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Document ofThe World BankFOR OFFICIAL USE ONLYReport No: 74614 - VNProject paperON APROPOSED ADDITIONAL financing and project restructuringIN THE AMOUNT OF gbp 5.83 million (USD 9.38 MILLION EQUIVALENT)TO THEsocialist republic of vietnamFOR theVIETNAM HIV/AIDS PREVENTION PROJECTJanuary 14, 2013Health UnitHealth, Population and NutritionEast Asia and Pacific RegionThis document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.CURRENCY EQUIVALENTS(Exchange Rate Effective of 29 October 2012)Currency Unit=GBPGBP 1=USD1.6079FISCAL YEARJanuary 1–December 31ABBREVIATIONS AND ACRONYMSAFAdditional FinancingAIDSAcquired Immuno-Deficiency SyndromeCPMUCentral Project Management UnitCSWCommercial Sex WorkersDFIDUK Department for International DevelopmentFSWFemale Sex WorkerHIVHuman Immunodeficiency VirusIBBSIntegrated Bio-Behavioural SurveyIDUInjecting Drug UsersM&EMonitoring and EvaluationMOHMinistry of HealthMSMMen having Sex with MenNIHEVietnam National Institute of Hygiene and EpidemiologyNTPNational Targeted ProgramPACProvincial AIDS CommitteePEPFARPresident’s Emergency Plan For AIDS ReliefPLWHAPeople Living with HIV/AIDSPMTCTPrevention of Mother-to-Child TransmissionPPMUProvincial Project Management UnitPSPPrimary Sexual PartnerPWIDPeople Who Inject DrugsSTISexually Transmitted InfectionVAACVietnam Administration for HIV and AIDS ControlWBWorld BankActing Vice President:Ulrich ZachauCountry Director:Victoria KwakwaSector Manager:Toomas Palu Task Team Leader:Mai Thi NguyenVIETNAM HIV/AIDS PREVENTION PROJECTcontentS TOC \o "1-3" \h \z \u I. Introduction PAGEREF _Toc345957599 \h 6II. Background and Rationale PAGEREF _Toc345957600 \h 6III. Proposed Changes PAGEREF _Toc345957601 \h 8IV. Appraisal Summary PAGEREF _Toc345957602 \h 12Annex 1: Results Framework and Monitoring PAGEREF _Toc345957603 \h 13Annex 2: Updated Operational Risk Assessment Framework PAGEREF _Toc345957604 \h 20Annex 3: Activities to be implemented with Additional Financing in 2013 PAGEREF _Toc345957605 \h 24Annex 4: Detailed Procurement Plan PAGEREF _Toc345957606 \h 27VIETNAM HIV/AIDS PREVENTION PROJECTAdditional Financing Data SheetBasic Information - Additional Financing (AF)Country Director: Victoria KwakwaSector Manager/Director: Toomas Palu/ Xiaoqing YuTeam Leader: Mai Thi NguyenProject ID: P144537Expected Effectiveness Date: February 05, 2013Lending Instrument: SIL Additional Financing Type: Scale-up Sectors: Health Themes: HIV/AIDSEnvironmental category: BExpected Closing Date: 31 December 2013Joint IFC: NoJoint Level: N/ABasic Information - Original ProjectProject ID: P082604Environmental category: BProject Name: HIV/AIDS Prevention Project Expected Closing Date: Dec 31, 2013Lending Instrument: SILJoint IFC: NoJoint Level: N/AAF Project Financing Data[ ] Loan [ ] Credit [ X ] Grant [ ] Guarantee [ ] Other: Proposed terms: 100% paid upon approval of Additional Financing planAF Financing Plan SourceTotal Amount (million USD)Total Project Cost: Cofinancing: Borrower: Total Bank Financing: IBRD IDA New Recommitted9.389.380.00.00.0Client InformationRecipient: Socialist Republic of Vietnam Responsible Agency: Ministry of Health/Vietnam Administration for HIV and AIDS ControlContact Person: Dr. Phan Thu HuongTelephone No.: 84 4 37724095Fax No.: NAEmail: cpmu_wb@.vnAF Estimated Disbursements (Bank FY/USD million)FY20132014TotalAnnual (DFID TF Grant)7.382.009.38Cumulative7.382.009.38Project Development Objective Original Project Development Objective: To assist the Government of Vietnam in establishing and maintaining national, provincial and local policies and capacity to design, implement and evaluate information and service delivery programs designed to halt the transmission of HIV/AIDS among vulnerable populations and between vulnerable populations and the general population, thereby assisting the Recipient in the implementation of its National Strategy on HIV/AIDS Prevention and Control. In the results framework of the IDA Grant, the vulnerable populations were defined – based on available epidemiological data and disease burden – as being Persons Living with HIV/AIDS (PLWHA), Injecting Drug Users (IDUs), Commercial Sex Workers (CSWs), and their clients and sexual partners). In the 2010 Additional Financing Project Paper, the list of vulnerable populations was revised to focus on IDUs, CSWs, and their clients and sexual partners. Project Development Objective with Revised Definition of Vulnerable Populations: To assist the Government of Vietnam in establishing and maintaining national, provincial and local policies and capacity to design, implement and evaluate information and service delivery programs designed to halt the transmission of HIV/AIDS among vulnerable populations (including people living with HIV/AIDS, injecting drug users, commercial sex workers and their clients and sexual partners, and men having sex with men) and between vulnerable populations and the general population, thereby assisting the Recipient in the implementation of its National Strategy on HIV/AIDS Prevention and Control. The PDO has the minor change on the definition of vulnerable populations, which has been expanded to include one more vulnerable population – men having sex with men (MSM). Project Description: The Project aims to achieve the PDO through 3 project components: Implementation of provincial HIV/AIDS Action Plans (Component 1), National HIV/AIDS policy and program (Component 2), and Project management (Component 3). Safeguard and Exception to PoliciesSafeguard policies triggered:Environmental Assessment (OP/BP 4.01) Natural Habitats (OP/BP 4.04) Forests (OP/BP 4.36) Pest Management (OP 4.09) Physical Cultural Resources (OP/BP 4.11) Indigenous Peoples (OP/BP 4.10) Involuntary Resettlement (OP/BP 4.12)Safety of Dams (OP/BP 4.37)Projects on International Waterways (OP/BP 7.50) Projects in Disputed Areas (OP/BP 7.60)[X]Yes [ ] No[ ]Yes [ X ] No[ ]Yes [ X ] No[ ]Yes [ X ] No[ ]Yes [ X ] No[ X ]Yes [ ] No[ ]Yes [ X ] No[ ]Yes [ X ] No[ ]Yes [ X ] No[ ]Yes [ X ] NoIs approval of any policy waiver sought from the Board (or MD if RETF operation is RVP approved)?Has this been endorsed by Bank Management? (Only applies to Board approved operations)Does the Project require any exception to Bank policy?Has this been approved by Bank Management?