This paper for senior World Bank (Bank) management and staff describes the current status and impact of the HIV (human immunodeficiency virus) and tuberculosis (TB) epidemic in southern Africa, the strategic role the Bank has played to date, and puts forward an action plan for deeper Bank engagement with the middle-income countries (MICs) in this subregion, especially in light of the new political commitment by the government of South Africa. The approach presented is consistent with the Bank’s Executive Board-approved Africa Region HIV/AIDS Agenda for Action 2007–2011 (World Bank 2008b) effort to “increase Bank engagement in the epicenter of the epidemic—Southern Africa” and the Global HIV/AIDS Program of Action (World Bank 2005), and is designed to support national efforts through evidence-based, prioritized strategies; scaling up targeted multisectoral and civil society responses that have demonstrated effectiveness; improving monitoring and evaluation (M&E) capacity; and harmonizing donor collaboration. This Southern Africa HIV/
AIDS and Tuberculosis Action Plan 2010–2011, for Botswana, Lesotho, Namibia, South Africa, and Swaziland (referred to henceforth as the “SACU Action Plan”) delineates an expanded operational response to the unique constraints posed by this subregion, with a focus on assisting countries to better utilize available resources, and making the money work better. This approach is aligned with the Africa Action Plan (AAP; 2005),1 emphasizing new ways of doing business, including enhanced leveraging of available financial
and technical resources. This strategy responds to the World Bank President’s strategic themes of “building a competitive menu of development solutions for middle-income countries, with customized services as well as finance” and “playing a more active role in
regional and global issues that cross national borders, including…infectious diseases.”2 The Bank has made specific attempts in recent years to adapt its approach to MICs, particularly the southern African MICs, in view of their economic impact on the continent, especially the impact of the South African economy on the rest of Africa (World Bank 2008a).