The Global HIV/AIDS Program Of Action

1. The Global HIV/AIDS Program Of Action David Wilson World Bank

2. Regional HIV/AIDS strategies and action plans • AFR:Intensifying Action against HIV/AIDS in Africa: Responding to a Development Crisis, 1999 • EAP: Responding to HIV/AIDS in the East Asia and Pacific Region, 2003 • ECA:Averting AIDS Crises in Eastern Europe and Central Asia, 2003 • LAC:HIV/AIDS in the Caribbean: Issues and Options, 2001; HIV/AIDS in Latin America The Challenges Ahead, 2003 • MNA:Preventing the Spread of HIV/AIDS in the Middle East and North Africa, 2005 • SAR:South Asia HIV/AIDS Business Plan FY04-FY06

3. The Actions … • Enhance & intensify Bank support to client countries for effective prevention, treatment, care and support • Contribute to and complement the work of our partners, consistent with GTT • Scope is Bank-wide, country, regional and global, big enough scale for impact • Activities must be firmly grounded in evidence.

4. The Program of Action responds to: • Need to strengthen country programs • Bank’s mandate and comparative advantages • Harmonization, “Three Ones” vision • Changed environment for HIV/AIDS support • Persistent and emerging challenges* • Recommendations of reviews of Bank HIV/AIDS work, lessons of experience* *More details on ensuing slides

5. World Bank HIV/AIDS projects: the global picture since 1988 Haiti Dominican Republic St Kitts & Nevis St Vincent & the Grenadines Cape Trinidad&Tobago Ver Grenada Barbados Jamaica Rwanda Burundi 1988-1998 1999-2005 Both

6. Lessons learned • The Bank can make a difference • Country ownership, capacity and leadership – crucial to success “Three Ones” • Programs need to be informed by evidence – M&E critical • AIDS - a development issue - integrate into broad development planning processes • Governments, private sector, civil society, PLWHA, communities all have important roles

7. What are the challenges?

8. Challenges – persistent and emerging • National HIV/AIDS planning not strategic, prioritized • Prevention, care & treatment efforts are too small, coverage is too low • Management and implementation constraints • Health systems weak, overwhelmed • Expanding access to treatment raises issues: equity, sustainability, adherence, health systems • Prevention, prevention, prevention • Stigma & discrimination, denial, silence persist • Donors could do better

9. WHO INT NGO CIDA 3/5 UNAIDS GTZ RNE UNICEF Norad WB Sida USAID T-MAP MOF UNTG PMO US$ 50M CF DAC GFCCP PRSP PEPFAR US$ 60M HSSP GFATM MOEC MOH SWAP US$290 M CCM NCTP CTU CCAIDS US$200M NACP LOCALGVT CIVIL SOCIETY PRIVATE SECTOR AIDS stakeholders and donors in one African country

10. The WB Global HIV/AIDS Program of ActionWork closely with partners for stronger, harmonized AIDS responses Key Action Areas Sustained funding for HIV/AIDS programs & health sector Support stronger strategic, prioritized national planning Accelerate implementation Build monitoring and evaluation systems & capacity Impact evaluation and analytic work to improve HIV/AIDS knowledge and improve programs

11. Sustained funding for effective HIV/AIDS programs & to strengthen health systems • Bank will remain a major funder, flexibly funding countries and activities others cannot fund • Long-term funding to strengthen health sectors crucial for HIV/AIDS response and other health goals • Supports stronger efforts in other key sectors • Strong commitment to harmonize efforts among donors for better impact • Ensure funding for CSOs and communities

12. Mismatch between funding and infection patterns

13. Help countries to strengthenstrategic, prioritized national planning • Training and “hands-on” technical support • HIV/AIDS to be better integrated in national development planning processes (PRSP, CAS, MTEF) • Programs and planning to be evidence-informed • Guidelines, good practice notes • Support a network of country practitioners to share expertise • Synthesis papers on national HIV/AIDS epidemiology and optimal responses to match

14. Support to accelerate implementation • Financial and technical support • Adequate funding for supervision • Simplify processes, procedures as needed • Implementation Advisory Service • Joint Problem Solving and Implementation Support Team (GIST) • Ensure CSOs, PLWHA, communities, private sector all play a role as needed • Networks among countries to share solutions, experiences

15. Build country monitoring and evaluation capacity and systems, so that evidence informs responses • GAMET country support team continue to provide intensive practical field support • Develop/strengthen national M & E frameworks • Guidelines, for national M&E systems • Good practice examples • Global, regional, and national M&E training – goal: strong national M&E expertise • More impact evaluation • Support better use of data to improve programs

16. Generate, share and use knowledge. Do more impact evaluation and analysis • Do more impact evaluations of Bank support • With others, carry out new analysis in key cross-cutting cross-country areas (e.g. poverty, finance) and country-specific AAA • New publication series (a) good practice notes, (b) HIV/AIDS analytic reports • Distribute reports, guidelines etc widely, target potential users • Improve WB AIDS website

17. AIDS Strategy & Action Plan (ASAP) Service

18. Strengths Forging high level commitment Broad range of actions Consultative process and involvement of various stakeholders Focus on stigma reduction and egalitarian responses Existing Strategies and Annual Action Plans Limitations • Not always based on evidence and transmission patterns • Not prioritized • Limited monitoring and evaluation • Limited costing • Not translated into implementable action plans • Not fully inclusive

19. Review of Existing Strategies Bank review shows evidence base and prioritization weakest - management and costing also weak Source: World Bank, 2005

20. Origins of ASAP • March 2005 Global Task Team (GTT) established to harmonize donors and improve implementation • June 2005 Statement of GTT Sub-Committee on Programming and Financing: • Well elaborated national AIDS strategies and annual action plans are a prerequisite for successful implementation • Requests from countries for assistance on improving strategies and preparing annual action plans • UNAIDS Division of Labor: WB to lead, on behalf of UNAIDS (ILO, UNDP, UNESCO, UNICEF, WHO and the UNAIDS secretariat as the main partners), in supporting strategic, prioritized, costed national plans

21. Origins of ASAP (cont’d) • GTT August 2005 Implementation Update call for • Establishment within the World Bank of a global technical assistance service (ASAP) • Development of internationally recognized standards and criteria/self-assessment tool • Thailand Workshop in January 2006 • Draft ASAP Business Plan: list of support activities ASAP might usefully offer • Outline for self-assessment tool

22. ASAP Menu of Possible Activities • Support for enhancing national strategies and annual action plans • Upgrading existing tools or developing new ones • Providing easy access to information and resources relevant to strategic planning • Responding to country requests to review and comment on strategic plans and annual action plans • Providing or helping countries to access sources of technical assistance

23. ASAP Menu of Possible Activities (cont’d) • Knowledge sharing and capacity building • Training in using various planning tools and model • Sharing information through workshops, networks of practitioners, on-line communities etc • Helping tocoordinate, harmonize and align efforts of differentstakeholders • Consolidating different sources of advice and guidelines on various aspects of strategic planning • Developing and supporting a process to help ensure wide donor support and buy-in to the strategy and annual plan