Making the Money Work

The Role of Coordination and Harmonization of Donors in the Fight Against HIV/AIDS

A presentation by Debrework Zewdie,
Global HIV/AIDS Program, The World Bank, Washington DC, USA

5/15/2006, Eastern European and Central Asian AIDS Conference, Moscow.
[Check Against Delivery]

Distinguished colleagues, ladies and gentlemen, good morning.  It’s a tremendous honor and privilege to be here today to address the first Eastern European and Central Asian AIDS Conference. Let me first of all express my deep felt gratitude to the organizers for organizing this conference and for inviting me. 

As recognized by leaders in the region, we are all too aware of the ever-increasing numbers of new HIV infections and AIDS deaths in Eastern Europe and Central Asia. These tragic numbers continue to grow year after year, reminding us of the work that remains to be done in the fight against HIV and AIDS.

Less than 10% of vulnerable groups have access to preventive programs

While we are making progress, indicators show that our efforts against AIDS are falling short of needs. For example, in Eastern Europe less than 8% of injecting drug users, 10% of sex workers, and 9% of men who have sex with men, have access to programs which could protect them from HIV infection. Therefore it is very encouraging to see this first regional conference organized to tackle the epidemic.

With an epidemic outrunning our efforts to address it, one of the areas we can work on to improve our response is donor coordination and harmonization. It has become clearly apparent that separate, poorly coordinated efforts are not working. I would like to spend a few minutes focusing on recent developments in this area.

The 'Three Ones'

As you may know, a large group of bilateral donors, multilateral agencies and foundations – guided by the advice and insights of country partners, came together to commit to the ‘Three Ones’ Principles.  The Three Ones vision is to have, in each country, one national HIV/AIDS action framework, one national HIV/AIDS coordinating authority with a broad multi-sectoral mandate, and one national HIV/AIDS monitoring and evaluation system. This would avoid duplication of effort, it would support country ownership and leadership, and would allow available resources to be leveraged and targeted to the priority needs of affected countries.

To speed progress towards the Three Ones, in March 2005, a Global Task Team (GTT) on improving AIDS Coordination among International Donors and Multilateral Institutions was formed by leaders of donor and developing country governments, civil society, UN agencies and other multilateral and international institutions.  There were three GTT working groups: one on harmonization of programming and financing (co-chaired by the World Bank and the United States Government), one on technical support, and finally one on monitoring and evaluation. In 80 days the GTT developed recommendations to further streamline, simplify and harmonize donor procedures and practices, to reduce the burden on countries, and improve the effectiveness of country-led responses. The GTT also reached agreements on improved coordination between the Global Fund and the World Bank, and the division of labor among the UNAIDS co-sponsors, particularly with regard to rationalizing the provision of technical support.

Improving coordination

The recommendations for The World Bank and the Global Fund include (i) aligning around country systems including national cycles and plans, joint annual program reviews, common financial procurement assessments and joint implementation processes, (ii) sharing information and developing concrete coordination and alignment steps at country level, and (iii) reviewing the comparative advantages of each agency to improve coordination.

In response to these recommendations and recognizing that harmonization among the World Bank and the Global Fund as well as PEPFAR will go a long way to ease some of the difficulties for countries of multiple, duplicative or conflicting donor initiatives; a tri-partite meeting, hosted by USAID, took place at the Bank in January 2006, at which agreements were reached on specific, concrete ways to work more closely together.

Furthermore, the Bank and the Global Fund jointly commissioned an independent assessment of their AIDS work, which made recommendations on how the two organizations could coordinate and work better together to make their support for countries more effective. Both organizations have welcomed the report, and are proceeding in light of its findings and recommendations.

In addition, The Global Fund, the UNAIDS Secretariat, WHO, UNICEF, UNFPA and World Bank have set up a Joint Global Problem Solving and Implementation Support Team (GIST). GIST’s role is to coordinate responses to requests for help across the UNAIDS co-sponsors and the Global Fund. GIST has sponsored a number of problem solving missions to various countries and regions. For example, one of the first activities of the GIST was a multi-organization review of the HIV and AIDS response in the Caribbean.

World Bank asked to take the lead on behalf of UNAIDS

Within the division of labor among the UNAIDS co-sponsors, the World Bank was asked to lead, on behalf of UNAIDS, in assisting countries to enhance their HIV/AIDS strategies by making them more prioritized, evidence based and inclusive and by establishing annual actions plans for better implementation. Good country strategic frameworks and action plans are vital for moving from individual donor-supported projects to coordinated, country-led, program support.

In January 2006 the Bank held a workshop with experts on strategic planning and HIV/AIDS and practitioners and program managers from several countries to discuss strengths and weaknesses in existing national AIDS strategic planning, and began developing a self-assessment tool that countries will be able to use to evaluate and strengthen their national strategies. A key output of the workshop was a draft business plan for the AIDS Strategy and Action Plan service (ASAP) setting out options for discussion. Currently these options are being discussed with key stakeholders in the public sector and civil society, donors and country partners, and within the UN system.

Building an effective collective response

The World Bank is also working with UNDP and UNAIDS to improve the integration of HIV/AIDS into poverty reduction strategies. The program began with a regional workshop in Johannesburg in December 2005 for seven countries. Participating countries are currently implementing follow-up activities that they identified during the workshop. As there is strong demand from countries, a second workshop is planned for the fall of 2006 for African countries and possibly a following third workshop for other regions.

With regard to monitoring and evaluation, the Global AIDS Monitoring and Evaluation Team (GAMET), based at the Bank, works with countries to develop unified national HIV/AIDS M&E systems and build country capacity to use M&E results for program decision making. GAMET is active in over 40 countries in various regions including Russia, and the Central Asian Republics. 

In collaboration with the Global Fund, UNICEF, WHO and other partners, the World Bank is also working on building capacity for procurement and logistics. Twelve workshops have been held where countries have developed procurement and supply management plans for Global Fund financing, including one in Moscow in March 2006.

The commitment among donors to work together towards common goals goes above and beyond the community of people working on AIDS. At the Gleneagles Summit in July, G8 leaders pledged to increase official development assistance by around US$ 50 billion a year by 2010, to apply the Three Ones principles in all countries, and to work towards the goal of universal access to prevention, care and treatment for all those who need it by 2010. Universal access to a package of prevention, care and treatment for all countries affected by HIV is a challenging but inspiring goal, that may push us to achieve more than we think possible.

Finally I would like to conclude by sharing with you the priority areas of the World Bank’s Global HIV/AIDS Program of Action, that outline how the Bank is contributing to these global efforts.

In reviewing the challenges that we are facing in fighting AIDS, five seemed to us to be especially pressing, and particularly needing the Bank’s resources and attention. The first action area is sustained funding for HIV/AIDS programs and for strengthening health systems. The second action area is to support better national HIV/AIDS planning; number three is accelerating implementation of those plans; fourth is building country monitoring and evaluation systems and capacity to collect, analyze and use data; and finally, fifth, is conducting impact evaluations and analytic work to improve HIV/AIDS knowledge and to improve programs.

In conclusion, I would like to stress the importance of coordination, harmonization and alignment around country-led responses. The effectiveness of our collective response to the epidemic will depend on how well we are able to translate the Three Ones into action.

I thank you!