Nigeria FY 2007 Country Operational Plan (COP)

NIGERIA

Project Title: Nigeria Fiscal Year 2007 Country Operational Plan (COP)

Budget Summary:

 

	Field Programs Funding by Account						Central Programs Funding by Account
	Notified as of March 2007			Notified as of June 2007			Notified as of November 2006
Implementing Agency	GAP	GHAI	Subtotal: Field Programs Funding	GAP	GHAI	New Subtotal: Field Programs Funding	GHAI Central Programs	Total Dollars Allocated: Field & Central Funding
DOD	0	9,606,033	9,606,033	0	9,406,033	9,406,033	0	9,406,033
DOL	0	0	0	0	0	0	0	0
HHS	3,056,000	99,966,962	103,022,962	3,056,000	137,007,315	140,063,315	18,230,999	158,294,314
Peace Corps	0	0	0	0	0	0	0	0
State	0	60,000	60,000	0	60,000	60,000	0	60,000
USAID	0	100,374,738	100,374,738	0	135,470,652	135,470,652	1,622,415	137,093,067
TOTAL Approved	3,056,000	210,007,733	213,063,733	3,056,000	281,944,000	285,000,000	19,853,414	304,853,414

^* The Global AIDS Program of HHS/CDC

HIV/AIDS Epidemic in Nigeria:
Estimated Population: 131,530,000^*
HIV Prevalence rate: 3.9%^*
# of HIV infected: 2,900,000^*
Estimated # of OVCs: 930,000^*¥
*Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
^Prevalence is in adults only (15-49 years)
^¥Orphans aged 0-17 due to AIDS

Country Targets and Projections to Achieve 2-7-10 Goals: Total Targets:

Nigeria	Total # Individuals Receiving Care and Support	Total # Individuals Receiving ART
End of Fiscal Year 2004*	43,800	13,500
End of Fiscal Year 2005**	67,900	28,500
End of Fiscal Year 2006***	234,600	67,100
End of Fiscal Year 2007****	415,867	122,531
End of Fiscal Year 2008****	731,703	267,175

^*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
^***Results. “Power of Partnerships: The President’s Emergency Plan for AIDS Relief.” Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February 2007
^****FY 2007 Country Operational Plan targets

Program Description:

With an estimated population of 137 million, Nigeria is both ethnically and culturally diverse. Under the federal system of government, Nigeria has six geo-political zones, 774 local government areas (LGAs), 36 states, and a Federal Capital Territory (FCT). At an average of 3.2 million inhabitants, many states are larger than some African countries. Nigeria’s large population and an estimated HIV prevalence of 3.9% (UNAIDS 2006) result in an estimated 2.9 million inhabitants infected with HIV. In addition, Nigeria has one of the highest tuberculosis (TB) burdens (290/100,000 population, WHO 2006) in the world and the largest TB burden in Africa. Many TB cases go undetected, despite increasing TB detection rates and TB program coverage.

Nigeria has a generalized HIV epidemic. However, prevalence rates vary widely across states and rural and urban areas. Concentrated HIV/AIDS epidemics occur in particular geographic regions and within certain segments of the population. The USG will support a population level survey in 2007, the goal of which is to clearly define variability within the epidemic. Nigeria’s epidemic largely is fueled by heterosexual transmission and mother-to-child transmission, but there are clearly identifiable risk groups, which are similar to those in many other African countries. One such risk group in Nigeria is girls who marry at a young age, causing their sexual debut to occur at an early age. This group, which has a mean age at first marriage of 14.6 years, is a vulnerable and largely underserved population, predominantly found in the northern part of the country. Activities specifically designed to engage, increase HIV knowledge among, and promote safe behaviors within this vulnerable population will be supported in fiscal year 2007.

The USG will provide support for a substantial number of HIV/AIDS orphans. By 2015, an estimated 16.2% of the total population under 15 years of age will be orphaned by losing either one or both parents from any cause, up from only 5.2% in 2000. The current HIV prevalence peak in the 20 to 24 year age group implies that people are becoming infected at an early age. With over half of the infected population under 25 years of age, Nigeria was classified as a “second wave” country by the National Intelligence Council (NIC). While prevalence estimates imply that the stage is set for another and larger wave of the epidemic over the next decade, the USG will work to counter such a situation.

Additional Funding: In June 2007, an additional $36,933,281 was allocated to support further expansion of programs into rural areas and to expand OVC programs.

