CCIH Annual Conference May 24-26, 2008

World Bank Roles, Issues

Katherine Marshall

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World Bank support for HIV and AIDS

is set in the context of The changing global HIV/AIDS landscape.. Changing roles and challenges for the

World Bank And the complex institutional setting at

global, regional and national levels Bank role involves finance, policy, research,

advocacy, and aid coordination It is closely tied to development issues and

challenges

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The AIDS epidemic is still growing

Source: UNAIDS/WHO, 2004.

People with HIV/AIDS, Cumulative Regional Totals

0

5

10

15

20

25

30

35

40

45

1986 1988 1990 1992 1994 1995 1998 2000 2002 2004

Sub-Saharan Africa Asia Latin AmericaEurope & N. America* Eastern Europe & Central Asia North Africa & Middle EastCaribbean

*Western and Central Europe & North America.

Millions

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Much higher global funding for HIV/AIDS is available (US$ millions)

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005*

World Bank MAP

GFATM

3 by 5PEPFAR

G8

Avg Price of ARVs

$7,944-20,224/Person per year

Avg Price of ARVs

$50-200/Person per year

* Projected fundingSource: UNAIDS, 2004.

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But resources available still fall far short of estimated needs

$8.3 $8.9 $10.0

$3.3$6.0

$12.1

2005 2006 2008

Resource Available Gap

$11.6 billion $14.9 billion $22.1 billion

Source: The Henry J. Kaiser Family Foundation (www.kff.org) Original source UNAIDS

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Much has been learned from experience: the dynamic picture

Country ownership, capacity and leadership are crucial to success

hence: the “Three Ones” Principles guiding efforts. AIDS Programs need to be informed by evidence – M&E

is critical. Much still to be done. AIDS response must be more strategic, more carefully

tailored to local epidemic pattern. Governments, private sector, civil society, PLWHA,

communities, etc. all have important roles; but plenty of questions about how to orchestrate

MOH MOEC

MOFPMO

PRIVATE SECTORCIVIL SOCIETYLOCALGVT

NACP

CTUCCAIDS

INT NGO

PEPFAR

Norad

CIDA

RNE

GTZ

Sida WBUNICEF

UNAIDSWHO

CF

GFATM

USAID

NCTPNCTP

HSSP

HSSP

GFCCP

GFCCP

DAC

CCM

T-MAP

3/5

SWAPSWAP

UNTG

PRSP PRSP

US$200M

US$290 M

US$ 50M

US$ 60M

Complex Environment for SupportAIDS stakeholders and donors in one African country

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Some important changes

New and emerging development agendas, budget support, HIPC and other instruments; but HIV/AIDS not adequately integrated in development agendas

Other emerging priorities, vertical Programs (Avian Flu etc)

Imbalance between treatment, care and support and prevention

Feminization of the epidemic Agreement on need for the “’Three Ones” and

Universal Access, but….

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Challenges – persistent and emerging

National HIV/AIDS planning not strategic, prioritized Prevention, care & treatment efforts are too small,

coverage is too low Management and implementation constraints Health systems weak, overwhelmed Expanding access to treatment raises issues:

equity, sustainability, adherence, health systems Prevention, prevention, prevention Stigma & discrimination, denial, silence persist Donors could do better

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The World Bank Global HIV/AIDS Program of Action

Key Action Areas

1. Support stronger strategic, prioritized national planning

2. Sustained, flexible funding for HIV/AIDS programs & health sector

3. Accelerate implementation

4. Build monitoring and evaluation systems & capacity

5. Impact evaluation and analytic work to improve HIV/AIDS knowledge and improve programs

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1. Help countries to strengthenstrategic, prioritized national planning Training and “hands-on” technical support

HIV/AIDS to be better integrated in national development planning processes (PRSP, CAS, MTEF)

Programs and planning to be evidence-informed Guidelines, good practice notes Support a network of country practitioners to share

expertise Synthesis papers on national HIV/AIDS epidemiology

and optimal responses to match

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Avoid mismatches between funding and infection patterns like this:

0%

20%

40%

60%

80%

100%

Sex workers General population

HIV rate Share of infections involving Share of funding

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2. Sustain funding for effective HIV/AIDS programs & to strengthen health systems

Bank will remain a major funder, flexibly funding countries and activities others cannot fund

Long-term funding to strengthen health sectors crucial for HIV/AIDS response and other health goals

Support stronger efforts in other key sectors

Strong commitment to harmonize efforts among donors for better impact

Ensure funding for CSOs and communities

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3. Support to accelerate implementation, and close the gap HIV/AIDS: Annual Needs, Commitments

and Disbursements (US$ Billion)

0

2

4

6

8

10

12

14

16

Com. Disb. Needs

World Bank MAP

GFATM

PEPFAR

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4. Build country monitoring and evaluation capacity and systems, so that evidence informs responses GAMET country support team continue to provide

intensive practical field support Develop/strengthen national M & E frameworks Guidelines, for national M&E systems Good practice examples Global, regional, and national M&E training – goal:

strong national M&E expertise More impact evaluation Support better use of data to improve programs

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5. Generate, share and use knowledge. Do more impact evaluation and analysis

Do more impact evaluations of Bank support With others, carry out new analysis in key cross-

cutting cross-country areas (e.g. poverty, finance) and country-specific AAA

Publication series (a) “Getting Results” notes, (b) HIV/AIDS analytic reports

Distribute reports, guidelines etc widely, target potential users

Improve WB AIDS website

Some Numbers on The World Bank and HIV/AIDS Major response for Africa launched in 1999: MAP focused on national strategies,

governance structures, and systems for fiduciary and monitoring and evaluation, a multisectoral response, focusing on HIV/AIDS as a development issue, engaging local communities and the private sector.

To date, the Bank has provided US$1.5 billion for HIV/AIDS programs in over 30 countries, including 29 Multi-country HIV/AIDS Program for Africa (MAP) countries and 5 sub-regional projects to address cross-border issues.

Global funding for AIDS programs has grown dramatically from US$1.6 billion in 2001 to $US 9.9 billion in 2007, mainly from The Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

All IDA countries in good standing have MAP projects approved. MAP performance has accelerated steadily and has disbursed over $1 billion. Mobilization of civil society has been especially promising: the MAP has supported nearly 50,000 civil society groups. Several repeater MAPs are have been approved or are under preparation.

Virtually all funding is grants, not loans The overall development objective of the MAP is to dramatically increase access to

HIV/AIDS prevention, care, and treatment programs, with emphasis on vulnerable groups (such as youth, women of childbearing age, and other groups at high risk).

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