Nasarawa State, Nigeria Report of Rapid Assessment in Selected - PDF - PDF by tsw71223


									Nasarawa State, Nigeria
Report of Rapid Assessment In Selected LGAs

Assessment Team:
Mr. Adamu Imam, FHI/Nigeria
Mr. Olusina Falana, FHI/Nigeria
Dr. O. Faweya, FHI/Nigeria
Dr. Denis Jackson, FHI/Europe
Dr. Olakunle Odumosu, NISER
Ms. Sujata Rana, FHI/Arlington
Ms. Julie Victor-Ahuchogu, FHI/Nigeria

              FA M I LY H E A LT H I N T E R N AT I O N A L   •   DECEMBER 2000
Rapid Assessment Report

Table of Contents


Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

1.    Introduction/Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

2.    Methodology and Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
3.    Nasarawa State Government                        . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

4.    Lafia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
      4.1   Political environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
      4.2   Risk environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
      4.3       Private/civil society environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
      4.4       Care and support networks and structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
      4.5       Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

5.    Keffi      ...................................                                .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .12
      5.1       Political environment . . . . . . . . . . . . . . . . .             .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .12
      5.2       Risk environment . . . . . . . . . . . . . . . . . . . .            .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .12
      5.3       Private/civil society environment . . . . . . . .                   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .12
      5.4       Care and support networks and structures                            .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .13
      5.5       Observations . . . . . . . . . . . . . . . . . . . . . . . .        .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .13
6.    Akwanga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
      6.1 Political environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
      6.2       Risk environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
      6.3       Private/civil society environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
      6.4       Care and support networks and structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
      6.5       Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
7.    Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
8.    Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Appendix A:           Persons Met . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Appendix B:           Rapid Assessment Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

                                                                    Nasarawa State

AIDSCAP    AIDS Control and Prevention Project
AIDSTECH   AIDS Technology Project
ANC        Antenatal cases
CBO        Community-based organization
CHEW       Community health extension worker
CHO        Community health officer
D&G        Democracy and Governance
ERCC       Evangelical Reformed Church of Christ Medical Services
FCT        Federal Capital Territory
FSW        Female sex worker
FHI        Family Health International
HBC        Home-based care
HOD        Head of department
IMPACT     Implementing AIDS Prevention and Care Project
JNI        Jama’atul Nasrul Islam
BFI        Baby-friendly initiative
KDF        Keffi Development Foundation
LGA        Local Government Area/Authority
MTCT       Mother-to-child transmission
NACA       National Action Committee on AIDS
NANNM      National Association of Nigeria Nurses & Midwives
NASCP      National AIDS and STD Control Programme
NAWOJ      National Association of Women Journalists
NCWS       National Council for Women Societies
NCWYCA     Nigerian Centre for Women, Youths and Community Action
NGO        Non-governmental organization
NMA        Nigerian Medical Association
NOA        National Orientation Agency
NPI        National Programme on Immunization
NURTW      National Union of Road Transport Workers
NUT        Nigerian Union of Teachers
NYSC       National Youth Service Corps
OLA        Our Lady of Apostles Hospital
OVC        Orphans and other vulnerable children
PHC        Primary health care
PLHA       Person/people living with HIV/AIDS
PS         Permanent Secretary
SFH        Society for Family Health
SSG        Secretary to the State Government
STD        Sexually transmitted diseases
STI        Sexually transmitted infections
TB         Tuberculosis
UNDP       United Nations Development Programme
UNFPA      United Nations Fund for Population Activities
UNICEF     United Nations Children’s Fund

Rapid Assessment Report

Executive Summary
In the initial phase of the IMPACT Project, FHI has been           Major Findings:
working with a variety of NGOs and national organiza-
tions to develop pilot initiatives in working with high-risk       • HIV/AIDS was generally seen as a problem.
populations. Under the next phase of the IMPACT proj-              • There was an increase in HIV-positive cases according
ect, FHI, working closely with National Action                       to hospital data, though it was difficult to clearly
Committee on AIDS (NACA), state and local government,                identify or locate the risk settings where these PLHA
plans to concentrate lessons learned in key high-risk areas          are coming from.
in Nigeria. The goal of the second phase is to develop             • The implementation of Sharia law was perceived to
comprehensive programming in key risk areas for both                 have influenced the influx of sex workers into
prevention and care. This will entail working with pilot             Nassarawa State.
Local Government Authorities (LGAs) to develop strate-             • The proximity of the state to the Federal Capital
gic plans of action and work with high risk and vulnera-             Territory has complicated the HIV/AIDS situation in
ble populations through local organizations and structures           the State.
in selected key risk areas. In each selected risk area, FHI        • There was little sense of “real demand” for prevention
will work with a variety of partners to reach those identi-          and care services – the government officials did not
fied as being at high risk and ensure that their care and            mention any specific programming problems that they
support needs are met. Where possible, this work will be             have had to confront yet.
linked to work with national and state organizations and           • Very few NGOs/CBOs programming in HIVAIDS/STI
structures, such as the FHI collaboration with the military,         were active on the ground - out of these, only a very
police, unions and schools.                                          few have any technical and programmatic capacity.
                                                                   • The skills and knowledge of healthcare providers were
Based on the FHI desk assessment of high-risk areas,                 observed to be limited.
Nasarawa State was identified as one of the states for
rapid assessment. A seven-member team visited Nasarawa             It was discovered that the Government of Nasarawa State
State in November 2000 to carry out a rapid assessment             actively supports and endorses Dr. Jeremiah Abalaka’s
of the HIV/AIDS situation there. The objectives of the             claims of having a cure for HIV/AIDS. Abalaka is a
assessment were to identify risk settings and behaviors;           Nigerian surgeon with wide claims of curing HIV/AIDS.
risk populations; potential implementing partners, net-
works and structures for prevention, care and support;
and health and social welfare systems and structures.              Recommendations:

The LGAs visited include Akwanga, Nasarawa Eggon,                  The team recommends further clarification of the state’s
Keffi and Lafia. At the state level, the team met with gov-        support for experimental therapies before any comprehen-
ernment officials in the ministries of health, women’s             sive prevention and care programming can be considered.
affairs, information, youth and sports, and education.             The Policy Project would seem to be best placed to pro-
Discussions were also held with officials of the State Local       vide the necessary orientation and advocacy.
Government Service Commission. The officials met pro-
vided enlightening perspectives of the perceptions of the          Once state level advocacy is completed, it will still be nec-
epidemic in Nasarawa State and discussed opportunities             essary to mobilize and raise the level of public awareness
for effective action. In addition to meeting with LGA and          regarding HIV risk behaviors and risk settings. The
state officials, the team also met with primary, secondary         capacity building among local health care providers,
and tertiary health care facilities and local NGOs based in        NGOs and other local organizations could occur simulta-
the state.                                                         neously so that the resultant demand for prevention and
                                                                   care activities can be met.

                                                                                                              Nasarawa State

1. Introduction/Background
Family Health International (FHI) is a private voluntary            FHI is using a participatory process as follows
organization based in the United States. FHI has more               • Rapid assessment in selected states and LGAs
than 30 years of experience in reproductive health, partic-         • Selection of partners
ularly in the areas of family planning and HIV/AIDS.                • In-depth assessments
With funding from USAID, FHI has been working for                   • Project design
more than a decade in HIV/AIDS programming in Nigeria               • Project implementation and evaluation.
through various projects: AIDSTECH (1988–1991); AID-
SCAP (1992–1997); a Bilateral Grant Agreement                       This overall comprehensive approach is aimed at estab-
(1997–1998); and the IMPACT Project that began in                   lishing a synergy of effort for a greater impact to ensure
1998. FHI has developed excellent collaborative rela-               the necessary linkages between prevention and care for
tionships with both public and private sector organiza-             high risk and vulnerable populations.
tions in Nigeria including non-governmental organiza-
tions (NGOs) and community-based organizations                      This report details the rapid assessment conducted in
(CBOs).                                                             Nasarawa State.

