Elizabeth LuleManager, ACTafricaThe Unfinished HIV/AIDS Agenda for Africa

Africa Region Consultation Kigali, Rwanda

June 13,2007

Global HIV epidemic, 19902005*HIV epidemic in sub-Saharan Africa, 19852005*Number of people living with HIV% HIV prevalence, adult (1549)Number of peopleliving with HIV (millions)0102030405019901995200020050.01.02.03.04.05.0198519901995200020050510152025300.02.55.07.512.515.0% HIV prevalence, adult (1549)Number of peopleliving with HIV (millions)Status of the AIDS EpidemicThis bar indicates the range around the estimate10.0Source: UNAIDS, 2006

OutlineWhy a new Africa HIV/AIDS Agenda for Action?

What is the new HIV/AIDS Agenda for Action?

What are the Banks comparative advantage and value-added?

What guidance do we need from the decision meeting?

Why A New Agenda for Action?Epidemic has changedMore financial resources, but great need to ensure resources are used effectively and efficientlyUnfinished multisectoral agenda Country needs have changedBank must continue to learn how to address epidemics

15-35%3-7%1-5%0-0.1%Middle-income countries are hardest hit Source: UNAIDS 2004 estimates used unless recent national population-based HIV survey available

Gender inequalities in HIV/AIDS

HIV Prevalence in Francistown, BotswanaSource: BAIS, 2005

Africas children are paying the price Source: UNAIDS, 2006

Global Resources Available Compared to Estimated Need$11.6 billion$14.9 billion$22.1 billionSource: The Henry J. Kaiser Family Foundation (www.kff.org) Original source UNAIDS Most available resources are:

Volatile Short term Off-budgetNot strategicPoorly coordinated External prioritiesTechnology focused

Our AIDS portfolio has declinedSource: Business Warehouse, March 2007. Data includes total commitments for MAP projects and coded amounts for projects with HIV/AIDS components.IDA 13IDA 14

How MAP Funds were spentLocal ResponseUS $502m committedUS $306m spent38%32%17%13%Institutional Strengthening$423m committed$258m spentHealth Sector Response$223m committed$137m spentPublic Sector Response (beyond health)US $172m committedUS $104m spent

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Local response38

Institutional strengthening32

Health response17

Public sector (non-health)13

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The Unfinished Multisectoral Agenda

What Our Partners Want From UsMacro and micro-economic analysis (impact of HIV/AIDS) Financing gaps: prevention, especially interventions for populations at riskCapacity buildingPredictable, sustainable and flexible fundingMajor/only funding for some countriesFocus on fiduciary aspects, governance and accountabilityReaching communitiesMulti-sectoral approach

Bottom lineHIV/AIDS undermines the Banks Poverty Reduction mission and achievement of the MDGs

We need to build on results achieved thus far Epidemic resurgence in Uganda reflects declining prevention effortsMainstreaming HIV/AIDS in key sectors is an unfinished agendaUniquely positioned to put HIV/AIDS on the development agendaRespond to the changing global AID architecture

Agenda for Action: Conceptual Framework

Strategic PillarsFoundation of the four strategic pillars is to Renew the Banks commitment

Pillar 1: Focus the response through evidence based and prioritized national HIV/AIDS strategies

Pillar 2: Scale-up targeted multi-sectoral and civil society response

Pillar 3: Deliver effective results through increased country M&E capacity

Pillar 4: Harmonize donor collaboration

Selected Anticipated Results

Objective

Anticipated Results

Countries access to predictable, flexible and sustainable financing for HIV/AIDS provided.

Funds committed to HIV/AIDS (at least $250 million annually) including IDA, IBRD, PRSCs, ACGF, and IDF increased.

Support to sub-regional and cross-border initiatives provided.

Improved HIV/AIDS awareness and prevention efforts through sub-regional and cross-border initiatives

Appropriate HIV/AIDS efforts into countries and Banks development agenda embedded (policy procedures).

Review 10 CASs and ISNs and 6 PRSPs to ensure HIV/AIDS is appropriately incorporated.

