This is the first report testing Multilateral Development Bank (MDB) commitment to promote reproductive health, prevent HIV and treat AIDS. It analyses the quantity and quality of MDB funding for these sectors during 2003-2006 and highlights how MDB and International Monetary Fund (IMF) policies undermine achieving the Millennium Development Goals (MDGs) reproductive health and HIV/AIDS targets. Although limited resources confined this report to a short timeframe, it provides a strong basis for critical deeper analysis and advocacy.
Despite firm commitments by all MDBs to achieving MDG reproductive health and HIV/AIDS targets, we identified a recent decline in World Bank spending and dearth of other MDB support for reproductive health and HIV/AIDS. The World Bank was the largest MDB funder addressing these two challenges; from 2003-2006 the World Bank approved $7.2 billion for reproductive health and HIV/AIDS projects and components. World Bank funding amounts declined from $2.3 billion for projects and components in both sectors in 2003 to $2.1 billion for the same in 2006. World Bank funding for HIV/AIDS projects and components dropped from $1.3 billion in 2004 to $790 million in 2006. The African Development Bank (AfDB) was the second largest MDB funder, but, despite the devastating HIV/AIDS pandemic affecting many African countries, the AfDB provided merely $44 million for HIV/AIDS projects and components from 2003-2006 compared to $108 million for reproductive health over the same period. The Inter-American Development Bank (IDB) provided $76 million in loans and grants for reproductive health and HIV/AIDS between 2003 and 2006. Asian Development Bank (ADB) investments in reproductive health and HIV/AIDS from 2003 to 2006 total $48 million and concentrate mostly on grants for HIV and AIDS. These investments averaged less than one percent of spending at the AfDB, ADB and IDB, and less than six percent at the World Bank from 2003 to 2006. As we explain further below, this Word Bank data is highly inflated.
We reviewed a sample of MDB reproductive health and HIV/AIDS projects to assess their quality, especially their gender sensitivity. Overall, the quality of these investments was disappointing with only a handful of projects addressing gender issues despite the critical importance of gender roles in reproductive health and HIV/AIDS. Although many projects acknowledged the plight of women or discussed gender inequality, they failed to follow through with mitigating actions. Most projects
focused solely on women, overlooking men’s involvement in reproductive health and rights and HIV/AIDS prevention and treatment. Furthermore, most MDB population projects focus primarily on maternal health and lack attention to reproductive and sexual health and rights. Compounding lack of gender sensitivity in MDB projects is their unsustainability caused by endemic MDB project shortcomings including short-term project duration and lack of funding for recurrent expenditures such as salaries for doctors and nurses.
MDB and IMF policies and practices also undermine meeting their MDG reproductive health and HIV/AIDS commitments. World Bank and IMF policy-based loans cut government funding for reproductive health and HIV/AIDS programs. Health sector privatization and user fees make reproductive health and HIV/AIDS services unaffordable to the poor. IMF imposed caps on public sector wages limit the number of doctors and nurses in a country. MDB and IMF promotion of intellectual property rights increase the price of essential medical supplies and drugs. Recently, conservatives have been using the World Bank to impose their anti-family planning ideology on the global South. Finally, lack of transparency of MDB and IMF data limits citizens’ ability to monitor their investments in reproductive health and HIV/AIDS.
We close by suggesting deeper research and extensive advocacy to overcome the foregoing impediments to deploying the world’s largest development assistance programs toward improving reproductive health, ending HIV/AIDS and achieving these and other MDGs.