Document of The World Bank Public Disclosure Authorized Report No. 16459 - SE STAFF APPRAISAL REPORT REPUBLIC OF SENEGAL Public Disclosure Authorized ENDEMIC DISEASE CONTROL PROJECT April 11, 1997 Public Disclosure Authorized Iluman Development 2 Public Disclosure Authorized Africa Region CURRENCY EQUIVALENTS Currency Unit: CFA Franc (CFAF) US$1 = CFAF500 (March 1997) ABBREVIATIONS AND ACRONYMS AGETIP Agence d'Execution des Travaux d'Inter6t Public contre le Sous-en7ploi (Contract Management Agency) AIDS Acquired Immune Deficiency Syndrome BRH Brigade Regionale d'Hygiene (Regional Hygiene Unit) CFA ComnmunauteFinanciere Africaine (African Financial Community) DAGE Direction de I 'Administration et de I 'Equipement (Administration and Equipment Directorate) DALYs Disability-Adjusted Life Years DSTAT Division des Statistiques (Statistics Division) DHSP Direction de l'llygiene et de la Sante Publique (Hygiene and Public Health Directorate) EU European Union FAC Fonds d'Aide crla C'oop&ration(French Cooperation) GDP Gross domestic product IDA International Development Association IEC Information, Education and Communication ICB International Competitive Bidding MRA Medical Region Administration MSPAS Ministere de Ia Sante Publique et de I 'Action Sociale (Ministry of Public Health and Social Affairs) OCP Onchocerciasis Control Program OMVS Organisation pour la Mise en Valeur du Fleuve Senegal (Organization for the Development of the Senegal River) PNA Pharmacie Nationale d'Approvisionnement (Central Pharmaceutical Procurement Agency) SA Special Account SSA Sub-Saharan Africa SGE Secteur des Grandes Endemies (Regional Endemic Disease Control Unit) SIG Systeme d'Information aidesfins de Gestion (Health Information System) SIP Health Sector Investment Project SNGE Service National des (GrandesEndemies (National Endemic Disease Service) STD Sexually Transmitted Disease UNICEF United Nations Children Fund USAID U.S. Agency for International Development VHW Village Health Worker WHO World Health Organization FISCAL YEAR January 1 - December 31 Vice President : Jean-Louis Sarbib Director : Mahmood A. Ayub Technical Manager : Ok Pannenborg Task Team Leader : Yves Genevier REPUBLIC OF SENEGAL ENDEMIC DISEASE CONTROL PROJECT CONTENTS BASIC DATA AND COMPARATIVE INDICATORS CREDIT AND PROJECT SUMMARY ...................................................... i 1. INTRODUCTION ....................................................... 1 2. THE CONTEXT...................................................... .I A. DEVELOPMENTCONTEXT ....................................................... 1 B. SECTORALCONTEXT ....................................................... 3 C. ISSUES....................................................... 7 D. GOVERNMENTPOLICIES AND ACTIONSAND THE BANK'S EXPERIENCE................................................... 8 3. THE PROJECT...................................................... 10 A. PROJECTOBJECTIVES AND STRATEGY...................................................... 10 B. PROJECTDESCRIPTION ...................................................... I I C. PROJECTCOST ANDFINANCING ...................................................... 19 4. PROJECT IMPLEMENTATION...................................................... 20 A. STATU1SOF PROJECTPREPARATION AND READINESS ...................................................... 20 B. PROJECTCOORDINATION AND MANAGEMENT ...................................................... 20 C. MONITORINGAND EVALUATION ...................................................... 21 D. PROCUREMENTAND DISBURSEMENT ...................................................... 22 E. ACCOUNTING,AUDITING AND REPORTING ...................................................... 25 5. PROJECT BENEFITS AND RISKS...................................................... 26 6. AGREEMENTS REACHED AND RECOMMENDATION ...................................................... 27 ANNEX I PROJECT LOGICAL FRAMEWORK & INDICATORS ANNEX 2 LETTER OF SUB-SECTOR POLICY ANNEX 3 MALARIA ANNEX 4 SCHISTOSOMIASIS ANNEX 5 ONCHOCERCIASIS ANNEX 6 HEALTH MANAGEMENT INFORMATION SYSTEM (SIG) ANNEX 7 NATIONAL ENDEMIC DISEASE SERVICE (SNGE) ANNEX 8 ECONOMIC ANALYSIS ANNEX 9 SUPERVISION PLAN ANNEX 10 PROCUREMENT PLAN ANNEX 11 PROJECT COSTS ANNEX 12 SELECTED DOCUMENTS & DATA IN PROJECT FILE This report is based on the findingsof an appraisalmission carried out in Senegalin December1996 by Mr. YvesGenevier (TaskManager), Mr. AlassaneDiawara (Resident Mission), Slaheddine Ben-Halima (Procurement specialist), and Dr. Jose Najera (Consultant)and has been the object of a DecisionMeeting, chaired by Mr. MahmoodAyub on January30, 1997. The project preparationhas alsobenefitted from consultation,review, and technicalwork from Dr. BemardLiese, Lead