Elizabeth Lule Manager ACTafrica The World Banks response to HIV/AIDS in Africa: MAP High Level...
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Transcript of Elizabeth Lule Manager ACTafrica The World Banks response to HIV/AIDS in Africa: MAP High Level...
Elizabeth LuleManager
ACTafrica
The World Bank’s response to HIV/AIDS in Africa: MAP
High Level Dialogue on Maximizing Synergies between Health Systems and Global Health Initiatives. Venice, June 22-23
Africa Region
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1,119 , 16%
2,881 , 39% 1,654 , 23%
480 , 7%
1,041 , 15%Agriculture
Infrastructure (Energy Mining & Transportation and Water/sanit/f lood protection
Human Development (Education, Health &Social Svcs)
Finance, Industry and Trade
Other (Public admin, Law )
World Bank IDA Sector allocations over time in Africa
(US$ millions, %)
Fiscal year 2006
585 , 12%
1,489 , 32%
953 , 20%
491 , 10%
1,268 , 26%
Fiscal year 2008
368 , 6%
2,404 , 42%
841 , 15%
326 , 6%
1,749 , 31%
Fiscal year 2009 (planned)
1,119 , 16%
2,881 , 39% 1,654 , 23%
480 , 7%
1,041 , 15%
Agriculture
Infrastructure (Energy Mining& Transportation andWater/sanit/f lood protection
Human Development(Education, Health &SocialSvcs)
Finance, Industry and Trade
Other (Public admin, Law )
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MAP reflected a long-term World Bank’s commitment to HIV/AIDS
Phase 1: Emergency response, scale up existing interventions and build capacity
• Phase 2: Mainstream programs that have proved effective, gather evidence, apply lessons learned and strengthen systems
• Phase 3: Focus prevention efforts in areas where spread of the epidemic continues; scale up and sustain care, support, and treatment for people who have developed AIDS
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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
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MAP Status33 countries + 5 sub-regional projects
$1.83 billion committed so far
$ 1.3 billion disbursed since 2001
> 50,000 civil society subprojects funded
Laid the groundwork for other donors
2nd phase MAPs prepared in 11 countries countries countries
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Multi-Sectoral Use of FundsProject Components Estimated Percentage of Financing
Civil society 38%
Ministry of Health 17%
Other Ministries 13%
Capacity Building 11%
Monitoring and Evaluation
4%
Program Coordination 10%
Other 7%
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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
• Weak M&E and limited impact evaluation• Weak 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
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Lessons Learned Political and sectoral commitment is key
Donor collaboration and coordination, led and owned by national authorities is vital
Strengthening country capacity in governance and accountability, coordination and implementation required
Countries must know the drivers of their epidemic, address gender inequalities, and engage civil society
Need to show results/impact and build M&E capacity
Integration of HIV/AIDS in national planning is critical
Cross border approaches to address the “public good” nature of the epidemics are needed
Current Crisis Suggests Potential for Slowdown Progress Toward the MDGs
• Financial crisis is trapping up to 53 million more people into poverty (<$2 per day)
• This is on top of the 130-153 million already pushed into poverty as a result of the food and fuel price increases in 2008
• Additional 44 million malnourished individuals• Slower growth rates will slow progress in reducing IMR
– 200,000 to 400,000 additional children may die every year
– Up to 1.4 to 2.8 million more infant deaths by 2015 if crisis persists
• Progress on MDGs affected by:– Reduction in income and spending on food, health, human K
– Governments’ ability to finance and deliver social services affected
• Reliance on ODA; devaluation of currency; real expenditure declines
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Agenda for Action’s Strategic Pillars
The Agenda for Action reaffirms the Bank's commitment to devote resources and remain actively engaged in supporting countries to achieve MDG 6.
