Blog

By: Namnso Owo

Since 1986 when the first case of HIV was discovered, Nigeria has been committed to halting and reversing the trend of the epidemic in line with global targets. With support and collaboration from the government and international community, the country has seen significant changes in the epidemic profile from 5.8% in 2001 to 4.1% in 2010.

Between 1986 and 1999, the HIV and AIDS response was health sector focused and driven. This period saw the establishment of the National AIDS Advisory Committee (NAAC), National Expert Advisory Committee on AIDS (NEACA) and National AIDS and STIs Control Program (NASCP).

The multi-sectoral response to the HIV and AIDS epidemic in Nigeria began in 1999 with the setting up of the National Action Committee on AIDS (NACA), which later metamorphous into a full agency—the National Agency for the Control of AIDS (NACA) in 2007—by an Act of the National Assembly with the mandate to coordinate the multi – sectoral response. Similarly, the State Action Committees on AIDS (SACAs) and the Local Government Action Committees on AIDS (LACAs) were established, and State Action Committees on AIDS (SACAs) were later transformed into agencies.

The Nigeria HIV and AIDS Program Development Project I and II became effective in 2002 and 2011 respectively. The HPDP I significantly contributed to the establishment and strengthening of institutions in Nigeria at national and sub-national levels, thus substantially empowering Nigeria to fight against HIV and AIDS epidemic.

The HPDP II, which was to build on the gains of the HPDP I, brought seismic epidemiological and institutional changes in the HIV response landscape in Nigeria. The objective was to reduce the risk of HIV infections by scaling up prevention interventions and to increase access to and utilization of HIV counselling, testing, care and support services.

Based on Nigeria’ s mixed epidemic, the approach adopted in the response was a mixed one to scale up interventions prevention, care and impact mitigation among high-risk groups and the general population at the national and sub-national levels. Therefore, the HPDP-2 focused on three key areas- (i) expanding the public sector response; (ii) expanding the civil and private sector engagement and response through the HIV/ADS Fund (HAF) and (iii) strengthening mechanisms for project coordination and management at all levels.

THE HPDP II

The focus of expanding the public sector response was to strengthen the capacity of the line ministries to fight HIV and AIDS, conduct an institutional assessment to strengthen the structure of the critical mass, and provide the technical advisory support necessary and design and implement evidence-based interventions.

So much was achieved from the support of HPDP II funds across the three components. In fact to mention but a few, the Independent Evaluation Group (IEG) report stated that the percentage of SACAs and public sector organizations that hold quarterly partner forums to report on planning, decisions, and progress increased from a baseline of 30% in 2009 to 86% in 2017. The number of Local Action Committees on HIV/AIDS implementing HIV/AIDS work plans reached 600, exceeding the target of 272 Local Action Committees; A web-based system and a mobile District Health Information System to strengthen Monitoring and Evaluation (M&E) were deployed. With this in place, 1500 health facilities were able to deliver service data directly to the system’s platform through mobile phones. The reporting rate improved from 0.3% in 2013 to 72.8% in 2015. Additionally, 22 National Youth Service Corps and State Ministry of Youth officers were trained on coordinating out-of-school youth HIV prevention activities; A Family Life HIV/AIDS Education Curriculum was developed and integrated into primary and secondary schools. At least 1,969 schools implemented the Family Life curriculum. Fact sheets and peer education manuals were printed for the Federal Unity Colleges and State Schools on Family Life HIV/AIDS education. Thirty-seven state education officers were trained on Family Life HIV and AIDS education coordination and delivery. Sixty-six Unity College head teachers were sensitized on Family Life delivery. 2,080 Unity College Family Life teachers were sensitized on curriculum delivery.

Five hundred and sixty-four CSOs implemented HIV/AIDS Fund activities in 33 states and the Federal Capital Territory. 2.4 million People were counselled, tested, and received results, and CSOs reached 161,000 most-at-risk people to provide a minimum package of interventions. 94 CSOs in 21 states undertook demand creation for PMTCT among pregnant women.

NACA and SACAs the coordinating agencies for the HIV response at the national and states were reportedly to be highly committed. Also, at the technical level, their performance was adequate overall, including scaling up the prevention of mother-to-child transmission, devising interventions for most-at-risk populations, organizing training at the federal and state levels in various sectors, and following up on M&E. Their performance was rated moderately satisfactory.

Sadly, after the HPDP II closed in 2017, some of these achievements could not be sustained.

For instance, the 600 LACAs that were performing optimally during the project were supported with stipends for transport and to facilitate monthly meetings, which stopped at the expiration of the project. At the community level, the LACAs and the CBOs were empowered to collect and report data directly to the DHIS platform. Hence, the reporting rate improved from 0.3% in 2013 to 72.8% in 2015. After the World Bank project, reporting data on the DHIS gradually came to a halt. Consequently, there was a significant decline in the reporting of the non-health sector data because most of the COBs became moribund. The skeletal report of non-health sector data was mostly from the implementing partners. The DHIS has been revamped with support from the Global Fund. The process started in 2022, by the end of quarter two (2) 2023 implementing stakeholders have started reporting data on the DHIS

Similarly, the percentage of SACAs and public sector organizations that hold quarterly partner forums to report on planning, decisions, and progress made in their various states or organisations may not be 86% as recorded during the project. Most of SACAs do not have the funds to hold coordination meetings.

Some of these coordination meetings are supported by the implementing partners. The same challenges are faced by the MDAs and CBOs that were supported during the World Bank project. So, a critical question to ask at this point is, was there a sustainability plan for the HPDP II? If the answer is yes, was this plan disseminated to stakeholders during the project life? If yes, was this plan rolled out? The Nigeria AIDS Indicator and Impact Survey (NAIIS) provided very useful estimates of the number and distribution of PLHIV, and the need to again think through our priorities, strategies, and the overall approach in the national HIV response. The post- NAIIS HIV has witnessed significant achievements in enrolment on ART, data management and stronger collaboration and community involvement among others The implementers have leveraged strongly on the community structures. This strategy has helped decentralise HIV services from the facilities to the communities. Through this approach, huge successes have been made in case findings and linkage to treatment with differentiated service delivery model including community-based ART groups, pharmacy groups and drug distribution points. In addition, CBOs are engaged by implementers to carry out targeted prevention services. The Traditional birth attendants (TBAs) in the community are coopted into the response. They are supported with some levels of training, commodities and reporting tools.

NAIIS response is the setting up of data access platforms. The National Data Repository (NDR) warehouses all patient-level data for all people living with human immunodeficiency virus (PLHIV). The electronic medical record (EMR) captures the daily patient interactions with the clinic and feeds patient data into the NDR. This platform is supposed to generate timely and reliable data to inform evidence-based clinical, and program management decision-making. The rollout of the NDR and EMR was in partnership between the Federal Ministry of Health and the President’s Emergency Plan for AIDS Relief (PEPFAR). The fund is provided by PEPFAR, the (Public Health Information, Surveillance Solutions, and Systems (PHIS3) implement the project.

These levels of achievements in community involvement in the response and data management (though support by the donors) need to be sustained.

All these interventions mentioned are almost completely supported by the IP.