Project appraisal document on a proposed loan in the amount of US $150 million to the Russian Federation for a tuberculosis and AIDS control project

Project development objective: The project objectives are to (i)contain the growth of the epidemics of tuberculosis(TB) and HIV/AIDS in the short term and (ii) halt and reverse the courses of these epidemics in the medium term. The achievement of these objectives will protect the Russian population and economy from uncontrolled epidemics of TB, HIV/AIDS and other epidemiologically important sexually transmitted infections (STIs). The project will enable the Russian Federation to achieve these objectives in the context of the larger Federal Target Project Program, "Prevention and Control of Social Diseases, 2002-2006", by using evidence-based approaches to support the following on a large-scale: (i) the control of TB through enhanced policies, surveillance, diagnosis, treatment and effective management; (ii) the control of HIV/AIDS through effective policies, surveillance, program development and interventions for prevention and care; and (iii) the surveillance, diagnosis and treatment of STIs. Russia has a unique combination of characteristics that render decision making in the health system very complex. On the one hand, it is a global power, being a member of the Group of Eight highly industrialized countries and a permanent member of the United Nations Security Council. On the other hand, it has a fast-growing epidemic of HIV/AIDS, a large burden of TB as in some countries that are much poorer, and a strong legacy of health services in the Soviet model, which is often at odds with contemporary approaches to evidence-based control of infectious diseases. These factors have contributed to a tension between a need for evidence-based disease control and traditional practices of doubtful effectiveness or potential harmfulness. This tension resulted in delays in project preparation. More details of the difficult history of the project and the political economy of TB and AIDS control are presented in Section B.2 (Main Sector Issues and Government Strategy) and Section D (Project Rationale). As a result of this context, the project concept and design stress the local development of Russian strategies and programs, not pre-packaged protocols, with the understanding that those Russian strategies and standards will be based on credible scientific evidence as documented in the international literature and WHO guidelines. This combination of substance and process will help to ensure project effectiveness while securing Russian ownership of the process. The project will support the Government's Federal Target Program, "Prevention and Control of Social Diseases, 2002-2006". With reference to the control of TB, the technical aspects of components to be supported by this Project will be based on the outcomes of ongoing consultations between the Ministry of Health (MOH) of the Russian Federation and the World Health Organization (WHO) on a set of evidence-based guidelines for diagnosis, treatment and surveillance. The main elements of the Government's Program are outlined in Section on "Strategic Context" 2.2.3, on
"Federal level response." The project objectives are designed specifically for Russia. In a broader context, they are also consistent with the Millennium Development Goals Target Number 7 whose goal is to have halted and begun to reverse the spread of HIV/AlDS by 2015
(http://sima.worldbank.org/mdg/NewFrame/goal-6.htm).

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