There have been significant achievements in the fight against HIV/AIDS but it would be suicidal to slow down as the challenges are enormous. Prominent among these challenges is funding. EZRA IJIOMA examines the options before Nigeria when the foreign aids eventually stop.
What happens to the fight against HIV/AIDS in Nigeria when foreign funds dry up? It is a question most Nigerians are afraid to ask because the answer is unthinkable and carries dire consequences. With the global financial crisis and attendant economic problems, many donor nations are tightening their fists and calling for more financial involvement from Nigeria and other aids recipient nations.
According to the Director General of National Agency for the Control of AIDS (NACA), Prof. John Idoko, funding for AIDS in Nigeria is largely from the outside “which is unsustainable.” External funding for AIDS in Nigeria accounts for 85.4 per cent in 2007 and 92.3 per cent in 2008. Poor countries like Nigeria were seen as unable to muster the required financial muscle and organisational expertise to address the epidemic hence the need to assist them. But it seems the poor nations do not want to grow up. They are stuck to the feeding bottle.
According to the Global Fund, which is the largest donor agency in Nigeria on HIV/AIDS, Nigeria has attracted approximately $200m (about N30bn) over five years to fight HIV/AIDS. This figure, the body said, is outside the yearly budgetary allocations to NACA from government and grants from other donor agencies.
Prof. Idoko’s during the opening ceremony of the Zonal/National Consultation Meeting on Ownership and Sustainability on the 13th of February 2012 in Abuja, pointed out that donor funding has dropped by 13 per cent and presented the financial gaps that exist in the implementation of the National Strategic Plan 2010 - 2015. For 2011, the financial gap between what is to be received and what is required was $206million; 2012, $577million; $1.1billion in 2013 and $1.7 billion in 2014. Many donor countries are defaulting in their commitments to contribute 0.7 per cent of their Gross Domestic Product as Overseas Development Assistance to less developed States. This was before the global financial crisis. Now that the crisis is here, how can countries like Greece, Portugal, Spain, Italy and even the United Kingdom be convinced to contribute? Also, there is the issue of corruption. A recent audited account of some donor receiving bodies in Nigeria last year showed inability to account for about N7billion. In a report filed with Independent Corrupt Practices and other related offences Commission (ICPC), the Office of the Inspector General of Global Fund to Nigeria discovered that $474,519,260 (about N72bn) disbursed between 2003 and 2009 could not be properly accounted for. This undermines the faith of the donor nations to continue to assist.
Getting to Ground Zero
In 2005, the international community met in Paris, capital of France, and called on nations to take ownership and sustain the strategies for the campaign against AIDS. Donor countries were to key into national response and use local systems. The same call was sounded again in Accra, capital of Ghana, in 2008 and in Busan, South Korea, last year. Efforts were encouraged for countries to mobilize local support both financial and otherwise and integrate the AIDS fight into the overall health and national development plans.
Even President Goodluck Jonathan at the High Level Meeting held in New York in June 2011 promised that the federal government will bear 50 per cent of the budget for AIDS, from 7 per cent, and eliminate mother to child transmission of HIV by half, Nigeria contributes about 30 per cent of the global burden of mother to child transmission.
But both promises have not been met as budgetary allocation to health and NACA continues to dwindle in real terms. The 2001 Abuja Declaration called on nations to commit 15 per cent of annual budget to health but health got 5.4 per cent in 2007, 5.1 in 2008, 5.0 in 2009, 4.0 in 2010 and 8.0 in 2012 in budgetary allocations. Of the N283billion for health in 2012, only N3.5bn is allocated to the procurement of HIV/AIDS Drugs. According to Minister of Health, Prof. Onyebuchi Chukwu, health cannot be isolated from the contemporary issues in the country with many other socio-economic issues demanding attention. “Even if you give health the entire budgetary allocation for the country, it won’t be enough,” he told LEADERSHIP. “So we have to wriggle within the room the budget allows us.” With foreign aid drying up and the paucity of government funds, what can be done?
Enter The Private Sector
The percentage of private fund for AIDS in 2007 was 0.0 and 0.1 in 2008. Government has been unable to co-opt the private sector into the fight against AIDS. In fact, there is no known strategy for that. When cheap billions come from overseas, who needs the local private sector’s peanuts and its attendant interference? Except for occasional road shows and seminars, there is little the private sector can show for the fight against AIDS. Most do not include prevention and treatment of HIV/AIDS in their company health policies. Stigma and discrimination remain rife as HIV positive workers face sack. Idoko agrees that a new vision for AIDS is required, a vision where “decision makers must move from lip service to meaningful action”. He continued, “Political leadership and accountability are sorely needed along with bold efforts to address the social drivers of HIV transmission.”
Also, the Country Coordinator for United Nations Programme on HIV/AIDS, Dr. Kwame Ampomah, at the recent event on ownership of AIDS funding, said that Nigeria should recognize that foreign aids cannot drive fight against HIV but local funds and strategies. “Nigeria is an oil rich country,” Ampomah said, “if you look around you will see massive projects going on and I have travelled to many states. What we say is that some of this money should be used to uplift the health of the people. People are the most important asset of the country.”
In order to engage the private sector, a National HIV/AIDS Fund (NAHAF) idea is being mooted. This is a public private partnership between the governments, private sector and civil society. It calls for innovative financing mechanisms backed by appropriate legislation and law. Several international facilities that finance aids for health programmes in developing countries like Nigeria are innovative mechanisms which NAHAF wants to domesticate. Such facilities include UNITAD, which levies airline tickets and has raised over $1.2 billion since 2006; GAVI Alliance, which funds immunization programme in Nigeria, sells bonds in international capital market and has raised two billion Euros since 2006; Product RED, which contributes to Global Funds and Debt2Health, which cajoles creditors to forgo a portion of their claims for financing health programmes in debtor nations.
Whether these programmes can be domesticated in Nigeria depends on a number of critical factors that include transparency, accountability and trust in government projects.
Given the level of corruption in the public sector, many private investors are wary to go into partnership with government agencies. Many government officials still see HIV/AIDS funding as a goldmine and not a service to save lives. Correcting this impression and effective management of resources will instill confidence in the private sector to partner with government as part of their corporate social responsibility.
How successful this becomes will define the new face of HIV/AIDS in Nigeria. Idoko advises, “If we are to transform the landscape of AIDS, it must remain high on the national and global agenda. We must move to a response that is long-term and sustainable.”
The HIV/AIDS fight remains government’s to win or lose.