Following the economic recession of 2016, the Nigerian government developed an Economic Recovery and Growth Plan for 2017-2020 with three broad strategic objectives: restoring growth; investing in human capital; and building a globally competitive economy that achieves agriculture and food security, industrialization, improved transport infrastructures and energy sufficiency.
Of these three objectives, one stands out: recognizing the importance of investing in human capital. This represents a major shift by the government, as it previously focused mostly on developing infrastructure—a move that came at the expense of other sectors, including healthcare.
Nigeria’s healthcare spending as a percentage of GDP remains one of the lowest in the world: about 0.6% of GDP in 2016, according to the World Bank. Per capita health spending by the Nigerian government is US$11, well below the recommended US$86 for low- and middle-income countries to deliver basic health services.
The historic underfunding of the country’s health sector has led to a population with a high disease burden, including HIV and AIDS. The diseaseaffects 1.8 million Nigerians aged 15-49, an important part of the country’s workforce. In a 2018 study on the impact of HIV and AIDS on the workplace, the International Labor Organization predicted that in2020 about 2.3 million Nigerians in the labor force would be people living with HIV, and that there would be more than 35,000 deaths in the labor force attributable to AIDS. This translates to about US$233 million in lost earnings due to HIV and AIDS.
International donor funding and technical support make up a significant portion of the country’s HIV response. But in a climate of dwindling donor commitment, Nigeria’s overreliance on foreign support is not a sustainable approach. In line with its renewed commitment to human development as a catalyst for economic progress, our government needs to take the lead on addressing HIV and AIDS (and other diseases that continue to affect our communities and cripple our economy).
To support the Nigerian government in this transition, Management Sciences for Health (MSH),an American global health nonprofit that focuses on strengthening health systems, has been working with donors such as the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR) to support the Nigerian government in addressing the systemic weaknesses that have enabled diseases like HIV to spread. Since it began work in Nigeria in 2004, PEPFAR has disbursed more than US$5.1 billion to support the Nigerian HIV and AIDS response. This makes it the largest funder of the response in Nigeria.
With funds and support from PEPFAR and USAID, MSH has partnered with the government of Nigeria to implement the Care and Treatment for Sustained Support (CaTSS) project— helping Nigeria achieve zero new HIV infections in the five states of Kebbi, Kwara, Niger, Sokoto, and Zamfara. HIV and AIDS work in these states is challenging as it is characterized by a low HIV prevalence and weak health infrastructure that make it difficult to reach newly infected people and sustain them on treatment. By improving the capacity of healthcare facilities to provide quality, sustainable, integrated HIV and AIDS services, MSH successfully overcame these challenges.
Between November 2016 and December 2019, MSH tested 1,093,092 people in the five states for HIV and identified 28,137 people living with HIV. We initiated 22,727 newly diagnosed HIV-positive patients on lifesaving antiretroviral treatment and followed up with 41,321 current patients to ensure treatment adherence. Over 85 percent of the individuals on treatment have successfully suppressed the virus and are living healthy lives. In addition, 77% of those now living healthy lives have achieved a status where the virus is undetectable and therefore are unable to infect others. This development is the key to arresting the spread of the virus and achieving zero new infection.
To better monitor the health of patients on antiretroviral therapy, MSH deployed an electronic medical record system to collect and analyze vital treatment data. This made it possible to make informed decisions on the next line of treatment for those patients. In partnership with the state government and PEPFAR, we also used the data to determine progress towards meeting program targetsand course correct whenever performance falls below the expected.To makethese interventions sustainable, MSH implemented a peer mentorship program where it transferred critical HIV patient and program management skills to frontline health workers of the state ministries of health.
Collaborations like this, between the Nigerian government and donors and organizations like MSH, hold the key to improving the capacity of Nigerian health workers to adopt a holistic evidence-based approach in the fight against HIV and AIDS, in line with global best practices. In addition, by encouraging increased leadership and ownership by the Nigerian government, USAID and PEPFAR are encouraging the Nigerian government to consider health funding as a priorityfor improving the health ofNigerians.
The successes recorded by projects like CaTSS should provide the Nigerian government with the blueprint it needs to address HIV. The country’s ability to do this well will lay the foundation for building a strong health system that can prevent and manage diseases like HIV. This will provide further justification for continued investments in human capital andfostering a healthy workforce to effectively support the country’s economic growth.
Anddy Omoluabi is the Project Director for the CaTSS program, which is implemented by Management Sciences for Health, a United States-based global health non-profit organization.