Exclusive interview with Dr. Francis Agbo, Acting Director of Surveillance, Research and Monitoring and Evaluation Department at the National Agency for the Control of AIDS (NACA)

By: Henry Umaru

How does NACA Collaborate with Governmental and non-governmental partners to ensure effective Data collection, monitoring, and E valuation of HIV/AIDS Programmes?

In this department, our approach is rooted in inclusivity, ensuring that everyone who should be a part of it is included. We also place a strong emphasis on participation, ensuring that those who are included actively engage in the process. We identify all relevant stakeholders, whether they are international donor agencies, implementing partners, Ministries, Departments, and Agencies (MDA), members of the community, and People Living with HIV (PLHIV). We actively involve and engage with representatives of these stakeholder groups in all our engagements.

Moreover, we maintain an open feedback loop to ensure that everyone remains engaged and informed. Typically, our Monitoring and Evaluation (M&E) activities involve data collection, analysis, and the generation of meaningful insights from the data. Stakeholders retain a keen interest in this valuable information generated from our monitoring and evaluation system and so we actively disseminated at a and information generated by the system.

Can you share some recent findings or insights from NACA’ s monitoring and evaluation efforts that have informed policy and programme decisions?

One of the pivotal initiatives in our monitoring and evaluation efforts is the National AIDS Indicator and Impact Survey (NAIIS) that was conducted in 2018, which, at the time of its implementation, stood out as the largest general population HIV survey ever conducted globally. The NAIIS helped Nigeria rebase her epidemic and it contributed to establishing a true baseline for HIV in the country thus contributing to improved decision-making, target setting, and resource allocation.

Prior to the NAIIS in 2018, there existed uncertainty regarding the precise prevalence of HIV in Nigeria. Pre-NAIIS It was unclear whether the reported figures were underestimated or overestimated. However, the 2018 NAIIS provided a much-needed sense of the actual HIV prevalence in the country.

In addition, Spectrum estimates are done annually, help generate HIV estimates for all 36 states, and help assess our progress towards the goals and priorities for the HIV response, make readjustments, course corrections in the direction the national response is going, and even help in the allocation of funds

How does NACA ensure the accuracy and reliability of data collected for monitoring and 52 evaluation purposes, especially in a dynamic and evolving field like HIV/AIDS?

We employ a series of steps to ensure data accuracy and reliability. The initial step involves the harmonization and standardization of data collection and reporting tools. This process unifies the tools used for data col lection, ensuring that every stakeholder employs the same instruments in collecting data. This standardization prevents variations in data collection methods and ensures that data are comparable across population groups and geographical locations.

In addition, we prioritize capacity building for the users of the tools. This entails training individuals on the utilization of these standardized data collection tools. By providing the relevant training, we ensure that people are able to use the standardized tools, as neglecting this aspect could lead to inconsistent reporting even with standardized tools available.

Furthermore, we implement data quality assurance and assessment procedures. Upon receiving data, we conduct periodic data spot checks, sending personnel to the reporting facilities to verify reported data. This involves verifying reported data to ensure that the numbers reported align with the actual figures on the ground while we also assess the underlying system that generates the data for gaps so that we implement corrective measures.

In addition, we have also largely transitioned from paper-based data collection and reporting systems to electronic methods. This shift is driven by the desire to reduce errors, as electronic systems are typically automated, resulting in fewer inaccuracies compared to paper-based methods.

What are some of the key challenges and opportunities in monitoring and evaluating HIV/AIDS programmes in the country, and how is NACA addressing them?

One of the primary challenges faced by the HIV response in Nigeria is securing adequate funding. As a standard, it is expected that resources allocated for M&E should be between 5-10% of programme budgets but this is not of-ten the case in the HIV response. As such, financial resources are often insufficient to cover the full scope of required activities. This funding challenge is particularly acute at the sub-national level, encompassing states and local governments.

