HIVAIDS Emergency Action Plan by iqm86975

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									HIV/AIDS Emergency
    Action Plan
A 3-Year Strategy to
  3 Year
      Deal with
      Deal with
HIV / AIDS in Nigeria
HIV / AIDS in Nigeria


 National Action Committee on
 National Action Committee on
              AIDS
              AIDS
             (NACA)
             (NACA)
   and its various partners
    and its various partners
                         The HIV/AIDS threat is a
                         National Emergency
                         n It affects millions of people -
                           especially productive populations
                           in all sectors
                         n It will affect millions more
                         n It is affects all aspects of our
                                             aspects
                           social and economic lives
                                        economic lives
                         n It threatens our nation
                         n It is getting worse




This is a brief introduction to the “HIV/AIDS National Emergency Action Plan” (HEAP)
for HIV/AIDS in Nigeria. For an effective and coordinated response to the AIDS
epidemic there is a need for the development of an overall National Strategic Plan. The
process of doing this encompasses several elements of which the situation and response
analyses have already been completed. The HEAP is the next step.

The development and implementation of an HIV/AIDS National Emergency Action Plan
(HEAP) is critical to the control of the epidemic and to the mitigation of the impact of
HIV/AIDs on our society. With its acceptance, dissemination, and application, the HEAP
will allow the Government of Nigeria and its many partners to move ahead in supporting
those essential activities whose progress will serve as a bridge to the longer-term strategic
plan.

It is anticipated that, following the adoption of the HEAP, Nigeria’s national and
international professionals will join together in partnership toward the HEAP’s execution
thus ensuring that Nigeria will become one of the success stories from Africa in the fight
against this scourge that has so ravaged this continent.

This presentation briefly gives a background to the epidemic and outlines the main
elements of the HEAP.

Nigeria is not alone in Africa in terms of the AIDS epidemic. AIDS is a threat that is real
and is a national emergency.
                      HIV/AIDS in Nigeria :
                      Data sources
                       n            Sero-
                           National Sero -prevalence Sentinel
                           Surveys
                           Surveys

                       n   Projections based on sentinel
                           surveys and on current population
                           estimates using the AIDS Impact
                           Model (AIM)
                           Model (AIM)




The projections presented in the following slides are based on the National Sero-
prevalence Sentinel Surveys of 1991, 1994, 1996, 1999, and on current population
estimates from the National Population Commission. The projections were made by an
expert review committee coordinated by NASCOP, using the AIDS Impact Model
(AIM). Members of the review committee included representatives from Ministry of
Health, the University of Lagos and the donor community.
                         HIV Incubation Period
                         (Adults)
                      Not
                      Infected - Infected - - - - Infectious - - - - AIDS - - - Death




                                           - - 3 - 10 years - -        -1 yr-




A person does not develop AIDS as soon as he or she becomes infected with HIV. There
is a lengthy incubation period of about three to ten years. Some people may survive
longer than 10 years with an HIV infection while others may develop AIDS and die two
or three years after infection. The average time from infection with HIV to development
of the disease AIDS is about 7 to 8 years. That is, on average, a person does not develop
AIDS until 7 to 8 years after becoming infected. For most of this period the person may
not have any symptoms and, therefore, may not be aware that he or she is infected. This
contributes to the spread of HIV, since the person can transmit the infection to others
without realizing it.
                       The HIV/AIDS Pyramid
                       The HIV/AIDS Pyramid
                       (Nigerian Statistics)

                                          26,276 Reported AIDS Cases (June 1998)


                                             590,000 Estimated Actual AIDS Cases
                                                (1999 Estimate)


                                                          2.6 million people with
                                                          HIV Infection
                                                          (1999 Estimate)




The lengthy incubation period is one reason that HIV/AIDS is often called a “hidden
epidemic.” The idea of a “hidden epidemic” can be seen in this graph which shows the
HIV/AIDS pyramid. The tip shows reported AIDS cases as of June 1998. Reported
AIDS cases represent only the visible part of the epidemic. This is what most people see.
However, there is much more to the epidemic than the number of reported cases.

