The World Bank pioneered global HIV and AIDS financing early in the emergency and remains committed to achieving Millennium Development Goal 6, to halt by 2015 and begin to reverse the spread of HIV and AIDS, through prevention, care, treatment, and mitigation services for those affected by HIV and AIDS.
Read More »
KIGALI, July 22, 2012—Between 2003 and 2008, the World Bank’s Multi-Country HIV/AIDS Program (MAP) provided associations of people living with HIV/AIDS in Rwanda with grants to help them find alternat... Show More +ive livelihoods. Many of these associations were later transformed into cooperatives with support from the government and local leaders.As the global HIV/AIDS community gathers in Washington, D.C. for the biannual International AIDS Conference, the time is right to salute the courage of one of these groups of Rwandan women, and recognize their government’s efforts to reach out to them with HIV testing, access to health insurance, and income-generating opportunities.In Kanombe district, on the outskirts of Kigali, Claudine looks proudly upon the results of her work—the manicured rows of trees lining the road leading to the airport. She and her friend Marceline belong to the Koranintege Cooperative, which supports former sex workers—many HIV-positive—to find work.The cooperative succeeded in securing a lucrative landscaping contract with Kanombe district. Using a truck bought some years ago with a grant from the MAP, the women now run a profitable business, and are able to access community insurance.“When women take control of their lives, that is the first key step towards turning the tide against AIDS,” said Charles Muvara, a soft-spoken former deputy mayor of Kanombe district. Muvara played a pivotal role in the mid-2000s, helping groups of women formerly engaged in sex work to access MAP funding.Koranintege: “Work with vigor”Women like Claudine were once trapped because their families rejected them; they were at risk of exploitation, abuse, and AIDS; and they were not considered suitable to marry. But as new opportunities for work and healthcare came their way they were able to find a new life, and the work continues today through cooperatives.“We did not lose hope when the MAP ended nearly four years ago, we continued to persevere,” said Claudine, who is raising three young children alone. Claudine’s perseverance is in the spirit of the Cooperative’s name, which means “work with vigor.”The Cooperative president notes that “while the monthly incomes are highly attractive there is insufficient work for all members.” The women take turns being gainfully employed. This requires collective decision making, and a strong sense of solidarity.“It is encouraging that these groups have been transformed into cooperatives. We need a more systematic focus on the sustainability of World Bank investments,” said Laura Frigenti, World Bank Chief of Staff and Director of the Office of the President, and sector manager for health in Africa at the time the Rwanda MAP was launched.Using HIV funding strategically for long-term impactWhen HIV/AIDS funding is used strategically, as in Rwanda, it can have a long-term impact that goes far beyond the treatment and care of those living with HIV/AIDS. For example, using MAP funds, Rwanda was able to not only help sex workers know their HIV status but also to build solidarity and tackle their underlying vulnerability.Also, grants to district hospitals under the MAP were used to boost human resources, allowing facilities to determine how the additional personnel were remunerated and deployed. Grants were combined with refurbishing of facilities and upgrading of laboratories which served other purposes beyond tackling HIV/AIDS. The performance-based financing for HIV/AIDS provided additional incentives to boost HIV testing, and other services.As a result of government leadership and donor support, Rwanda has made important strides in the fight against HIV/AIDS, expanding access to HIV testing, enhancing knowledge, improving coverage of key services, and stabilizing the epidemic.For example, according to the 2010 Rwanda Demographic and Health (DHS) Survey, nearly nine in 10 women (88 percent) who were pregnant in the previous two years received HIV counseling, were offered and accepted an HIV test, and received their test results. This is up from 22 percent in 2005.Between 2005 and 2010, Rwanda has also quadrupled the use of modern contraception, increased the share of assisted births, nearly halved the child mortality rate and appears to be on the way to meeting its Millennium Development Goal (MDG) target for reducing maternal mortality.“It has been a long journey and our partners have accompanied us along the way,” said Dr. Agnes Binagwaho, Minister of Health of Rwanda. “We emerged from a legacy of genocide, but over the past decade, we have built trust and respect with our partners. Today, they have confidence in us, as they see that we produce results, and we do it in a transparent and efficient manner.”Developing a national HIV/AIDS programThe 2012 Millennium Development Goals Report cites Rwanda as one of three countries in the world with a generalized HIV epidemic to have attained universal access to antiretroviral therapy (that is, at least 80 percent of those who need treatment receive it).“When we negotiated the $30 million MAP grant for Rwanda, the country had roughly 870 patients on antiretroviral therapy at several urban facilities and all of them were paying out of their pockets,” said Miriam Schneidman, Lead Health Specialist, in the World Bank’s Africa Region.Under the government’s leadership and with support of the U.S. Centers for Disease Control and Prevention, the Clinton Foundation, and others, the MAP led the decentralization of AIDS treatment and care to underserved and vulnerable groups in Rwanda.