Lessons from the World Bank financed HIV/AIDS projects in the Caribbean
S. Chao, C. Carpio, W. De Geyndt
The World Bank, Latin America and Caribbean Region - Health Unit, Washington, United States
Between 2001 and 2010 the World Bank financed eleven HIV/AIDS projects in nine Caribbean countries and one regional partnership. The development objectives of the country-specific projects were similar yet outcomes and achievements were different. Early high-level political commitment helped in a quick start up but did not translate into ongoing support during project implementation. Projects were prepared too quickly and subsequently required adjustments and restructuring. Countries would have liked more continuity of Bank staff. Some projects have closed and others are closing soon. All face two issues: (i) how to make the national HIV/AIDS program financially sustainable especially in continuing to provide ART; and (ii) how best to integrate the trained staff into the structure of the Ministry of Health while at the same time maintaining the multisector character. The second issue has been or is being solved by some countries.
Description: A Knowledge-Sharing Forum was organized for all participating countries to draw lessons from the implementation experience, to learn from one another´s experiences, and to identify why some projects were successful in certain areas while others were not.
Lessons learned: Use pragmatic approaches in dealing with the number one obstacle, i.e. stigma and discrimination and outdated criminalizing legislation. Know what drives the epidemic and enlist the cooperation of CSOs to reach the most vulnerable population groups. Small countries are challenged by project management, fiduciary and implementation obstacles but have more constrained human resources than larger countries. Projects located in the Ministry of Health have performed better and have ensured multisectoriality by appointing dedicated coordinators for non-health line ministries and CSOs. Small countries are more vulnerable to economic downturns; having costed HIV/AIDS strategies with cost effective interventions may help protect their budgets.
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