The true number of AIDS cases in Nigeria is not known. However, as seen in the green
portion of the pyramid, it is estimated that almost 600,000 adults and children had
developed AIDS by the end of 1999.

The red portion of the pyramid indicates the much larger number of people who are
infected with HIV but have not yet developed AIDS. Many of these people show no
symptoms and do not even know they are infected. The worst of the epidemic is yet to
come as these HIV infected people develop AIDS. Most of them will die within the next
ten years or so. There is no cure for AIDS and no effective vaccine.
                                                     1991-
                    Nigeria HIV Prevalence Increase: 1991- 1999

                                  6
                                                    4.5       5.4
                                  5
                                             3.8
                                  4

                        Percent
                                  3   1.8
                                  2
                                  1
                                  0
                                      1991   1994   1996   1999




UNAIDS measures prevalence in a country by the percentage of 15 to 49 year olds who
are infected. In Nigeria, prevalence increased from 1.8 percent in 1991 to 4.5 percent in
1996. The Ministry of Health estimates that by 1999, 5.4% of persons 15 to 49 were
infected. Although the percentage levels may seem low when compared to Eastern and
Southern African countries, in fact, in actual numbers of persons infected, Nigeria has
one of the worst HIV/AIDS epidemics in the world - fourth only to India, Ethiopia, and
South Africa.
                   Nigeria: HIV Prevalence by Zone, 1999
                   Nigeria: HIV Prevalence by Zone, 1999
                      N.Central                                           8.0%

                        S.South                                 6.4%

                        S. East                             5.9%

                         N.East                   4.1%

                        S.West              3.5%
                        N.West             3.2%
                             0.0%   2.0%   4.0%          6.0%          8.0%      10.0%
                                                  Percent




Although the median prevalence rate at the national level is 5.4 percent there is
considerable variation across zones and states, ranging from 3.2% in the North West zone
to 8% in the North Central zone.
                       HIV Prevalence by State, 1999
                       HIV Prevalence by State, 1999
                          Under 2


                           2-4


                           4-6


                           6-10


                          10+




As this map shows, all states are affected. The most seriously affected states are Kaduna
(11.6 ), Benue (16.8), Nasarawa (10.8) and Akwa Ibom (12.5).
                        Nigeria: HIV Prevalence by Age Groups
                        (National Average,1999)

                                    9            8.1
                                    8                     6.9
                                    7
                                    6     4.9


                          Percent
                                    5
                                                                       3.4
                                    4
                                    3
                                                                                1.3
                                    2
                                    1                                                 0.2
                                    0
                                        15-19   20-24   25-29         30-34   35-39   40+
                                                                Age




Infection rates vary with age, with the highest rate found amongst young adults (20-24).
However, there is also an alarming 4.9% prevalence among the adolescent population –
Nigeria’s future.
                          Projected HIV + Population
                          Aged 15 - 49 years (Nigeria)


                      6,000,000


                      5,000,000


                      4,000,000

                                                                                                    Female
                      3,000,000
                                                                                                    Male
                      2,000,000


                      1,000,000


                             0
                              1991   1993   1995   1997   1999   2001   2003   2005   2007   2009




The rapid growth in the 15 to 49 year population and an expected increase in HIV
prevalence will lead to an increase in the number of HIV infected people in the
population. Projections indicate that by the year 2005, the number of HIV infected adults
will be about 4 million, and by the year 2010, 5 million.
                        Projected Annual Number of
                        New AIDS Cases in Nigeria

                     400,000
                     350,000
                     300,000
                     250,000
                                                                                                     Female
                     200,000                                                                         Male
                     150,000
                     100,000
                     50,000
                          0
                                 92



                                               96




                                                                    02



                                                                                  06
                           0



                                         4



                                                       8

                                                              0



                                                                            4



                                                                                          8

                                                                                                 0
                        199



                                      199



                                                    199

                                                           200



                                                                         200



                                                                                       200

                                                                                              201
                               19



                                             19




                                                                  20



                                                                                20
The number of new AIDS cases will also increase rapidly. Current projections show the
number of adults developing AIDS each year will increase from more than 250,000 in
2000 to an estimated 360,000 in the year 2010.
                        Projected Cumulative Deaths
                        due to AIDS in Nigeria
                       4,500,000
                       4,000,000
                       3,500,000
                       3,000,000
                       2,500,000                                                                         Female
                       2,000,000                                                                         Male
                       1,500,000
                       1,000,000
                        500,000
                               0
                              90

