The World Bank Report No: ISR16108 Implementation Status & Results Madagascar Second Multisectoral STI/HIV/AIDS Prevention project (P090615) Public Disclosure Copy Operation Name: Second Multisectoral STI/HIV/AIDS Prevention project Project Stage: Implementation Seq.No: 21 Status: ARCHIVED Archive Date: 27-Sep-2014 (P090615) Country: Madagascar Approval FY: 2006 Product Line: IBRD/IDA Region: AFRICA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Key Dates Board Approval Date 12-Jul-2005 Original Closing Date 31-Dec-2009 Planned Mid Term Review Date 15-Dec-2008 Last Archived ISR Date 05-Jul-2014 Effectiveness Date 05-Jan-2006 Revised Closing Date 30-Sep-2014 Actual Mid Term Review Date 15-Dec-2008 Project Development Objectives Project Development Objective (from Project Appraisal Document) To increase utilization of STI/HIV/AIDS, maternal and child health and nutrition services in the project area. Has the Project Development Objective been changed since Board Approval of the Project? ● Yes No Component(s) Component Name Component Cost Harmonization, donor coordination, and strategies 1.50 Support to Health Sector Response 12.50 Funds for STI/HIV/AIDS prevention and care-taking activities (FAP) 7.40 Monitoring and evaluation 4.70 Project management and capacity building 4.40 Public Disclosure Copy Health, Nutrition, and HIV/AIDS Services 5.20 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Satisfactory Overall Implementation Progress (IP) Satisfactory Satisfactory Overall Risk Rating Moderate Moderate Implementation Status Overview The MSPPII will be fully disbursed by the closing date of the AF credit, and all activities are expected to be completed and the project development objectives met. The original Page 1 of 10 The World Bank Report No: ISR16108 financing closed on December 31, 2012 and supported a range of activities focused on prevention and treatment of STI/HIV/AIDS including: (i) behavioral change communication activities with NGOs and Associations for People Living with HIV/AIDS (PLWHAs) through performance based contracts verified by program data and external verification reports; (ii) procurement of drugs and medical supplies (ARV, STI kits, HIV test and condoms); (iii) several national surveys (e.g. National Surveillance Survey (NSE), the Biological Surveillance Survey, combined biological and behavioral surveillance survey, and a study on chemo-sensitivity of STI drugs); (iv) activities supporting the health medical waste management plan; Public Disclosure Copy and (v) the development and implementation of a new reporting system, using mobile phones, to monitor the medical care of PLWHAs through rapid data collection. With the support of the Additional Financing credit, the Project scope was expanded to help increase access and utilization of health and nutrition services including support to community nutrition sites in delivering a set of direct nutrition interventions, child immunization and micronutrient supplementation (Vitamin A and Iron Folic Acid), early prenatal care for pregnant women, assisted deliveries at facility level, and a pilot on Result Based Financing (RBF). Locations No Location data has been entered Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Decrease in Syphilis prevalence among SW Percentage Value 16.60 15.80 15.00 (%) Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 Comments Source: Biological Source: Combined Biological Original Financing Ending Surveillance Survey and Behavioral Surveillance 2012 Survey Target Not Achieved Pregnant Women tested positive and treated Number Value 179.00 2139.00 1913.00 for syphilis during prenatal consultations in Date 31-Dec-2010 03-Sep-2014 30-Sep-2014 project areas (number) Comments Source: MOH Report Source: MoH Reports ADDITIONAL FINANCING Achieved Percentage of targeted groups who can cite Percentage Value 66.80 64.30 68.00 three methods of HIV/AIDS prevention Date 31-Dec-2012 31-Dec-2012 31-Dec-2012 Comments Source: Independent Source: Biological M: 68% Verification