The Africa Multi-Country AIDS Program 2000-2006: Results of the World Bank's Response to a Development Crisis

According to this World Bank report, communication strategies such as the mobilisation of empowered "grassroots" communities - along with delivering condoms and life-saving treatments - are beginning to slow the pace of HIV/AIDS in Africa. The core point to emerge from the 188-page report is that continued success in curbing the epidemic will depend on marshalling effective prevention, care, and treatment measures to boost "social immune systems" in African countries - that is, by changing people's beliefs, perceptions, and social and individual behaviours around the disease.

Having provided various statistics to emphasise the scope of the epidemic and patterns in the overseas development assistance (ODA) being dispatched to address it, the report offers background on the World Bank's Multi-Country HIV/AIDS Program (MAP) for Africa, which was set up in 2000 to offer long-term support to any country with a sound HIV/AIDS strategy and action plan. The MAP has worked to address the following 4 needs:

1. the need for strong political and government commitment to respond to HIV
2. the need to create a conducive institutional environment with adequate resources to enable successful HIV/AIDS interventions to be scaled up to a national level
3. the need to make the response local - increasing community participation in and ownership of HIV/AIDS interventions by providing financial resources and capacity
   building
4. the need to move to a multisectoral approach in which all government sectors are appropriately involved, with improved coordination at national level and decentralisation through subnational government structures.

In an effort to understand and outline strategies that have been found to be successful throughout this process, the report documents the contributions of the MAP over the past 5 years (2000-2006), drawing on countries' surveys and programme data. It also proposes a new Results Scorecard and Generic Results Framework to better measure and report future results of HIV/AIDS programmes in Africa that the World Bank helps to support.

Making funding decisions that are sensitive to the needs of, and that support approaches appropriate to, each local context is central to the Bank's work with MAP. While one emphasis has been on providing funding that focuses on high-level leadership (as part of an effort to "make it easier for leaders to break the silence" around HIV/AIDS), often it has been supporting strong engagement of civil society that has contributed to what the Bank describes here as real progress in preventing new infections, mitigating the impact of AIDS, and providing treatment to those infected with the disease. Elizabeth Lule, Manager of ACTAfrica (the World Bank's Africa AIDS Campaign team) comments that "country-inspired and directed responses, grounded in careful analysis of the local epidemic and the factors driving it, that are coordinated and efficiently carried out by a broad range of parties - including countries themselves, the international development community and its aid-giving complex, local community and [non-governmental organisation, or] NGO groups, organizations of people living with AIDS, the media, and others - and carefully monitored and coordinated - are the only sustainable way to help the people of Africa to prevail over HIV/AIDS."

To illustrate this strategy, when considering how to allocate funding as part of the MAP, the World Bank attended closely to evidence that "no country has successfully stopped the spread of HIV, and cared for its sick and dying adults and orphaned children, without the active engagement of community-based groups and NGOs". To that end, the Bank's Africa MAP channelled funds toward locally-based community mobilisation actions designed to reduce stigma, change risky behaviours, and care for people living with, and affected by, the disease. Community-level groups receiving these funds spent 56% on prevention activities, 15% on care and treatment, 11% on mitigation work such as caring for orphans and micro-credit for widows and women living with AIDS, and 18% on work that trained and supervised small NGOs that offer care and support at local levels.

As detailed here, the MAP's development objective focused on output-level results, rather
than on outcome or impact objectives. These results are examined in detail within the report. Two tables illustrate contributions the MAP has made to various outputs; for instance, MAP helped establish 1,1512 new voluntary counselling and testing (VCT) sites. Furthermore, "All data sources concur that the MAP has helped build strong political leadership." A second table in the report details outcome-level results at the levels of systems strengthening, HIV prevention, HIV care and treatment, impact mitigation, and monitoring and evaluation (M & E). In short, "The MAP has been the only significant source of support for community and grassroots initiatives, empowering over 50,000 communities, civil society and faith-based organizations, and organizations of people with HIV to define their needs and work together to fill them; caring for orphans; offering home-based care for poor people ill with AIDS; providing counseling and psychosocial support; providing information on prevention and treatment;
encouraging HIV testing; and supporting income-generating activities."

Click here to access:

• A press release in English
• Video clips of Elizabeth Lule, Manager of ACTafrica, the World Bank's Africa AIDS Campaign team
• The complete report as one PDF file, or separate chapters (also in PDF format) - in English language
• The complete report as one PDF file, or separate chapters (also in PDF format) - in French language

To request that the report be sent to you by email, please write to the contact below.