[ ]Yes [ X ] No[ ]Yes [ X ] No[ ]Yes [ X ] No[ ]Yes [ X ] NoConditions and Legal Covenants:Financing Agreement ReferenceDescription of Condition/CovenantDate DueNot applicableI. Introduction The Project Paper (PP) presents an Additional Financing in the amount of GBP 5.83 million (USD 9.38 million equivalent) through a DFID-financed Trust Fund grant to the Vietnam HIV/AIDS Prevention Project (P082604). In addition, this PP seeks approval of the Vice President of a restructuring comprising: (i) minor revision of the Project Development Objective by adding one vulnerable population (men having sex with men) to the beneficiaries of the project; (ii) revision of the results framework to measure the results associated with the additional vulnerable population, and to ensure that the country's set of national indicators is used in the measurement of the project results; and (iii) reallocation of project cost from Unallocated Category to provincial Sub Grants Category under Part A of the project. To date, the project has been financed by (i) an IDA Grant (IDA Grant Number H1520-VN) that closed on December 31, 2012 and which is fully disbursed (99.97%); and (ii) Additional Financing from DFID (RETF096672) with a current closing date of December 31, 2013.In September 2012, DFID informed both the Government of Vietnam and the World Bank that it had made available additional funds to the existing financing agreement for a 12-month period (up to 31 December 2013) in the amount of GBP 5.95 million (equivalent to USD 9.56 million). Of this amount, GBP 5.83 million (equivalent to USD 9.38 million) will be available to the Government for scaling up of project activities to enhance impact and facilitate sustainable transfer of project activities to other funding mechanisms, and GBP 0.12 million will be allocated to the World Bank for administrative costs and supervision. In their response in October 2012, the Vietnam Ministry of Health indicated that the additional funds would be used for scale-up and sustainability purposes to enhance the impact of the project. On January 4, 2013, the State Bank of Vietnam requested the World Bank to process the Additional Financing.II. Background and Rationale Background What the Project set out to achieve: In 2005, the World Bank financed the Vietnam HIV/AIDS Project (P082604) through an IDA grant that closed on December 31, 2012 (IDA Grant Number H1520-VN, USD 35 million, effective October 17, 2005). The PDO was to assist the Government of Vietnam in establishing and maintaining national, provincial and local policies and capacity to design, implement and evaluate information and service delivery programs designed to halt the transmission of HIV/AIDS among vulnerable populations and between vulnerable populations and the general population, thereby assisting the Recipient in the implementation of its National Strategy on HIV/AIDS Prevention and Control. In the results framework of the IDA Grant, the vulnerable populations were defined as being People Living with HIV/AIDS (PLWHA), Injection Drug Users (IDUs), Commercial Sex Workers (CSWs), and their clients and sexual partners (based on available epidemiological data and disease burden). Additional Financing in 2010 to scale-up and fund additional Project activities: In 2010, DFID and the World Bank negotiated an Additional Financing (‘2010 AF’) for the scaling up of activities financed by the Project. The value of the 2010 AF managed by the Government through an RETF (TF096672), which became effective on March 10, 2010, was GBP 17.20 million (equivalent to USD 27.66 million). This co-financing enabled an increase in the number of Project provinces from 20 to 32 (out of the total 63) provinces in Vietnam, and was intended to enhance the achievement of the original PDO. During the 2010 AF negotiations, the project results framework was adjusted to reflect changes in project indicators and a refinement of project activities, and the list of vulnerable populations was revised to be defined as IDUs, CSWs, and their clients and sexual partners.Current Status: The project has recorded satisfactory results to date. Implementation and progress toward achieving the PDO are both rated satisfactory. Overall implementation has been positive and progressing well in terms of achieving the targets. The latest ISR (December 2012) indicates that PDO indicators and one intermediate indicator have exceeded their end-of-project targets; four of the other six Intermediary Results indicator values are within 20% of the end of project targets set for them. Harm reduction activities for vulnerable populations are being implemented despite lower levels of funding in calendar year of 2012. Progress with project outputs (up to October 2012) are as follows:IDUs: The project target in 2012 is to reach 68,310 IDUs out of the estimated number of 82,626 IDUs in 32 project provinces. In the first eight months of 2012, the project was able to reach 62,755 IDUs, representing 92% of the annual target to date. Up to September 2012, the project distributed 18.5 million syringes and needles to IDUs, accounting for 75% of the 2012 annual target. This is on track in terms of reaching the annual 2012 target. The number of communes where activities have been implemented increased from 1,593 in 2011 to 1,823 in 2012.CSWs, CSW clients and CSW sexual partners: In the first nine months of 2012, 73% of the estimated CSWs in the project localities were reached, which is slightly higher than 2011. The number of condoms sold in the first nine months of 2012 was 25.4 million – 47% through traditional outlets and 53% through non-traditional outlets. As expected, the number of condoms distributed for free dramatically decreased by 61% from 16.8 million in 2011 to 6.5 million in 2012 (due to the condom social marketing program, which promotes the purchasing rather than free distribution of condoms).Commitments, Disbursements and Covenants: The IDA grant (Grant H1520-VN) is now closed. The DFID Trust Fund (TF096672) is also almost fully disbursed, with an undisbursed amount of USD 2.06 million out of the original USD 27.66 million1, to be fully committed by December 31, 2013. All grant covenants are met. All audits have been satisfactory and no overdue audit report has been noted.Rationale for Additional Financing Additional project activities in line with the Country Partnership Strategy (CPS) and epidemic dynamics in Vietnam: The new AF (2013 AF) activities are in line with the CPS priorities of addressing improvements in basic public service delivery and access are especially needed for Vietnam’s poor, vulnerable, or otherwise disadvantaged people (in this case, all sub populations at higher risk of contracting HIV, including MSM). The project will (a) continue to address the most critical HIV prevention challenges identified