Summary of Lessons Learned from Implementation of the Multi-Country HIV/AIDS Program (MAP)

by 
Debrework Zewdie
Director, World Bank Global HIV/AIDS Program
South Africa, July 1, 2003

Let me start by saying that I  welcome this opportunity to share with you the World Bank experiences and some of the lessons we have learned  in trying to come to grips with the HIV/AIDS pandemic.

As many of you are aware, in the past, lack of funding for AIDS programs was the biggest limitation for African countries to deal with the growing pandemic. However, recent years have seen an explosion in the availability of funds from various sources, multilateral, bilateral, and private. In partnership with the UNAIDS family, other donors and the countries in Africa we have launched, what I would call, a "major offensive"  against the plague of the 21st century that threatens the development and future of the region and the continent.

The World Bank has been providing assistance to many of its clients worldwide in fighting HIV/AIDS. The lessons learned prompted the necessity for a new design to tackle urgently the problems particularly faced by the African countries.  That is how the Multi-Country HIV/AIDS Program for Africa, known as MAP, was developed in partnership with UNAIDS in late 2000, with the goal to provide long-term, flexible support to national programs.

MAP is more of a partnership than a project, since it enables countries to reprogram the aid as conditions evolve and in coordination with programs of other donors. 

MAP funds the entire spectrum of care-from basic prevention through anti-retroviral therapy-and all aspects of a multisectoral response by channeling support to all stakeholders, strengthening capacity for program implementation and promoting ongoing knowledge exchange, both within and among countries

What is the current status of MAP ? 

The strong demand for resources represents an unprecedented expansion of Africa's commitment to address HIV/AIDS.  The strength of this demand also encouraged the creation of the Global Fund to Fight AIDS, malaria and TB. 

MAPs have been approved for 21 African countries, representing a total commitment of $722 million, with 10 more countries in the pipeline for next year. 

MAP commitments for 6 SADC countries, currently effective or proposed, amount to
$302 million. These countries are Angola, DRC, Malawi, Mozambique, Tanzania and Zambia.  This is complemented by additional Global Fund commitments of $275 million for 10 SADC countries

Beginning in July 2003, the MAP will also start funding sub-regional and cross-border projects,  the first being the Abidjan-Lagos Transport Corridor.

Allow me to say few words about our general progress of the Program. While there is a lot more we need to do together to streamline implementation so that countries can absorb the donor funds that become available for AIDS programs, I would like to focus on the considerable success achieved under MAP and the lessons learned so far.

One of the most important lessons is that success hinges on the full coordinated involvement of all stakeholders and on adopting a participatory approach toward the entire process. In this respect, experience from MAP implementation indicates that:

First, leadership and commitment from the highest level of government, together with the support of "champions", individuals as well as "champion" agencies or ministries, can greatly influence the success and implementation of HIV/AIDS activities as a major development agenda.  We need to encourage this and cultivate this also at lower levels of government.  Thus,

National AIDS Councils and their Secretariats need clear mandates and should serve more as facilitators providing guidance to line ministries on effective ways to mainstream AIDS activities;

Line ministries are essential partners and should be assisted in putting together action plans and setting up a core HIV/AIDS team within each ministry acting as a single focal point;

Ministry of Health is a critical partner for the national strategy and should be a facilitating technical agent; especially as we roll out ARV treatment and strengthen health systems.

Ministry of Education is particularly pivotal because of its daily influence on a key audience for the AIDS message and its potential for shaping attitudes, values and behaviors of youth;

Second, strong uptake by Civil Cociety is imperative.  Thousands of communities and civil society organizations have received both financial and technical support for programs of their own design.  A testimony to the dedication of civil society is the NGO Forum that was held right here yesterday.   And the display at the NGO Knowledge Fair is  a showcase of the role  various groups can play .

In current MAP-supported programs, there is faster and more effective implementation by civil society organizations (CSOs), including people living with HIV/AIDS, than by any other group;

Participatory processes developed for community involvement in HIV/AIDS projects are an important tool for changing behaviors and values regarding sexual practices and taboos; and 

Local learning networks created through partnerships of  NGOs and CSOs have created synergy and allowed more experienced organizations to provide training on, and exposure to, good practices for AIDS activities. 
Third,  ENHANCED PRIVATE SECTOR ENGAGEMENT SHOULD BE ENCOURAGED.. The Private sector is a powerful stakeholder and could do much more in partnership with the national programs. Outreach under the MAP has helped stimulate the creation of Business Councils on HIV/AIDS in a number of countries, and accelerated interaction between the public and private sectors.   Several private enterprises in Africa, especially large firms, are already implementing specific HIV/AIDS programs, primarily targeting their workforce. 
A commendable example from the NGO Forum  is the donation of 5 vehicles by a Lesotho private company  to church organizations helping  people living with AIDS.