In the initial phase of the IMPACT project, FHI collabo-            The desk assessment revealed that despite a high HIV
rated with a variety of NGOs and national organizations             prevalence (10.5%) there seems to be a low level of com-
to develop pilot initiatives for working with high risk pop-        munity responses. In order to assess the community per-
ulations. Under the next phase of the IMPACT project,               ception of HIV/AIDS and to better understand the
FHI, will work closely with the National Action                     responses on the ground, FHI selected three LGAs for the
Committee on AIDS (NACA), state and local government,               rapid assessment: Keffi, Lafia and Nasarawa Eggon
to concentrate lessons learned in key high-risk areas in
Nigeria. The goal of the second phase of the project is to
develop comprehensive prevention and care and support
programming in key risk areas. This will entail working
with pilot LGAs to develop strategic plans of action and
working with high risk and vulnerable populations
through local organizations and structures in selected key
risk areas. In each selected risk area, FHI will work with
a variety of partners to reach those identified as being at
high risk and ensure that their prevention and care needs
are met. Where possible, this work will be linked to work
with national organizations and structures, such as the
FHI collaboration with the military, police, unions and

To initiate the second phase, FHI conducted a desk assess-
ment of HIV/AIDS data in Nigeria. Based on the findings
of the desk assessment exercise, a set of criteria was devel-
oped for selecting states/LGAs where comprehensive pro-
grams will be implemented. The criteria included the
prevalence rates and existence of high risk settings, fol-
lowing which FHI selected five states; Anambra, Kano,
Lagos, Nasarawa and Taraba for an initial rapid assess-
ment with plans to finally select four states for compre-
hensive programming.

Rapid Assessment Report

2. Methodology and Objectives
The rapid assessment methodology is based on the initial
development of a rapid assessment tool. The tool is then
used to guide key informant interviews with government
officials at state and local government levels, NGOs, key
institutions and key health care workers in major health

The objectives of the assessment were to identify:

• Risk settings and behaviors
• Risk populations
• Potential implementing partners, networks and struc-
  tures for prevention and care programming
• Health and social welfare systems and structures
• Political environment

                                                                Nasarawa State

3. Nasarawa State Government
Nasarawa State, located in the North-Central zone of
Nigeria, was created out of Plateau state in 1996. At the
time, the population of the new state was projected to be
1,645,000 (according to the official 1991 census:
1,125,016) with the 2000 figures estimated to be over 2

The state has 13 LGAs: Toto, Keffi, Karu, Keana, Doma,
Obi, Nasarawa, Nasarawa Eggon, Kokona, Akwanga,
Wamba and the state capital, Lafia.

The rapid assessment team met with government officials
in the Ministry of Health, Directorate of Local
Government, Ministry of Women’s Affairs, Ministry of
Information and Ministry of Education. The ministries
provided enlightening perspectives of the perceptions of
the epidemic in Nasarawa State and discussed opportuni-
ties for effective action

Rapid Assessment Report

4. Lafia
4.1 Political environment                                           Ministry of Women Affairs and Social Development
                                                                    This ministry felt that HIV/AIDS is mainly a “health issue”
Lafia is the state capital of Nasarawa State with a popula-         so it does not implement prevention activities although the
tion of about 350,000. It is the most densely populated of          ministry is a member of the State AIDS Committee. The
all the LGAs visited. It is the major commercial nerve cen-         ministry’s main focus is child welfare and women’s empow-
ter in the state, located on the link road between the north        erment. Related activities that could be linked with future
and east of the country.                                            HIV prevention efforts are girl child and street children
                                                                    education and women’s empowerment programs such as
Ministry of Health                                                  micro-credit. The Permanent Secretary reportedly felt that
The Ministry of Health’s current health activities are              any HIV prevention efforts must work at improving par-
focused on such childhood killer diseases as measles, polio         ent-to-child communication around sexuality.
diphtheria, tuberculosis and pertusis. In this area, the
state has very good partnerships with UNICEF, WHO,
UNFPA and USAID. A specific goal of reducing maternal               Secretary to the State Government (SSG)
and infant mortality rates has been set and many repro-             The SSG, was well aware of the efforts of the state MOH
ductive health centers have been created.                           and Minstry of Women Affairs in the area of HIV/AIDS.
                                                                    He also felt that one of the bold steps taken by Nasarawa
Poverty was reportedly a major factor in many of the fam-           State in fighting HIV/AIDS was to link up with Dr.
ily-related illnesses/diseases. HIV’s “endemic nature” is due       Abalaka in Abuja. Factors that could promote the spread
to the state’s proximity to the Federal Capital Territory           of HIV were said to be polygamy, poverty and the pres-
(FCT), Abuja. HIV/AIDS is referred to as “Abuja                     ence of large numbers of female sex workers (FSWs).
Disease.” There is a sporadic increase in the state’s popu-
lation due to influxes of people from sharia states in par-         Ministry of Education
ticular. Critical LGAs most in need of HIV programming              The Ministry of Education has been involved in general
efforts are Lafia, Nasarawa Eggon and Karu.                         health promotion talks in schools throughout the state
                                                                    with a total of 133 secondary schools, 28 private second-
Currently, the State AIDS Program Coordinator is active-            ary schools, four tertiary schools and four vocational
ly involved in social mobilization efforts within the health        training schools. This ministry, in collaboration with the
sector. A multisectoral AIDS committee has been estab-              Ministry of Youth and Sports and the National
lished, featuring government and NGO representation, to             Orientation Agency (NOA), implements a program direct-
implement planned activities for 2001. However, the                 ed at the prevention of cultism, HIV/AIDS and drug abuse
Ministry of Information will be in charge of “social mobi-          throughout the state.
lization” for HIV/AIDS. Youth are at high risk and need
to be reached through community efforts (“should go                 In partnership with UNFPA, the ministry of education
along with condoms”) and integration of HIV/AIDS edu-               strongly promotes family life education and adolescent
cation into the school-based curriculum. The state has              reproductive health throughout the school system. This
also successfully linked a local NGO in HIV/AIDS pre-               program is being implemented at two levels, by incorpo-
vention activities and hopes to involve more NGOs in its            rating relevant subject matter into the school curriculum
multisectoral approach to HIV programming.                          and training teachers. Teachers and guidance counselors
                                                                    are trained to use the curriculum. In the long term, the
The state refers PLHA to Dr. Jeremiah Abalaka for care              program aims to have anti-AIDS clubs and health clubs to
and support. Abalaka is a Nigerian surgeon who claims               sustain prevention efforts. Peer education training is also
to be able to cure HIV/AIDS. In fact, Nasarawa State has            being planned.
given Dr. Abalaka some N8.5 million, mostly for equip-
ment. Blood safety is a technical area of concern because
most clinics do not screen for HIV before blood transfu-
sion even though test kits are available in public health
facilities across the state. Laboratory workers are report-
ed to be inadequately trained.

                                                                                                            Nasarawa State

Chairman of the Local Government                                  Chairman of Lafia LGA
Service Commission                                                The Chairman of Lafia LGA was not available as he was
The team was encouraged to meet with relevant LGAs as             away defending the LGA budget at the State House of
the problem of HIV/AIDS needs to be combated at the               Assembly. However, the team met with Council Secretary
grassroots level. While the chairman felt that “AIDS is           Alhaji Muhammad Hamza and he provided some relevant
everywhere”, he also voiced the opinion that many people          documents on the LGA.
hide in the villages once they discover their HIV status.

