER) PROJECTS...............................................................................7 BENIN: Second Decentralized Cities Management (appraisal phase) ........................... 8 BURUNDI: Public Works and Employment..............................................................10 CONGO, Republic of: Emergency Reconstruction, Rehabilitation and Living Conditions Improvement ....................................................................................................12 COTE D'IVOIRE: Municipal Support (PACOM) (09/27/1995 ­ 06/30/2004)..................13 LESOTHO: Highlands Water.................................................................................14 MOZAMBIQUE: National Water Development (1998-2005) .......................................15 NIGERIA: Lagos City Strategy (ESW) ....................................................................17 NIGERIA: Community Based Urban Development ...................................................17 RWANDA: Urban Infrastructure and City Management.............................................18 SENEGAL: Urban Mobility Improvement (UMIP)......................................................20 SOUTHERN AFRICAN Urban Work & Cities Alliance..................................................21 ZAMBIA: Mine Township Services .........................................................................22 ANNEX II: DISCUSSION QUESTIONS FOR INTERVIEWS WITH TTLS ......................................24 ANNEX III: MAINSTREAMING HIV/AIDS INTO URBAN/LOCAL GOVERNMENT PROJECTS: A GUIDANCE NOTE........................................................................................................25 ENDNOTES................................................................................................................27 ACKNOWLEDGEMENTS The authors would like to thank the Task Team Leaders who agreed to be interviewed for this paper. LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 1 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS KEY ISSUES AND FINDINGS ease of transportation and mobility are central factors in the urban bias of the epidemic. The Introduction impact of HIV/AIDS is felt by municipalities and local governments both internally through In recent years, the World Bank has been an the impact on municipal staff4 as well as active and prominent player in the global fight externally through the impacts on the against HIV/AIDS. The approach has been community (i.e., street children, increased multifaceted, with over $1.8 billion committed household vulnerability, etc.) through grants, loans and credits for HIV/AIDS activities worldwide, much of which has been With HIV/AIDS posing evident short- and long- provided through the Multi-Country HIV/AIDS term risks for urban projects5, the argument Programs (MAPs) in Africa and the Caribbean. for mainstreaming HIV/AIDS should resonate The Global HIV/AIDS Program1 has leveraged as a logical intervention that is supported by considerable resources2 to support monitoring both internal management and the client. and evaluation and social and economic impact analysis as well as to facilitate regional Process research and initiatives. Recognizing that HIV/AIDS cannot be addressed within the Since 2002, there has been a small initiative in confines of health and HIV/AIDS projects the Urban Unit looking specifically at the role of alone, there has been considerable emphasis local governments/municipalities in addressing on mainstreaming HIV/AIDS into lending HIV/AIDS. This team has worked with a portfolios where HIV/AIDS poses a significant number of HIV/AIDS and urban projects in the risk. Africa region6 to advise on how local governments can be strengthened (technically The rationale for mainstreaming HIV/AIDS into and financially) to address HIV/AIDS. Much of projects is twofold: this work has built upon a publication, Local Government Responses to HIV/AIDS: A (i) From a national and global perspective it Handbook, published in 2003, in collaboration increases the reach of targeted HIV/AIDS with a range of partners. interventions to all sectors and to more people than can be reached through health projects In 2005, at the recommendation of the Urban alone Sector Board, this team began looking more specifically within urban projects to identify the (ii) From a project perspective it serves to extent and nature of how/whether HIV/AIDS mitigate the (short- and long-term) risks that has been mainstreamed. Initially, this exercise HIV/AIDS may have on projects (i.e., impact has been confined to AFTU1 (East and on human resources, vulnerability, Southern Africa) and AFTU2 (West and Central governance, etc.). Mainstreaming does not Africa). Task Team Leaders (TTLs) in each of mean turning urban projects into HIV/AIDS the units were invited to share their projects; it means integrating targeted experiences through a series of short components that can help protect the client interviews7. At the completion of the exercise, communities that Urban projects support from seven interviews were conducted in AFTU2 and the economic and social effects of HIV/AIDS. six interviews in AFTU1. For urban areas, there are more specific For each of the interviews, a short case study reasons for proactively addressing HIV/AIDS3. was prepared (Annex I) and available reports In nearly all countries where HIV/AIDS is on and TORs were compiled8. the rise (particularly within the regions with newer epidemics--South Asia and Eastern and A practical guidance note on how to Central Europe), the urban environment poses mainstream HIV/AIDS into urban/local additional risks that invariably result in higher government projects has also been prepared urban HIV/AIDS prevalence. Concentrations of and is available in Annex III. people, particularly vulnerable groups (i.e., commercial sex workers, truckers, etc.), and 2 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS Project Name (Task Manager) Amount for HIV/AIDS Benin: Second Decentralized Cities Management (F. Bousquet) $200k Burundi: Public Works and Employment (E. Ouayoro) $1.0m Congo, Republic of: Emergency Reconstruction, Rehabilitation and Living $1.0m Conditions Improvement Project (E. Ouyoro) Cote D'Ivoire: Municipal Support (PACOM) (closed) (A. Casalis) $400k Lesotho: Highlands Water Project (A. Macoun) Mozambique: Municipal Development Project (K. Kuper) Mozambique: National Water Development Project (C. Revels) $85k Nigeria: Lagos City Strategy/Community-Based Urban Development (D. Tewari) $210k Rwanda: Urban Infrastructure and City Management (S. Debomy) $200k Senegal: Urban Mobility Improvement Project (C. Diou) $200k Southern Africa/Cities Alliance [incl. South Africa, Swaziland, Namibia, Lesotho, Addis/Jo'burg] (D. Degroot) Uganda: Local Government Development Project (L. Morrell) Zambia: Mine Township Services Project (F.C. Eng) $200k HIV/AIDS interventions in the African urban teams decide to respond to HIV/AIDS Urban portfolio and the impetus for them to do so vary considerably. Projects in the urban portfolio vary greatly, from infrastructure and water projects to local To generalize, we have identified five types of government capacity building and municipal HIV/AIDS interventions in urban projects. finance projects. Similarly, the ways in which Type of Intervention Description & Rationale Examples Workplace Provides information, education and communication Mozambique (IEC) on HIV/AIDS--and condoms--to employees Water, within the counterpart organization--public utilities, Zambia Mines, municipal offices, holding companies, Project Lesotho Management Unit. Rationale: HIV/AIDS is a human Water, resource management risk. Rwanda, Senegal Awareness Raising for Provides HIV/AIDS IEC and condoms to the Burundi, Beneficiary Communities communities with which the project is interacting-- Congo, Lagos including most commonly construction sites, as well as (CBUD), vulnerable groups (truckers, commercial sex workers, Lesotho, etc.) and schools. Rationale: The urban project has a Rwanda, comparative advantage in reaching certain groups with Zambia, HIV/AIDS information and services that are critically Senegal needed. LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 3 Municipal HIV/AIDS Supports local government authorities (and the AIDS Benin, Cote Committees within them where applicable) in planning D'Ivoire, and (more often) implementing their HIV/AIDS Jo'burg, activities. In many cases, the starting point will be the Addis, municipal workplace activities but will often include Rwanda, outreach implementation activities for the SACN, communities. Rationale: Addressing HIV/AIDS is a Uganda, mandate of the municipality, and the Urban project is Mozambique, therefore well placed in supporting HIV/AIDS activities Uganda as one such (often unfunded) mandate. Mainstreaming within Supports HIV/AIDS related infrastructure within the Mbabane, Upgrading/Infrastructure context of upgrading or reconstruction. May also Congo provide support in identifying HIV/AIDS risks and implications for upgrading activities. Rationale: HIV/AIDS has created infrastructure demands that can be met within urban capital investments that respond to neighborhood and community needs, i.e., local Voluntary Counseling and Testing (VCT) centers. Analytical and Sector Integrates HIV/AIDS into ongoing analysis of a sector Lesotho EA, Work (e.g., transport) or into a larger piece of urban Nigeria, analysis (i.e., service delivery, business climate) in Senegal, order to identify the HIV/AIDS issues that may then be SACN addressed more strategically through follow on projects or by other partners. Rationale: HIV/AIDS is a development issue that impacts all sectors and has significant implications (in the short- and long-term) and is therefore a logical issue to integrate into any analytical work. What are the drivers behind HIV/AIDS component during mid-term review mainstreaming HIV/AIDS interventions in to respond to mainstreaming. Yet, there the African Urban portfolio? appears to be some lack of clarity among urban staff as to whether the principle to The decision to allocate resources from an mainstream