67643 T I O N A L BA N NA K ER F T O IN R WORLD BANK T REC EN ON PM ST O RU L CT E VE ION AND D January 2005 HIV/AIDS Series A regular series of notes highlighting recent lessons emerging from the operational and analytical program of the World Bank‘s Latin America and Caribbean Region ACTION THROUGH PARTNERSHIPS: THE PAN-CARIBBEAN PARTNERSHIP AGAINST HIV/AIDS (PANCAP) Mary Mulusa and Carmen Carpio Background approximately 6% of the Gross Domestic Product (GDP) of the region in 2005. The HIV/AIDS epidemic is a major threat The Pan-Caribbean Partnership Against HIV/AIDS to the economic growth of the Caribbean region. (PANCAP) was designated an “international best practice� by the Joint United Nations Program on HIV/AIDS (UNAIDS) A regional response to HIV/AIDS during the press launch of the joint CARICOM/UNAIDS secretariats’ publication: “Common Goals, Shared Re- The Caribbean region is characterized by high rates of sponses: A Case Study on the Pan-Carib- population mobility due to the large bean Partnership Against HIV/AIDS socioeconomic differences among the (PANCAP)� in December, 2004. countries. People travel from island to PANCAP is an umbrella mechanism island for work, study, and family rea- which brings together key partners to sons. The Caribbean is also a popular accelerate and coordinate the regional tourist destination. This movement fu- response to the spread of HIV/AIDS in els the HIV/AIDS epidemic. Further- the Caribbean. more, the small size countries and the limited human resources and institu- HIV/AIDS in the Caribbean tional capacity render highly specialized HIV/AIDS prevention, care and treat- The Caribbean region is second only to ment expensive. It was recognized very Sub-Saharan Africa in HIV prevalence early on that a collaborative and coordi- with an estimated adult HIV prevalence nated response was an imperative for rate of 2.3% in 2003. Approximately the region. This collaboration aims to 430,000 adults and 23,000 children are bridge the resource gap, improve effi- living with HIV in the region. HIV/ ciency of resource allocation, gain AIDS is the leading cause of death economies of scale and enhance quality. among adults in the age group 15-44 The regional response also provides an years. The epidemic is not just a health opportunity for sharing information and problem, but a developmental and eco- replicating best practices among coun- nomic problem as it affects the most tries. productive human resources and redi- rects efforts from productive activities to HIV/AIDS treat- The groundwork for the establishment of PANCAP was laid ment and care. If the prevalence of HIV in the Caribbean through a process which included technical cooperation region continues to increase and maintains its negative effects involving: CAREC, UWI, the Caribbean Community on production and savings, per capita growth will signifi- (CARICOM) Secretariat, the Caribbean Regional Network of cantly decline. A study of the University of West Indies Persons Living with HIV/AIDS (CRN+), the Caribbean (UWI) and the Caribbean Epidemiology Center (CAREC) Health Research Council (CHRC), together these agencies estimated that the total cost of the epidemic could reach and bilateral and multilateral external partners developed the 1 Caribbean Regional HIV/AIDS Strategic Framework led by the Caribbean Task Force on HIV/AIDS and high level dialogue. “The collective programme that has been adopted through the Caribbean Regional Strategic Plan is in- Consultative meetings were held within the region and be- deed a model of functional cooperation that has spared tween regional leaders and external partners. HIV/AIDS was the small countries of the Region from having to put on the agenda of two consultative meetings of donors and duplicate efforts and has enable the rationalization of Caribbean Governments: the Caribbean Consultative Group scarce resources.� Dr. Denzil Douglas, Prime Minister donors’ meeting in Brussels in April, 2000; and, and the St. Kitts and Nevis, 2004 Meeting of the Caribbean Group for Cooperation in Eco- nomic Development (CGCED) at the World Bank, Washing- ton, in June 2000. A meeting of CARICOM Heads of PANCAP. The CRSF was developed through a series of Governments in St. Vincent and the Grenadines in August, partner and stakeholder consultations in the region. The 2000 recognized the threat HIV/AIDS posed to development CRSF has established seven priority areas each with a achievements. responsible lead partner: In September of 2000, the Caribbean Conference on HIV/ (1) Advocacy, policy development and legislation - AIDS was held in Barbados. It was sponsored by Lead Partner: CARICOM CARICOM, PAHO, UNAIDS and the World Bank. This conference demonstrated to the international community the (2) Care, treatment, and support for people living with region’s high-level political commitment to respond to HIV/ HIV/AIDS - Lead Partner: CRN+ AIDS and led to direct action from the donor community including the World Bank’s pledge for a substantial financial (3) Prevention of HIV transmission, with a focus on support to the individual countries. The decision was taken young people - Lead Partners: Red Cross/UNICEF/ during the meeting to establish