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

Prevention: $52,917,884 ($47,847,781 Field and $5,070,103 Central) (19.5% of prevention, care and treatment budget)

Prevention activities in Nigeria include prevention of mother-to-child transmission (PMTCT), abstinence and be faithful (AB) programs, blood and injection safety, and other prevention initiatives, including activities focused on high risk populations. In fiscal year 2007, the USG will expand support to PMTCT centers and will continue its dialogue with the Government of Nigeria (GON) regarding the most effective protocols for expanding these treatment activities from the tertiary and secondary centers out to the rural areas where most women give birth. The USG will train health workers in PMTCT services and also will work to mobilize communities, creating greater demand for PMTCT and increasing the number of pregnant women who are screened for HIV and the number of HIV-positive mothers who receive prophylaxis in an antenatal care (ANC) setting.

The Emergency Plan will continue to support high-quality, tightly-targeted behavior change programs to deliver abstinence and be faithful messages. New emphasis this year will be on changing norms and behaviors of men in the general population, as opposed to only high-risk men. In addition, “be faithful” messages, which have received less emphasis in past years, will be given more prominence this year. Mass media messages, such as the popular and successful national “ZIP UP” campaign, will continue; in addition, new media will be identified and exploited for more targeted messages. In an effort to recruit new partners, USG Nigeria will provide institutional capacity-building support to local civil society organizations (CSOs), nongovernmental organizations (NGOs), and faith-based organizations (FBOs) delivering AB 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. In particular, the nationally branded Heart to Heart VCT Centers as well as mobile VCT services will be maintained, since they provide strategic venues for communicating behavior change messages on prevention. Strategies for discordant couples will be developed in fiscal year 2007, and targeted activities will facilitate prevention for positives in both community-based care and anti-retroviral therapy (ART) clinical settings. 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, and will work to ensure that all clinical settings receiving USG support will have the capacity to screen all transfused blood for HIV. Universal precautions will also be promoted in all clinical settings.

Principal partners: Family Health International/GHAIN, Harvard University School of Public Health/APIN+, University of Maryland/ACTION, Partnership for Supply Chain Management, Catholic Relief Services/7 Dioceses, Society for Family Health, Management Sciences for Health (MSH)/Leadership Management and Sustainability (LMS), USAID/Annual Program Statement Solicitation, Center for Development and Population Activities, Population Council, John Snow Incorporated, Nigerian Federal Ministry of Health, and Safe Blood for Africa Foundation.

Care: $79,551,513 ($80,003,825 Field and $452,312 Central) (29.5% of prevention, care and treatment budget)

Care activities in Nigeria include VCT, palliative care, TB/HIV activities, and support for orphans and vulnerable children (OVC). To increase uptake of HIV counseling and testing services at the health facility level, the USG will implement and expand provider-initiated routine testing (based on an opt-out approach) in clinical settings (e.g., TB clinics, STI points of services, and ANC centers) and enhance linkages to HIV care and treatment services, as appropriate. The USG also will continue to support stand-alone VCT sites linked to treatment and care service networks, and expand through the development of mobile testing services.

The GON has made progress in establishing a basic package of services for HIV-positive people and their families. Although families, communities, and organizations will continue to benefit from Emergency Plan-supported palliative care services, the focus in fiscal year 2007 will be on ensuring delivery of 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 ART. An additional focus will be providing increased services at the community and home level, to augment services provided at the facility level and to increase overall care coverage. The Emergency Plan will promote access to home-based care and will strengthen networks of health care personnel and community health workers, to provide nursing care and psychosocial support.

In addition, the USG will promote provider-initiated, routine HIV testing within TB facilities, and will ensure that facilities offering ART have co-located government Directly Observed Therapy Short-course (DOTS) TB services available. These services include regularly screening all HIV-infected clients for TB, which will lead to increased identification of HIV-infected clients as TB cases. TB preventive therapy also will be provided through a phased approach to HIV-positive clients, in order to reduce their risk of developing TB.

The USG will support the Federal Ministry of Women Affairs and Youth Development to develop national guidelines and policies that address the needs of OVC. The Emergency Plan will support a community network to implement a household- and family-based strategy for OVC. The USG also will support interventions to advocate among and mobilize a broad range of stakeholders, in order to raise awareness of OVC issues. In fiscal year 2007, the USG will continue clinical care services for OVC, including prevention and management of opportunistic infections, as well as provision of ART drugs and services for eligible children.