remains a management priority. urban project to address HIV/AIDS usually stems from the Bank side and is most often Urban projects may have a comparative well received by the client. advantage in reaching down to communities quickly and efficiently, particularly when the Particularly where prevalence is very high, larger resource streams for HIV/AIDS (from there is a sense that addressing HIV/AIDS is MAP projects or other donors) may be just an integral part of working with the client--a getting started or facing delays in "common sense" approach. In Mbabane, implementation. This is particularly true in Swaziland, for example, a new upgrading post-conflict settings, such as Congo and program will be integrating HIV/AIDS, not as a Burundi, where the national institutional separate line item but as part of all infrastructure to implement an HIV/AIDS components. project may be lacking, but an urban project is already actively working with communities In some projects, particularly during 2000- (i.e., Public Works in Burundi, Reconstruction 2002, the impetus for including HIV/AIDS in Congo). followed a management directive to `mainstream'. This was the case during the In other projects, the push to include Mozambique Water project which integrated an HIV/AIDS interventions stemmed from the 4 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS client, particularly when mayors or local was relatively straightforward, and did not governments have been mobilized to address cause significant delays, because of well- the issue. In Cote D'Ivoire, the launch of the articulated TOR and performance Alliance of Mayors Against AIDS in Africa indicators. (AMICAALL) created demand from mayors for · Given concerns about simplification of support to address HIV/AIDS within the projects and the avoidance of so-called ensuing Municipal Development Project. Christmas Tree projects (with many separate components), some task mangers Where other partners or the client may already have found ways of leveraging HIV/AIDS be active in carrying out HIV/AIDS activities within existing activities through municipal within the project area/target community, the contracts and public works contracts9. In urban projects may be well placed to pick up many of the Central and West African an area that is not funded. For example, in countries, the AGETIP and municipal Rwanda the municipalities had already contract systems allow the Bank and the developed their HIV/AIDS plans, but funding client to agree to a set of performance- remained lacking for the municipal workplace based activities. Integrating HIV/AIDS interventions, which were then integrated into activities/outcomes within these contracts the new urban project for support. can be an effective way to avoid components and create genuine buy-in What are the lessons learned from from clients. This is being used in the new Urban/Water projects? Rwanda project among others. · A common concern among urban teams is In the process of reviewing the 13 projects, their lack of expertise about HIV/AIDS; there were some encouraging lessons however, technical resources in terms of identified. In summary: staff and TOR are often more readily available than it would seem. Both the · Ring fencing resources for HIV/AIDS Nigeria projects and the Mozambique activities, by using a placeholder during Municipal Project are benefiting from the preparation, allows the task team to buy technical expertise available from field- time. In Zambia, a placeholder was used based Human Development (HD) staff. In during preparation and was then used to addition, an initiative within TUDUR10 contract an initial consultancy to design the component and another consultancy to (Urban Anchor) can provide TOR, training implement the component. tools and consultants to interested staff. · Small interventions, particularly within · Building the capacity of Project capacity building components, can be Management Units and AGETIP partners to designed to catalyze demand for HIV/AIDS understand and address HIV/AIDS issues activities, which can then be funded was emphasized as an important through other funding streams (such as ingredient for successful mainstreaming. MAP). In Uganda and Mozambique, This was the case in the Senegal Urban capacity building on HIV/AIDS planning is Mobility project where the analytical work being integrated into the curriculum for on HIV/AIDS was useful both for the municipal planners. project team as well as the client in raising · Well-defined consultancies can be fairly awareness of the key issues. easy to manage. Most HIV/AIDS · Where there are active partners engaging components in urban projects are fairly in similar work, the task of supporting small ($200k) and are often implemented HIV/AIDS activities is made easier for the through a single consultancy. By selecting urban team. Notably, where AMICAALL11 is good quality contractors and ensuring that active, there are good opportunities for the TOR are well defined with clear coordination and collaboration. Similarly, performance indicators, task managers partners such as GTZ (Zambia, often feel that the implementation is rather Mozambique) have extensive expertise in straightforward and relatively easy to areas relating to workplace HIV/AIDS supervise. For example, while the Burundi policies and district planning for HIV/AIDS. project had to change the initial contractor because of poor performance, the process LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 5 Lessons Learned from HIV/AIDS (MAP) Projects Since 2002, there has been increasing interest in improving the District/Local Government participation in National HIV/AIDS projects (supported with MAP resources). Through projects in Malawi, Zambia, Swaziland, Uganda, Eritrea and Tanzania, some of the lessons/challenges have been identified: Local Government Authorities (LGA) are often tasked with new responsibilities with regards to HIV/AIDS but lack the guidance and capacity to develop targeted and strategic interventions. Local Government Authorities are often overwhelmed and do best when they have a clearer vision of what is expected. Experience indicates that LGAs can play an important role in (i) municipal workplace HIV/AIDS interventions, (ii) coordination of public and private AIDS Service Providers, (iii) supervision and M&E of community interventions, (iv) mainstreaming HIV/AIDS into LGA activities, and (v) leadership and advocacy. HIV/AIDS resources for LGAs are often slow in reaching them (if at all), and in some cases the modalities for how LGAs can access money to address HIV/AIDS remain unclear. Issues of fiscal decentralization and transparency in regional allocation of resources may sometimes be overlooked. National HIV/AIDS programs are often conceived of by Health and HIV/AIDS agencies with little coordination with partners and ministries that work directly with local government authorities. There are considerable missed opportunities, particularly in capacity building and monitoring and evaluation. Urban areas in most countries still have the highest HIV/AIDS prevalence, but few national HIV/AIDS programs have initiative targeting urban areas. Addressing challenges based case for why HIV/AIDS is relevant to my project development objectives? While there is clearly good reason for (and positive experiences from) mainstreaming Even when projects have HIV/AIDS HIV/AIDS into urban/water projects, there components, there are considerable challenges remain a number of practical challenges facing in accessing the expertise and variable budget task managers in urban. These were discussed to support their involvement in project with Africa Urban and Water staff at a recent supervision. This may lead to some of the event12 hosted during Urban Learning Week. following challenges: The challenges may be grouped around three · Given that there is not additional budget central themes: (i) bringing HIV/AIDS into an available to adequately supervise an urban/water project, (ii) preparing and HIV/AIDS component or activity, will I run supervising HIV/AIDS components/activities the risk of being accountable (through and (iii) coordinating with HIV/AIDS partners QAG) for a poorly performing component? (notably MAP). Are there any resources available for this kind of mainstreaming13 support? As the process of compiling the case studies suggested, many urban and water projects in In nearly all countries in Africa, there is Africa do not have HIV/AIDS elements in them. support for HIV/AIDS available through the Some of the common issues raised by task Multi-Country AIDS Program (MAP) that managers were: provides flexible funding to support national HIV/AIDS programs. However, there appears · Is it still a management priority to to be rather sporadic coordination between mainstream HIV/AIDS into non-health MAP teams and urban teams and even less projects--especially now that MAP is up coordination on the complementarities of and running? Will including an HIV/AIDS HIV/AIDS activities. Some of the practical component in my project make my project questions that were raised include: less compliant with simplification procedures? Do I have a strong evidence- · Would it be possible for MAP to take on supervision responsibilities of HIV/AIDS 6 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS components within urban projects? Whose responsibility is it to coordinate HIV/AIDS interventions across projects and sectors (i.e., MAP, country team, etc.)