Elizabeth Lule Manager ACTafrica

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What Role Should the World Bank Play in HIV/AIDS Campaign in Africa 2007-2011. Elizabeth Lule Manager ACTafrica. Consultation with Key Stakeholders August 13, 2006 Toronto, Canada. A global view of HIV infection. 2. 50. 40. 30. 20. 10. 0. 1986. 1988. 1990. 1992. 1994. - PowerPoint PPT Presentation

Text of Elizabeth Lule Manager ACTafrica

  • Elizabeth Lule

    Manager

    ACTafrica

    What Role Should the World Bank Play in HIV/AIDS Campaign in Africa 2007-2011

    Consultation with Key Stakeholders

    August 13, 2006 Toronto, Canada

  • 2

    A global view of HIV infection

  • The Diverse Epidemics

    Manzini

    Kampala

    Dakar

    0

    10

    20

    30

    40

    50

    1986

    1988

    1990

    1992

    1994

    1996

    1998

    2000

    2002

    2004

  • Much Higher Global Funding for HIV/AIDS (US$ millions)

    World Bank

    MAP

    GFATM

    3 by 5

    PEPFAR

    G8

    Avg Price

    of ARVs

    $7,944-20,224/

    Person

    per year

    Avg Price

    of ARVs

    $50-200/Person

    per year

    * Projected funding

    Source: UNAIDS, 2004.

  • Much lower ARV prices and more emphasis on expanding access to treatment
    e.g. Uganda 19982003, first line ARV, US$/year

    Source: UNAIDS/WHO, 2004.

    2 000

    4 000

    6 000

    8 000

    10 000

    12 000

    14 000

    0

    Price US$

    Jun

    00

    Oct

    00

    Feb

    01

    Apr

    01

    Dec

    00

    Nov

    00

    Jul

    01

    Mar

    03

    Sep

    98

    Aug

    98

    Jul

    98

    Oct

    03

    Jun

    98

    Sep

    03

    Jan

    01

    May

    01

    Aug

    01

    Mar

    10

    Jun

    01

    Accelerating Access Initiative

    Generic companies start production

    Further price reductions

    Further price reductions

    Negotiations by Clinton

    Foundation

    Comments from Nadeem talk about universal access to provention as well

  • Resources Available Compared to Estimated Need

    $11.6 billion

    $14.9 billion

    $22.1 billion

    Source: The Henry J. Kaiser Family Foundation (www.kff.org) Original source UNAIDS

  • MAP Status Update

    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

  • World Bank Funds

    Project Thematic AreasEstimated PercentageEstimated millions US$Prevention35%455.52Care and Treatment22%283.88Mitigation (OVC)13%165.05Advocacy14%178.25Monitoring and Evaluation4%52.81Other 14%184.85Total100%1,320.36
  • Multi-Sectoral Use of Funds

    Project ComponentsEstimated Percentage of FinancingEstimated overall allocationCivil society38%501.74Ministry of Health17%224.46Other Ministries13%171.65Capacity Building11%145.24Monitoring and Evaluation4%52.81Program Coordination10%132.04Other7%92.43
  • Sources of HIV Spending in Three Countries

    US$ 1.87

    HIV and AIDS spending per capita

    US$ 0.59

    US$ 0.28

    World Bank loan 27%

    All donors

    14%

    Public 86%

    Public 9%

    Global Fund

    9%

    Bilateral

    35%

    World Bank

    credit 32%

    Multilateral

    (excluding GF)

    15%

    Bilateral

    32%

    Public

    36%

    Global Fund 2%

    Multilateral

    (excluding GF)

    3%

    India

    Russian

    Federation

    Burkina Faso

    10.11

    Source: UNAIDS, based on National AIDS Spending Assessments.

  • Trends in HIV and AIDS per-capita expenditures in
    current US$, selected sub-Saharan countries

    0.22

    0.65

    0.31

    0.15

    0.49

    0.0

    0.1

    0.2

    0.3

    0.4

    0.5

    0.6

    0.7

    0.8

    0.9

    1.0

    2001

    2002

    2003

    2004

    2005

    HIV

    per capita

    spending

    (US$)

    Sources: Countries reporting on UNGASS on domestic public expenditure; UNAIDS estimates

    11.3

  • What has changed from 2000 to date?