in the original Project Appraisal Document, (b) including through new epidemiological evidence about increased HIV prevalence amongst MSM in some provinces in Vietnam, and (c) through ongoing policy dialogue. Additional financing will result in enhanced sustainability by focusing on supplementary activities that can be implemented by confirmed funding sources after project closing: In order to ensure sustainability of project activities, innovation grants (innovation grants were a short term set of activities financed under the project in the initial years of implementation, meant to provide new ideas on how to prevent HIV) will not be financed under the 2013 AF (i.e. activities with no foreseeable implementation lifespan beyond December 31, 2013), nor will behavior change activities be financed under the 2013 AF (because of other funding being available for these activities); however implementation will be done per agreed arrangements to ensure that the gamut of HIV prevention services that the project has funded will continue to be delivered after project closing on December 31, 2013 (for example: some HIV counseling and testing sites that the project financed will in future be financed by the Global Fund for HIV programs in Vietnam). Further, sustainability will be strengthened by ensuring that the most efficient models of HIV prevention service delivery are funded in 2013. Where needed, alternative models of service delivery will be tested and assessed for efficiency. Consequently, implementation of the activities in 2013 will need to be carried out in close collaboration with other programmes such as those funded by the Global Fund, United States Government, United Nation agencies and the Vietnam Government-funded National Targeted HIV Program. III. Proposed Changes Minor PDO change – addition of one population (MSM) to the vulnerable population definition: The epidemic among MSM appears to be growing especially in urban areas (HIV prevalence amongst high risk MSM in Ho Chi Minh City, for example, has surged more than five-fold to 15.3% in 2011), and it is therefore an important population to focus on so as to ensure that the PDO is achieved. It is therefore necessary to add this population to the definition of ‘vulnerable populations’ as defined by the project. Original Project Development Objective: To assist the Government of Vietnam in establishing and maintaining national, provincial and local policies and capacity to design, implement and evaluate information and service delivery programs designed to halt the transmission of HIV/AIDS among vulnerable populations and between vulnerable populations and the general population, thereby assisting the Recipient in the implementation of its National Strategy on HIV/AIDS Prevention and Control. In the results framework of the IDA Grant, the vulnerable populations were defined – based on available epidemiological data and disease burden – as being PLWHA, IDUs, CSWs, and their clients and sexual partners. In the 2010 Additional Financing Project Paper, the list of vulnerable populations was revised to focus on IDUs, CSWs, and their clients and sexual partners. Project Development Objective with Revised Definition of Vulnerable Populations: To assist the Government of Vietnam in establishing and maintaining national, provincial and local policies and capacity to design, implement and evaluate information and service delivery programs designed to halt the transmission of HIV/AIDS among vulnerable populations (including people living with HIV/AIDS, injecting drug users, commercial sex workers and their clients and sexual partners, and men having sex with men) and between vulnerable populations and the general population, thereby assisting the Recipient in the implementation of its National Strategy on HIV/AIDS Prevention and Control. In essence, the PDO wording remains the same but the definition of vulnerable populations has been expanded to include one more vulnerable population – men having sex with men. Revisions to the Results Framework (a) Change one intermediate outcome for Project Component 1: The intermediate outcome will include the addition of MSM as a vulnerable population: 32 participating project provinces have the policies and capacities to utilize block grants to design, implement and monitor HIV/AIDS programs which promote harm reduction (increased opiate substitution, clean needle-syringe and condom use) to reduce HIV transmission among vulnerable populations (IDU, CSW, their clients and families and MSM). (b) Add one additional intermediate outcome indicator for Component 1, with a target: The number of lubricant sachets distributed to MSM in the last 12 months. The 12-month cumulative target is for 480,000 lubricant sachets to have been distributed. Align the PDO and component 1 intermediary results indicators to the new 2012 National HIV M&E system indicators: The Government of Vietnam had only developed a national HIV M&E system in 2007, and revised it in 2012. Since the project aims to assist the Government of Vietnam in establishing and maintaining national, provincial and local policies and capacity to design, implement and evaluate information and service delivery programs designed to halt the transmission of HIV/AIDS among and between vulnerable populations and the general population, the project indicators need to be drawn from the national HIV M&E system (in line with WB OP 13.60). The 2010 Additional Financing Paper outlines the selected national HIV M&E system indicators with which project results would be measured. For the purpose of the 2013 AF, the 2010 results framework has been refined to exclude all the indicators that were dropped in 2010, and updated to reflect the 2012 set of indicator definitions, the latest indicator data, and indicator-specific targets. See Annex 1 for the proposed changes to the indicators, the project results achieved to date, and the project’s proposed revised results framework.Finally, the proposed restructuring seeks to reallocate the full amount under the DFID Grant Unallocated Category of the original Trust Fund Grant (TF096672) to the provincial Sub Grants Category under Part A of the project.The three original project components will receive additional financing under the AF 2013 (details in Annex 3):Component 1: Implementation of provincial HIV/AIDS Action Plans (GBP 3.60 million/USD 5.79 million). Support will be provided to the 32 provinces and cities. The provinces will be allocated block grants based on specific criteria to determine the size of each year's allocation. Proposed