? If we integrate HIV/AIDS within a local government planning program, for example, can we be assured that local governments will be able to access resources? Conclusion: Starting a dialogue The issues raised here represent a starting point for a productive dialogue between HIV/AIDS teams (MAP projects) and Urban teams to identify mechanisms and resources to address the common challenges. In addition, the compiled case studies (and the TOR and reports that informed them) that follow in Annex I provide rich examples of ongoing successes and experiences. LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 7 ANNEX I: LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO AFTU1 AND AFTU2 (URBAN/WATER) PROJECTS Summary Notes available for: Benin: Second Decentralized Cities Management (F. Bousquet) Burundi: Public Works and Employment (E. Ouayoro) Congo, Republic of: Emergency Reconstruction, Rehabilitation and Living Conditions Improvement (E. Ouyoro) Cote D'Ivoire: Municipal Support (PACOM) (closed) (A. Casalis) Lesotho: Highlands Water (A. Macoun) Mozambique: National Water Development (C. Revels) Nigeria: Lagos City Strategy/Community Based Urban Development (D. Tewari) Rwanda: Urban Infrastructure and City Management (S. Debomy) Senegal: Urban Mobility Improvement (C. Diou) Southern Africa/Cities Alliance [incl. South Africa, Swaziland, Namibia, Lesotho, Addis/Jo'burg] (D. Degroot) Zambia: Mine Township Services (F.C. Eng) These summaries have been presented alphabetically. 8 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS BENIN: SECOND DECENTRALIZED planning, management, implementation, CITIES MANAGEMENT (APPRAISAL PHASE) coordination, monitoring on a local scale; and (iv) development of links between the P082725 (TTL: F. Bousquet) different actors; and · Development of the participatory approach in municipalities, developing sensitization HIV/AIDS situation and prevention actions against HIV/AIDS: HIV adult prevalence rate is 4.1%; in medium- (i) identification of the specific needs of size cities prevalence is up to: 13.98% in each municipality to implement effectively Dogbo, 13.46% in Savalou, 6.38% in Grand HIV/AIDS actions; (ii) identification of Popo. Benin's National Strategic Plan against priority actions targeted on the orphans HIV/AIDS (period 2003-2006) focuses on and the women, single-parent; (iii) municipalities and communities and on identification of a communication plan and developing local actions to increase local the means, adapted to each municipality; governments' responsibilities and participation and (iv) implementation of these actions in HIV/AIDS actions. An advantageous under the responsibility of the local institutional framework and social services are governments. already in place for implementing effective HIV/AIDS plans. Process As this was a follow-up project, the Bank team Project description recommended the integration of HIV/AIDS The overall project objective is to improve the actions into the project design. efficiency and the quality of service delivery in urban zones, particularly in the low-income While the Bank Urban team was helped during and ill-equipped areas, in the three main cities preparation by a team specialized in HIV/AIDS (Cotonou, Parakou, Porto-Novo) and in a few issues from the Secretariat of the UN at secondary cities. Cotonou, the design was modified during implementation. There was some concern that Description of HIV/AIDS elements the initial design was too analytical (large During the first phase of the project, the cities consultancy) and not implementation oriented. of Cotonou, Parakou and Porto-Novo have The revised activities (as described in the integrated HIV/AIDS actions in their programs. attached text box) were designed to be more The interest and will of the beneficiary cities, action oriented. the achievements of the first phase, and the general strategic policy made the situation Issues/lessons learned advantageous to integrate HIV/AIDS actions in The methodology of the ONU/AMICAAL14 the second phase. program was proven to be an effective framework to support HIV/AIDS actions at the The main objectives of the HIV/AIDS municipal level. subcomponent are to (i) analyze the local HIV/AIDS situation and (ii) identify and implement HIV/AIDS activities in collaboration with the mayors, local government staff, and development organizations. It will focus first on the Cotonou-Porto-Novo axis, with a specific study on the municipality of Semekodj, and Parakou. HIV/AIDS actions will be integrated in two components: · Capacity building, strengthening the municipalities and increasing their responsibilities in the management of local affairs related to HIV/AIDS: (i) information programs for the local governments and mayors; (ii) extension of these programs to the population; (iii) capacity building actions for all the actors in terms of LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 9 Sub-component A1 -- Support municipalities to face the challenge of HIV/AIDS at the local level (est. costs: 200k USD) This sub-component will support the fight against the spread of HIV/AIDS by complementing, and supporting existing programs (MAP, PASNAREF, "Programme Plurisectoriel de Lutte contre le SIDA" [PPLS], BHAPP) and assisting local NGOs working on HIV/AIDS. Within cities and towns, there are groups of people that are particularly at-risk of HIV/AIDS. These include young women (school-age girls), unemployed youth, truckers, seasonal migrants, and sex workers. Municipalities can play an important role in identifying local needs and coordinating local responses (i.e., facilitating partnerships). This sub-component will also support the strengthening of the capacity of the cities to better respond to the HIV/AIDS fight. The activities to be funded under this sub-component have been agreed upon with the Benin MAP team and are in line with the other above-mentioned projects and the national strategy for fighting HIV/AIDS as well. The Communal Committees for Fight Against HIV/AIDS (CCLS - Comités Communaux de lutte contre le SIDA) are the appropriate structures at the decentralized level for the coordination, follow-up and mobilization of resources for the fight against HIV-AIDS. Despite their important function, these Committees do not currently receive sufficient support (equipment, staff) in order to fulfill their role. The first phase of the APL of the Decentralized City Management Project identified the main HIV/AIDS-related issues in the cities of Cotonou, Porto-Novo and Parakou, and carried out in these cities pilot sensitization activities along with workshops to take into account communities' preoccupation. To build open this pilot's activities and experiences, the current proposed project will remain in these identified main cities and will include: i) institutional support to the CCLS to help them better play their coordination role in fighting HIV/AIDS; this support will also consist of funding some key supplies; ii) development of information, sensitization and education programs by NGOs, media, journalists and specialized communication agencies; iii) creation of youth centers with the support of CCLS and NGOs in remote poor areas; iv) specific sensitization activities on primary and high schools, workers and sexual workers on work sites, condom distribution, organization of games and competition); v) capacity building of the staff of the CCLS, NGOs and health centers with appropriate equipment; and vi) support of the existing social promotion centers. 10 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS BURUNDI: PUBLIC WORKS AND Lessons learned EMPLOYMENT · The team expressed that it would have been easier to implement part of the P064961 (TTL: E. Ouayoro) HIV/AIDS project that was being developed through MAP/MoH, but since this was not possible at the time, the project team Description chose to design and implement a This Public Works and Employment project, in component on their own. a post conflict setting, was designed to reach a · During supervision, the inclusion of an large number of individuals through small HIV/AIDS specialist would have been labor-intensive sub-projects. Because of this welcome (perhaps as part of a MAP outreach capacity, it was felt to be a good mission). However, the team felt that vehicle for an HIV/AIDS IEC (information, given that the component was not very education and communication) campaign for technical, they felt fairly confident in their communities, laborers and commercial sex own capacity to supervise. Also by using a workers within the project area that included well established and respected NGO, they the capital, Bujumbura and other cities. felt that the implementation/methodology Burundi is a very small country, and the was most likely in order. project was able to reach a large number of individuals. Process Although this is primarily an infrastructure project, the Bank team included the HIV/AIDS component from the very beginning of the project cycle. The team acknowledged that the push for this came from the "culture of the unit" which encourages inclusion of HIV/AIDS components15. The component was reviewed through the internal meetings of the unit, with resources set aside totaling $1m (out of a $40 million investment) The Multi-Country AIDS Program (MAP), was developing a project in Burundi at the time of preparation, and they were consulted on the component initially. Given the relatively small amount of the component, and the ability of the project to contract out the implementation to a large NGO, it was felt that the project could implement the information program quicker (than MAP) and without bureaucratic delays. A competitive procurement process was undertaken for an NGO to implement the component on a national level. Clear terms of reference, regular reporting and targets were identified for the NGO (and included in the PAD). When these were not being met by the first NGO hired, the competitive process began again and a competent replacement was found. The project has met its target of reaching 43,000 people (8,000 women and 35,000 men) nation-wide and sensitizing them on HIV/AIDS issues, well ahead of the 2006 deadline. LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 11 Project Component 3 -- US$ 1.00 million Support for the Prevention of HIV/AIDS This component will help in the fight against the spread of HIV/AIDS by including a community information and education program, targeting high-risk groups, such as the youth and women. The themes, which will be developed in information and education programs, will be based on existing frameworks already developed by youth and women's associations in Burundi. The Bank is collaborating with UNAIDS in Burundi. It has been strongly recommended by UNAIDS to invest in a participatory diagnostic process to better sensitize and educate people on HIV/AIDS prevention. Taking into consideration that much of Burundi is still rural, the UNAIDS group has recommended in its action plan a program of "peer sensitization" to better disseminate relevant HIV/AIDS information. This program will also target workers who will be involved in building public works under this project. The first intervention will be targeted at those communities receiving the first tranche of sub-projects. In addition, this sub-component may also finance specific programs targeting mobile people, such as truck drivers, seasonal workers who live in town but still have their wives and children in rural areas, prostitutes, and so forth. Possible partners in the implementation of this sub-component include the Red Cross of Burundi, the Society for Women Against AIDS in Burundi (SWAA-Burundi), and other NGOs actively working on HIV/AIDS prevention. Hospitals and health centers near sub-project implementation sites will be involved in HIV diagnostic and treatment. This component will also finance studies and preparation activities for a future multi-sectoral HIV/AIDS project to be financed by IDA and other donors. 