Another pressing challenge is that of M&E technical capacity gaps. These gaps call for sustained and continuous capacity building for enhanced skills and expertise among the M&E workforce to effectively carry out programme monitoring and evaluation.

Furthermore, ensuring proper or adequate coordination among the various stakeholders involved in HIV/AIDS programmes remains a major challenge. The HIV response in Nigeria is multisectoral involving many players . The presence of numerous individuals and organizations engaged in this field makes effective coordination essential but complex.

Additionally, data quality is a concern we still grapple with. Timely, accurate, and reliable data are essential for sound programme assessment, but they can sometimes fall short of the desired level of precision.

NACA is actively working to overcome these challenges, aiming to mobilize funding, build technical institutional and technical capacity for M&E, improve coordination, and enhance the quality of data to ensure the successful monitoring and evaluation of HIV/AIDS programmes in the country.

How does NACA engage with communities and affected individuals to gather their input and experiences in the monitoring and evaluation process?

The future of the HIV response lies in our ability to achieve HIV epidemic control and transition the HIV programme to the subnational level (states, LGAs, and communities. As such NACA recognizes the critical role of communities if we are to achieve our goal for a sustainable HIV response that is also locally owned and driven. NACA employs a comprehensive approach to engaging with communities and individuals affected by HIV/AIDS in the monitoring and evaluation space. This commitment to inclusivity is fundamental `to our work.

When we refer to “communities,” we are addressing individuals at the grassroots level, as well as PLHIV. It’s important to note that the estimated two million people living with HIV in Nigeria may not all be directly engaged, but their voices are represented through specific organizational 53 entities known as the Network of People Living with HIV/AIDS in Nigeria (NEPHWAN).

NEPHWAN serves as an umbrella organization that advocates for the interests of PLHIV. Their role is pivotal in ensuring that the experiences, concerns, and perspectives of affected individuals are incorporated into NACA’s activities. This partnership is essential because we acknowledge that we cannot effectively implement programmes or make informed decisions without the active involvement of PLHIV. Their engagement in the process is not just a formality; it is a cornerstone of our approach.

This principle extends to our M&E efforts as well. In the context of M&E, we firmly believe that community participation is indispensable. We actively collaborate with people at the grassroots level to gather their input and experiences. Their contributions are invaluable in assessing the impact of our programmes and making necessary adjustments to improve outcomes.

In essence, NACA’ s engagement with communities and affected individuals is rooted in the recognition that their involvement is not just a checkbox on a checklist that we tick, but also a fundamental aspect of our work. It ensures that our initiatives are more effective, responsive, and reflective of the real experiences and needs of those living with HIV in Nigeria.

Could you share some success stories or examples of how NACA’s research and evaluation work has led to positive outcomes in the fight against HIV/AIDS?

NACA’s research and evaluation work has played a pivotal role in achieving positive outcomes in the battle against HIV/AIDS. This effort primarily involves two key functions: data collection through monitoring and evaluation and in-depth research analysis.

M&E is instrumental in routine tracking the coverage of HIV services, ensuring that data on individuals receiving such services at healthcare facilities are collected and reported in a timely manner. Additionally, NACA’s M & E includes a research component that delves deep into assessing the effectiveness of the interventions and activities in the HIV response.

One concrete example of how research and evaluation have led to positive outcomes is our approach to age specific outreach. Through rigorous research, we identified a gap in reaching the youth demographic with HIV prevention and treatment services. This evidence prompted us to intensify our efforts in targeting and engaging with young people, recognizing that they were underserved in the past.

Another notable area of impact is related to key population groups. Our research revealed that specific key populations were not adequately covered by our services. In response, we have focused on enhancing programming to reach these underserved groups, ensuring that they receive the necessary care and support to prevent and manage HIV.

Furthermore, the data driven approach has been instrumental in identifying areas where pregnant HIV positive women were not accessing essential services. This insight has led to the development of tailored solutions to ensure that this vulnerable demographic receives the care they require.