“The World Bank played a pivotal role at a critical juncture in the scale up of our national HIV/AIDS program. With the clear vision of government and the support from our partners, we have now achieved universal access to HIV care and treatment,” said Dr Anita Asimwe, Deputy Director of the Rwanda Bio Medical Center.Putting people at the center of development“Putting people at the center of development and focusing on individual welfare has been our overriding strategy,” concluded Minister Binagwaho, who celebrates Rwanda’s huge recent gains in poverty reduction—one million people lifted out of poverty in a short space of time. “Sustained economic growth will ultimately be critical to reducing our dependence on external financing,” she notes.While Rwandan authorities continue to make solid progress towards the attainment of the MDGs, the sun sets in Kanombe district and a fresh cool breeze blows in.Claudine, Marceline, and their friends stand up and, on a whim, begin to dance. They exude a renewed sense of confidence. Show Less -
July 20, 2012 -Yellow, pink and green are the colors of promise in a country where 3.5 million people live with HIV.In the suburbs of Abuja, Nigeria, dedicated implementers of HIV programs are meticul... Show More +ously mapping the area’s HIV epidemic with colorful dots, symbolizing the locations of most-at-risk populations. Nationwide, these populations—including female sex workers, injecting drug users and men who have sex with men—comprise about 3.4% of the national population but account for as much as 40% of new infections in the country.The mapping of these at-risk populations is part of a first-time, nationwide effort supported by the World Bank to track a virus that infects close to 1,000 people a day in the West African country—the second highest number in the world.The exercise is connecting the dots between health facilities and civil society organizations (CSOs) that provide services—including antiretroviral therapy, HIV counseling and therapy, and prevention of mother-to-child transmission (PMTCT) of HIV—and the most at-risk populations. It is also calculating the size of these populations, where they operate and their behaviors, which will expose programmatic gaps and help improve the design, implementation and evaluation of programs to prevent infections.The task is daunting: Abuja, the Federal Capital Territory (FCT), is just one of more than 30 areas across the country that state agencies are mapping. The FCT Agency for the Control of AIDS is mapping 1,560 locations where female sex workers work, 116 linked to men who have sex with men and 43 linked to injecting drug users.“We took this approach because we knew resources for HIV were limited,” says Uche Okoro, Program Manager for the FCT Agency for the Control of HIV/AIDS. “We wanted our programs for these populations to be based on facts.”Big challenges, big investmentsA quarter-century has passed since the first case of HIV was diagnosed in Nigeria. Before 2000, advocates, agencies and partners tried to keep pace with the deadly disease, but fell short in the absence of national coordination and detailed data that told the true story of the epidemic.In 1999, Nigeria’s president moved HIV/AIDS to the top of the country’s agenda and a year later, created the National Action Committee on AIDS, which later became an agency. The same year, the World Bank scaled up its support to countries to improve the efficiency, effectiveness and sustainability of their national AIDS responses. Since then, the World Bank has committed $2 billion to 33 African countries—including $366 million toward HIV prevention efforts in Nigeria—and four regional, cross-border projects in Africa to expand national HIV/AIDS efforts.Nigeria’s five-year strategic HIV/AIDS plan (2010-2015) is focusing on prevention for those most at risk (and including PMTCT), expanding access to treatment, and improving strategic knowledge and management of the epidemic to inform implementation programs. With less than one in five HIV-positive women with access to PMTCT services, and with only limited coverage of most at-risk populations, strengthening or establishing local and state AIDS control agencies and CSOs playing key roles in information and service delivery is essential to saving millions of lives. Show Less -
NDJAMENA, April 10, 2012 -- Djiatou is a village that is largely inaccessible year-round, and those who live there are cut off from health care centers. Although it is located a mere 25 kilometers fro... Show More +m the Pala health district (400 kilometers southwest of the capital), it takes more than one hour in a 4x4 land cruiser to get there.Recently, a group comprised of mainly women stood under the blazing sun in the village’s public square, and they were not there for the region’s weekly markets. All the villagers gathered at that location have one concern; receiving the invaluable care provided by the reproductive health mobile team, established by the Second Population and HIV/AIDS Project (PPLS2) to extend medical care to far-flung and inaccessible villages.Once a month, the mobile teams visit the most remote villages to provide healthcare which they may not otherwise get. The teams, most often comprised of a midwife, two nurses, a laboratory assistant, a social worker, and a driver, are striving to improve maternal and infant health services and to prevent STI/HIV/AIDS.Thus far, the achievements of this initiative are exceeding expectations in the project zone, and the most significant benefit has been to put an end to the suffering of pregnant women who travel long distances for prenatal visits in Pala or Léré. Eleven mobile teams manage to visit 20 sites per month, logging between 100 and 120 consultations per visit.Local political authorities, community leaders, civil society and even beneficiaries took advantage of the opportunity to thank the World Bank for its support of the work in remote areas. The Governor of Mayo-Kebbi West and the Prefect of Lac Léré Department mentioned the colossal health needs of the region and commended the World Bank’s work in the health sector through the deployment of mobile teams.The chiefs of the three villages visited all expressed their appreciation for the PPLS2 through the work being done by the mobile teams, which have helped improve the health of women and children in villages far removed from urban centers.