Regional : Greater Mekong Subregion Capacity Building for HIV/AIDS Prevention Project

Project Name

Greater Mekong Subregion Capacity Building for HIV/AIDS Prevention Project

Project Number

42179-013

Country / Economy

• Regional
• Lao People's Democratic Republic
• Viet Nam

Project Status

Closed

Project Type / Modality of Assistance

• Grant
• Loan
• Technical Assistance

Source of Funding / Amount

Grant 0312-REG: Greater Mekong Subregion Capacity Building for HIV/AIDS Prevention (LAO/VIE)

Source	Amount
Asian Development Fund	US$ 5.00 million

Loan 2930-REG: Greater Mekong Subregion Capacity Building for HIV/AIDS Prevention Project (LAO/VIE)

Source	Amount
Asian Development Fund	US$ 15.00 million

TA 8204-REG: Regional Capacity Development for Strengthened HIV Response

Source	Amount
Cooperation Fund for Fighting HIV/AIDS in Asia and the Pacific under the Health Financing Partnership Facility	US$ 1.00 million

Strategic Agendas

• Inclusive economic growth
• Regional integration

Drivers of Change

• Gender Equity and Mainstreaming
• Governance and capacity development

Sector / Subsector

• Health / Disease control of communicable disease

Gender

Gender equity theme

Description

The project impact is to contribute to achieving and sustaining the Millennium Development Goal to have halted and begun to reverse the spread of HIV/AIDS in the Lao PDR and Viet Nam. The expected outcome of the project will be increased coverage and quality of services for targeted populations in 23 border provinces. The project has four outputs.

Output 1: Strengthened planning and management capacity at national, provincial, and district levels.

Output 2: Enhanced capacity to provide quality and accessible services to people vulnerable to HIV transmission.

Output 3: Improved access to HIV prevention outreach among target populations in communities and cross-border areas.

Output 4: Effective and sustainable regional collaboration to strengthen HIV response established.

Project Rationale and Linkage to Country/Regional Strategy

The GMS is one of the fast-growing subregions in economic development. GMS investments in transport corridors and trade agreements have improved regional connectivity and integration, thereby attracting more investment and facilitating the movement of people and goods across borders. ADB investment programs continue to give high priority to supporting enhanced connectivity as a driver of continuing the economic development in the GMS. Better regional connectivity and economic integration also increase mobility and migration which contribute to increased HIV risks and vulnerability, especially along newly developed economic corridors with high population mobility. The HIV epidemic in the region is fuelled by high-risk behaviors such as injecting drugs with unsterile equipment, having unprotected sex with multiple and concurrent partners, and through unprotected anal sex, primarily between men.

ADB's GMS and HIV Strategy recognizes that the GMS program and priorities with its focus on connectivity, competitiveness and community clearly intersects with some of the key risk factors and features of the HIV epidemic in the sub-region. Hence, the GMS HIV Strategy articulates that ADB has both an obligation to mitigate the HIV risks associated with transport and other infrastructure and an opportunity, to contribute strategically to the response to HIV and poverty in the sub-region. ADB's Country Strategies and Programs for Lao PDR and Viet Nam emphasize the need for continued support to communicable disease control including the containment and prevention of the spread of HIV in transport and economic corridors.

The proposed Project will address current gaps in HIV prevention and control in reaching high-risk and vulnerable populations, including migrants and mobile populations at higher risk settings along the economic corridors. The aim is to mitigate HIV risks due to increased mobility, migration and rapid economic development. The Project aims to strengthen HIV response systems through improved capacity for planning and management, accessibility and quality of services, awareness and knowledge of target populations along the economic corridors. Particular attention will be given to migrant, mobile and high risk populations along these corridors and border towns.

Impact

Contributed to achieving and sustaining MDG 6a target on HIV/AIDS in the Lao PDR and Viet Nam

Project Outcome

Description of Outcome

Increased coverage and quality of services for targeted populations

Progress Toward Outcome

LAO: The project has achieved one out of two outcome performance targets, which increased the service utilization among target groups.

VIE: The final review mission found that the target increases in the use of HIV/AIDS services (i.e. VCT and ART), community prevention services (i.e. MMT and BCC) by 50%, and PMTCT by 30% have been achieved. On achieving '80% of target populations reached by the project can articulate correct information on HIV transmission and means of prevention , the endline survey showed that 86% of IDU, 68% of EM, and 76% of MMP have good grasp of information on HIV transmission and means of prevention, slightly increased from the baseline survey carried out in Nov 2016.

Implementation Progress

Description of Project Outputs

Strengthened planning and management capacity at national, provincial, and district levels

Enhanced capacity to provide quality and accessible services to people vulnerable to HIV transmission

Improved access to HIV prevention outreach among target populations in communities and cross-border areas

Effective and sustainable regional collaboration to strengthen HIV response established

Status of Implementation Progress (Outputs, Activities, and Issues)

O4: 4 MOU were signed:

" CHAS-VAAC Sep 2014

" Kontum-Attapeu Mar 2014

" Houaphanh-Thanh Hoa-Son La May 2014

" Phongsali-Dien Bien June 2014 (ratified agreement dated Nov 2013)

Regional cooperation focal points were appointed by 2013 and functional by 2014. PCCAs and DCCAs are the focal points.

