1. 1 Mainstreaming MDGs & HIV/AIDS into National Development Instruments and PRSPs Vladimir Mikhalev, UNDP Bratislava Regional Center RESPONDING TO HIV/AIDS IN EUROPE AND THE CIS 4th RBEC Community of Practice Meeting Moscow, 5-7 June 2007

2. 2 What is the PRSP? PRSPs emerged from 1999 as a result of WB & IMF initiative intended to improve development outcomes PRSP is a short-term national policy framework comprising key development objectives and policy tools aimed at poverty reduction PRSPs operationalise long-term objectives such as MDGs by specifying concrete public policies and expenditure priorities Serve as a framework for all external assistance geared towards poverty reduction Serve as a framework for all external assistance geared towards poverty reduction

3. 3 PRSPs underlying principles County-driven, involving broad-based participation County-driven, involving broad-based participation Comprehensive in recognizing the multi-dimensional nature of poverty Comprehensive in recognizing the multi-dimensional nature of poverty Result-oriented and focused on outcomes that benefit the poor Result-oriented and focused on outcomes that benefit the poor Partnership-oriented involving coordinated participation of development partners Partnership-oriented involving coordinated participation of development partners Based on long-term perspective for poverty reduction Based on long-term perspective for poverty reduction

4. 4 IFIs support to PRSPs PRSPs introduced a new way of providing assistance to low income countries by WB & IMF Low income countries were required to develop PRSPs in order to get access to concessional resources and debt relief under HIPC programme IMF aligned support to PRSP through PRGF as the main lending instrument WB introduced PRSC to support PRSPs

5. 5 PRSPs / PRSs in EECA region PRSP countries that rely heavily on IFI financing: PRSP countries that rely heavily on IFI financing:  Tajikistan, Kyrgyzstan, Armenia, Azerbaijan, Georgia, Moldova, Albania, Serbia & Montenegro, Bosnia-Herzegovina Other countries having PRS but not linked to IFI funding: Other countries having PRS but not linked to IFI funding:  Uzbekistan, Kazakhstan, Ukraine No PRSs: No PRSs:  Russia, Belarus, Turkmenistan New EU member states and EU accessions countries incorporate poverty reduction policy in EU social inclusion agenda New EU member states and EU accessions countries incorporate poverty reduction policy in EU social inclusion agenda

6. 6 PRSP policy components Macroeconomic programme Macroeconomic programme  including growth projections and key fiscal choices Pro-poor structural and sectoral polices, Pro-poor structural and sectoral polices,  including private sector & SME development, financial and trade liberalisation Polices for social inclusion and equity: Polices for social inclusion and equity:  employment policies, rural development, education, health, social protection Governance and public sector management Governance and public sector management Prioritised and costed action plans in all policy components Prioritised and costed action plans in all policy components

7. 7 Strengths of PRSPs Improved focus on poverty Improved focus on poverty Based on sound poverty diagnostics Based on sound poverty diagnostics Capture multidimensional income and non- income poverty aspects Capture multidimensional income and non- income poverty aspects Gather sector strategies and expenditure plans under poverty reduction umbrella Gather sector strategies and expenditure plans under poverty reduction umbrella Enhanced monitoring systems Enhanced monitoring systems Broad participation Broad participation

8. 8 Weaknesses of PRSPs Lack of understanding of sources of growth and its social impact Lack of understanding of sources of growth and its social impact Too broad objectives, lack of vision and operational guidance (road maps) Too broad objectives, lack of vision and operational guidance (road maps) Weak linkages between growth and poverty reduction, between macroeconomic growth and sectoral policies (e.g. fiscal polices and SME support) Weak linkages between growth and poverty reduction, between macroeconomic growth and sectoral policies (e.g. fiscal polices and SME support) Pro-poor policy choices focus on public expenditures on health, education and other social programmes but lack attention to infrastructure and rural development Pro-poor policy choices focus on public expenditures on health, education and other social programmes but lack attention to infrastructure and rural development Poor costing and prioritisation (wish lists) and weak links to budgetary processes (MTEF) Poor costing and prioritisation (wish lists) and weak links to budgetary processes (MTEF) Imperfect monitoring indicators and lack of data Imperfect monitoring indicators and lack of data Limited participation in PRS implementation and monitoring by parliaments, civil society, private sector Limited participation in PRS implementation and monitoring by parliaments, civil society, private sector

9. 9 Poverty reduction outcomes Poverty in EECA in 1998-2003 decreased Poverty in EECA in 1998-2003 decreased  from 20 % to 12 % of the population; 40 million moved out of poverty; poverty did not decreased in Georgia, Poland & Lithuania Inequality declined with the exception of Georgia and Tajikistan Inequality declined with the exception of Georgia and Tajikistan Mixed progress on non-income poverty: Mixed progress on non-income poverty:  improvements in education, but in Western Balkans, Tajikistan & Kyrgyzstan enrolment declined;  HIV and TB spread in many countries, high infant mortality and increased maternal mortality in Central Asia and Caucasus,  poor access to safe water in lower income countries Growth failed to generate enough jobs Growth failed to generate enough jobs Growth in low income counties did not increase productivity in agriculture and small trade; incomes of large sections of workforce employed there did not increased Growth in low income counties did not increase productivity in agriculture and small trade; incomes of large sections of workforce employed there did not increased Regional inequalities increased – gap between capital cities and rural areas & small towns Regional inequalities increased – gap between capital cities and rural areas & small towns

