The World Bank reaffirms its long-term commitment to HIV & AIDS in Africa
By JONATHAN MUNDELL (1)
Last month, on the 14th of May, the World Bank released its latest strategy document, outlining its plan for tackling HIV & AIDS in Africa over the next five years. The document is entitled “The World Bank’s Commitment to HIV/AIDS in Africa: Our Agenda for Action, 2007–2011” (2), and will serve as a guideline for the Bank in their efforts to combat the HIV & AIDS epidemic in Africa. Prepared primarily for the World Bank’s Board of Directors, senior management, and staff, the 146-page report not only discusses the Bank’s “Agenda for Action (AFA)”, but also includes a comprehensive summary of the Bank’s response to the epidemic thus far, lessons learned, and discusses the “significant emerging challenges to the effective control of the epidemic”. The report therefore also provides valuable information for a wide variety of organisations and institutions working in the field of HIV & AIDS, and not simply the Bank itself. According to Peter Piot, Executive Director of UNAIDS, the AFA reaffirms the World Bank’s long-term commitment to assist African countries in their fight against HIV & AIDS.
THE FIRST GLOBAL RESPONSE
It was almost a decade ago, in 1999, when the World Bank launched what was to be the very first major global response to HIV & AIDS. Since then, in attempts to combat the epidemic, the Bank has provided over US$ 1.5 billion to more than 30 countries in Sub-Saharan Africa. In an initial first stage of its commitment to fighting the disease, back in 2000, the Executive Directors of World Bank approved a US$ 500 million commitment with the Multi-Country HIV/AIDS Program (MAP) for Africa. An AIDS Campaign Team for Africa (ACTafrica) was introduced to implement the strategy, and also to provide operational support. Two years later, in February 2002, the World Bank Board approved a further US$ 500 million, improving their reach, and leading to the support of a number of regional programs and second-generation projects in Sub-Saharan Africa.
The primary goals of the MAP were to “raise political awareness, promote a strategic response; strengthen systems and institutions to help manage that response; mobilize communities to promote activities for prevention, care, mitigation, and treatment; decentralize the response; create mechanisms to monitor and evaluate the results; and stimulate global funding for HIV/AIDS in Africa”. There were also four pressing country needs addressed by the program, namely:
- Strong political and government commitment to respond to HIV;
- A favourable institutional environment with adequate resources and capacity to enable successful HIV and AIDS interventions to be scaled up to a national level;
- A local response that increases community participation in, and ownership of HIV & AIDS interventions through providing financial resources and capacity building; and
- A multisectoral approach in which all government sectors are appropriately involved, with improved coordination at the national level and decentralization to sub-national government structures.
Since launching the program, the World Bank has taken a number of positive steps in the global response to the HIV & AIDS epidemic, and has met the majority of the goals that were initially drawn up. For example, one of the Bank’s most important contributions has been the successful promotion of a mulltisectoral response to the epidemic, “involving a broad array of stakeholders, from civil society and the private sector to multiple agencies of government—education, transport, defence, interior, agriculture, gender, social protection, youth, and other ministries.
LESSONS FROM THE PAST, GUIDING PROGRESS FOR THE FUTURE
The World Bank’s latest strategy document also outlines the lessons that have been learnt over the past 9 years, in an attempt to assist in the future improvement of the MAP. In short, these lessons include the recognition that addressing issues related to HIV & AIDS is a far more “formidable challenge” than had been originally anticipated. In addition, the Bank states that it is critical for developing countries to integrate their HIV & AIDS strategies with their plans for development in general. They also emphasise the importance of monitoring and evaluation (M&E), and of integrated services, due to the fact that HIV & AIDS is interrelated with issues such as reproductive health, nutrition, and various other diseases. The document mentions the importance of strengthening administrative and management capacity, stating that “strengthening financial and procurement systems, health care human resources, health facilities, health information systems, and health supply chains is critical to achieving universal access and ensuring good governance, transparency, and accountability”. The improvement of relationships between donors and fund recipients, and an improved focus on “engaging stakeholders and working with communities” were also listed as important lessons, which should be used in the refinement of future efforts.
A PLAN OF ACTION
The AFA team was headed by the manager of the AIDS Campaign Team for Africa (ACTafrica), Elizabeth Lule. Utilising the lessons learnt from the past, and through consultations with “a broad constituency, including countries, donors, communities, civil society, non-governmental, and non-profit organisations, the documents AFA comprehensively outlines a number of proposed objectives and commitments for the next five years. The most noteworthy of these is a commitment to provide at least US$ 250 million a year for HIV & AIDS initiatives, based on country needs and demands.
The document also states that the “principal goal of the AFA is to reaffirm the Bank’s promise to devote its resources to help halt and begin to reverse the spread of HIV/AIDS, one of the Millennium Development Goals (MDGs)”. In addition to the annual funding commitment, therefore, the Bank will also aim to establish an HIV & AIDS grant incentive fund of US$ 5 million annually. This will promote capacity building, analysis and HIV & AIDS Project components. The Bank will also strive to expand on strategies to engage with countries in Southern Africa, and assist these countries with the development of sustainable, integrated development agendas. Another important objective will be the improvement of donor coordination and shared learning.
In an effort to more effectively realise these goals, the Bank lists four key “Pillars of Action”:
- Focus the response, through evidence-based and prioritised HIV/AIDS strategies.
- Scale up targeted multisectoral and civil society responses.
- Deliver more effective results through increased country monitoring and evaluation capacity.
- Harmonize donor collaboration.
The World Bank’s reaffirmation of their long term commitment to the fight against HIV & AIDS in Africa is encouraging, especially following the re-authorisation of the Presidents Emergency Plan for AIDS Relief (PEPFAR) earlier this year, in April. With the development of their AFA, the World Bank are well on track to continue being a leading force in the fight against the HIV & AIDS epidemic, and also to further their overarching goal of poverty alleviation.
(1) Jonathan Mundell is Director: HIV & AIDS Unit at Consultancy Africa Intelligence (jonathan.mundell@consultancyafrica.com).
(2) The World Bank’s strategy document is available online.
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