The World Bank's Commitment to HIV AIDS in Africa: Our Agenda for Action, 2007-2011

146 Pages·2008·0.71 MB·English

by  World Bank

THE WORLD BANK’S COMMITMENT TO
HIV/AIDS IN AFRICA
OUR AGENDA FOR ACTION, 2007–2011
THE WORLD BANK’S COMMITMENT TO
HIV/AIDS IN AFRICA
OUR AGENDA FOR ACTION, 2007–2011

THE WORLD BANK’S COMMITMENT TO
H I V / A I D S I N A F R I C A
OUR AGENDA FOR ACTION, 2007–2011
Washington, DC
© 2008 The International Bank for Reconstruction and Development/The World Bank
1818 H Street, NW
Washington, DC 20433
Telephone: [phone]
Internet: www.worldbank.org
E-mail: [email protected]
All rights reserved
1 2 3 4 11 10 09 08
This volume is a product of the staff of the International Bank for Reconstruction and Development/The World Bank.
The findings, interpretations, and conclusions expressed in this volume do not necessarily reflect the views of the Execu-
tive Directors of The World Bank or the governments they represent.
The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denomi-
nations, and other information shown on any map in this work do not imply any judgement on the part of The World
Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.
Rights and Permissions
The material in this publication is copyrighted. Copying and/or transmitting portions or all of this work without permis-
sion may be a violation of applicable law. The International Bank for Reconstruction and Development/The World Bank
encourages dissemination of its work and will normally grant permission to reproduce portions of the work promptly.
For permission to photocopy or reprint any part of this work, please send a request with complete information to the
Copyright Clearance Center Inc., 222 Rosewood Drive, Danvers, MA 01923, USA; telephone: [phone]; fax: 978-
750-4470; Internet: www.copyright.com.
All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of
the Publisher, The World Bank, 1818 H Street, NW, Washington, DC 20433, USA; fax: [phone];
e-mail: [email protected].
English: French: Portuguese:
ISBN: 978-0-8213-7448-1 ISBN: 978-0-8213-7464-1 ISBN: 978-0-8213-7466-5
eISBN: 978-0-8213-7449-8 eISBN: 978-0-8213-7465-8 eISBN: 978-0-8213-7467-2
DOI: 10.1596/978-0-8213-7448-1 DOI: 10.1596/978-0-8213-7464-1 DOI: 10.1596/978-0-8213-7466-5
Cover design:Naylor Design, Inc.
Cover photos: Curt Carnemark/World Bank (left & right); Robert T. Schreiber (middle).
Library of Congress Cataloging-in-Publication Data
World Bank.
The World Bank’s commitment to HIV/AIDS in Africa : our agenda for action, 2007-2011.
p. ; cm.
March 2008.
Includes bibliographical references and index.
ISBN-13: 978-0-8213-7448-1 (alk. paper)
ISBN-10: 0-8213-7448-6 (alk. paper)
1. World Bank. 2. AIDS (Disease)—Africa, Sub-Saharan—Prevention—Finance. 3. AIDS (Disease)—Africa, Sub-
Saharan—International cooperation. 4. AIDS (Disease)—Economic aspects—Africa, Sub-Saharan. I. Title.
[DNLM: 1. World Bank. 2. Acquired Immunodeficiency Syndrome—economics—Africa—Tables. 3. HIV Infec-
tions—economics—Africa—Tables. 4. Acquired Immunodeficiency Syndrome—prevention & control— Africa—
Tables. 5. HIV Infections—prevention & control—Africa—Tables. 6. International Agencies—Africa—Tables. 7.
