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Publication
The Fiscal Dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda
(World Bank, 2012)HIV/AIDS imposes enormous economic, social, health, and human costs and will continue to do so for the foreseeable future. The challenge is particularly acute in Sub-Saharan Africa, home to two-thirds (22.5 million) of the people living with HIV/AIDS globally, and where HIV/AIDS has become the leading cause of premature death. But now, after decades of misery and frustration with the disease, there are signs of hope. HIV prevalence rates in Africa are stabilizing. This book sheds light on these concerns by analyzing the fiscal implications of HIV/AIDS in Southern Africa, the epicenter of the epidemic. It uses the toolbox of public finance to assess the sustainability of HIV/AIDS programs. Importantly, it highlights the long-term nature of the fiscal commitments implied by HIV/AIDS programs, and explicitly discusses the link between HIV infections and the resulting commitments of fiscal resources. The analysis shows that, absent adjustments to policies, treatment is not sustainable. But it also shows that, by accompanying treatment with prevention, and making existing programs more cost-effective, these countries can manage both treatment and fiscal sustainability. Even in countries where HIV/AIDS-related spending is high or increasing (as past infections translate into an increasing demand for treatment), the fiscal space absorbed by the costs of HIV/AIDS-related services will decline if progress in containing and rolling back the number of new infections can be sustained. The purpose of this study is to refine the analysis of the fiscal burden of HIV/AIDS on national governments and assess the fiscal risks associated with scaling-up national HIV/AIDS responses. The study complements and contributes to the agenda on identifying and creating fiscal space for HIV/AIDS and other development expenditures. The findings from this study, and the analytical tools developed in it, could help governments in defining policy objectives, improving fiscal planning, and conducting their dialogue with donor agencies. -
Publication
Using Public Expenditure Tracking Surveys to Monitor Projects and Small-Scale Programs : A Guidebook
(World Bank, 2010)The goal of this guidebook is to serve as a starting point for civil society organizations, as well as Bank teams interested in conducting Public Expenditure Tracking Surveys, both on a small and larger scale. It is designed to lead a research team from idea inception to results dissemination, while emphasizing the importance of utilizing evidence to influence policy, regardless of whether it is on a macro or micro-level. Though the World Bank has been at the forefront of efforts to measure the effectiveness of service delivery, it is hoped that Bank teams and civil society alike will take the research one step further and empower citizen users to keep service providers accountable through information dissemination and citizen engagement efforts. -
Publication
Characterizing the HIV/AIDS Epidemic in the Middle East and North Africa : Time for Strategic Action
(World Bank, 2010)Despite a fair amount of progress on understanding human immunodeficiency virus (HIV) epidemiology globally, the Middle East and North Africa (MENA) region is the only region where knowledge of the epidemic continues to be very limited, and subject to much controversy. It has been more than 25 years since the discovery of HIV, but no scientific study has provided a comprehensive data-driven synthesis of HIV/AIDS (acquired immunodeficiency syndrome) infectious spread in this region. The current report provides the first comprehensive scientific assessment and data-driven epidemiological synthesis of HIV spread in MENA since the beginning of the epidemic. It is based on a literature review and analysis of thousands of widely unrecognized publications, reports, and data sources extracted from scientific literature or collected from sources at the local, national, and regional levels. The recommendations provided here focus on key strategies related to the scope of this report and its emphasis on understanding HIV epidemiology in MENA as a whole. The recommendations are based on identifying the status of the HIV epidemic in MENA, through this synthesis, as a low HIV prevalence setting with rising concentrated epidemics among priority populations. General directions for prevention interventions as warranted by the outcome of this synthesis are also discussed briefly, but are not delineated because they are beyond the scope of this report. This report was not intended to provide intervention recommendations for each MENA country. -
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Intensifying the Fight Against Malaria : The World Bank's Booster Program for Malaria Control in Africa
(Washington, DC : World Bank, 2009)This document describes the purpose and context of the Booster Program, its first three years of operation and the proposed design of phase two of the program. Phase two seeks to build on the successes of and lessons learned from phase one and to enable the World Bank to play its expected role in scaling up and sustaining malaria control interventions to reach the new ambitious but achievable global goal set by the Roll Back Malaria (RBM) Partnership, of eliminating malaria as a major public health problem in Africa by 2015. The Bank has subscribed fully to this agenda, as illustrated by statements made by senior management in several public forums. -
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Namibia: Country Brief
(World Bank, 2009)Namibia is a large country in Southern Africa that borders the South Atlantic Ocean, between Angola to the north and South Africa to the south. With a surface area of 824,290 square kilometers, it is similar in size to Mozambique and about half the size of the U.S. state of Alaska. Namibia has a small population of approximately 2.1 million people. It is also one of the least densely populated countries in Sub-Saharan Africa, with an average density of approximately 2.5 people per square kilometer, compared to 34 people per square kilometer for the region as a whole. Namibia was the last colonized country in Sub-Saharan Africa to become independent. After nearly 70 years of South African rule, Namibia gained its independence on March 21, 1990. Until 1990, Namibia's official languages were German, Afrikaans, and English. Following independence, English became the official language, although it is the first language of only a very small percentage of Namibians. Oshiwambo dialects are the mother tongue of approximately half of the population. Namibia, a lower-middle-income country, has one of the highest levels of per capita income in Sub-Saharan Africa. Namibia is one of very few countries in Sub-Saharan Africa that maintains a social safety net for the elderly, the disabled, orphans and vulnerable children, and war veterans. It also has a social security act that provides for maternity leave, sick leave, and medical benefits. Namibia has one of the most productive fishing grounds in the world. The fishing industry is an important source of foreign exchange and a significant employer. The tourism industry in Namibia is similar in size to that in Botswana and is the country's third-largest foreign exchange earner. Namibia is one of the largest producers of gem quality diamonds in the world. It is estimated that 98 percent of its mined diamonds are gem quality. In 2006, almost half of total production was recovered from offshore sources. Namibia is the driest country in Sub-Saharan Africa, with deserts occupying much of the country. It has no perennial rivers or any other permanent water bodies. Due to the low and erratic rainfall and scarce ground and surface water, less than five percent of the country is arable, including through irrigation. Namibia was the first country in the world to incorporate environmental protection into its constitution. Nearly six percent of its land is nationally protected, including large portions of coastal areas within the Namib Desert. -