O4: Joint strategy for regional cooperation 2015-2017 has been finalized on 1 October 2014 and ratified after the Hanoi meeting on 15 October 2014.

Joint strategy were drafted and four joint action plans were prepared between:

" CHAS-VAAC

" Kontum-Attapeu

" Houaphanh-Thanh Hoa-Son La

" Phongsali-Dien Bien

O4: Pilot was planned in 2014/2015 for 4 paired provinces in Vietnam (Thanh Hoa, Kom Tom, Dien Bien, Binh Phuoc), and 3 in Laos. The pilot activities included communication campaign, mass media communication at community (radio), and training in BCC.

In 2016, the implementation was expanded to total 7 provinces in Vietnam (Dien Bien, Son La, Thanh Hoa, Kon Tum, Ha Tinh, Quang Nam, and Quang Tri). c

By December 2016, following activities were implemented:

-Communication training for commune/village leaders: 2,230 people [women: 876 (39.3%) and minority: 1,446 (64.8%)].

-BCC sessions: 302 sessions; estimated 30,567 people attended with of about 24,546 minority people (80.3%); 1,910 mass media communication via loudspeakers.

-Harm reduction:

+ Received needles: 2,324 people [4 women (0.2%), 1,695 EM (72.9%)].

+ Received condoms: 2,884 people [34 women (1.18%), 1,952 EM (67.7%)]

-Number of people counselled and tested: 1,265 [women: 688 (54.4%) and 251 (19.8%)].

O4: " At the provincial level, three paired border provinces were selected for implementation of the MOUs: (i) Attapeu and Kon Tum; (ii) Houaphan and Thanh Hoa and Son La and (iii) Phongsaly and Dien Bien. These provinces have organized annual cross-border collaboration meetings regularly. HIV and AIDS are included in the topics discussed during the meetings.

O4: All paired provinces incorporated cross-border activities into project AOPs in 2016/2017.

O1: Annual operation plans prepared by the provincial health offices follow MOH's standard planning template. HIV prevention and care interventions are systematically integrated into the plans.

With regard to gender sensitivity, AOPs for FY 2014/2015 have been reviewed by the international and national gender consultants recruited in May 2015.

During the workshop in April 2015 on review of progress of the project implementation and preparation of the project AOPs for the year 2015-2016, CHAS presented to PCCAs from the 8 target provinces the project gender and ethnic group action plan and provided recommendations on integration of project activities in the plan.

The national BCC and gender consultants recruited in May 2015 prepared specific integrated activities in the AOPs for FY 2015-2016. This includes mainstreaming gender and ethnic group sensitivity into plans, dissemination of GEGAP and DMF indicators to monitor, review of training and BCC materials, TOTs, conduct awareness activities on HIV/AIDS prevention using gender mainstreaming and ethnic sensitized materials with BCC in target villages.

O2: Mobile clinic services on VCT and STIs for female sex workers, migrants, and truck drivers commenced in April 2015. To date, number of target population reached by mobile clinics increases from 1,978 in 2015 to 3,055 (2,002 or 65% are female) in 2016, and 3,659 (2,614 or 71% are female) in 2017 (as of June 2017).

O2: Update of national guidelines and standard operation procedures for VCT trainers and counsellors, and STI treatment and management guidelines were completed. Related training are complete.

O2: Development of and training on quality assurance tools were complete. The tools are being used for assessing service quality at health facility and mobile clinics.

O3: As of June 2017, a total of 130,648 persons (68,706 or 53% females, 94,106 or 72% from ethnic groups) were reached by peer education activities.

O1: Sex-disaggregated data collection is integrated into the project's monitoring and evaluation system.

CHAS completed training on project management and planning for PCCAs and DCCAs. It also conducted trainings on mapping of target populations and rapid assessment of high risk behaviors. This data is used by DCCAs and PCCAs to prepare annual operational plans with activities directed to these high risk groups.

PMU and CHAS requested in June 2015 PCCAs to provide an update of the high risk populations targeted in each province. The update is provided in Appendix 8 of the quarterly report. High risk populations targeted in each province was updated during the first quarter of 2016. The update in provided in appendix 9 of QR 10. The target population mapped in 2016, subject to revision if necessary, will be the basis for preparation of AOP 2017.

O3: A total of 641 (274 or 42% are women, 396 or 61% from ethnic groups (151 women)) peer educators were recruited from 501 target villages and trained and provided with these BCC materials.

O1: In March 2017, VAAC issues guidelines for development of annual provincial HIV/ AIDS prevention and control plan which include gender-sensitive HIV strategy (i.e. prevention and care for pregnant women). All provinces are required to comply with the strategies stipulated in the guidelines.

O1: 100% of district and province managers (272) completed management training by 2017, including all the female (105) and ethnic minority managers (37).

O1: Competency assessment revealed that the mean scores of provincial and district managers were higher than the minimum standards defined (i.e. 80% of minimum total score based on level-3 responses in all sections) provincial mean score was 724 compared to minimum standards of 451, district mean score was 254 compared to minimum standards of 154.

