What's the buzz in Toronto?

It's both energizing and exhausting to be at this largest ever AIDS Conference in Toronto. With 25,000+ delegates and an impressive line-up of global, national and community leaders attending this conference, the message is very clear: it isn't just time to deliver, but rather it is Time to Deliver NOW! With 25 years behind us, billions of dollars spent, millions of deaths and millions more being infected there is no time and money to waste. The AIDS pandemic is both an emergency and a long term development dilemma so we must deliver now and with a plan for the future. The business of AIDS will be deemed profitable if and only if people stop dying from AIDS and if people stop getting infected; it is not only about treating people, but keeping them alive and preventing new infections.

Some highlights from a couple of sessions I attended that were directly related to the HIV/AIDS Monitor and aid effectiveness:

Evaluating donor assistance for HIV/AIDS was a topci of discussion at a pre-conference meeting of the International AIDS Economics Network on Saturday. Panelists included Martha Ainsworth from the Independent Evaluation Group at the World Bank, Julia Compton from the Evaluation Office at the UK Department of International Development, Ruth Abraham of the United Nations Development Brogram, and Sulley Gariba of the Institute for Policy Alternatives in Ghana. The main take away messages from this very interesting session were that:

• Over 20 years, the urgency of the epidemic has been used as an excuse not to invest in costly and time-consuming evaluations of donor programs, but this lack of information about impact is no longer acceptable and must inform ongoing donor support.
• Counting HIV and AIDS spending is problematic due to the lack of budget line items for specific activities, few disaggregated numbers, the difficulty of tracking policy work, and the fact that partners funded by donors have different definitions and tracking systems for spending.
• How does one count spending on activities that are not exclusively for HIV/AIDS? For example: when you have general budget support and sector program support; when HIV/AIDS related activities are included in other health activities such as reproductive health; and when wider "enabling" activities such as tackling violence against women have a direct impact on decreasing women’s vulnerabilities to HIV.
• Changes in aid modalities may necessitate a move from donors tracking their funding as it moves through their system to tracking funds through national systems.

World Bank Pre-Conference Consultation on the World Bank Revised Strategy on HIV/AIDS in Africa was an informative session convened by Elizabeth Lule of the World Bank’s ActAfrica group on Sunday. Ms. Lule called on the audience to assist the Bank in preparing an Agenda for Action in Sub-Saharan Africa by asking specific questions including:

• What has changed since the original HIV/AIDS strategy to warrant a fresh approach?
• What have we learned from the experience of the MAP Program over the past five years that will help shape the agenda for action?
• How would a new strategy complement and add value to the World Bank's GHAP, the Africa Action Plan and the forthcoming Health Sector Strategy?
• What might be the Bank's comparative advantage in HIV/AIDS support relative to other donors and development agencies?
• What might be realistic expectations for results over the next five years and how will these be measured?
• How might the way of doing business change to implement the strategy and enhance the effectiveness of the Bank's work on HIV/AIDS in Africa?

These are important questions for the Bank as they re-think their role, and they should be commended for taking this action. Of course, we at CGD will watch these developments with interest in anticipation of the new Agenda for Action scheduled to be launched on December 1, 2006. Several other speakers also spoke at this session including Andy Berg from the IMF, who did a brilliant job of explaining the concept of trade-offs in the world of financing the response. As a non-economist, I appreciated the simple explanations about fiscal space, competition of sectors and how the primacy of AIDS is not appreciated by all sectors and the fungibility of funds, i.e. country governements can cut domestic spending for AIDS because of donor money and move these resources to other sectors and this is often interpreted as an issue of fiscal space. My colleague David Goldsbrough is will have a lot more to say about this with a report from a new CGD Working Group on IMF-Supported Programs and Health Spending.

More to come...