95525
Project Profile: Botswana & HIV/AIDS                                                                March 19, 2010




 FIGHTING HIV/AIDS

 Innovative financing boosts prevention in Botswana




Overview
Botswana’s HIV/AIDS epidemic has affected nearly one quarter of the country’s population and
undermined significant socioeconomic development achievements realized over the past three
decades. In 2009, the International Bank for Reconstruction and Development (IBRD) formed a
partnership with the government to boost prevention efforts across the country. While the
project is in its infancy, it has already introduced a new financial instrument, supported by the
European Commission, which promises flexible and cost-effective support for a range of
prevention efforts.

   Full Brief—3 Pages
Innovative Financing Underpins Ibrd Support to Botswana’s Fight Against Hiv/Aids—PDF, April
2010




Challenge                                                           More Results
Botswana has the second most severe HIV/AIDS epidemic
in the world, after Swaziland. The scale of the human cost of
the epidemic is immense. AIDS-attributed mortality in              PARTNERS
Botswana increased from 4 percent to 27 percent of all
                                                                    European Commission (EC)
reported deaths between 1992 and 2003, and the national
prevalence rate among adults of 15-49 years is now                  National AIDS Coordinating
estimated at 24 percent. Some 283,000 people out of a               Agency (NACA)
population of more than 1.8 million were living with HIV/AIDS
in Botswana in 2008. Key factors fueling the epidemic             
include the incidence of multiple concurrent sexual
partnerships, the incidence of unprotected sex and inter-
generational sexual relationships, higher vulnerability among women, persistent inequality and
poverty, and high levels of population mobility.


Approach
IBRD is supporting Botswana’s efforts to contain the HIV/AIDS epidemic through the Botswana
National HIV/AIDS Prevention Support (BNAPS) project, focused on enabling a transition from
an “emergency” response to a broader, more strategic, and more sustainable approach.
BNAPS is funded through a $50 million loan facility known as a “buy-down” program, piloted in
China to support TB prevention efforts. Given that its upper middle-income status excludes
Botswana from the World Bank’s interest-free or low interest rate International Development
Association (IDA) resources, Botswana asked that the BNAPS project be financed utilizing this
new IBRD facility. The Botswana facility relies on donor resources from the European
Commission (EC) to lower the cost of the loan. The EC has agreed to provide funds directly to
Botswana’s Ministry of Finance and Development Planning once agreed-upon performance
targets are achieved, ensuring swift and direct support.
BNAPS became operational in July 2009 and is making gradual progress toward its objective:
to assist the government in increasing the coverage, efficiency and sustainability of targeted
and evidence-based HIV/AIDS efforts. The project also aims to strengthen institutional
management and coordination capacity, and finance strategic and innovative HIV/AIDS-related
prevention and mitigation activities.


Results

Key indicators used to monitor the results of this ongoing project, include the following:

       Proportion of sexually active males and females who report having had sex with more
       than one partner in the past 12 months by age group: (a) 15-to-19 years; (b) 20-to-24
       years; and (c) 25-to-49 years;

       Proportion of youths aged 15-to-19 years and 20-to-24 years who both correctly identify
       ways of preventing the sexual transmission of HIV and who reject major misconceptions
       about HIV transmission;

       Proportion of youth aged 15-to-19 years and 20-to-24 years reporting either (a) no
       sexual activity; or (b) condom use during the last sexual encounter with a non-regular
       partner in the past 12 months; and

       Proportion of people 15-to-19 years and 20-to-24 years who report a sexual partner
       with more than 10 years age difference during the last 12 months.

Also, there’s a special focus on raising the institutional capacity of Botswana’s National AIDS
Coordinating Agency (NACA) and on the performance of the civil society and private sector
component. Performance of NACA assessed by their beneficiaries and of the technical advisors
within NACA twice during the project (year 2 and 4).


Toward the Future

The BNAPS Project is in its first year of a five-year implementation period. The government,
with support from IBRD and other development partners, has mobilized different sectors
(Including health, transport and education), civil society organizations and communities to
increase their capacity to respond to the demands of the HIV/AIDS epidemic. Although the
project is a modest contribution to the overall national response, it provides focused assistance
of institutional strengthening, especially in key areas such as fiduciary management and results
reporting among civil society organizations; strategic planning and monitoring and evaluation;
managing targeted technical activities in participating ministries and government agencies; and
evidence-based policymaking in the health sector through a modest agenda of research and
evaluation at the Ministry of Health. By relying on local groups and specialists in building this
critically important technical and institutional capacity, it is expected that the core elements of
the BNAPS effort will continue well after the five-year project lifespan.

 


                                                     Last updated: 2010-03-22