Transcript The World Bank’s response to HIV/AIDS in Africa: MAP High Level Dialogue on Maximizing Synergies between Health Systems and Global Health Initiatives. Venice, June 22-23 Elizabeth.

The World Bank’s response to
HIV/AIDS in Africa: MAP
High Level Dialogue on Maximizing
Synergies between Health Systems and
Global Health Initiatives.
Venice, June 22-23
Elizabeth Lule
Manager
ACTafrica
World Bank IDA Sector allocations
over time in Africa
(US$ millions, %)
Fiscal year 2006
Fiscal year 2009 (planned)
Fiscal year 2008
368 , 6%
585 , 12%
1,041 , 15%
1,119 , 16%
1,268 , 26%
1,749 , 31%
480 , 7%
2,404 , 42%
1,489 , 32%
491 , 10%
1,654 , 23%
326 , 6%
2,881 , 39%
841 , 15%
953 , 20%
Agriculture
1,041 , 15%
1,119 , 16%
Infrastructure (Energy Mining & Transportation and Water/sanit/flood protection
480 , 7%
Human Development (Education, Health &Social Svcs)
Finance, Industry and Trade
Other (Public admin, Law )
1,654 , 23%
2,881 , 39%
Africa Region
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MAP reflected a long-term World Bank’s
commitment to HIV/AIDS
Phase 1: Emergency response, scale up
existing interventions and build capacity
• Phase 2: Mainstream programs that have
proved effective, gather evidence, apply lessons
learned and strengthen systems
• Phase 3: Focus prevention efforts in areas
where spread of the epidemic continues; scale
up and sustain care, support, and treatment for
people who have developed AIDS
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Africa Strategy 1999 and the WB 2005 Global
Program of Action (GHAP)
1999 Africa Strategy
• Advocacy to intensify action
• Resource mobilization –
internal and external
• Knowledge management
• Mainstreaming
• Capacity building
• Partnerships
2005 GHAP Program of Action
• Assist countries to
– prioritize and cost national
strategies and annual action plans
– integrate HIV/AIDS into the
broader development framework
(PRSP, MTEF)
– mainstream HIV/AIDS in other
sectors
• Fund HIV/AIDS programs, groups,
activities not funded by others and
health systems
• Accelerate implementation
• Results focused (M&E)
• Analysis and knowledge sharing
• Partnerships
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MAP Status
33 countries + 5 sub-regional projects
$1.83 billion committed so far
$ 1.3 billion disbursed since 2001
> 50,000 civil society subprojects funded
Laid the groundwork for other donors
2nd phase MAPs prepared in 11 countries countries
countries
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Multi-Sectoral Use of Funds
Project Components
Estimated Percentage of Financing
Civil society
38%
Ministry of Health
17%
Other Ministries
13%
Capacity Building
11%
Monitoring and
Evaluation
4%
Program Coordination
10%
Other
7%
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Country Challenges – persistent and emerging
• National HIV/AIDS planning not strategic or prioritized
• Stigma & discrimination, denial, silence persist
• Prevention, care & treatment efforts are too small, coverage is
too low, and resource allocation dilemmas persist
• Absorptive capacity low because of management, HR, and
implementation constraints
• Lack of transparency, accountability and corruption
• Investment in health system infrastructure are inadequate
• Scaling up access to treatment raises issues of: equity,
financial sustainability, fiscal space, adherence, human
resource needs
• Weak M&E and limited impact evaluation
• Weak donor coordination and priorities
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AIDS stakeholders and donors in one African country
CIDA
GTZ
WHO
UNAIDS
RNE
Norad
Sida
USAID
US$
50M
CF
T-MAP
CCM
MOF
UNTG
DAC
US$ 60M
US$290 M
GFCC
P
MOH
HSSP
PMO
PRSP
MOEC
SWAP
NCTP
CTU
US$200M
LOCALGVT
UNICEF
WB
PEPFAR
GFATM
INT NGO
3/5
CIVIL SOCIETY
CCAIDS
NACP
PRIVATE SECTOR
Lessons Learned
 Political and sectoral commitment is key
 Donor collaboration and coordination, led and owned by
national authorities is vital
 Strengthening country capacity in governance and
accountability, coordination and implementation required
 Countries must know the drivers of their epidemic,
address gender inequalities, and engage civil society
 Need to show results/impact and build M&E capacity
 Integration of HIV/AIDS in national planning is critical
 Cross border approaches to address the “public good”
nature of the epidemics are needed
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Current Crisis Suggests Potential for Slowdown
Progress Toward the MDGs
• Financial crisis is trapping up to 53 million more people into
poverty (<$2 per day)
• This is on top of the 130-153 million already pushed into poverty
as a result of the food and fuel price increases in 2008
• Additional 44 million malnourished individuals
• Slower growth rates will slow progress in reducing IMR
– 200,000 to 400,000 additional children may die every year
– Up to 1.4 to 2.8 million more infant deaths by 2015 if crisis persists
• Progress on MDGs affected by:
– Reduction in income and spending on food, health, human K
– Governments’ ability to finance and deliver social services affected
• Reliance on ODA; devaluation of currency; real expenditure
declines
Agenda for Action’s Strategic Pillars
The Agenda for Action reaffirms the Bank's commitment to
devote resources and remain actively engaged in supporting
countries to achieve MDG 6.
The Agenda for Action is structured around four Pillars:
 Pillar 1: Focus the response through evidence based and prioritized
national HIV/AIDS strategies integrated in national development
planning
 Pillar 2: Scale-up targeted multi-sectoral and civil society responses
 Pillar 3: Deliver effective results through increased country M&E
capacity and strengthened national and health systems
 Pillar 4: Harmonize donor collaboration and knowledge sharing
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What the World Bank is Doing
• Ensure women, newborns, and children are given a high
priority
• Focus on nutrition and MDG 1c
• Promoting and supporting effective pro-poor policies and
programs including financial protection strategies
• Supporting and strengthening health systems in the poorest
countries and sustaining support to communicable diseases
• Promoting efficiency gains and making overall efforts effective
Bank’s Africa HIV/AIDS Agenda for Action: Linking Objectives to Results
Strategic Objectives
Strengthened long-term, sustainable national
HIV/AIDS response
Accelerated Implementation of HIV/AIDS
programs