O2: All health facilities provide HIV services as per provincial plans. As of 2017, 64% of CHS and 89% of DHCs in project districts undertake harm reduction activities; 86% of DHC provide VCT; 55% distribute methadone; PMTCT, care and treatment of AIDS opportunistic infections, and ART were provided at 51%, 45%, and 37.5% of DHC. Less than 40% of district hospitals or regional polyclinics offer any type of HIV services.

O2: As of 31 Dec 2017, 51% of total 12,180 staff trained by the project were female and 26% were ethnic minorities.

O2: Assessment using 9 basic questions testing knowledge of HIV/AIDS care and treatment was conducted for 76 staff. Result shows 92% had at least 7 questions answered correctly (88% for female and 100% for EM staff).

O2: The 11 surveyed district health centers met 44% of the quality criteria established by the project in 2017, and reached 49% in 2018, achieving improvement of 5%.

O3: VIE: By 2018, 56% of ethnic minority people in project districts received at least one BCC session during the past 12 months, of which 56% were female.

O3: VIE: For the 6,000 VHW targeted, 4,702 were trained in BCC technique (78%), among which 60% were female (2,837) and 41% were EM (1,933). 100% of trained VHWs received a BCC kit.

*The project would have achieved if not because of the new regulations restricting use of loans for training.

Geographical Location

Lao People's Democratic Republic - Nation-wide, Attapu, Champasak, Houaphan, Khoueng Bokeo, Khoueng Oudomxai, Khoueng Phongsali, Louangnamtha, Salavan; Viet Nam - Nation-wide, Dak Nong, Gia Lai, Huyen Dien Bien, Kon Tum, Long An, Tinh Binh Phuoc, Tinh Ha Giang, Tinh Ha Tinh, Tinh Lai Chau, Tinh Lao Cai, Tinh Quang Binh, Tinh Quang Nam, Tinh Quang Tri, Tinh Son La, Tinh Thanh Hoa

Safeguard Categories

Environment

C

Involuntary Resettlement

C

Indigenous Peoples

B

Summary of Environmental and Social Aspects

Environmental Aspects

The Project has no expected environmental impact, and does not involve any civil works.

Involuntary Resettlement

The Project did not involve involuntary resettlement.

Indigenous Peoples

The project is classified as category B for indigenous peoples. The project includes a significant proportion of ethnic groups among its beneficiaries, who are among some of the poorest and most marginalized households in the Lao PDR and Viet Nam. The ethnic groups plan ensures ethnic peoples' needs will be analyzed and they will participate in and have access to project benefits.

In Laos, there is an ongoing mapping of risk behaviors and KAP of ethnic groups by gender and age. Thirty-five districts are covered by the mapping survey conducted by CHAS under grant funding in June 2014. The data for monitoring of the proportion of the ethnic people accessing services relative to the total population of the ethnic community and data reported by sex, age and ethnicity as well as type of services was completed in 2014 in 35 districts. The target of 100% participation of provincial, district, and village level ethnic health staff in various trainings is provided by the project. This has already been integrated in 2014 in peer educators' curriculum training.

In Viet Nam, the project has prioritized the involvement of ethnic minority staff in relevant project activities.

Stakeholder Communication, Participation, and Consultation

During Project Design

During project preparation, consultations with key stakeholders were undertaken including for preparing social and poverty analyses.

During Project Implementation

Business Opportunities

Consulting Services

All consultants were recruited according to Guidelines on the Use of Consultants by ADB and its Borrowers (2010, as amended from time to time).

International individual consultants and national individual consultants were engaged in both countries. The executing agencies advertised consulting opportunities through the Consultant Management System at www.adb.org.

Procurement

All procurement of goods and works were undertaken in accordance with ADB Procurement Guidelines (2010, as amended from time to time).

International competitive bidding procedures were used for supply contracts valued more than $1,000,000 for Lao PDR and Viet Nam. National competitive bidding procedures were used for supply contracts valued at less than $1,000,000 for Lao PDR and Viet Nam. Shopping method were used for procurement of contracts of goods worth $100,000 and below. Vehicles were procured from the United Nations Office for Project Services (UNOPS) for Lao PDR.

In Lao PDR, the project procured medical goods consisting of test kits, drugs, condoms and laboratory consumables. In Viet Nam, the project procured medical equipment, basic laboratory equipment and supplies, reagents among others. The project also procured support equipment such as vehicles, computers and printers, audio-visual equipment, and office equipment.

The project closed in 30 June 2018.

Contact

Responsible ADB Officer

Xu, Ye

Responsible ADB Department

Southeast Asia Department

Responsible ADB Division

Human and Social Development Division, SERD

Executing Agencies

Ministry of Health

Timetable

Concept Clearance

18 Aug 2010

Fact Finding

09 Apr 2012 to 23 Apr 2012

MRM

-

Approval

30 Oct 2012

Last Review Mission

-

Last PDS Update

21 Sep 2018

Funding

Grant 0312-REG

Loan 2930-REG

TA 8204-REG