Is Nigeria ready to take full ownership of HIV control?

Whereas the choice shocked many, it was according to President Trump’s marketing campaign rhetoric of prioritising American pursuits over worldwide support.

For growing international locations, notably these in Sub-Saharan Africa, the place PEPFAR performs a important position, this coverage shift raised issues about the way forward for HIV intervention programmes.

PEPFAR, a US authorities programme combating the HIV/AIDS epidemic, has been an important supply of funding for Nigeria’s HIV response since 2005. With roughly 1.8 million Nigerians dwelling with HIV, any disruption in funding can considerably influence remedy and prevention efforts.

Nonetheless, many specialists described this growth as a wake-up name for Nigeria to scale back reliance on overseas support and take full possession of its HIV response alongside different public well being wants.Nigeria’s response

This stance remained even after the US granted a waiver for HIV intervention.

By way of the Nationwide Company for the Management of AIDS (NACA), the Nigerian authorities introduced plans to domestically produce HIV-related medical instruments, together with check kits and antiretroviral medication.

Whereas this was seen as a proactive transfer, specialists stay sceptical about Nigeria’s potential to totally fund and maintain the initiative.

It additionally authorised N4.8 billion for HIV remedy, based on the Minister of Finance and Coordinating Minister of the Financial system, Wale Edun.

The extra allocation, equal to $200 million, will goal well being programmes akin to Tuberculosis, HIV,Malaria and Polio.

Persistent underfunding of well being sector

Even in 2024, when the sector obtained its highest-ever finances, it accounted for under 5.75 per cent of the whole finances.

A good portion of the funds goes towards salaries and administrative bills somewhat than direct illness management and prevention.

The finances for HIV/AIDS management is even decrease, with worldwide donors overlaying many of the prices. In accordance with the US Division of State, PEPFAR is Nigeria’s main funding supply for antiretroviral remedy, testing, and prevention providers.

HIV/AIDS funding: PEPFAR vs NACA

Knowledge from the US Division of State web site exhibits that between 2015 and 2024, the US offered $2.28 billion (N3.4 trillion at an alternate fee of N1,493 per greenback) in HIV/AIDS help to Nigeria.

This quantity is roughly 53.21 per cent of Nigeria’s whole well being finances from 2015 to 2024.

In 2015, Nigeria obtained N292.63 billion as support for HIV/AIDS, which elevated to N392.66 billion in 2016 and N358.32 billion in 2017. The help continued with N346.38 billion in 2018, N262.77 billion in 2019, and a peak of N409.08 billion in 2020.

Nigeria obtained N306.07 billion in 2021, N370.26 billion in 2022, N341.90 billion in 2023, and N328.46 billion in 2024.

As compared, Nigeria’s budgetary allocation for NACA has fluctuated considerably over time. The company obtained N2.78 billion in 2015, which elevated to N3.42 billion in 2016 however then dropped sharply to N738.49 million in 2017.

Nonetheless, from 2018 onward, NACA’s funding elevated. In 2018, the company obtained N4.53 billion, and N6.70 billion in 2019. The allocation dropped barely to N6.21 billion in 2020 earlier than rising once more to N4.51 billion in 2021.

The finances rose to N6.42 billion in 2022 and to N8.28 billion in 2023. By 2024, it reached N10.04 billion, and for 2025, a proposed allocation of N19.03 billion has been made, marking the very best in recent times.

Regardless of this upward pattern, specialists argue that Nigeria wants a a lot bigger and extra constant monetary dedication to successfully fight HIV/AIDS.

Home funding

In the meantime, the US, by way of PEPFAR, tried to assist Nigeria and different African international locations cut back dependency on exterior funding and strengthen home possession of HIV programmes.

Between 2011 and 2015, the programme instituted a discount of about $83 million in yearly programme help to Nigeria. On the time, the programme’s focus shifted from emergency response to sustainability and nation possession. Nonetheless, this effort failed.

A number of reviews and research confirmed that the federal government struggled to extend home funding sufficient to cowl the hole the discount created. Key areas of the HIV response suffered, akin to the provision of antiretroviral medication, testing providers, and healthcare infrastructure.

These gaps in funding led to disruptions in remedy for individuals dwelling with HIV, elevated stockouts of important drugs, and restricted entry to care, notably in rural and underserved areas.

What Nigeria must do — Skilled

Victor Adepoju, director of HIV, Viral Hepatitis, and Infectious Ailments at Jhpiego, an affiliate of Johns Hopkins College, believes that Nigeria will want a special funding mannequin to maintain its HIV/AIDS response if PEPFAR funding is withdrawn.

In accordance with Mr Adepoju, one important step the nation has taken is establishing an built-in Technical Working Group (TWG) for HIV, TB, and Malaria.

He argued that whereas Western donors beforehand funded these programmes individually, the method made them much less environment friendly and extra pricey. He famous that by integrating efforts, Nigeria can lower prices and enhance programme effectivity.

Mr Adepoju additionally highlights the necessity for native manufacturing of TB, HIV, and malaria medication, which might decrease remedy prices and improve sustainability. Nonetheless, he cautions that Nigeria should still wrestle to independently fund the HIV response given its present nationwide finances.

“Nigeria received’t have the ability to totally maintain (the programme) given the necessity, however will have the ability to salvage some,” he mentioned.As an example, he famous that Nigeria not too long ago authorised the procurement of HIV medication for 150,000 folks, whereas over a million folks depend on remedy.

“Many will nonetheless die,” he warned, emphasising that the federal government should undertake a special method to HIV/AIDS funding.

Whereas methods like native drug manufacturing might improve long-term sustainability, he careworn that they’re nonetheless future-focused options and don’t tackle the quick funding hole that may come up if PEPFAR pulls out.

To bridge this hole, he instructed increasing medical insurance, attracting non-public sector funding, and creating a security internet for susceptible populations who can not afford remedy.

Equally, Dan Onwujekwe, a former principal investigator at PEPFAR and analysis fellow on the Nigerian Institute of Medical Analysis (NIMR), revealed that worldwide donor companies had warned Nigeria way back to 2012 to organize for a possible pullout.

Mr Onwujekwe, a TB/HIV specialist, famous in an earlier interview with Punch newspaper that between 2012 and 2015, PEPFAR repeatedly engaged with Nigerian well being authorities, advising them on methods for transitioning to home possession of diagnostics, medication, gear, and infrastructure.

Regardless of these warnings, he mentioned, little was finished, resulting in present shortages of TB/HIV medication, particularly for individuals over 40 years previous dwelling with HIV/AIDS.

“It’s going to be a giant problem regardless of the early warnings,” he mentioned. “They (PEPFAR) gave Nigeria three years of discover, holding a number of conferences on the transition course of and suggesting methods to take possession.”

He warned that dropping donor help might cripple Nigeria’s HIV/AIDS management efforts and referred to as for pressing authorities motion in any respect ranges.

He urged the authorities to designate a particular tax allocation —akin to a portion of stamp obligation — to fund TB and HIV programmes, emphasising that failure to behave could be disastrous for a rustic with one of many highest burdens of TB and HIV globally.