RUSSIAN FEDERATION
International Agreements for Improving the Coordination and Effectiveness of Global Fund, World Bank and UN Agencies on HIV/AIDS Activities
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Briefing Note for Russian Authorities on International Agreements for Improving the Coordination and Effectiveness of Global Fund, World Bank and UN Agencies on HIV/AIDS Activities
Public Disclosure Authorized
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The World Bank Group November 25, 2005
2 Briefing Note for Russian Authorities on International Agreements for Improving the Coordination and Effectiveness of Global Fund, World Bank and UN Agencies on HIV/AIDS Activties Recently agreements have been reached in the international HIV-AIDS community with the Global Fund, UNAIDS and the World Bank that have implications for the HIV-AIDS work of different international agencies, offering opportunities to improve the services that are provided to the countries. This note explains these agreements. The information is lengthy, a lot has happened in the first half of 2005, so the note is divided into a summary and into sections with details including background documentation. Summary The purpose of this note is to: (i) advise on recent developments on coordinating, harmonizing and aligning the HIV/AIDS programs supported by international organizations, particularly with regard to relations among UN organizations, the Global Fund and the World Bank; (ii) point out specific areas of impact as a result of the Global Task Team (GTT) process, especially country level relations with UN organizations and the Global Fund; (iii) identify opportunities for mobilizing additional assistance to support the implementation of national HIV/AIDS projects; and (iv) alternative options on how to improve inter-agency partnerships, particularly in areas in which the global community expects the World Bank to take the lead in the battle against HIV-AIDS. These areas are: (a) enhancing country HIV/AIDS strategies and annual action plans; (b) incorporating the treatment of HIV/AIDS in PRSPs and other development framework documents and processes; (c) capacity building in fiduciary areas, especially the procurement of ARVs and medical devices; (d) starting up a Joint Global Problem Solving and Implementation Support Team (GIST); (e) expanding support for country monitoring and evaluation; and (f) specific areas in which the Global Fund and the World Bank have agreed to work more closely together globally and at country level. A.
Background
The Three Ones – Agreed in 2004 In April 2004, the UNAIDS co-sponsors, the Global Fund, the World Bank and important bilaterals including the U.K. and the U.S. agreed to support the Three Ones at country level in order to improve the efficiency and effectiveness of HIV-AIDS funding
3 and the speed by which commitments were translated into action on the ground. The Three Ones are • • •
One agreed HIV-AIDS strategy and action framework to coordinate the work of all partners; One national AIDS coordinating authority with a broad-based multi-sectoral mandate; and One agreed country-level monitoring and evaluation system.
Assessing Progress In March 2005 donors and recipient countries met in London, assessed progress in meeting the Three Ones and determined that progress in putting them into practice was insufficient. UNAIDS was tasked to facilitate the formation of a Global Task Team (GTT) of donors, recipient countries and organizations and other partners to produce recommendations within 80 days on improving AIDS coordination among multilateral institutions and international donors in the context of the Three Ones. Task forces were established on: (a) strategy and funding; (b) technical assistance; and (c) monitoring and evaluation. The World Bank co-chaired the working group on strategy and funding and was a member of the working group on monitoring and evaluation as well as of the overall Global Task Team. B.
GTT Recommendations – “Making the money work”
The GTT presented its recommendations within the 80 day deadline including agreements on: (i) improved coordination between the Global Fund and World Bank; and (ii) a division of labor among the UNAIDS co-sponsors particularly with regard to rationalizing the provision of technical support; and (iii) the need to raise substantial new funding for additional technical support by UNAIDS co-sponsors, especially to deal with the “unfunded mandate” of supporting the implementation of Global Fund programs. Number (iii) is of particular importance in as much as the Global Fund’s mandate is to remain a “financial instrument” and leave implementation assistance to others. The overall report of the GTT is attached. Implementing the GTT recommendations involves: (i) improving coordination between the Global Fund and the World Bank - the two major multilateral sources of funding; (ii) agreeing on a specific program of technical support with various UNAIDS co-sponsors taking the lead in different technical areas; and (iii) establishing a Global Problem-Solving and Implementation Support Team (GIST) based in part on the World Bank’s HIV-AIDS Implementation Acceleration Team. C.