                                     92

                                            94

                                                   96




                                                                 00

                                                                        02

                                                                               04

                                                                                      06

                                                                                             08

                                                                                                    10
                                                          98
                            19

                                   19

                                          19

                                                 19




                                                               20

                                                                      20

                                                                             20

                                                                                    20

                                                                                           20

                                                                                                  20
                                                        19




By the year 1999, an estimated 850,000 Nigerians had probably died from AIDS, but the
full brunt of the epidemic is yet to come. Over the next ten years, perhaps another 3.3
million Nigerians will die from the disease.
                         NIGERIA: AIDS Deaths vs. All Deaths
                         Among the Population 15-49

                      600,000

                      500,000

                      400,000

                      300,000                                      All Deaths
                                                                   AIDS Deaths
                      200,000

                      100,000

                            0
                                1990   1995   2000   2005   2010




Already, more than half of all deaths in the 15-49 age group can be directly attributed to
HIV/AIDS. If a high number of deaths occur to economically productive persons ages 15
to 49, the labour force will be disrupted. When deaths occur to trained and educated
persons, the overall economic development of the country can be disrupted.
                        Projected Number of AIDS
                        Orphans in Nigeria

                     3,000,000

                     2,500,000

                     2,000,000

                     1,500,000

                     1,000,000

                      500,000

                            0


                                                   96




                                                                                      06
                               0

                                      2

                                             4




                                                           8

                                                                  0

                                                                         2

                                                                                4




                                                                                              8

                                                                                                     0
                            199

                                   199

                                          199




                                                        199

                                                               200

                                                                      200

                                                                             200




                                                                                           200

                                                                                                  201
                                                 19




                                                                                    20
One of the worst impacts of AIDS deaths to adults is an increase in the number of
orphans. We define an AIDS orphan as a child under the age of 15 who has lost the
mother to AIDS. With this definition, the number of AIDS orphans would increase to
more than 1.8 million by 2005 and to almost 2.4 million by 2010.

There will be a tremendous strain on social systems to cope with such a large number of
orphans.
                        Projected Annual Child Deaths
                                               Deaths
                        due to AIDS in Nigeria

                     60,000

                     50,000

                     40,000

                     30,000

                     20,000

                     10,000

                         0
                           90

                                  92

                                         94

                                                96

                                                       98

                                                              00

                                                                     02

                                                                            04

                                                                                   06


                                                                                           8

                                                                                                  0
                                                                                        200

                                                                                               201
                         19

                                19

                                       19

                                              19

                                                     19

                                                            20

                                                                   20

                                                                          20

                                                                                 20
AIDS also affects child survival. About 30-40% of babies born to infected mothers will
also be infected with HIV. Most of these babies will develop AIDS and die within two
years. Few will survive past the age of five.

Current projections show that the number of children dying from AIDS each year is
estimated to increase from more than 37,000 in the year2000 to about 56,000 in 2010.
                        Multi-factorial causation of AIDS

                    Socio-economic
                                            Behavioral Determinants
                    Determinants



                                HIV/AIDS

                                                      FACTORS
                                               SYTEM FACTORS
                     Biological                (Blood supply,
                     determinants              contaminated instruments)




The magnitude and impact of determinants of the HIV/AIDS epidemic varies
considerably from state to state and from community to community in Nigeria. However,
as a summary statement, the HEAP partners will aggressively and proactively respond to
the following key determinants:

