The World Bank Report No: ISR5718 Implementation Status & Results Barbados Barbados Second HIV/AIDS Project (P106623) Public Disclosure Copy Operation Name: Barbados Second HIV/AIDS Project (P106623) Project Stage: Implementation Seq.No: 7 Status: ARCHIVED Archive Date: 03-Aug-2011 Country: Barbados Approval FY: 2009 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Specific Investment Loan Implementing Agency(ies): National Commission on HIV/AIDS Key Dates Board Approval Date 07-Aug-2008 Original Closing Date 30-Nov-2013 Planned Mid Term Review Date 05-Dec-2011 Last Archived ISR Date 03-Aug-2011 Effectiveness Date 06-Jan-2009 Revised Closing Date 30-Nov-2013 Actual Mid Term Review Date 05-Dec-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) The project would support the implementation of the 2008-2013 Barbados National HIV/AIDS Strategic Plan, specifically to increase: - Adoption of safe behaviors, in particular amongst key populations at higher risk. - Access to prevention, treatment and social care, in particular for key populations at higher risk. - Capacity of organizational and institutional structures that govern the NAP. - Use of quality data for problem identification, strategy definition and measuring results. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Component 1: Prevention and Care 31.50 Component 2: Institutional Strengthening 3.50 Overall Ratings Public Disclosure Copy Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Unsatisfactory Overall Risk Rating Implementation Status Overview This project is an integral part of the National AIDS Program (NAP) and is one of the main sources of financing for the National Strategic Plan (NSP) 2008-2013. The Bank team, jointly with the Barbados Government team and other development partners, conducted the Mid-Term Review (MTR) of the NAP and of the Second HIV/AIDS Project (the Project) from December 5-9, 2011. As part of preparation for the MTR, the project commissioned two assessments on the National AIDS Program (NAP) and of the Second AIDS Project, Page 1 of 5 The World Bank Report No: ISR5718 which supports the implementation of the NAP. The first assessment focused on the response from the health sector to HIV/STIs and the second assessment focused on the implementation of the Project. These two assessments were well done and provided very useful information and recommendations for the MTR. The National HIV/AIDS Commission (NHAC) organized a two-day workshop with the participation of representatives of the Government, civil society, and the development partners and the findings and recommendations from the two assessments were presented and discussed. Public Disclosure Copy The MTR concludes that the Project Development Objectives of the Second AIDS Project remain relevant and consistent with the Barbados overall National Development Objectives. The Project has made significant progress in the areas of (a) maintaining a high level of awareness of HIV among general population and youth; (b) reducing AIDS mortality; (c) preventing mother to child transmission with no babies born HIV+ in the past 4 years; (d) expanding access to HIV testing and coverage of AIDS treatment and (e) improving the surveillance and M&E system. The Ministry of Health (MOH) continues to conduct case-based surveillance for HIV and AIDS according to established international best practice. Collected data show a declining number of newly reported cases from a high of 180 in 2000 to 135 in 2010. However, the Project still faces many challenges: the NAP has expanded services to some high risk groups such as sex workers (SW), but has been less successful in reaching men who have sex with men (MSM), a main driver of the epidemic in Barbados. While there is engagement of Government ministries in the national response, the involvement of civil society organizations (CSOs) is limited. Delays in implementing the CSO Grant System have impacted the ability of the NAP to reach most at risk populations (MARPs). Progress under Component 2 (Institutional Capacity Building) has been limited. The Bank and the Government agreed at the MTR to restructure the project in order to improve the project performance and increase the chance of reaching Project Development Objectives in the remaining two years and to improve sustainability of the overall National Response to HIV/AIDS. Various options of restructuring the project were discussed at the MTR and the Government has informed the Bank that the MOH would assume responsibilities for the implementation of the Project. The government and the Bank will work out the details for the project restructuring in the coming months. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Percentage of female sex workers reporting the Percentage Value 80.00 0.00 85.00 use of a condom with their most recent client Date 31-Dec-2006 31-Dec-2011 31-Dec-2012 Comments Baseline reported for 2006 No available data provided at MTR. BSS survey to be Public Disclosure Copy conducted in 2013 for female sex workers (FSW). Percentage of men reporting the use of a Percentage Value 64.00 0.00 70.00 condom the last time they had sex with a male Date 31-Dec-2007 31-Dec-2011 31-Dec-2011 partner Comments Baseline reported for 2007. No available data provided at MTR. BSS survey to start in 2012 for MSM. Page 2 of 5 The World Bank Report No: ISR5718 Percentage of young men and women aged Percentage Value 21.00 50.00 65.00 15-24 years reporting the use of a condom the Date 31-Dec-2006 31-Dec-2009 31-Dec-2013 last time they had sex with non marital non Comments