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Averting AIDS Crises in Eastern Europe & Central Asia The World Bank ’ s Regional Strategy

Averting AIDS Crises in Eastern Europe & Central Asia The World Bank ’ s Regional Strategy. Washington, D.C. 15 October 2003 Armin Fidler (Health Sector Manager, Europe & Central Asia Region). Today ’ s agenda:. What is the World Bank doing in support of ECA countries? Overview

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Averting AIDS Crises in Eastern Europe & Central Asia The World Bank ’ s Regional Strategy

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  1. Averting AIDS Crises in Eastern Europe & Central AsiaThe World Bank’s Regional Strategy Washington, D.C. 15 October 2003 Armin Fidler (Health Sector Manager, Europe & Central Asia Region)

  2. Today’s agenda: What is the World Bank doing in support of ECA countries? • Overview The Regional Strategy: • Highlights • Dissemination • Crucial issues at country and sub-regional levels

  3. Helping countries to fight HIV/AIDS & TB by…. • Mobilizing support for cost-effective actions • Improving knowledge base for HIV/AIDS & TB Control • Supporting evidence-based strategies and programs • Mobilizing financial resources • Improving access to technical assistance • Assisting countries to implement programs

  4. Overview • Non-lending services – policies & programs • Regional strategy – September 2003 • Sub-regional studies – various stages • Supporting country efforts to mobilize additional resources • Improving access to technical assistance • Lending services • Belarus • Moldova (Approved, IDA Grant) • Ukraine (Approved) • Russian Federation (Approved) • Others (e.g., Albania PRSC)

  5. Sub-Regional Studies • Poland and the Baltics [In press] [Mukesh Chawla, mchawla@worldbank.org, marzena kulis (mkulis@worldbank.org)] • Central Asia [Country profiles in press] [Joana Godinho, jgodinho@worldbank.org] • Bulgaria, Romania, Croatia [Published] [Dominic Haazen, dhaazen@worldbank.org, Tom Novotny (Tnovotny@Psg.Ucsf.Edu)]

  6. Multiple needs, limited $:allocating scarce resources & overcoming non-financial constraints • Ongoing work in country program preparation • Future regional workshops • Resource allocation models • Getting value for money • Setting priorities • Making choices explicit

  7. Estimating the economic impacts of HIV/AIDS at the country level (1) • How big is the problem? • How big is it likely to become? • Issues: Poor data, multiple assumptions • How to make sense from the numbers?

  8. Estimating the economic impacts of HIV/AIDS at the country level (2) • Country example: Russia • Joint effort by Russian specialists and World Bank staff • Financed by a grant from DFID-UK • For more details, see: http://www.worldbank.org.ru/eng/group/hiv/

  9. Refining Estimates of Resource Needs(a non-lending service) Study of incremental resource requirements for HIV/AIDS Programs in ECA Region • Joint effort by WB & UNAIDS Secretariat • Contractor: The Futures Group International • Approach: Refinement of model and direct interactions with country program managers and specialists • Completed in 2003, available at www.worldbank.org/eca/aids

  10. Improving Access to Technical Support(a non-lending service) Development of Directory of Technical and Managerial Resources • Joint WB-UNAIDS Secretariat effort • Completed in September 2003: online in a few weeks: Henning Mikkelsen, (UNAIDS Secretariat), Olusoji Adeyi (oadeyi@worldbank.org)

  11. Promoting a more supportive policy environment(a non-lending service) High-level advocacy in support of HIV/AIDS control in ECA Region • Formative research underway in 2 countries in a 1st Phase • Advocacy and PR to be based on findings of formative research • Roll-out will benefit from lessons in 2 countries during Phase 1 [Contact: Sharon Felzer: sfelzer@worldbank.org]

  12. New: The World Bank’s Regional Support StrategyAverting HIV/AIDS Crises in ECA Region • Unifying framework for the evidence base, advocacy, policies and programs • Identifying major unmet needs • Defining future areas of WB work based on our comparative advantages • Outlining approaches to continued collaboration with partner agencies [Executive summary in 6 languages at www.worldbank.org/eca/aids

  13. What the regional strategy does (1) • Provide a unifying framework for the Bank’s efforts. • Clarify options for integrating effective interventions against HIV/AIDS and TB into the broader agenda of poverty reduction and economic development.

  14. What the regional strategy does (2) • Identify the main barriers limiting the effectiveness of HIV/AIDS and TB control efforts, and actions to eliminate them. • Define short- to medium-term priorities for the Bank’s work in the region, with emphasis on the Bank’s comparative advantages and high-impact partnerships.

  15. Priorities for World Bank Support • Raising social and political commitment • Generating & using essential information • Preventing HIV & TB infections • Ensuring sustainable care of good quality • Facilitating large-scale implementation

  16. Raising social & political commitment • Regional forums (e.g. CIS) • Country-level engagement, formal and informal • NGOs, general public, particularly the youth - - accurate information

  17. Generating & Using Essential Information • Estimating economic and social effects • Surveillance - - epidemiological, behavioral • Getting value for money - - cost, effectiveness • Estimating resource requirements

  18. Preventing HIV & TB Infections 5 high-yield priorities • Increasing blood safety • Promoting harm reduction (including decriminalization of needle exchange and treatment of drug dependency) • Supporting interventions among sex workers & their clients • Interventions among prisoners & ex-inmates • Controlling HIV-TB dual infections

  19. Ensuring sustainable care of good quality • Continuum of care, including treatment of STIs, palliative care, antiretrovirals. • Caution: on sustainability and quality of Highly Active Antiretroviral Therapy (HAART) • Having “cheap” ARVs not enough • Scientifically sound protocols crucial (international peer review is useful) • Staff skills & laboratory support: monitor patients, limit drug resistance

  20. The Bank will take the following approaches… (1) Externally: • High-impact partnerships with governments, NGOs, research institutions, multilateral organizations (including UNAIDS system & GFATM), bilaterals and foundations. • Program contents to be based on knowledge base, specific to ECA and/or global sources. • Lending and non-lending, depending on context and demand.

  21. The Bank will take the following approaches… (2) Internally: • Cross-unit collaboration: For example, Human Development Sector (education, social protection, health), Development Economics, World Bank Institute, International Finance Corporation. • Integrate analyses & recommendations into key instruments: For example, Country Assistance Strategies, Public Expenditure Reviews, Development Policy Reviews, Poverty Assessments, Poverty Reduction Strategy Papers

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