Community Response to HIV and AIDS: Achieving Efficiencies Rosalía Rodriguez-García, MSc, PhD World Bank ICASA December 4-8,2011

The AIDS Reality The epidemic stays as chronic condition Stagnation of funding Must improve efficiencies and effectiveness –Getting to Zero & AIDS Free Generation Need to show community level results in – Actions – Services – Enablers 2

Libya Madagascar Cote D’Ivoire Algeria Botswana Kenya Sierra Leone- Mali Democratic Republic of the Congo Somalia Guinea-Bissau- Ghana Uganda Mozambique Mauritania Angola Sudan Niger Zambia Ethiopia Western Sahara Chad Guinea Nigeria Tunisia Namibia South Africa Egypt Tanzania Equatorial Guinea -Lesotho -Burundi -Djibouti Rep. of the Congo- Rwanda- Senegal Togo Gabon -Malawi Morocco Liberia Central African Republic Zimbabwe Benin Eritrea -Swaziland The Gambia- Cape Verde Comoros Mauritius Sao Tome & Principe Seychelles Burkina Faso EVALUATION OF THE COMMUNITY RESPONSE 3 Global Approach India Brazil Peru

Design: Mixed-Method, Multi-method Approach Strong Causal Evidence (experimental) Strong Evidence (quasi- experimental) Surveys and Desk Studies Reviews Desk Studies Burkina Faso Lesotho Senegal South Africa Kenya (HCT) Kenya, Nigeria Zimbabwe India (2) Typology of com. response Funding mechanisms OVC Review

Evaluation Findings Show: Strong casual evidence that specific community interventions can affect the course of the HIV epidemic through increased HIV knowledge, reduced stigma, increased condom use, testing uptake, treatment adherence and increased use of services. Strong relationship evidence that community-based actions play a pivotal complementary role to national programs by providing services to communities which otherwise would have been left without access to services such as rural communities and high risk groups. However, there is mixed evidence on social transformation outcomes – Context matters. Allocative and programmatic efficiencies weak. 5

Funding from Four largest Donors to NGOs/CSOs Funding provided by ◦ PEPFAR, Global Fund, DFID and World Bank ◦ Large in absolute terms (At least US$600 million per year) But: ◦ Small in relative terms (It represents 15% of the four largest donor assistance for the AIDS response) ◦ However, other sources matter more for CBOs

CBOs Receive Little Funding Average annual funding per CBO in Communities Higher community activity Lower community activity Nigeria$22,500$6,200 Kenya$21,49915,300 Higher and lower number of CBOs

CSOs Mobilize Other Resources too UNAIDS/World Bank: The Global Economic Crisis And HIV Prevention and Treatment Programmes: Vulnerabilities And Impact: Update On The Impact (2009)

And Volunteers’ Resources are Substantial Average Number of volunteers per CBO KenyaNigeria Volunteers with compensation 1936 Volunteers with no compensation 2771 Average per CBO2158 Implicit increase in resources due to unpaid volunteers 40%48% 9 New slide— needs to be filled in with actual insight from the papers

But Efficiencies can be Improved 10 Percentage of CBOs Engaging in Specific Activity Categories, Adamawa, Nigeria. Percentage of Total CBO Expenditures by Categories, Adamawa.

Framework for Achieving Efficiencies 11 INPUTS ACTIVITIES ACTION S ACTIVITIES ACTION S OUTPUS OUT COMES OUT COMES IMPACTS Cost (Resources) Efficiency Effectiveness Cost to Program Effectiveness Allocation Efficiency: Budget aligned to epidemic Implementation Efficiency: Program spending aligned to budget and priorities

What Have we Learned? Funding of CSOs is s ubstantial but small share of total AIDS funding Limited trickling down from international sources to NGOs and CBOs CBOs both access and mobilize resources through government channels and own fund raising Potential for expanding CSOs role but need for better alignment of actions and activities with priorities and better focusing of actions to desired results to achieve efficiencies.

Community Response to HIV and AIDS: Achieving Efficiencies THANK YOU Rosalía Rodriguez-García, MSc, PhD Team Leader, CR Evaluation, The World Bank 13