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.
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Ho Chi Minh City, July 1, 2011 - Every evening, Nguyen Thanh Lam starts packing his bags and going out to meet his clients. Just like any salesman doing his job.The difference is that his clients are ... Show More +drug users, sex workers and any one prone to HIV infection. It means he has to go to high risk places where his clients work, sometimes, being intimidated by them, and a lot of the time being misunderstood by his acquaintances. But it just can’t stop this once drug-addict from what he is doing, as he wants to do something to his peers.Like Lam, Le Thi Hong Yen faced family boycott when she decided to act as a peer educator on HIV. Her sister and brother in law refused to talk to her unless she quitted what she was doing. But she decided to keep on what she was doing merely because she believes in the value brings to society by her work.(Video interview & transcript).Recognizing the impacts of peer educators’ works, the World Bank has included a component on using peer educators to its HIV AID prevention project.The project has recognized that face to face communications, especially through the peer to peer methodology is the most effectgive and principal methods of communicating messages relating to HIV, especially with regard to reaching the high risk groups.This fact is also confirmed by the Vietnam HIV/AIDS Prevention Agency, that has been trying many different methods to clamp down the HIV infection rate.According to Dr. Chu Hong An, Deputy Director General of the Agency, there are currently more than 5000 registered peer educators nationwide that have received training and are now active in convincing the community about the risks related to prostitution and drug use.Thanks to their efforts, the HIV infection rate among drug users has reduced from 30% in the year 2000 to just 18% last year, meaning thousands of drug users have been saved from the risk of HIV infection that could otherwise been the case.To further enhance the effectiveness of peer educators’ work, with the Bank’s support, a forum has been designed and held bi-annually for them so that they can meet, exchange experience in approaching clients, transferring experience and to have fun together. Nguyen Thanh Lam and Le Thi Hong Yen are two of the faces appeared at this forum and presenting their own experiences to their peers.“Peer educators’ activities are important in the sense that it help prevent the spread of HIV AIDs,” says Dr. Do Hong Kien, Director Lam Dong Province HIV/AIDS Prevention Center. “Peers educators share the same background with their clients, and so they understand each other and can find the way out while no other can. Through their works, the society understand and appreciate their work. They are very enthusiastic and responsible. They all think that this work helps their peers, and contribute to society’s efforts for HIV preventions, and that this is a humane thing to do.” (Video interview)“In short, peer educators can do things that others can't,” says Dr. Lai Kim Anh, Director of Can Tho City HIV/AIDS Prevention Center. Show Less -
VIENTIANE, Laos, June 18, 2011 --The World Bank and AusAid organized the Young Entrepreneurial Marketplace Competition, a contest where young Laotians could pitch their business ideas and turn these i... Show More +nto reality over the next year. Candidates stood a chance at winning $5,000.00 and mentorship from the Young Entrepreneurs Association of Lao PDR. 212 proposals- covering business ideas about tech, farm products, and more - were submitted.Meet the 11 teams who emerged as winners of the competition:Teaching Computer SkillsTuny Inthanongsak, Apple Inthanongsak, and Sidavanh Thammavong“Information technology (IT) is rapidly growing in Laos. We’ve been working with computers and electronics for nine years and know how IT can be used in all work and help generate income. This is why we want to set up a training center for students, teachers, and local people from Dongkhamxang Village (Vientiane) who want to gain IT skills.”Empowering Women with HIV to Make and Sell HandicraftsPhennapha Phommachanh and Sengaloun Luenglitthideth“There are more than 4,000 people in Laos who have HIV and most of them face discrimination because of their illness and unemployment. The Dokataven group was formed in 2004 to help Lao women with HIV regain their strength and also earn. The group, comprising 10 women from Nongbone Village, are now making bed sheets, bags, and handicrafts. Our business will make their products available to foreign buyers inside and outside Laos through direct selling and product orders.”Hydroponic Vegetables for SaleVilaysack Sengphouthay“In farming, one has to depend on the climate for a good harvest. But new techniques and science now make it possible to do that consistently throughout the year. My market research also shows that people in big cities are very interested in organic vegetables because of their nutritional value. My business idea is to grow organic vegetables for salads using hydroponics (growing plants in water without soil).”Turning Scraps into HandicraftsVilayphone and Bounyong Phetsamone“We used to collect