The Agenda for Action is structured around four Pillars:
Pillar 1:Pillar 1: Focus the response through evidence based and prioritized national HIV/AIDS strategies integrated in national development planning
Pillar 2:Pillar 2: Scale-up targeted multi-sectoral and civil society responses
Pillar 3Pillar 3: Deliver effective results through increased country M&E capacity and strengthened national and health systems
Pillar 4Pillar 4: Harmonize donor collaboration and knowledge sharing
What the World Bank is Doing • Ensure women, newborns, and children are given a high priority
• Focus on nutrition and MDG 1c
• Promoting and supporting effective pro-poor policies and programs including financial protection strategies
• Supporting and strengthening health systems in the poorest countries and sustaining support to communicable diseases
• Promoting efficiency gains and making overall efforts effective
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Bank’s Africa HIV/AIDS Agenda for Action: Linking Objectives to Results Strategic Objectives Anticipated Results
Strengthened long-term, sustainable national HIV/AIDS response
At least $250 million annually committed to HIV/AIDS including IDA, IBRD, PRSCs, ACGF, IDF and other Trust Funds.
Making other donors’ money work.
Accelerated Implementation of HIV/AIDS programs
HIV/AIDS integrated in Bank lending and non-lending activities in priority sectors depending upon country context, and with special attention to vulnerable groups and Southern Africa.
Strengthened national and health systems
Countries have functional, harmonized M&E systems, and strengthened human resources and fiduciary capacity, procurement and supply chain management.
Improved Donor Coordination
More efficient, effective and sustainable HIV/AIDS resource allocation
Countries lead joint annual national program reviews and planning with donors adhering to national processes.
Learning and Knowledge Sharing
Incentive Fund actively supports knowledge generation and sharing.
Countries and partners fully engaged in knowledge generation and sharing.
Bank Lending and Grants Focused on MDGs (4,5,6,1c):
• HNP Strategy emphasizes results, pro-poor focus, health systems strengthening and monitoring.
• Health Systems for the Health MDGs in Africa– Launched in 2008– Focus on 14 IHP+ countries– Increasing on-the-ground technical assistance and coordination
for HSS– Two regional hubs (Dakar and Nairobi) established– Recruitment of 10 high level HSS experts– Implemented in strong partnership with HHA, H8
Bank Lending and Sector Work• Results-based Financing (RBF for Health)
– 2008 - 2012
– Tied to IDA
– Pilot projects in 8 countries: Zambia, Rwanda, Eritrea, Afghanistan, DR Congo, Benin, Ghana, and Kyrgyz Republic
– Focus on performance-based incentives to health workers, district managers, and conditional cash payments to households
– Many pilots focusing on mechanisms to improve quality and increase utilization of institutional deliveries
– All pro-poor focused
– Large impact evaluation component and assessment of cost-effectciveness (learning and evidence building)
– MDTF: Support
Bank Lending and Sector Work
• Continued health system strengthening as the ground floor upon which all of the benefits of other investments can be made
– Ensure budget expenditures targeting the poor remain– Assure essential drugs and commodities– Support HR strategies to ensure adequate numbers and distribution of staff– Strengthen and support insurance and risk pooling mechanisms– Governance– HMIS
• Nutrition– Ambitious agenda of scaling up nutrition portfolio– Focus on Africa and SE Asia, some LAC– Additional staffing for regions
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Africa HNP: Strengthening Health Systems for Outcomes
Africa HNP strategy: Achieving the MDGs through Strengthening Health Systems ….
Upstream diagnostic
Financing Projects and Programs
MDGs
Country Status Report on Health, Poverty, Health systems and the MDGs
Focused funds:,Malaria Booster, HIV/AIDS, Tuberculosis etc.
Bank operations: problem specific and health systemfocused (eg: SWAPs)
Joint Bank-Partners Programs (eg: Results-basedfinancing)
Nutrition (MDG1)
Child health (MDG4)
Maternal Healthand mortality (MDG5)
Malaria,AIDS, TB, prevalence and mortality (MDG6)
Financial protection
Non Communicable Diseases
Human Resources For Health
Pharmaceuticals
Governance and Service Delivery
Public finance and health insurance
Infrastructure and ICT
Health systems
One country, costed plan for country supported by all partners (IHP+)
Policy dialogue
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Strategic Challenges: Tensions and Trade Offs• Fiscal sustainability versus promise of universal access• Short tem results versus long term results• Health sector response versus multisectoral response• Project approach versus budget/program support• Integration of HIV, TB, SRH, nutrition and other health
issues versus vertical units within MOH • Accountability and effectiveness versus attribution • Measuring Outputs/trends versus measuring outcomes
and impact• Balancing investments between the public sector, private
sector or community response• Supply versus demand
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Now to Action