12 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS CONGO, REPUBLIC OF: EMERGENCY developed (with clear performance indicators), RECONSTRUCTION, REHABILITATION and having received necessary training, the AND LIVING CONDITIONS IMPROVEMENT MoH staff have been effective in supervising activities (although the MOH did not receive P074006 (TTL: E. Ouayoro) funds directly). Issues/lessons learned HIV/AIDS situation · The project benefited from the good Congo is one of the most urbanized countries relationship between the MoH and Project in the region with an estimated urbanization Management Unit, and the resulting rate of 60 percent. Brazzaville, the capital city, implementation arrangements appear to be has a population of about one million people, working satisfactorily (with 70% of funds representing 35 percent of the Congolese disbursed). population. Years of conflict have made data · There had been some debate between the collection on HIV/AIDS a challenge, but the MoH and the project team on the location conservative estimates range from 5-10% of the VCT sites--the urban team's prevalence. preference for neighborhood locations (rather than central sites) provides a good Project description example of influencing service delivery to The project was developed as a post-conflict meet community (spatial) demands. emergency intervention to improve · Given the size of the component (as infrastructure and living conditions by (i) compared with other such mainstreamed rehabilitating primary, secondary and social components), the project would likely infrastructure; (ii) promoting employment benefit from inclusion of an HIV/AIDS or creation through labor execution of public Health Specialist in supervision to assess works; and (iii) supporting institutional the quality of the sites and interventions. strengthening and capacity building to · While Brazzaville is a particularly high-risk maintain primary, secondary, economic and area, the project has not targeted specific social infrastructure. interventions to the local government authorities within the cities. The project In line with the national HIV/AIDS prevention has expressed interest in expanding in this strategy, the project supports: area (to include capacity building for LGA) · Information, education and communication but feels strongly that such capacity (IEC) campaigns (including condom building must be coupled with financial distribution) targeted for construction sites resources in order to be meaningful. In (for public works) and schools. such cases, deliberate discussions and · Sexually transmitted disease (STD) partnerships with MAP (to ensure that treatment for construction workers and resources can complement capacity commercial sex workers in and around the building) may be fruitful. A Mid Term work sites and along railway lines (STD Review mission is planned for March/April drugs and condoms are procured directly (05). through the project). · Construction of two advanced VCT centers located in the neighborhoods within which (From PID) HIV Prevention, Care and Support the project is working (instead of within ($1.0m): This component will support local the district hospital) NGO's working on HIV/AIDS prevention, care and support. The work programs to be funded Process by this component will be agreed to with the Based on the lessons learned from the Burundi UNAIDS focal person in Congo and will closely Public Works project, the HIV/AIDS component follow the national strategy to fight HIV/AIDS. was designed to be more comprehensive than Sensitization programs on work sites, and just an outreach program. Significant funding condom distribution will also be funded. was set aside at the outset of the project ($1m), and the HIV/AIDS component was discussed and developed with MAP. The project worked closely with the Ministry of Health (MoH) which helped design the component and are also managing it. A procedural manual was LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 13 COTE D'IVOIRE: MUNICIPAL SUPPORT The support that was provided to the Club (PACOM) (09/27/1995 ­ 06/30/2004) AIDS Stop, membership in which is open to high school students as a way to motivate PO37575 (TTL: A. Casalis) them in their studies, provided a greater opportunity for young people to improve their knowledge of health-related issues and, thus, Description their ability to maintain safe and healthy life- In the Municipal Support project, a small styles. component ($0.4m) was included in 2002 to assist in the implementation of the National In July 2003, a pilot project to form Municipal HIV Program. Two activities were identified to HIV/AIDS Information Cells under the direction support the creation of Municipal HIV/AIDS of the municipalities was officially launched. Information Cells: (i) the organization of The main function of these cells is to bring the workshops for the HIV municipal teams; and plan of action in the fight against HIV/AIDS (ii) the organization of a week-long seminar for closer to the communities. the mayors, "Journées des Maires contre le HIV." These Municipal HIV/AIDS Information PACOM was closed on June 30, 2004, and this Cells serve as liaisons between the National activity was evaluated as Satisfactory by the HIV/AIDS Program and the local organizations client and the Bank. The HIV/AIDS PACOM and communities. activities were highlighted by OED as a support for a public awareness campaign in the Process municipalities. In 2002, a new national HIV program was prepared, following the first meeting of the AMICAALL held in Abidjan. This national HIV program was initiated by the Cote d'Ivoire Alliance of Mayors16, which promoted decentralized HIV activities in order to support local governments in their efforts to mitigate locally the impact of HIV. The fight against HIV activities that were not included in the design of the Municipal Support project (PACOM) in 1995 were introduced (as requested by the Bank) as a new project activity in 2002. PACOM supported HIV/AIDS activities against epidemic (2002-2004)17 in the amount of US$ 0.4m. The resources were disbursed through the Alliance of Mayors (UVICOCI). The supervision was implemented by the UVICOCI and PACOM without any indicator. Achievements of PACOM HIV activities Through the initiative of the UVICOCI, municipal committees for the fight against HIV/AIDS were established with 85 members in 24 municipalities where action teams were established. The teams were trained and worked across sectors and with the population which gave a new impetus to the fight against HIV/AIDS. During the second phase, the program that had emerged from the participatory training sessions was implemented. 14 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS LESOTHO: HIGHLANDS WATER effects of the project on the prevalence of HIV/AIDS in the area, helped to convince the P001409 (TTL: A. Macoun) client that it was in its best interest to address the issue. The inclusion of a public health Description specialist in the project team was important in The project, which began in 1986, is a massive presenting the case to the client, and providing infrastructure project to export water to impact assessments would have strengthened neighboring South Africa. A public awareness the arguments. campaign conducted to educate workers and communities about HIV/AIDS was introduced Introducing an expanded component during in Phase 1A (1986-1998). A baseline survey such a late stage of the project was difficult, was completed in 1993 and subsequent studies but having a broader framework such as a MAP have indicated a sharply rising trend in means that such a project may be able to HIV/AIDS within the project area as elsewhere contribute to or expand a program already in the country, notably during the height of the developed. construction activities. During Phase 1B (current project commenced 1998), an (from PAD) Public Health: A full Public expanded set of activities was introduced to Health program has been proposed, not only the client, RSA18. HIV/AIDS is clearly identified to try to mitigate the potential negative as part of the Environmental Assessment and impacts of the project (the biggest of which is highlighted within the project risk are AIDS and other STDS) but also to assessment as a `high' risk. provide general medical services to the work force, resettlers and other local During Phase 1B, the expanded list of activities communities. It will also provide training and included an awareness campaign for capacity building to Ministry Staff. A management and staff of LHDA (Lesotho program to provide water supply and Highlands Development Authority), building of sanitation to national standards for all partnerships to facilitate technical and communities in the catchment area (over resources support, strengthening institutional and above those directly affected by the arrangements within the