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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ChallengeThe new authorities face myriad challenges as they bid to return the country to a path of economic growth. Three such challenges are of particular importance: to avoid further violence betwee... Show More +n rival factions (security); to manage the fall-out from investigations into the atrocities (reconciliation); and to establish a stable government and to restart the economy (reconstruction). The Bank is working very closely with the International Monetary Fund (IMF) to support Côte d’Ivoire efforts and progress towards the Heavily Indebted Poor Countries (HIPC) Completion Point.SolutionA Country Partnership Strategy (CPS) for the period FY10-FY13 was discussed by the World Bank’s Board of Executive Directors in April 2010 with four key pillars: (i) strengthening economic governance; (ii) infrastructure renewal; (iii) agricultural production and export promotion; and (iv) private sector development. As of January 31, 2012, the IDA-financed portfolio in Côte d’Ivoire consists of nine active projects with total commitments (including regional projects) of US$655 million, with an undisbursed balance of US$260 million (a disbursement ratio of 60 percent). The Bank also supervises seven trust funds representing commitments of US$9 million. These trust funds include three State and Peace-building Fund (SPF) grants.ResultsFollowing the re-engagement of the Bank in 2008, tangible results have been achieved with International Development Association (IDA) financing.Under the Post-Conflict Assistance Project (PCAP), as of January 31, 2012:18,000 ex-combatants, individuals associated with an armed group, and youth at risk have participated in project economic reintegration activities;74 of the 83 planned sub-prefecture offices (civil registry offices) have been constructed; and65 km of rural roads rehabilitated using high intensive labor method. Under the Emergency HIV/Aids Project, the following results have been achieved as of June 2012:% of female sex workers reporting the use of a condom with their most recent client (disaggregated by age (<25, 25+>) (UNGASS, AAP ) 93% as of 29-Mar-2012% of women and men from 15-49 years of age having had more than 1 sexual partner in the preceding 12 months reporting condom use during their last sexual intercourse; 70.3% women ;77.9% men as of 30-Mar-2012Percentage and number of HIV-infected pregnant women who received a completed antiretroviral treatment to reduce the risk of mother -to-child transmission (UNGASS, UA, AAP) : 44% as of 29-Jun-2012Percentage and number of adults and children with advanced HIV infection receiving antiretroviral therapy [disaggregated by sex and age (<15, 15+)] - (UNGASS, UA, AAP) 108% and 2710 as of 29-Jun-2012Number of condoms distributed (male & female) among the CSW in the 4 target Project regions. 2941301 as of 29-Jun-2012Number of sub-contracts awarded and implemented for HRG and vulnerable populations 81 as of 29-Jun-2012Number of decentralized ( department) plans developed and implemented in the four regions for Health and Education 16 as of 29-Jun-2012Health personnel receiving: 2633.00 as of 30-Mar-2012PartnersThe Bank works closely with other multilateral and bilateral technical and financial partners in Côte d’Ivoire, including inter alia, the African Development Bank, the European Union, the French Development Agency, the International Monetary Fund (IMF), the UN System, Germany, Japan, the United States Agency for International Development (USAID), etc. The Ministry of Finance recently launched the preparation of an aid management framework that will include a donor coordination mechanism. The Bank has also been actively involved in the international post-crisis support to Côte d’Ivoire, notably through two Roundtables co-organized with the African Development Bank on the sidelines of the 2010-2011 World Bank/IMF Annual Meetings.Moving ForwardAdjustments to the Country Partnership Strategy for 2010-2013 will be derived from the progress report on its implementation, in an ongoing effort to improve the relevance, timeliness and significance of the Bank’s response. The World Bank Group-financed program will continue to help government deliver essential services and accelerate growth, while contributing to national reconciliation through the improvement of social and physical infrastructure and promoting good governance. Show Less -
ChallengeAt the project’s original appraisal in 2000, CAR suffered from political instability, armed conflict, and a poverty rate of 67 percent as recurrent conflicts had pushed CAR to 165 out of 173 ... Show More +countries in the Human Development Report, with life expectancy an estimated 44.3 years. Periodic mutinies and coup attempts destroyed infrastructure and social services, delaying project implementation until 2007, when national elections and peace agreements with key rebel groups had been achieved. Sporadic violence persisted as IDA re-engagement focused on improving delivery of basic social services and HIV/AIDS prevention and control. In 2001, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated 10.7 percent of the population aged 15-49 was living with HIV/AIDS, 13,000 to 23,000 of whom were killed by the disease each year. Basic healthcare, primary education and access to water and sanitation are often inaccessible. This situation drove infant mortality to 106 per 1,000 live births, and the percent of malnourished children under 5 years old to 19 percent. Maternal mortality was high, 20 percent of children under 5 years old had malaria, and the teacher-pupil ratio sank to around 1:100, causing 30 percent of pupils to repeat grades and 40 percent not to finish primary school.SolutionThe project was designed to assist CAR in response to urgent social needs, such as increased access to water supply, improved primary education, prevention of malaria and access to prevention treatment and mitigation of HIV. The project consisted of the following four components:Support to the National Program against HIV/AIDS ($5.72 