$Billions of AIDS money down the drain

For some time AIDS has been getting the lion's share of funding - both TB and Malaria accounting for only 5% of expenditure - good intentions dont always make for good policy.


GLOBAL: "Report Says Bank's AIDS Effort Are Failing"

New York Times (05.01.09):: Celia W. Dugger

Projects to combat AIDS accounted for most of World Bank's efforts against communicable disease in the last decade with poor results, says a recently released internal evaluation.

In Africa, the center of the AIDS pandemic, the World Bank's efforts were particularly disappointing. Eighty percent of the organization's AIDS projects there were ineffective, compared to 70 percent of such projects around the world, the report said. Since 1997, the World Bank has financed about $17 billion in projects aimed at improving global health, nutrition, and population. Efforts against AIDS accounted for about 60 percent of its projects addressing communicable disease.

The head of the division evaluated in the report acknowledged the shortcomings. "Too often we had overambitious objectives, given the capacity of the country and sometimes our own," said Julian Schweitzer, World Bank director of health, nutrition, and population.

The poorly performing projects, which typically involved numerous donors, nonprofit groups, and government agencies, were too complex for the governments asked to implement them, the report said. Evaluators recommended the World Bank focus on simpler, less ambitious projects that involve fewer governmental agencies.

Outside observers suggested that the World Bank's focus on AIDS shortchanged other public health problems, and they called for a reordering of priorities. Report lead author Martha Ainsworth, for example, championed efforts to address Africa's fertility rates as a way to reduce the region's high maternal mortality figures.

The World Bank's public health initiatives not related to AIDS were generally more successful, with 90 percent of such projects performing satisfactorily. At the same time, other communicable diseases were funded at levels much lower than was AIDS: Malaria accounted for 3 percent of the projects, tuberculosis for 2 percent.