Scaling Up AIDS Services in Nigeria through Better Leadership and Management

Guided by the motto “building the ship as we’re sailing it,” MSH is rapidly scaling up the availability of comprehensive HIV & AIDS services in Nigeria while strengthening the country’s health care system. Supported by the President’s Emergency Plan for AIDS Relief (PEPFAR), the AIDS Care and Treatment (ACT) Project is using a decentralized model to reach the country’s diverse and primarily rural population. ACT is combining intensive outreach with the building of sustainable structures and systems at the state and local levels. And, by incorporating principles of leadership and management into all its activities, the program is reinforcing ownership by governments and communities.

In just nine months, the ship is already sailing. Since July 2007, the project has supported the start-up of HIV & AIDS prevention, care, and treatment activities in selected facilities and communities in Kogi and Niger states. At the state level, where most health facilities in Nigeria lie, ACT is renovating facilities and training health workers and officials in all aspects of supervising and providing comprehensive AIDS care and treatment services. At the local level, ACT has an outreach program, including mobile HIV counseling and testing services, to increase community mobilization through influential leaders and community groups.

By the end of March 2008, 4,485 individuals had received counseling and testing for HIV and tuberculosis. Activities began with the renovation of 11 facilities, training of 67 health workers to deliver antiretroviral therapy (ART) services, and provision of 1,100 HIV rapid test kits and other medical supplies. MSH trained 20 state officials in supervision and quality assurance systems and 58 lab workers in techniques for diagnosis, treatment, and care of HIV patients. To support prevention of mother-to-child transmission (PMTCT) activities, MSH readied 12 facilities to provide a minimum package of services and trained 133 health workers to provide PMTCT services. Almost 1,700 women have received HIV counseling and testing for PMTCT to date, and 32 of those women have received ART.

Nigeria has the third highest AIDS burden in the world. With a prevalence rate of 3.9 percent, more than 4 million adults are living with AIDS, a number that is estimated to increase to between 7 and 9 million by 2010. In March 2007, only 74,000 people in Nigeria were receiving ART. Since 2005, the Nigerian government has met the AIDS crisis with a national plan that sets policies and standards, but the government lacks the resources to fully implement this plan and build HIV & AIDS services at the state and local levels.

Through the Leadership, Management and Sustainability (LMS) Program, MSH is strengthening the leadership skills and management capacity of the National AIDS and STI Programme, along with other national agencies, to improve oversight of national and donor-supported programs, coordinate national efforts, and improve the efficiency and leadership of governmental programs.

MSH is also providing institutional capacity-building support to emerging Nigerian organizations so they can act with accountability and increase their institutional, programmatic, and financial sustainability. New nongovernmental, faith-based, and civil-society organizations need nurturing to play their vital role in serving and mobilizing communities and to manage grants from international donors. Since 2006, with funds from PEPFAR, MSH has been assisting 24 civil-society organizations offering community-based HIV & AIDS prevention, treatment, and care services, including support for orphans and vulnerable children.

MSH Supports Leadership Role of Nigerian Network of Health Organizations The Christian Health Association of Nigeria (CHAN), an umbrella organization for facilities providing health services to 40 percent of Nigerians, is leading NICAB, the Nigeria Indigenous Capacity Building Project. This project will increase the capacity of its member institutions to provide high-quality HIV & AIDS services. MSH has been assisting CHAN with proposal writing, programming, and budgeting. Dr. Nanshep Daniel Gobgab, the Program Director of CHAN, asserts that “the partnership with MSH is not only preparing CHAN for this project but is preparing CHAN for larger projects in the future. We have no doubt that we can succeed.” The NICAB project is building the capabilities of its members and other local NGOs to manage referral services, diagnose and initiate appropriate treatment, and link hospitals to community facilities. As these organizations become more effective, they will be able to respond better to the needs of the people living with AIDS who depend on their services.

Focusing on financial, governance, planning, and human resource systems—all components of effective, sustainable organizations—MSH is using a participatory approach to build the capacity of civil-society organizations to absorb PEPFAR and other donor funds and manage, monitor, and report on their activities. Included in these activities is a fellowship program, designed to build skills and increase the management and leadership capacity of health practitioners to respond to the challenges they face in managing HIV & AIDS services. Twenty-five nurses, drawn from all parts of Nigeria, will make up the first round of the fellowship program. By increasing the leadership and management capacity of health leaders and local organizations, MSH is not only helping Nigeria to rapidly scale up HIV & AIDS service delivery in the present but is also helping the country to build the foundation it needs to continue to meet public health challenges in the future. MSH has worked in Nigeria since 1994, with funding from the US Agency for International Development, and is providing assistance in child health, reproductive health, tuberculosis, and polio eradication as well as HIV & AIDS. MSH has also helped the Country Coordinating Mechanism (CCM) in Nigeria, which is charged with maintaining standards set by the Global Fund to Fight AIDS, Tuberculosis and Malaria, to assess its governance.