million)Civil society responses to HIV/AIDS based on behavioral changes and support for those affected by the disease were supported. The Ministries of Health, Education, Defense, Social Affairs, and Public Services were assisted in providing prevention services and support to affected individuals, including voluntary counseling and testing services and antiretroviral treatment. The National HIV/AIDS Coordinating Committee received financing and assistance for a national health and HIV/AIDS study.Support to Emergency Health Needs ($8.33 million)About 300,000 insecticide-treated nets were distributed to pregnant women and children under five to prevent malaria contraction. Small community projects to address emergency health needs such as rural water supply systems, drainage of marshlands to restrict mosquito reproduction, small medical supplies, and training of health workers also received financing.Support to Emergency Needs in the Education Sector ($2.64 million)Teacher training improved quality and the student-teacher ratio, while the project provided textbooks, small furniture, teaching kits, and other education material to underserved primary schools.Support to Financial Management and Procurement ($2.26 million)ResultsThe main outcomes included:By March 2012, voluntary counseling and testing was strengthened with new equipment, training, marketing, and logistical support, which resulted in the testing of 118,862 people, including 10,465 pregnant women, 1,999 teachers, and 6,845 military personnel and their families.45 laboratory staff were trained in blood transfusion, 16 labs were provided generators, and medical equipment was provided to 15 health facilities.Antiretroviral treatment was provided to 1,624 adults and 95 children.18,448 individuals and families were sensitized by the Ministry of Social Affairs, 8,948 of whom were tested and received results, 332 of whom are now receiving treatment.1,023 teachers were recruited and trained.178,500 textbooks, 5,596 school kits, and 5,130 table benches were distributed.3,000 new curricula were printed, and 22 heads of school districts were trained.192 community microprojects led to 46 forges, 46 water sources, 9 wells, and a set of rehabilitated health facilities.15 restaurants and 19 mini motels were financed for 31 associations of people living with HIV/AIDS.Condoms were distributed by the Ministry of Education.Bank Group ContributionDespite CAR’s status as a fragile state, the project has made substantial progress. IDA contributed $18.95 million to the project as the sole source of funding. Of this sum, $5.72 million supported people living with HIV/AIDS, $8.33 million supported urgent health needs, $2.64 million supported the education sector, and $2.26 million supported the Financial Management and Procurement Unit.PartnersDomestic civil society organizations were the main project partners, as the $5.72 million component was focused on supporting and strengthening the work of the Ministries of Health, Education, Defense, Social Affairs, and Public Services.Moving Forward The Global Fund to Fight AIDS, Tuberculosis and Malaria will fund 31 Projet multisectorielsanté, éducation et SIDA (PSES) sites to provide treatment to patients receiving antiretrovirals and expand prevention of mother-to-child transmission, while the government will begin funding the National HIV/AIDS Coordinating Committee. The $38 million Fast Track Initiative Catalytic Fund will support the National Education Strategy through school construction and rehabilitation, as well as teacher training and the provision of education materials. A $28.3 million IDA and Health Results Innovation Trust Fund operation will support utilization and quality of maternal and health services. Finally, a $24 million IDA-financed Additional Financing for the Emergency Urban Infrastructure Rehabilitation Project will improve water supply and drainage while mitigating flood impact. Beneficiaries N/A Show Less -
ChallengeAs of 2007, an estimated 1.32 million Ethiopians were infected with HIV, with over 130,000 new infections each year. An epidemic of HIV transmission was taking place in most at-risk populatio... Show More +ns, particularly sex workers and their clients. As a result, life expectancy was falling and expected to drop from 59 to 50 years by 2010. In 2005, 80% of the 60 million Ethiopians lived rurally, and 39% lived below the poverty line. AIDS had become the leading killer of 15-49 year olds, causing 43% of all adult deaths, severely damaging economic growth and slowing poverty alleviation. Poverty, illiteracy, widespread transactional sex, gender disparity, population movement, and traditional practices such as female genital mutilation all contributed to the epidemic.SolutionThe first Ethiopian Multisectoral HIV/AIDS Project (EMSAP1), closed in 2006, supported general awareness of HIV and AIDS, as well as increased condom use, but not at a sufficiently high level. This project, EMSAP2, set out to scale up where EMSAP1 left off, notably to increase the percentage of:young people who could correctly identify ways of preventing sexual transmission of HIV and who reported the use of a condom with their last sexual intercourse with a non-regular partnersex workers who report using a condom with their most recent clientpeople over the age of 15 in voluntary HIV counseling and testingdistricts supporting groups for people living with HIV/AIDS and programs for orphansThe project was designed to:Strengthen public, private, and civil society organizations to improve coordination and strengthen the monitoring and evaluation system in line with the national capacity building program.Promote Peer education, counseling and testing, condom distribution, and mechanisms for reduction of harmful traditional practices were supported to prevent HIV spread.Support community and district-based initiatives to deliver proven HIV prevention and mitigation activities to at-risk groups.Results9.8 million people over the age of 15 undergoing voluntary HIV counseling and testing each year, as of 201079% of females and 84% of males aged 15-24 both correctly