activities are expected to reflect the diversity of provincial needs as well as the different responses needed in each location. One more vulnerable population (men having sex with men) will be provided with intervention support in the form of commodities ponent 2: National HIV/AIDS Policy and Program (GBP 1.26 million/USD 2.03 million). This component will strengthen capacity at the national and provincial levels, and promote the development of innovative, effective prevention through condom promotion and needle exchange programs. Opiate substitution therapy in the form of methadone maintenance therapy will also be scaled up with the technical support of ponent 3: Project Management (GBP 0.97 million/USD 1.56 million). This component will provide support to 32 provincial Project Management Units (PPMUs) in the 32 project provinces. It will also provide support to the institutions that will manage and implement the project, such as the Central Project Management Unit (in the Ministry of Health), Provincial AIDS Steering Committees and other implementing ponentProject Cost by Component (USD million)Original Project Costs financed by IDA Grant (Board Approval in March 2005)(A)Additional Costs financed by DFID Trust Fund Grant (March 2010)(B)Additional Costs financed by supplementary funds in DFID Trust Fund Grant (January 2013)(C)Revised Total Project Cost(A + B + C)1. Provincial Implementation of HIV/AIDS Action Plans (as Sub-Grant to be distributed for implementation at provincial level)2. National HIV/AIDS Policy and Program2.1 Policy and Program Development and Implementation2.2 Monitoring and Evaluation2.3 Behavior Change Communication Focused on Reducing Stigma and Discrimination3. Project ManagementTotal Baseline CostsContingenciesTotal Project Costs21.607.222.862.102.265.1834.001.0035.0015.984.454.45006.3326.760.927.665.792.031.450.5801.569.3809.3843.3713.708.762.682.2613.0770.141.972.04[Exchange rate of DFID Trust Fund 2010: 1 GBP = 1.45 USD] [Exchange rate with additional financing 2013 as of 29 October 2012: 1 GBP = 1.6079 USD]Project Costs by Category (USD)CategoryOriginal Project Costs financed by IDA GrantDFID AF Cost 2010DFID AF Cost 2013Revised Cost(1) Provincial Sub-Grants under Component 1, including- Goods- Consulting Service22,600,00014,583,6535,840,000960,000630,00043,023,653(2) Innovation Sub-Grants under Component 2.1 (d) 500,00064,3160564,316(3) Civil works70,000128,6320198,632(4)Goods1,930,0003,344,432 430,0005,704,432(5)Consultants’ services5,200,0008,119,895 1,620,00014,939,895(6)Training1,700,0001,157,688 1,200,0004,057,688(7)Incremental Operating Costs3,000,000257,264 290,0003,547,264(8) Unallocated0000TOTAL AMOUNT35,000,000 27,655,8809,380,00072,035,880Procurement: The procurement process under the AF will apply the revised World Bank Guidelines of 2011 (of Goods, Non-consulting services and Consultants' services): "Procurement of Goods, Works and Non-consulting Services under IBRD Loans and IDA Credits & Grants" dated January 2011 (Procurement Guidelines, January 2011); and "Selection and Employment of Consultants under IBRD Loans and IDA Credits & Grants" dated January 2011 (Consultant Guidelines, January 2011), and the provisions stipulated in the Amended Grant Agreement. The procurement under Category 1 (provincial sub-grants) focuses on continuing the financing to provincial project management units, peer educators and training workshops (advocacy, training of health workers, workshop on lessons learned, etc.) and the continued implementation of the provincial HIV prevention plans. These activities will be implemented in accordance with the procedures and guidelines outlined in the Project’s Operations Manual. In addition, the AF will finance the purchase of goods and technical consulting services (social marketing for condoms) under Category 1. With regard to the use of the 2011 Guidelines, the Bank Team will ensure procurement training and support to project staff on application of the new Guidelines, and strengthen the capacity to carry out procurement at both the central and provincial levels. For each contract to be financed by the AF, the different procurement methods or consultant selection methods, estimated costs, prior review requirements and time frame are agreed between the Recipient and the World Bank in the Procurement Plan for the whole period of the AF (see Annex 4). The Procurement Plan may be updated as needed to reflect the actual project implementation needs and improvements in institutional capacity.Management costs of the Additional Financing will be reduced below levels that have been the norm thus far. Fewer Central Project Management Unit (CPMU) staff will be supported and it has been agreed that combining some management functions with other CPMUs (i.e. those supported by the Global Fund and the US Government) will be an appropriate cost-cutting measure. Program management at the provincial level will be rationalized and standardized, with responsibility vested in the Provincial AIDS Committee (PAC). This will result in a greater proportion of management costs that will be borne by provinces from their own general resources.Changes to the institutional arrangements: No changes are proposed.IV. Appraisal SummaryThe proposed changes are not expected to have major effects on the original economic, financial, technical, institutional, or social aspects of the project as appraised. The project will continue to provide harm reduction services for most at risk and vulnerable populations. The project will continue to address important HIV prevention challenges and focus on ensuring sustainability of project activities by other grant mechanisms and involving the private sector and the government together for low cost implementation mechanisms. In particular, it should help to continue the focus on HIV prevention activities for vulnerable populations at highest risk of HIV transmission and acquisition.The proposed activities under the AF will not trigger any additional safeguard policies. The Environmental Management Plan and Indigenous Peoples Plan prepared for the original project will continue to be applicable for the AF.There are no Bank policy exceptions that need to be approved for the Additional Financing request to be approved. There are also no waivers of Bank policies that need to be made or approved by the Board. The overall risk to achieving the PDO is rated as “moderate.” The rating reflects the uncertainty in implementing all of the planned sustainability measures for project activities. Annex 1: Results Framework and