* Says money voted for scourge not missing

By Emma UJAH & VICTORIA OJEME

The National Agency for the Control of AIDS, NACA, has been in the news lately and for the wrong reason. There were allegations of misappropriation of funds in the organization. But, in this interview, its Director-General, John Idoko, a professor of medicine specializing in  infectious disease and the immunology of infection, with over years experience on the battle against HIV/AIDS, explains that no money is missing in NACA.
According to him, NACA passes donor funds to sub-recipients who actually implement programmes.  Idoko adds that the agency has introduced system re-engineering to make the process more transparent and accountable. Excerpts:

There appears to be a perception there is a lot of money in NACA and that to be D-G is a big job.  How did you land yourself this job?

I am a prof. of medicine and my area of specialization is infectious disease and the immunology of infections. These two areas qualified me to be on a seat like this. But beyond that, I have been in the area of HIV for well over 20 years. I have published well over 65 papers on HIV.

I have written at least three books and I ran the largest clinic in this country which was attracting 15,000 people in care. My excitement for coming here was that I thought that the job I did in Plateau State and to be specific at the Jos University Teaching Hospital would be replicated throughout the country. I decentralized HIV care from the teaching hospital through secondary healthy centres or general hospitals.

From there we went down through 47 primary health care centres to more than 150 communities.  Not just that, we integrated our work to TB, malaria, and maternal and child health- inclusive of family planning. This dramatically changed many of the things as far as HIV was concerned. For example, the national coverage of prevention of mother to child which was 11% as at 2009, as a result of what we did, moved from 5% in Plateau  to 45% and my excitement therefore was if I can replicate this in the rest of the country, then we will be addressing MDG 4,5 and 6.

Even before I came here, I used to be with Prof Akinsete, special consultant on HIV/AIDS to the PTF and, from 2002-2009, I actually was the chairman of the committee on anti-retroviral drugs of the ministerial advisory committee.

In terms of the experience, technical experience, I was eminently qualified for the job. In terms of administration, I have been head of department; I was the deputy vice chancellor of the University of Jos.

There are allegations of miss-management of funds in NACA. What is the situation?

Not really, let me be specific. The one that has attracted so much attention recently is that of the Office of the Inspector General of the Global Fund report. The country co-coordinating mechanism is in the best position to clear the air so I will speak for NACA.

The country co-coordinating mechanism, which actually oversees and supervises, has put an advertorial to this effect but let me be specific about NACA. The fund was Global Fund Round I which was given to us to treat patients and to do prevention of mother to child and the fund started in 2003 but we didn’t do so well; so the fund was terminated in 2006 or thereabouts. Let me also add that I was appointed only in 2009. The issues have got nothing to do with me.

I was not here during the period in focus. But besides that, NACA is what we call Principal Recipient, PR. Principal Recipient is the one who is involved in writing the proposals and gets the money but doesn’t implement. Our mandate doesn’t allow us to implement; so when we get the money, we  employ sub-recipients like NASCA, IHBM, Harvard, which are organisations working with the various hospitals in implementing the programmes. We don’t touch donor funds. The only funds we get, and we control is the government of Nigeria funds through the budget.

In the process of running this grant, from 2003-2006 the grant was cancelled because it wasn’t performing well that was before I became D.G. There was a lot of unretired funds, people at the site where implementation was happening took these funds but did not retire them adequately. In fact, the office of the OIG, who are auditors, spent seven weeks here. When they first came, the amount of unretired funds was $6 million but in the seventh week we reduced it $600,000. So when you look at what portion of what is called missing money is $600, 000.

That was the money that was not retired before they left and we are still working hard. We are at this point even working on that. I want to emphasize this is an audit thing, it’s a backward and forward thing, and we are telling them that even if they give us three more months, we will probably reduce it further, I am talking for NACA.

We have learnt from it and, currently, we have the highest global fund grant and we are now very specific that in two weeks you must retire all your money. Our new policy is that within weeks, whatever funds you have, once you’ve used it, you must retired it. But we are working hard to reduce the old funds. So it is not that there’s mismanagement as such. It was unretired funds and we are working hard to retire them. Another thing the OIG pointed out was that we have a weak financial system and they have recently strengthened our financial system.