HIV/AIDS project) is also included. The Leribe Trauma Coordination committee, developing a proposal unit will continue to serve the general public to define LHDA's role and developing a as well as the project itself. The community stakeholder workshop. public health benefits in phase IA were quite substantial. Process The client (RSA) was persuaded during implementation to consider funding additional HIV/AIDS activities, after the project team cited its responsibilities under the "no harm" clause of the international treaty between the two countries and because of the probability that the project had contributed to elevated HIV incidence in the highlands project areas. Since the LHWP (Lesotho Highlands Water Project) is already paying compensation for losses as a result of the infrastructure works, it was possible to use the same argument to fund services that were burdened due to the increased prevalence of HIV/AIDS in the project area. A proposal has been prepared and is now under discussion. Lessons learned A dedicated project team that refined its arguments over time was rewarded with relative success. Using the compensation and "no harm" clause, after demonstrating the LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 15 MOZAMBIQUE: NATIONAL WATER · Ensure access to useful and quality DEVELOPMENT (1998-2005) information about HIV/AIDS to all employees, regardless of their P039015 (TTL: C. Revels) organizational levels. The consultancy built on previous pilot Overall project description trainings financed by SDC. The project is The National Water Development I project scheduled to close in April 2005, and future seeks to increase the capacities of the support to RWSS will be provided within the organizations and people of the sector and PRSC. No follow-on activities are planned as prepare for the private sector management of there is not a follow up project planned. the urban water supply systems of five cities (Maputo, Beira, Quelimane, Nampula and Process Pemba) so that sector organizations can The decision to include the consultancy on provide sustainable water supply and sanitation services to an increasing proportion HIV/AIDS into the project came from IDA19, of the community and manage water resources but there had been active engagement sustainably. There are five components in this between DNA and SDC on the issue. The TOR project: (i) institution building and policy for the consultancy were drafted by the DNA development; (ii) preparation for private sector and were reviewed by the TTL and SDC staff management of urban water supply; (iii) rural based in Maputo. There has been some contact water supply and sanitation (RWSS); (iv) with the team supporting the MAP (HIV/AIDS water resources management; and (iv) human Project). resources development. Issues/lessons learned HIV/AIDS situation It was recognized that using already available With a national HIV prevalence near 14%, communications channels--such as employee Mozambique is one of the most heavily newsletters, posters and utility bills--can be a affected IDA countries. Mozambique is stronger and more cost effective means of receiving $55 million IDA credit for HIV/AIDS sharing information on HIV/AIDS. through the MAP. In the process of designing and implementing Description for the HIV/AIDS elements of the this process there were some delays because project sector implementers prioritized other activities. Within the component on human resource In addition, there was an initial resistance to management, the National Directorate of the idea of inviting NGOs to bid for the work. Water (DNA) was supported with a consultancy ($85,000 IDA + $50,000 SDC (Swiss Development Corporation) to conduct training and education on HIV/AIDS at the Provincial level to approximately 6,500. The training is targeted at employees of the DNA, is implemented through a decentralized structure of "Local Commissions" and will be piloted in three districts. It is expected that the findings from these pilot districts will inform a national program for the DNA (with funding possibly from SDC or MAP). The education and training is targeted at the following objectives: · "Break the silence and promote open and constructive dialogue about the epidemic; · Discourage all acts of discrimination and stigma in relation to infected employees in the water sector; · Eliminate preconceptions originated by taboos, religious beliefs and other cultural traditions; and 16 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS Project Component 5 - Human Resources Development (base cost US$4.3 million) (of which HIV/AIDS was a small sub-component). This component is aimed at alleviating one of the most important constraints on good performance of the water sector in general, with special attention to the needs and requirements of the urban water activities of the National Water Development ­ II Project. A human resources development strategy will be prepared and agreed based upon a comprehensive options paper developed through extensive consultations and stakeholder involvement during project preparation. This component will then support the implementation of the strategy. Elements of the strategy would include (a) support of the institutions providing education and training of managerial and professional personnel, and other personnel involved in the process of institutional reform and development, in key management functions such as finance, human resources, planning, regulation and monitoring; (b) support of candidates undertaking training and the temporary plugging of gaps in the water sector organizations providing key officers for training; (c) the development of personnel policies and practices based on equality of opportunity, performance evaluation and consistent emolument policies and sanctions; (d) the support of incentives encouraging consistent good performance; and (e) adequate personnel policies and incentives, as well as other measures, should aim to promote the full utilization and retention of existing staff, in parallel with the recruitment of additional selected personnel. An initial emphasis of IDA-supported training in this project will be at the management and professional level, later widening to sub-professional and basic skills training LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 17 NIGERIA: LAGOS CITY STRATEGY staff within the country office. Staff working on (ESW) the HIV/ADS project conducted a half-day training for the 35 PMU staff and have also P081048 (TTL: D. Tewari) reviewed the IEC proposals that have been submitted by the cities. NIGERIA: COMMUNITY BASED URBAN Issues/lessons learned DEVELOPMENT · For technical assistance on HIV/AIDS to be P069901 (TTL: D. Tewari) useful, it requires that the TA is (i) self funded (Bank budget and variable) and (ii) appropriately selected to meet the needs of Description the team. There appears to be a larger There are two pieces of HIV/AIDS related work challenge relating to social sector that have been integrated into the Nigeria participation and fostering multisectoral Urban portfolio. teams within urban projects, of which i) Within the ESW for the Lagos City HIV/AIDS is one small part. Strategy, questions on HIV/AIDS have · Hard tools and technical guidance--rather been integrated into the 10,000 HH than softer issues notes--would be survey and five firm surveys. The welcome, i.e., TOR, surveys, etc. HIV/AIDS questions within these · Practical steps on how to access IDA surveys aim to answer the questions: resources (and technical skills) for "What is the impact of HIV/AIDS on inclusion of an HIV/AIDS component within service delivery?" and "What are the urban projects would also be useful. economic impacts of HIV/AIDS on Lagos?" ii) In the Community Based Urban Project Component 5 - US$0.21 million Development Project, a small HIV/AIDS awareness campaign: The component ($0.21m) was included to project will support the development and implement an AIDS Education execution of an appropriate AIDS Education Information and Communication Information and Communication Campaign Campaign on construction sites, in in the project areas. This campaign will be project-supported schools and clinics, conducted within the framework of the and along the solid waste collection, National Action Committee on AIDS (NACA) transport and disposal network. Each and the State Action Committee on AIDS of the seven Project Implementation (SACA). The campaign will be implemented Units is given the opportunity to on construction sites, in project schools and develop a proposal for activities ($20k clinics, and among staff handling solid allotted for each). waste. Process HIV/AIDS was integrated within the ESW because it was felt that addressing HIV/AIDS would be "common sense" if the study was to effectively present a picture of the economic climate and future direction for Lagos. The consultant responsible for developing the HH survey had experience working in South Africa and was already familiar with HIV/AIDS specific issues. (Survey Questionnaire and consultant CV available. Data forthcoming.) The IEC component was developed by the TTL based on interactions with the Nigeria HIV project team and a review of their project appraisal document. During implementation the component has benefited from strong on the ground collaboration with the Health (HIV/AIDS Project) and Social Development 18 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS RWANDA: URBAN INFRASTRUCTURE This would include prevention, testing AND CITY MANAGEMENT and cure, and support to affected people. P060005 (TTL: S. Debomy) ii) Within the Urban Infrastructure component of the project, targeting construction workers and companies Overall project description (US$50,000) to implement an AIDS The overall project objective is to improve Education Information and access to urban infrastructure in Kigali and five Communication Campaign on secondary cities through improved urban construction sites. management practices. This objective would be achieved through the combined impact of the The objectives of these activities in the anticipated results of