Social Determinants: The role and impact of commercial sex workers, of non-acceptance
by religious and conservative groups of all proven HIV preventive methods, of stigma
and discrimination against PLWAs (persons living with and affected by HIV/AIDS), of
low to irregular incomes, of peer pressure for high-risk behaviour, of culturally-dictated
subjugation and subordination of women, of weaknesses in the legal and political
framework and of lack of support for out-of school youths;
Behavioral Determinants: Unprotected sexual behaviour among mobile population
groups, unwillingness to acknowledge infection and seek assistance, and deterioration of
traditional social discipline and norms of behavior; and
Biological determinants: Uncontrolled proliferation of infection associated with sexually
transmitted diseases and both unsafe and unregulated blood transfusions.
                              AIDS affects all sectors.
                          Health      Agriculture
                                                           Children
                   Labour Force
                 Economic               AIDS                   Women
                 Development
                                                               Family
                    Education
                                       Others       Security



The HIV/AIDS epidemic is a development crisis in Nigeria and will be the most
significant problem facing the country over the next decade. AIDS is not just one more
problem among many in Nigeria. The epidemic is a development crisis that is ravaging
the country and undermining all social and economic development efforts. A radical
response that mobilizes all of Nigerian society is required. Government sectors, private
enterprise, NGOs, the churches, the schools, the traditional leadership and many other
groups and individuals need to be engaged in the effort to combat HIV/AIDS.

b For these reasons the HEAP uses a multi- sectoral approach.

Nigerian leaders have a critical role to play in stopping this epidemic. Leaders can help
make programs work by speaking out often and strongly about the devastating nature of
HIV/AIDS and the need for a broad and unequivocal response.
                        The HIV/AIDS Emergency
                              Action Plan
                                       Strategy for
                         A Three Year Strategy for
                        Dealing with the Epidemic in
                                  Nigeria
                          (Jointly conceived and developed by relevant
                             partners
                             partners under the leadership of NACA)




The National Emergency Action Plan (HEAP),developed as a response strategy to the
HIV/AIDS epidemic, identifies over two hundred activities which the Federal
Government intends to pursue over the period 2001 to 2004. Most activities under the
HEAP are conceived as short-term, high impact interventions whose implementation will
form the base for a medium term Strategic Plan for HIV/AIDS in Nigeria. The HEAP
will therefore serve as an important testing ground for deriving best practices,
coordinating strategies and high impact responses and as a bridge to the definition of a
longer-term vision for the future. The HEAP was designed to promote a multi-sectoral,
participatory response to HIV/AIDS prevention and impact mitigation. Moreover, as a
document for use in guiding the implementation of activities and the appropriate
assignment of available resources, the HEAP is intended to serve as an expression of the
Government of Nigeria’s interest in and commitment to a dynamic and proactive
response to the HIV/AIDS epidemic.
The dual-track strategic approach
n Preparing the long-term National Strategic
  Plan through a broad -based participatory
  process
while
while
n Undertaking immediate action to build
  capacity, remove barriers, empower
                             empower
  communities and carry out preventive as
  well as care & support activities
                         Guiding Principles of the HEAP
                     n
                     n A national framework with adaptation at
                                 local levels
                       State and local levels
                     n A participatory process of partnership to
                       prepare, implement and monitor
                         multi-
                     n A multi-sectoral approach against a
                       development problem
                     n All communities and all persons are
                       involved in prevention and care and
                       support.
                       support.
                     n A proactive response to gender issues



The Government of Nigeria and its many partners in the implementation of the HEAP’s
response to the HIV/AIDS epidemic will be guided by an agenda of proactive principles.
Considered as a set of guidelines, the HEAP’s principles represent a multi-sectoral
consensus on priorities for action during the immediate future.
                                    Objectives of HEAP
                   n                        and sensitization of general population
                       Increase awareness and sensitization of general population
                            key stakeholders
                       and key stakeholders
                   n   Promote positive behavior change in both low risk and high
                                         behavior change in both low risk and high
                       risk populations
                       risk populations
                   n   Build partnerships and capacity for HIV/AIDS Control
                   n   Ensure that communities and individuals are empowered to
                                           community-           action plans
                       design and initiate community-specific action plans
                   n   Ensure laws and policies against discrimination and
                       stigmatization related to HIV/AIDS
                   n   Provide care and support for PLWHA
                   n   Mitigate the impact on PLWHA, AIDS orphans and other
                       affected groups
                       affected groups
                   n           networks of PLWHA and others affected by AIDS
                       Create networks of PLWHA and others affected by AIDS
                   n   Establish an effective HIV/AIDS surveillance system
                   n   Stimulate research on HIV/AIDS


