The Bank’s Regional HIV/AIDS Strategies An Overview

Bank Regional HIV/AIDS Strategies Africa (1999) Africa (1999) Latin American & the Caribbean (2001) Latin American & the Caribbean (2001) Eastern Europe & Central Asia (ECA) (2003) Eastern Europe & Central Asia (ECA) (2003) South Asia (2003) East Asia & the Pacific (2003) Middle East & North Africa (2005)

Main Points of Regional Strategy Overview Objective/goal of the regional strategy Objective/goal of the regional strategy Priorities Priorities What has been achieved? What has been achieved? What is addressed adequately? Inadequately? What is unique? What will be the advantage of a global strategy for the region?

Objective of the Africa Regional HIV/AIDS Strategy To urgently assist African governments and mobilize the Bank, development partners, the private sector and civil society to intensify actions/programs to address the implications of HIV/AIDS epidemic To urgently assist African governments and mobilize the Bank, development partners, the private sector and civil society to intensify actions/programs to address the implications of HIV/AIDS epidemic Priority was to provide the necessary resources and technical support to country programs as quickly as possible Priority was to provide the necessary resources and technical support to country programs as quickly as possible

What was unique about this strategy? First to place HIV/AIDS at the center of the development agenda for Africa First to place HIV/AIDS at the center of the development agenda for Africa First to advocate for multisectoral approaches, flexible financing and learning from experience First to advocate for multisectoral approaches, flexible financing and learning from experience Moved HIV/AIDS beyond the health sector Moved HIV/AIDS beyond the health sector Recognized that the Bank needed to change as an institution and develop innovative mechanisms for delivering resources to government and civil society Recognized that the Bank needed to change as an institution and develop innovative mechanisms for delivering resources to government and civil society

What has been achieved in the Region from the strategy? Created the AIDS Campaign Team for Africa (ACTAfrica) Created the AIDS Campaign Team for Africa (ACTAfrica) Committed new funding (US $1.1 billion to 28 countries and 3 sub-regional projects) Committed new funding (US $1.1 billion to 28 countries and 3 sub-regional projects) IDA called for 100% grant financing IDA called for 100% grant financing Largest single commitment to HIV/AIDS by the Bank and the first large scale use of grants Largest single commitment to HIV/AIDS by the Bank and the first large scale use of grants Extensive involvement of civil society with 40% of MAP funds to over 30,000 subprojects Extensive involvement of civil society with 40% of MAP funds to over 30,000 subprojects

What did it not address adequately? Technical and implementation support to MAP projects Technical and implementation support to MAP projects Monitoring and evaluation Monitoring and evaluation Health infrastructure development Health infrastructure development Treatment and OVC Treatment and OVC

Latin America and the Caribbean Focused on the Caribbean with the same objective as the African regional HIV/AIDS strategy and the same approach of “intensifying action” Focused on the Caribbean with the same objective as the African regional HIV/AIDS strategy and the same approach of “intensifying action” Caribbean selected as the priority because the region had the second highest HIV prevalence in the world Did not address needs and priorities for Latin America (Bank supports 6 country programs including Brazil)

Uniqueness of Caribbean strategy First regional approach that brought together small countries First regional approach that brought together small countries Sought to learn from Africa Sought to learn from Africa Proposed new Bank financing through a multi-country adaptable program lending Proposed new Bank financing through a multi-country adaptable program lending

What has been achieved as a result of the Caribbean strategy? Bank approved the US $155 million Caribbean MAP in 2001 Bank approved the US $155 million Caribbean MAP in 2001 US$118 million committed to 9 country programs and 1 regional project using the multisectoral approach US$118 million committed to 9 country programs and 1 regional project using the multisectoral approach Caribbean program a UNAIDS best practice (2004) Caribbean program a UNAIDS best practice (2004)

Eastern Europe and Central Asia Objectives to control HIV and TB in the region, and to clarify options for integrating HIV and TB into agenda of poverty reduction Objectives to control HIV and TB in the region, and to clarify options for integrating HIV and TB into agenda of poverty reduction Priorities include TB and HIV, raising political and social commitment, estimating economic and social impact and improving surveillance

What is unique about the ECA strategy? The inclusion of preventing and managing TB The inclusion of preventing and managing TB First to explicitly states that the Bank will only finance operations in HIV/AIDS and TB if they also support HIV/AIDS surveillance First to explicitly states that the Bank will only finance operations in HIV/AIDS and TB if they also support HIV/AIDS surveillance First to point to the advantages of the Bank’s instruments for policy dialogue and analytic services e.g country assistant strategies, as being more important than it’s role as a financier in middle income countries First to point to the advantages of the Bank’s instruments for policy dialogue and analytic services e.g country assistant strategies, as being more important than it’s role as a financier in middle income countries First Bank strategy to include harm reduction, ART, and social protection First Bank strategy to include harm reduction, ART, and social protection