a partnership against HIV/ Caribbean Federation of Youth AIDS building on the Caribbean Task Force on HIV/AIDS and other existing processes and struc- (4) Prevention of HIV transmission tures. PANCAP was formally established among especially vulnerable groups - in February of 2001 through the signing Lead Partner: UNAIDS PANCAP Member of the Caribbean Partnership Commit- ment at a meeting of CARICOM Heads Countries (5) Prevention of mother to child trans- of Government. The original six signato- Anguilla mission – Lead Partner: CAREC/PAHO ries were the Prime Minister of Barbados, Antigua & Barbuda who was at the time the Chairman of The Bahamas (6) Strengthen national and regional ca- CARICOM, the Prime Minister of St. Barbados pacities for analysis, program design, Kitts and Nevis, who was responsible for Belize implementation, management, and the CARICOM health portfolio, the Sec- Bermuda evaluation – Lead Partner: University of retary General of CARICOM, the Execu- British Virgin Islands the West Indies tive Director of UNAIDS, the Founder Cayman Islands and Coordinator of the Caribbean Net- Cuba (7) Resource Mobilization – Lead Part- work of People Living with HIV/AID, Dominica ner: CARICOM and the Director of the PAHO. Today, Dominican Republic PANCAP consists of 70 partners (1) Grenada The core functions of PANCAP are to: member countries (all 28 countries), (2) Guyana regional NGOs, (3) academic/educational Haiti (1) Provide and maintain collective/uni- organizations, (4) private sector, (5) reli- Jamaica fied vision and direction among partners gious/faith-based organizations, (6) net- Montserrat to eradicate HIV/AIDS in the Caribbean work of persons living with HIV, (7) Netherlands Antilles region; regional inter-governmental organiza- Puerto Rico tions, (8) networks of national AIDS pro- St. Kitts & Nevis (2) Coordinate partners’ activities at the grams/commissions, (9) UN agencies, St. Lucia regional level, particularly with respect (10) bilateral donor organizations and St. Vincent & The Grenadine to the CRSF, the CARICOM Action governments. Suriname Plan, and the Global Fund Program; Trinidad & Tobago Turks & Caicos Islands (3) Act as a clearinghouse for informa- PANCAP US Virgin Islands tion for decision-making; The Caribbean Regional Strategic Frame- work for HIV/AIDS, 2002-2006 (CRSF) (4) Build awareness of HIV/AIDS is- provides overall vision and direction for sues and advocate for the elimination of 2 discrimination against persons infected or affected by Although there is much work ahead, the foundation has been the disease and the greater participation of persons liv- laid with key advances. PANCAP has provided the structure ing with HIV/AIDS; and mechanism for coordinated and collaborative action by bringing together partners to work under the CRSF. (5) Build the capacity of partners; PANCAP has directly supported resource mobilization by (6) Increase the flow of resources for the fight against HIV/AIDS; (7) Monitor the impact of programs in member coun- tries and organizations, and (8) Assist in streamlining programs and projects to avoid duplication of effort and consequently, more ef- fectively utilize resources. The overall structure of PANCAP is made up by four main areas – the partner members, the steering committee, the PANCAP Coordinating Unit (PCU), and technical working groups. The Steering Committee is made up of 17 representa- providing donors with information to better coordinate fund- ing efforts. Through its annual meetings, outreach, and communications material, PANCAP has strengthened com- munication among partners allowing for sharing and ex- changing of best practices. PANCAP has also served as a platform through which its members can pool resources and coordinate activities so as to not duplicate efforts. One of PANCAP’s principal achievements has been leading joint regional initiatives such as the successful negotiations with pharmaceutical companies for reduced prices for anti- retroviral drugs for Caribbean countries. PANCAP’s achievements have also had a global impact as Caribbean countries are sharing best practices on a global scale and are providing guidance to other regions on how to develop an approach for ARV price negotiations. Challenges tives of the PANCAP membership and serves as the decision- Although a politically supportive environment emerged for making executive board. The PCU is responsible for the day- the establishment of PANCAP, there were a number of to-day operations from administrative to technical support. It challenges. Given the differences in size of countries and the is supported by the CARICOM Secretariat. There are four economic status of the countries, it was important to convince Technical Working Groups created by the Steering Commit- the smaller countries that these differences would be taken tee to liaise with national into account in resource allo- AIDS programs for program cation. In addition, partners in implementation. They cover: non-health sectors needed “I believe PANCAP is a model of a successful regional (1) Care, Treatment and Sup- strong guidance on ways in approach which can be a stimulus and a source of port; (2) prevention; (3) Hu- which they could contribute to lessons learned for other regions.