Advisor; Mr. ArminFidler, Peer Reviewer;Mr. FlorentAgueh; Mr. BernardAbeille, Procurement Specialist; Ms. MyrinaMcCullough, ProgramAssistant, and Ms. BronaghMurphy, Editor. REPUBLIC OF SENEGAL ENDEMIC DISEASE CONTROLPROJECT BASICDATA AND COMPARATIVEINDICATORS Sub-Saharan POVERTYand SOCLAL Senegal Africa Low-income Population mid-1995 (millions) 8.5 589 3,188 GNP per capita 1995 (US$) 570 490 460 GNP 1995 (billions US$) 4.8 289 1,466 Average annual growth, 1990-1995 Population (%) 2.7 2.8 1.8 Labor force (%) 2.6 2.8 1.9 Most recent estimate (latest year available since 1989) Poverty: headcount index (% of population) Urban population (% of total population) 42 31 29 Life expectancy at birth (years) 50 52 63 Infant mortality (per 1,000 live births) 62 92 58 Child malnutrition (% of children under 5) 20 .. 38 Access to safe water (% of population) 51 47 75 Illiteracy (% of population 15+) 67 43 34 Gross primary enrollment (% of school-age population) 56 71 105 Male 67 77 112 Female 50 64 98 Development dlamond' Life expectancy GNP Gross per - - primary capita enrollment Accessto safewater Senegal Low-incomegroup REPUBLIC OF SENEGAL ENDEMIC DISEASE CONTROL PROJECT CREDITAND PROJECTSUMMARY Borrower: Republic of Senegal Implementing Agency: Ministry of Public Health and Social Affairs (MSPAS) Beneficiaries: Not applicable Poverty Category: Not directly applicable Amount: SDR10.8 million (US$14.9 million equivalent) Terms: Standard IDA terms with 40 years maturity Financing Plan: IDA :US$14.9 million EU :US$0.3 million FAC :US$0.7 million WHO :US$0.1 million UNICEF :US$0.l million Government :US$0.9 million Staff Appraisal Report: Report No. 16459 Map: IBRD No. 28634 Project lID: SN-PE-41567 Project Description 1. For every population cohort in Senegal, infectious diseases are the main cause of mortality and morbidity, with malaria, respiratory infections and diarrhea being most prevalent. In recent years, there has been a recrudescence of epidemic diseases such as cholera, a steady increase of endemic diseases such as malaria, schistosomiasis, onchocerciasis and hepatitis B, and the emergence of new viral diseases such as AIDS. 2. The organization of endemic and epidemic diseases surveillance and control is the responsibility of the Endemic Disease Control sub-DirectorateService National des Grandes Endemies (SNGE). Over the past 20 years, the resources allocated to the SNGE have steadily decreased to 1 percent of the Ministerial budget. Surveillance and control activities have been mainly supported by the donor community, with a project-by-project and donor-by-donor approach. The capability and organization of the SNGE as a team have progressively deteriorated, undermining the effectiveness and motivation of its staff. Furthermore, knowledge of the epidemiological situation in the country has decreased in the absence of an effective and communicative health management information system, leaving no opportunity for prevention or proactive measures. 3. The project was born from the dialogue between Government and IDA about the New Orientations of the Health and Social Sector Policy (Nouvelles Orientations de la Politique de ii Sante et d'Action Sociale) defined in June 1995, and was developed during a series of consultative meetings organized by the Government over an 18-month period. Participants in these meetings were drawn from all stakeholder groups, including district and regional medical staff, from the medical university, and partners in development for Senegal. 4. The long-term objective of the project is to strengthen national capacity to control endemic and epidemic diseases, with greater concern for rationalization in the use of resources and cost-effectiveness in the choice of control stategy. Project strategy consists in institutionally strengthening the SNGE, supporting its efforts to control, in particular, three diseases of public health importance, i.e. malaria, schistosomiasis and onchocerciasis, and implementing a computerized health management information system. The project design includes three main components: (a) support to malaria, schistosomiasis and onchocerciasis control activities, (b) development of a computerized health management information system; and (c) institutional strengthening of the SNGE. Project Benefits 5. By reducing the burden of malaria, schistosomiasis and onchocerciasis, the project will directly benefit the populations in rural areas where these diseases are most prevalent. As a result of the reinforcement of national capacities to control endemic and epidemic diseases, the project will also significantly benefit people in poor urban areas who have been severely hit by recent epidemics of cholera, and who are still at high risk from other epidemics such as cerebral meningitis. The social