What has been achieved as a result of the ECA strategy? Raised profile of HIV/AIDS in the region Raised profile of HIV/AIDS in the region First strategic analytical work completed on HIV/AIDS in the Baltic states and Central Asia First strategic analytical work completed on HIV/AIDS in the Baltic states and Central Asia New grant financed projects in Moldova and first ever regional project in Central Asia New grant financed projects in Moldova and first ever regional project in Central Asia Increased policy dialogue in Russia Increased policy dialogue in Russia Increased donor support and coordination Increased donor support and coordination

South Asia HIV/AIDS Business Plan Objectives are to improve and accelerate response; Objectives are to improve and accelerate response; support countries in SA to prevent the spread of HIV/AIDS; and support countries in SA to prevent the spread of HIV/AIDS; and support countries in offering affordable treatment and care to PLWHA support countries in offering affordable treatment and care to PLWHA

SAR HIV/AIDS priorities Scale up resource mobilization and lending operations (both grant and credit) Scale up resource mobilization and lending operations (both grant and credit) Adopt innovative approaches in lending such as performance- based disbursements Adopt innovative approaches in lending such as performance- based disbursements Strengthen and simplify management of existing projects Leverage Bank’s comparative advantages in analytic work and capacity building Focus on strengthening partnerships with donors and international collaboration

What is unique about the SAR HIV/AIDS strategy? Written as a business plan-clear and succinct Written as a business plan-clear and succinct First strategy to acknowledge the changing donor landscape and the need to focus on the Bank’s comparative advantages First strategy to acknowledge the changing donor landscape and the need to focus on the Bank’s comparative advantages Defines clear targets for the Bank three years from now e.g. Which country programs will be strengthened, what donor coordination will occur Defines clear targets for the Bank three years from now e.g. Which country programs will be strengthened, what donor coordination will occur

What has been achieved as a result of the strategy in SAR Targets met for new projects and analytical work Targets met for new projects and analytical work Increase in Bank technical staff dedicated to HIV/AIDS for the region Increase in Bank technical staff dedicated to HIV/AIDS for the region M&E strengthened M&E strengthened

East Asia and Pacific HIV/AIDS strategy Goal is to develop country specific strategies that will be the basis for the Bank engagement Goal is to develop country specific strategies that will be the basis for the Bank engagement Priorities include political commitment and multisectoral support, surveillance, M&E, prevention and care and treatment, and health services delivery Priorities include political commitment and multisectoral support, surveillance, M&E, prevention and care and treatment, and health services delivery

What is unique about the EAP strategy? Takes a critical look at the Bank’s previous projects in the region to draw lessons Takes a critical look at the Bank’s previous projects in the region to draw lessons First strategy to note that the Bank will soon not be the largest financier of HIV/AIDS programs in the region First strategy to note that the Bank will soon not be the largest financier of HIV/AIDS programs in the region

What is addressed adequately/not adequately? Comparative advantages and lessons from experience adequately addressed Comparative advantages and lessons from experience adequately addressed Does not state what countries may be a priority for Bank support or what country specific plans might look like Does not state what countries may be a priority for Bank support or what country specific plans might look like Does not set clear goals for the future Does not set clear goals for the future

Why a global HIV/AIDS strategy? Provide a unifying global framework Provide a unifying global framework Define what the Bank needs to do in the next 5 to 10 years Define what the Bank needs to do in the next 5 to 10 years Define the Bank’s role in the environmental changes since most of these regional strategies were written (e.g. GFATM, PEPFAR, the Three One’s, 3x5 etc.) Define the Bank’s role in the environmental changes since most of these regional strategies were written (e.g. GFATM, PEPFAR, the Three One’s, 3x5 etc.) Will meet the need to appropriately position the Bank Will meet the need to appropriately position the Bank Will build on decades of experience Will build on decades of experience

What can we learn from the strategies of other institutions? Heed call for better donor coordination, better funding and more comprehensive programs Heed call for better donor coordination, better funding and more comprehensive programs Operationalizing the “Three Ones” a priority Operationalizing the “Three Ones” a priority Keep the focus on prevention and mitigation Keep the focus on prevention and mitigation Need for long term commitment Need for long term commitment