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485560Wp0hiv1r10box338914b 48556 THE WORLD BANK OPERATIONS EVALUATION DEPARTMENT Public Disclosure Authorized Public Disclosure Authorized Evaluation of the World Bank’s Public Disclosure Authorized Assistance in Responding to the AIDS Epidemic: Russia Case Study Judyth L. Twigg Richard Skolnik Public Disclosure Authorized This paper is available upon request from OED. 2005 The World Bank Washington, D.C. ENHANCING DEVELOPMENT EFFECTIVENESS THROUGH EXCELLENCE AND INDEPENDENCE IN EVALUATION The Operations Evaluation Department (OED) is an independent unit within the World Bank; it reports directly to the Bank’s Board of Executive Directors. OED assesses what works, and what does not; how a borrower plans to run and maintain a project; and the lasting contribution of the Bank to a country’s overall development. The goals of evaluation are to learn from experience, to provide an objective basis for assessing the results of the Bank’s work, and to provide accountability in the achievement of its objectives. It also improves Bank work by identifying and disseminating the lessons learned from experience and by framing recommendations drawn from evaluation findings. OED Working Papers are an informal series to disseminate the findings of work in progress to encourage the exchange of ideas about development effectiveness through evaluation. This document is one of four case studies commissioned by the Operations Evaluation Department (OED) of the World Bank for its evaluation of the World Bank’s assistance for HIV/AIDS control. For more information, consult the evaluation website: www.worldbank.org/oed/aids. The findings, interpretations, and conclusions expressed here are those of the author(s) and do not necessarily reflect the views of the Board of Executive Directors of the World Bank or the governments they represent. The World Bank cannot guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply on the part of the World Bank any judgment of the legal status of any territory or the endorsement or acceptance of such boundaries. Contact: Knowledge Programs and Evaluation Capacity Development Group (OEDKE) e-mail: [email protected] Telephone: 202-458-4497 Facsimile: 202-522-3125 http:/www.worldbank.org/oed Acknowledgements The authors thank Jennifer Vollett-Krech for significant and valuable research assistance and William Hurlbut for editorial assistance. Comments on the first draft from members of the OED project evaluation team (Martha Ainsworth, Eric Jensen, Judy Hahn, Joan Nelson, Denise Vaillancourt, Heinz Vergin) and are gratefully acknowledged. Acronyms AIDS Acquired Immunodeficiency Syndrome APL Adaptable Program Loan ARV Anti-retroviral (treatment) AZT Azidothymidine CBO Community-based organization CAS Country Assistance Strategy CDC U.S. Centers for Disease Control and Prevention CIDA Canadian International Development Agency CSW Commercial sex workers DFID Department for International Development (UK) DOTS Directly observed treatment, short course ECA Europe and Central Asia GDP Gross Domestic Product GFATM Global Fund to Fight AIDS, TB, and Malaria GMP Good Manufacturing Practices HIV Human Immunodeficiency Virus IDU Injecting drug use/users MAP Multi-country HIV/AIDS Program MDR Multidrug-resistant MOE Ministry of Education MOH Ministry of Health MOJ Ministry of Justice MSF Médicins Sans Frontières MSM Men who have sex with men NGO Non-governmental organization OED Operations Evaluation Department OSI Open Society Institute PCD Project Concept Document PAD Project Appraisal Document PSI Population Services International RHCF Russian Health Care Foundation SIDA Swedish International Development Cooperation Agency STI Sexually transmitted infection TB Tuberculosis UNAIDS Joint United Nations Program on HIV/AIDS UNDP United Nations Development Program UNESCO United Nations Education, Scientific and Cultural Organization UNICEF United Nations Children’s Fund USAID United States Agency for International Development WHO World Health Organization i Contents Executive Summary...........................................................................................................v 1. Introduction and Analytic Framework......................................................................1 Objectives of this Review .........................................................................................1 Evaluation Framework ............................................................................................1 Limitations ...............................................................................................................2 2. Health and AIDS in the Soviet Era (1987-1991) .......................................................3 Early Spread of HIV/AIDS.......................................................................................3 Political and Social Context for HIV in the Soviet Union .......................................4 3. AIDS in Post-Soviet Russia (1991-2003) ....................................................................5 Political and Social Context ....................................................................................5 Health Systems Context............................................................................................7 Accelerated Spread of HIV ......................................................................................8 Government Policy Response ................................................................................11 HIV/AIDS-related Legislation...................................................................11 Public Sector AIDS Institutions and Programs for Specific Groups .........13 Trends in Public Expenditure.....................................................................15 Political Commitment ................................................................................17 Response of NGOs and Civil Society.....................................................................18 4. World Bank Engagement with Russia on HIV/AIDS.............................................20 Early World Bank Health Efforts in Russia...........................................................20 The World Bank’s Approach to HIV/AIDS in Russia ............................................22 Project Preparation ...............................................................................................23 Initial Preparation (February 1999-June 2001)..........................................23 A Pause in Project Preparation (July 2001-February 2002) ......................25 Renewed Project Preparation and Approval (March 2002-April 2003) ....27 Coordination with Other Donors...........................................................................29 Analysis and Stakeholder Views of the Process.....................................................30 5. The Impact of the Bank’s HIV/AIDS Assistance....................................................32 Political Commitment ............................................................................................33 Strategic Choices and Prioritization .....................................................................34 A National Plan for Expanding the Response........................................................35 ii Multisectoral Approaches......................................................................................35 Role of NGOs and CBOs........................................................................................35 AIDS and the Health Sector...................................................................................36 Monitoring and Evaluation....................................................................................36 Institutional Development......................................................................................36 6. Conclusions.................................................................................................................37 Development Effectiveness of the Bank’s HIV/AIDS Assistance ...........................37 Relevance...................................................................................................37 Efficacy......................................................................................................38 Efficiency...................................................................................................39 Lessons for the World Bank’s HIV/AIDS Assistance.............................................39 The Importance of Understanding the Country Context............................39 Reducing the Pressure to Borrow as a Catalyst to Policy Dialogue ..........40 Using Analytic Work to Generate Commitment and Ownership of HIV/AIDS as a Problem ......................................................................40 Leverage from Small Operations in Large Countries................................40 Continuity, Seniority, and Proximity of Task Management......................40 The Future..............................................................................................................41 References.........................................................................................................................43 Annex A. Persons Interviewed........................................................................................53 Annex B. Timeline of HIV/AIDS Events in Russia.......................................................55 Annex C. Risk factors and epidemiology of HIV/AIDS in Russia...............................60
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