Agency report Surveillance Survey (ESBC F: 67% Public Disclosure Copy M: 66.8% 2012) SW: 61% F: 65.8% above only shows male as Military: 57% _______________ others cannot be inputted in. Original financing ending SW: 60% below is breakdown: 2012; Military: 53% M: 64.3% F: 64.4% Partially Achieved. Target for SW: 74.0% SW and Military groups were Military: 62.9% met and Male and Female were not met. Source: CombinedBiological and Behavioral Surveillance Page 2 of 10 The World Bank Report No: ISR16108 Survey; 2012 % Percentage of targeted groups who can cite Percentage Value 49.50 72.20 54.00 three methods of HIV/AIDS prevention IN Public Disclosure Copy Date 31-Dec-2010 31-Dec-2013 31-Dec-2013 PROJECT AREAS (%) Comments Source: Independent Source: Independent ADDITIONAL FINANCING Verification Agency report; Verification Agency report; M: 54% M: 49% above only shows male as F: 56% F: 50% others cannot be inputted in. SW: 67% SW: 63.6% below is breakdown: Military: 78% Military: 75% M:72.2% Partially Achieved F: 70.1% Met Male and Female target. SW: 57.5% Did not meet SW and Military Military: 41.3% end target Percentage of men and women aged 15-49 Text Value M : 38.1% M: 16.0% M : 20% who report having sex with a non-regular F : 16.8% F: 2.1% F : 9% partner in the last 12 months. Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 Comments Source: EDS 2003/2004 Source: EDS 2008/2009; Original Financing Ending 2012 Target not achieved Percentage of target population reporting the Text Value M: 28.3% M: 58.8% M: 35% use of a condom in their last act of sexual F: 25% F: 52.7% F: 30% intercourse with a non-regular partner inthe last Military: 61.2% Military: 70% Military: 70% 12 months in project areas. Date 31-Dec-2010 31-Dec-2013 30-Sep-2014 Comments Source: Independent Source: Independent ADDITIONAL FINANCING Verification Agency report Verification Agency report Source: Independent Verification Agency report Target Achieved. Percentage of SW reporting the use of a Text Value 79.4% 85% 86% condom in their last act of sexual intercourse Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 with a client. Comments Source: ESC 2006 Source: ESC 2012 Original financing ending 2012 Public Disclosure Copy Target Almost Achieved. Percentage of youth aged 15-24 that have Text Value M: 7.7% M: 16.0% M: 20% received an HIV test in the last 12 months and F: 8.7% F: 16.0% F: 22% who know their results (by age and by gender) Date 05-Jan-2006 24-May-2013 30-Dec-2012 Comments Source: ESC 2006 Source: ESBC 2012 Original financing ending 2012 Target not achieved Page 3 of 10 The World Bank Report No: ISR16108 Percentage of SW that have received an HIV Percentage Value 49.10 77.00 64.00 test in the last 12 months and who kow their Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 results (by gender) (%) Comments Source: ESC 2006 Source: ESBC 2012 Original financing ending Public Disclosure Copy 2012 Target achieved Pregnant women receiving antenatal care Number Value 57242.00 140989.00 108415.00 during a visit to a health provider (number) Date 31-Dec-2012 03-Sep-2014 30-Sep-2014 Comments Source: MoH reports Source: MoH Reports ADDITIONAL FINANCING Target achieved. Children 0-24 months obtaining monthly Number Value 48200.00 51834.00 50215.00 adequate minimum weight in project areas Date 31-Dec-2012 03-Sep-2014 30-Sep-2014 (number) Comments Source: NGO and Nutrition Source: NGOs & Nutrition ADDITIONAL FINANCING sites reports sites reports Target Achieved Children immunized (number) Number Value 53214.00 132226.00 96850.00 Date 31-Dec-2012 03-Sep-2014 30-Sep-2014 Comments Source: MoH reports Source: MoH reports ADDITIONAL FINANCING (Full immunization) (Full immunization) Target Achieved Children immunized - under 5 years against Number Value 53214.00 132226.00 96850.00 Polio (number) Sub Type Date 03-Sep-2014 30-Sep-2014 Breakdown Comments Source: MoH reports This is part of the full ADDITIONAL FINANCING (Full immunization) immunization package above. This is part of the full Source: MoH reports immunization package. (Full immunization) Source: MoH reports (Full immunization) Direct project beneficiaries Number Value 234069.00 1960856.00 1929774.00 Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 Comments of which Female: 63%; of which Female: 71%; of which Female: 64%; Source: Project data 2006 Source: Project data Dec Original financing ending 2012. 