Appendix a : Conceptual Framework for the Evaluation

By The World Bank

Description
Economics

Excerpt
Evaluating the development effectiveness of the Bank?s HIV/AIDS assistance is challenging because, first, there are many determinants of the spread of HIV beyond the activities of the Bank, donors, and governments. Individual and household behavior ultimately determines the course of the epidemic and is conditioned on factors such as culture, political institutions, educational levels, the status of women, and the macroeconomic environment. Second, the Bank is only one of many actors in HIV/AIDS, and all Bank-supported projects are implemented by government, directly or indirectly, often in collaboration with other co-financiers. While the Bank can influence policies, responsibility for key policy decisions and the implementation of programs rests with the government. Thus, the development effectiveness of the Bank?s activities is strongly linked to the effectiveness of government. Figure A.1 presents a schematic diagram of the channels through which World Bank HIV/AIDS assistance affects government outputs, behavioral outcomes, and epidemiological impacts at the country level. The Bank?s policy advice, analytic work, and lending can affect government policy directly by influencing government strategies, policies, and public spending on activities relevant to the HIV/AIDS epidemic. Collectively, these are indicators of government commitment. In countries where decision making has been decentralized, government commitment is reflected in the strategies and expenditure decisions of many levels of central and local administration. The Bank can affect commitment indirectly through its influence on the behavior of other donors and effective coordination with their activities. Unlike other donors, which can interact both with government and directly with the private sector and nongovernmental organizations (NGOs) as implementers, the Bank affects the behavior of the private sector and NGOs through its impact on government policies and spending. Government policies and public spending influence HIV/AIDS through strengthening the government?s resources and capacity to provide public goods, service coverage and quality, and the strengthening of institutions to manage the response to HIV/AIDS, both in the public health system and in other public services, such as education, transport, and social protection. Government also affects the response of the private sector and NGOs through the regulatory and legal environment, public subsidies for certain activities, and subcontracting management and implementation. The capacity and activities of the private sector and NGOs also affect the activities of the public health system, in some countries augmenting it. The two-way arrow in figure A.1 between the public health system and other public services reflects the degree of multisectoral coordination of activities. The outputs of this middle tier of public and private agencies represent the implementation of government strategies, policies, and activities, some of which may be financed by the Bank.