And we have done this through building  human capital. They requested for people from the Accountant General Office to beef it up. UNI has helped us, the Global Fund and World Bank to put in place software and hardware that can help us. Beyond that, we now have a monitoring team that goes out to the various centres to ensure that we look at their books and that they must produce report on time. So I think that in a way we have learnt from some of the past experiences and we are trying to improve on it.

You remember we are a very young institution, even though this place was a committee and it only became an agency in 2007 and its structure actually started being put in place when I came in. So at this point in time, we are strengthening the whole system, the financial system, the administrative system, the procurement system so all these is helping us and we are relying on the recommendations we have got from not only the OIG.

Did you receive any official query from your superiors? Maybe they felt that there were things that were left undone.

It is an audit query and the Global Fund has even come out to say that what they have put out is an interim report and, that until the final report is out, no one should discuss it the way it is being reported. Unfortunately in this country, some people have taken it to the press. We are still trying to reduce this retirement and we should be actually be praised for doing this.

How readily available are anti-retroviral drugs for those living with HIV/AIDS?
We have significantly achieved progress in terms of number of the people we have given anti-retroviral drugs to. Let me be specific, in 2008 there were less than 300,000 people who were assessing this drug. But the UNA report 2010 put it at nearly 400,000.

At that time we thought we had 800,000 but the goal post has changed because the new guidelines now saying that people should be treated much earlier. So we still have about 1million to treat as a result of the new guidelines. What efforts are we making to bridge this gap? One, we have a grant from the Global Fund which is going to treat about 110,000 and we are just waiting to start.

Number two, most of the treatment that we have had has been supported by the United States government which has agreed that in the next four years they are going to add another 250,000.  The government of Nigeria including MDGs hits another 100,000 between now and next year. So if you put all these together we are hoping that in the next 2-3years we should be able to put 350, 450,000 on drugs.

In order to put people on drugs, you need to test people and one of the big issues we are having is that there is still stigmatization and discrimination. How are we addressing that? That’s where we need to work with various partners particularly people living with HIV AIDS. Once people see HIV having a face, see that people are living long, then the fear of going to test will be reduced, especially, now that we have drugs.

We are driving our services to the communities through the primary health care system. We innovate the PHCs, we build the capacity, we build their ability to collect data, and we also build ability to do testing. So we believe that when we add all these as we go on, we are integrating and not just going with HIV. HIV is not alone. For example, one of the big issues we have is that in this country, 60, 70,000 children are born  HIV positive and we have to stop that. Many of them don’t see their second or third birthday. So how do we get the women to come to anti-natal care? How do we ensure that there is deliverance in the anti-natal care? How do we ensure that they don’t transmit HIV to their children. 6million women get pregnant every year. Out of these, somewhere between 225-250,000, women are HIV positive.

But we can interrupt this. We have the strategy to do this. We have the technology. So, driving this thing down and linking it with all these is actually addressing MDGs 4, 5and 6.  We want to cut this down to less than 5% by the year 2015.

There are claims and counter claims  by orthodox medical practitioners and alternative medical practitioners on cure for AIDS. Some people said they could cure HIV and all of that.  Have you been looking at this lately?

I am a scientist and I have done a lot of research on HIV and I am aware of some of these claims. I wouldn’t want to mention names but I want to just end up with just two sentences. The first is, God has not given anyone the cure for HIV/ AIDS yet, however what God has given us-and being religious on this – the drugs that we use have become so portent, so convenient, with very few side effects such that it has transformed this disease such that people can live a normal life with those drugs.

We now call it like any of the strong diseases like hypertension, diabetes. You can live a normal life with HIV and I can give you examples from my experience. I was one of the first to start using those drugs for my patients in this country. And I could remember the first trial we did. People were given 18-tablets a day in1997. But today there is one tablet you need to take in the night. Can you imagine how technology has improved? 1997 was when I first started treating people with those drugs but now we have what we call six-dose combination.

Three drugs in one, you just swallow one tablet. If you are taking your drugs and you are consistent  and you are not missing it, you can live a normal life. I can tell you that there are people whom I started treating in 2002 and, as we speak, they are still healthy, undetected because they are taking my drugs.

When was your last prevalence survey and when do you intend to conduct another. How do you get your report? Is your report based on the testing that is done or the report collected at the centres?

If you want to know whether HIV is rising or coming down, you need to do what is called incidence- HIV incidence. That is the number of new infections that is coming up over a period based on the population. But that is a very costly study to do.