World Bank MAP(s) its Results in Africa

The World Bank recently released its first comprehensive review of the Multi-Country HIV/AIDS Program (MAP) for Africa, one of the first major donor initiatives to tackle HIV/AIDS in Africa. Billed as a review of results rather than a critical assessment of MAP's impact, the report nonetheless offers an exceedingly upbeat stock-taking of the program’s implementation, concluding that MAP is achieving its objectives and addressing country needs.When the World Bank established the MAP in 2001, donor money for HIV/AIDS was scarce but the landscape has changed, and MAP must find a way to remain relevant by staking out a particular niche for itself. The MAP report offers important insight into what distinguishes MAP from the other major global HIV/AIDS donors - the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria - as well as how the World Bank sees its role in the international effort against the HIV/AIDS epidemic in Africa.Recognizing that MAP can no longer compete with PEPFAR and the Global Fund financially, the report suggests that the Bank can leverage its strengths by playing a unique leadership role in coordination and harmonization of donor efforts, as well as by integrating HIV into the broader development agenda. MAP can also provide assistance to countries in developing national HIV/AIDS strategies and in the management and monitoring of their programs. The data in the report reflects this focus: a full 40% of MAP funding has gone toward systems strengthening.The MAP should continue down this path. As PEPFAR and the Global Fund attempt to disburse large amounts of money as fast as possible, often circumventing national healthcare systems and failing to build capacity in recipient countries, the MAP can play an important role via capacity-building, technical assistance, and the integration of HIV/AIDS programs into national health and development strategies. Such an approach will complement the work of the other major donors, strengthening and transforming local institutions so that they are better able to take advantage of increased funds from PEPFAR and the Global Fund to build increasingly sustainable programs.Another important way in which MAP has distinguished itself from other donors is through its focus on prevention efforts. After systems strengthening, prevention received more money than any other sector at 35% of disbursed funds. This is significant at a time when PEPFAR and the Global Fund are focused on scaling-up ARV treatment and may be losing sight of more cost-effective prevention programs. In fact, a report from the Center for Public Integrity shows that PEPFAR funding for prevention has fallen from 34% of the FY04 budget to just 22% in FY06. These developments make it all the more important that MAP continue its focus on prevention.Like other donors, the World Bank is getting up to speed to claim its successes in the fight against HIV/AIDS. Not surprisingly, the report is limited in its scope to assessing whether the MAP is being implemented as designed - a process evaluation. Lack of data (and foresight when the MAP was originally designed) clearly limits the extent to which one can say that the MAP has contributed to outcome and impact measures. Recognizing this limitation, the authors end the report by proposing a framework for "routine measuring and reporting of MAP results" for future Bank financed HIV/AIDS Programs. If the routine measuring and reporting of MAP results does in fact intend to evaluate the impact of HIV/AIDS programs moving forward, this would be an opportune time for the Bank to join efforts with the Global Fund and PEPFAR; developing common outcome and impact measures and one M & E system for each country, rather than by donor, makes sense when you want to know "what" has changed and "why" in a given country. Of course, understanding "how" donors contribute to the process of making these changes happen is equally important, but knowing the "how did we spend the money" without the "what did the money do" isn't quite so convincing in keeping the dollars flowing.