Nigeria FY 2006 Country Operational Plan (COP)

NIGERIA

Project Title: Nigeria FY 2006 Country Operational Plan (COP)

Budget Summary:

	Field Programs Funding by Account						Central Programs Funding by Account
	Notified as of May 2006			Current Notification August 2006			Current Notification August 2006
Implementing Agency	GAP	GHAI	Subtotal: Field Programs Funding by Account	GHAI	GAP	New Subtotal: Field Programs Funding by Account	GHAI Central Programs	Total Dollars Allocated: Field & Central Funding
DOD	-	7,707,000	7,707,000	101,500	-	7,808,500	-	7,808,500
DOL	-	-	-	-	-	-	-	-
HHS	3,056,000	66,550,000	69,606,000	812,000	-	70,418,000	17,296,862	87,714,862
Peace Corps	-	-	-	-	-	-	-	-
State	-	300,000	300,000	-	-	300,000	-	300,000
USAID	-	57,958,000	57,958,000	5,171,500	-	63,129,500	4,654,887	67,784,387
TOTAL Approved	3,056,000	132,515,000	135,571,000	6,085,000	-	141,656,000	21,951,749	163,607,749

HIV/AIDS Epidemic in Nigeria:

Adult HIV Prevalence Rate: 3.9% [2.3-5.6%] (UNAIDS 2006)
Estimated Number of HIV-infected People: 2 ,900,000 [1,700,000-4,200,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: 930,000 [510,000-1,300,000 (UNAIDS 2006)

*Results. "Engendering Bold Leadership: The President's Emergency Plan for AIDS Relief." First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, March 2005
**Results. "Action Today, a Foundation for Tomorrow: The President's Emergency Plan for AIDS Relief." Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, February, 2006
***Projections from FY 2006 Country Operational Plan

Program Description:

Nigeria is the largest country in Africa with at least 135 million citizens, accounting for 47% of the West African region’s population. Under the federal system of government, Nigeria has 36 states and a federal Capital Territory (FCT); at an average of 3.2 million inhabitants, many states are larger than some entire African countries. Because of this size, Nigeria carries one of the heaviest HIV/AIDS burdens in Africa despite its relatively low prevalence (3.9% in 2006). An estimate of the HIV-infected population is approximately 2 ,900,000 [1,700,000-4,200,000] according to the UNAIDS Nigeria Fact Sheets. In addition, Nigeria has one of the highest tuberculosis (TB) burdens in the world. Available data indicate that between 25-50 percent of Nigerian TB patients also have HIV, but no systematic survey of co-infection rates has been conducted since 2000 (FGON, 2001, WHO 2003). Unfortunately, only 10-15% of an estimated 320,000 cases have been detected.

Nigeria has both generalized and concentrated HIV/AIDS epidemics. Nigeria’s epidemic is largely fueled by heterosexual transmission and mother-to-child transmission, and there are clearly identifiable risk groups that are similar to many other countries on the continent. A risk group warranting particular attention in Nigeria is married girls. This group, which has a mean age at first marriage of 14.6 years, is more prevalent in the Northern, predominantly Muslim, region and special activities are being included in this year’s country operational plan (COP) to address this very vulnerable and largely un-served population.

The number of orphans that the USG Nigeria program will soon support is substantial. Recent projections indicate that the number of maternal orphans will rise from 0.3 million in 2000 to nearly 4 million in 2015. By 2015, an estimated 16.2% of the total population under 15 years of age would be orphaned by losing either or both parents from any cause, up from only 5.2% in 2000. The current prevalence peak in the 20-24 year age group implies that people are becoming infected at an earlier age. With over half of the population being under 25 years of age, Nigeria is classified as a “second wave” country and the stage is set for the next and larger wave of the epidemic.

In this context, Emergency Plan funding will be focused on the following program areas, which contribute to the 2-7-10 targets.

