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How alignment 2.0 will help Nigeria’s HIV response

Since the first case of HIV was reported in Nigeria in 1986, the country has continued to make strides and face challenges in preventing and…

Since the first case of HIV was reported in Nigeria in 1986, the country has continued to make strides and face challenges in preventing and managing the disease.

Thirty-six years after the first case, an estimated 1.9 million people live with HIV in Nigeria, with over 70 per cent of the national HIV/AIDS donor funded.

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Experts say this underscores the need for the country to have an effective national HIV response where there is epidemic control and greater and sustainable ownership of its response, especially with dwindling donor funding to mention a few.

This need led to the first alignment of the HIV response in the country three years ago called alignment 1.0.

 While the 1.0 alignment has strengthened the government-led HIV treatment programme, the National Agency for the Control of AIDS (NACA) and other HIV stakeholders are now working towards 2.0 alignment, which they say holds a lot of promises and benefits for the HIV response in the country.

Daily Trust learnt that Nigeria is the only country that started the alignment, and with the success recorded with alignment 1.0, the United States Government, and International organisations are now advising countries across the globe to come to Nigeria to learn how it was able to do it, and also learn what the country is planning to do in alignment 2.0.

Namibia visited last year in relation to this while Ethiopia and Kenya visited recently.

According to the director general of NACA, Dr Gambo Aliyu, alignment is essentially a process that examines a country’s response and how the response could gradually belong only to the country in terms of ownership and sustainability.

He said while the vigorous fight against HIV started about 40 years ago worldwide, in Nigeria, the vigorous fight commenced in 2005, with the coming of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) into the country.

He said having successfully completed alignment 1.0, the country has now begun realigning to 2.0.

“Under alignment 2.0, we want to see more local resources and investment coming in to support the HIV response. We would want to see more investments from the federal government, private sector, as well as from the state in terms of putting the state in the driver’s seat, and having more service integration with the National Health Insurance Authority and primary health care at the grassroots, as well as having the capacity to see HIV patients, tuberculosis patients, malaria cases among others using the same structure,” he said.

He said alignment 2.0 commenced with the launch of the HIV Trust Fund in February this year, and that two states out of the 36 states have already signed agreements to lead their HIV response.

According to him, what the agency and other stakeholders will bring up in November would give more direction in terms of policy, and how to navigate the alignment 2.0 terrain for the next three to four years.

“After which, we believe the country would be well positioned in terms of our ability to own the program and to sustain it,” he added.

Explaining the alignment journey from alignment 1.0, Dr Aliyu said , “We are aware that we may be approaching epidemic control but when we approach epidemic control, then what happens next? Instead of waiting for this time to come, three years back we started working on it. We said before the government takes over, we must create one national program instead of PEPFAR doing one thing, Global Fund doing another thing, and the government of Nigeria doing another thing separately.

“We said we need to bring everyone under one roof and assign responsibilities to each one in such a way that duplication would be eliminated.”

He said to achieve this, four things were done and they include, PEPFAR, Global Fund, and that the Government of Nigeria should not implement programs in the same state, and whichever organisation is implementing the program in a state should be in charge with patients receiving the same treatment package which ever they go to.

Thirdly, a unified supply chain system was outlined so that resources are pooled together in one place, and moved to various locations at the same time instead of each of the organisations doing them differently.

He said, “The fourth one is that we want to see more government investment. We cannot talk of sustainability without the government driving the entire team, whether it is at the centre or at the state.

“The agreement was that the federal government should support the treatment of at least 100, 000 people for the next three years.

“Government has fulfilled that promise, and gradually with time we will begin to add more patients, this means that the patients that would now be under the care of development partners, would continue to reduce. This we have done, and we have done very well in the last three years.”                                   

The NACA DG said under alignment 2.0, experts want to put the state in the driver’s seat, instead of having implementing partners implementing programs using state structures like hospitals and human resources.

Asked what would happen to the implementing partners, he said, “The implementing partners would now become the teacher, and show the state what they have been doing in the past 20 years, to sustain the response and to provide treatment services to people in different locations throughout the state.

“At the first instance they do it together, and after a period of one year, the implementing partner now steps aside and serves as technical adviser, providing the state guidance and technical services for the state to continue to drive the response.

“So this is the essence of alignment 2.0 and we believe that by the time we arrive at that, then the country is fully structured for ownership,” he added.

The National Coordinator of the Network of People Living With HIV/AIDS in Nigeria, NEPWHAN, Abdulkadir Ibrahim said the first alignment (1.0) was literally trying to harmonise the HIV response in the country, both from the Global Fund and PEPFAR by putting Nigerian government at the driver’s seat and has really been significant.

However, he said there are a lot of issues with the first alignment because most of the community component and interventions that are more targeted at empowering NEPHWAN or organisations of people living with HIV and other vulnerable groups was not really prioritised.

“So what we want to see now in the alignment 2.0 is to ensure that priorities are given to other interventions such as sensitization, rights protection, fighting against stigma and ensuring that community programs like NEPHWAN and our subordinates are really empowered and adequately supported in terms of funding and systems strengthening so that we can have a strong organisation and do other interventions without any problems.

He said even though the resources have been there in alignment 1.0, it has not really gone down to the communities and Nigeria is still lagging behind in the prevention of mother-to-child transmission (PMTCT) HIV services.

“We need to allow our PMTCT HIV programmes to continue because the way it is going most of the international partners has reduced their funding in terms of community intervention and only focus on tertiary institutions or specialist hospitals, they focus on 11 local government areas of a state for instance that has over 30 states; what then happens to the other LGAs?.

“So we want to see real change and we have been doing a lot of mapping. About 21 states have been mapped where community interventions will really be focused to ensure that pregnant women are mobilized, sensitised, tested and linked to where they can access treatment. This is what we can do right and ending HIV is possible.”