leftover fabrics from factories and sew them into handicrafts. These became popular in our area and traders would come to our home to buy. I want to expand the business by setting up sewing groups in different areas. We also want to involve disabled and unemployed women in our work.”Cooking Up Nutritious Food ProductsKhampane Kousonsavath“I buy surplus vegetables and fruits from farms and markets to make preserved food such as fruit jams, ginger tea, and dried banana. My marketing plan is participate in more festivals and have sales incentives- such as giving free items to customers who buy in bulk. I think expanding my business is also good because it will translate to more jobs for the young people in Ban Nonkhor.”Creating a High-tech Platform for Consumer FeedbackPhavanhna Douangboupha“YourMoment will provide online marketing and customer tracking tools for companies in Laos. It will allow people to review the services or products and provide this data to companies so that they can improve their business. YourMoment will integrate social media channels like YouTube, Twitter, and more to enhance its services.”Organizing Ethnic Events for Visitors in LaosBounmy Sisamone“Luang Prabang traditions have been passed down through generations. Our folklore, national dress, and ceremonies are cherished parts of Laos culture. My business is to share these with visitors to our country. An example of this is organizing baci or other ritual ceremonies for couples who visit Laos on their honeymoon.” Sow-ing SuccessEkkaphoth Thongpadith“I want to have a pig farm. I’ll start with six pigs because it makes sense to work on a small-scale first and then see which pig breed is most suited for the climate in Luang Prabang. If I’m successful, I plan to increase the number of pigs to raise, hire more workers, and even expand my business to other parts of Laos”. Mushroom FarmingOrlady Hadaoheauang“I used to be a sales staff and, during that time, read books about how to grow oyster mushrooms. Inspired, I went to agriculture school and started farming mushrooms with my parents. I currently grow oyster and white mushrooms- these grow during different parts of the year so I have a continuous harvest. I’d like to use the grant money to build a mushroom greenhouse to increase my yield.” Reselling High Quality Coffee BeansSouphaphone, Kongkeo, and Souvannalath Sihanon“95% of Paksong residents are coffee farmers and my family used to be among them. Our coffee garden wasn’t big enough to accommodate market demand so we shifted from farming to buying Arabica and Kang coffee beans from our neighbors and reselling them to big coffee companies. Our proposal is about increasing the amount of coffee we collect in order to meet the current demand.” Raising PigletsKhamsoth Outhamixay“Pork is a meat staple in Lao cooking. Piglets, in particular, are in very high demand because these are cooked during celebrations and year-round festivals. We used to raise just enough piglets for our family to eat during special occasions but I’ve turned it into a small business. I’d like to turn my parent’s land into a pig farm.” Show Less -
OverviewThe China Tuberculosis Control Project was the largest tuberculosis (TB) control project funded by the World Bank in the world. The project objective was fully achieved and targets for case de... Show More +tection and cure rates for TB were exceeded. The project registered and treated close to 1.6 million new patients. More than 1.5 million of these patients completed treatment (94.2 percent) and nearly 1.5 million patients were cured (93.8 percent).ChallengeBy 2002, China had one of the highest “TB burdens” in the world—after India—and was facing particular challenges in Multi-Drug Resistant TB (MDR-TB) and HIV/TB co-infection. More than 600,000 people were estimated to be infected with HIV, about one-third of them expected to die from TB. Parts of China had some of the highest rates of MDR-TB in the world. The disease also contributes to the cycle of poverty for many Chinese citizens. The largest group in the population affected by TB is adults in their most productive years. Their sickness and death contribute to the impoverishment of entire families.A key challenge in addressing this problem was to increase the financing for and improve the quality of healthcare in the poorer provinces. Indeed, in the 1980s, health financing in China shifted from a centralized to a decentralized and individual responsibility approach. The share of government spending on health decreased substantially and “out-of-pocket” spending increased. The extremely low coverage of health insurance was especially problematic for TB control. One survey showed that 37 percent of TB patients were unable to seek care because of financial difficulties, and many TB patients became poor because of treatment costs.Despite the major public health threat posed by TB, funding for its control remained insufficient. The less-developed provinces in western regions found it particularly hard to find the financing for TB control.ApproachThe Tuberculosis Control Project covered 16 provinces, selected for their low per capita incomes, high prevalence of TB and commitment to implement the program with local financial