Mobilizing capital for AIDS responses in huge capital projects What opportunities are presented by the Capital Infrastructure Projects in Africa in the context of HIV/AIDS & Environment Impact Assessments? World AIDS Day High Level Meeting on Domestic Financing for Health Theme: “Invest in Health, Get to Zero – Africa’s Responsibility to End AIDS by 2030” Zimbabwe, Victoria Falls, Elephant Hills 30 November 2014

Presentation structure 1.EIA and stages to mitigate impact 2.HIV, Health and EIA Challenges 3.AU Roadmap 4.National Development plans 5.The Evidence 6.Opportunities for domestic Resource mobilization 7.Recommendations 8.Conclusion 2

EA soup  EIA is a proactive tool used for identifying, predicting, evaluating and mitigating the relevant negative effects of large capital (development) projects prior to making decisions (Includes Environmental, Social and Health Impact Assessments)  Provides decision-makers with a holistic and informed opinion based on sound and objective research and analysis of how such projects may render whole communities vulnerable.  The 5 main stages of the Environmental Assessment Process are good entry points where stakeholders can make strategic contributions in support of national AIDS responses. 3 Environmental Impact Assessment (EIA) Environmental Assessment (EA) The Environmental Impact Assessment

The 5 EA stages to Mitigate the Impacts Capital Development on HIV 1.Screening: Assessment of whether a large capital project requires an environmental assessment or not and at what level (Usually by the NEMA and line ministry involved) 2.Scoping: Scoping is the process of determining the issues to be addressed, the information to be collected, and the analysis required to assess the environmental and social impacts of the project. 3.Environmental Impact Assessment: As the administrative or regulatory process by which the environmental impact of a project is determined in a systematic and scientific manner 4.Environmental Management Plan: Management and mitigation measures are implemented on the ground through a well formulated Environmental Management Plan (EMP) 5.Environmental Monitoring: activities undertaken by a company or contractor during project construction and operation to monitor its effects on the environment All stages are entry points for partnerships and participation of of NAAs, MoH, MoFP, MoWs, Private sector developers, CSOs and affected communities

HIV and Health challenges  70% of the 35 million PLHIV globally are in Africa  More than 13.5 million PLHIV are in SADC region alone  37% of female sex workers in Africa are estimated to be living with HIV  Low uptake of HIV testing and inadequate innovative HIV prevention services  Unsustainability of funding  Most Countries in Sub-Saharan Africa not meeting the Target of 15% National budget allocation to Health – Abuja declaration  We can expect decrease in funding from existing HIV&AIDS funding sources with possible high levels of future AIDS funding needs  Inadequate attention to the long term structural drivers including migration, stigma and discrimination and weak laws Also:  Rapid increase in Non-Communicable Diseases (NCDS) such as heart disease, diabetes, cancers road traffic accidents and trauma.  Communicable diseases continue to ravage most countries in Africa. e.g SADC Member States are among the fifteen countries with the highest TB incidence rate in the world. Malaria is endemic across African Member States  There has also been re-emergency of Neglected Tropical Diseases such as Trypanosomiasis, Schistosomiasis, Filariasis, Leprosy.  Further, the region experiences unsustainable population growth in excess of 2%, high fertility rates and concomitant high maternal and infant mortality rates. 5

EIA challenges in Africa  Weak understanding of and a lack of willingness by developers to invest in social interventions  Confusion on the role of developers, government and civil society in terms of the planning, programming & execution of social intervention related to EA  Lack of general indicators to monitor social impacts and interventions within the EIA process  Weak accountability mechanisms  Narrow definition of environment 6

AU Roadmap 7 The AU has recognized the need for Universal access of a package of care (with financial protection) that will address these challenges. There is now growing interest to research to show linkages between increasing HIV infections and large infrastructure projects

