The Multi-Country HIV/AIDS Program (MAP) for Africa Status and Findings Keith Hansen ACTafrica February 2005

Approved and Pipeline HIV/AIDS Projects June 2000 Projects in the pipeline

Projects approved Approved and Pipeline HIV/AIDS Projects June 2004 Projects in preparation

Projects approved Approved and Pipeline HIV/AIDS Projects December 2004 Projects in the pipeline Capacity building help Subregional projects (approved & pipeline)

MAP status 28 countries + 3 subregional projects $1.08 billion committed so far Nearly $400 million disbursed ~ 40% of money to civil society Laying groundwork for others Several countries preparing second phase

Support to national programs Strengthen national mechanisms –38 countries have NACs / joint reviews spreading –Global Fund building on mechanisms in many cases Stimulate action by public sector –Benin: 20 ministries have AIDS plans funded –Cameroon: treatment has achieved 80% adherence and immune restoration / Global Fund scaling up –Eritrea: sex by students down from 9% to 2% –Ghana: M & E focal pts reporting in all 110 districts

Support to civil society Roughly 40% of overall funds Greater involvement in governance Over 30,000 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

MAP Interim Review 2004 Joint effort of World Bank, UNAIDS, bilateral donor, NGO 6 country visits Document review of other countries Hundreds of interviews Available on World Bank website

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

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 ?)

Review: 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 Accelerate attention to treatment More explicit gender dimension And … step up health sector support

Unfocused funding

MAP eligibility criteria: Where do things stand? 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

Component performance Capacity building –Need to improve, esp. in civil society Public sector –Limited, cookie-cutter, MOH disengaged Civil society –Strong but need to gauge impact better Program coordination and M&E –M&E in urgent need almost everywhere

Africa’s tomorrow depends on what we, together, do about HIV/AIDS today.