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Prosper Okonkwo, 15+ Years of PEPFAR - The Nigeria Experience

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Prosper Okonkwo, 15+ Years of PEPFAR - The Nigeria Experience

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October 7, 2019

On October 7, 2019, the Harvard Global Health Institute will host a one-day symposium to explore what enabled this visionary program, and to showcase how it has transformed not just the worldwide HIV/AIDS response but global health delivery more broadly.
There are many lessons learned in PEPFAR’s story - from what it took to build a supply chain where there was none, to establishing the use of generic antiretroviral therapies (ARTs) and leveraging human capacity. This event convened the early architects of PEPFAR as well as experts and implementers currently leading the charge. We took a historically informed look at what it will take to stop global transmission, and shared tools useful for others hoping to move the needle on vexing problems in global health.

For more information, visit our website at https://petrieflom.law.harvard.edu/events/details/15-years-of-pepfar

October 7, 2019

On October 7, 2019, the Harvard Global Health Institute will host a one-day symposium to explore what enabled this visionary program, and to showcase how it has transformed not just the worldwide HIV/AIDS response but global health delivery more broadly.
There are many lessons learned in PEPFAR’s story - from what it took to build a supply chain where there was none, to establishing the use of generic antiretroviral therapies (ARTs) and leveraging human capacity. This event convened the early architects of PEPFAR as well as experts and implementers currently leading the charge. We took a historically informed look at what it will take to stop global transmission, and shared tools useful for others hoping to move the needle on vexing problems in global health.

For more information, visit our website at https://petrieflom.law.harvard.edu/events/details/15-years-of-pepfar

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Prosper Okonkwo, 15+ Years of PEPFAR - The Nigeria Experience