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Youth Employment in Sierra Leone : Sustainable Livelihood Opportunities in a Post-conflict Setting
(World Bank, 2009)This study focuses on short- and medium-term solutions. It informs the government about the type of programs and policies that could improve the employability of young people, paying special attention to areas in which productivity can be rapidly improved. The report consists of six chapters. Chapter two profiles young people in Sierra Leone. Chapter three examines young people in the labor market, with a focus on the labor supply side of the equation (that is, the skills young people bring to the labor market). Chapter four turns to employers (the demand side of the labor market) to better understand why they do or do not employ young people. Chapter five reviews skill development programs to enhance employability of young people in Sierra Leone and other countries and presents policy options for improving worker skills (supply side) and employer interest (demand side). Chapter six summarizes the lessons from the analysis and concludes with policy and program recommendations. -
Publication
Attacking Inequality in the Health Sector : A Synthesis of Evidence and Tools
(World Bank, 2009)The overwhelming evidence of inequalities in health outcomes and in the use of health services calculated and disseminated by the World Bank and other development agencies in the last 10 years has energized global efforts to address the needs of the poor and socially vulnerable. These efforts have led to a renewed interest at the global and national levels in both understanding the causes of health sector inequalities and developing policies to tackle them. It is time to synthesize the new knowledge being generated from research and experimentation on addressing inequality. The main purpose of this book is to make available the accumulated knowledge of successful policy and analytical tools in this fight to reverse the vicious circle of income-poverty and ill health. The book presents both a practical set of analytical tools for understanding the causes of inequality in the use of health services and a menu of proven pro-poor policy actions. It is based on the evaluation of 14 successful policy changes in low- and middle-income countries in Africa, Asia, and Latin America, and a review of the published literature on inequality in the health sector. -
Publication
The Changing HIV/AIDS Landscape : Selected Papers for the World Bank's Agenda for Action in Africa, 2007-2011
(World Bank, 2009)The HIV/AIDS pandemic in Sub-Saharan Africa remains a long-term development challenge for the region. Nearly 12 million African children have been orphaned as a result of the disease, and 22.5 million people in Africa 61 percent of them women live with HIV. The hyperepidemics in Southern Africa have diluted poverty reduction efforts and in several countries substantially reduced life expectancy. The critical need to address this development problem is reflected in the sixth Millennium Development Goal (MDG), which seeks to halt and begin to reverse the spread of HIV/AIDS by 2015 and to make access to treatment for HIV/AIDS universal for all those who need it by 2010. With Sub-Saharan Africa representing nearly two-thirds of those living with HIV globally, and the fact that human development indicators of several countries in the region lag far behind the rest of the world, prospects for Sub-Saharan Africa reaching any of the MDG goals will require a sustained response to HIV/AIDS. Reversing the spread of HIV/AIDS is closely linked to combating other major diseases referenced in sixth MDG, promoting gender equality (MDG 3), reducing child mortality (MDG 4) and improving maternal health (MDG 5). -
Publication
Hospital Performance in Brazil : The Search for Excellence
(Washington, DC : World Bank, 2008)This book combines a comprehensive overview of the Brazilian hospital sector with in-depth analyses of the key elements of interest in promoting and ensuring excellence in hospital performance. It does so in an accessible manner and within the organizational and financial context of Brazil. Thus, the book can offer specific recommendations that go to the heart of the problem, as well as suggest what kinds of approaches work in that context. The recommendations themselves are based on what works in Brazil while drawing on international experiences relevant to the Brazilian context to broaden the policy options. But the authors go a step further by providing recommendations on implementation, specifically highlighting the need to strengthen governance arrangements, improve accountability, and sharpen resource management. -
Publication
Economic Implications of Chronic Illness and Disability : In Eastern Europe and the Former Soviet Union
(Washington, DC : World Bank, 2008)This report aims to fill in the knowledge gap in this field by analyzing cross-country data on basic indicators, and by carrying out more detailed empirical analysis on causal relationships of interest, including the impact of disability on employment, wages, poverty, and children's school enrollments-focusing on four transition countries with household survey data sets that allow more elaborate econometric analyses. This report argues that it is timely to bring the economic costs of disability to the forefront of development policy because of the large impact poor health status and disabilities have on employment, poverty, children's schooling, and time spent in caring for disabled individuals, especially by adult females (which in turn inhibits higher female labor force participation prospectus). In recent years, there has been some recognition of the need to discuss disability issues in strategy documents such as poverty reduction strategy papers (PRSPs) and country assistance strategies (CASs). But in the absence of basic empirical evidence on the living conditions and behavior of disabled individuals, it is a challenge to formulate concrete steps to tackle this particular economic development problem.