two types of beneficiary districts are (i) to reduce HIV/AIDS interventions: stigmatizing responses and high-risk behaviors (i) Physical investment and upgrading in the workplace by providing information programs defined through a support, condoms, and access to confidential participatory process will be and free testing and (ii) to support affected implemented in targeted cities and staff by bridging people with existing cure and made accessible to the local financial mechanisms. Activities will be population. financed by the project except ARV which will (ii) The local and national stakeholders will be supported by health centers. have the capacity to: (a) apply appropriate programming, financing, Process and implementation mechanisms to Many activities and projects have been improve service delivery; (b) improve launched to reduce the spread of HIV/AIDS local resource mobilization; (c) set up and support affected people. However nothing simple urban planning tools; and (d) specific has been organized towards municipal rationalize municipal management and staff, which will not play a significant role in maintenance. diffusing informed prevention message and behaviors. HIV/AIDS activities to be developed Rwanda urban centers HIV/AIDS situation in the project have been identified and In the City of Kigali, HIV prevalence rate is embraced by the AIDS Urban Commission 13.2% with a rate of 15 to 19% in high risk (CULS). They will be more detailed during a groups and young women. workshop to be organized at project launch. They are in line with the orientations of the Three successive HIV/AIDS plans have been HIV/AIDS National Policy and the MAP project adopted since 1988, and a National that includes a component to support public Commission against AIDS was created in 2001. sector interventions. The activities will be A National Strategic plan was prepared for the implemented by the AIDS district commissions period 2002-2006 and sets the stage for the with the support of the CULS. The Rwanda preparation and financing of a MAP program Association of Local Governments (RALGA) will that focuses on prevention, cures and also be involved in the process. These activities alleviation of social impacts. This program will be part of the institutional capacity building takes into account issues linked to the post- component of the municipal contracts that will conflict situation and emphasizes a phased be signed between the Government of Rwanda approach supported by a special effort in (the project) and the districts. capacity building. The activities targeted at construction Description of the HIV/AIDS elements of the companies and workers will be implemented project under the supervision of the AGETIP with the There are two pieces of HIV/AIDS related work support of HIV/AIDS project staff. The that will be integrated into the project: mechanism to implement HIV/AIDS prevention i) Within the Institutional Capacity measures will be developed in contractual Building Component of the project to documents between the construction company the benefit of participating local and the AGETIP. governments staff in the workplace (US$150,000) including municipal Supervision will be part of the normal workers involved in waste collection. supervision mission. We expect to share LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 19 results with the MAP project and count also on their support and advice. Issues/lessons learned · The project makes use of the AGETIP and the municipal contract, which are standard in many AFTU2 projects, as a mechanism for leveraging and supporting HIV/AIDS activities. · While there are tools and resources available (Local Government Responses to HIV/AIDS: A Handbook), the team feels that some training for municipal and project staff would be helpful to make this material more accessible. In addition, many of the municipalities already have their plans and require facilitation in implementation (rather than planning). 20 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS SENEGAL: URBAN MOBILITY preparation and supervision phases of the IMPROVEMENT (UMIP) HIV/AIDS-related actions. The TORs proposed by the Project Coordination Unit and the Bank P055472 (TTL: C. Diou) team were approved by MAP. Issues/lessons learned HIV/AIDS situation Built-in assistance to the Project Coordination Senegal is one of the most developed African Unit (PCU) focused on the HIV/AIDS-related countries in terms of actions against HIV/AIDS. programs is crucial for the satisfactory The Government of Senegal has been carrying implementation of these actions. This out actions against HIV/AIDS since 1986. In assistance should be knowledgeable and 2004, the HIV prevalence rate was estimated efficient regarding HIV/AIDS issues in order to at 1.4 percent. Today, Senegal is in its fourth compensate for the lack of experience of the action plan against HIV/AIDS (2002-2006), PCU staff in this specific sector. focusing on keeping the HIV rate below 3% and on upgrading the living conditions of the The action plan against HIV/AIDS carried out HIV-infected population. by the Government of Senegal has been an important tool in maintaining the low rates of Project Description HIV. The overall project objective is to improve the safety, efficiency, and quality of urban mobility The HIV/AIDS activities (US$ 200,000) in the metropolitan area of Dakar and to In the investment programs: (i) identification improve road safety in Thies and Kaolack by of the HIV/AIDS issues related to the public promoting public transportation services and transportation sector; (ii) identification of the by facilitating the safe movement of targeted populations, the actors, and the pedestrians. necessary actions; and (iii) implementation of these actions under the responsibility of the In line with the national HIV/AIDS prevention local governments. In the capacity building for strategy, the UMIP integrated HIV/AIDS issues local government programs: (i) awareness in the components of this project and focused programs regarding HIV/AIDS risks and issues on urban transport activities in the cities of linked with urban public transportation Dakar, Pikine, Guediawaye, and Rufisque, and equipment; (ii) training programs for mayors in the municipalities of Bargny and Diamnadio. and local government staff; and (iii) precise and effective planning and project The main objectives of these HIV/AIDS management of HIV/AIDS-related actions. activities are to: · identify quickly the links between urban transportation and HIV/AIDS proliferation; and · carry out awareness-raising and sensitization actions, targeted at the population concerned by public transportation. Process The National Senegal AIDS strategy requires the inclusion of HIV/AIDS prevention in each of the different sector policies. The CETUD (Conseil Exécutif des Transports Urbains de Dakar), which is involved in the public transportation policy of Senegal and, in particular, in the regulation of urban transportation in Dakar, introduced the HIV/AIDS prevention activities through the UMIP. The Bank team included the HIV/AIDS activities from the very beginning of the project cycle (the project design). A consulting firm was recruited to organize and follow the LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 21 SOUTHERN AFRICAN URBAN WORK project has produced and supported a number & CITIES ALLIANCE of studies and a compilation of experiences and challenges.20 In addition, the consultant (TTL: D. De Groot) contracted to this work with SACN (Ntombini Merrangane) is now working with Cities Description Alliance and will bring to the team--and to the The Southern African urban team has few Bank--valuable expertise and networks on the lending operations but reaches a number of issue of city/local government responses to countries and cities through Cities Alliance HIV/AIDS. activities. Issues/lessons learned Through Cities Alliance grants, HIV/AIDS has At one point there had been discussion of been integrated into the following activities: accessing resources to hire an advisor who · South African Cities Network ($750k over could be dedicated to supporting cities in three years: nearing completion): This addressing HIV/AIDS. While this was done includes a separate consultancy to work within the rubric of the SACN support, it was with the nine cities in developing and felt that support to the cities of the region strengthening HIV/AIDS activities. more widely would still be of value. · Mbabane Upgrading ($600,000 just beginning): This program will mainstream HIV/AIDS into all elements of the upgrading discussion. · Addis Ababa ­ Johannesburg Partnership Program: This is a new partnership program that will address a number of urban issues, among them strategies for addressing HIV/AIDS. Ongoing preparation with the following countries will mainstream HIV/AIDS into activities as appropriate: · Namibia: PHRD grant has been used for initial assessment work (non HIV/AIDS) and with interest and partnership from the Canadian Local Government Association. It appears likely that there will be an opportunity to carry out some HIV/AIDS activities. · Lesotho Local Government Strengthening Project is likely to mainstream HIV/AIDS as one of the areas for local government strengthening (rather than make a separate HIV/AIDS component). Process Where there are separate HIV/AIDS components in the projects that have relied on individual consultancies, the push is to genuinely mainstream HIV/AIDS as part of the core business of local government/city management and the integrated support provided to this process. To date, the support to the South African Cities Network (SACN) has been the most extensive and has generated considerable institutional knowledge for SACN and its partners. The 22 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS ZAMBIA: MINE TOWNSHIP SERVICES was put in the project, and the details for what the component would include were developed P064064 (TTL: F. Eng) through a small initial consultancy once implementation began. A consultancy was Description hired to implement the awareness program for The