Principal partners: Partnership for Supply Chain Management, Family Health International/GHAIN, University of Maryland/ACTION, Catholic Relief Services/AIDSRelief, Harvard University School of Public Health/APIN+, Center for Development and Population Activities, Society for Family Health, Christian Aid, CRS/7 Dioceses, and Winrock.

Treatment: $138,527,705 ($124,196,706 Field and $14,330,099 Central) (51.0% of prevention, care and treatment budget)

Treatment activities in Nigeria include the provision of ARV drugs and services to eligible patients, as well as laboratory support for the diagnosis and monitoring of HIV-positive patients identified through USG-supported activities. Funds will be used to purchase FDA approved or tentatively approved generic drugs whenever possible, in an effort to maximize the number of Nigerians receiving treatment.

Harmonization and cost leveraging are major emphasis areas in fiscal year 2007. Harmonization refers to standardization of services and training across implementing partners, as well as full integration with the National ARV program, with regard to standard operating procedures and service delivery. In fiscal year 2006, drug commodities were leveraged effectively at several treatment sites. Such leveraging is being expanded in fiscal year 2007, with several USG partners anticipating the delivery of drugs and other commodities from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). Cost savings resulting from strategic resource leveraging will be completely reinvested into program implementation.

Logistics management activities are a key component of ARV drug delivery. This includes not only the purchase of drugs but also a number of interdependent logistics management activities, such as: product selection, forecasting and procurement, freight forwarding and importation, and warehousing and distribution. A Logistics Management Information System (LMIS) and Inventory Control System (ICS) provide data that are essential for the delivery of ARV drugs to treatment sites and patients in a smooth and efficient manner. Efforts to develop and implement an LMIS and ICS will continue in fiscal year 2007. Staff will be trained to maintain a safe and secure supply of high-quality pharmaceutical products in a cost-effective and accountable way.

As treatment and services continue to increase in fiscal year 2007, laboratories will focus on maintaining high quality services. In fiscal year 2007, the Emergency Plan will emphasize the actualization of networks of care with a tiered approach to service delivery. Discussions with GON counterparts on improving cost efficiencies will continue in fiscal year 2007, with the hope of further reducing overall treatment costs and making routine monitoring available to all ART patients.

Principal partners: Family Health International/GHAIN, Harvard University School of Public Health/APIN+, CRS/AIDS Relief, and University of Maryland/ACTION.

Other Costs: $33,404,000

In fiscal year 2007, Emergency Plan funds will continue to strengthen the capacity of the GON to provide comprehensive ART and to build the systems and structures that will support this countrywide effort. A key component of this effort includes improving the policy environment underpinning the provision of prevention, care, and treatment services. Monitoring and evaluation practices also will be strengthened to effectively measure progress in these three program areas.

Activities to strengthen the GON’s provision of comprehensive ART will include improving ARV commodity forecasting and procurement in the national system, surveillance, 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 direct the provision of prevention, care, and treatment, specific legislation influencing HIV/AIDS activities (such as legislation 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.

The USG also will use funds to collect qualitative and quantitative data to monitor all partners’ performance. In this regard, information necessary for reporting on Emergency Plan indicators will be collected, compiled, analyzed, and used for programmatic decision making.

Principal partners: Family Health International/GHAIN, University of Maryland/ACTION and The Futures Group/ENHANCE.

Management and staffing funds will support the in-country personnel needed for USAID, HHS, Department of State, and DOD. Funds will ensure effective program management, monitoring and accountability; foster adherence to USG policy, while working under the leadership of the Nigerian national response; and cover office and administrative costs (e.g., compensation and logistical support).

Other Donors, Global Fund Activities, Coordination Mechanisms:

In addition to the USG, development partners in Nigeria include: the Global Fund; World Bank; the UK, Japanese, Canadian and Italian development agencies; UN agencies (UNAIDS, WHO, UNICEF, International Labor Organisation (ILO), UNDP, UNDCP, UNFPA, and UNIFEM); and the African Development Bank.

The USG will continue to leverage funding from multiple partners – for example, from both the Global Fund and the Clinton Foundation. The Global Fund has approved a Round 5 HIV/AIDS grant, totaling up to approximately $250 million over five years, to support the expansion of ART and PMTCT and the promotion of civil society’s role in the HIV/AIDS response.

Program Contact: Emergency Plan Coordinator Jennifer Graetz

Time Frame: Fiscal year 2007 – fiscal year 2008

Approved Funding by Program Area: Nigeria