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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
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Elizabeth LuleManager
ACTafrica
What Role Should the World Bank Play in HIV/AIDS
Campaign in Africa 2007-2011
Consultation with Key StakeholdersAugust 13, 2006 – Toronto, Canada
2
A global view of HIV infection
2
3
The Diverse Epidemics
Manzini
Kampala
Dakar0
10
20
30
40
50
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
4
Much Higher Global Funding for HIV/AIDS (US$ millions)
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
$50-200/Person per year
* Projected fundingSource: UNAIDS, 2004.
5
Much lower ARV prices and more emphasis on expanding access to treatment
e.g. Uganda 1998−2003, first line ARV, US$/year
2 000
4 000
6 000
8 000
10 000
12 000
14 000
0
Pri
ce U
S$
Jun00
Oct00
Feb01
Apr01
Dec00
Nov00
Jul01
Mar03
Sep98
Aug98
Jul98
Oct03
Jun98
Sep03
Jan01
May01
Aug01
Mar10
Jun01
Accelerating Access
Initiativ
e
Generic companies start p
roduction
Further p
rice re
ductions
Further p
rice re
ductions
Negotiatio
ns by Clinton
Foundation
Source: UNAIDS/WHO, 2004.
6
Resources Available Compared to Estimated Need
$8.3 $8.9 $10.0
$3.3$6.0
$12.1
2005 2006 2008
Resource Available Gap
$11.6 billion $14.9 billion $22.1 billion
Source: The Henry J. Kaiser Family Foundation (www.kff.org) Original source UNAIDS
7
MAP Status Update29 countries + 4* sub-regional projects
$1.12 billion committed so far
$744 million disbursed
> 50,000 civil society subprojects funded
Laid the groundwork for other donors
2nd phase MAPs prepared in 5 countries – 4 approved and 3 under preparation
8
World Bank Funds
Project Thematic Areas Estimated Percentage Estimated millions US$
Prevention 35% 455.52
Care and Treatment 22% 283.88
Mitigation (OVC) 13% 165.05
Advocacy 14% 178.25
Monitoring and Evaluation
4% 52.81
Other 14% 184.85
Total 100% 1,320.36
9
Multi-Sectoral Use of FundsProject Components Estimated Percentage
of FinancingEstimated overall allocation
Civil society 38% 501.74
Ministry of Health 17% 224.46
Other Ministries 13% 171.65
Capacity Building 11% 145.24
Monitoring and Evaluation
4% 52.81
Program Coordination 10% 132.04
Other 7% 92.43
10
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 Fund9%
Bilateral 35%
World Bankcredit 32%
Multilateral(excluding GF) 15%
Bilateral32%
Public 36%
Global Fund 2%
Multilateral(excluding GF) 3%
India Russian Federation
Burkina Faso
10.11Source: UNAIDS, based on National AIDS Spending Assessments.
11
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 estimates11.3
12
What has changed from 2000 to date?
• Many more players since 2000• Regional variations and diverse epidemics• More resources but unpredictable, conditional,
ideological and funding gaps persist• Health systems, supply chains, and infrastructure
are overwhelmed with program demands of multiple diseases
• Human Resource crisis more critical• Use of Line 2 ARVs may increase and costs
remain too high
13
What has changed (2)• New and emerging development agendas, budget
support, HIPC and other instruments but HIV/AIDS not adequately integrated in development agendas
• Other emerging priorities (Avian Flu)• Imbalance between treatment, care and support and
prevention • Feminization of the epidemic• The “’Three Ones” and Universal Access• New World Bank Global Program of Action in 2005
14
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
• Donor coordination and priorities
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
AIDS stakeholders and donors in one African country
16
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
17
Strategic Challenges: Tensions and Trade Offs
• Fiscal sustainability versus promise of universal access• Vertical programs versus horizontal spending• Grant funding versus credit funding• Health sector response versus multisectoral response• Project approach versus budget support• Integration of HIV, TB, SRH and other health issues• Accountability and effectiveness• Balancing investments between the public sector, private
sector or community response
18
Objectives of the World Bank Africa HIV/AIDS Agenda for Action
• Reaffirm the Bank’s commitment to long term vigorous support for HIV/AIDS control in Africa
• Articulate the Bank‘s role and comparative advantage in a harmonized international program of support
• Identify priority interventions for the next generation of activity based on evidence of success and lessons of experience
• Identify 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
19
What role should the World Bank play in HIV/AIDS Campaign in Africa 2007-2011What 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 2007-2011How 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)