MonitoringVietnam hiv/aids prevention project Revisions to the Results FrameworkComments / Rationale for changePDOCurrent Proposed changeOriginal Project Development Objective: To assist the Government of Vietnam in establishing and maintaining national, provincial and local policies and capacity to design, implement and evaluate information and service delivery programs designed to halt the transmission of HIV/AIDS among vulnerable populations (Persons Living with HIV/AIDS (PLWHA), Injecting Drug Users (IDUs), Commercial Sex Workers (CSWs), and their clients and sexual partners) and between vulnerable populations and the general population, thereby assisting the Recipient in the implementation of its National Strategy on HIV/AIDS Prevention and Control. To assist the Government of Vietnam in establishing and maintaining national, provincial and local policies and capacity to design, implement and evaluate information and service delivery programs designed to halt the transmission of HIV/AIDS among vulnerable populations (including people living with HIV/AIDS, injecting drug users, commercial sex workers and their clients and sexual partners, and men having sex with men) and between vulnerable populations and the general population, thereby assisting the Recipient in the implementation of its National Strategy on HIV/AIDS Prevention and Control. Definition of vulnerable population has been clarified whereby men having sex with men are part of the HIV/AIDS vulnerable population in Vietnam.PDO IndicatorsCurrent Proposed changePercent of vulnerable groups in participating provinces reporting safer injection practices (from 20% to70%)Percent of vulnerable populations in participating provinces reporting condom use in sexual intercourse (from an estimated 40% at baseline to 80% at project end)Percent of vulnerable groups in participating provinces reporting safer injection practices (from 20% to70%):Percentage of injecting drug users who constantly use clean syringes and needles in the last month (indicator 28 in national M&E framework)Percent of vulnerable populations in participating provinces reporting condom use in sexual intercourse (from an estimated 40% at baseline to 80% at project end):Percentage of commercial female sex workers reporting condom use with their most recent casual clients (indicator25 of national M&E framework) Percentage of commercial female sex workers reporting condom use with their most recent regular clients (indicator26 of national M&E framework )To align the indicators with the Government’s national HIV M&E systems of 2007, and as revised in 2012.Intermediate Results IndicatorsCurrent Proposed changeAn increased percentage of vulnerable populations (from an estimate 10% at baseline to 80% by project end) are reached by provincial services% of commercial female sex workers receiving condom in the last 6 months% of commercial female sex workers receiving IEC materials in the last 6 months% of commercial female sex workers receiving introduction of STI treatment in the last 6 months% of commercial female sex workers receiving information from Peer educators in the last 6 months% of commercial female sex workers receiving HIV testing in the last 6 months% of IDUs receiving clean S&N in the last 6 months % of IDUs receiving IEC materials in the last 6 months: % of IDUs receiving information from Peer educators in the last 6 months% of IDUs receiving condom in the last 6 months. % of IDUs receiving HIV testing in the last 6 monthsNumber of lubricant sachets distributed to MSM in the last 6 monthsTo align the indicators to the vulnerable-population-specific indicators in the Government’s national HIV M&E systems of 2007, and as revised in 2012.To measure project activities focusing on the additional vulnerable population -- MSMPDO Level Results IndicatorsCoreUnit of MeasurementBaselineOriginal ProjectStart (2005)Progress to dateTarget Values(2013)FrequencyData Source/MethodologyResponsible for Data CollectionCommentsPercent of vulnerable groups in participating provinces reporting safer injection practices (from 20% -70%), as measured by this indicator in the Government of Vietnam’s national HIV M&E system: Percentage of injecting drug users who constantly use clean syringes and needles in the last month (indicator 28 in national M&E framework) FORMCHECKBOX %N/A85.9852-3 yearsSpecial surveys such as BSS/IBBS/HSS+CPMU/VAACPercent of vulnerable populations in participating provinces reporting condom use in sexual intercourse (from an estimated 40% at baseline to 80% at project end), as measured by this indicator in the Government of Vietnam’s national HIV M&E system:Percentage of commercial female sex workers reporting condom use with their most recent casual clients (indicator 25 of national M&E framework ) N/A93.6852-3 yearsSpecial surveys such as BSS/IBBS/HSS+ CPMU/VAACPercentage of commercial female sex workers reporting condom use with their most recent regular clients (indicator 26 of national M&E framework FORMCHECKBOX %N/A84.8852-3 yearsSpecial surveys such as BSS/IBBS/HSS+ CPMU/VAACIntermediate Results IndicatorsCoreUnit of MeasurementBaselineOriginal ProjectStart (2005)Progress to dateTarget Values(2013)FrequencyData Source/MethodologyResponsible for Data CollectionCommentsCOMPONENT ONE: Implementation of provincial HIV/AIDS Action PlansAn increased percentage of vulnerable populations (from an estimate 10% at baseline to 80% by project end) are reached by provincial services, as measured by these indicators in the national M&E framework, 2007. Percentage of commercial female sex workers receiving condom in the last 6 monthsPercentage of commercial female sex workers receiving IEC materials in the last 6 monthsPercentage of commercial female sex workers receiving introduction of STI treatment in the last 6 monthsPercentage of commercial female sex workers receiving information from Peer educators in the last 6 monthsPercentage of commercial female sex workers receiving HIV testing in the last 6 monthsPercentage of IDUs receiving clean S&N in the last 6 months Percentage of IDUs receiving IEC materials in the last 6 months: Percentage of IDUs receiving information from Peer educators in the last 6 monthsPercentage of IDUs receiving condom in the last 6 months: Percentage of IDUs receiving HIV testing in the last 6 monthsNumber of lubricant sachets distributed to MSM in the last 6 months FORMCHECKBOX %%%%%%%%%%NumberN/AN/AN/A N/AN/AN/AN/AN/AN/AN/A0 (2011)70.468.275.168.049.785.569.774.646.139.2N/A80808080808080808080480 0002-3 yearsIBBS and routine dataCPMU/VAACAn increased