Improving coordination between the Global Fund and the World Bank
An important focus of the GTT process was to improve coordination between the Global Fund and the World Bank. Both institutions need to coordinate more effectively
4 and align their funding around country systems, an important focus of the international movements towards harmonization. As a result of the GTT, the Global Fund and the World Bank have put together the attached matrix containing twelve areas in which the two institutions pledge to make progress, indicating in each which institution is to take the lead. Key among them are: Aligning around country systems including identifying countries where the two institutions can pilot joint use of country systems e.g. using joint annual country-led reviews (WB to take the lead), joint fiduciary assessments, especially with regard to financial management and procurement (Global Fund to take the lead) particularly where the Global Fund and the World Bank are using the same implementing agency i.e. Ministries of Health or use the same implementation channel (World Bank to take the lead).. Improving operational communications (World Bank to take the lead) including sharing mission TORs and mission reports between Global Fund portfolio managers and World Bank team leaders (TTLs), and holding bi-monthly teleconferences and annual meetings between managers and staff of the two institutions. Working together in establishing and operating the Joint Global Problem Solving and Implementation Support Team (GIST) – see below for more on the GIST. This would require country level coordination among UNAIDS cosponsors and funders. World Bank task team leaders are already working with partners on the GIST in Guinea Bissau, Mozambique, Niger, Nigeria and in the Caribbean. Evaluating and clarifying areas of overlap, comparative advantage and complementarity between the Global Fund and the World Bank initially through jointly hiring a consultant, Alex Shakow, a former Bank director, to assess the situation. Defining specific problems at country level between the single national AIDS coordinating authority (NAC) and the Country Coordinating Mechanism (CCM) used for Global Fund governance at country level (Global Fund to lead). D.. Improving coordination among UNAIDS Cosponsors and agreeing on an expanded program of technical support. The GTT updated the existing division of labor for technical support among the UNAIDS cosponsors, determined funding requirements to provide this support, and addressed the modalities for aligning around country strategies and actions plans. The traditional division of labor among UNAIDS Cosponsors has been updated with regard to providing technical support to countries. The summary and rationale for the UNAIDS technical support division of labor is attached. Heretofore, the World Bank has traditionally been mandated principally to take the lead for the UNAIDS cosponsors
5 in economic analysis and impact and monitoring and evaluation at country level. Under the new GTT division of labor the Bank is also being asked to: (i) take the lead in supporting countries to improve their HIV-AIDS strategic plans and the annual action programs to implement these plans; and (ii) support other UNAIDS co-sponsors in: a. integrating HIV-AIDS into PRSPs; b. improving procurement and supply chain management, particularly capacity building; and c. enhancing monitoring and evaluation. To implement the GTT recommendations, the UNAIDS co-sponsors prepared in July/August a $166 million program of technical support according to the division of labor. The 2006-2007 consolidated UN technical support plan for AIDS is attached. The areas of most immediate relevance for the Bank and for HIV-AIDS TTLs are those which deal with specific Bank assignments. Country strategies and annual action plans. One of the key areas for improvement identified by the GTT was the need for countries to improve their HIVAIDS strategies by making them more prioritized, evidence based and inclusive and by establishing annual actions plans for better implementation. The UN technical support plan includes $5.6 million to improve HIV-AIDS strategies in 15 countries and $6.8 million to improve annual action plans in 28 countries. The Global HIV-AIDS Program (GHAP) would establish the AIDS Strategy and Action Plan (ASAP) capacity in the World Bank to do this. Once funding is secured World bank TTLs will be asked to help determine what countries should have priority in accessing ASAP and to assist in this process. Integrating HIV-AIDS into PRSPs. A joint UNICEF/World Bank study in African countries last year found that HIV-AIDS was poorly integrated into PRSPs, even in high prevalence countries, and very seldom budgeted for or supported by a results based monitoring and evaluation framework. UNDP is taking the lead in this area and has asked the World Bank through GHAP and World Bank Institute (WBI) to establish a program of regional workshops in this area to be complemented by country level actions. WBI is leading a process within the Bank to identify countries to participate in the regional seminars. $1.7 million would be available to do this in 13 countries beginning in the second half of calendar 2005. Procurement and supply chain management. Under the overall leadership of UNICEF, the existing WHO/World Bank procurement training consortium, working together with GFATM and bilaterals, will continue its program of regional and national training seminars. $1.5 million is planned for this effort in 2006/2007 which would be complemented by $15.7 million to place technical assistance in 45 countries. Monitoring and evaluation. $2.6 million will be made available to supplement on-going support from the UNAIDS Secretariat and from GHAP’s Global Monitoring
6 and Evaluation Team (GAMET) for monitoring and evaluation in addition to $9.2 million to place additional M&E experts at country level. An important element of the new approach to M&E is to establish at country level joint monitoring and evaluation support teams to rationalize the UNAIDS cosponsors’ M&E efforts.
7 F. Joint Global Problem Solving and Implementation Support Team (GIST) The GIST is to operate at both global and country levels. At global level it is composed of senior staff from the Global Fund, UNAIDS Secretariat, WHO, UNICEF, UNFPA and World Bank and is designed to coordinate responses to problems both at country and global levels. The secretariat of the GIST is with WHO which chairs this group with the Global Fund as the vice chair. GIST will both try to coordinate responses among UNAIDS co-sponsors and the Global Fund and access funding through the GTT. At its first meeting in July GIST was tasked to: (a) prepare a technical support program for countries having difficulty with second phase Global Fund financing – Bolivia, Guinea Bissau, Mozambique, Niger and Nigeria; (b) expand the participation of the World Bank’s Caribbean review; and (c) coordinate within WHO requests for procurement training which should be channeled to the WHO/World Bank training programs being implemented by WBI. World Bank TTLs, operations advisers, and other staff are already participating in GIST at country level. The future objective is to have both World Bank and Global Fund staff, at both headquarters and at country level, in addition to stakeholders in countries, utilize the GIST mechanism to resolve difficulties, much as the Implementation Acceleration Team (IAT) serves this function within the Bank. Conclusion A lot has happened in the last four months in promoting coordination and harmonization in HIV-AIDS programs. There are challenges and opportunities.