Commissioner for Information, Youth and Sports                    4.2 Risk Environment
The Commissioner for Information, Youth and Sports
described the overall HIV/AIDS outlook as serious as              Lafia is a transit route linking the northern and eastern
“there is no extended family that has not suffered AIDS.”         sections of the country. The LGA has major truck and bus
He said Nasarawa State has the “misfortune of being close         stops bustling with activities during the day.
to Abuja” as this has complicated the HIV/AIDS situation
in the community.                                                 Poverty and ignorance are the biggest factor contributing
                                                                  to the spread of HIV/AIDS. Other contributory factors are
Awareness of HIV/AIDS is high but the response mecha-             the increase in the number of “sugar daddies” (adult sex-
nism is low. There is need for greater enlightenment in           ual partners) due to the economic situation of some fami-
terms of HIV/AIDS prevention. He says government is               lies. It is not uncommon to have a substantial number of
highly interested in working in partnership with various          teenage girls drop out of school due to unplanned preg-
relevant bodies such as NMA, NANNM, NUT, NYSC,                    nancy.
Medical Laboratory Scientists, Nasarawa State Youth
Council, Nassarawa State Student Associations, State              Youth are the most vulnerable to HIV infection but the
Chapter of NAWOJ, NCWS, JNI and religious leaders.                rural populace are and even more “endangered species”
                                                                  than the traditional social groups. Officials and NGOs are
The Ministry of Information has been mandated to devel-           most concerned about the youth. HIV prevention activi-
op a comprehensive public awareness program for                   ties are needed that focus on youth in order to have an
HIV/AIDS, and prevention and initial activities (public           impact on the epidemic because the greatest opportunities
awareness/enlightenment campaign) have begun. Religion,           for prevention programming lay in intervening with
taboos, poverty, gender issues and low literacy are crucial       youth.
issues that may affect HIV/AIDS programming.
                                                                  The geographic areas where risk behaviors take place are
Youth are the most vulnerable to HIV infection but the            usually around “hotels” where sex workers are based.
rural populace was said to be more of an endangered               Cinema halls were said to be another common setting for
species than the “traditional social groups.” Blood trans-        risk behaviors. The Nigerian Centre for Women, Youths
fusion is another source of spread. An effective HIV/AIDS         and Community Action (NACWYCA) recently organized
program in the state should include the following:                a workshop for transport workers, women’s organizations
                                                                  and other risk populations such as “going riders” (motor-
• Direct campaign through village and rural associations          cycle taxi service).
• Integration of HIV/AIDS into the National
  Programme on Immunization (NPI)—considered
  important for reaching out to the general population
• Church groups
• Other religious bodies
• Social groups
• NYSC anti-AIDS clubs
• NUT—health science teachers in particular
• Media campaign through the radio in local languages
• News magazines in local languages
• Using government functions where the governor and
  commissioners can speak about HIV/AIDS

In all the commissioner said a direct campaign is the most
effective since participants will be able to ask questions.

Rapid Assessment Report

4.3 Private/Civil Society Environment                                4.4 Care and Support Networks and Structures

NACWYCA is a two-year-old NGO based in Lafia.                        The state specialist hospital has 137 inpatient beds, with a
Though new to HIV programming, the agency has a good                 catchment area of 30-40 kilometers, covering seven LGAs:
history of community-based programming focussed on lit-              Idoma, N/Eggon, Awe, Keana, Obi, Akwanga and Lafia.
eracy and micro-credit schemes. NACWYCA currently                    Referrals are received from four PHC clinics, cottage hos-
works in three communities in two LGAs, two in Lafia                 pitals, private hospitals and one traditional healer as well
and one in Obi.                                                      as self-referrals. There are six doctors, 60 nurses and 25
                                                                     ward orderlies. There are five PHC clinics in Lafia. The
NACWYA’s move into HIV prevention was motivated by                   hospital does not receive referrals from NGOs or church-
the understanding that HIV is a major problem in                     es and has one counselor who was trained by UNFPA.
Nasarawa and that HIV is more than just a “health prob-
lem.” With funding from UNDP, NACWYA recently con-                   The hospital conducts HIV testing, and the main popula-
ducted an awareness campaign, which included a work-                 tion screened is ANC attendees (for sentinel surveillance
shop for women’s organizations and transport workers.                purposes). Screening is also done for diagnostic purposes
NACWYA staffs were trained by the Society for Family                 and for blood transfusion. Blood donors are tested before
Health on HIV/AIDS as preparation for this workshop.                 bleeding, and the positive ones are deemed unfit to
NACWYA has received requests from the Chairmen of                    donate. Donors who test positive are not informed of
Nasarawa Eggon, Keffi and Toto LGAs to assist in HIV                 their HIV status.
programming. At the moment, NACWYA is actively
involved in the state’s AIDS committee. There are more               The medical superintendent noted that there is a shortage
opportunities for this organization to be linked to govern-          of gloves, disinfectant household bleach (sodium
ment-level programming, as Mr. Aboki is also the perma-              hypochlorite)—the essentials of universal precautions. He
nent secretary of the Bureau of General Administration.              does not have a copy of the National Policy on HIV/AIDS
                                                                     but he does have guidelines on universal precautions from
Other than HIV prevention programming focused on                     UNFPA. Working in the hospital for four years, he
youth, NACWYA is in contact with two PLHA and they                   observed that the number of HIV/AIDS cases has been
are being encouraged by the state to consider setting up a           increasing. There are a large number of self-referrals to
PLHA group. The organization is also interested in set-              the hospital. Suspected TB cases are referred to
ting up a counseling center.                                         Evangelical Reformed Church of Christ (ERCC) Alushi,
                                                                     and Our Lady of Apostle (OLA) hospital, both in
As an institution, NACWYA seems to be well organized                 Akwanga since the hospital does not have reagents, etc.
and has a current budget and workplan, is legally regis-
tered with the relevant authorities and has three paid staff.        Paediatric ward
The office is located in a house with three rooms and has            The most common childhood illnesses include malaria,
two computers, which were running on solar power. They               vomiting diarrhea, malnutrition, measles, meningitis,
produce regular newsletters and have a good understand-              typhoid, and chicken pox. Chicken pox, measles and
ing of the principles of program planning and manage-                diarrhea cases increase during the dry season (October to
ment. The team was informed that there was going to be               April). One (1) case of TB was referred to ERCC, Alushi,
a management retreat in early December to prepare the                this year.
2001 workplan and budget.
                                                                     Oral thrush in children above three months old is uncom-
                                                                     mon, and only six pediatric HIV cases have been con-
                                                                     firmed since the beginning of the year. Treatment is symp-
                                                                     tomatic, with no structured follow-up. HIV testing is
                                                                     done only when there is no improvement on treatment of
                                                                     clinically diagnosed ailments, as parents must pay for the
                                                                     test (about N350.00). It is unclear whether HIV-positive
                                                                     cases are followed up or not.

                                                                     Adult male medical and surgical ward
                                                                     The nurse in charge reported that they have about three
                                                                     cases of suspected HIV/AIDS weekly. Patients usually
                                                                     present with rashes, diarrhea, cough and are always ema-
                                                                     ciated. The number of patients seen in the last 10 months

                                                                                                                Nasarawa State

has remained the same. AFB positive patients are usually            4.5 Observations
referred to the ERCC Alushi (state referral center) and no
further related services are provided at this location. The         The assessment team did not understand the extent of
patients are also referred to the in -house counselor.              active state support for Dr. Abalaka until its visits to var-
                                                                    ious state officials. Given the level of commercial activi-
The nurse was also worried about the community percep-              ty, geographic location of the town (transit road) and the
tion about AIDS. The idea that AIDS is unreal and claims            relatively large population, it would seem that the levels of
of cure have given the populace a sense of false security           risk behaviors and risk settings are the most concentrated
that encourages unprotected sex. The use of the same drip           in this LGA.
set and needles by up to 10 patients in unlicensed “hospi-
tals” run by unqualified practitioners in the villages will
allow the AIDS epidemic to increase.

