Introduction
Nigeria remains the Global Fund’s largest investment portfolio. The Global Fund (GF) has contributed more than US$4.8 billion since 2002. These funds have contributed to major gains in HIV, TB, and malaria control, and in health systems strengthening. The Government of Nigeria (GoN) has initiated processes to increase the sustainability and the integration of the HIV response.
Background
HIV Funding landscape
Nigeria’s HIV response, while making significant strides, remains heavily reliant on international funding. In the 2021-2023 period, the country had a ~USD 1.1B allocation from PEPFAR and a ~USD 300M allocation from Global Fund.
Alignment agreement between Government of Nigeria, Global Fund and PEPFAR
In 2020, a national alignment agreement was reached between the Global Fund, PEPFAR and the GoN. The main objective of the agreement was to create a platform for joint planning between the two major donors funding the HIV response: to place GoN at the centre of national program planning and oversight and to avoid duplication of efforts, fully exploiting each entity’s comparative advantages to maximize the collective reach and impact of the investments.
During the first phase of the alignment (referred to as alignment 1.0), the HIV program achieved impressive results, and Nigeria is one of the few countries globally that maintained an upward trajectory in ART initiation despite disruptions caused by the COVID-19 pandemic. The program was able to scale up enrollment to treatment increasing ART coverage to over 85% in 2023 compared with 55% in 2019, a testament that the vision for the alignment was a game-changer in the fight to end HIV in Nigeria.
While significant successes were achieved under alignment 1.0 (2021-2023) concerns remained that the process followed in defining the strategic focus, roles, and responsibilities was driven by the international donors/funders and GoN and excluded other major some HIV stakeholders such as civil society, representatives of the client communities, private sector actors, and other multilateral organizations such as the UN joint team. To ensure that all key stakeholders were involved in shaping Alignment 2.0 (2024-2026), a 10-month consultative process was adopted to guide planning for the period 2024 to 2026.
New Business Model for HIV programming in Nigeria
As part of the alignment 2.0 process, New Business Model was proposed to strengthen Nigeria’s HIV control efforts, sustain and improve on current achievements while addressing the existing gaps limiting country ownership and sustainability by 2030.
The current HIV Service delivery model in Nigeria, where implementation is driven by PEPFAR implementing partners (IPs) and Global Fund Principal Recipients (PRs) and SubRecipients (SRs), has aided the country in achieving positive outcomes towards epidemic control. However, it has limited the ability of GoN structures to take leadership in direct program implementation. During the Alignment 2.0 implementation period (2024-2026), a transition readiness criterion will be developed, and a guided transition facilitated from IPs and PRs/SRs to states ready for direct implementation.
Recommendations of the Global Fund Technical Review Panel (TRP)
The TRP in its GC7 feedback to Nigeria, considered that more can be done to coordinate and integrate the HIV, TB and Malaria programs with RMNCAH services through Primary Health care indicating that there are insufficient integration efforts and suboptimal service delivery to reach children and women currently who are underserved by HIV, TB, and malaria programs.
The country was tasked to ensure that key high-volume primary health centers serve as one-stop centers for antenatal care, sexual and reproductive health care, HIV, Tuberculosis, malaria and integrated management of childhood illnesses.
In addition, TRP recommend that a situation room should be established to steer the implementation of integrated services for better coordination and integration of HIV, TB and Malaria programs with antenatal and broader RMNCAH Services in Nigeria in a process that includes all of the relevant stakeholders at national and state levels.
Ongoing Country efforts on Sustainability
There are three key normative documents related to HIV sustainability in Nigeria. First, the National Agency for the Control of AIDS (NACA) is developing a National HIV Sustainability Framework in line with the New Business Model. Second, UNAIDS leads the development of an HIV Response Sustainability Roadmap as part of the global response to the general challenge in the fiscal space for HIV. Lastly, the National AIDS, Viral Hepatitis, and Sexually Transmitted Infections Control Programme (NASCP) launched a five-year HIV Health Sector Sustainability Framework, which mainly aims to strengthen the capacity of State AIDS Control Programmes (SASCP) nationwide, starting with 12 states initially.
Moreover, in November 2020, a N50 Billion (US$150 Million) private sector-led Trust Fund promoted by the Nigeria Business Coalition Against AIDS (NiBUCAA) and NACA was established to ensure sustainable mobilization of resources from the private sector towards funding for HIV. To date there have been minimal investments by the Trust Fund.
The Trust Fund was set up to have a particular focus on the prevention of mother to child transmission of HIV (PMTCT) and toward funding strategic inputs such as ARVs, Test Kits, Reagents and the logistics to deliver these commodities to the facilities in different locations all over Nigeria where they are needed. The immediate beneficiaries are the HIV facilities while the ultimate beneficiaries are the Persons Living with HIV/AIDS in Nigeria.
Beyond HIV, there are ongoing cross-cutting efforts for scaling up health sector sustainability more broadly. The Nigeria National Health Sector Renewal Investment Initiative (NHSRII), launched in December 2023, aims to revitalize the country’s healthcare system by enhancing primary health care services and achieving universal health coverage. Central to this initiative is the adoption of a Sector-Wide Approach (SWAp), which promotes coordinated efforts among federal and state governments, development partners, and other stakeholders to address challenges such as inadequate financing, workforce shortages, and infrastructure deficits. The SWAp emphasizes the principles of “One Plan, One Budget, One Report, One Conversation,” ensuring alignment and efficiency in resource utilization.
Positioned as the core vehicle for health sector sustainability in Nigeria, the SWAp fosters alignment among federal and state governments, development partners, and other stakeholders under a unified framework. This coordinated effort aims to reduce fragmentation, enhance resource efficiency, and ensure that all initiatives contribute cohesively to the country’s overarching goal of Universal Health Coverage.
Objective
The purpose of this consultancy is to support and advance HIV sustainability and integration efforts in Nigeria by assisting in the development and implementation of key national sustainability documents, facilitating primary care integration, supporting discussions on cofinancing commitments, and leveraging private sector resources to enhance long-term HIV care and prevention. The consultancy will contribute to:
Experience and skills
Education
Essential:
Desirable:
Experience
Essential:
Desirable:
Competencies
DEADLINE: 28 April 2025
