Academic journal article Global Governance

The World Bank: Failing the Multi-Country AIDS Program, Failing HIV/AIDS

Academic journal article Global Governance

The World Bank: Failing the Multi-Country AIDS Program, Failing HIV/AIDS

Article excerpt

The Multi-Country AIDS Program (MAP) is a World Bank commitment of $1 billion to fight HIV/AIDS in sub-Saharan Africa. The main aim of the MAP, launched in 2000, was to bring about a major scaling up of the multisectoral response to HIV/AIDS. Multisectorality referred to the involvement of community-based organizations (CBOs), nongovernmental organizations (NGOs), line ministries, and, principally, the highest level of state government in shaping and leading the response to HIV/AIDS. As a consequence, the MAP engendered significant state support, an upsurge in community participation, and a reconfiguration of the interplay between international organizations, the state, and the community within global governance. The MAP, however, has failed, and such failure has provided the foundation on which the current HIV/AIDS response is based. This foundation rests on rivalry between international organizations, limited community engagement, and contention over state sovereignty. This article demonstrates how the MAP has failed and why.

Setting a Precedent

The MAP was the first multilateral commitment to fighting HIV/AIDS in sub-Saharan Africa that prioritized multisectorality with such financial backing; it provided the foundation for the current $10 billion annual commitment to fight HIV/AIDS. (1) Significantly, the MAP presents the most sophisticated working example of the Bank's commitment to partnership, government ownership, and promotion of development knowledge. Great in scope and ambition, the MAP presented a turning point in both the response to HIV/AIDS and the World Bank's working practice.

The success of the MAP is evident in the precedent that its scope and originality established. The MAP set a precedent for both institutional working practices and the future HIV/AIDS response in the following ways. First, the MAP placed HIV/AIDS at the top of the political agenda within the sub-Saharan African state. HIV/AIDS had previously occupied this position in a number of African states; however, stigma, denial, and avoidance remained pertinent to many. The MAP confronted issues of stigma and denial by stipulating three preconditions: states must adopt (1) a national strategic plan; (2) a national coordinating body housed in the highest level of state government; and (3) a commitment to disbursing 40-60 percent of funds to civil society organizations (CSOs). (2) These three preconditions facilitated the establishment of National AIDS Authorities within the Office of the President/Prime Minister in each of the twenty-eight countries that implemented a MAP project. (3) The purpose of the National AIDS Authorities was to remove HIV/AIDS from the health sector so as to recognize the multifaceted impact of the epidemic and the multisectoral response this engendered with the full support of the government. This set a precedent within the African state; leaders who received MAP funds began to recognize and prioritize a multisectoral response to HIV/AIDS in states where working with CSOs had not previously been the norm. Multisectorality further affected states where prioritization of CSOs and a high-level HIV/AIDS response already existed. For example, in Uganda--a state often synonymous with high-level political commitment to fight HIV/AIDS--the response had been located within the Ministry of Health alone with limited recognition of multisectorality until the establishment of the Uganda AIDS Commission under the Ugandan MAP: the Uganda AIDS Control Project.

Multisectorality facilitated an upscaling of community-based activity. Community-led initiatives had been thus far integral to the care, treatment, prevention, and mitigation of the socioeconomic impact on people living with or affected by HIV/AIDS. This had been recognized by some states, international NGOs (INGOs), and bilateral donors. However, it was MAP funding that highlighted and promoted such activity at the global, state, and community level. …

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