Mine Township Services Project (Zambia) AHC-MMS, and its employees and the program is a water and sanitation project aimed at were expanded to the greater community providing these services to the former copper based upon initial success. Within AHC-MMS a mining townships in the Copperbelt following company policy and core unit was developed the privatization of the copper mining industry on HIV/AIDS and continues to function as a there. The project created an asset holding focal point for the communities it serves as a company (AHC-MMS) to act as the public entity public asset holding company. Supervision for responsible for owning and developing the this component was carried out by the AFTU1 water and sanitation assets. team, but it largely relied on the reporting from the consultant (who is a well respected A small component was included in the project HIV/AIDS expert). to support the HIV/AIDS awareness campaign for AHC's staff and their family members Lessons learned ($200,000 out of a $37 million project). AHC- · Entities such as AHC-MMS need guidance MMS hired a consulting firm to carry out a (9- in applying for MAP (ZANARA) funding; an month) program for increasing awareness of initial proposal was turned down because HIV/AIDS throughout the communities in the AHC-MMS itself cannot access ZANARA former mine townships, including (i) the funds, only communities in their own rights provision of specific support to AHC-MMS could. AHC-MMS decided to assist these employees and their families; (ii) assessment, communities to put in their applications. data gathering and evaluation; (iii) While this project has benefited from a development of HIV/AIDS prevention and good working relationship between the mitigation strategy; (iv) support for the AFTU1 and MAP TTL for Zambia, there HIV/AIDS implementation strategy designed by remains a need for synergy between AHC-MMS; and (v) implementation, activities `seeded' with urban resources coordination, monitoring and evaluation of the and the resources dedicated to HIV/AIDS program. (MAP). · Impact assessments of HIV/AIDS on public Since August 2003, AHC-MMS has carried out utilities would be helpful for TTLs to be various workshops and training programs in all able to have a good rationale for inclusion its former mine township operational areas, of such a non-core component in an including: HIV/AIDS Awareness, Home Based infrastructure project. Care, Leadership and Partnership, Popular · This component has been an overall Theatre, Counseling, VCT, and Peer Education success, and the team would replicate such a component in similar projects. However, Although originally designed for about 1,995 the team recognizes that there are some participants, a total of 9,284 people have gone challenges that come with mainstreaming through the various workshops and training (HIV/AIDS being one example) that would program outlined above. Although the project benefit from closer analysis and debate. funds have now run out, AHC-MMS is assisting How can mainstreamed components be the community in coordinating and putting reconciled with simplification procedures? together community proposals for submission What resources are available (or could be to other HIV/AIDS programs in the country-- leveraged) to ensure quality of preparation including the Bank-supported ZANARA (Zambia and supervision of mainstreamed National Response to HIV/AIDS) project. components? · The use of a placeholder during Process preparation freed the team from having to The HIV/AIDS directive from senior focus on the details of what the component management was the catalyst for including the would look like while being assured that component in the project, therefore funding for there would be an opportunity to develop it was not questioned. A placeholder amount during project implementation. LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 23 Project Component 2 - US$0.20 million HIV/AIDS component: US$200, 000 -- This component is designed to provide specific support to employees of AHC-MMS and their families and in general increase awareness of HIV/AIDS throughout the community. The MSTP is not anticipated to significantly increase the risk of HIV infection in the mining townships--it is not a typical infrastructure and mine project that draws workers away from their families and increases commercial sex work in the area. Including the HIV/AIDS component, the project supports the Government's multi-sectoral, multi-partner program for the prevention and mitigation of HIV/AIDS. It is not expected that this component will be "stand-alone" but will draw on and complement other existing programs. Based on an assessment to determine attitudes about HIV/AIDS among workers and residents of the townships and data collected about the social and economic impacts, a strategy will be devised to increase awareness and effect behavioral changes resulting in prevention of HIV/AIDS throughout the community at large and to provide workplace interventions for workers and their families. The project will provide funds for assessment, data gathering, development of the strategy (all to be accomplished with broad stakeholder participation) and some initial steps in strategy implementation, likely to include information dissemination and workplace interventions. For example, the strategy may call for including a HIV/AIDS module in training programs for workers, and the project could fund development of the module or adaptation of existing modules to fit within the broader training program of the commercialized utilities. The following component activities will be undertaken: (1) Assessment, data gathering and evaluation, including a needs assessment of stakeholders to determine attitudes and behaviors and data gathering to social and economic impacts: Estimated time, three months; estimated cost, $20,000; (2) Strategy development--Develop HIV/AIDS prevention and mitigation strategy through a participatory process: Estimated time, three months; estimated cost, $20,000; (3) Support to implementation of strategy: It is anticipated that the strategy will call for the two types of activities: a. Workplace interventions (training of workers designed to help identify and change risky behaviors, referral for voluntary counseling and testing, distribution of condoms, providing health care for treatment of STI and care for infected workers and their families, with emphasis on maintaining confidentiality) ; and b. Information dissemination to customers (perhaps as bill stuffers, using AIDS awareness materials developed by NGOs): Estimated time, two years; estimated cost, $100,000; (4) AHC-MMS implementation, coordination, monitoring and evaluation--AHC-MMS will be responsible for implementing the project, including contracting with NGOs, CBOs or others to carry out the activities described above. Strategy implementation activities will be undertaken in Phase III of MTSP, when the private operator takes over operation of the Commercialized Utilities. AHC-MMS will assume a monitoring and evaluation role at that point, which may be carried out by a staff member or may be contracted out to an independent NGO, CBO or contractor. Estimated time, two man years over four years; estimated cost, $20,000. Coordination with other HIV/AIDS prevention and mitigation activities. It is anticipated that AHC-MMS will contract with NGOs or CBOs already active HIV/AIDS prevention and mitigation activities in the communities to accomplish the first two steps so that coordination of this component of the project with other HIV/AIDS activities in the community is designed in. In addition, this component will be closely coordinated with the Government's multi-sectoral, multi-partner programs. To the extent possible, informational and educational materials will be drawn from information already developed by NGOs (e.g., Soul City). During the implementation phase an advertising/PR firm may be hired to survey existing materials, to conduct focus groups to determine their effectiveness in MTSP townships, to adapt materials to fit local needs, if necessary, and to print and distribute materials. Coordination with the private operator. It will be necessary to make reference to the HIV/AIDS prevention and mitigation strategy in the management agreement between the private operator and AHC-MMS. The private operator would not be required to carry out the HIV/AIDS project activities but would be required to coordinate with them. Data gathered and analyzed in the early stages of the project should be presented to the private operator so that the benefits of coordination are clear. The private operator may, for example, adopt policies and procedures for referral to voluntary counseling and testing, treatment of STI and care for infected workers and their families, respecting the privacy of workers with regards to HIV/AIDS, and integrating prevention and mitigation modules into worker training. 24 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS ANNEX II: DISCUSSION QUESTIONS FOR INTERVIEWS WITH TTLS Description 1. Describe the HIV/AIDS component or element in your project. How is it financed and is there any direct or indirect linkage to MAP? Preparation 2. Where in the project cycle was this element identified as a priority? 3. Was this component/element asked for by the client, or recommended by the team? 4. Did you receive any assistance in the preparation of this component/element? (from MAP, HDN, consultants?) 5. What type, if any, of assistance would have been helpful? Supervision 6. How would you rate the success of the HIV/AIDS element? How is it measured? 7. Have there been any challenges/opportunities that have come with including and supervising non- core activity in the project? 