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World Bank Document Document of The World Bank Public Disclosure Authorized Report No: ICR00003511 IMPLEMENTATION COMPLETION AND RESULTS REPORT (IBRD-75680) ON A LOAN Public Disclosure Authorized IN THE TOTAL AMOUNT OF US$50 MILLION TO THE REPUBLIC OF BOTSWANA FOR A NATIONAL HIV/AIDS PREVENTION SUPPORT PROJECT Public Disclosure Authorized April 28, 2016 Public Disclosure Authorized Health, Nutrition and Population Global Practice (GHNDR) Africa Region CURRENCY EQUIVALENTS (Exchange Rate Effective July 31, 2015) Currency Unit = Pula US$1.00 = 10.15 Pula US$1.00=0.72 SDR ABBREVIATIONS AND ACRONYMS AIDS Acquired Immunodeficiency Syndrome MAP Multi-Country HIV/AIDS Program ART Antiretroviral Therapy MCP Multiple Concurrent Partnership ARV Antiretroviral MDGs Millennium Development Goals BAIS Botswana AIDS Impact Survey M&E Monitoring and Evaluation BCC Behavioral Change Communication MFDP Ministry of Finance and Development Planning BHRIMS Botswana HIV/AIDS Response Information MIST Ministry of Infrastructure, Science &Technology Management System BNAPS Botswana National HIV/AIDS Prevention MJDS Ministry of Justice, Defense, and Security Support BNTP Botswana National TB Program MLG Ministry of Local Government CSO Community Society Organization MMR Maternal Mortality Ratio CD4 Cluster of Differentiation 4 MOESD Ministry of Education and Skills Development CMS Central Medical Store MOH Ministry of Health DAC District AIDS Coordinator MTCT Mother to Child Transmission DMSAC District Multisectoral AIDS Committee MTR Mid-Term Review DHS Demographic and Health Survey MYSC Ministry of Youth, Sport and Culture DP Development Partner NAC National AIDS Council GDP Gross Domestic Product NACA National AIDS Coordinating Agency HIV Human Immunodeficiency Virus NCCPP National Cervical Cancer Prevention Program HDI Human Development Index NDP National Development Plan HMIS Health Management Information System NGO Non-governmental Organization IBRD Int’l Bank for Reconstruction & Development NSF National Strategic Framework ICR Implementation Completion Results OP Operational Policy IEC Information, Education, Communication OPCS Operations Policy and Country Services IDA International Development Association PAD Project Appraisal Document IDU Injecting Drug Users PBF Performance-based Financing IEC Information, Education, Communication PDO Project Development Objectives IMF International Monetary Fund PLWHA Persons Living with HIV/AIDS IO Intermediate Outcome Indicator PMTCT Prevention of Mother-to-Child Transmission ISN Interim Strategy Note PRRR Pink Ribbon Red Ribbon ISR Implementation Status Report PSO Private Sector Organization EC European Commission RF Results Framework EDF Economic Development Framework SMC Safe Male Circumcision ERV External Results Verification TA Technical Assistance EU European Union TB Tuberculosis FBO Faith-based Organization UN United Nations FM Financial Management UNAIDS United Nations Program on HIV/AIDS GDP Gross Domestic Product USAID United States Agency for Int’l Development GFATM Global Fund to Fight AIDS, TB and Malaria VCT Voluntary Counseling and Testing GOB Government of Botswana WHO World Health Organization HNP Director: Olusoji Adeyi Country Director: Guang Zhe Chen Practice Manager: Magnus Lindelow Project Team Leader: Sheila Dutta ICR Team Leader/Author: Edit V. Velenyi ii REPUBLIC OF BOTSWANA NATIONAL HIV/AIDS PREVENTION SUPPORT PROJECT Table of Contents A. Basic Information……………………………………………………………………………….. v B. Key Dates………………………………………………………………………………………… v C. Ratings Summary……………………………………………………………………………….. v D. Sector and Theme Codes………………………………………………………………………. vi E. Bank Staff………………………………………………………………………………………… vi F. Results Framework Analysis…………………………………………………………………... vi G. Ratings of Project Performance in ISRs……………………………………………………… xv H. Restructuring……………………………………………………………………………………. xv I. Disbursement Profile…………………………………………………………………………… xv 1. Project Context, Development Objectives and Design………………………………….. 1 1.1 Context at Appraisal………………………………………………………………………... 1 1.2 Original Project Development Objectives (PDO) and Key Indicators)……………… 4 1.3 Revised PDO and Justifications…………………………………………………………... 4 1.4 Main beneficiaries………………………………………………………………………..... 4 1.5 Original Components………………………………………………………………………. 4 1.6 Revised Components……………………………………………………………………….. 5 1.7 Other Significant Changes………………………………………………………………… 5 2. Key Factors Affecting Implementation and Outcomes…………………………………. 6 2.1 Project Preparation, Design and Quality at Entry…………………………………….. 6 2.2 Project Implementation……………………………………………………………………. 9 2.3 Monitoring and Evaluation Design, Implementation and Utilization……………….. 11 2.4 Safeguard and Fiduciary Compliance……………………………………………………. 15 2.5 Post-completion Operation/Next Phase………………………………………………….. 