The HEAP has a number of overall objectives that deal with the following categories:
Awareness raising
Behavior change
Empowerment
Mitigation of the affects of AIDS
Care and support for PLWAs
Data and research
                        Strategic Components of HEAP
                        n   Creation of an Enabling Environment
                               v   Removal of Barriers
                               v   Catalyzing Community Response
                                   Catalyzing Community Response
                        n   Specific Interventions against HIV/AIDS
                                     Interventions against HIV/AIDS
                               v   Preventive interventions
                               v   Care and Support




The HEAP is built around two strategic components: CREATION OF AN ENABLING
ENVIRONMENT and SPECIFIC HIV/AIDS INTERVENTIONS TARGETED to
HIGH-RISK GROUPS. The wording and substance of these two components and of the
HEAP’s 15 strategies and of its over 200 activities was purposely chosen to reflect both
the HEAP’s currently limited timeframe as well as the urgency associated with the
establishment of the programme’s structure and of legislation and policies.
                            Creation of an Enabling Environment
                             1.   Removal of Socio-Cultural Barriers
                             2.   Removal of Information Barriers
                             3.   Removal of Systemic Barriers
                             4.   Catalyzing Community Responses




Strategy 1: Removal of Socio-Cultural Barriers
Under Strategy 1, NACA and its implementers will focus on largely advocacy initiatives. Under this
strategy, the need to sensitize the general public and to support advocacy and activities through the
development of legislation and policies centered on human rights of PLWAs and others affected by
HIV/AIDS. Due to the importance of this strategy, it is planned to complete the majority of the strategy’s
activities within the four quarters following the HEAP’s approval by the Government of Nigeria.
 Strategy 2: Removal of Information Barriers
Strategy 2 will address the need to develop a reliable and timely flow of information to decisions makers
and program implementers. As part of this strategy, NACA will work with key ministries in establishing an
overall framework for HIV/AIDS research. Once developed, the framework will guide the public and
private sector in the definition of issues to be addressed, protocols to be followed, and dissemination
processes to follow.
Strategy 3: Removal of Systemic Barriers
Under Strategy 3, NACA will address its own need for organizational and capacity development as well as
that of SACAs and LACAs. However, as with any issue of such complexity, NACA will address its
organization development needs as well as the HEAP’s specificity over time and as conditions change and
call for modification. Similarly, NACA will identify SACA and LACA’s capacity development with an eye
towards implementing concrete activities only after the four quarters following the HEAP’s approval by the
Government of Nigeria.
Strategy 4: Catalyzing Community-Based Responses:
Under Strategy 4, the importance of including a separate strategy for catalyzing communities is recognized.
Accordingly, the strategy’s main thrust is the creation of a community-based fund to ensure unobstructed
flow of resources to local communities. The fund will support community mobilization, selection and
training of community volunteers, and the design and implementation of a Commu nity Action PLAN
(CAP). LACA will provide technical support to local communities in the development of their action plans
while funds will flow direct to communities whose plans are approved by SACA.
                            5. Preventive Interventions targeted
                            to special groups
                        1. The Youth
                        2. Empowerment of Women to Negotiate Safer
                            Sex
                        3. The Armed Forces and the Police
                        4. Prevention of Mother-to-Child Transmission
                            (MTCT)
                        5. Commercial Sex Workers
                        6. Prisons, Immigration & Border Control
                        7. Workplace policies and programs related to
                            HIV/AIDS
                        8. Transport Workers