International Cooperation—Africa—Tables. 8. Regional Health Planning—Africa—Tables. WC 503 W9273w 2008]
RA643.86.A357W67 2008
362.196'979200967—dc22
2007051390
Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
The Agenda for Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Continuing Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Future Actions for the Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Implications for the Africa Region Work Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
2 The Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
The Epidemiology of HIV/AIDS in Sub-Saharan Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
The Development Impact of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
The Implications for Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
3 The Bank’s Response to Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
The Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Lessons Learned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
4 Strategic Challenges in the New Environment . . . . . . . . . . . . . . . . .25
Finance, Sustainability, and Accountability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Operational Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
5 The Agenda for Action 2007–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Strategic Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Overall Conceptual Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
The Foundation: Renew the Commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Pillar 1: Focus the Response through Evidence-Based and Prioritized HIV/AIDS Strategies . . . .41
Pillar 2: Scale Up Targeted Multisectoral and Civil Society Responses . . . . . . . . . . . . . . . . . . . .42
Pillar 3: Deliver Effective Results through Increased Country M&E Capacity . . . . . . . . . . . . . . . .45
v
vi The World Bank’s Commitment to HIV/AIDS in Africa
Pillar 4: Harmonize Donor Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
Anticipated Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
The Potential Impact and Consequences of Inaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
6 Operational Implications for the Bank . . . . . . . . . . . . . . . . . . . . . . . .51
Work Program Implications for the Africa Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
An HIV/AIDS Support Program for FY2007–FY2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Implications for Staffing and Budgeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
7 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Appendixes
1 Agenda for Action Consultations . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
2 HIV Indicators for Sub-Saharan Africa . . . . . . . . . . . . . . . . . . . . . . . .67
3 Bank Response to HIV/AIDS: A Chronology of Events . . . . . . . . . .71
4 The Potential Impact of HIV/AIDS Interventions: Methodology
and Simulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
5 World Bank HIV/AIDS Portfolio for Africa, Fiscal Years
1989–2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
6 MAP Achievements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
7 MAP Challenges and Improving Performance of the MAP
for Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
8 HIV Prevalence and Global Financing . . . . . . . . . . . . . . . . . . . . . . . .91
9 The Bank’s Role in the UNAIDS Division of Labor . . . . . . . . . . . . .93
10 Agenda for Action: Implementation Plan and Results Framework . .94
11 The HIV/AIDS Results Scorecard . . . . . . . . . . . . . . . . . . . . . . . . . .109
References and Other Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119
Contents vii
Figures
2.1 Estimated Number of People Living with HIV in Sub-Saharan Africa, 1990–2007 . . . .11
2.2 The Heterogeneity of HIV Prevalence in Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
2.3 Changes in Life Expectancy at Birth in Selected African Countries with High and
Low HIV Prevalence, 1965–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
4.1 Active HIV/AIDS Commitments by World Bank Sector . . . . . . . . . . . . . . . . . . . . . . . . .32
5.1 Global Funding for HIV/AIDS in the Top 10 High-Prevalence African Countries . . . . . .36
5.2 World Bank HIV/AIDS Lending in Africa FY00-FY07 . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
5.3 World Bank HIV/AIDS Agenda for Action in Africa Conceptual Framework . . . . . . . . .40
A2.1 Life Expectancy at Birth for Selected Sub-Saharan African Countries, 1965–2005 . . .70
A4.1 Universal Access to Treatment: Number of Deaths Averted, 2007–2030 . . . . . . . . . . .75
A4.2 Universal Access to Treatment: Cumulative Number of Life Years Gained in
Sub-Saharan Africa, 2007-2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
A4.3 Infections Averted Due to Prevention Efforts in Sub-Saharan Africa, 2007-2011 . . . . .76
A4.4 Number of OVC in Sub-Saharan Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
Tables
2.1 Ten Most Common Causes of Mortality and Morbidity in Sub-Saharan Africa . . . . . .10
4.1 Funding Sources and Commitments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
