Report Says Bank's AIDS Efforts Are Failing

Celia Dugger | 30 Apr 2023
New York Times
JOHANNESBURG — A vast majority of the World Bank's projects to combat AIDS failed to perform satisfactorily over the past decade, with the ones in Africa, the region at the epicenter of the pandemic, registering the worst record, according to a new internal evaluation.

Seven of 10 AIDS projects that the bank financed around the world — and 8 of 10 in Africa — had unsatisfactory outcomes, according to the evaluation, released Thursday.

The projects were typically too complex for the weak or inexperienced bureaucracies carrying them out, researchers found. And coordinating the plethora of donors, nonprofit groups and government agencies involved made delivering results very difficult.

"It's true, and we agree, that too often in the projects, we had overambitious objectives, given the capacity of the country and sometimes our own," said Julian Schweitzer, the World Bank's director of health, nutrition and population, the division evaluated in the report.

The broad assessment of the World Bank's $17 billion investment in health, nutrition and population since 1997 comes after a decade in which foreign assistance for global health, especially for combating AIDS, has soared — and as the bank is tripling its financing of such projects to $3 billion in 2009 from $1 billion in 2008. About two-thirds of the bank's lending on these themes had satisfactory outcome.

The wealth of data in the report is likely to inspire a variety of interpretations. William Easterly, an economics professor at New York University, said in an e-mail message that the evaluation confirmed for him "a fear that many of us have had for some time: that hugely disproportionate attention to AIDS has had a negative effect on aid efforts for all other health problems."

While the focus on AIDS accounted for nearly 60 percent of the bank's projects on communicable diseases from 1997 to 2006, more successful efforts aimed at malaria, tuberculosis and leprosy, among others, got far fewer resources. Malaria, for example, made up 3 percent of the projects, and tuberculosis only 2 percent. Nine of 10 of these other communicable disease projects performed satisfactorily or better.

As the World Bank put more resources into AIDS projects, its support for family planning and efforts to reduce malnutrition plunged, according to the report, by the Independent Evaluation Group, a unit that answers to the bank's board and president.

Helping women control the number of children they bear is essential to reducing the high rates at which they die in childbirth in the poorest nations, said Martha Ainsworth, lead author of the evaluation. "The fact that no one's been paying attention to reducing high fertility is critical for Africa," she said.

Leaders of the evaluation group said Thursday in interviews that the bank needed to intensify its efforts in family planning and nutrition. Mr. Schweitzer, of the World Bank, said he heartily agreed.

The evaluators' prescription for improving effectiveness is to simplify projects, reduce the number of government ministries involved and tackle more modest objectives.

But Mr. Schweitzer essentially argued that the donors and the recipient countries needed to do a better job of coordination aimed at achieving specific results.

"It's not always so simple to keep things simple," he said. "Health is complicated.";=world