5.1: Youth (High risk youth population and non-high risk youth population):
Strategy 5.1 deals with developing Nigerian youth’s capacity to define preventive strategies for responding
to the HIV/AIDS epidemic. Both in-school and out-of school youths will be incorporated in the program,.
5.2: Empowerment of Women to Negotiate Safer Sex:
As specified, the thrust of the Strategy 5.2 will be upon empowering women to determine their own
standards of sexual behavior.
5.3: HIV/AIDS Intervention with the Arme d Forces and the Police.
Substrategy 5.3, deals with efforts to ensure that the Armed Forces and POLICE can more effectively deal
with the epidemic. This will provide IEC and training materials as needs dictate. In reality, many of these
activities are already in progress, thus illustrating the importance of ensuring that all HIV/AIDS related
activities are coordinated in both the public and private sectors.
 5.4: Prevention of Infection through MTCT
Under substrategy 5.4, NACA and its implementers will focus on developing a strategy to support efforts to
prevent HIV/AID transmission between mothers and their children. As such, this substrategy calls for the
development of IEC materials, the organization of rallies, the training of health workers.
5.5: Commercial Sex Workers
The objective of this is to undertake integrated participatory mapping, peer counseling and promotion of
condom use by CSWs.
5.6: Prisons, Immigration and Border Control
The objective of this is to reduce the rate of infection amongst the prison population and staff and
immigration personnel and at border control posts
5.7: Workplace policies and programs related to HIV/AIDS
Activities under sub strategy 57.7 will work towards preventing HIV infection and provide care and
support for workers infected and affected through the initiation of workplace policies & programs.
5.8: Transport Workers
Activities here will attempt to reduce the rate of infection amongst LDDS, touts, seafarers.
                        6. Preventive Interventions for the
                        General Population
                        n   Health workers provided with materials
                            and training related to syndromic
                            management of STIs
                        n   Policies and regulations with reference to
                            safe blood supply are developed and
                            implemented
                        n   Structures and systems for providing
                            affordable VCCT services are developed




Under Strategy 6, the HEAP focuses on ensuring that:
•     Health workers are provided with materials and training related to syndromic
management of STIs;
•     Policies and regulations with reference to safe blood supply are developed and
implemented; and
•     Structures and systems for providing affordable VCCT services are developed.

As this strategy is one of several of the HEAP’s strategies and substrategies which
require intensive development, actual implementation of statewide activities will most
probably not begin until at least the 5th quarter following the HEAP’s approval. However,
due to the importance of this strategy, NACA and its partners will need to address
logistics and procurement issues for drugs and medical supplies early on in the 1st four
quarters following the HEAP’s approval by the Government of Nigeria.
                                   Care and Support

                        7. For Persons Infected with HIV/AIDS

                        8. For Persons Affected by HIV/AIDS




Strategy 7: Care & Support for Persons Infected by HIV/AIDS
Under Strategy 7, the numerous problematic issues associated with persons infected by
HIV/AIDS will be addressed. Accordingly, this strategy focuses on the development of
guidelines on such issues as appropriate and effective care for PLWAs infected with TB,
development of guidelines for training health workers and PLWAs themselves, and
establishing parameters on home-based care, this strategy is one of several of the HEAP’s
strategies and substrategies which require intensive development. Thus, actual
implementation of statewide activities will most probably not begin until at least the 5th
semester following the HEAP’s approval. However, due to the importance of this
strategy, NACA and its partners will need to address logistics and procurement issues for
drugs and medical supplies early on in the 1st four quarters following the HEAP’s
approval by the Government of Nigeria.

 Strategy 8: Care & Support for Persons Affected by HIV/AIDS
Under Strategy 8, the numerous problematic issues associated with persons affected by
HIV/AIDS will be addressed. As the strategy focuses on the development of guidelines to
assist communities in developing a welfare scheme for orphans and family members
affected by HIV/AIDS, actual implementation of statewide activities will most probably
not begin until at least the 9th quarter following the HEAP’s approval.
                        Adoption & Adaptation of
                        HEAP
                        n
                         n HEAP is a FRAMEWORK conceived of at
                           the national level by key partners
                         n To be translated into Action Plans by
                           implementing partners at:
                            u National level

                            u State level

                            u Local level




An objective of the HEAP is to foster the development of a dialogue with States and local
communities so that, within the HEAP’s first four quarters of approval by the
Government of Nigeria, 18 of Nigeria’s states – those which are currently assumed to be
facing the most dire impact of the epidemic – will develop a state-specific action plan for
implementation during the second year following the Government of Nigeria’s approval
of the HEAP. Current HEAP development strategy calls for state- level activities to be
developed, funded, and launched first within Nigeria’s six so-called hot spot states of
Benue, Plateau, Kaduna, Ebunyi, Lagos, and Akwa Ibom
                       The HEAP is implemented by a variety
                       of institutions and organizations.

                             NACA           Federal Govt.
                                            Federal Govt.

                   State Govt.
                         Govt.
                                                     Local Govt.
                                      HEAP           Local Govt.
                      SAC                               LACA
                                                        LACA
                      A
                       NGOs         Private
                                    Private           Donors
                                    Sector
                       Media                      Universities
                                                  Universities

                             International Agencies
                                           Agencies


All segments of society and all organizations in Nigeria must be involved in the HEAP if
the fight against AIDS is to be successful. In addition to the national, state and local
governments, an equally important are Nigeria’s many potential private sector and
international partners. The HEAP provides for these institutions to identify specific
components, strategies, objectives and activities which best lend themselves to support
based on each of our partner’s comparative advantage.
                           HEAP: Implementation and Fund Flow
                    FEDERAL MIN.         World            OTHER INTERNATIONAL FINANCING AGENCIES
                    OF FINANCE           Bank (IDA)       (U.N. Agencies, AfDB, Bilateral donors, Foundations)




                                                             NACA/NPT               HAF



                        NATIONAL                                                                     NATIONAL
                                           FEDERAL                             NATIONAL NGOs
                        LEVEL              LINE                                CIVIL SOCIETY
                                                                                                     LEVEL
                                           MINISTRIES                          PRIVATE FIRMS



                                                             SACA/SPT               HAF
                                                                                                             STATE
                        STATE
                        LEVEL                                                                                LEVEL

                                                                                           STATE NGOs
                                   STATE LINE                                              CIVIL SOCIETY
                                   MINISTRIES                                              PRIVATE FIRMS



                      LOCAL                                                                 HAF                LOCAL
                      LEVEL                                                                                    LEVEL
                                                                LACA
                                LOCAL                                                        COMMUNITIES
                                GOVERNMENT                (Coordination and                  LOCAL NGOs
                                AUTHORITIES                technical inputs)                 CIVIL SOCIETY
                                                                                             PRIVATE FIRMS



                       PUBLIC SECTOR                  COORDINATING &                      NON-PUBLIC SECTOR
                       IMPLEMENTING PARTNERS          FACILITATING PARTNERS               IMPLEMENTING PARTNERS



                    Each arrow represents flow of proposals, funds, & reports




The HEAP will be funded from a variety of national and international sources. The
Federal Government will provide support through line ministries at the federal level and
down through to the states. The World Bank will provide funds through a loan to Nigeria.
Other international donors such as the UN, USAID, DFID and others will continue to
provide support directly and through their local cooperating agencies. Additional
resources (not shown in the diagram here) can be expected to come from communities
themselves as they contribute to their support for civil society groups. Family level
resources will also be mobilized to assist with care and support for PLWAs and orphans
and other vulnerable children who are affected by the epidemic. Lastly, the private
commercial sector will play a vital role in the form of condoms and pharmaceutical
products used in treatment.
                                State-Level Next Steps
                 n Creation/Consolidation of Multi-sectoral State Action
                   Committee on AIDS in the Governor’s Office - with
                   stronger NGO representation
                 n Recruitment of State Program Teams
                 n Institutional Capacity Assessments
                 n NGO Assessments
                 n Baseline Studies
                 n Preparation of Annual Action Plans
                 n “Process Test” for HIV/AIDS Fund and its Operations
                   Manual
                 n Facilitate LACA creation in as many LGAs as possible



In order for the HEAP to be implemented at the state level, several steps are needed.
These steps have to do basically with establishing the necessary institutional base and
information base upon which the programs will be built. Primary among these are the
creation and consolidation of he SACAs and facilitation of the creation of the LACAs.
Developed in Cooperation with
Developed in Cooperation with
     The POLICY Project
      The POLICY Project
                                POLI CY
                                  LI

								
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