participation. While it covered the entire population of these provinces (over 680 million people), it focused on the poor. Special arrangements were made to maximize project benefits for the high proportion of ethnic minorities and other socially vulnerable groups in the project provinces.The project piloted and scaled-up the World Health Organization (WHO)-recommended “DOTS” (Directly Observed Treatment, Short-course) strategy, which involves not just finding and curing infectious TB patients, but ensuring that they receive free care and that they take their full six-month treatment.The project also emphasized institutional development, policy and program development, and coordination at the national level. The bulk of activities focused on the improvement of access to and the quality of TB control services. The project, which incorporated lessons from two previous TB-control projects, was an integral part of the National TB Control Program (NTP). TB control efforts were tailored to the local context, patient profile and existing health service delivery systems. Performance-based incentives were used, with doctors and health workers in rural and urban areas receiving a fee for reporting and referring a TB patient and for supervising a patient to complete treatment for the entire six months.ResultsFrom 2002 to early 2009, the project registered and treated approximately 1.598 million new smear-positive patients; 1.505 million patients completed the treatment (94.2 percent) and 1.499 million patients were cured (93.8 percent).The project reduced TB-associated deaths by 770,000, and prevented 20 million people from being infected by TB and 2 million people from falling ill.The project achieved its target of a 70 percent case detection rate of new smear-positive cases; the rate exceeded 70 percent in 2005 and has remained at around 77 percent since.The cure rate for new smear-positive cases greatly exceeded the goal of 85 percent.A Ministry of Health evaluation of the project noted that the focus on western and poorer regions of China was critical to bolstering the national TB strategy.The project created a supportive policy environment and invested in institutional strengthening to improve case finding and treatment effectiveness.Health education activities were conducted to improve knowledge and awareness of TB under the national IEC plan using a health promotion resource database developed with the project’s support. The project tailored health promotion materials to its target population by using the languages of main ethnic minority groups.The project achieved its objective of establishing adequate institutions at all government levels to control TB and established effective TB control institutions by strengthening their capacity in financial management and planning and improving the quality of TB care.Bank ContributionThe project—integrated from its inception into China’s overall national TB control program—was financed through a US$101.44 million loan from the World Bank; a US$35.65 million grant from the U.K. Department for International Development (DFID); a US$14 million grant from Japan; and US$124 million in government counterpart funding. Other major international partners included the Bill & Melinda Gates Foundation, the WHO, KNCV Tuberculosis Foundation (Netherlands), and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).PartnersProject preparation benefited from outstanding collaboration and partnership between the Ministry of Health, the World Bank, the WHO and DFID, each organization playing the role that corresponded to its comparative advantage. The WHO provided technical leadership and guidance; the World Bank focused on implementation arrangements, fiduciary aspects, and project financing mechanisms. The KNCV Tuberculosis Foundation aided the Bank on technical matters. DFID provided valuable inputs financially and technically, particularly in relation to the pro-poor orientation of the project.Moving ForwardThe project successfully achieved its objectives, but TB control remains a major long-term public health challenge for China. Many issues remain, which could not be accommodated under the scope of the completed project. During the past 10 years, China has implemented significant health sector reforms particularly in the area of health financing. It is important that TB control and other public health programs are “mainstreamed” in these systemic reforms rather than being isolated public health interventions.The next phase of TB control and of potential collaboration between China and the Bank includes reducing the inequity in TB detection and treatment, the programmatic management of MDR-TB, the introduction and scale-up of new diagnostic tools and drugs, TB control and health system reforms, and the strengthening of the role of hospitals and laboratories in TB control.Since the Bank and China started collaboration on TB control, the global donor architecture in relation to TB care has significantly changed, mainly as a result of the arrival of the Global Fund and a number of philanthropic organizations. It is important to continue coordinated efforts among the Ministry of Health and various donors to maximize synergy and to reduce duplication. Show Less -