2012 Public Disclosure Copy Target Achieved Female beneficiaries Percentage Value 15163.00 1299963.00 1235055.00 Sub Type Supplemental HIV Interventions - Direct Project Beneficiaries Text Value 58061 150325 135210 Date 31-Dec-2010 31-Dec-2013 30-Sep-2014 Comments Source: Project reports Source: Project reports Source: Project reports ADDITIONAL FINANCING Target Achieved Page 4 of 10 The World Bank Report No: ISR16108 of which Female (HIV Interventions - direct Text Value 50% 61% 51% project beneficiaries) Sub Type Date 31-Dec-2010 31-Dec-2013 30-Sep-2014 Breakdown Comments Source: Project report Source: Project report ADDITIONAL FINANCING Public Disclosure Copy Target Achieved Health and Nutrition Interventions - Direct Text Value 0 420584 420584 Project Beneficiaries Date 31-Dec-2010 03-Sep-2014 30-Sep-2014 Comments ADDITIONAL FINANCING Target Achieved. of which Female (Health and Nutrition Text Value 61% 61% 61% Inteventions - Direct Project Beneficiairies) Sub Type Date 31-Dec-2010 31-Dec-2013 30-Sep-2014 Breakdown Comments Pregnant Women and Source: Project reports ADDITIONAL FINANCING; Children Under Five; Target Achieved Source: Project reports People with access to a basic package of Number Value 336047.00 395349.00 336047.00 health, nutrition, or reproductive health services Date 31-Dec-2012 03-Sep-2014 30-Sep-2014 (number) Comments Source: Project reports 94% (percent increase based on number of people); Pregnant Women and children Under Five; AF Target Achieved Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target The National Strategic Plan for HIV/AIDS is Text Value NSP 2001-2006 NSP updated and NSP updated and revised and disseminated by the end of 2006 disseminated by end 2010 disseminated by end 2010 Date 05-Jan-2006 31-Dec-2012 31-Dec-2010 Comments Source: 2006 ES/CNLS Source: 2009 ES/CNLS Source: Annual reports from Public Disclosure Copy reports reports ES/CNLS. Original Financing Ending 2012 End target achieved Annual Reporting allows identifying each donor Number Value 0.00 6.00 6.00 contribution to the program in a coherent Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 manner Comments Source: Reports ES/CNLS Source: 2012 ES/CNLS Source: 2012 ES/CNLS 4 by Dec. 2010 reports; End target achieved reports; Original Financing Ending 2012 End target achieved Page 5 of 10 The World Bank Report No: ISR16108 The national communication plan is updated Text Value National communication National Communication National Communication according to recommendatins of midterm stategy developped in 2004 Strategy updated for Strategy updated for evaluation 2009-1012 2009-1012 Public Disclosure Copy Date 05-Jan-2006 31-Dec-2010 31-Dec-2012 Comments Source: 2006 ES/CNLS report Source: 2009 ES/CNLS report Source: 2012 reports from ES/CNLS Revised National Communication strategy. End target achieved. Original Financing Ending 2012; Number of STI treatment kits sold in public and Number Value 81750.00 3536000.00 249350.00 private sectors (number) Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 Comments Source: Project reports Source: Project Reports; Original Financing Ending 2012 Target Achieved. ARV Treatment Guidelines are adequate and Text Value n/a ARV Protocol revised in 2008 ARV Protocol revised in 2008 implemented Date 05-Jan-2006 31-Dec-2010 31-Dec-2010 Comments Source: PNLS reports Source: PNLS; Original Financing Ending 201 Indicator achieved End target achieved Number of condoms distributed and sold Number Value 5000000.00 25000000.00 25000000.00 through the public sector and NGO programs Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 per year Comments