The laboratory attendant, Mr Adamu Ohagene indicated
that spot tests are done in the laboratory to screen for HI.
The immunocomb and immunoconfirm supplied by the
PTF last year for sentinel surveillance have expired, so
they purchase the generic spot test made by different com-
panies. The spot test presently being used is Red Dot Test:
Cal-Tech diagnostic Inc; Chino, CA 91710, USA.

No pre- or post-test counseling is done, so blood donors
who test positive for HIV are sent away without being
informed of their serostatus. Twenty percent of blood
donors test positive, while the hospital’s suspected AIDS
cases have increased. Out of a total 218 tested (not regu-
lar or consistent testing) over the last three years, 108
were positive. The medical lab scientist does not have the
national HIV policy guidelines on universal precautions;
he relies on bio-safety measures taught in school. It was
observed that much work is required in biosafety in order
to reach acceptable standards.

PHC Clinic and Maternity Center
The key informant stated that she had been informed by
state officials that 30-40% of her ANC cases tested HIV-
positive from samples collected from her clinic in the sero-
surveillance survey of 1999. The clinic provides services
for pregnant women and postnatal care for children
between one and nine months of age. There are two nurs-
es and four CHWs, providing 24-hour in- and outpatient
care. The center has reciprocal referrals for delivery from
the State Specialist hospital.

Rapid Assessment Report

5. Keffi
5.1 Political Environment                                            number of commuting workers from all over the country
                                                                     and the involvement of these workers in possible risk
The assessment team met with Alh. Tanimu Dogara, direc-              behaviors in Abuja seem to be of concern.
tor of the PHC in Keffi LGA. It was not possible to meet
with the chairman of the LGA as arranged, but the team               Youth are considered to be the most vulnerable in this
was well assisted by Sambo Tukur, deputy sirector PHC                environment – there are two tertiary institutions and seven
and Lawal Ramallan, clerk to the Keffi Local Government              secondary schools.

Despite having an AIDS Action Manager, HIV/AIDS efforts              5.3 Private/Civil Society Environment
within this LGA seem to be in the very early stages. A recent
campaign was launched which comprised “health talks”                 The team met with two NGOs, the Keffi Development
given to women visiting health facilities. Other health serv-        Foundation (KDF) and the National Union of Road
ices provided in this LGA consist of TB, Onchocerciasis,             Transport Workers (NURTW/ Keffi branch). At both
family planning and immunization campaigns.                          meetings, the response from members of these NGOs was
                                                                     very positive. The NURTW has a membership of 2,000
The current 2000-2001 budget has funds allocated specif-             transport workers within this LGA. While they have no
ically for HIV/AIDS activities. This is the first time that          specific program focussed on HIV/AIDS, they have been
such funds have been set aside. But there is no workplan             involved in some “public enlightenment” events. At the
to go with this allocation of funds. Discussions with the            monthly meetings, the issue of HIV/AIDS is discussed reg-
PHC director and other staff revealed that the funds could           ularly. Five union members were reported to have died
perhaps go into prevention efforts targeting FSWs and ter-           this year of diseases suspected to be related to HIV/AIDS.
tiary level students.                                                While this could not be verified, it was clear to the team
                                                                     that these key union figures were well sensitized to some
                                                                     aspects of HIV/AIDS transmission. It was emphasized
5.2 Risk Environment                                                 that all members are encouraged to go to health centers
                                                                     with their own new needles/syringes and all the key
The most commonly mentioned risk populations were                    informants voiced a demand for condoms. NURTW/Keffi
FSWs and youth (specifically tertiary school students).              has received condoms in the past from National Youth
The most common location where commercial sex is                     Service Corps Doctor as well as an unidentified NGO
transacted is hotels where it is common to have FSWs.                from Abuja. It was interesting that the demand for con-
The major geographic area where these hotels/bars are                doms was very specific – they felt that the condoms avail-
located is Makwalla. Besides bars/hotels, this area has a            able in the local chemists were of poor quality.
large cinema hall and numerous street hawkers/vendors.
The Keffi Development Foundation (KDF) also mentioned                NURTW seems ready to scale up its HIV/AIDS efforts.
a trend of migrating sex workers moving into this area.              The interest and awareness of risk behaviors is there but
This migration is a direct result of the introduction of the         they have received no formal HIV training and the format
sharia legal system in neighboring states.                           for conveying critical information is in the form of lec-
Given the population of Keffi town (50,000; LGA
150,000) and its proximity to Abuja, it is not an overnight          The KDF is a non-profit, non-religious organization
truck stop. In fact, the main part of town is located off            whose mission is to “contribute to the welfare of its mem-
the main road. The motor park is divided into a garage               bers and the entire people of Keffi town.” KDF is a total-
area and a passenger loading/unloading area. There are a             ly voluntary organization and most of its funds are raised
few small stalls serving food although most of the food is           from its members. They have one paid full-time typist and
sold to passengers by child hawkers (boys and girls).                all other activities are carried out by members on a volun-
There did not seem to be any obvious locations for FSWs              tary basis.
within the motor park or its environs.
                                                                      KDF’s experience is centered on two main activities, pro-
One area of concern in terms of perception of risk behav-            viding health service for the general public and helping
ior is the fact that there is a large number of commuters            youth with education. They have built a block in the local
from Nasarawa state who work in Abuja. The growing                   general hospital to help house the visiting/accompanying

                                                                                                               Nasarawa State

relatives of patients. They have also conducted eye camps          PHC and BFI Clinic, Unguwar Waje
and general health camps. Interestingly, KDF seems to              Mrs Lami Rabiu, the nurse in charge, had never seen a
have great success working collaboratively with the NGO            patient suspected of HIV infection, and thought that gen-
and government sector. On some larger projects, they have          eral morbidity in the population was falling. She refers
been able to access LGA funds (LGA staff are members of            suspected TB cases to Federal Medical Centre.
KDF) and in the case of health camps, they have partnered
with one international NGO. Until now, they have not               Federal Medical Centre, Keffi
conducted specific HIV-related activities although the             Dr Samuels, medical officer (MO), and Mrs Usman,
interest is there. They have no clear plans for incorporat-        matron, received the team. The overall impression was
ing HIV into their ongoing youth programs.                         that of a well-run district hospital with committed staff.
                                                                   There are 78 inpatient beds, four doctors, 43 nurse/mid-
As an institution, KDF seems to be well organized. It has          wives and 45 ward orderlies. They serve a total popula-
a current budget, is legally registered with the relevant          tion of approximately 250,000 people in four LGAs:
authorities and has a branch office in Kaduna. Funds               Keffi, Karu, Kokona and Nasarawa. There has been an
seem to be readily available from within the organization          increase in the number of HIV-positive patients over the
as monthly and annual membership dues and special levies           past year, with one or two a week confirmed after clinical
are in place. KDF has successfully raised funds from com-          suspicion. Referrals are received from a 70-km radius,
munity members and almanac launches as well. They have             while difficult cases are referred to Gwagwalada specialist
both a savings and current account and they have several           hospital in Abuja and Jos University Teaching Hospital.
committees, including an audit committee, which ensure             The hospital procures HIV rapid kits in the open market
accountability of funds and activities.                            and operates a cost recovery system. The hospital is one
                                                                   of the 1999 HIV sentinel surveillance surveys respondents.
The perceived limitations to HIV/AIDS programming in
the community were said to be “lukewarmness” of the                Patients who are highly suspected of having AIDS or with
community members and government inaction (as opposed              persistent STD symptoms, surgery, blood donation are
to being proactive). Some members felt it is essential for         tested for HIV. HIV prevalence in blood donors is over
the government to take a visible role in HIV prevention,           10% whilst HIV-positive cases are not followed-up or
which could then be followed by NGOs such as KDF.                  counselled. The MO is unaware and does not have a copy
                                                                   of the National HIV Policy Guidelines, and there is no
                                                                   universal precaution policy. Sputum tests for AFB are
5.4 Care and Support Networks and Structures                       performed, and positive cases referred to ERCC. They
                                                                   have no condom supply.
Danbal Private Hospital has 18 beds and Dr Bala Usman
manages it on a full-time basis with two part-time assis-
tants. There are two nurse/midwives, one community                 5.5 Observations
health officer (CHO), and five community health exten-
sion workers (CHEWs). Referrals are largely by word of             All key informants are aware of the problem of HIV/AIDS.
mouth from the NURTW, private practitioners, CHOs                  But perception and knowledge of specific risk behaviors
and nurses, while others come as far as 60km to visit.             and risk populations is less evident. It also was not possi-
Referrals are occasionally received from church leaders            ble for the team to identify any specific high-risk sites.
and Jama’atul Nasrul Islam (JNI). Patients are referred to
the Federal Medical Centre, Keffi, Gwagwalada specialist
hospital in Abuja, and Jos University Teaching Hospital.
TB cases are referred to Evangelical Reformed Church of
Christ Medical Services (ERCC) Alusha and HIV- patients
to Dr. Jeremiah Abalaka’s clinic.

