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The World Bank’s Support to HIV/AIDS Programs in Africa. Elizabeth Lule Manager ACTafrica. A global view of HIV infection. 2. HIV/AIDS and DISABILITY. 60 million people live with disability in Africa People with disabilities face high risks of HIV infection - PowerPoint PPT Presentation
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Elizabeth LuleManager
ACTafrica
The World Bank’s Support to HIV/AIDS Programs in Africa
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A global view of HIV infection
2
3
HIV/AIDS and DISABILITY• 60 million people live with disability in Africa
• People with disabilities face high risks of HIV infection
– 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
• Double stigma
• Lack of inclusion and participation in HIV and AIDS policy formulation and programming
4
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
5
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 Status29 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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Projects approved
Approved and PipelineApproved and PipelineHIV/AIDS ProjectsHIV/AIDS ProjectsMay 2006May 2006
Projects in the pipeline
IDF grants
Subregional projects (approved)
THE MAP
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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
• 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?
• 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
– www.africacampaign.org
References– Global Survey on HIV/AIDS and Disability, by Nora Groce, Yale University and World Bank (April 2004)– The Forgotten Tribe" Persons with Disabilities and HIV/AIDS by Ambrose Murangira, National Union of Disabled Persons,
Uganda (July 2005)– The Africa Campaign on Disability and HIV & AIDS
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Need to redefine the role of the World Bank for 2007-2011
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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MUCH MORE NEEDS TO BE DONE