percentage (for an estimated 10% at baseline to 90% at project end) of provinces prepare high quality provincial plans FORMCHECKBOX %1085901-2 yearsTRT (technical reviewed team)CPMU/VAACAn increased percentage of provinces (from an estimated 10% at baseline to 90% at project end) meet targets specified in provincial plans FORMCHECKBOX %108590Annual Annual Provincial reports & PAPCPMUIntermediate Results IndicatorsCoreUnit of MeasurementBaselineOriginal ProjectStart (2005)Progress to dateTarget Values(2013)FrequencyData Source/MethodologyResponsible for Data CollectionCommentsAn increased percentage of provinces (from 0 to 90% at project end) establish adequate M&E systems, including appropriate biological and behavioral surveillance, effectiveness research and program activity and financial monitoring. FORMCHECKBOX %010090Annual Annual Provincial reports & PAPCPMU/VAACIncreased number of provinces offering MMT services (from an estimated 0 at baseline to 6 by project end) # of provinces04 (in 2012 ISR)6Annual Annual Provincial reports & PAPCPMU/VAACIncreased number of injecting drug users enrolled in MMT services (from an estimated 0 at baseline to 2,000 by project endNumber01000 (in 2012 ISR)2000Annual Annual Provincial reports & PAPCPMU/VAACIntermediate Results IndicatorsCoreUnit of MeasurementBaselineOriginal ProjectStart(2005)Progress (2008)Progress (2011)Target Values(2013)FrequencyData Source/MethodologyResponsible for Data CollectionCommentsCOMPONENT TWO -- Sub-component 1: Policy and Program Development and ImplementationKey capacity building products, including provincial study tours, policy papers, guidelines, training curricula and courses, research protocols and completed studies FORMCHECKBOX NAResult: Yes. Note: Budget was contributed to VAAC for assessing capacity of national system of HIV/AIDS prevention and control. VAAC is submitting a proposal on building capacity of Provincial HIV/AIDS Prevention Centers to Prime Minister.ContinuedContinuedAnnual Annual reports and action Plan, Monitoring CPMU/VAACKey outcomes, including improved policy and contextual environment for interventions among vulnerable populations achieved NAResult: Yes. Note: Assist VAAC in developing documents supported for National action plan of capacity building VCT, M&E National framework, M&E training.ContinuedContinuedAnnual Annual reports and action Plan, MonitoringCPMU/VAACCOMPONENT TWO -- Sub-component 2: Monitoring and Evaluation National and regional research institutions’ strengthened, through establishment of AIDS M&E nuclei and recruitment and training of AIDS M&E staff FORMCHECKBOX NAResult: implementingNote: Project supported to set up national and regional M&E unitsContinuedContinuedAnnual Annual reports and action Plan, Monitoring CPMU/VAACBiological, behavioral and health facility surveillance strengthened, effectiveness research initiated and functioning provincial program activity and financial monitoring systems established by Y 1NAResult: ImplementedNote: Project supported to implement surveillances among target groups (please see report), financial monitoring system in all 20 provincesResult: YesNote: Project supported to implement surveillances among target groups, financial monitoring system in all 32 provincesContinuedAnnual Annual reports and action Plan, Monitoring CPMU/VAACMechanisms developed to regularly disseminate M&E results and to use data for program improvementNANANAEnd 2011: 100% of 32 provinces regularly disseminate M&E results and to use data for program improvement and planning100% of provinces Annual Annual reports and action Plan, Monitoring CPMU/VAACCOMPONENT THREE: Project ManagementProject management unit and administrative, technical, financial and procurement sub-units established, bank account opened, staff and consultants recruited, systems established, implementation plan prepared and improved, coordination and technical support provided to provinces and coordination services provided to implementation partners FORMCHECKBOX NAImplemented in all 20 provincesImplemented in all 20 provincesContinued all 32 provincesAnnual Annual reports and action Plan, Monitoring CPMU/VAACProject management units prepare adequate plans, meet annual implementation targets and provide timely financial and activity reporting FORMCHECKBOX Implemented in all 20 provincesImplemented in all 32 provincesContinued all 32 provincesAnnual Annual reports and action Plan, Monitoring CPMU/VAACBaseline, mid-term and end-of-project management and capacity reviews demonstrate enhanced project management /institutional capacity, evidencing an increase in the number of provinces judged to have adequate managerial and institutional capacity (0-80%)%0implementingimplementingAnnex 2: Updated Operational Risk Assessment FrameworkProject Stakeholder Risks RatingModerateDescription: Lack of close coordination among different projects supporting HIV/AIDS program at both provincial and central level. Risk Management: Action plan development will be led by VAAC and PACs to ensure the coordination process.Implementing Agency Risks (including fiduciary)Rating:ModerateDescription: Project activities will be handled by PACs but staff capability is limited at some provinces. Differences between the Bank’s Guidelines and Government regulations on procurement and tendency to follow Government procurement regulations by project staff at both central and local levels. Bureaucracy in review/appraisal/approval procedures by MOH and Provincial People’s Committees for work plan and procurement plan that potentially delay the implementation and procurement process.Risk Management?: Training and retraining will be conducted. Close guidance and supervision by CPMU and the World Bank team. Intensive procurement training (on routine and/or ad-hoc basis) would be done for the selective provincesProject RisksRating:LowDescription: There is a risk on duplication of harm reduction activities at provincial level.Risk Management?: In depth stakeholder consultations will be conducted during project implementation to establish understanding on the project activities. It will also be minimized through annual planning process which will be handled by VAAC and PACs.Social & EnvironmentalRating:LowDescription: The proposed project is continuing to apply EMP and health waste management plan which has been adopted by the Government since 2010.Risk Management: Review the implementation at supervision missions. Program & DonorRating:LowDescription: Limitation on coordination has led to a narrow focus on project level rather than program