Strengthening HIV/AIDS Programs for People with Disabilities in Africa

1. The World Bank’s Support to HIV/AIDS Programs in Africa Elizabeth Lule Manager ACTafrica

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

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

6. MAP Status • 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

7. THE MAP Approved and Pipeline HIV/AIDS Projects May 2006 Subregional projects (approved) Projects approved Projects in the pipeline IDF grants

8. 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

9. 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

10. 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

11. 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?)

12. 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

13. 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

14. Need to redefine the role of the World Bank for 2007-2011 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.

15. MUCH MORE NEEDS TO BE DONE