ccih annual conference may 24-26, 2008 world bank roles, issues katherine marshall 1
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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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