Strengthened national and health systems

Improved Donor Coordination


Learning and Knowledge Sharing

Anticipated Results
At least $250 million annually committed to
HIV/AIDS including IDA, IBRD, PRSCs, ACGF,
IDF and other Trust Funds.
Making other donors’ money work.
HIV/AIDS integrated in Bank lending and nonlending activities in priority sectors depending upon
country context, and with special attention to
vulnerable groups and Southern Africa.
Countries have functional, harmonized M&E
systems, and strengthened human resources and
fiduciary capacity, procurement and supply chain
management.
More efficient, effective and sustainable HIV/AIDS
resource allocation
Countries lead joint annual national program
reviews and planning with donors adhering to
national processes.
Incentive Fund actively supports knowledge
generation and sharing.
Countries and partners fully engaged in knowledge
generation and sharing.
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Bank Lending and Grants Focused on
MDGs (4,5,6,1c):
• HNP Strategy emphasizes results, pro-poor focus, health systems
strengthening and monitoring.
• Health Systems for the Health MDGs in Africa
– Launched in 2008
– Focus on 14 IHP+ countries
– Increasing on-the-ground technical assistance and coordination
for HSS
– Two regional hubs (Dakar and Nairobi) established
– Recruitment of 10 high level HSS experts
– Implemented in strong partnership with HHA, H8
Bank Lending and Sector Work
•
Results-based Financing (RBF for Health)
– 2008 - 2012
– Tied to IDA
– Pilot projects in 8 countries: Zambia, Rwanda, Eritrea, Afghanistan, DR
Congo, Benin, Ghana, and Kyrgyz Republic
– Focus on performance-based incentives to health workers, district
managers, and conditional cash payments to households
– Many pilots focusing on mechanisms to improve quality and increase
utilization of institutional deliveries
– All pro-poor focused
– Large impact evaluation component and assessment of costeffectciveness (learning and evidence building)
– MDTF: Support
Bank Lending and Sector Work
•
Continued health system strengthening as the ground floor upon which all of
the benefits of other investments can be made
– Ensure budget expenditures targeting the poor remain
– Assure essential drugs and commodities
– Support HR strategies to ensure adequate numbers and distribution of staff
– Strengthen and support insurance and risk pooling mechanisms
– Governance
– HMIS
•
Nutrition
– Ambitious agenda of scaling up nutrition portfolio
– Focus on Africa and SE Asia, some LAC
– Additional staffing for regions
Africa HNP: Strengthening Health Systems for
Outcomes
Africa HNP strategy: Achieving the MDGs
through Strengthening Health Systems ….
Upstream
diagnostic
Policy
Financing Projects
dialogue
and Programs
Health systems
MDGs
Nutrition (MDG1)
Country
Status
Report on
Health,
Poverty,
Health
systems
and the
MDGs
One
country,
costed
plan for
country
support
ed by all
partners
(IHP+)
Focused funds:,
Malaria Booster,
HIV/AIDS,
Tuberculosis etc.
Bank operations:
problem specific
and health system
focused (eg:
SWAPs)
Joint BankPartners
Programs (eg:
Results-based
financing)
Human
Resources For
Health
Pharmaceuticals
Governance and
Service Delivery
Public finance
and health
insurance
Infrastructure
and ICT
Child health
(MDG4)
Maternal Health
and mortality
(MDG5)
Malaria,AIDS, TB,
prevalence and
mortality (MDG6)
Financial
protection
Non
Communicable
Diseases
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Strategic Challenges: Tensions and Trade Offs
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Fiscal sustainability versus promise of universal access
Short tem results versus long term results
Health sector response versus multisectoral response
Project approach versus budget/program support
Integration of HIV, TB, SRH, nutrition and other health
issues versus vertical units within MOH
Accountability and effectiveness versus attribution
Measuring Outputs/trends versus measuring outcomes
and impact
Balancing investments between the public sector, private
sector or community response
Supply versus demand
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Now to Action
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