CCIH Annual Conference May 24-26, 2008 World Bank Roles, Issues Katherine Marshall

1. CCIH Annual Conference May 24-26, 2008 World Bank Roles, Issues Katherine Marshall

2. World Bank support for HIV and AIDS is set in the context of • The changing global HIV/AIDS landscape.. • Changing roles and challenges for the World Bank • And the complex institutional setting at global, regional and national levels • Bank role involves finance, policy, research, advocacy, and aid coordination • It is closely tied to development issues and challenges

3. The AIDS epidemic is still growing People with HIV/AIDS, Cumulative Regional Totals Millions *Western and Central Europe & North America. Source: UNAIDS/WHO, 2004.

4. Much higher global funding for HIV/AIDS is available (US$ millions) Avg Price of ARVs $7,944-20,224/ Person per year G8 PEPFAR 3 by 5 World Bank MAP GFATM Avg Price of ARVs $50-200/Person per year * Projected funding Source: UNAIDS, 2004.

5. But resources available still fall far short of estimated needs $11.6 billion $14.9 billion $22.1 billion Source: The Henry J. Kaiser Family Foundation (www.kff.org) Original source UNAIDS

6. Much has been learned from experience: the dynamic picture • Country ownership, capacity and leadership are crucial to success hence: the “Three Ones” Principles guiding efforts. • AIDS Programs need to be informed by evidence – M&E is critical. Much still to be done. • AIDS response must be more strategic, more carefully tailored to local epidemic pattern. • Governments, private sector, civil society, PLWHA, communities, etc. all have important roles; but plenty of questions about how to orchestrate

7. Complex Environment for SupportAIDS stakeholders and donors in one African country WHO INT NGO CIDA 3/5 UNAIDS GTZ RNE UNICEF Norad WB Sida USAID T-MAP MOF UNTG PMO US$ 50M CF DAC GFCCP PRSP PEPFAR US$ 60M HSSP GFATM MOEC MOH SWAP US$290 M CCM NCTP CTU CCAIDS US$200M NACP LOCALGVT CIVIL SOCIETY PRIVATE SECTOR

8. Some important changes • New and emerging development agendas, budget support, HIPC and other instruments; but HIV/AIDS not adequately integrated in development agendas • Other emerging priorities, vertical Programs (Avian Flu etc) • Imbalance between treatment, care and support and prevention • Feminization of the epidemic • Agreement on need for the “’Three Ones” and Universal Access, but….

9. Challenges – persistent and emerging • National HIV/AIDS planning not strategic, prioritized • Prevention, care & treatment efforts are too small, coverage is too low • Management and implementation constraints • Health systems weak, overwhelmed • Expanding access to treatment raises issues: equity, sustainability, adherence, health systems • Prevention, prevention, prevention • Stigma & discrimination, denial, silence persist • Donors could do better

10. The World Bank Global HIV/AIDS Program of Action Key Action Areas Support stronger strategic, prioritized national planning Sustained, flexible funding for HIV/AIDS programs & health sector Accelerate implementation Build monitoring and evaluation systems & capacity Impact evaluation and analytic work to improve HIV/AIDS knowledge and improve programs

11. Help countries to strengthenstrategic, prioritized national planning • Training and “hands-on” technical support • HIV/AIDS to be better integrated in national development planning processes (PRSP, CAS, MTEF) • Programs and planning to be evidence-informed • Guidelines, good practice notes • Support a network of country practitioners to share expertise • Synthesis papers on national HIV/AIDS epidemiology and optimal responses to match

12. Avoid mismatches between funding and infection patterns like this:

13. Sustain funding for effective HIV/AIDS programs & to strengthen health systems • Bank will remain a major funder, flexibly funding countries and activities others cannot fund • Long-term funding to strengthen health sectors crucial for HIV/AIDS response and other health goals • Support stronger efforts in other key sectors • Strong commitment to harmonize efforts among donors for better impact • Ensure funding for CSOs and communities

14. Support to accelerate implementation, and close the gap PEPFAR GFATM World Bank MAP

15. Build country monitoring and evaluation capacity and systems, so that evidence informs responses • GAMET country support team continue to provide intensive practical field support • Develop/strengthen national M & E frameworks • Guidelines, for national M&E systems • Good practice examples • Global, regional, and national M&E training – goal: strong national M&E expertise • More impact evaluation • Support better use of data to improve programs

16. Generate, share and use knowledge. Do more impact evaluation and analysis • Do more impact evaluations of Bank support • With others, carry out new analysis in key cross-cutting cross-country areas (e.g. poverty, finance) and country-specific AAA • Publication series (a) “Getting Results” notes, (b) HIV/AIDS analytic reports • Distribute reports, guidelines etc widely, target potential users • Improve WB AIDS website

17. Some Numbers on The World Bank and HIV/AIDS • Major response for Africa launched in 1999: MAP focused on national strategies, governance structures, and systems for fiduciary and monitoring and evaluation, a multisectoral response, focusing on HIV/AIDS as a development issue, engaging local communities and the private sector. • To date, the Bank has provided US$1.5 billion for HIV/AIDS programs in over 30 countries, including 29 Multi-country HIV/AIDS Program for Africa (MAP) countries and 5 sub-regional projects to address cross-border issues. • Global funding for AIDS programs has grown dramatically from US$1.6 billion in 2001 to $US 9.9 billion in 2007, mainly from The Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). • All IDA countries in good standing have MAP projects approved. MAP performance has accelerated steadily and has disbursed over $1 billion. Mobilization of civil society has been especially promising: the MAP has supported nearly 50,000 civil society groups. Several repeater MAPs are have been approved or are under preparation. • Virtually all funding is grants, not loans • The overall development objective of the MAP is to dramatically increase access to HIV/AIDS prevention, care, and treatment programs, with emphasis on vulnerable groups (such as youth, women of childbearing age, and other groups at high risk).