level. Risk Management: Information sharing on project design to other donors. Improve capacity on planning and coordination for Government staff. Delivery Monitoring & SustainabilityRating:SubstantialDescription: Sustaining the harm reduction activities will require additional budget from the Government and innovative approaches, integrate HIV/AIDS prevention and care in the health service delivery system, addressing the scope of service, staffing qualifications, financing system under the universal coverage scheme.Risk Management: Discussion with MOH on social marketing and support the Government on innovative approach which will sustain the successes of the project.Project Team Proposed Rating Before Review Preparation Risk Rating: Low Implementation Risk Rating: ModerateComments: Project design is straightforward and there is a wealth of experience in the project team. Project preparation risk is mostly about securing the date to meet the deadline of each approval steps of the Government procedure. Comments: There is some concern about the leadership capacity of MOH in coordinating the involvement of the wide range of stakeholders during project implementation, particularly in securing the cooperation of and collaboration among the donors to avoid project focus rather than program focus. Annex 3: Activities to be implemented with Additional Financing in 2013All activities in the extension year would be focused on sustainability and be conducted in close collaboration with other programmes such as those funded by Global Fund, USG, the UN agencies and the National Targeted Program (NTP).Management costs need to be reduced below levels that have been the norm in previous years. Fewer CPMU staff will be supported, and it is suggested that combining some functions with other CPMUs (i.e. those supported by Global Fund and US Government) will be an appropriate cost-cutting measure. Programme management at provincial level needs to be rationalized and standardized, with responsibility vested in the PAC. A greater proportion of management costs needs to be borne by provinces from their own general resources.Priority activities to be supported would be:1. Harm reduction for people who inject drugsConsidering the epidemiology of HIV in Vietnam, this needs to be the foremost priority. The following activities should be supported:Continuation of existing needle and syringe programmes in all 32 provinces, including procurement of needles/syringes and support for existing peer educator networks. This will be for the first 6 months of 2013, after which all districts with larger numbers of IDUs will be transferred to Global Fund funding, including the peer educators. Districts with fewer IDUs will be transferred to the NTP.Before a final decision on selection of districts is made, the cut-off point for number of IDUs in a district needs to be agreed and provinces should re-estimate IDUs numbers in districts where it could be expected that numbers may exceed current estimates. Needles/syringes may be procured in 2012 to ensure no stock-outs during the transition to the extension period.In some provinces the development of a more sustainable model for provision of clean needles and syringes (N/S) for IDUs in the long term should be piloted, working with the private sector. The supply of free N/S through government channels would be greatly reduced to the level that can be domestically financed. This approach will be prioritised in urban areas in better resourced provinces. A variety of approaches may be tried, including more work with pharmacies, other potential retail outlets and social marketing.During this extension period it would be appropriate to provide additional training for peer educators with the explicit objective of increasing rates of HIV testing for IDUs and early detection and treatment of HIV positive IDUs.Continued funding of methadone clinics currently supported by DFID/WB can be considered for the first 6 months of 2013, after which these should be taken on by the Global Fund. The methadone itself will continue to be provided through PEPFAR funding during this period.2. Condom social marketing through private sector providers for vulnerable populationsThe new approach currently being rolled out through private sector contracts in each province needs more time to establish a sustainable model. This should be continued throughout 2013 and will be taken on by the Global Fund in 2014. The approach needs to continue to move the emphasis away from traditional outlets with more and more condoms being made available through non-traditional outlets. Arrangements for smooth handover need to be put in place during 2013.The independent external evaluation, being funded separately by DFID and to be completed within 2012, will look at the social marketing model in detail. Recommendations of the evaluation should be used to make appropriate modifications to the model in 2013.Continuation of existing sex work programmes for both venue-based and street based sex workers will be supported in all 32 provinces, including procurement of condoms for free distribution to CSW and support for existing peer educator networks. This will be for the first 6 months of 2013, after which all districts with larger numbers of CSW will be transferred to Global Fund funding, including the peer educators. Districts with fewer CSW will be transferred to the NTP.3. Work among MSMThe epidemic among MSM appears to be growing, with the limited survey data available suggesting prevalence rates now higher than for IDUs. And yet there is still very limited knowledge of MSM networks, behaviors and sero-prevalence in most provinces. Working in collaboration with PEPFAR-funded activities, further work in developing effective approaches to work among MSM should be supported in selected provinces, primarily focusing on major urban centers. Activities to be supported should include procurement and distribution of condoms and lubricants, support for peer educators, support for networking activities such as meetings and the piloting of innovative approaches (e.g. some funding for basic operating costs of local MSM organizations and training for MSM in areas such as how to set up and manage an organization). This will be for the 12 months of 2013, after which all districts with MSM activities will be transferred to Global Fund funding in 2014. Arrangements for smooth handover need to be put in place during 2013.As far as possible, condoms and lubricants should be made available through commercial and/or social marketing channels. Free distribution