10. 10 Policy challenges The projected rates of growth are insufficient to achieve MDG poverty reduction targets by 2015 The projected rates of growth are insufficient to achieve MDG poverty reduction targets by 2015  higher rates of growth are needed  growth needs to be more pro-poor Core policy areas are employment generation and private sector development Core policy areas are employment generation and private sector development Non–income MDGs, especially in health are unlikely to be met Non–income MDGs, especially in health are unlikely to be met  public investment needs to be strengthened to improve social infrastructure and services

11. 11 What is needed in new PRSPs Build on the good experience of the previous PRSP Build on the good experience of the previous PRSP Incorporate MDGs and focus on particular aspects of human poverty: quality of education and skills, health, gender, water and sanitation Incorporate MDGs and focus on particular aspects of human poverty: quality of education and skills, health, gender, water and sanitation Focus on regions and tailor made for specific regional needs Focus on regions and tailor made for specific regional needs Broad participation of development partners Broad participation of development partners Result-orientation and focus on outcomes Result-orientation and focus on outcomes Robust monitoring and evaluation system Robust monitoring and evaluation system

12. 12 Mainstreaming MDGs into PRSPs PRPS have direct references to MDGs PRPS have direct references to MDGs  Armenia, Azerbaijan, Moldova, Tajikistan and Kyrgyzstan explicitly establish relationship between PRSP & MDGs and targets  Armenia PRSP have special tables linking PRSP to MDG targets and indicators  Tajik PRSP establishes 2015 as target year and MDG targets as PRSP targets PRSPs plan increased resource flow to MDG sectors: job creation, micro financing, education, health, environment PRSPs plan increased resource flow to MDG sectors: job creation, micro financing, education, health, environment Despite increase in funding it is not sufficient for MDG achievement Despite increase in funding it is not sufficient for MDG achievement PRSP & MDG monitoring is aligned PRSP & MDG monitoring is aligned Time consistency Time consistency  PRSPs are mid-term 3-5 year strategies, targets are aligned with 2015 MDGs based on assumption of linear progress  Armenia PRSP are long-term having 2015 time horizon

13. 13 Prominence of HIV/AIDS in PRSPs The new Welfare Improvement Strategy in Uzbekistan  Acknowledges HIV/AIDS epidemic as the fastest growing in the region  Key groups at risk: intravenous drug users and prison population (but no mention of sex workers and men having sex with men)  Increasing transmission of HIV from mother to child National goal: halting and beginning to reverse the spread of HIV/AIDS by 2015

14. 14 Measures combating HIV/AIDS 1.Preventive measures focused on groups at risk  Create conducive legal environment to work with high risk groups  Increased availability of voluntary testing  Counselling  Building capacity of health professionals  Involvement of civil society 2.Better access to medical care for those infected  Availability of antiretroviral treatment, especially for pregnant women and children 3.Supportive environment for and protection of the rights of people living with HIV / AIDS  Targeted safety nets

15. 15 Key problems: costing and funding Experience of Tajikistan Experience of Tajikistan  Costing model developed for UNAIDS by Futures Group  Estimates are highly speculative  No funds available for HIV / AIDS in the health budget other than at the expense of other interventions  Financing gap amounts to almost all HIV / AIDS costing and is likely to go uncovered without external assistance Lack of sufficient detail on HIV/AIDS in PRSPs; need for link to health SWAPs / health care reform programmes Lack of sufficient detail on HIV/AIDS in PRSPs; need for link to health SWAPs / health care reform programmes

16. 16 Tajikistan: Financial Estimations for combating HIV/AIDS, 2005-2015 (US$ million) Tajikistan: Financial Estimations for combating HIV/AIDS, 2005-2015 (US$ million) Source: MDG Needs Assessment, Republican Centre on AIDS Prevention and Control of the MoH, 2005 200520102015Total Total2.724.9103.0404.0 Prevention1.87.211.176.1 Care and treatment 0.7716.5387.06308.6 Policy, administration and research 0.11.24.919.2

17. 17 HIV /AIDS costing methods Cost estimates depend on Cost estimates depend on  Pace of epidemic expansion  Price of drug therapies  Range of care and treatment offered Assumptions in the resource model for Tajikistan Assumptions in the resource model for Tajikistan  Adult prevalence rate rises to 5.4 by 2010 and remains constant thereafter  Annual 10-per cent reduction in the cost of palliative therapies  Peer education for 20 percent of the labour force each year  Unit costs of interventions based on regional average in some cases adjusted to Tajikistan’s specifics