8. Do you receive any assistance in the supervision of this component/element? (from MAP, HDN, consultants?) LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 25 ANNEX III: MAINSTREAMING HIV/AIDS INTO URBAN/LOCAL GOVERNMENT PROJECTS: A GUIDANCE NOTE Mainstreaming HIV/AIDS into the Urban lending portfolio is essential if we accept HIV/AIDS as a development--rather than purely a health--issue. This is a new subject area for many Task Team Leaders (TTLS), and this note is intended to provide some basic guidance on why, where, when and how to mainstream HIV/AIDS into Bank projects. Additional support and guidance is available to all TTLs who wish to learn more. 1. Determine the Local RISK 2. Identify the Most Appropriate APPROACH What is the national and urban prevalence of HIV/AIDS? (Presume that the urban prevalence Given the above considerations: Does it is higher than the national prevalence): make sense to do any or some of the following? a) If the urban prevalence is above 5%, this is a generalized epidemic--and not addressing 1. Prepare a separate HIV/AIDS project HIV/AIDS poses a risk to all project component. objectives. Must act. 2. Integrate responses to HIV/AIDS into b) If the urban prevalence is between 1-5%, planned project activities within other this is a medium to high-risk situation--and components (training, capacity building, addressing HIV/AIDS can have a valuable municipal/district development planning, impact on preventing the onset of a municipal development grants, research, generalized epidemic. Highly construction, human resource recommended to act. management). c) If the urban prevalence is below 1%, this 3. Conduct an awareness raising activity for may be considered a low risk situation--and the project team, including what resources identifying vulnerable groups and providing and support are possible from HIV/AIDS some information regarding HIV/AIDS into projects. 4. Not address HIV/AIDS at this time, but the project can support low prevalence. create a place marker for HIV/AIDS Not essential but can be effective. component. Preparation can then be financed through project funds during When asked to `mainstream' HIV/AIDS into our implementation. work, there are three inter-related issues to 5. Not address HIV/AIDS at all. consider: 1. How will the HIV/AIDS epidemic impact the Things to think about: Does it make sense to have project objectives (short-, medium-, and a separate HIV/AIDS Project Component (1) or long-term)? integrate HIV/AIDS into other components (2)? 2. Is there a possibility or likelihood that the · Stand-Alone: Small consultancies can be easy project will increase HIV prevalence or to design and supervise--especially when high- impact negatively on activities designed to quality firms are employed. Requires minimal fight the epidemic? expertise from team. 3. Are there elements in the project that Integration: May require more consideration/ expertise in design (i.e., designing training modules, could (with marginal modification or developing survey questions, etc.) but in high-risk support) contribute positively to the countries, it is likely to be more responsive to client national and local responses to HIV/AIDS? priorities (i.e., most Ministry of Local Governments, and most CAS, have identified HIV/AIDS as a priority issue; most Local Government Authorities are mandated with some new HIV/AIDS responsibilities). 26 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS After selecting the best approach, you will How to OPERATIONALIZE need to identify available resources: · Knowledge resources: examples, TORs Awareness raising, sensitization and from other projects (i.e., impact training of trainers (on HIV/AIDS and assessment, consultancy, etc.), Local relevant interventions) Government AIDS Handbook, CD-ROM · WB Urban project teams, project training tool, and partner and consultant management units (for projects--AGETIPE, database. PCUs, PIUs), training institutes and · Project staff, consultants (TUDUR advisory consultants. support). Coordinating internal linkages · Preparation funds (trust fund allocations, · Linking Urban projects with MAP (and/or PHRD). health) projects · MAP funds and programs that may be · Linking with IFC and private sector financing complementary activities. initiatives (when working with large · Grant money on HIV/AIDS for all IDA municipal service providers: power, water, countries (as per IDA 13). etc., and/or private contractors, etc.). Creating an enabling environment. Project How much to include in your project? teams wanting to address HIV/AIDS may A percentage of the project? e.g., .025% require: A minimum amount? e.g., $200,000 · Management (Sector Board) support in project reviews. Safe space reviews. What are the OPTIONS · Supervision/preparation support--either in terms of budget or in terms of committed What types of interventions might an Urban (and paid for) advisory support.1 project support? · IDA funds to cover HIV/AIDS activities · IEC (information, education and (could increase portfolio without increasing communication) component for local lending). government, public works staff and/or communities. · Complete workplace interventions for For more information, contact Kate Kuper local government staff--from information, (AFTU1), Sylvie Debomy (AFTU2), or Nina training, and treatment (e.g., Chad, Schuler (TUDUR). Cameroon). · Analytical work (e.g., Environmental Impact Assessment, PHRD Impact Assessment (e.g., Nigeria, Senegal)). · Capacity building for LGAs (e.g., Benin, Uganda, Mozambique). · Budgeting and planning (i.e., raising HIV/AIDS during PRAs, etc.); training modules on HIV/AIDS integrated into LGA capacity building programs; workplace policy to address implicit (staff time for funerals) and explicit (absenteeism) impact on local government functioning; monitoring and evaluation; and project management. · Infrastructure sub-projects: include a menu option relating to HIV/AIDS (i.e., AIDS orphanage, Voluntary Counselling & Testing center (e.g., Congo)). · Design of project M&E to include HIV/AIDS-related indicators. 1Urban HIV/AIDS Trust Fund (a proposed idea, not yet a reality)--i.e., committed funds that would allow TTLs to have access to variable budget to address HIV/AIDS during project preparation and implementation. LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 27 ENDNOTES 1http://www.worldbank.org/afr/aids/map.htm. 2Largely through the UNAIDS Unified Budget and Workplan (UBW). 3More on this can be found in the introduction to the publication: Local Government Responses to HIV/AIDS: A Handbook, which can be located on the website: http://www.worldbank.org/urban/hivaids/ 4In Nairobi, a municipal official estimated that up to 5 staff members were dying each week- it is expected that many of these deaths may be attributed to HIV/AIDS. 5A Draft Guidance Note for Task Managers on Mainstreaming HIV/AIDS into Urban projects has been developed. 6Swaziland, Uganda, Kenya, Tanzania, Eritrea, Zambia, Malawi, Mozambique, South Africa. 7Initially, a desk review of projects was conducted- but it was found that many of the HIV/AIDS activities were often included at Mid Term or were for some other reason not explicitly mentioned in the PAD. In addition, much of the available documentation for AFTU2 was in French, and therefore not easily shared within the Bank. Questionnaire for interviews available in Annex 1. 8These can be accessed by contacting Nina Schuler (TUDUR), nschuler@worldbank.org, Kate Kuper (for AFTU1) kkuper@worldbank.org, or Sylvie Debomy (for AFTU2) sdebomy@worldbankorg. 9This has been widely practiced in Transport projects, where all public works contracts must include a small amount for HIV/AIDS prevention/education/condom distribution to employees and affected communities. 10For more information on this- visit the web: http://www.worldbank.org/urban/hivaids/ or contact UrbanAIDS@worldbank.org. Internally, more information can be found through Iris 4 in the folder: P091751 - Urban Health & HIV/AIDS_TUDUR. 11AMICAALL (http://www.amicaall.org/) has chapters in Burkina Faso, Central African Republic, Cote D'Ivoire, Kenya, Malawi, Mali, Namibia, South Africa, Swaziland, Tanzania, Uganda, and Zambia. AMICAALL has also received an IDF grant from the World Bank. For more information on AMICAALL please contact Didem Ayvalikli (dayvalikli@worldbank.org). 12Over 30 staff from AFTU1, AFTU2, ACTAfrica, WBI, and TUDUR attended a learning event (March 8, 2005) to share the case studies and discuss experiences and impediments to mainstreaming HIV/AIDS into Urban/Water projects. 13From within Infrastructure there are examples such as the Carbon Fund, Road Safety, and Sanitation/Hygiene where mainstreaming initiatives have been coupled with resources and expertise. In HIV/AIDS, the Education sector relies on Trust Fund support to provide HQ and field staff to support integration of HIV/AIDS into Education projects. 14ONU/AMICAAL has been program supported HIV/AIDS actions in Benin informing the mayors and local governments on: the creation of a National Mayor Alliance for HIV/AIDS in Benin, the collaboration with the Mayor Alliance of Africa for HIV/AIDS, and the implementation of a national AMICAAL program in Benin. 28 LESSONS AND EXPERIENCES FROM MAINSTREAMING HIV/AIDS INTO URBAN/WATER (AFTU1 & 2) PROJECTS 15This was also mentioned with regards to the Internal Review Process for projects- where TTLs are able to share approaches and lessons learned with regards to their HIV/AIDS components. 16In November 1999, the Mayors of Côte d'Ivoire, members of AMICAALL, created a national coordination. 17Côte d'Ivoire is one of the West African regions most affected by the HIV epidemic. In 2002, it was estimated that one in 10 teenagers and adults between 15 and 49 years old was HIV positive, while approximately 420,000 children were HIV orphans. The prevalence rate of infection was estimated at between 12.8% and 15.1% in urban areas; and between 6.7 and 8.4% in rural areas. This translates to a rate of between 9.5% and 12.7% at the national level. 18RSA pays under an international treaty but the project is in Lesotho; "an enclave project in Lesotho serviced by RSA." The Treaty requires that no-one affected by the project should be worse off as a result of the project. 19This occurred during the MTR, when there was increasing demand from IDA to ensure that all projects were mainstreaming HIV/AIDS. 20Available online: http://www.sacities.net/2004/hiv_full_report.pdf.