Another key lesson  is the introduction of simplified, efficient and transparent procedures
The MAP has helped countries put in place STREAMLINED PROCESSES,  simpler and faster procedures for channeling funds and accounting for results.  These include simplified fiduciary mechanisms, and increased access to funding by CSOs. Using these mechanisms, countries are now delivering more support than ever before. 

Capacity building and mobilizing all available skills in a coordinated and efficient manner can speed up the process considerably

We believe existing capacity should be effectively used in the first year, then scaled up through adequate provision of resources to expand structures and skills in later years.  Unleashing existing capacity will ensure that all relevant actors are enlisted in the national HIV/AIDS effort, greatly expanding the speed and scope of program impact. 

Similarly, subcontracting or outsourcing basic project management, procurement, disbursement, monitoring and evaluation has proven to be cost-effective, and has liberated public officials to perform the substantive program functions.

MONITORING and EVALUATING the progress at every stage of implementation is crucial to measuring the impact of our interventions and making the necessary adjustments

UNAIDS and the World Bank have created a dedicated team to strengthen monitoring and evaluation systems throughout Africa. A vital lesson of the past 20 years, that MAP-supported programs incorporate, is to make M&E systems operational before activities begin. As communities have the largest stake in the success of HIV/AIDS programs, monitoring and evaluation should first serve their needs to make informed choices about their strategy in fighting the pandemic and ensures maximum transparency and social control.   

A key goal of MAP is to promote knowledge exchange & dissemination.  As countries scale up their programs, it is vital that they learn from one another in order to improve implementation as quickly as possible.  Hence,

The World Bank's ACTafrica and UNAIDS continually derive lessons from program execution and have captured them in a comprehensive overview that is publicly available and updated on a regular basis.

ACTafrica and Global HIV/AIDS units of the Bank  have co-hosted with UNAIDS four major workshops in Africa, open to all countries, reaching nearly 400 HIV/AIDS practitioners from 38 countries; and

UNAIDS and the World Bank supported the creation of the HIV/AIDS Program Managers' Network, an African-based network that  ties together AIDS practitioners from National AIDS Secretariats, cabinet ministries, civil society, and the private sector to encourage learning and knowledge exchange. 

We are mobilizing resources and partnerships to accelerate access to ARV in Africa. We have launched a treatment acceleration program to assist countries to initiate and scale up treatment. We held a meeting on scaling up ARV at the Bank on June 17-18 which was a land mark meeting where the fact that treatment in resource poor settings is not only possible but also with good results was affirmed.

Last but not least, we need to work together. As I mentioned earlier, MAP is a partnership. Therefore, HARMONIZATION and COLLABORATION are very important. MAP has supported countries in hosting truly comprehensive program reviews encompassing all donors, replacing the former system of separate reviews by each donor.  We have initiated mechanisms to work very closely with the Global Fund and the Bush initiative.

To sum up, we at the World Bank understand that challenges still remain in scaling up national efforts against HIV/AIDS. 

While no country has perfected its program, each one has solved some pieces of the puzzle. We are aware that HIV/AIDS is a tough adversary but we can overpower it by pulling together our resources, energies, and competencies; by making the fight against AIDS everybody's war; by embracing those that suffer from the disease and their families.

Countries and donors need to be more flexible and more inclusive, and donors in particular need to ensure they are harmonizing their support within the national AIDS program. 

With expanded knowledge exchange and faster application of lessons learned, each country could build on the experience of others.  As lessons continue to emerge, the World Bank and UNAIDS will continue to capture and disseminate them through updated guidelines, technical support teams, workshops, contributions to HIV/AIDS networks, and other methods as appropriate. 

Honorable Ministers, ladies and gentlemen,

These are some of the experiences we have had and the lessons we have learned. These are clear indications that when these essential elements come together, the tide of the pandemic can be reversed. In closing let me reaffirm as we do in the MAP document: "The Bank's engagement with countries is a fifteen to twenty year commitment until countries build sustainable capacity to fight the HIV/AIDS pandemic".  This is the principle of the MAP and this is what we are trying to do. We remain ready to partner with you as you pursue your own fight against this scourge that plagues the development of your countries and the future of your children.

Thank you.