Beyond Donor Funding: Why Public Health Needs Local Support

Twenty-five years ago, an HIV/AIDS diagnosis in Nigeria was widely regarded as a death sentence. Treatment options were virtually non-existent and hope was in short supply.

For families, the priority was often not care but burial arrangements. For those who were single, marriage and childbearing were considered impossible. Employment was rare and stigma was overwhelming.

According to the Chief Executive Officer of APIN Public Health Initiatives, Prof. Prosper Okonkwo, the early 2000s represented a period when silence, fear, and death defined the HIV narrative in Nigeria.

“In the year 2000, a person living with HIV in Nigeria was, in most cases, living with a death sentence. There were no antiretroviral drugs widely available. There was no pathway to an undetectable viral load,” Okonkwo recalled.

He described a time when even the idea of an HIV-positive person having a normal family life was unimaginable.

“An HIV-positive person was too busy trying to stay alive and hide their status. The idea that a woman living with HIV could deliver a healthy child and breastfeed that child was not a reality most people believed was possible,” he said.

Today, however, that story has changed significantly. The transformation has been driven by bodies like APIN Public Health Initiatives, which began in 2001 as a project under the Harvard School of Public Health with funding support from the Bill and Melinda Gates Foundation.

Over the years, and later through major global initiatives such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Nigeria’s HIV response evolved from crisis management to structured treatment and prevention systems.

At its 25th anniversary in Abuja, APIN reflected on its journey from a donor-funded HIV programme to an indigenous organisation strengthening Nigeria’s broader health system.

Okonkwo explained that over the past 25 years, the organisation has trained healthcare workers, built laboratory networks across multiple states, supported treatment programmes that have kept hundreds of thousands of Nigerians alive, and strengthened community-based health communication systems.

According to him, APIN has supported more than 319,000 people living with HIV and worked with over 400 health facilities nationwide, evolving into an independent Nigerian NGO delivering evidence-based health interventions

Former Minister of Health, Professor Isaac Adewole, in his keynote address, described the HIV response as one of the greatest public health success stories in modern history.

“The HIV response remains one of the great public health success stories of our time. Free and subsidised antiretroviral therapy, decentralised HIV care and prevention services have helped improve outcomes for millions of people,” he said.

He noted that expanded treatment coverage, prevention of mother-to-child transmission programmes, behavioural interventions, and community-based services have significantly reduced infections and AIDS-related deaths.

But beyond HIV, Adewole highlighted how these systems have strengthened other areas of healthcare, including tuberculosis control, malaria prevention, maternal and child health, and immunisation.

Improvements such as the expansion of immunisation coverage, better nutrition, and increased access to essential medicines have contributed to declining maternal and child mortality rates.

In tuberculosis control, he pointed to innovations such as Directly Observed Treatment Short-course (DOTS), GeneXpert diagnostics, and integrated TB/HIV services. In malaria response, interventions such as insecticide-treated nets, artemisinin-based therapies, rapid diagnostic testing, and malaria vaccines have improved outcomes.

Despite these gains, Adewole warned that the progress remains fragile.

“We need to do more than ever before to ensure that these gains are sustained,” he said, noting that emerging threats such as antimicrobial resistance, climate change, pandemics, and economic shocks could reverse hard-won achievements.

He also raised concern about declining international donor funding, stressing that countries must increasingly rely on domestic resources to sustain public health systems.

“The issue of local funding has become critical, and countries must now use their own resources in order to address health challenges,” he added.

While unlike 25 years ago, people with HIV/AIDS can now live a normal life, thanks to efforts of bodies like APIN Public Health Initiatives, the journey that lies ahead is still not without hazards. And that is why so much still needs to be done.