Elizabeth Lule Manager ACTafrica The World Bank’s Support to HIV/AIDS Programs in Africa

2 A global view of HIV infection 2

3 HIV/AIDS and DISABILITY 60 million people live with disability in Africa People with disabilities face high risks of HIV infection – high exposure to sexual violence, coercion and rape because of physical dependence, life in institutions, lack of legal rights, low education status250M in ’05 alone Poor access to HIV information and services –Low education status, low literacy rates, social and economic obstacles limit access, lack of physical access to HIV testing and treatment, misperceptions that disabled people are not sexually active Double stigma Lack of inclusion and participation in HIV and AIDS policy formulation and programming

4 Africa Strategy 1999 and the WB 2005 Global Program of Action (GHAP) 1999 Africa Strategy Advocacy to intensify action Resource mobilization – internal and external Knowledge management Mainstreaming Capacity building Partnerships 2005 GHAP Program of Action Assist countries to –prioritize and cost national strategies and annual action plans –integrate HIV/AIDS into the broader development framework (PRSP, MTEF) –mainstream HIV/AIDS in other sectors Fund HIV/AIDS programs, groups, activities not funded by others and health systems Accelerate implementation Results focused (M&E) Analysis and knowledge sharing Partnerships

5 MAP eligibility criteria: 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

6 MAP Status  29 countries + 4* sub-regional projects  $1.12 billion committed so far  $744 million disbursed  > 50,000 civil society subprojects funded  Laid the groundwork for other donors  2nd phase MAPs prepared in 5 countries – 4 approved and 3 under preparation

7 Projects approved Approved and Pipeline HIV/AIDS Projects May 2006 Projects in the pipeline IDF grants Subregional projects (approved) THE MAP

8 MAP structural achievements Strengthen national mechanisms –All countries have national authorities & programs –Financial, procurement, M&E systems improving –Harmonization—joint program reviews spreading –Global Fund building on mechanisms in many cases Strengthen civil society involvement –Financial architecture in place; 40% of money to CS –Proven viability of decentralized flow –“Revolutionized” community dialogue on HIV/AIDS

9 Support to civil society Roughly 40% of overall funds Greater involvement in governance Over 50,000 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

10 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

11 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 ?)

12 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 to reach vulnerable groups including disabled Accelerate attention to treatment More explicit gender dimension Focus on vulnerable groups And … step up health sector support

13 What needs to work for people living with disabilities More analytical work to generate the evidence base for effective policy dialogue Deepen political commitment Capacity building for effective advocacy and participation Disseminate tools and good practices of what is working Forge strategic alliances and build coalitions – References –Global Survey on HIV/AIDS and Disability, by Nora Groce, Yale University and World Bank (April 2004) –The Forgotten Tribe" Persons with Disabilities and HIV/AIDS by Ambrose Murangira, National Union of Disabled Persons, Uganda (July 2005) – The Africa Campaign on Disability and HIV & AIDS

14 Need to redefine the role of the World Bank for World Bank MAP GFATM 3 by 5 PEPFAR G8 Avg Price of ARVs $7,944-20,224/ Person per year Avg Price of ARVs $50-200/Person per year * Projected funding Source: UNAIDS, 2004.

15 MUCH MORE NEEDS TO BE DONE