The World Bank Report No: ISR14263 Implementation Status & Results Brazil AIDS-SUS (National AIDS Program - National Health Service) (P113540) Public Disclosure Copy Operation Name: AIDS-SUS (National AIDS Program - National Health Project Stage: Implementation Seq.No: 7 Status: ARCHIVED Archive Date: 06-May-2014 Service) (P113540) Country: Brazil Approval FY: 2010 Product Line: IBRD/IDA Region: LATIN AMERICA AND CARIBBEAN Lending Instrument: Specific Investment Loan Implementing Agency(ies): Departamento de Vigilancia, Prevencao e Controle de DST e AIDS e Hepatite Viral Key Dates Board Approval Date 18-May-2010 Original Closing Date 31-Dec-2014 Planned Mid Term Review Date 18-Mar-2013 Last Archived ISR Date 16-Oct-2013 Effectiveness Date 01-Dec-2010 Revised Closing Date 31-Dec-2014 Actual Mid Term Review Date 22-Mar-2013 Project Development Objectives Project Development Objective (from Project Appraisal Document) The proposed project development objectives are the following: (i) Increase access and utilization of HIV/AIDS and Sexually-Transmitted Diseases (STD) prevention, care and treatment services by Groups Most at Risk; and, (ii) Improve the performance of the National HIV/AIDS and STD Program through decentralized implementation, improved governance and results-based management. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) Component Name Component Cost Improving Surveillance, Prevention and Control of HIV/AIDS and STD 192.00 Building Decentralized Governance and Innovation Capacity 7.83 Overall Ratings Public Disclosure Copy Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview The AIDS-SUS Project is a Specific Investment Loan (SIL) with a Sector Wide Approach (SWAp), in which disbursements are partially triggered by the execution of agreed programs and achievement of specific results targets (Disbursement-linked Indicators - DLI). The Project was approved by the Board on May 18, 2010, was signed on October 5, 2010, and became effective on December 1, 2010. The total disbursed amount as of March 27, 2014 was US$33.3 million (50% of loan proceeds). Page 1 of 6 The World Bank Report No: ISR14263 The Project is making progress towards the Project Development Objectives (PDO) as measured by seven out of 12 PDO indicators. Updated results (for December 2013) will be reported after the upcoming supervision mission scheduled for April 7 - 14, 2014. Based on December 2012 data, the end of Project target (49%) for the indicator on People Living with HIV/AIDS (PLHA) accessing condoms had already been surpassed at 56%. The indicator on prisoners accessing condoms achieved 77.7% when its target for December 2012 was 64%. The indicator on Civil Society Organization (CSO) with results-based contracts achieved 91%, also surpassing the expected target for December 2012 (75%), and even the Public Disclosure Copy end of Project target (85%). Some challenges are posed by indicators depending on the State Health Secretariats (SES), and Municipal (capital city) Health Secretariats (SMS). As per request of the Department of Prevention and Control of STD and AIDS and Viral Hepatitis (DDAHV) of the Ministry of Health, a Project restructuring is underway and is expected to be concluded by the end of May 2014. Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target At least 70% execution of project Eligible Percentage Value 82.00 70.00 Expenditure Programs (EEPs) - DLI (Global Date 31-Dec-2008 31-Dec-2012 31-Dec-2013 Indicator) Comments Not applicable Annual target surpassed Increase of Men who Have Sex with Men Percentage Value 63.00 63.00 72.50 (MSM) reporting the use of a condom the last Date 31-Dec-2010 31-Dec-2012 31-Dec-2013 time they had sex in the last year (DLI #1) Comments RDS-MSM 2010 +15%. Next RDS in 2013 Increase of sex workers (SW) reporting the use Percentage Value 90.10 90.10 99.10 of a condom with their most recent client (DLI Date 31-Dec-2008 31-Dec-2012 31-Dec-2013 #2). Comments RDS-SW 2010 +10%. Next RDS in 2013 Increase of Drug Users (DU) who report the Percentage Value 40.70 40.70 46.80 use of a condom at last sexual intercourse (DLI Date 31-Dec-2010 30-Nov-2012 31-Dec-2013 #3) Public Disclosure Copy Comments RDS-DU 2010 +15%. Value to be defined Next RDS in 2013 once the baseline is available. People Living with HIV/AIDS (PLHA) accessing Percentage Value 37.00 56.00 49.00 condoms (DLI #4) Date 31-Dec-2007 31-Dec-2012 31-Dec-2014 Comments The method of calculation of End target surpassed the indicator has been revised and the baseline changed from 35% to 37%. Prisoners accessing condoms (DLI #5) Percentage Value 50.50 77.70 70.00 Page 2 of 6 The World Bank Report No: ISR14263 Date 31-Dec-2008 31-Dec-2012 31-Dec-2014 Comments The method of calculation of End target surpassed the indicator was revised and Public Disclosure Copy the baseline changed from 58% to 50.50%. The Department would like to revise the targets for this indicator. 