Baseline reported for Data from 2009 KAPB study cohabitating sexual partner. Public Disclosure Copy 2005-2006 Percentage of young women and men aged Percentage Value 94.30 92.30 90.00 15-24 indicating sexual relations as a way of Date 31-Dec-2006 31-Dec-2009 31-Dec-2013 transmitting HIV Comments Baseline reported for Data from 2009 KAPB study Target is to maintain at least a 2005-2006 rate of 90%. Percentage of identified HIV positive pregnant Percentage Value 96.00 100.00 95.00 women who gave birth in the last 12 months Date 31-Dec-2008 31-Dec-2011 31-Dec-2013 receiving a complete course of ARV to reduce Comments Baseline reported for year- Based on the new indicator Target is to maintain a MTCT end 2008. the value is 100% (8/8). PMTCT rate above 95% over Based on previous indicator the 2008-2013 period. the value is 90.9%. Percentage of people living with HIV on first Percentage Value 60.00 57.10 70.00 line antiretroviral regimen achieving virologic Date 31-Dec-2008 31-Dec-2011 31-Dec-2011 success within the first 6 months of treatment. Comments Baseline reported for year- Total: 57.1% Target is to maintain a end 2008. Females: 54.5% virologic success above 70%. Males: 70% (2011) Percent of most at-risk populations (female sex Percentage Value 0.00 0.00 70.00 workers and men who have sex with men) Date 31-Dec-2011 31-Dec-2012 reached with HIV prevention services. Comments No baselines Updated information will be The target for FSW is 70% provided through the BSS and the target for MSM is surveys to be conducted in 75%. 2013 for FSW and to start in 2012 for MSM. Amount of funds spent by CSOs under results- Amount(USD) Value 0.00 11750.00 150000.00 based agreements. Date 31-Dec-2008 31-Dec-2011 31-Dec-2013 Public Disclosure Copy Comments US$11,750 has been spent in CY2011. Evidence-based Strategic Plan 2014-2018. Text Value Strategic PLan 2008-2013 Expressions of Interest will be 2014-2018 Plan developed by reissued in 2012 June 2013 Date 31-Dec-2008 31-Dec-2011 30-Jun-2013 Comments Consultants have been hired to support the NHAC with this process. Intermediate Results Indicators Page 3 of 5 The World Bank Report No: ISR5718 Indicator Name Core Unit of Measure Baseline Current End Target Amount spent on HIV/AIDS in the past 12 Amount(USD) Value 6900000.00 2008399.00 6650000.00 months Date 31-Dec-2007 31-Dec-2011 31-Dec-2011 Public Disclosure Copy Comments US$6.9 million baseline Target is to be met every year reported for 2006-2007. of 70% of Eligible Program Expenditures (EPEs) which is at least US$6.65 million. Data on Financial Performance (as of 13-Oct-2011) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P106623 IBRD-75850 Effective 07-Aug-2008 25-Sep-2008 06-Jan-2009 30-Nov-2013 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P106623 IBRD-75850 Effective USD 35.00 35.00 0.00 11.10 23.90 32.00 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation The MTR highlighted three major challenges under the implementation and reached initial agreements on how to move forward: Page 4 of 5 The World Bank Report No: ISR5718 Challenges: 1. Underutilization of available funds. As of December 4, 2011, total disbursement of the loan was US$11.1 million (31.7% of the total). The main issue is not under-provision of Public Disclosure Copy budget from the Government, but rather underutilization of the budget provided to the NAP. Since 2008, the Government has provided a total of US$39.6 million to the NAP, and actual expenditures until 2011 were US$27.2 million, or 69 percent of the allocation. US$23.9million remains to be utilized before the closing date of the project on November 30, 2013. 2. Lack of coordination between MOH and NHAC. Current implementation arrangements do not function efficiently. There is little coordination between the MOH, the main implementer of the NAP, and NHAC. This has affected the implementation of the project and the possibility of fully utilizing the loan before the project closing date of November 30, 2013. 3. Weak capacity and leadership at NHAC. Lack of capacity for fiduciary management and weak leadership have hampered NHAC’s ability to coordinate the national response across agencies and has delayed implementation of the Project. The NHAC has been functioning inefficiently as an implementing agency rather than performing as a coordination body for the NAP. Agreements: Based on the findings and recommendations from the MTR, the Government (MOF, MOH, and MFCSY) initiated discussions as to possibly consolidating project management functions within the MOH, including M&E, fiduciary management, and prevention activities. In particular: • To ensure the sustainability of the National Response to HIV and to improve the efficiency and effectiveness of the NAP and project, the financing and implementation arrangements will be restructured; • MOH will be responsible for implementation of the Second AIDS Project, and the implementation function under NHAC will move to the MOH, including the M & E unit, fiduciary management, and prevention activities; • The World Bank will explore the possibility of increasing the financing percentage for Component 1 and expanding the definition of eligible expenditures to strengthen health system development within the scope of Project Development Objectives; • NHAC will retain functions as a coordinating body for the Project. The Government will inform the Bank on how to strengthen the leadership of the NHAC. Restructuring History Level two Approved on 29-Jul-2011 Public Disclosure Copy Related Projects There are no related projects. Page 5 of 5