� man Rights and Stigma Re- the response as it became clear Dr. Peter Piot, Executive Director, Joint United Nations duction; and (4) Capacity that the response needed to be Programme on HIV/AIDS (UNAIDS), 2004 building and Resource Mobili- multi-sectoral. Another key zation. challenge faced by the re- gional partners in the estab- Achievements lishment of PANCAP was the need to identify what would be handled at the regional level and how regional actions would PANCAP has been instrumental in maintaining HIV/AIDS as support and complement national level actions. Most impor- a priority for the Caribbean region’s development agenda. tantly as the need for action on a regional level grew, 3 PANCAP was faced increasingly with a shortage of re- sources. When it came to resource mobilization, the PCU faced the challenge of dealing with the different processes required to secure funding, while at the same time having to About the HIV/AIDS En Breve Series meet the expectations of its partners who were eager to see rapid results. Thanks to the commitment and patience of En Breve is proud to present the HIV/AIDS Series PANCAP’s partners, these challenges are being overcome. which will run from January until June of 2005. The series looks to raise awareness on how HIV/AIDS directly affects the overall development of the region Lessons learned focusing on the Caribbean. The series will include A number of lessons emerge from PANCAP’s experience. monthly notes each highlighting a different priority The building of the partnership was regionally led and topic relating to HIV/AIDS in the Caribbean region. owned. It built upon the existing Caribbean regional coop- Among the topics to be addressed are: PANCAP, eration; political leadership was mobilized once HIV/AIDS Gender and HIV/AIDS, Raising HIV/AIDS awareness was recognized as a threat to the economic development of in the most vulnerable groups, HIV/AIDS workplace the region; the People Living with HIV/AIDS (PLWHA) policies and their implementation/enforcement, Ongo- played a central role in the building of the regional partner- ing social research in HIV/AIDS and what it means, ship; the process of the development of a strategic framework HIV/AIDS and Orphan Care. on HIV/AIDS through a consultative process helped to secure the buy-in of the partners and to guide collective action; The Series will be complemented by parallel, interac- priority was given to resource mobilization to a solid funding tive global dialogues facilitated through the Global base for the regional response and resulted in increased Development Learning Network (GDLN). These glo- resources both to countries and to the PCU and regional bal dialogues will bring together stakeholders and partner agencies; PANCAP maintained open coordination policy-makers from the Caribbean nations of Barba- and communication channels with partners; partners were dos, Jamaica, and St. Lucia with counterparts in Ghana, provided with the opportunity to contribute to the develop- Tanzania, and Ghana. The global dialogues will serve ment of the regional strategic framework, the regional dia- as the channel through which cross-regional exchanges logue and the resource mobilization based on their different can take place and will feed the development of the En areas of focus and strength. These lessons are important for Breve Series. In addition, the monthly topic will be other regions and groups looking to embark on a similar featured on the www.worldbank.org/lacaids website challenge of strengthening regional cooperation or coordi- through which additional publications and background nated and collective responses to the HIV/AIDS epidemic. documents will be available. Looking ahead As PANCAP moves forward with its agenda and with the This Series is made possible thanks to a joint collabora- commitment of its partners it will need to maintain and tion of the Human Development and Knowledge Man- strengthen high-level leadership, support visible and concrete agement teams of the World Bank’s Latin America and results at the country level, create synergy between the Caribbean Region. regional level advances and those on a national scale, clearly define the roles of its members and the role of its functioning structure with relation to other regional bodies, and strengthen the communication and coordination among the About the Authors members of the Partnership. It will in particular, need to Mary Mulusa is a Senior Public Health Specialist in the strengthen the capacity of the PCU to support the work of the Health, Nutrition and Population Sector of the Human Devel- Partnership. PANCAP is still in its early stages but even as it opment Department and also serves as the HIV/AIDS Focal strives to con- Point of the Latin America and Caribbean Region of the solidate and World Bank. strengthen its role, it is already Carmen Carpio is a Knowledge Management Officer with the a model for re- Knowledge Management Team of the Latin America and gional collabora- Caribbean Region of the World Bank. tion in dealing with the HIV/ AIDS epidemic. About “en breve� Subscribe to “en breve� by sending an email to en_breve@worldbank.org 4