Prevention Funding: $27,982 ,798 as of August 2006 ($21,315,340 Field and $6,667,458 Central) (19.4% of prevention, care and treatment budget)

Prevention activities in Nigeria include prevention of mother-to-child transmission (PMTCT), abstinence and faithfulness programs, blood and injection safety, and other prevention initiatives including those focused on high risk populations. With FY 2006 funding, the USG will support 115 PMTCT centers and will continue its dialog with the Government of Nigeria (GON) regarding the most effective protocols for expanding these treatment activities from the tertiary and secondary centers out into the more rural areas where most women give birth. In conjunction with training 1,151 health workers, community mobilization, and demand creation, these activities should allow USG in Nigeria to reach its target of screening 150,547 pregnant women and providing 9,557 women with prophylaxis in a PMTCT setting.

USG in Nigeria will continue to use FY 2006 funds to support high-quality, tightly targeted behavior change programs to deliver abstinence and be faithful (AB) messages. New emphasis this year will be on changing norms and behaviors of men in the general population, as opposed to only men who practice high-risk behaviors. In addition, “be faithful” messages, which have received less emphasis in past years, will be given new prominence this year. Mass media messages, such as the popular and successful national “ZIP UP” campaign will continue and new media will be identified and exploited for more targeted messages. Prevention activities will be incorporated into all activities, and opportunities to introduce prevention messages into other program areas, such as voluntary counseling and testing (VCT), will be maximized. Strategies for discordant couples in all communities will be developed, and prevention for positives in both community-based care and antiretroviral therapy (ART) clinical settings will be enhanced. Efforts to reduce new infections among high-risk and high-transmission communities will continue with messages specifically targeted for each individual risk group.

The USG supports a significant number of clinical points of service in its Emergency Plan programming. With FY 2006 funds, the team has committed to ensuring that all clinical settings funded by the USG will be able to screen all transfused blood for HIV. Fifty-one clinical service outlets will benefit from support, and the funds will help train 465 staff. Universal precautions will also be promoted in all clinical settings. The USG Nigeria Safe Blood program is also engaged in a Public Private Partnership with Exxon-Mobil to provide technical assistance for safe blood activities in the Federal Capital Territory.

In the May 2006 notification, an additional $3,127,682 was allocated for prevention activities. These funds will support 14 service facilities for safe blood including training 130 staff. Additionally, at least 12,250 mothers will be screened for HIV and 874 will receive ARV prophylaxis to prevent mother-to-child transmission.

In August 2006, an additional $579,318 was allocated for prevention activities. These funds will support the screening of 27,175 pregnant women for HIV and enable 1,636 HIV-positive pregnant women to receive antiretroviral prophylaxis. Additionally, four new service outlets will conduct safe blood activities and 2,764,213 people will be reached with support for abstinence and fidelity.

Principal Partners: Catholic Relief Services, Family Health International (FHI), Harvard University School of Public Health, University of Maryland, International Foundation for Education and Self-Help (IFESH), Safe Blood for Africa Foundation, John Snow International (JSI), Nigerian Ministry of Health, Department of Defense, the Public Affairs Section of the State Department, Hope Worldwide, Food for the Hungry, Population Council, Columbia University and the Society for Family Health.

Care: $39,677,872 as of August 2006 ($39,514,003 Field and $163,869 Central) (27.5% of prevention, care and treatment budget)

Care activities in Nigeria include VCT, palliative care and support for orphans and vulnerable children (OVC). Bringing 350,000 persons to ART by 2008 will require providing VCT services to an estimated 13 million individuals in the coming years. To increase uptake of counseling and testing services at the health facility level, USG Nigeria will implement routine testing (based on an opt-out approach) in all clinical settings. With FY 2006 funding support, the USG will continue to support stand-alone VCT sites, which are linked to treatment and care services, and expand its reach by developing mobile testing services. National promotion is essential and an initiative to brand and franchise a national counseling and testing (CT) campaign will attempt to expand nationally recognized services beyond USG sites. This will dramatically expand access to high quality, confidential counseling and testing which is linked to a care and treatment network.