Dr Bala Usman’s performed HIV tests in suspected HIV
cases in his laboratory, and sputum for AFB in cases where
there was cough or weight loss. It should be noted that he
was unable to name the HIV test system he used, even on
prompting. He sees approximately six to 10 STD patients
each month, and thinks that the number has increased
over the past five years.

Rapid Assessment Report

6. Akwanga
6.1 Political Environment                                           als. Group Africa in collaboration with SFH normally
                                                                    comes around to present road shows to the community
The team conducted a rapid assessment of Akwanga LGA                every other month. NURTW also collaborates with the
for two main reasons: From the information provided in              marketplace association to reach out to female traders.
Lafia, it became clear that Akwanga serves as a primary
referral point for HIV and TB from throughout the state.            Radio is the most effective medium for reaching members
The team was also informed that Akwanga has a higher                with behavioural change communication messages.
concentration of “HIV problems” than Nasarawa Eggon.                Religion and denial among the general populace were
Also, due to a civil servants’ strike in Nasarawa Eggon, it         identified as hindrances to HIV/AIDS programming.
was not possible to meet any key informants there.                  Young male students are most vulnerable to HIV/STI
                                                                    because of their stubbornness and unwillingness to listen
There was not enough time to meet with any key LGA                  to advice or use condoms with sex workers.
officials at short notice.
                                                                    The union identified a brothel close to the park which hous-
                                                                    es sex workers from Otukpo in Benue State and girls from
6.2 Risk Environment                                                the eastern part of the country as the main risk setting.

Akwanga is centrally located in Nasarawa State and serves           Catholic Women’s Organization (CWO)
a junction town, linking the North Central zone with the            The Catholic Women’s Organization (CWO), inaugurated
Northeast zone. The level of migration into Akwanga                 in 1999, has about 1,000 members. Their initial focus was
seems to be quite high for commercial market activities as          Democracy and Governance supported by CEDPA.
well as for transit.                                                Training was given to women in Akwanga, Nassarawa
                                                                    Eggon, Laafia and Wamba LGAs. The organization invites
Key informants emphasized that youth are at the highest             lawyers, nurses with experience in human rights, family
risk for HIV. One key informant felt the “I don’t care atti-        planning and HIV/AIDS/STIs, to give talks at these train-
tude” of the people and the presence of “free women” in             ings. Other programs include seminars on safe mother-
the society are some of the factors responsible for the             hood and blood safety.
increasing spread of HIV. The risk settings were confined
to specific geographic areas such as Angwan Tiv and loca-           The organization’s scheduled meetings are held once a
tions where locally brewed beer (Burukutu) are sold.                month while there are other meetings two to three times a
                                                                    month. The organization is funded by the members’ con-
                                                                    tributions. There is no paid full-time staff, though with the
6.3 Private/Civil Society Environment                               acquisition of a typewriter and a photocopier, there needs
                                                                    to be a full-time secretary. CWO has both savings and
The Akwanga branch of NURTW has implemented some                    checking accounts with the president, treasurer and
HIV/AIDS activities, one of which was the World Bank                accountant as signatories.
Awareness seminar. The members believe that AIDS is
real and therefore accept and practice preventive meas-             During the awareness campaigns/ seminar/ workshops,
ures such as condom use for sexual intercourse. Condoms             film shows are used to illustrate the reality of the AIDS
in the local parlance are referred to as “shirts” and it is         pandemic. The organization is presently focused on
their belief that anyone who refuses to use the “shirts”            reaching out to youth in schools. A poverty alleviation
will be stung by the “scorpion” which is HIV. The Gold              program for women was abandoned for lack of funding,
Circle Condom was described as the “original shirt.” One            though concerted efforts are being made to raise funds
of the members of the union was suspected of having                 from the wealthy people in the community/church.
from AIDS.
                                                                    The factors responsible for the increasing spread of HIV in
Although members have benefited from HIV/AIDS semi-                 the society are the “I don’t care attitude” of the people and
nars organized by the Akwanga LGA PHC Department,                   the presence of “free women.” An effective response for
monthly meetings are held to discuss welfare issues, such           curbing the pandemic will include facing reality, preaching
as HIV/AIDS/STIs. Information obtained from seminars                and discussing HIV/AIDS from the pulpit to the church
can be disseminated to members at such meetings, togeth-            members. A seminar was recently organized for couples
er with distribution of condoms and educational materi-             which emphasized the importance of fidelity. To prevent

