The Millennium Development Goals (MDGs), committed AU governments, of which Nigeria is a key player, to reducing child mortality, improving maternal health and combating major diseases such as HIV/AIDS. To help achieve this, the Abuja Declaration of 2001 made AU states promise to commit at least 15 percent of their annual budgets to healthcare.
The vast majority, regrettably among them Nigeria, have failed to do so, and in March 2010 some members proposed dropping the 15 percent commitment. Although the proposal was defeated in Kampala in July, however, the fact that it is even being discussed shows how commitment has wavered. Every day across Africa, thousands die from preventable diseases such as HIV/AIDS, maternal mortality, privatisation, cuts in public spending and rise in user fees which indicates that the poor still struggle to access basic health services.
As the world celebrates the World AIDS Day, with about five years left on the MGD pledge, all hands are on deck to support governments meet their commitment. Enhancing Nigerian Capacity for AIDS Prevention (ENCAP) is one of such efforts. In this interview, with Charles KUMOLU Dr. Victoria Agbara, Chief of Party, ENCAP Project, notes that there is need for rethinking on strategic approaches to HIV/AIDS. Excerpts
WHAT is the current statistics with respect to the prevalence of HIV/AIDS globally?
The recently released 2010 UNAIDS Global Report on the AIDS epidemic, indicates that after nearly 30 years of living with the epidemic, we are finally beginning to see a reversal in the spread.
The report shows that an estimated 2.6 million people became newly infected with HIV, as opposed to 3.1 million in 1999. At the end of 2009, 33.3 million people were estimated to be living with HIV, up slightly from 32.8 million in 2008.
This is largely due to more people living longer as a result of increased access to antiretroviral therapy, For instance, in 2009, 1.8 million people died from AIDS-related illnesses, nearly one-fifth lower than the 2.1 million who died in 2004.
New data clearly indicates that HIV prevention and treatment efforts are working; the number of people newly infected with HIV is declining and AIDS-related deaths are decreasing. Globally, the number of new infections has fallen by 19 percent since the epidemic peaked in 1999. In 33 countries, HIV incidence has fallen by more than 25 percent.
The biggest epidemics in sub-Saharan Africa (Ethiopia, Nigeria, South Africa, Zambia and Zimbabwe) have stabilised or are beginning to decline. Among young people in the most severely affected countries HIV prevalence has fallen by more than 25 percent as a result of the adoption of safer sex practices. I must say however, that it is not all good news, a number of regions and countries do not fit the described trend. In seven countries, HIV incidence has actually increased by more than 25 percent between 2001 and 2009.
This means we still have a lot of work to do to ensure the observed global reversal is maintained.
What is the current statistics with respect to the prevalence of HIV/AIDS in Nigeria?
Median National HIV prevalence is at 4.6 percent based on the findings of the 2008 ANC survey which is normally used to monitor HIV prevalence trends in the country.
However, the 2007 National AIDS and Reproductive Health Survey (NARHS) which is a population-based survey, estimates the National prevalence at 3.6 percent. Current estimates by the Federal Ministry of Health (FMOH) indicate that by 2009, 2.98 million people were living with HIV/AIDS in Nigeria.
Despite the national prevalence of 4.6 percent, as many as 18 states actually have a prevalence rate that is higher than the national average. It is important to note that Nigeria, with about 2.98 million people living with HIV, makes up about nine percent of the global HIV burden.If we look at prevalence by age groups, you’ll find that the worst affected is the 25-29 years age group, prevalence for this group is 5.6 percent.
The 2008 ANC survey reports over 300,000 new infections recorded and the results of a Modes of Transmission study conducted in 2008 indicate that over 40 percent of new HIV infections occur among couples, who at the time could be considered as engaging in ‘low-risk’ sex.
Although Nigeria is one of the countries said to have a stabilised epidemic, the persistent high risk behaviour in spite of high level of awareness particularly among young people indicates that greater efforts are needed in order to reach the youth and young couples with effective prevention interventions to address their specific needs and stimulate the adoption of safer behaviours which would reduce the risk of HIV transmission. This is the only way we can ensure that the country does not slide back into a progressing epidemic.
Is the level of funding for HIV/AIDS work in Nigeria better than what it used to be? Would you say given the picture of the prevalence you have just painted this funding is sufficient to meet the challenge? If not how much more should we be asking for?
It is difficult to determine the exact amount of funds being spent to tackle the HIV/AIDS epidemics in Nigeria. This is in part due to the fact that there are various sources of funding, most of which are not coordinated through a central purse. In Nigeria, like most countries, the AIDS response is funded through multiple sources, these may include domestic public funding, international aid, private-sector, philanthropic and individual out-of-pocket funding.
