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                                                                                                    April 8, 2007

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When the project was prepared in 2002 Rwanda was classified among the 10 African countries
most severely HIV/AIDS-affected countries. At the time, funding was not adequate to address the
scope and scale of the epidemic, with life-saving anti-retroviral therapy provided only at a few
urban facilities for those who could afford to pay.




Early on the government of Rwanda demonstrated strong commitment to both HIV prevention
and treatment. It quickly recognized the negative development impact of the AIDS epidemic,
adopted a multi-sectoral approach, and developed a national HIV/AIDS strategic plan. Rwanda
requested Bank assistance as part of the Multi-Country Action Program against HIV/AIDS (MAP)
in Africa. The project is financed by a US$30.5 million IDA grant and supports the full range of
preventive, medical and support services for those living with HIV/AIDS. Most activities have had
a nationwide focus and have been funded on a demand-driven basis. Civil society organizations,
faith-based groups, and grass-root associations are important beneficiaries.




Access to AIDS care and treatment has expanded to rural areas where the majority of
Rwandans live on less than US$.70 per day and HIV infections rates among youth in
Rwanda has declined.


Highlights:
- Under the MAP operation over 5,000 patients have benefited from highly subsidized access to
life saving antiretroviral therapy or roughly 60 percent of those in need. The majority are poor
women who might have succumbed to the disease. In total, Rwanda has placed over 32,000
patients are on ART at 130 sites nationwide, in comparison to 870 patients/7 sites in December
2002.
- There is also encouraging news on the prevention side. The percentage of females who
correctly identify ways of preventing sexual transmission and reject misconceptions rose
dramatically to over 51% in 2005 from about 23% in 2000. There has also been a reported
decline in HIV infection rates among youth in Rwanda (UNAIDS 2006) to which the project has
contributed.
- Under this IDA-financed project, about 500,000 people have been tested.
- Roughly 12 million condoms have been distributed.
- Some 27,000 orphans and vulnerable children have benefited from financial assistance for
school fees.
- Roughly 52,000 households have received subsidized access to community health insurance,
reaching a quarter of a million people.
- Some 100,000 individuals have benefited from income-generating activities.
- Capacity to diagnose, treat and follow up AIDS patients has been established at 12 district
hospitals serving about 2 million Rwandans. The program is being decentralized to an additional
18 health centers which imply shorter travel time for patients and lower costs to the system.
- Innovative approaches such as vouchers for HIV testing and performance contracting for
HIV/AIDS services were introduced.




- US$30.5 million in grant financing since 2003; US$10 million supplemental grant was recently
approved by the Bank's Board of Directors.
- IDA supported analytical work which led to the design of the treatment program; the US
Centers for Disease Control was recruited to do a baseline assessment and design a model of
care for the project.
- IDA supported the basket funding of ARVs drugs, with the World Bank and the Global Fund to
fight AIDS, Tuberculosis and Malaria financing generics and the United States President's
Emergency Plan for AIDS Relief (PEPFAR) procuring brand name drugs in a coordinated fashion
using the Clinton Foundation pre-negotiated prices and relying on country procurement systems;
this has generated important cost savings and enhanced planning and forecasting skills.
- IDA has spearheaded and supported an important impact evaluation of the national program.
- IDA has helped build national capacity to manage the HIV response with disbursement
mechanisms replicated at the country level and with successes from Multi-Country Action
Program systems for planning and monitoring being used as a blueprint for developing a district
planning and monitoring system.
- IDA fills financing gaps through this program as donor of last resort, which enables speed,
flexibility, a learn-by-doing approach, and participatory strategies which empower beneficiaries to
design their own interventions.




The Global Fund to fight AIDS, Tuberculosis and Malaria, US Centers for Disease Control and
the United States President's Emergency Plan for AIDS Relief (PEPFAR).




The main challenge at this stage is to use the recently approved US$10 million grant to
consolidate and sustain the gains from the initial investments and to develop a long-term
financing strategy for HIV/AIDS.




Multi-Sectoral HIV/AIDS Project (2003-08)
Project documents  |  Additional grant (Feb. 2007)  | AIDS report extract: Saving lives in Rwanda | News
story: AIDS program hailed by Rwandan First Lady