                                                                                                                Nasarawa State

pregnancy in nursing mothers it was suggested that their            ment posting from different schools of health technology
husbands use condoms. The promotion of condom use by                in Plateau, Kaduna and Nasarawa states.
church members should be encouraged since the transmis-
sion of HIV is not only in “free girls.”                            The center had a recorded outpatient attendance (both old
                                                                    and new) of 22,175 between October 1999 and September
The CWO would not have any problems working with                    2000. This was double the 11,000 of the previous report-
these “free girls” in the future because success depends on         ing year. There is an HIV counseling unit, but the CHC
the approach used for reaching out to these women. The              notes in its annual report that patients stay for days before
most effective methods of communication are organizing              they receive attention, and advises the management to
workshops that use materials translated into their mother           train more counselors to meet the demand. (Brief annual
tongues and relevant films. Other topics that can be                report of the CHC, 18th October 2000)
included in these workshops include care of the environ-
ment or sanitation to reduce the prevalence of TB in the            Referrals are made from ECWA hospital in Keffi and
community, attributed to ”filthy environments.”                     Seventh Day Adventist Hospital in Wamba, both of which
                                                                    are church hospitals. Referrals are also made from TBAs
Part of the future plan of the organization is to change the        and traditional healers (including bone setters).
name and scope of the organization to ensure a wider
membership from other religious bodies.                             There are 20 STD cases monthly, mostly men complaining
                                                                    of “painful urination.” CHC advises contact referral and
                                                                    treatment. STD patients are given drugs but not con-
6.4 Care and Support Networks and Structures                        doms. ERCC does not object to condom use or counsel-
                                                                    ing patients to use condoms although they do not direct-
Evangelical Reformed Church of Christ Medical                       ly provide condoms to STD patients The team was told
Services, Headquarters, Alushi, Akwanga                             that condoms are available at the family planning section
Services are being provided through a cost recovery                 for patients who are interested, although no direct refer-
scheme and through support from Netherlands TB and                  ral is made.
Leprosy program. The ERCC has a little funding from
government.                                                         The clinic has a copy of NASCP STD syndromic manage-
                                                                    ment guidelines and there was training in syndromic man-
The facility was established in 1942 and has a192-bed               agement. Diagnosis is based on lab test, swab, wet mount,
capacity. It comprises the following units:                         smear test or Gram stain. Usually, CHC waits for lab test
                                                                    results before treating STD patients. They prescribe doxy-
• Comprehensive Health Center, including a family care              cycline and sometimes combine this with flagyl (note: this
  unit                                                              does not follow the guidelines). CHC does not do syphilis
• Tuberculosis and leprosy referral center                          testing. General drugs and supplies for CHC and ERCC
• Laboratory                                                        generally are obtained from CHANPHARM.
• Peripheral units: 28 peripheral clinics in Nasarawa
  state, five in Kaduna state and one in Bauchi state               CHC does not have a copy of the National HIV/AIDS pol-
                                                                    icy. HIV testing is performed using the HIV spot test pro-
Other special programs include:                                     duced by GENELABS, USA. The kit does not require
                                                                    refrigeration as power supply in the state is poor. CHC
•   HIV/AIDS home-based care project                                did not have HIV test kits for four months this year and
•   HIV/AIDS awareness program                                      patients were referred to OLA for screening. Testing kits
•   Village health program                                          are bought from CHAN pharmacy in Jos and the State
•   Community-based rehabilitation program (CBRP)                   Specialist Hospital in Lafia sometimes gives them kits.
•   Primary eye care program                                        Confirmatory tests are not conducted in general.

The Comprehensive Health Center (CHC)                               Pre- and post-test counseling are conducted by trained
Provides general medical services. Patients come from dif-          counselors (trained in CHAN Jos and Catholic Hospital,
ferent areas of Nasarawa state for general medical servic-          Ogoja Cross River state). The counselors tell patients the
es (Lafia, Karu, Keffi etc). CHC has two doctors, three             implications of the test for both patient and family. No
nurse/ midwives, one theatre nurse, one ophthalmic nurse,           formal VCT programme was identified.
one CHO, eight community health supervisors, 20 CHWs
and 13 Junior CHWs, trainees on practical clinical attach-

Rapid Assessment Report

Reasons for HIV testing include the following:                     Learning Site:
• Prolonged illness                                                ERCC has a School of Health Technology that admits
• For diagnosis when the following signs exist: prolonged          about 200–300 students a year. Training is controlled
  cough, prolonged diarrhea, weight loss, itchy rash.              centrally from Lagos. The program for CHWs is three
• Blood donors are tested (approximately 20% are                   years and two years for Junior CHWs. It could be possi-
  positive)                                                        ble to include the CHW and JCHW in the curriculum.

STD and ANC patients are not screened routinely due to             Tuberculosis and Leprosy Unit:
the low availability of kits. There is demand for HIV              This serves as a referral center for the state. It is the only TB
screening of at least 10 patients a week who are suspected         referral center in Nasarawa State and serves other states as
of having HIV/AIDS, but often the demand is not met due            well. Patients come from as far as Sokoto, Lagos, Maiduguri,
to the unavailability of kits. Suspected HIV/AIDS cases            Kaduna and the FCT. The center also serves as a practical
also have sputum testing for AFB (TB).                             training site for the National Tuberculosis and Leprosy
                                                                   Center, Kaduna. Students from the School of Health
There is no PLHA group although there are AIDS patients            Technology, Alushi and other schools of health technology
in the facility. Not many of the PLHA want their serosta-          undergo their practical attachment sessions in the unit.
tus to be divulged to the others to avoid stigmatization.
There are plans to facilitate the formation of a PLHA              The CHC recorded an increase in mortality, due to
group. In September, orphans were provided some money              increases in TB cases. There were 50 TB-related deaths
for their needs. As for psychosocial support, PLHA with            and five AIDS-related death out of a total of 221 deaths
depressive symptoms are usually referred to a clergyman            during the reporting period. Sputum-positive cases dou-
for counseling and spiritual support. After the initial            bled from 355 in 1998-99 to 633 in 1999-2000.
counseling by the clergyman, patients are referred to their
church leaders.                                                    • TB case record: Between July 1999 and June 2000,
                                                                     502 TB patients were admitted into the TB unit.
CHC sees children under five, but has not seen cases of              Patients are admitted for two months, after which
pediatric HIV. It has seen very few older babies or young            they are discharged and visit the center monthly for
children with oral thrush. There are few malnourished                review and check up. Treatment lasts for eight
children, and these have responded to treatment of their             months using DOTS.
medical disorders and feeding. They have not noticed that
these cases have increased. These are presently two pedi-          • HIV case record: An average of 30 new HIV cases is
atric TB cases.                                                      seen monthly. Between January and April 2000, the
                                                                     hospital did not have testing kits and suspected cases
Data from HIV/AIDS program, 2000 (May – Oct 2000)                    of HIV were sent to other facilities for testing.
Of 356 persons screened, 142 were HIV-positive, 189
were TB patients , 72 were blood donors and 45 were sus-
pected AIDS patients. The data do not allow reporting of           Our Lady of Apostles Hospital (OLA)
seroprevalence by screening group. It is to be noted that          Established in 1956, OLA has 118 beds, one doctor, 12
the testing was done sporadically as test kits were not            nurse/midwives, six CHOs, five CHWs and 18 ward
available for four months this year.                               orderlies. There are two student CHWs on practical
                                                                   attachment from Keffi. Between three and five new HIV
Home visits to HIV patients have been initiated with 134           patients are seen weekly, but not all suspected HIV/AIDS
visits to 30 PLHA. Names and addresses of the PLHA are             patients are screened because some cannot afford to pay
picked up from hospital records and are visited at home.           N400 for the test. The reasons for HIV testing include
The home visit team consists of eight members with four            blood transfusion and high clinical suspicion. Pediatric
persons conducting the home visits per week. Distance              AIDS cases usually present with diarrhea, vomiting and
covered in the visits includes Nasarawa state, towns in            failure to thrive, but there are not many cases like this.
Kaduna bordering Nasarawa state and as far as 200km to             The hospital does not have trained counselors; the doctor
Minna, Niger state. During home visits PLHA are                    informs people of their result. There are approximately
instructed in hygiene, nutrition and how to deal with              three blood transfusions daily, and there is approximately
waste. They are taught to use polythene bags as gloves             20 percent HIV prevalence among blood donors. The
and JIK (bleach) as disinfectant.   PLHA with financial            hospital does not have an HIV policy and screening is
difficulties are sometimes given money and when in dire            done using the red dot test. Confirmatory tests are not
need are asked to come back to ERCC, where they are                performed in the hospital.
treated and exempted from paying hospital fees.

                                                                 Nasarawa State

HBC: There is presently no HBC, but an initial meeting to
start home visits was recently held. Orphans and vulner-
able children are present but have not been contacted
since there is no program for them. The hospital has
organized awareness campaigns within the church and
they plan to “celebrate” WAC 2000 on December 1.
Sputum tests are carried out for almost all suspected HIV
cases. Some TB patients are treated in the hospital, but
some do not comply with their treatment and come back
after developing resistant strains.

6.5 Observations

The ERCC plays a critical role in managing TB and
HIV/AIDS, serving both Nasarawa and neighboring
states. The CWO is highly visible and active in communi-
ty development. The awareness of HIV/AIDS was high in
the key informants contacted.

Rapid Assessment Report

7. Observations
• There is consensus among all key informants that               • There are very few NGOs/CBOs programming in
  “HIV/AIDS is a problem.”                                         HIVAIDS/STI prevention and care, and only a very
                                                                   few with any technical and programmatic capacity.
• Although it seems that the number of HIV-positive                This will entail a major effort in capacity building on
  people are increasing according to hospital data, it is          the part of the IMPACT project.
  difficult to clearly identify/locate the risk settings
  where these PLHA are coming from.                              • Nasarawa state is geographically located between key
                                                                   “hotspot” states such as Kaduna, Benue, Plateau and
• There is no significant OVC or MTCT activities.                  Taraba.

• There is an influx of sex workers from sharia states to        • Active state support and endorsement of Dr. Abalaka’s
  Nasarawa. Due to the high cost of living in Abuja,               claims of curing HIV/AIDS pose a serious threat to
  people live in Nasarawa and commute daily to Abuja.              any HIV/AIDS prevention activities.

• Technical skills and knowledge of health care workers
  need to be upgraded.

• There was little sense of “real demand” for prevention
  and care services, and government officials did not
  mention any specific programming problems that they
  have had to confront.

                                                                    Nasarawa State

8. Recommendations
Further clarification of the state’s support for experimen-
tal therapies is needed before any comprehensive preven-
tion and care programming can be considered. The Policy
Project would seem to be best placed to provide the nec-
essary orientation and advocacy.

Once state-level advocacy is completed it will still be nec-
essary to mobilize and raise the level of public awareness
regarding HIV risk behaviors and risk settings. The
capacity building among health care providers, local
NGOs and other organizations could occur simultaneous-
ly so that the resultant demand for prevention and care
activities can be met.

Rapid Assessment Report

Appendix A: Persons Met
 Organisations visited            Persons contacted               Designations

 Primary Health Department,       Alh. Tanimu Dogara              Director, PHC
 Keffi LGA                        Alh. Sambo Tukur                Dep. Director PHC

 Keffi LGA                        Lawal Ramalan                   Clerk to the Keffi LG Council

 Ministry of Women Affairs &      Stephen Z. Barau                Permanent Secretary
 Social Development, Lafia        A. Dauada                       Director Admin/Finance
                                  Alh. I.O Egyyesimi              Ag. Director Social Welfare
                                  B. Joseph Erubugushili          Director, Community Development

 Ministry of Education,           Mrs. Phoebe D. Ayenajeh         Permanent Secretary
 Lafia                            Mr. JA. Envuladu                Director, Education Services
                                  Alh. I.K. Dairu                 Director, Inspectorate Services
                                  T.G Kadon                       Director Higher Education
                                  K.D. Tanze                      Director of Schools
                                  Shehu D. Adamu                  Director of Science/Technology

 Ministry of Health,              Hajiya Ramatu Ajuji Aububakar   Hon. State Commissioner for Health
 Lafia                            Dr. Mohammad Ahmed              Permanent Secretary

 Nasarawa State Local             Mr. A.A. Kauta                  Chairman
 Government Service               Mr. David D. Ari                Director of Personnel
 Commission, Lafia                Alkali Zakari Yusuf             Dep. Director of Personnel

 Keffi Development Foundation,    Lawal Ramalan                   Secretary

 NURTW/Akwanga                    Bala Dogula                     Secretary

 Catholic Women Organization,     Chief (Mrs.) Theresa Wuya       President
 Akwanga                          Sallau Aboh-Kumme               Accountant

 Ministry of Information,         Mr. Labaran Maku                Hon. State Commissioner for
 Youth and Sports                                                 Information

 The Nigerian Centre for Women,   Mr. Simon Aboki                 Executive Officer
 Youth & Community Action

 NURTW/Lafia                      Alhaji Mohammed                 Chairman
                                  Alh. Bala                       Organizing secretary

 ERCC                             Mr. Daniel Markus               Deputy Director

 AKWANGA                          Mr. Auta M. Bubo                Head of Department
                                  Sr. Ladi Mbarka                 Nurse i/c of HIV/AIDS program

                                                                                Nasarawa State

Appendix A (cont)
 Organisations visited          Persons contacted          Designations

 Our Lady of Apostle,           Donatus Kwalikie,          Nurse
 Akwanga                        Bartholomew Baba,          Lab Tech assistant

 Office of SSG                  Alh. Mohammed Sabo Keana   SSG
                                Mr. James Agbo             Diretor Admin/ Finance
                                Mr. Simon Aboki            Perm Sec.
                                Raliwamu Elayo             Staff Officer

 Federal Medical Center,        Dr. Samuel                 Medical Officer
 Keffi                          Mrs. Usman                 Matron

 Danbal Hospital                Dr. Bala Usman             Medical Director

 State Specialist Hospital,     Dr. Haruna Ekoh            Medical Superintendent
 Lafia                          Mrs. Liatu Agyeno          Matron
                                Mrs. Laraba Awaya          In-charge, Pediatric Ward
                                Mr. Alexander Bama         In-charge, Adult Male Medical &
                                                           Surgical Ward
                                Mr. Adamu Ohagene          Laboratory Attendent

 PHC & BFI Clinic,              Mrs. Lami Rabiu            Nurse in-charge
 Unguwar Waje, Keffi

 PHC clinic, Doma Road, Lafia   Aishat Dalhatu             Matron & Sister-in-charge

Rapid Assessment Report

Appendix B: Rapid Assessment Tools
 Key Informant Interview Guide

Government Response

• Ongoing efforts
• Ongoing collaboration-
  With donors/international agencies
  With NGOs/CBOs

Acceptability of donor support
• Ongoing program with women, youth, poverty alleviation, microenterprise and child welfare
• Presence of structures
     Are there any community health workers here – TBA, CHOs, etc.?
        - AIDS Committee at state level
        - State AIDS Coordinator
        - AIDS Action Manager
        - Integration of AIDS into PHC
        - Number of schools – secondary, tertiary, etc.
        - Economic activities (any major employers)
• Awareness of NACA and other state multisectoral strutures (is there a state HIV/AIDS policy or do they have access
  to policy papers)
• Perceived effectiveness of existing structures (regular meetings, activities, etc.)
• Budgetary allocations, released and actual expenditure related to HIV/AIDS
• Felt need for HIV/AIDS programs
  - Other areas of priority
• Socio-cultural/religious issues and concerns

HIV/AIDS/STI Risk Settings

• Risk behavior – what kind of behaviors/activities have you seen that make people vulnerable/susceptible to HIV?
• What in your own opinion constitutes the greatest risk behavior that facilitates HIV/STI transmission in this
• What do you feel is the risk for HIV in this community OR what is perceived to be the risk in this state/LGA/com-
• What are the geographic areas where risk behaviors take place?
• Community mobilization around the issue of HIV/AIDS
• What opportunities are there for HIV/AIDS prevention and care programming in this community?
• What do you think is an effective way to handle the HIV/AIDS situation in this community?

                                                                                                              Nasarawa State

Assessment of Civil Society Organizations’ Potential for Behavior Change Interventions

1.   Experience in community development and HIV/AIDS activities
2.   HIV-related programming experience
3.   Relevant local/state/regional experience
4.   Collaboration
     • Other organizations working in HIV prevention and care?
     • Networks of local NGOs in community development and HIV?
     • Linkages/referral systems with other service providers in the area (health service, spiritual service, micro-enter-
       prise, education, etc.)?
     • Perception of work with other NGOs?
     • Perception of work with government?
5.   Do you use any communications materials?
     • What materials are you using?
     • What is the most effective channel to communicate with your target group?
6.   Where are you currently getting your funding for programs?
7.   Where do you refer people for services?
8.   Relevant administrative/managerial resources and expertise
     • What is the organizational structure – is there an organizational chart?
     • Do you have a bank account?
9.   Access to personnel and other resources
     • What is your membership? How many voluntary and how many full-time paid staff?
     • Access to communications – telephone, fax, email?