16 3. Assessment of Outcomes……………………………………………………………………… 17 3.1 Relevance of Objectives, Design and Implementation…………………………………. 17 3.2 Achievement of Project Development Objectives……………………………………….. 19 3.3 Efficiency………………………………………………………………………................... 25 3.4 Justification of Overall Outcome Rating……………………………………………….... 27 3.5 Overarching Themes, Other Outcomes and Impacts…………………………………… 28 3.6 Summary of Findings of Beneficiary Survey and/or Stakeholder Workshops………. 29 4. Assessment of Risk to Development Outcome…………………………………………… 29 5. Assessment of Bank and Borrower Performance……………………………………….. 31 5.1 Bank Performance………………………………………………………………………….. 31 5.2 Borrower Performance……………………………………………………………………. 33 6. Lessons Learned……………………………………………………………………………….. 35 7. Comments on Issues Raised by Borrower/Implementing Agencies/Partners………. 36 Annex 1. Project Costs and Financing………………………………………………………… 37 Annex 2. Outputs by Component……………………………………………………………… 40 Annex 3. Economic and Financial Analysis………………………………………………….. 53 Annex 4. Bank Lending and Implementation Support/Supervision Processes……….. 68 Annex 5. Implementing Agency Survey Results……………………………………………. 69 iii Annex 6. Stakeholder Workshop Report and Results……………………………………… 69 Annex 7. Summary of Borrower's ICR and/or Comments on Draft ICR…………….. 70 Annex 8. Comments of Co-financiers and Other Partners/Stakeholders……………… 70 Annex 9. List of Supporting Documents……………………………………………………… 71 Annex 10. Illustrative Tables and Figures for the Assessment of BNAPS…………….... 72 MAP…………………………………………………………………………………………………. 81 iv A. Basic Information Botswana National Country: Botswana Project Name: HIV/AIDS Prevention Support Project Project ID: P102299 L/C/TF Number(s): IBRD-75680 ICR Date: 04/28/2016 ICR Type: Core ICR Government of Botswana, Ministry of Lending Instrument: SIL Borrower: Finance and Development Planning Original Total USD 50.00M Disbursed Amount: USD 50.00M Commitment: Revised Amount: USD 50.00M Environmental Category: C Implementing Agencies: National AIDS Coordinating Agency (NACA). Cofinanciers and Other External Partners: B. Key Dates Revised / Actual Process Date Process Original Date Date(s) Concept Review: 11/09/2006 Effectiveness: 06/30/2009 06/30/2009 12/29/2011 Appraisal: 04/21/2008 Restructuring(s): 07/15/2013 08/20/2014 Approval: 07/10/2008 Mid-term Review: 06/13/2011 05/13/2011 Closing: 09/30/2013 03/31/2015 C. Ratings Summary C.1 Performance Rating by ICR Outcomes: Moderately Satisfactory Risk to Development Outcome: Substantial Bank Performance: Moderately Satisfactory Borrower Performance: Moderately Satisfactory C.2 Detailed Ratings of Bank and Borrower Performance (by ICR) Bank Ratings Borrower Ratings Moderately Moderately Quality at Entry: Government: Satisfactory Satisfactory Moderately Implementing Moderately Quality of Supervision: Satisfactory Agency/Agencies: Satisfactory Overall Bank Moderately Overall Borrower Moderately Performance: Satisfactory Performance: Satisfactory C.3 Quality at Entry and Implementation Performance Indicators Implementation QAG Assessments Indicators Rating Performance (if any) Potential Problem Quality at Entry Project at any time No None (QEA): (Yes/No): Problem Project at any Quality of Yes None time (Yes/No): Supervision (QSA): DO rating before Satisfactory Closing/Inactive status: D. Sector and Theme Codes Original Actual Sector Code (as% of total Bank financing) Health 58 58 Other social services 7 7 Public administration- Health 35 35 Theme Code (as% of total Bank financing) HIV/AIDS 85 74 Participation and Civic Engagement 15 20 Tuberculosis 4 NCD 2 E. Bank Staff Positions At ICR At Approval Vice President: Makhtar Diop Obiageli Ezekwezili Country Director: Guang Zhe Chen Dirk Reinermann (Acting) Practice Magnus Lindelow Christopher J. Thomas Manager/Manager: Project Team Leader: Sheila Dutta Sheila Dutta ICR Team Leader: Edit V. Velenyi ICR Primary Author: Edit V. Velenyi F. Results Framework Analysis Project Development Objectives (from Project Appraisal Document) The project development objective is to assist the Government of Botswana to increase the coverage, efficiency, and sustainability of targeted and evidence-based HIV/AIDS interventions through (i) strengthening the National AIDS Coordinating Agency's institutional management and coordination capacity; and (ii) financing strategic and innovative HIV/AIDS-related prevention and mitigation activities. This project development objective will be measured by vi utilizing indicators addressing the longer-term planning, implementation, and effectiveness of national and decentralized coordination efforts. Revised Project Development Objectives (as approved by original approving authority) To assist the Government of
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