HIV/AIDS integrated into at least 75% of PRSPs, CASs and ISNs prepared each year.

Bank support in capacity building to develop prioritized, and costed national strategies and action plans provided.

Capacity building and technical assistance to develop prioritized, costed national strategies and annual action plans in 20 countries over five years.

HIV/AIDS components in transport, infrastructure, urban and private sectors to address gender inequalities and social protection for vulnerable groups increased.

At least 10 analytical efforts addressing HIV and key sectors, gender inequality, OVCs, and regional aspects.

Harmonized M&E frameworks at the country level strengthened.

Bank to continue to play leading role (GAMET) in supporting countries.

All countries have a harmonized, functional M&E system reporting and using data.

Collaboration with key partners to harmonize and strengthen national M&E systems, HR capacity, procurement and supply chains strengthened.

GAMET to continue to support countries to strengthen M&E in close collaboration with other partners.

Joint planning and analytical work with UNAIDS and other partners increased.

All countries would have moved towards joint annual national program reviews and planning.

Knowledge generation and sharing to improve prioritization, decision-making and program design supported.

Design and impact of HIV/AIDS investments based on knowledge sharing.

Countries and partners fully engaged in knowledge generation and sharing.

A girl at a daycare center in Kibera, in Nairobi, Kenya. The center provides basic education and meals for orphaned children.A boy and his grandmother in Maseru, Lesotho. He is one of three grandchildren she cares forfollowing the death of their parents from AIDS.The 19-year-old girl on the left cares for herself, her two siblings, andher older sister's three children in Harare, Zimbabwe. Her parents andolder sister died of AIDS.Source: UNAIDS, UNICEF and USAID, Children on the Brink 2004.The Cost of Inaction

Even though the HIV prevalence rates have stabilized in sub-Saharan Africa, the actual number of people infected continues to grow Because of population growth. Applying the same prevalence rate to a growing population will result in increasing numbers of people living with HIV

Diverse epidemics across the ContinentSome countries with concentrated epidemics and very low prevalence (under1%)Others with generalized epidemics and prevalence rates approaching 40%Overwhelmingly heterosexual transmission, along with Mother-to-Child TransmissionWomen especially young women more vulnerable (59% of people living with AIDS)12 million orphans a generation lost

Bank support only 5 percent of totalThis graph shows the percentage and amount of funding given to each of the sectors that were funded by the MAP. The 32% of funding given for institutional strengthening, shows the commitment of the Bank to creating conducive institutional structures to manage, coordinate, monitor and evaluate the HIV response at the national and local levels.

This graph also shows that the MAP achieved its principle of using multiple implementation agencies.

PERCENTAGES OF ACTIVE COMMITMENTS BY SECTOR FOR HIV/AIDSAs of March 2007. none of the PRSCs have included HIV/AIDS as a theme While the majority of HIV/AIDS projects are managed by Human Development (Health, Nutrition and Population, Education and Social Protection), continued efforts are being made to mainstream HIV/AIDS into non-health sectors. Sectors in the Africa Region that have integrated HIV/AIDS into their sectoral response include Education, Urban Development, Transport, Social Protection, Social Development, Rural Sector, and the Private Sector.

Projects with HIV/AIDS components of less than $5 million are also managed by Water Supply and Sanitation, Environment, and Public Sector Governance.

WB funding fills key gaps and needsMost predictable, long-term & flexible fundingMajor/only funding for some countriesMacro and micro-economic analysis (impact of HIV/AIDS), policy dialogueFocus on fiduciary aspects, governance and transparencyFinancing gaps: prevention, especially interventions for populations at riskReaching communitiesMulti-sectoral approachHealth system strengtheningCapacity building

Banks comparative advantage/value-added in:

Strategy

Implementation

Monitoring and Evaluation

Agenda for Action:

Renew the commitment to sustain the response

Focus the response by supporting evidence based prioritized strategies and implementation

Target the multi-sectoral response

Deliver results through enhanced efficiency, effectiveness and transparency

Make the money work

COST OF INACTION: