NACA Robs Nigeria's HIV Treatment Programme Of N11 Billion
By EMMANUEL MAYAH and Adedeji Ademigbuji

Several Nigerians living with HIV/AIDS who require treatment may have suddenly found themselves in limbo following the termination of $50 million in aid as a result of the National Action Committee on AIDS (NACA) questionable management of the fund. 

The Global Fund to Fight AIDS, Tuberculosis and Malaria, an international coalition of governments, civil society and the private sector, has suspended about $50 million USD worth of program funding for the National Action Committee on AIDS.  The government agency is accused of using unreliable data and being unable to meet treatment targets.

Observers say the decision to freeze the transfer of funds to NACA raises serious doubt over Nigeria’s commitment to the HIV/AIDS crusade, especially in the very week that members of the African Union met in Abuja to launch an initiative aimed at reducing the number of new HIV cases on the continent. Some even suggest that the loss of funding could halt Nigeria’s much-lauded progress in curbing the spread of HIV/AIDS.

“Their duty was to ensure that the grants were well utilized,” said Mr. Ebojie Arebam-Okojie of Human and Environmental Liberties Project (HELP), which works with women, youth and other vulnerable groups. “Definitely, with this development, the effort to reduce the high prevalence of HIV will suffer a set-back."

In a report the Board of the Global Fund submitted in April, an independent review panel criticized NACA for using unreliable data collection methods, failing to submit progress reports to Global Fund, and its inability to provide free ARV treatment as extensively as promised.

“IRP find that for the most important ARV access targets, access to ARVs and drugs for OIs (women and babies) is zero as the drugs are not available. The ARV expansion grant objective has not been met since it has been achieved at less than 30%.”

According to documentation provided to board members, NACA’s ARV (anti-retroviral) grant was supposed to have 14,000 people on treatment by the end of the fourth quarter; the actual number was zero. Global Fund also discovered by the end of the seventh quarter that while 24,000 people were supposed to be on treatment, the actual number was 6,865. The donor also noted that "multiple other targets have not been met", just as it revealed that questionable data was provided by NACA. Finally, Global Fund criticized the government agency for its use of a manual accounting system.

In November, the Global Fund alerted NACA to their “lack of progress regarding the implementation of grants,” which totalled $69 million USD. On Friday April 28, they suspended the remaining $50 million allotted to NACA that had not yet been handed over. The two terminated Nigerian grants were a Round I grant providing ARV treatment, and a Round I grant providing PMTCT (Prevention of Mother to Child Transmission) services.

Observers of performances of HIV/AIDS programs in Nigeria said they saw the Global Fund’s red card coming. As early as November last year, a Global Fund panel recommended the drastic action, citing NACA’s inability to meet its goal of  providing free ARV therapy to Nigerians. Though at first some Global Fund board members dissented when the issue was tabled via e-mail, not one member spoke up in defence of Nigeria’s handling of the grants at the Board meeting last week.

Bede Ezeifuli, Project Director for Center for Right to Health, Lagos accused NACA of gross manipulation. “Last year, the federal government said they were going to treat 250,000 people living with HIV with ARV and towards the end of the year, you could see what we had. We have about 10,000 people on government ARV; we have about 16,000 Presidential Emergency Fund (PEFAN), we have 6,800 on the Global Fund. If you add it up, is it not even up to 50,000?” Bede said further that the grants were supposed to help provide life-saving medication to 26,000 people and as at today, more than two-and-a-half years after the fund has been committed, it has only provided succor for 6,800 people. He said further that the fund was supposed to train people working on HIV/AIDS including doctors, counselors, and nurses but could that NACA was unable to achieve this goal before funding was frozen.

Already NGOs, HIV/AIDS activists and people living with the virus are counting the cost of Global Fund’ loss of faith in NACA. Mr. Fred Adegboye, the student who was expelled from Nigerian Institute of Journalism (NIJ) on account of his HIV status but later re admitted, said the grants cancellation portends great danger not only to current beneficiaries but millions of others on the waiting list.

"The fund is meant to take care of people living with HIV; the cancellation will have obvious serious implications. I may not be in the best position to rate the performance of NACA, however, I have personally benefited from the agency, especially their intervention when I had problems with NIJ.”

Mr. Adegboye said the recent issue with NACA is actually symptomatic of larger problems in the non-profit sector.

“But beyond NACA, there are many NGOS whose performances are so dismal. I can only give pass mark to a few; the majorities just collect grants without having anything to show for them."

In a communiqué issued at the end of the executive meeting of the Treatment Action Movement (TAM) of Nigeria on May 26, 2006, participants said they were outraged by the unfortunate but avoidable loss of the Global Fund grant. Quoting Oba Oladapo, the secretary of the body, “we were scandalized that the impact of the loss is being downplayed in official quarters as being of little or no consequence due to the award of the round five grants to the country. This gives the erroneous impression to the uninformed that the round five grants is a replacement to the lost grant”.

Mr. Arebam-Okojie agreed, saying that in the beginning, donor agencies used to deal directly with home government. "It came a time when they realised the money was not getting to the NGOs and they switched to the NGOs directly, only to find out that some of them cannot stand the test of time. They have since returned to governmental agencies and communities, which is like turning full circle.”

“In my opinion, the community approach is the best because it will be easy for donor agents to monitor what work has been done."

Professor Oshotimehin said the loss of funding was because NACA was still learning the process. “We have learnt a great deal of lessons. One is to engage more professionals in our treatment programmes. This is because they determine the pace of activities. But we have also set up a good reporting mechanism whereby we get constant feedback from our various programme sites. To also facilitate fluidity in our activities, between 250 and 500 sites for various antiretroviral treatments would be established in the next few months. We are also recruiting more staff… I can say this is because of the inconsistencies that trailed the first round. This was because we were trying to understand the system and this took a fairly longer time. The Global Fund was not too swift in making funds available to commence activities. So, termination was based on the performance at that first instance.”

Meanwhile, as Global Fund shops for a new Principal  Recipient in pursuit of what it called "alternative options," the donor has said that Nigerians currently receiving ARV treatment will continue to have their treatment financed by the fund for up to two years.

In the ongoing free treatment, there have also been several complaints of poor service and fraud at some sites that still charge a treatment fee. Apart from providing drugs, treatment includes measuring of CD4 counts and viral load cost. There were reports that some people are still buying the drugs despite the national government’s directive that ARV should be available at federal clinics for free. In Enugu state, the Executive Director of Coalition of Enugu State Support Groups Organisation (CESSGO) lamented on defiance to the federal government directive by University of Nigeria Teaching Hospitals. According to him, “We still pay N1,000 to get drugs in Enugu.” He said both the state and the federal medical centers are still selling the drugs in the state.

In Kaduna, Adangba Muhammad Adamu of Living Hope Foundation (LHF) said the situation is no different. It was gathered that the treatment is not free as people still continue to pay N1,000.  Adamu revealed further that it was only at the 44 Reference Hospital, a military hospital in Kaduna, that free ARVs are being administered and even there, the supply is limited and drugs are given out selectively. “Only 300 PLWHA receive ARV at the center,” said Adamu.

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