will be kept to a minimum and highly targeted towards the most vulnerable (e.g. street-based male sex workers).Activities to improve syndromic management of Sexually Transmitted Infections (STIs) and reporting of male STIs by key public and private STI providers in 10 provinces will be continued in the 10 pilot provinces. In addition to this current support for syndromic management of male and female STIs, the network of STI clinics will be trained on management of STIs in MSM to create some ‘MSM-friendly’ STI providers. This activity will be for the first 6 months of 2013, after which activities will be transferred to the NTP.4. Strengthening M&EFurther support is needed to help provinces improve their data management and analysis, and to ensure that all the required routine data are recorded. This can include support for online reporting. Before agreeing what to fund in 2013, a strategy for the location of a sustainable domestic capacity in M&E needs to be agreed. Some capacity building and technical assistance will need to be provided in 2013. Support for M&E will be for the national system, not just for the 32 supported provinces. However, in-province support will not be provided for other provinces, except for the D28 upgrade.5. Capacity building and advocacyA range of training activities supporting areas 1 to 5 above will be supported. This should include interprovincial learning activities including workshops and in-country study tours. International study tours will not be supported unless there is a very compelling case for them. Attendance at international meetings and conferences will only be supported if there is a strong case and the Vietnamese participants will be presenting papers on the Vietnam experience.This can include capacity building for various national bodies including the National Committee for AIDS, Drugs and Prostitution Control, the National Assembly and key ministries such as Ministry of Labor, Invalids and Social Affairs (MOLISA), Public Security and Justice. The aim will be to strengthen the enabling legal framework and policy environment for effective HIV prevention. The focus of the limited advocacy work undertaken under this project will be on the promotion of the effectiveness of combination prevention. The emphasis should be on developing, analyzing and publishing the data, e.g. documenting the decreasing HIV prevalence in those IDUs targeted by the programme. The widespread implementation of needle and syringe program, Methadone Maintenance Therapy (MMT) linked to HIV diagnosis and treatment has been dramatically effective in lowering HIV rates with no evidence of increasing numbers of new drug users, and all this at a time when the numbers of residents in 06 Centers is at a five year low. This material can be used to advocate for appropriate strategies and budget allocations, especially at the provincial level. The project could fund a series of workshops or debates that focus on evidence-based approaches to key issues in HIV prevention.Annex 4: Detailed Procurement PlanNo.ActivitiesNo. of BidImple-menting AgencyBudgetBid MethodReview by the BankSchedule for procurement activitiesRemarks GBP USD equivalent StatusContract Negotiation & signingContract ImplementationContract signing dateContract start dateComple-tion dateA. Procurement Plan at Central Project Management Unit?Goods??270,000440,000???????1Procurement of syringes (planed 5,8 million syringes)1CPMU180,000 298,000 NCBPostPlanned10-Apr-1310-Apr-139-Jul-13?2Procurement equipment for 04 central and regional Institutes 1CPMU50,000 80,000 ShoppingPostPlanned10-Apr-1310-Apr-139-Jul-13?3Hire Bravo for Financial software maintenance 1CPMU10,000 12,000 DCPriorPlanned20-Feb-1320-Feb-1331-Dec-13?402 panels to promote SCM of VIP Plus in Ha Noi and Ho Chi Minh city1CPMU30,000 50,000 ShoppingPostPlanned3-May-133-May-131-Aug-13??Consultants??1,010,000 1,623,300 ???????5Hire consulting firm for Financial audit 20131CPMU28,000 45,000 CQSPostPlanned22-Apr-1322-Apr-1331-Dec-13?6Hire consulting firm for Procurement audit 20131CPMU50,000 80,000 SSSPriorPlanned8-Apr-138-Apr-1331-Dec-13Single source selection Deloitte 7Hiring WHO for technical support to CPMU in 20131CPMU168,000 270,000 SSS PriorPlanned22-Jan-1222-Jan-1220-Jul-12Extend the Agreement with WHO signed 20108Hiring 02 local consultants for syntherize and writting report HSS+ in year 20131CPMU14,000 22,000 ICPostPlanned30-Aug-1330-Aug-1328-Dec-13?9Hiring 02 local consultants to develop standard guideline of sentinel surveillance, integration monitoring1CPMU6,000 10,000 ICPostPlanned6-Mar-136-Mar-133-Aug-13?11Hiring 02 local consultants to assessement training command for staffs working in HIV/AIDS prevention field1CPMU23,000 37,000 ICPostPlanned2-Mar-132-Mar-1328-Sep-13??Project Staff 19 ?????????12Extention of contract for existing CPMU staffs19CPMU193,000 310,111 ICPostPlanned1-Jan-131-Jan-1331-Dec-13?13Extention of contract for existing full time consultant at 4 regional institutes4CPMU31,000 50,400 ICPostPlanned1-Jan-131-Jan-1331-Dec-13?14Hire 01 additional driver1CPMU2,700 4,389 ICPostPlanned15-Jan-1315-Jan-1331-Dec-13?15Hire 01 short term accountant1CPMU5,600 9,000 ICPostPlanned15-Jan-1315-Jan-1331-Dec-13?16Extention of contract for existing PPMUs staffs12832 PPMUs488,000 785,400 ICPostPlanned1-Jan-131-Jan-1331-Dec-13??Total A??1,280,0002,063,300???????B. Procurement Plan at 32 Provincial Project Management Units?Goods??590,000961,045???????1Procurement of needles & syringes 3232 PPMUs576,900 940,095 ShoppingPost?1-Apr-131-Apr-131-May-13?2Procurement of personal equipment for PE, PC3232 PPMUs10,000 16,000 ShoppingPost?1-Apr-131-Apr-131-May-13?3Procurement consumable material1111 PPMUs3,100 4,950 ShoppingPost?1-Apr-131-Apr-131-May-13??Consultants??390,000 630,000 ???????4Hire consulting firm for contribution of VIP Plus condom in Condom Social Marketing program3232 PPMU390,000 630,000 CQSPost??30-Mar-1331-Dec-13Extended contract with current consultant firms?Total B??980,0001,591,045????????Grand Total (A+B)??2,260,0003,654,345???????NOTE: The procurement under Category 1 (provincial sub-grants) focuses on continuing the financing to provincial project management units, peer educators and training workshops (advocacy, training of health workers, workshop on lessons learned, etc.) and the continued implementation of the provincial HIV prevention plans. These activities will be implemented in accordance with the procedures and guidelines outlined in the Project’s Operations Manual. ................
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