The Global HIV/AIDS Program Of Action

David Wilson

World Bank

2

Regional HIV/AIDS strategies and action plans AFR: Intensifying Action against HIV/AIDS in Africa:

Responding to a Development Crisis, 1999 EAP: Responding to HIV/AIDS in the East Asia and

Pacific Region, 2003 ECA: Averting AIDS Crises in Eastern Europe and

Central Asia, 2003 LAC: HIV/AIDS in the Caribbean: Issues and Options,

2001; HIV/AIDS in Latin America The Challenges Ahead, 2003

MNA: Preventing the Spread of HIV/AIDS in the Middle East and North Africa, 2005

SAR: South Asia HIV/AIDS Business Plan FY04-FY06

3

The Actions …

Enhance & intensify Bank support to client countries for effective prevention, treatment, care and support

Contribute to and complement the work of our partners, consistent with GTT

Scope is Bank-wide, country, regional and global, big enough scale for impact

Activities must be firmly grounded in evidence.

4

The Program of Action responds to: Need to strengthen country programs

Bank’s mandate and comparative advantages

Harmonization, “Three Ones” vision

Changed environment for HIV/AIDS support

Persistent and emerging challenges*

Recommendations of reviews of Bank HIV/AIDS work, lessons of experience*

* More details on ensuing slides

5

World Bank HIV/AIDS projects: the global picture since 1988

1988-1998

Haiti

Rwanda

1999-2005

Both

Dominican RepublicSt Kitts & NevisSt Vincent & the Grenadines CapeTrinidad&Tobago VerGrenada Barbados Jamaica

Burundi

6

Lessons learned The Bank can make a difference

Country ownership, capacity and leadership – crucial to success “Three Ones”

Programs need to be informed by evidence – M&E critical

AIDS - a development issue - integrate into broad development planning processes

Governments, private sector, civil society, PLWHA, communities all have important roles

7

What are the challenges?

8

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

9

AIDS stakeholders and donors in one African country

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

10

The WB Global HIV/AIDS Program of ActionWork closely with partners for stronger, harmonized AIDS responses

Key Action Areas

1. Sustained funding for HIV/AIDS programs & health sector

2. Support stronger strategic, prioritized national planning

3. Accelerate implementation

4. Build monitoring and evaluation systems & capacity

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

11

1. Sustained 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

Supports stronger efforts in other key sectors

Strong commitment to harmonize efforts among donors for better impact

Ensure funding for CSOs and communities

12

Mismatch between funding and infection patterns

0%

20%

40%

60%

80%

100%

Sex workers General population

HIV rate Share of infections involving Share of funding

13

2. 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

14

3. Support to accelerate implementation

Financial and technical support

Adequate funding for supervision

Simplify processes, procedures as needed

Implementation Advisory Service

Joint Problem Solving and Implementation Support Team (GIST)

Ensure CSOs, PLWHA, communities, private sector all play a role as needed

Networks among countries to share solutions, experiences

15

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

16

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

New publication series (a) good practice notes, (b) HIV/AIDS analytic reports

Distribute reports, guidelines etc widely, target potential users

Improve WB AIDS website

17

AIDS Strategy & Action Plan (ASAP) Service

18

Existing Strategies and Annual Action Plans

Strengths Forging high level

commitment Broad range of actions Consultative process and

involvement of various stakeholders

Focus on stigma reduction and egalitarian responses

Limitations• Not always based on

evidence and transmission patterns

• Not prioritized• Limited monitoring and

evaluation• Limited costing• Not translated into

implementable action plans• Not fully inclusive

19

Review of Existing Strategies

Bank review shows evidence base and prioritization weakest - management and costing also weak

Source: World Bank, 2005

86%

43%

29%

57% 57%

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

% o

f S

ati

sfa

cto

ry S

tra

teg

ies

Goals EvidenceBase

Prioritization Mgmnt Costing

20

Origins of ASAP March 2005 Global Task Team (GTT) established to

harmonize donors and improve implementation June 2005 Statement of GTT Sub-Committee on

Programming and Financing: Well elaborated national AIDS strategies and

annual action plans are a prerequisite for successful implementation

Requests from countries for assistance on improving strategies and preparing annual action plans

UNAIDS Division of Labor: WB to lead, on behalf of UNAIDS (ILO, UNDP, UNESCO, UNICEF, WHO and the UNAIDS secretariat as the main partners), in supporting strategic, prioritized, costed national plans

21

Origins of ASAP (cont’d)

GTT August 2005 Implementation Update call for Establishment within the World Bank of a global te

chnical assistance service (ASAP) Development of internationally recognized

standards and criteria/self-assessment tool Thailand Workshop in January 2006

Draft ASAP Business Plan: list of support activities ASAP might usefully offer

Outline for self-assessment tool

22

ASAP Menu of Possible Activities

Support for enhancing national strategies and annual action plans Upgrading existing tools or developing new ones Providing easy access to information and

resources relevant to strategic planning Responding to country requests to review and

comment on strategic plans and annual action plans

Providing or helping countries to access sources of technical assistance

23

ASAP Menu of Possible Activities (cont’d) Knowledge sharing and capacity building

Training in using various planning tools and model Sharing information through workshops, networks of practiti

oners, on-line communities etc Helping to coordinate, harmonize and align effor

ts of different stakeholders Consolidating different sources of advice and guidelines on

various aspects of strategic planning Developing and supporting a process to help ensure wide d

onor support and buy-in to the strategy and annual plan