What the World Bank Group is Doing

South Asia Multi Sector briefs on HIV/AIDS Finance and Private Sector The Business Case for AIDS AIDS kills primarily young and middle-aged adults during their peak productive years. At the macro economic level, HIV/AIDS can impact the workforce by reducing the labor supply and disposable incomes and thus have a negative effect on markets, savings, investment and consumer spending. While assessing the economic impact of AIDS is difficult, studies suggest that some of the hardest-hit countries with generalized epidemics may forfeit 2% or more of GDP growth per year to the epidemic. South Asia has not reached this level, but in South and East Asia, the HIV/AIDS epidemic is spreading among groups at high risk with over 7.1 million people living with HIV, nearly 0.9 million of whom are newly infected. In India alone the number of people living with HIV/AIDS has reached about 5.1 million, with generalized epidemics in six states. Businesses are not immune to HIV/AIDS. They are impacted directly through their workforce. Companies experience increased expenditures in medical and health insurance costs, funeral costs, payment of death benefits, and the necessity to recruit and train to replace lost personnel. As experienced in generalized HIV/AIDS epidemics, firms experience increased costs and decreased revenues as a result of higher absenteeism and staff turnover, reduced productivity, declining morale and a shrinking consumer base. This can be prevented in South Asia if actions in the private sector are taken and efforts are scaled up now. The private sector is an important stakeholder and an effective partner in addressing HIV/AIDS in South Asia. Private companies have many comparative advantages that can be mobilized in the fight against AIDS including: Coverage and Influence: A large proportion of Asians work in private companies and the private sector has significant influence over the general workforce; this could be harnessed in HIV/AIDS awareness campaigns and behavior change interventions. In addition, most people seek care in the private sector, irrespective of income level. Results Approach: The efficiency of the private sector could be applied to achieve effective HIV/AIDS programs. Special Expertise: Private sector core competencies such as financial and accounting skills, technical know-how, communications, media, marketing, training skills, and logistics expertise can be applied in the task of changing opinions, attitudes and behaviors of large numbers of people that is required to reduce stigma and have an impact on the HIV/AIDS epidemic. Financial Resources: Private firms can afford to finance HIV/AIDS programs. The private sector can find innovative ways to finance programs and sustain them. For example, London financiers issued a securitized bond that would raise US$2 billion to fund development of AIDS treatments for the developing world. Financial Times: Tuesday January 25, 2005. What the World Bank Group is Doing • The Bank is working with partners in the prevention, treatment, care, and mitigation of HIV/AIDS through multisector approaches. The Global HIV/AIDS Program, ACT Africa (AIDS Campaign Team for Africa) and the South Asia Regional multi-sector AIDS team coordinate this work, globally and in respective regions, and all include private sector endeavors. Similar approaches and team efforts exist in the other regions. The World Bank Institute supports the Bank's efforts in AIDS lending, research and advocacy, and contributes to leadership and capacity building. The • June 2006 program has been developed in collaboration with World Bank staff and country clients, UNAIDS, bilateral and multilateral donors, researchers and practitioners, the NGO community and business leaders. • The IFC assists clients to develop successful and sustainable projects with low environmental and social impacts including addressing HIV/AIDS. IFC's Environment and Social Development Department provides IFC clients with advisory services and social facilities across all regions, industry sectors, and specialized areas including HIV/AIDS. Private Company Efforts in South Asia Some individual companies in South Asia have taken the initiative in developing and implementing their own HIV/AIDS programs for their workforces. Examples include the following companies listed below: Tata Tea Ltd (TTL) formed a public-private partnership with the Munnar branch of the Indian Medical Association (IMA) to implement an HIV/AIDS program. The programs provide education, prevention, and awareness; voluntary counseling and testing (VCT) for employees, dependants, and community members; and programs for employees and dependants. Tata Steel employs almost 43,000 people and implements various programs including: AIDS Awareness; Drugs & Alcohol Awareness; and Training of Trainers. Apollo Tyres Ltd, India provides HIV/AIDS prevention services for truckers. The program components include; Treatment of Sexually Transmitted Diseases, Education, AIDS Awareness Campaigns, Condom Promotion and Behavior Change Communication. Modicare, a part of the KK Modi Conglomerate, and a leading direct selling company in India organizes education programs for staff and for the local communities where they work, distributes condoms and provides antiretroviral treatment for its HIV positive employees. What can be done to mainstream HIV/AIDS in Finance and Private Sector Development? Type of Action Policy and Strategy work Develop policies and strategies for the engagement of the private sector in the establishment of workplace programs. Adopt policies and strategies, such as the ILO code of practice on workplace programs. Economic and Sector