National Development Plans Meanwhile : Africa is experiencing a boom in the development of its resources for which large capital projects are pre- requisites Large infrastructure projects feature in most NDPs e.g.  South Africa’s $113 billion infrastructure Plan  Angola’s transport infrastructure plan  Mozambique’s development of its oil and natural gas resources  Uganda’s oil discoveries in the Albertine Rift Valley  South Sudan’s plans to improve trade and oil export corridors through Uganda and Kenya  Botswana’s planned trans-Kalahari railway  Cameroon’s mega seaport in Kiribi  Tanzania’s road upgrades to the port of Mtwara  Zambia’s construction of the Kazungula Bridge and Link Zambia 8000  Nigeria’s planned 100 Billion railway expansion project  Implementation of the EAC priority Projects  SADC infrastructure Plan etc 8

The Evidence Initial reports linking large capital projects and HIV were from the Asian Development Bank and the Great Mekong region but are corroborated by recent studies by IOM and by other studies in Africa  Execution of road networks can be an HIV vulnerability factor i.e. Nacala corridor in northern Mozambique  In the extractive industry, migrant miners in South Africa (30-44 age group) estimated to be 15% more likely to be HIV positive  A woman whose partner is a migrant miner was 8% more likely to become HIV infected  A study of the HIV prevalence in the coal-mining province of Tete in Mozambique showed an increase of 80% between 2009 and 2011  Niger Delta is one of the most highly affected regions in Nigeria for HIV. Two of the three states that experienced a more than 100% increase in sero- prevalence rates between 1991 and 1997 were in the Niger Delta where oil is produced. 9

The Evidence  The construction of the Khatse dam in Lesotho played a significant role in the spread of HIV e.g. in Leribe, infection rate amongst year olds rose from 3% in 1991 to 12.6% in 1993  By 1999, tests for antenatal women living in the villages around the Khatse Dam indicated that 22% were HIV positive  In South Africa, the construction of the Madupe nuclear power plant coincidentally saw a rise in new HIV infections in the Waterberg district from 23% to 30.3% in

 Opportunities for domestic resource mobilization 3 Key Messages 1.We can take advantage of the construction boom and the relatively large resources attached to them, to mitigate health risks that might be associated with them. 2.We need to improve the ability of all stakeholders (decision makers, politicians, regulatory authorities, developers, health and gender experts, civil society and the community, etc.) to better predict social impacts, particularly those related to Health, HIV,HR and gender associated with such projects 3.We need an integrated approach to the design and implementation of interventions, to maximize the benefits of such developments whilst mitigating the negative consequences 11 In the context of raising additional domestic financing for AIDS, Environmental and Social Assessment Process is the only legally approved tool in all countries that can be used to do that.

Recommendations Mobilizing Domestic Financing for Health  AUC and the RECs work with Member States to: o Increase advocacy at the highest levels of government and through relevant AUC structures e.g. to raise awareness on the links between infrastructure development and HIV/Gender vulnerability. o Facilitate research so that developers and governments recognise social interventions around large capital projects as investments rather than as mere expenditures. o Develop continental wide indicators that can be adapted and used by national governments and developers to monitor social interventions associated with large capital projects. o Promote accountability within the EIA process by helping to: strengthen CSO and community engagement in public participation; formulate evidence informed mitigation measures; (i) tighten compliance auditing and monitoring to make sure that the EMPs are fully implemented; and (ii)ensure that Mobilized funds attached to large capital projects are efficiently allocated, utilized and monitored. o Advocate for a % allocation of budgets for mitigation plans to be invested in Health, HIV and gender interventions 12

13 Conclusion Impact Assessment/Analy sis to ensure intended use Impact Assessment/Analy sis to ensure intended use Efficiency Allocative Technical Efficiency Allocative Technical Sustainability Increase domestic financing and country ownership Sustainability Increase domestic financing and country ownership Partnership PPP for innovative financing Partnership PPP for innovative financing Human Rights Leave no one behind, especially not KPs. Human Rights Leave no one behind, especially not KPs. “Invest in Health, Get to Zero – Africa’s Responsibility to End AIDS by 2030”

Thank You Acknowledgements: a.Benjamin Ofosu-Koranteng & UNDP HIV, Health and Development Team (Addis Ababa) b.Bryony Walmsley (Southern African Institute for Environmental Assessments) c.Peter Tarr ((Southern African Institute for Environmental Assessments) 14