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Our commitment: World Bank's Africa region HIV/AIDS agenda for action 2007-2011
World Bank
May 2008

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Introduction

The World Bank is committed to support Sub-Saharan Africa in responding to the HIV/AIDS epidemic. This Agenda for Action (AFA) is a road map for the next five years to guide Bank management and staff in fulfilling that commitment. It underscores the lessons learned and outlines a line of action. HIV/AIDS remains-and will remain for the foreseeable future-an enormous economic, social, and human challenge to Sub-Saharan Africa. This region is the global epicenter of the disease. About 22.5 million Africans are HIV positive, and AIDS is the leading cause of premature death on the continent. HIV/AIDS affects young people and women disproportionately. Some 61 percent of those who are HIV positive are women, and young women are three times as likely to be HIV positive than are young men. As a result of the epidemic, an estimated 11.4 million children under age 18 have lost at least one parent. Its impact on households, human capital, the private sector, and the public sector undermines the alleviation of poverty, the Bank's overarching mandate. In sum, HIV/AIDS threatens the development goals in the region unlike anywhere else in the world.

The Agenda for Action

This is not a conventional strategy document. It is deliberately titled The World Bank's Commitment to HIV/AIDS in Africa: Our Agenda for Action, 2007-2011 to underline the importance of actions the Bank needs to take to continue to play a significant role in combating the HIV/AIDS epidemic in Africa.

HIV/AIDS is not a conventional disease. It is the largest single cause of premature death in Africa. With an average incubation period of eight years, the dimensions and the future consequences of the disease are not well known. Slightly more than a quarter of the Africans requiring treatment are currently being treated, but the promise of universal access to treatment and prevention has major financial and health care implications. Stigma and discrimination remain major obstacles to an effective response.

Africa is also a unique region. National health systems are overwhelmed by numerous health challenges, and the capacity to respond and manage the overall health burden is often extremely limited. Most governments lack the fiscal space to cope with HIV/AIDS program funding in the absence of external financing, which tends to be volatile and unpredictable.

We recognize that strategies are only useful to the extent that they meet three criteria: (i) client demand, (ii) client capacity, and (iii) the ability of the Bank to meet technical and resource demands. From our extensive consultations, we believe there is considerable demand for the Bank's continued active engagement from member countries, other development partners, and service providers, such as civil society organizations. At the same time, we believe the Bank needs to reorient and retool its own effort to ensure it provides effective, efficient, and sustainable support to containing the epidemic in the next five years. The principal audience of this report is the World Bank's Board of Directors, senior management, and staff.

The AFA has four principal objectives:

• Reaffirm the World Bank's commitment to long-term support for curbing the spread of HIV/AIDS in Africa;
• Articulate the comparative advantages of the Bank in a harmonized international program of support and, consequently, the potential role for the Bank;
• Identify priority interventions for the next generation of activity, whether funded by the Bank or others, based on evidence of success and lessons of experience; and
• Specify actions the Bank will need to take to ensure it can respond to the demands of member countries and other partners for financial, technical, analytical, and collaborative support.

The AFA articulates a program of support that fits squarely within the Bank corporate strategic priorities, as articulated by World Bank President Zoellick in October 2007. It honors, reinforces, and translates into discrete actions the six corporate strategic directions of the Bank's Global HIV/AIDS Program of Action (GHAP), the Africa Action Plan (AAP), the Africa Capacity Development Management Action Plan (CDMAP), and Healthy Development: The World Bank's Strategy for Health, Nutrition and Population (HNP) Results. It focuses on mainstreaming HIV/AIDS activities into broader national development agendas as a critical aspect of economic growth and human capacity development. In preparing the AFA, consultations have been carried out over several months with a broad constituency, including countries, donors, communities, civil society, nongovernmental, and nonprofit organizations.

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