27 State Secretariats of Health (SES) reaching Percentage Value 50.00 3.70 85.00 at least 70% of Results-based Action Plans Date 31-Dec-2008 31-Dec-2012 31-Dec-2014 (PAM) targets (DLI #6) Comments (1 SES) Problem with MIS system 26 Municipal (Capital City) Secretariats of Percentage Value 39.00 11.50 66.00 Health (SMS) reaching at least 70% of PAM Date 31-Dec-2008 31-Dec-2012 31-Dec-2014 targets (DLI #7) Comments (3 SMS) Problem with MIS system Increase in SES with information on STD and Percentage Value 19.00 77.70 39.00 HIV/AIDS in institutional sites- epidemiological Date 31-Dec-2010 31-Dec-2012 31-Dec-2014 and financial (DLI #8) Comments End target surpassed >20%. Increase in SMS with information on STD and Percentage Value 15.00 50.00 35.00 HIV/AIDS in institutional sites - epidemiological Date 31-Dec-2010 31-Dec-2012 31-Dec-2014 and financial (DLI #9) Comments End target surpassed >20%. Civil Society Organizations (CSO) with results- Percentage Value 2.50 90.90 85.00 based contracts (DLI #10) Date 31-Dec-2008 31-Dec-2012 31-Dec-2014 Comments Numerator: Total number of SIMOP 169 out of 186 CSO projects funded by the subprojects DST/AIDS with End target surpassed disbursements linked to the achievement of results. Public Disclosure Copy Denominator: Total number of CSO projects funded by the DST/AIDS. National HIV/AIDS Strategic Plan 2014-2019 Text Value Available on the web. based on project-generated evidence available Date 31-Dec-2010 31-Dec-2012 31-Dec-2014 on the web (DLI #11) Comments Not applicable Aligned with MOH's instruments. Intermediate Results Indicators Page 3 of 6 The World Bank Report No: ISR14263 Indicator Name Core Unit of Measure Baseline Current End Target MSM reporting access to free condoms in the Percentage Value 70.80 70.80 81.40 last 12 months (DLI #12) Date 31-Dec-2010 31-Dec-2012 31-Dec-2013 Public Disclosure Copy Comments RDS-MSM 2010 +15% Next RDS in 2013 SW reporting access to free condoms in the Percentage Value 77.20 77.20 88.80 last 12 months (DLI #13). Date 31-Dec-2010 31-Dec-2012 31-Dec-2013 Comments RDS-SW 2010 +15% Next RDS in 2013 DU reporting access to free condoms in the Percentage Value 71.40 71.40 82.10 last 12 months (DLI #14) Date 31-Dec-2010 31-Dec-2012 31-Dec-2013 Comments RDS-DU 2010 +15% Next RDS in 2013 MSM reporting having been tested for HIV in Percentage Value 23.50 23.50 27.00 the last 12 months (DLI #15) Date 31-Dec-2010 31-Dec-2012 31-Dec-2013 Comments RDS-MSM 2010 +15% Next RDS in 2013 SW reporting having been tested for HIV in the Percentage Value 30.40 19.80 35.00 last 12 months (DLI #16) Date 31-Dec-2010 31-Dec-2012 31-Dec-2013 Comments RDS-SW 2010 +15% Next RDS in 2013 DU reporting having been tested for HIV in the Percentage Value 44.40 14.70 51.00 last 12 months (DLI #17) Date 31-Dec-2010 31-Dec-2012 31-Dec-2013 Comments RDS-DU 2010. Tested for HIV RDS-DU 2010. Tested for HIV +15%. RDS-DU 2013 will some time in their life, not in some time in their life, not in include both questions - some the last 12 months. PCAP the last 12 months. time in their life and in the last 2008 provides data for the Next RDS in 2013 12 months. last 12 months - 16.7% Public Disclosure Copy MSM accessing services which provide Percentage Value 25.80 35.60 49.00 condoms (DLI #18) Date 31-Dec-2008 31-Dec-2012 31-Dec-2014 Comments The method of calculation of the indicator was revised and the baseline data was changed from 35% in 2008 to 25.80% in 2009. Page 4 of 6 The World Bank Report No: ISR14263 SES executing at least 70% of Incentive Policy Percentage Value 59.00 43.80 83.00 resources transferred each year (DLI #19) Date 31-Dec-2008 31-Dec-2012 31-Dec-2014 Comments Public Disclosure Copy SMS Capital city executing at least 70% of Percentage Value 54.00 73.70 76.00 Incentive Policy resources transferred each Date 31-Dec-2008 31-Dec-2012 31-Dec-2014 year (DLI #20) Comments SES qualified for performance award Percentage Value 0.00 0.00 50.00 Date 31-Dec-2010 31-Dec-2012 31-Dec-2014 Comments Mechanisms for performance award pending Impact evaluation carried out Text Value 3 designed 3 carried out Date 31-Dec-2009 31-Dec-2012 31-Dec-2014 Comments Increase in DSEI with Plan STD and HIV/AIDS Number Value 26.00 34.00 34.00 implemented Date 31-Dec-2009 31-Dec-2012 31-Dec-2014 Comments Data on Financial Performance (as of 18-Jul-2013) Financial Agreement(s) Key Dates Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P113540 IBRD-79010 Effective 18-May-2010 05-Oct-2010 01-Dec-2010 31-Dec-2014 31-Dec-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P113540 IBRD-79010 Effective USD 67.00 67.00 0.00 33.27 33.73 50.00 Public Disclosure Copy Disbursement Graph Page 5 of 6 The World Bank Report No: ISR14263 Public Disclosure Copy Key Decisions Regarding Implementation The major changes to the Project and rationale, pursued through the restructuring, are: i. The Results Framework (RF) - including indicators, baseline, and targets – would be modified to increase clarity, and improve the accuracy of indicator definitions and data. ii. Some implementation arrangements would be deleted given changes in the Incentive Policy legislation since Project approval. In addition, various details and covenants that were no longer applicable would be deleted or modified. iii. The closing date would be extended by 12 months from December 31, 2014 to December 31, 2015 to allow the Government sufficient time for achieving the Project’s Development Objective (PDO) and implementation of its research and studies program and goal achievement. iv. As per Government's request, partial cancellation of loan proceeds would be made. Project financing, and disbursement estimates and arrangements would be adapted accordingly. v. A number of activities under Components 1 and 2 would be excluded. Restructuring History Public Disclosure Copy There has been no restructuring to date. Related Projects There are no related projects. Page 6 of 6