The GON has acknowledged the need for palliative care and has moved forward in establishing a basic package of services for HIV positive people and their families. Although families, communities and organizations will continue to benefit from the USG’s palliative care services, the focus of funding from FY 2006 will be on ensuring a minimum package of services (including opportunistic infection management, laboratory follow up, and referral to a care network) to all HIV positive patients identified in USG programs, regardless of their need for antiretroviral treatment. The USG will promote access to home-based care and strengthen networks of health care personnel, community health workers and promoters to provide nursing care and psychosocial support. In addition, USG will promote HIV testing within TB facilities and ensure that all facilities offering antiretroviral treatment develop the ability to diagnose TB and provide nationally accepted directly-observed therapy, short course strategy (DOTS) sites within their facility.

The USG will also support the Federal Ministry of Women Affairs and Youth Development to develop national guidelines and policies, which address the needs of OVC. USG Nigeria will support a community network to implement a household/family-based strategy for OVC. The USG will also support interventions to advocate and mobilize a broad range of stakeholders to raise awareness of OVC issues. With FY 2006 funds, the USG will begin providing more extensive clinical care to OVC that includes prevention and management of opportunistic infections as well antiretroviral treatment for eligible children.

In the May 2006 notification, an additional $4,910,095 was allocated for care activities. The additional funds will support over 28,000 people receiving counseling and HIV test results and care for over 20,000 PLWHA in 28 USG-supported health facilities. Additionally, 4,500 clients in TB clinics will be screened for HIV and 375 will receive ARVs.

In August 2006, $600,000 of funding for care related programs was reprogrammed for OVC to support counseling and testing for 30,400 more people via the addition of five service outlets as well as access to palliative care services for 2,000 HIV+ patients.

Principal Partners: Catholic Relief Services, Family Health International, IFESH, Department of Defense, Harvard University School of Public Health, Columbia University School of Public Health, the University of Maryland, Institute for Human Virology, Hope Worldwide, US Embassy Public Affairs Section and the World Health Organization.

Treatment: $76,741,822 as of August 2006 ($61,621,400 Field and $15,120,422 Central) (53.1% of prevention, care and treatment budget)

Treatment activities in Nigeria include the provision of antiretroviral (ARV) drugs and services to eligible patients as well as laboratory support for the diagnosis and monitoring of HIV+ patients identified in USG programs. The downstream treatment target for FY 2005, which includes patients on USG-purchased drugs as well as those in GON treatment facilities that benefit from USG laboratory services, is 36,222. Downstream treatment targets are expected to increase to 42,489 in FY 2006 and to 47,936 in FY 2007. 1,141 trained personnel will provide these services in 65 treatment sites. Funds will be used to purchase Food and Drug Administration (FDA) approved generic drugs whenever possible in an effort to maximize the number of Nigerians receiving treatment.

Systems that allow for tracking, forecasting and dispensing drugs and commodities will be strengthened with FY 2006 funding and accountability for these valuable resources will remain at consistently high levels. Staff in all sites will be trained in all aspects necessary to maintain a safe and secure supply of high-quality pharmaceutical products in a cost-effective and accountable way.

Laboratories will focus on maintaining high quality services as the numbers for provided treatment and services continues to increase. Discussions with GON counterparts on improving cost efficiencies will also continue in 2006 and 2007 with the hope of further reducing overall treatment costs and making routine monitoring available to all antiretroviral treatment patients.

In the May 2006 notification, an additional $14,020,723 was allocated for Treatment activities. The additional funds will support 17,400 people receiving ARVs in 28 USG-supported health facilities. Additionally, assistance will be provided to allow laboratories to ensure support to train at least 212 staff and to perform over 100,000 tests.

In August 2006, an additional $1,321,697 was allocated for treatment activities. These funds will enable 2,800 people to begin antiretroviral treatment and to access the necessary support services. Please note that pediatric AIDS funding that is attributed to OVC programs is included in the care program area total and is deducted from the treatment program area total.

