Background

An example of this leadership is illustrated by Obasanjo’s introduction of the Nigerian National ART Programme in 2001 which led to the purchase of antiretrovirals (ART) for 10,000 adults and 5,000 children.

“Within the (former) administration some strong advocates for AIDS have emerged, including President Obassanjo. There is an opportunity to continue the legacy of Obbasnajo by demanding that this commitment be kept by (the new government) allocating funds from the national budget to support AIDS responses,” stated Nancy Snauwaert, UNAIDS Partnership Adviser in Nigeria.

The National Agency for the Control of AIDS (NACA) was established in 2000 to coordinate the multisectoral response to AIDS. Recently, NACA was established as an independent agency. The board of the new Agency has representation from civil society including the umbrella body, Civil Society for HIV in Nigeria (CiSHAN), the Network of People living with HIV/AIDS in Nigeria (NEPWAN), Society for Women and AIDS in Africa, Nigeria (SWAAN) and others. NACA extends to all states through the State Agencies for the Control of AIDS (SACAs) and to district level through the Local Agencies for the Control of AIDS (LACAs).

In 2001, Nigeria joined other African countries in signing the Abuja Declaration, committing to allocate at least 15% of its annual budget to the improvement of the health sector. However, in 2006, the country allocated only 5.6% of its annual budget (including debt relief gains) to health, which illustrates that even with increased budgetary allocations, the health sector is still inadequately funded. In addition, only 1% of the 2006 budget was spent on HIV10. A National HIV/AIDS Strategic Framework (NSF) has been developed to guide the country’s response to AIDS from 2005-2009. In 2006, the NSF was costed and some states developed state strategic plans11. The NSF is implemented by partners including government, NGOs, community-based organisations, faith-based organisations and people living with HIV/AIDS.

Target Setting: Where Are We?

Compared to most sub-Saharan African countries, the discussion of universal access is well advanced in Nigeria. “The universal access process is quite far along in Nigeria. Two separate consultations were held to set targets and a roadmap was drawn up in February 2006. The targets were presented in Brazzaville in March 2006,” stated Olayide Akanni of Journalists.

Against AIDS (JAAIDS). The groups consulted during the WACST visit mentioned that there was a lack of clarity or consensus regarding universal access targets. Best known are the ‘President’s targets’, set in June 2005 by former President Obasanjo, which aimed to place 250,000 PLWHA on ART by the end of 2006.

“The President’s targets (putting 250 000 people on treatment) were set up arbitrarily without due consultation or input from civil society. It is seen more as a political statement without a plan or any resources allocated,” added Akanni.

“It is difficult to pinpoint which targets are accepted for universal access, as there are other targets set by the President. These treatment targets are better known and owned nationally, and could be what policymakers are held to account to,” stated Snauwert.

Some groups identified the review of the NSF in 2007 as a key opportunity to confirm targets. “The challenge is that there are several targets including those in the NSF as well as the 80% target set in Abuja. There is a need to harmonise targets in Nigeria and one set of country-specific targets have been advocated for by civil society.

However, for targets to be adopted and owned, it has to be done in a governmental process. The targets need to be meaningful, because if this target setting is led by civil society, these targets would not be owned by the country. The NSF offers an opportunity to build on national milestones and to look at these under universal access,” stated Snauwert.

“In the NSF, there is a strong section on promoting, monitoring, and advocating with government to agree on clear targets. An additional issue is not only confirming the targets, but accelerating action to reach them.” she added.

These groups questioned the rationale behind the set targets and emphasised that setting targets is not sufficient; an action plan to achieve them is needed. During WACST’s discussions with civil society groups, they noted that few inroads had been made to follow up on the implementation of universal access plans.

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