identify ways of preventing HIV transmission and reject major misconceptions about HIV transmission, as of 201181% of females and males aged 15-24 reported the use of a condom during their last sexual intercourse with a non-regular partner, as of 201198% of sex workers reported using a condom with their most recent client98% of districts are supporting effective groups for people living with HIV/AIDS and implementing community programs to support orphansThe project also established an HIV/AIDS information and monitoring and evaluation system that supports improved policy and program decision making by the timeBank Group ContributionThe International Development Association (IDA) was the only financier of the project, contributing a total of US$25,997,472 to the project.PartnersFederal and regional HIV/AIDS prevention and control offices were established to coordinate the national response with oversight provided by a board chaired by the Minister of Health.Other Partners:The Global Fund for AIDSPresident’s Emergency Plan for AIDS Relief (PEPFAR)Moving ForwardThe project closed in March 2012. The government and civil society have limited resources and capacity to sustain the necessary levels of inputs and services, and there is concern that the Global Fund and PEPFAR will not sustain current levels of financing. Thus, other sources of funding must be identified, including government appropriations and community contributions. Show Less -
ChallengeWith a per capita gross income of $380, Burundi is one of the poorest countries in the world, with individuals spending less than $49 on health per year. A 2007 survey showed HIV presence in ... Show More +the general population at 3 percent and among commercial sex workers at 38 percent, as well as a rapid increase in prevalence in rural areas. Causes of the epidemic include commercial sex work, widespread presence of multiple concurrent partnerships, and low rates of male circumcision. Implementation of Burundi’s 2002-2006 National HIV/AIDs Strategy (NHAS) was constrained by a host of institutional, technical, financial, and capacity-related issues, the lessons of which were used to develop a second NHAS. IDA was needed to provide strategic guidance, lessons learned, and technical assistance to the second NHAS, and to ensure synergy between health system strengthening and HIV/AIDS interventions. Finally, the government has advocated the importance of IDA’s continued support to civil society through subprojects and capacity building activities. SolutionThe project set out to “increase the utilization of a selected set of preventive services, among groups highly vulnerable to, or affected by HIV/AIDS.” Commercial sex workers, Burundians aged 15-49 with multiple sex partners in the past year, and pregnant women with HIV were all targeted by the projectNumber and value of subprojects targeting vulnerable populations and high risk groupsPercentage and number of people with advanced HIV receiving antiretroviral therapyNumber of pregnant women with HIV who received antiretroviral therapy to prevent mother-to-child transmission (PMTCT)Number of persons living with HIV/AIDS reached through small grant activitiesNumber of public sector organizations with HIV control-related activities as part of their annual plans or sector strategies.To achieve these goals, the project financed behavior change activities in a range of organizations, with support for preventing PMTCT and for male circumcision through direct transfers to the Ministry of Health (MoH). The project also supported the expansion of antiretroviral (ARV) treatment with the use of performance based contracting managed by the MoH. Small grants were provided to vulnerable families and HIV/AIDS activities were supported in key ministries and local governments.ResultsHIV prevalence among commercial sex workers (CSWs) decreased from 37.7 to 19.8 percent.Nationwide HIV prevalence decreased from 3 to 1.4 percent, even as treatment with ARVs more than doubled.The number of people on antiretroviral therapy increased from 10,928 to 25,117.The percentage of HIV-infected pregnant women who received a completed antiretroviral treatment to reduce risk of mother-to-child transmission increased from 6 to 32 percent.Condom use rate among female commercial sex workers increased from 82 to 91.2 percent.The percentage of Burundians aged 15-49 with more than one sexual partner in the past year who reported using a condom during their last sexual intercourse increased from:o Men: 6 to 13.9 percento Women: 10.9 to 14.3 percent.A total of 272 CSW peer educators were trained in the prevention of Sexually Transmitted Infections. Approximately 4,426,322 male condoms and 28,573 female condoms were distributed.A total of 169 CSWs and 189 security officers were educated on the rights of CSWs.A total of 5,292 CSWs underwent HIV testing and know their results.Bank Group ContributionThis project was funded by an IDA grant, which disbursed over $9.0 million, and supported 247 activities, reaching an estimated 94,763 Burundians. PartnersPopulation Services International and the Conseil National de Lutte contre le SIDA (CNLS) served as implementation partners for this project. Moving ForwardThe government continues to pay for HIV related services since the closing of the project with support from the Health Sector Development Support Project, PRIDE, the European Union, and the Belgian development agency. The Executive Secretariat for the National HIV/AIDS Council will be restructured, focusing on re-organization and staffing BeneficiariesCecile 25, who started sex work at the age of 13, was able to give up sex work and start a palm oil business using a grant from this project. “With 2000 Burundi francs ($1.50), I’m able to pay my daily food ration,” says Cecile, who is HIV-negative and glad that she no longer has to go from pub to pub in search of clients. Jeanne, another of the country’s 14,000 female sex workers says, “We have been sensitized by watching movies showing that HIV/AIDS kills and we were given condoms to protect ourselves against sexually transmitted infections.” Show Less -