  1. 1. 15+ Years of PEPFAR –The Nigeria Experience Dr Prosper Okonkwo APIN Public Health Initiatives, Nigeria
  2. 2. The Birth of PEPFAR in 2003 “HIV/AIDS is one of the great medical challenges of our time…Across Africa, this disease is filling graveyards and creating orphans and leaving millions in a desperate fight for their own lives. They will not fight alone…The legislation I sign today launches an emergency effort that will provide $15 billion over the next 5 years to fight AIDS abroad…In the face of preventable death and suffering, we have a moral duty to act, and we are acting” -President George W. Bush
  3. 3. Pre-PEPFAR Era • HIV diagnosis at the time was perceived as a death sentence, with entire families and communities often falling ill, and only few on any treatment . • In 2001, President Obasanjo lunched the Nigeria’s national HIV/AIDS program with an initial goal to provide treatment for 10,000 people at 25 government sites • ARVs were supplied to clients at these facilities at the cost of $7 US per month • ARVs from the private sector cost $350 per month ( GDP per capita <$750, Health insurance coverage <5%, out of pocket expenditure>75%) • PLHIV were queuing to get enrolled and literarily praying for others “to move on”, so they could be enrolled HIV Prevalence in Sub- Saharan AFRICA 2003
  4. 4. PEPFAR funding enabled a period of rapid expansion. JUTH for example enrolled over 3000 patients within one year. New systems were created to accommodate the huge numbers. “ We had to move everybody on the waiting list into treatment……we had to open up all the days of the week for consultation” Clinician experience With PEPFAR intervention, patients were receiving HIV/AIDS care at par with the care in the US and Europe. Free treatment made a huge difference in the lives of the patients. “When PEPFAR fully came in , we started getting the drugs and the lab tests for free……and that was when the patients started coming out” - Igho Jefferson Patient experience PEPFAR Era: What changed in Nigeria?
  5. 5. ….Massive Scale up of ART Services 1074 1046 1357 2391 7075 8114 690 675 959 1410 5622 6546 393 446 491 516 820 1057 2009 2010 2011 2012 2013 2014 HCT Sites PMTCT sites ART Sites Number of HCT, PMTCT and ART sites in Nigeria (2009-2014) From only 25 sites in Nigeria in 2001, number of ART sites have increased to more than 1000, PMTCT sites to more than 6500. Majority of these sites are PEPFAR funded . Currently , APIN supports 664 sites (ART sites=339; PMTCT sites 325) through PEPFAR/CDC in 8 States in Nigeria
  6. 6. Number of people on treatment continues to increase over the years with PEPFAR responsible for 75% of the treatment numbers. APIN supports more than 25% of the PLHIV in the PEPFAR program in Nigeria …..Improved Access to care and treatment
  7. 7. PEPFAR-Supported PLHIV on Treatment, Nigeria, 2004–18 Growth by 141x 5,702 871,843
  8. 8. HIV Prevalence in Nigeria- 2001-2019 5.8 5 4.4 4.6 4.1 3 1.4 2001 2003 2005 2008 2010 2014 2019(NAIIS SURVEY) HIVPrevalence% Year Birth of PEPFAR Program in Nigeria
  9. 9. 5 NAIIS 2018 - HIV Prevalence by State Benue Akwa
  10. 10. Impact of PEPFAR on the Nigerian Health System • Nigeria’s is the third-largest U.S President’s Emergency Plan for AIDS Relief (PEPFAR) program and has received over $5 billion since 2004. • PEPFAR has positively impacted all building blocks of the Nigerian Health System
  11. 11. Financing the Nigerian HIV response $812,416,393 , 20% $35,009,929 , 1% $2,551,216,112 , 63% $642,968,497 , 16% National HIV/AIDS EXPENDITURE BY FUNDING SOURCE (2007-2014) GON Private PEPFAR Other Int'l agencies Source: NASA 2007-2014 Between 2007 and 2014, PEPFAR accounted for about two-third of Nigeria HIV/AIDS expenditure
  12. 12. Impact of PEPFAR-Leadership and Governance • Increasing political commitment and prioritization of public health issues among state actors. • More structured coordinating mechanisms. • Improved fiduciary management systems to meet the accountability standards required of such funding. • Emergence of formidable non-state actors now responding to and managing many more international grants and projects. Leadership, Governance
  13. 13. • Supported the establishment of logistic management coordination units across the country, building their capacity to track commodities across all facilities. • Integration of commodities supply across vertical programs such AIDS, TB, Malaria and family planning services • HIV/AIDS supply chain unification project and pooled procurement to drive down cost of ARVS and other commodities Impact of PEPFAR on Medicines and logistics management Logistics Management
  14. 14. Impact of PEPFAR on the Health Information System Nigeria • PEPFAR supported GoN to improve data quality and use for decision making • Moving HIV program data from paper base to electronic (EMR) – Improve quality, accountability and monitoring – NDR is allowing real time assessment of clinical experiences and outcomes. – Other programs leveraging on these successes. • Patient biometric system (PBS) in EMR is helping to avoid patients duplication and misidentification. APIN is taking lead in PBS in Nigeria • Quality data supporting learning and research APIN Health informatics structure
  15. 15. Impact of PEPFAR’s HIV/AIDS program on the Nigerian health system : Health work force § At the beginning of the epidemic in Nigeria, there were few Health care workers with capacity to provide services for PLHIV § PEPFAR supported massive capacity building initiatives § Training and re-training § On site technical assistance to health care workers § Curriculum development to address knowledge and skill gap § HRH policy development issues § New cadres of staff § Task shifting § Service integration post emergency phase of PEPFAR Health Workers
  16. 16. Impact of PEPFAR program Laboratory Support • Laboratory infrastructure development • Human capacity development • Quality Management System • Accreditation preparedness • Laboratory information management system
  17. 17. Laboratory Development Before After
  18. 18. PEPFAR Era: What changed? Leadership view Prof. I. Adewole - Former Minister of Health “PEPFAR gave patients hope, it epitomizes really our humanity, that compassion that comes with dealing with people who are sick….to show people that actually there is hope for the future” “And then the game changer (PEPFAR) came in 2003 and massively we changed the landscape. It has transformed the way we do business, the way we do research, the way we manage our clients” Dr Aliyu - Former NACA DG
  19. 19. Impact of PEPFAR’s HIV/AIDS program. Moving towards epidemic control: The unfinished business in Nigeria
  20. 20. Unfinished Business- Progress towards ownership and Sustainability $812,416, 393 , 20% $35,009,9 29 , 1% $2,551,21 6,112 , 63% $642,968, 497 , 16% National HIV/AIDS EXPENDITURE BY FUNDING SOURCE (2007-2014) GON Private PEPFAR Other Int'l agencies Source: NASA 2007-2014 • Need for greater momentum towards demonstrated state ownership and promotion of program sustainability • User fees for few services no longer supported by PEPFAR is a barrier to access of care, in the era of moving towards Universal Health Coverage.
  21. 21. ......Summary Points • The PEPFAR program, though not without some challenges, has truly been transformative not only of the national HIV/AIDS program, but the whole health sector in Nigeria. • From stages of denial and of HIV diagnosis being synonymous with a death sentence, the PEPFAR program now ensures high quality, affordable, acceptable and accessible care to PLHIV. • Non State actors that started off solely as PEPFAR implementing partners, have developed robust management systems that now enable them to apply for and manage many other grants. • Using evidence from recent surveys, PEPFAR is supporting the last push towards epidemic control of HIV in Nigeria. • For all these gains to be sustained and improved upon , the pace of assuming ownership by the government would need to be accelerated.
  22. 22. THANK YOU FOR LISTENING 10 Ndagi Mamudu Close | Behind Apostolic Faith Church | Jabi District, Abuja | Nigeria | ☎ +234-9-7809-377 | P.M.B 769 | Garki, Abuja | | www.apin.org.ng

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