Care and Support

Overarching Impression Discussion Points *
* To be discussed by each site team before deployment and at debriefing meeting

State HIV prevalence rates                                                 MC name               OMC name

1. High risk populations, locations and size: FSW, Truckers, Migrant men, At-risk youth, Informal settlements
2. Who are partners in broad HIV/AIDS comprehensive care and support—public, voluntary and private—and what
   are they doing?
3. Patient load/demand for care and support? Change over time? In each level of care from state to primary?
4. Potential for establishing learning site, e.g., nursing training college, care partners, etc., within a site (LGA)?
5. Home-based care (professional support for illnesses), demand for terminally/chronically ill?
6. Get a sense of the burden of the HIV/AIDS epidemic through mortality estimates in general and for TB patients.

Health Care Structure

How many of the following are in the LGA?
     Government Hospitals
     Teaching Hospitals (specify whether governmental)
     Mission Hospitals
     Private Hospitals
     Public Health Centres
     Public Health Clinics
     Church and religious clinics
     Private Sector providers

Rapid Assessment Report

  NGO clinics
  CBO clinics
  Traditional medicine practitioners

Are there community health workers in the area?

Health Facilities

What is your position designation?
What are your primary duties?
What kind of health facility is this?
How many in-patient beds are there?

What is the geographical catchment area of this facility?
What is the catchment area of this facility in terms of population?
How many doctors in this facility?
How many nurses in this facility?
How many CHO/CHEWs in this facility?

Who refers patients to you?

To whom/where do you refer patients (name if possible)?
  Teaching hospital
  Federal medical centre
  Specialist hospital
  General hospitals
  Primary health care centres
  Primary health care clinics
  Village health workers
  Church and religious clinics
  Private sector providers
  NGO/CBO clinics
  Traditional medicine practitioners

Are there community health care workers attached to this health facility?

When did you start seeing suspected AIDS cases?
Has there been a gradual increase of suspected AIDS cases?.
Have there been periods of rapid change (more or less)?
How many suspected AIDS cases do you see each week?

Do you have a copy of the National HIV Policy Guidelines?
Can we see which version you are using?
Do you have your own HIV policy?
Can we see it?

                                                                                                         Nasarawa State

Specific Technical Areas

  Do you do HIV testing in this facility? Where do you get your supplies?
  Do you send patients for testing? Where?
  What happens to those who test positive? Are they told their results?

  Do you have HIV counseling services?
  Who trains your HIV counselors? What curriculum is used? When?

      -   Not active but planned – where and when will they open? Who will be in charge?
      -   Do you have linkages with other care and support activities and services?

Home-based care (professional support for illnesses)
  - Describe HBC activities
  - Describe the structure of home-based care staff/teams
  - Demand for terminally/chronically ill care
  - Describe composition and types of services provided and the length of time they have been active (e.g., terminally
    ill vs. HIV only, TB incorporated, linkages to clinical care)
  - Linkages with other care and support activities and services
  - Linkages with prevention activities?

PLHA groups/networks
  - Are there any PLHA groups? Name, location, who is in charge?
  - Not active but planned
  - Describe composition and types of services provided and length of time they have been active (e.g., advocacy, sup-
    port, peer education, etc.)

 - Any MTCT interventions? What are they?

  - When children do not have their immediate parents, who takes care of them?
  - Do you suspect any changes in the ability of extended families to take care of their relatives’ children?
    Briefly describe.
  - What type of impact has HIV/AIDS had on children?
  - Are there any child survival projects in the area? If yes, please give a brief description.
  - Are there any homes for motherless children? If yes, please give number and a brief description.

  -   Are TB patients cared for at this facility? If not, where are they referred?
  -   Has there been a gradual increase of TB cases?
  -   Method of treatment
  -   Availability of drugs, type and consistency

Rapid Assessment Report         Nasarawa State

  Name and address of HCF

                                                 PERSON INTERVIEWED (NAME AND POSITION)

      Teaching hospital
      Federal medical centre
      General hospital
      Health centre
      Private clinic
      NGO clinic

  How many STD patients were seen in this health care facility last week?

  How many STD cases do you see at this clinic
  during an average month?                                 M             F

  Are the numbers of male patients with STDs
  increasing compared to last year?                        Y       N

  Are the numbers of female patients with STDs
  increasing compared to last year?                        Y       N

  From your records:
                                                           1997                    1998   1999

  How many STI in adult males
  Male urethral discharge
  Male genital ulcer
  How many STI in adult females
  Female urethral discharge
  Female genital ulcer

  Who refers patients to you?
      Teaching hospital
      Federal medical centre
      General hospital
      Health centre
      Private clinic
      NGO clinic

                                                                                      Nasarawa State

Where do you refer difficult STD cases?

What type of diagnosis do you base your treatment on:
     •   An etiologic diagnosis such as gonorrheoa or syphilis?
     •   A syndromic diagnosis such as urethral discharge or genital ulcer disease?
         Etiologic       =1
         Syndromic       =2
         Both            =3

Do you have a microscope in this clinic?                                 Y        N

Do you perform HIV testing in this clinic?                               Y        N
What is the name of the test
Do you tell the patients the results?                                    Y        N
Do you counsel patients on the meaning of the results?                   Y        N

Do you send your STD patients (or specimens) to
another facility for laboratory investigations?                          Y        N

Do you keep a supply of condoms in this clinic?                          Y        N
                                             ASK TO HAVE ONE             Y

Do you provide condoms to your STD patients?                             Always

Do you provide instructions to your patients on how to use condoms?      Always

Do you follow any specific treatment guidelines in
your management of STD patients?                                         Y        N
                IF YES, which?

Have you received a copy of the STD treatment schedules
recommended by the National AIDS and STD Control Programme?              Y        N

                                                              Verified   Y        N

What are the main constraints on your work with STD?

Rapid Assessment Report         Nasarawa State

Health Care Facility Data

We would be very grateful for the following information, if it is available:

 Hospital admissions and clinic attendance
                                                                     1997                    1998                  1999

  Medical admissions
  Surgical admissions
  Paediatric admissions

  Adult male outpatient attendance
  Adult female outpatient attendance
  Paediatric outpatient attendance (under 5)

  How many TB cases (all forms) were recorded?
  How many smear positive pulmonary TB cases
   were recorded?
  How many smear negative pulmonary TB cases
   were recorded?
  How many extra pulmonary TB cases were recorded?
  How many smear positive pulmonary TB cases
  completed their TB treatment?
  How many smear positive pulmonary TB cases died
   before completing their TB Rx?
  How many smear positive pulmonary TB cases were
  lost to follow up?

If this intervention is not available until later, please leave a copy of this form with the health care facility. It should be
returned to:

         Family Health International
         18a Temple Road

             Nasarawa State


Rapid Assessment Report   Nasarawa State


             Nasarawa State


          Family Health International implements the USAID IMPACT Project
in partnership with the Institute of Tropical Medicine, Management Sciences for Health,
    Population Services International, Program for Appropriate Technology in Health
                  and the University of North Carolina at Chapel Hill

                             Family Health International
                                 Institute for HIV/AIDS
                              2101 Wilson Blvd., Suite 700
                               Arlington, VA 22201 USA


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