Principal Partners: Catholic Relief Services, Family Health International, Department of Defense, Harvard University School of Public Health, Columbia University, and the University of Maryland.

Other Costs: $19,205,257 as of August 2006

With FY 2006 funds, USG Nigeria will continue to strengthen the capacity of the Government to provide comprehensive antiretroviral treatment and to build the systems and structures that will support this countrywide effort. This effort also includes strengthening the policy environment that surrounds the provision of prevention, care and treatment services, as well as strengthening the systems required to measure progress in these areas.

Specifically, the USG will support the strengthening of antiretroviral commodity forecasting and procurement in the national system, surveillance efforts, patient management and monitoring systems, targeted evaluations and population-based surveys. In addition to supporting the development and dissemination of guidelines and policies necessary to guide the provision of prevention, care, and treatment (National Strategic Framework on HIV/AIDS, National HIV/AIDS Policy, ARV guidelines, National OVC Action Plan, Counseling and Testing Guidelines, Blood Safety Policy, National Palliative Care Guidelines), specific legislation influencing HIV/AIDS activities (such as those dealing with stigma and discrimination and the transformation of the National and State Action Committees on AIDS into a Federal Agency) will be supported in the National Assembly. Other National Agencies, such as the National Agency for Food Drugs and Administration and the Nigerian Institute for Medical Research will be supported in their AIDS related activities.

USG Nigeria will also utilize funds in this program area to collect qualitative and quantitative data to monitor all partners’ performance. Information necessary to report on Emergency Plan indicators will also be collected, compiled, analyzed and used for programmatic decision making.

Management and staffing funds will support the in-country personnel needed for U.S. Agency for International Development (USAID), Health and Human Services (HHS), Department of State (State), and Department of Defense (DOD). Funds will ensure program monitoring and accountability; ensure USG policy and technical leadership within the Nigerian national response, and office and administrative costs (e.g. compensation and logistical support).

In the May 2006 notification, an additional $1,900,000 was allocated for policy analysis, systems strengthening, and management and staffing activities. The additional funds will support the development of needed legislation and enable the development of HIV/AIDS policy in Nigeria. There is no change in the amount of funding allocated for these activities as of this operational plan.

Principal partners: National Democratic Institute, Catholic Relief Services, Family Health International, PHRPlus, Harvard University School of Public Health, University of Maryland, MEASURE Evaluation, JSI/DELIVER, Society for Family Health, and The Futures Group.

Other Donors, Global Fund Activities, Coordination Mechanisms:

The U.S. Government in-country partners include USAID, HHS/CDC, HHS/NIH, State, and DOD. In addition to U.S. Government partners, development partners include the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), World Bank, UNAIDS, DfID, JICA, CIDA, WHO, UNICEF, and the country coordinating mechanism (CCM). Others include ADB, ILO, Italian Cooperation, UNDP, UNDCP, UNFPA, and UNIFEM.

A World Bank/IDA five-year credit worth $105 million is available for 18 states and the FGON. United Nations Children’s Fund (UNICEF) has done innovative work in training peer educators among National Youth Service Corps members prior to their community postings. CIDA is currently in discussions to award support to Economic Community of West African States (ECOWAS). The Bill and Melinda Gates Foundation is the largest source of private foundation support, in addition to the Ford, Packard and McArthur Foundations. GFATM has approved three Round one HIV/AIDS grants totaling more than $28 million in lifetime award for HIV/AIDS, to support the expansion of ART, PMTCT and the promotion of civil society’s role in the HIV/AIDS response. Currently, approximately $20 million has been disbursed on these three awards. Unfortunately, the Phase II monies for two of the HIV/AIDS grants has been cancelled and is an estimated loss of approximately $42 million.

Program Contact: Ambassador John Campbell and USG Nigeria Emergency Plan Coordinator, Nina Wadhwa

Time Frame: FY 2006 – FY 2007

Approved Funding by Program Area: Nigeria

August 2006 Operational Plan Main Page