Transcript Document 7320498

The World Bank’s Support to
HIV/AIDS Programs in Africa
Elizabeth Lule
Manager
ACTafrica
A global view of HIV infection
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HIV/AIDS and DISABILITY
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60 million people live with disability in Africa
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People with disabilities face high risks of HIV infection
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high exposure to sexual violence, coercion and rape because of physical
dependence, life in institutions, lack of legal rights, low education status250M
in ’05 alone
Poor access to HIV information and services
– Low education status, low literacy rates, social and economic obstacles
limit access, lack of physical access to HIV testing and treatment,
misperceptions that disabled people are not sexually active
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Double stigma
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Lack of inclusion and participation in HIV and AIDS policy
formulation and programming
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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 eligibility criteria:
• Strategic approach to HIV/AIDS
– Strategies, but not enough strategic action
• High-level coordinating body
– Too closed, too much command-&-control
• Exceptional implementation measures
– Flow of funds still slower than necessary
• Funding multiple agencies/actors
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MAP Status
29 countries + 4* sub-regional projects
$1.12 billion committed so far
$744 million disbursed
> 50,000 civil society subprojects funded
Laid the groundwork for other donors
2nd phase MAPs prepared in 5 countries – 4
approved and 3 under preparation
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THE MAP
Approved and Pipeline
HIV/AIDS Projects
May 2006
Subregional projects
(approved)
Projects approved
Projects in the pipeline
IDF grants
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MAP structural achievements
• Strengthen national mechanisms
– All countries have national authorities & programs
– Financial, procurement, M&E systems improving
– Harmonization—joint program reviews spreading
– Global Fund building on mechanisms in many cases
• Strengthen civil society involvement
– Financial architecture in place; 40% of money to CS
– Proven viability of decentralized flow
– “Revolutionized” community dialogue on HIV/AIDS
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Support to civil society
• Roughly 40% of overall funds
• Greater involvement in governance
• Over 50,000 subprojects funded
– Large share at community level
– Proven viability of decentralized flow
– Building mechanisms all partners can use
• Combine $ with capacity support
– Kenya: training in financial and project
management, proposal writing, M&E
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Review: What’s working?
• Laying foundations for national action
• Promotes “The Three Ones”
– National leadership, strategy, and M & E
– Joint reviews in Ethiopia, Kenya, Rwanda
– Multi-donor pooled support in Malawi
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Substantial, flexible, streamlined resources
Engaging civil society (unprecedented)
Stimulating multisectoral involvement
New MAPs learning from older MAPs
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Review: What needs work?
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Accelerate implementation (variable)
Strengthen NACs and clarify role
Deepen political commitment
Strengthen public sector response
– Better sector programs; greater MOH engagement
• Simplify civil society procedures
• Use full scope of MAP flexibility (outsource)
• Substantially strengthen M&E (condition?)
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What to add?
• More strategic national frameworks
– Design the program for the local situation
• Link disbursements to performance
• Technical guidance on good practices
• Enlarge civil society involvement to reach
vulnerable groups including disabled
• Accelerate attention to treatment
• More explicit gender dimension
• Focus on vulnerable groups
• And … step up health sector support
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What needs to work for people living
with disabilities
• More analytical work to generate the evidence
base for effective policy dialogue
• Deepen political commitment
• Capacity building for effective advocacy and
participation
• Disseminate tools and good practices of what is
working
• Forge strategic alliances and build coalitions
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www.africacampaign.org
References
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Global Survey on HIV/AIDS and Disability, by Nora Groce, Yale University and World Bank (April 2004)
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The Forgotten Tribe" Persons with Disabilities and HIV/AIDS by Ambrose Murangira, National Union of Disabled Persons,
Uganda (July 2005)
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The Africa Campaign on Disability and HIV & AIDS
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Need to redefine the role of the World Bank for 2007-2011
9000
8000
7000
Avg Price
of ARVs
$7,944-20,224/
Person
per year
6000
5000
4000
3000
G8
PEPFAR
World Bank
MAP
3 by 5
GFATM
Avg Price
2000
of ARVs
$50-200/Person
1000
per year
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005*
* Projected funding
Source: UNAIDS, 2004.
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MUCH MORE NEEDS TO BE DONE
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