Source: project report Source: Project reports Original Financing Ending 2012 Target Achieved Number and percentage of pregnant women Number Value 54806.00 986682.00 500000.00 test for syphilis during prenatal consultations Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 Comments % n.a Source: 2012 PNLS report; Original financing ending Source: PNLS 2007 report End-target surpassed for the 2012 numbers. Target Achieved Number of syphilis treatments distributed in Number Value 3280.00 6641.00 5740.00 Public Disclosure Copy public health centers in project areas (number) Date 31-Dec-2010 03-Sep-2014 30-Sep-2014 Comments Source: Project reports ADDITIONAL FINANCING (AF) Target Achieved Number of condoms distributed through the Number Value 0.00 17571703.00 10000000.00 public sector and NGO programs per year in Date 31-Dec-2010 31-Dec-2013 30-Sep-2014 project areas Comments Source: Project reports ADDITIONAL FINANCING (AF) Target Achieved. Page 6 of 10 The World Bank Report No: ISR16108 Number of SW, Youth aged 15-24 (by gender) Number Value 0.00 91075.00 76760.00 and Military tested for HIV in the last 12 months Date 31-Dec-2010 31-Dec-2013 30-Sep-2014 and received their test results in project areas Comments SW: 0 Source: Independent Source: Independent Public Disclosure Copy ----------------- Verification Agency reports. Verification Agency reports. M: 0 Above is total of the following: Above is total of the following: F: 0 M: 44627 M: 21,900 ----------------- F: 46448 F: 22,200 Military: 0 Military:15519 Military: 14,180 Source: Independent SW: 20498 SW:18,480 verification reports Additional Financing Fully Achieved Number of pregnant women receiving iron folic Number Value 81994.00 184482.00 114792.00 acid in project areas Date 31-Dec-2012 03-Sep-2014 30-Sep-2014 Comments Source: MoH reports Additional Financing Target Achieved Number of children under five receiving Vitamin Number Value 310010.00 772324.00 499608.00 A supplementation in project areas Date 31-Dec-2012 03-Sep-2014 30-Sep-2014 Comments Source: MoH reports Additional Financing Target Achieved Number of Pregnant women attended their first Number Value 22776.00 43112.00 44642.00 antenatal visit before the end of the first quarter Date 31-Dec-2012 03-Sep-2014 30-Sep-2014 (<4 months) of pregnancy in project areas Comments Source: MoH reports Additional Financing Target not achieved Number of births attended by skilled personnel Number Value 17020.00 39442.00 33358.00 in project areas Date 31-Dec-2012 03-Sep-2014 30-Sep-2014 Comments Source: MoH Reports Additional Financing Target Achieved Number of children under five treated with Zinc/ Number Value 16500.00 32203.00 28000.00 SRO for diarrhea in project areas Date 31-Dec-2012 03-Sep-2014 30-Sep-2014 Public Disclosure Copy Comments Source: MoH Reports Additional Financing Target Achieved Number of children under five enrolled in the Number Value 161259.00 193975.00 161259.00 growth monitoring and promotion program in Date 31-Dec-2012 03-Sep-2014 30-Sep-2014 project areas Comments Source: Nutrition Site reports Nutrition site reports Additional Financing Target Achieved Health personnel receiving training (number) Number Value 0.00 347.00 282.00 Date 31-Dec-2010 03-Sep-2014 30-Sep-2014 Page 7 of 10 The World Bank Report No: ISR16108 Comments Source: Project reports Project reports Additional Financing Target Achieved Number of women involved in growth Number Value 88227.00 114968.00 88783.00 Public Disclosure Copy monitoring and promotion activities in project Date 31-Dec-2012 03-Sep-2014 30-Sep-2014 areas Comments Source: PNCC site reports Nutrition site reports Additional Financing Target Achieved Annual Operation Plan reflects Number Value 4.00 6.00 6.00 recommendations of Consolidated Annual Date 31-Dec-2010 16-Mar-2012 31-Dec-2012 Report Comments Source: PNLS reports Source: UGP report; Original Financing Ending Indicator achieved each year. 2012 Target achieved Number of national surveys and studies Number Value 4.00 13.00 13.00 undertaken in