Work Conduct socio economic analysis of impact of HIV/AIDS. Methods Examples of what to do and monitoring of progress Encourage public commitment by the relevant bodies, industry leaders and regulatory agencies to adopt workplace policies for HIV/AIDS and publicly display their strategies. Indicator: workplace policy exists and is publicly displayed. Conduct, synthesize and present findings from analysis of economic impact of HIV/AIDS and of unit cost of treatment for infected persons; use this to make a business case and advocate for the need for private sector involvement. Indicator: Context specific and relevant information and data is readily available. Dialogue and Advocacy Inform policy, and make the business case for HIV/AIDS by providing the evidence-base for it. Adapt and use the Investment Climate Assessments (ICA) and Doing Business Indicators to gather information and promote dialogue. Sensitize industry leaders. Devote (parts of) peer reviewed publications to the impact of HIV/AIDS on the business climate and report on business indicators. Use high profile speakers, and get industry leaders to address the epidemic in public along side HIV/AIDS campaigners to break barriers to dialogue. Organize a South Asia Business summit on HIV/AIDS. Indicator: Business indicators adapted and used. The business case is written up and readily available. Industry leaders & target audiences are informed and attitudes changed (as measured by KAP surveys). Develop prevention, VCT, and treatment programs, in accordance with national prevention & treatment policies. Build public-private partnerships and sectorspecific business coalitions on AIDS. Indicator: Employers aware off and use HIV/AIDS prevention, VCT, and treatment services offered at the workplace. HIV/AIDS at the Workplace Capitalize on SASFP’s long standing relationships with various regulatory agencies – central banks, ministries of finance and commerce, securities and exchange commissions, insurance authorities, pension boards – to introduce HIV/AIDS at the workplace policies and programs. Type of Action Capacity building Methods Examples of what to do and monitoring of progress Train task team leaders to be competent and confident in discussing HIV/AIDS prevention with clients. Encourage clients to appoint focal persons and peers to facilitate HIV mainstreaming in the workplace. Organize seminars and workshops for task team leaders on HIV/AIDS. Encourage the designation of focal persons who will be trained on HIV/AIDS related issues and serve as resource person in the respective organizations. Indicator: task team leaders & focal persons trained and with plans for mainstreaming. Challenges within and outside the World Bank – and how to tackle them There are several challenges to implementing a comprehensive and effective private sector strategy for the South Asia Region, including: • Many Bank staff and their clients are not convinced of the necessity of a comprehensive, multi-sector approach to combating HIV/AIDS beyond the efforts of the health sector. In addition, Bank staff and counterparts working in the areas of finance and private sector development do not have adequate knowledge and experience for policy dialogue, strategy development and implementation of HIV/AIDS programs. partners on HIV/AIDS. Identify champions who will be trained on HIV/AIDS related issues and serve as resource persons in their respective units or organizations. • The business case for investment in HIV/AIDS programs in South Asia for most industries has not yet been convincingly made, especially in the context of low prevalence and concentrated epidemics. Without a strong case, companies will not spend money even where offered the best-laid, affordable plans. What can be done: Organize seminars and workshops for task team leaders and What can be done: Present findings from analysis of the economic impact of HIV/AIDS and unit cost of treatment for infected persons to advocate for the need for private sector involvement. Include the impact of HIV/AIDS on the business climate and on business indicators in advocacy and policy documents. Useful references and websites: • • • • • • • • • • Family Health International (FHI) “Workplace HIV/AIDS Programs: An Action Guide for Managers.” UNAIDS and the International Organization of Employers. Employers Handbook. The Policy Project of the Futures Group International. HIV/AIDS Policy Compendium Database with national HIV/AIDS policies including about policy on HIV/AIDS in company operations. The World Economic Forum's Global Health Initiative. “Business Tools” web page with corporate case studies, best practices and a networking directory. The Global Business Coalition on HIV/AIDS Links to workplace-related resources. The Corporate Council on Africa. U.S.-based corporations doing business in Africa report on HIV/AIDS with case studies and best practices in policy and program design and implementation. Business Coalition on AIDS. Best practices, case studies, and key NGO and private sector contacts in Asian countries. IFC against AIDS. Specifically tailored tools and advice to address workforce and community-related concerns stemming from the disease. South Asia HIV/AIDS Multi-sector Team Website containing regional multi-sector activities on HIV/AIDS. This brief is a work in progress. It is updated as new information becomes available. We welcome your comments and feedback. Please send them to Mariam Claeson, South Asia HIV/AIDS Program Coordinator, mclaeson@worldbank.org, Sabine Durier, World Bank Principal Strategy Officer and Program Leader sdurier@ifc.org, or Samuel Munzele Maimbo, World Bank Sr. Financial Sector Specialist smaimbo@worldbank.org