“The introduction of mobile health teams in the region has clearly helped such vulnerable population groups as women and children in Mayo-Kebbi West,” said a midwife from the Pala urban health center.While expressing their appreciation for World Bank interventions, local authorities also expressed their concern regarding the sustainability of these activities. They expressed the hope that the mobile teams will continue their work until a health center is established in the village.Mobile teams have not only shortened distances traveled but have also significantly stimulated demand for maternal and infant care and for screening.“The mobile teams have greatly expanded community access to maternal and infant health services,” said a patient interviewed during their consultation. “Communities are totally satisfied with vaccinations, prenatal consultations, and STI and HIV/AIDS screening.”The strong demand and excellent response to family planning (birth spacing, use of condoms and contraceptives, etc.) have led to significant behavioral changes in the beneficiary population.The teams do not, however, have adequate resources to meet this strong demand. They mentioned in particular cases of severe malnutrition, which, unfortunately, they do not have the resources to treat. A number of problems should be mentioned such as frequent supply shortages, malnutrition cases that go untreated, and heavy demand from communities that is fueling the need for additional resources. Lastly, community demand for the services of mobile teams, which cover only three of the eight prefectures in Mayo-Kebbi West, remains strong. Show Less -
When her husband died of AIDS in 2002, Jeanne—a young woman living in the town of Rumonge on the shores of Lake Tanganyika—turned to sex work to be able to raise her two young children. A decade later... Show More +, she is 39 years old and now knows she has HIV.With a small grant from a World Bank-supported HIV/AIDS project implemented by Population Services International in Burundi, Jeanne was able to seek an alternative living by selling cassava flour with her friend Bella. Cassava is a staple grown around Rumonge. Show Less -
Lesotho is a small country with huge development challenges. Its people face the triple threat of high food prices, poverty and HIV/AIDS. Despite average GDP growth of four percent before the recent g... Show More +lobal economic crisis, more than half the country’s population lives below the national poverty line, according to the latest World Development Indicators.In 2000, the Government of Lesotho determined to narrow the gap between strong economic growth and weakening human development. It set out on a path to increase access to, and provide quality delivery of, essential health services. Show Less -
The project benefits from collaboration within the World Bank Group and a strong partnership with the government of Lesotho. The World Bank provided technical assistance to the design and management o... Show More +f the PPP as part of the Health Sector Reform Program.The International Finance Corporation (IFC), the Bank’s private sector arm, acted as lead advisor to the government of Lesotho throughout the planning, structuring, tendering and implementation phases of the PPP agreement, including extensive due diligence to establish the project’s feasibility and to engage and secure the support of stakeholders locally, regionally and internationally.Jean Philippe Prosper, IFC Director for Eastern and Southern Africa said, “This pioneering project is the first public-private partnership in Africa's health sector that outsources the design, build and full operation of a hospital and all clinical services. It provides an innovative and sustainable model for governments and the private sector to collaborate in delivering better health services in Lesotho and across sub-Saharan Africa.” The Global Partnership for Output Based Aid (GPOBA), a partnership program administered by the World Bank, is providing a US$6.25 million grant to help subsidize the cost of access to services for the residents of Maseru District, the capital city and home to nearly one-third of the country’s population.“The GPOBA grant means expectant mothers, infants, children, and patients at risk of or living with HIV/AIDS and tuberculosis will have access to improved health services,” said Feng Zhao, Senior Health Specialist and task manager for the project for the World Bank and GPOBA. “As well as providing access to basic services for the poor, the output-based approach puts an emphasis on accountability and efficiency in service delivery, which complements the overall design of the larger hospital PPP project.”The innovative financing and implementation structure of the project positions Lesotho as a leader in health sector public-private arrangements, potentially providing a model that could be replicated regionally and even globally. Show Less -