The most recent information available for Nigeria from the National AIDS Spending Assessment (NASA 2008) shows a total domestic and international expenditure of close USD400Million for the year, however more than 90 percent of that amount, came from international donors. As regards your question on the sufficiency of available funding, I can tell you that even globally; resources available for the AIDS response have always fallen short of what is required. This makes it more important to ensure the use of more cost effective interventions which will achieve maximum impact for less.
You have said this project targets young adults and will involve very significantly capacity building. These are not new approaches to the best of our knowledge. So what is unique about the ENCAP project approach?
I agree, many other projects have and are targeting young adults and involve capacity building. However, ENCAP is unique in the sense that we focus on capacity building with great emphasis on quality and sustainability. We promote an internally driven process which allows the organisation to take responsibility for their capacity building. We believe this approach will promote ownership and sustainability.
ENCAP’s strategic approach is to build both organisational and technical capacity of our partners to achieve expected results in a way that is cost effective and sustainable. Joint capacity building activities will facilitate mentoring and networking between local organisations, while one-on-one, on-site coaching will deliver tailored support to each local partner. Capacity building events targeting organisational development will address a range of critical operational functions: management, leadership and governance, finance and accounting, grant management, human resources, strategic planning, and business development/resource mobilisation.
These activities will complement HIV technical assistance to help organisations implement HIV prevention programmes that are proven effective and specifically tailored for target populations in each state.
The ENCAP approach focuses less on formal training methodologies and more on practical, applied opportunities to translate new skills and information into new systems and processes that are actually institutionalised within organisations and communities, in addressing underserved populations, unmet needs and to ensure the sustainability of the intervention.
This resonates and aligns with national guidelines and strategy which encourages responsiveness and promotes decentralisation of interventions through the adoption of best practices and improvements in programme design. Furthermore, the organisations we work with are small community based organisations that operate in local communities they are best placed to understand the needs of the communities and have their trust to deliver on those needs.
Our approach also reflects the fact that government agencies, Nigerian organisations and communities need to be the driving force in the response, and that there must be strong resources to contribute to that response in every part of every state, not just in Abuja or state capitals.
How expansive is the project in terms of coverage; national or a part of the country, and duration?
The ENCAP project is funded by USAID and is implemented by Deloitte Consulting Overseas in collaboration with AED. The project will work intensively over a five year period with 25 local partner organisations across five states and the FCT; our target states include Bayelsa, Rivers, Benue, Taraba, and Ebonyi. The project is collaborating with NACA, SACAs, umbrella organisations and other partners working in target states to explore synergies and maximise the efficiency of interventions.
In Benue, Bayelsa and Rivers states for instance where we have had our formal launch, local project partners have been identified and have carried out a self-assessment to determine what their capacity building needs are.
ENCAP will be working with them to address these needs. Most of the organisations we are working with would normally not have access to external funding but are doing great work in the communities they serve.
What is the budget line for this project in the span of time that it would last?
For us, it really isn’t about the amount, it is more about the impact we hope to be able to make during the period and beyond the resources we have. However, to respond to your question, over a period of five years the project will receive close to $10million (N1.5 billion) to carry out both capacity building interventions and provide grants to partner organisations to implement prevention interventions.
This is quite moderate considering the dual nature of the project; however we are confident we can achieve greater sustainability through this approach
What is the relationship with States National Action Committee on AIDS (SACAs) and the National Action Committee on AIDS (NACA) and other agencies?
This project recognises NACA’s mandate as the National Coordinating body and the SACAs at state level, as such we have made every effort to build a close working relationship with these agencies both at national and at state level, because we believe that these agencies constitute the backbone of a sustainable national response.
We do not intend to re-invent the wheel here and so have intend to collaborate with other partners who have been working in our target states in order to complement their efforts and support the state response. We believe that through a collaborative effort we can achieve maximum impact..
When we talk about funding for such essential services, we always look out to international donors. Many are of the views that local sources are available and remain untapped. Do you really believe we have local sources that can provide the kind of amount required to meet challenges posed by the HIV/AIDS epidemic?
Nigeria is such a rich and blessed country.
There is no doubt that we have resources in this country to meet the everyday needs and key challenges that we are confronted with. What we need is prudent resource management on the part of the public, we also need to look inwards and tap into locally available resources. We have scores of wealthy individual, philanthropists, private sector organisations that can be approached to mobilise the needed resources.
Nigeria is not a poor country, we just need to look inwards, we have everything we need to make a difference. Looked from a different perspective, it is only a healthy population that can support a viable economy by improving the demand for goods and services that keeps the wheels of the economy running. A sick population can only drain the economy so it is only by investing in health care and other essential social deliverables such as education, water and sanitation that we can facilitate the broad-based economic growth required to eradicate poverty.
It is heartwarming that foundations are increasingly being set up by wealthy and well-meaning Nigerians to address these needs. My hope is that more people and private sector organisations will begin to respond to the needs of the less privileged and by doing so bring hope and succor to the millions of Nigerians who need it.