NIGERIA'S RESPONSE TO GLOBAL FUND CUTS

UNCLAS SECTION 01 OF 02 ABUJA 001255

SIPDIS

PASS HHS FOR OGHA STEIGER
USAID (GLOBAL HEALTH AND AFR)

E.O. 12958: N/A
TAGS: EAID KHIV ELAB SOCI NI
SUBJECT: NIGERIA'S RESPONSE TO GLOBAL FUND CUTS

REF: ABUJA 2410


1. Summary. The Global Fund To Fight AIDS, Tuberculosis,
and Malaria canceled on April 28 the funding of two five-
year Nigeria HIV grants totaling $81 million. The Fund did
so because of "inadequate performance" by the Fund's
principal recipient in Nigeria, the National Action
Committee on AIDS (NACA),and the failure of the Nigeria
Country Coordinating Mechanism (CMM) to conform to Global
Fund standards. Nigeria's ARV program was supposed to have
14,000 people on treatment by the end of the program's first
year, but the actual number was zero. Nigeria was supposed
to have 24,000 people on treatment by the end of the
program's seventh quarter, but the actual number was 6,865.
The USG, the Global Fund, and UNAIDS have made specific
recommendations since 2004 on improvements to comply with
Global Fund requirements. The Fund's Nigeria CCM dissolved
itself on May 8, 2006, and on May 22 elections were held to
select representatives of six civil-society constituencies
to create a new CCM. The USG Nigeria team continues meeting
with the GON and NACA to detail how they can improve their
performance. End summary.


2. After only two years, the Global Fund To Fight AIDS,
Tuberculosis, and Malaria programs in Nigeria canceled on
April 28 two five-year HIV grants to Nigeria totaling $81
million. The Fund cited "inadequate performance" by the
Fund's principal recipient in Nigeria, the National Action
Committee on AIDS (NACA),and the failure of the Nigeria
Country Coordinating Mechanism (CCM) to conform to Global
Fund standards. According to the Fund's Secretariat, lapses
in Nigeria's HIV/AIDS program included failures to meet
multiple targets, and disbursing funds at a much lower rate
than intended. Nigeria's anti-retroviral (ARV) program was
supposed to have 14,000 people on treatment by the end of
the program's first year, but the actual number was zero.
Nigeria was supposed to have 24,000 people on treatment by
the end of the program's seventh quarter, but the actual
number was 6,865.

Significant Program Failures
--------------


3. Further, NACA provided "questionable data" to the Fund,
reporting the numbers of people receiving treatment who
instead turned out to be the numbers of people who could
have been treated if all the drugs sent to health facilities
had been used. Nigeria's HIV/AIDS program spent money on
"inappropriate activities," including foreign travel.
Additionally, Nigeria's CCM failed to acknowledge or report
many of these problems or to reform the CCM as promised.
The multi-sectoral CCM develops and submits grant proposals
to the Global Fund. Once a grant is approved, the CCM
oversees the progress in the programs financed by the grant.


4. Nigerians currently receiving ARV treatment under the
canceled grants will continue to have their care paid by the
Fund for up to two years while alternatives are pursued.
The Fund approved Nigeria for a major ARV grant worth more
than $180 million -- but which likely will be administered
by a different principal recipient once the grant agreement
is signed.

Previous U.S., Global Fund efforts to aid the GON
-------------- --------------


5. Nigeria consistently failed to restructure its CCM to
create a more efficient and transparent body, and to provide
adequate oversight over NACA, the primary recipient. The
USG is a member of the CCM and first became concerned in
July 2004 about the lack of progress of Global Fund Round
One HIV/AIDS grants. At that time, the USG worked with
UNAIDS to arrange for a consultant to assist the CCM to
reform. The consultant's report listed concrete
recommendations that the USG endorsed.


6. The Government of Nigeria (GON) implemented none of these
reforms by February 2005, when the USG team again became
concerned about the lack of progress toward benchmarks. As
chair of the Donor Coordination Group, the USG invited the
CCM Secretariat to inform donors of the situation and to
discuss the likelihood of achieving targets before the Phase
Two renewal process began. At that time, the CCM
Secretariat was unwilling to discuss candidly with donors

SIPDIS
the status of the program.


7. The USG held follow-up meetings with NACA, the principal
recipient of Nigeria's Round One Global Fund grants, and
with Nigeria's Ministry of Health (MOH),the principal sub-
recipient. They informed the USG that while these programs
got off to a very slow start, they were making every effort
to accelerate progress before the May 2005 deadline. The
USG offered its support to NACA and the MOH to achieve
results. The MOH requested assistance in drug procurement
and logistics, which the USG continues to provide. NACA
requested and is receiving support in monitoring and
evaluation, especially in developing an ARV patient-
monitoring and patient-management system.


8. The USG is a key member of the Country Implementation
Support Team (CIST) created in October 2005 to coordinate
multilateral and bilateral support to Global Fund programs
in Nigeria. The CIST assessed the situation and created a
coordinated donor support body to help the CCM and NACA
correct their shortcomings.


9. The Global Fund cited numerous deficiencies to NACA in
October 2005, warning that a second phase of funding could
be suspended. The USG then met with representatives of
bilateral and multilateral agencies. While the USG
concluded in November 2005 that NACA had made some progress,
it found the CCM had not made significant progress in
adopting recommended reforms. The CCM requested and
received the Global Fund's support to develop a plan to
reorganize the CCM by the end of May 2006. This was a
prerequisite to sign Round Five tuberculosis and HIV/AIDS
grants worth more than $200 million. The USG reviewed the
Global Fund consultant's preliminary report and agreed with
all of its recommendations. The CCM, however, failed to
adopt or implement the consultant's recommendations,
resulting in the Global Fund's canceling the $81 million in
grants.

Next steps
--------------


10. The USG Nigeria team continues to meet with the GON and
NACA to specify what they must achieve to comply with Global
Fund accountability requirements. The GON must demonstrate
the will to change drastically its management of these
Global Fund programs in Nigeria. The first steps occurred
on May 8 when the CCM dissolved itself and put in place an
interim CCM (ICCM) with the mandate to hold elections to
choose new CCM members. With the support of the CIST, new
election procedures were put in place, and the bilateral and
multilateral partners held elections under an official
observer, then reported back to the ICCM. On May 22,
representatives of six CCM constituencies were elected with
the assistance of a facilitator and an observer; elections
of representatives of about one third of other CCM
constituencies remain pending. The USG was represented as a
facilitator and an observer and determined that these
elections were carried out acceptably. The ICCM planned to
hold a Global Fund orientation and the first meeting of the
new CCM on May 23-24. These activities were delayed
following UNAIDS' suggestion that they instead take place in
early June with technical assistance from UNAIDS and the
Global Fund.


11. The CCM is required to meet by the end of June the
deadline for the Global Fund's Malaria Phase II renewals, as
well as for the selection and confirmation of the Round Five
principal recipient. The USG Nigeria team continues to
monitor and participate in these processes to increase
accountability and strengthen the operations of Global Fund
recipients in Nigeria.
CAMPBELL