4.2 Resource Needs for Universal Access, 2007–2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
5.1 Country Types and HIV/AIDS Typology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
5.2 Possible Differentiated Responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
5.3 Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
5.4 Pillar 1: Focus the Response through Evidence-Based and Prioritized HIV/AIDS
Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
5.5 Pillar 2: Scale Up Targeted Multisectoral and Civil Society Responses . . . . . . . . . . . .49
5.6 Pillar 3: Deliver Effective Results through Increased Country M&E Capacity . . . . . . . .50
5.7 Pillar 4: Harmonize Donor Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
A1.1 Agenda for Action Consultations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
A2.1 HIV Prevalence, Income, Access to Treatment, and Quality of Health Services in
Sub-Saharan Africa, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
A2.2 Life Expectancy at Birth for Selected Sub-Saharan African Countries, 1965–2005 . . .69
A3.1 Bank Response to HIV/AIDS: A Chronology of Events . . . . . . . . . . . . . . . . . . . . . . . . . .71
A4.1 Cross-Classification of Interventions by Cost Effectiveness and Impact . . . . . . . . . . . .78
A4.2 Studies of Cost Effectiveness of HIV/AIDS Interventions in Sub-Saharan Africa . . . . .79
A5.1 Closed MAP and Stand-Alone Projects, and Closed Projects with HIV/AIDS
Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
A5.2 Active MAP and Stand-Alone HIV/AIDS Projects, and Active Projects with
HIV/AIDS Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82
A6.1 Results in Countries in Africa with MAPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
A6.2 Outcome-Level Results to Which MAP Has Contributed . . . . . . . . . . . . . . . . . . . . . . . .86
A7.1 Overview of the Key Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
A8.1 HIV Prevalence and Financing, by Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
viii The World Bank’s Commitment to HIV/AIDS in Africa
A9.1 World Bank Role in UNAIDS’ Technical Support Division of Labor . . . . . . . . . . . . . . . .93
A10.1 The Foundation: Renew the Commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94
A10.2 Pillar 1: Strengthened Long-Term Sustainable National Response . . . . . . . . . . . . . . . .98
A10.3 Pillar 2: Accelerated Implementation of HIV/AIDS Programs . . . . . . . . . . . . . . . . . . . .100
A10.4 Pillar 3: Strengthened National Systems for Financial Management,
Human Resources, Procurement, Supply Chains, and Health and Social Systems . .104
A10.5 Pillar 4: Strengthened Donor Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
A11.1 The HIV/AIDS Results Scorecard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
Foreword
HIV/AIDS poses an unprecedented development and human challenge,
especially in Africa. In many countries, the epidemic has cut life expectancy
and robbed society of millions of people in their prime working years. It has
dimmed the hope of living full and productive lives for unimaginable num-
bers of infants, children, and young adults.
The World Bank, an institution dedicated to the reduction of poverty
worldwide, was one of the first organizations to respond to the HIV/AIDS
emergency. Since 2000, it has provided more than $1.5 billion to more than
30 countries in Sub-Saharan Africa to combat the epidemic. The World
Bank has helped put in place the foundations of an effective response—a
governance structure; a strategic direction; a multisectoral approach; com-
munity engagement; and programs for prevention, treatment, and care.
World Bank support has also helped mobilize significant new funding for
HIV/AIDS and engendered collaboration among donors.
Today, we have a better understanding of the epidemic and its transmis-
sion than at any time in the past. We now know that it is not one but sev-
eral different epidemics. We are more conscious that this horrific scourge
has disproportionately hit women and young girls, who need the legal,
social, and economic power to protect themselves, access treatment and
care, reverse infection, and stem stigmatization. And we have seen funding
for HIV/AIDS dramatically increase. HIV/AIDS remains, however, the
leading cause of premature death and is a major threat to development in
Africa.
The World Bank is vigorously working together with the peoples of
Africa—the communities, their national leaders, and external partners—to
find solutions to this scourge, which is an attack on our common humanity.
For this reason, the Bank rededicates itself to a long-term engagement in
fighting HIV/AIDS in Africa. The title of this report is appropriate: The
World Bank’s Commitment to HIV/AIDS in Africa: Our Agenda for Action,
2007–2011.
This Agenda for Action reaffirms the Bank’s determination to remain a
full partner in the fight against HIV/AIDS through the provision of fund-
ing, analytical support, capacity development, and knowledge sharing. The
Bank will use its convening power and other technical resources to combat
ix