Table 2 Summary of Key Findings

Leadership/Governance

Government Leadership, Government Commitment, Political Will, Continuity, Strategic Plans and Policies, Coordination and Coordinating Structures

Country ownership (CO) involves government providing strategic direction, showing more commitment and taking up more responsibility in the management of its HIV response

Government is demonstrating CO through the takeover of HIV/AIDS services in 2 states

Nigeria’s HIV response has been largely donor driven while lack of political will and poor leadership are some of the factors hampering CO in Nigeria

Advocacy to top government officials can engender CO

CO does not necessarily mean government should be responsible for direct implementation; CO also involves multiple stakeholders

Nigeria has strategic plans and policies that will engender CO

The Strategic Plan may not have the appropriate implementation plan

Respondents feel donor support should still continue for a while

Plans and Policy frameworks are crucial for attainment of CO

Nigeria has made significant progress when it comes to coordination

Paucity of funds may affect optimal functioning of Logistics Management Coordinating Unit (LMCU)

Government should maximize the presence of donors to strengthen other aspects of the healthcare system

Donor Support

Supply Chain System (SCS) must be adaptable

General in-country HIV coordination structures include, National Agency for the Control of AIDS (NACA) and National AIDS and STI Control Program (NASCP) at the national level, SACAs and LACAs at state and LGA levels respectively

Attention of donors may shift to other interventions or countries

Systems (possibly electronic) must be put in place to ensure accountability and the current administration appear to be pursing this vigorously

Transparency and Accountability, Public-Private Partnership

Sustainability involves continuity of program after termination of donor(s)’ support

National Product and Supply Chain Management Programme (NPSCMP), Procurement and Supply Management Technical Working Groups (PSM TWGs) and LMCUs are the Supply Chain Coordination Structures in the country (covers other programs outside HIV)

Transparency and Accountability in government is poor as procurement processes are sometimes not followed

Government must demonstrate willingness to be accountable in order to encourage private sector funding

Some level of program modification such as patients paying for HIV/AIDS services may be necessary for sustainability

There may be need and it appears plans are underway to establish LMCUs at local government level

Some shady deals may also be going on within the government settings

The private sector and partner can be of help to government in addressing certain challenges

Nigeria has a near-perfect Public Procurement Act

NACA may not have all the necessary structures for grant management

Government may need to move away from running the supply chain and donors may be more comfortable working through the private sector due to better accountability

Prevention

Government needs to prioritize prevention activities to reduce new infections

Healthcare financing

Domestic Funding, Bureaucratic Bottlenecks, Alternative Funding Sources

Funding of a large percentage of a country’s HIV response by the government is a marker of CO

There was a time a special intervention fund in form of President's comprehensive response plan (PCRP) was set up by government (this may still be on under a new name) and there are plans to increase funding

Inadequate domestic funding is the biggest challenge hampering CO which in turn has affected the ability of the government to bridge the gap left by donors.

Payment of subsidized fee for HIV services is recommended as a means of engendering sustainability and improving adherence

Private sector is involved in Nigeria’s HIV response and can be a possible source of financing Nigeria’s HIV response-even though government funding might just be sufficient

PCRP has an element of fund mobilization from the private sector

The challenge of funding is further compounded by the poor economic situation of Nigeria

Private companies should not be compelled by law to fund HIV response but can be incentivized to do so

There is evidence of sub-national fund allocation

There is evidence to show that funding for certain activities is being withdrawn

States can support HIV programme through their drug revolving fund (DRF)

There is visibility into funding of donors and government only bridges gap

Out of pocket payment by HIV patients may not be a viable option for domestic financing

Expansion of National Health Insurance Scheme (NHIS) coverage to the informal sector is also important

Funds budgeted by government are sometimes not released at all and when released are either not timely or not in full or both

High level advocacy to the relevant stakeholders can catalyze sub-national funding allocation

Available resources may hinder implementation of test and treat policy

Government funding should extend beyond procurement but must also cover other supply chain expenses such as port clearance, distribution e.t.c.

Significant co-funding by government may improve co-planning with donors

Health workforce

Human Resource for Health, Training and Mentoring, Capabilities and Behavioural Disposition

Most of the staff at the lower levels are Nigerians employed by government

There is adequate capacity at the national level (especially in the private sector) but not yet at the sub-national level

Advocacy to relevant authorities can help reduce transfer of trained staff to sites where there skills may not be needed

Private sector is involved and can be used for capacity building

Donor intervention has contributed to capacity building for healthcare workers

There is dearth of manpower for service delivery and the current poor economic situation may not allow for recruitment in the immediate future, Capacity also needs to be built on an ongoing basis

Workers need to be motivated for optimal performance through regular salary payment, absorption of ad hoc staff under appropriate terms of service

Pre-Service Training has been instituted in the schools of Pharmacy, Laboratory Science and Health Technology as a means of addressing the human resource capacity gap

Attrition of trained staff is a big challenge with remuneration differential contributing to this attrition as well as inequitable distribution of healthcare professionals

There may be need to prioritize certain professionals for some logistics roles

Capacity gaps exist in areas such as quantification and program management at the state and national levels

There may be need for professional recognition of logisticians and special remuneration for those performing logistics functions

Poor attitude to work is impacting negatively on CO

Task shifting will be of help in addressing the human resource challenge

Clear performance benchmark can address some of the attitudinal challenges

Proper planning and mentorship can help address capacity gap

Capacity of government officials need to be built as some changes are dependent on them

Government can also attract best brains from the private sector to improve public sector performance

It might be helpful to institutionalize logistics as a professional postgraduate programme in Nigeria

Medical products, technologies

Local Manufacturing, Unification and Integration, Infrastructure, Public-Private Partnership

Local production HIV commodities is a marker of CO

Nigeria has a unified HIV/AIDS Supply Chain which leveraged on existing government structures

Even though there is no local production of ARVs, local production has the potential of fostering price reduction and continuous product availability

Nigeria is in the process of integrating supply chain systems across multiple programme areas and this should enhance overall program effectiveness and efficiency

Nigeria has warehouses that can be used for commodity storage

The LMCU is the state-level technical arm for integration

Warehouse-in-a-Box is planned to be managed through a public- private partnership arrangement

Information and research

Data availability, Data Quality and Data for Action

The LMCUs have increased visibility into happenings in other program areas and use of data for decision making

Quality of data in other programme areas may need more improvement

Electronic data capture system will help improve data quality

Logistics data is available and of improved quality, there may however be need to put appropriate infrastructures in place

Logistics data is now being used for advocacy and decision making

LMCU is doing a lot on the use of data for action and is also serving as an avenue to stimulate improvement of the data quality for other program areas

Service delivery

Physical infrastructure Access, Integration

One of the major contributions of government towards CO is making available HFs for service delivery and payment of staff salaries

Infrastructures such as vehicles and even road network need to be improved upon

Donor support has contributed significantly to infrastructural upgrades. Donors and partners also provided infrastructural donations to LMCU

Government should consider integration of health services as this can potentially reduce the reporting burden on healthcare workers and reduce stigmatization

New sites are being activated to improve access but more needs to be done to improve coverage

Stigma has reduced while treatment acceptance has improved

Private health facilities are being used to improve access