accordance with agreed Date 05-Jan-2006 31-Dec-2012 31-Dec-2012 timetable Comments Source: Project reports Source: Project reports Original Financing Ending 2012 Target Achieved Number of health personnel trained in Number Value 0.00 166.00 100.00 monitoring and evaluation Date 31-Dec-2006 31-Dec-2012 31-Dec-2012 Comments Source: Project reports Source: Project reports Original Financing Ending 2012. End target achieved Percentage of PLWHA reference centers Percentage Value 96.00 94.00 98.00 having submitted monthly reports within 15 Date 30-Dec-2011 31-Dec-2013 30-Sep-2014 days of the end of the month Comments Source: PNLS report Source: PNLS report Additional Financing 97.00 (target Y1 & Y2 vs Target Not Achieved 95%) Quaterly Independant Verification Agency Number Value 5.00 4.00 6.00 Reports submitted within 45 days of the end of Date 31-Dec-2012 31-Dec-2013 30-Sep-2014 the quarter Comments Quarterly Activities ended in 2013 as Additional Financing Public Disclosure Copy Source: Independent was agreed under the NGO Activities ended in 2013 as Verification Agency Reports contracts which is why the was agreed under the NGO number of reports is less that contracts which is why the what was originally number of reports is less envisioned. thatwhat was originally envisioned. Target Partially Achieved Page 8 of 10 The World Bank Report No: ISR16108 Monitoring committee meetings held within 2 Number Value 5.00 4.00 6.00 weeks of submission of quarterly Independent Date 31-Dec-2012 31-Dec-2013 30-Sep-2014 verification Agency Report Comments Source: Project reports Source: Project reports Additional Financing Public Disclosure Copy Activities ended in 2013 as Additional Financing was agreed under the NGO Activities ended in 2013 as contracts which is why the was agreed under the NGO number of meetings is less contracts which is why the than what was originally number ofmeetings is less envisioned. than what was originally envisioned. Target Partially Achieved Percentage of capacity-building plan Percentage Value 33.00 100.00 100.00 implemented by year Date 05-Jan-2006 30-Nov-2012 31-Dec-2012 Comments Annually; Source: Project reports Annually Source: Copy of capacity- confirm that this indicator has Original Financing Ending building plan; Project reports been achieved each year. 2012 Target Achieved Percentage of PIU audits without reserves Percentage Value 100.00 100.00 100.00 Date 31-Dec-2010 03-Sep-2014 30-Sep-2014 Comments Source: Audit reports Additional Financing Target Achieved Percentage of IFRs submitted by deadline Percentage Value 100.00 100.00 100.00 Date 31-Dec-2010 30-Sep-2013 31-Dec-2012 Comments Source: IFRs; PIU Source: Project data reports Original Financing Ending that this indicator is achieved 2012 each quarter. Target Achieved Data on Financial Performance (as of 19-Aug-2014) Financial Agreement(s) Key Dates Public Disclosure Copy Project Ln/Cr/Tf Status Approval Date Signing Date Effectiveness Date Original Closing Date Revised Closing Date P090615 IDA-41040 Closed 12-Jul-2005 13-Jul-2005 05-Jan-2006 31-Dec-2009 31-Dec-2012 P090615 IDA-51240 Effective 14-Jun-2012 27-Jul-2012 22-Feb-2013 30-Sep-2014 30-Sep-2014 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P090615 IDA-41040 Closed XDR 20.20 19.60 0.60 19.60 0.00 100.00 P090615 IDA-51240 Effective XDR 3.90 3.90 0.00 3.19 0.71 82.00 Page 9 of 10 The World Bank Report No: ISR16108 Disbursement Graph Public Disclosure Copy Key Decisions Regarding Implementation As agreed during the last mission (May 5-16, 2014), the Project was restructured in July 2014 to allow for a reallocation of remaining resources to the RBF pilot and to better align the baselines and targets to the actual implementation period of the Project. The Project will close as scheduled on September 30, 2014. Restructuring History Level two Approved on 28-Dec-2011, Level 2 CD Decision on 05-Aug-2014 Related Projects P128169-Second Multisectoral STI/HIV/AIDS Prev II Additional Financing Project Public Disclosure Copy Page 10 of 10