    Many more players since 2000Regional variations and diverse epidemicsMore resources but unpredictable, conditional, ideological and funding gaps persistHealth systems, supply chains, and infrastructure are overwhelmed with program demands of multiple diseasesHuman Resource crisis more criticalUse of Line 2 ARVs may increase and costs remain too high
  • What has changed (2)

    New and emerging development agendas, budget support, HIPC and other instruments but HIV/AIDS not adequately integrated in development agendasOther emerging priorities (Avian Flu)Imbalance between treatment, care and support and prevention Feminization of the epidemicThe Three Ones and Universal AccessNew World Bank Global Program of Action in 2005
  • Country Challenges persistent and emerging

    National HIV/AIDS planning not strategic or prioritizedStigma & discrimination, denial, silence persistPrevention, care & treatment efforts are too small, coverage is too low, and resource allocation dilemmas persistAbsorptive capacity low because of management, HR, and implementation constraintsLack of transparency, accountability and corruptionInvestment in health system infrastructure are inadequateScaling up access to treatment raises issues of: equity, financial sustainability, fiscal space, adherence, human resource needsDonor coordination and priorities
  • AIDS stakeholders and donors in one African country

    MOH

    MOEC

    MOF

    PMO

    PRIVATE SECTOR

    CIVIL SOCIETY

    LOCALGVT

    NACP

    CTU

    CCAIDS

    INT NGO

    PEPFAR

    Norad

    CIDA

    RNE

    GTZ

    Sida

    WB

    UNICEF

    UNAIDS

    WHO

    CF

    GFATM

    USAID

    NCTP

    HSSP

    GFCCP

    DAC

    CCM

    T-MAP

    3/5

    SWAP

    UNTG

    PRSP

    US$200M

    US$290 M

    US$ 50M

    US$ 60M

  • Africa Strategy 1999 and the WB 2005 Global Program of Action (GHAP)

    1999 Africa Strategy

    Advocacy to intensify action Resource mobilization internal and externalKnowledge management MainstreamingCapacity buildingPartnerships

    2005 GHAP Program of Action

    Assist countries to prioritize and cost national strategies and annual action plansintegrate HIV/AIDS into the broader development framework (PRSP, MTEF)mainstream HIV/AIDS in other sectorsFund HIV/AIDS programs, groups, activities not funded by others and health systemsAccelerate implementationResults focused (M&E)Analysis and knowledge sharingPartnerships

    29 countries + 4* sub-regional projects

    $1.12 billion committed so far

    $625 million disbursed$250M in 05 alone

    > 50,000 civil society subprojects funded

    Interim Review led to strong Board agreement to stay the course, mainstream MAP and step up sub-regionals

    Repeater MAPs prepared in 5 countries 3 approved, 2 scheduled for Board approval in March 2006

  • Strategic Challenges: Tensions and Trade Offs

    Fiscal sustainability versus promise of universal accessVertical programs versus horizontal spendingGrant funding versus credit fundingHealth sector response versus multisectoral responseProject approach versus budget supportIntegration of HIV, TB, SRH and other health issuesAccountability and effectivenessBalancing investments between the public sector, private sector or community response
  • Objectives of the World Bank Africa HIV/AIDS Agenda for Action

    Reaffirm the Banks commitment to long term vigorous support for HIV/AIDS control in AfricaArticulate the Banks role and comparative advantage in a harmonized international program of supportIdentify priority interventions for the next generation of activity based on evidence of success and lessons of experienceIdentify the role of the Bank to fill financing gaps, in non-lending activities, TA and analytical work, capacity building and mainstreaming HIV/AIDS in other sectors
  • What role should the World Bank play in HIV/AIDS Campaign in Africa 2007-2011

    What is the comparative advantage of the Bank relative to other donors and development agencies?

    How can the Bank better support client countries to integrate HIV/AIDS in broader development frameworks (PRSPs, MTEFs, sectoral annual budgets) and also sustain the local response?

    What might be the realistic expectations for results 2007-2011

    How can the Bank support Middle Income Countries worst affected?

    How do we improve the linkages between HIV/AIDS and health sector reform and health systems strengthening?

    How should we improve mainstreaming in other sectors?

    How can the Bank better support the Three Ones

    How can the Bank improve coordination and collaboration with other partners (GFATM, PEPFAR, European donors, UN Agencies, & foundations)

    $8.3

    $8.9

    $10.0

    $3.3

    $6.0

    $12.1

    200520062008

    Resource Available Gap

    0

    1000

    2000

    3000

    4000

    5000

    6000

    7000

    8000

    9000

    1996199719981999200020012002200320042005*