1. AIDS Prevention Initiative Nigeria AIDS Prevention Initiative in Nigeria (APIN): Development and Status Prosper Okonkwo. MD APIN, Nigeria 8 th Annual Track 1.0 ART Program Meeting Maputo, Mozambique August 11, 2010

2. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria Outline Development Introduction Governance Phases of Transition Management Systems Status Lessons learned Questions from the field

3. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria Introduction History APIN was established as a program of HSPH in 2000 with a grant from the Gates Foundation The Harvard PEPFAR(APIN Plus) Program APIN LLC was incorporated as a local NGO in 2007 to gradually assume HSPH’s work in Nigeria. Triggers of NGO formation

4. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria Governance Two tiered structure HRSA’s recommendations on governance New board Composition More diversified board Meeting transition guidelines (85 % Nigerians) Broadened scope of activities E.g. Resource mobilization for sustainability

5. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria Phases of Transition APIN as sub contractor managing all HSPH sites. APIN as sub contractor for all HSPH sites and an independent IP ( RFA PS07- 730). APIN as sub contractor for some sites and IP with more sites transferred from HSPH each year. APIN to soon absorb all “available” HSPH sites.

6. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria APIN Ltd and Harvard PEPFAR Sites Nigerian states that currently include sites under APIN Ltd & Harvard PEPFAR 1 1

7. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria APIN/Harvard PEPFAR Sites: as of 2007 APIN Program Office Sites Under Harvard PEPFAR Sites Under APIN Ltd 68 Nigerian Army Reference Hospital Nigerian Institute for Medical Research National Military Hospital, ‘Creek’ Lagos University Teaching Hospital University of Lagos, College of Medicine Mushin General Hospital PHC-Iru Victoria Island Onikan Women’s Hospital 68 Nigerian Army Reference Hospital Nigerian Institute for Medical Research National Military Hospital, ‘Creek’ Lagos University Teaching Hospital University of Lagos, College of Medicine Mushin General Hospital PHC-Iru Victoria Island Onikan Women’s Hospital Sacred Heart Catholic Hospital Lantoro Federal Medical Centre Makurdi Jos University Teaching Hospital Our Lady of Apostles Hospital Jos 8 Satellite Hospitals, 44 PHCs Jos University Teaching Hospital Our Lady of Apostles Hospital Jos 8 Satellite Hospitals, 44 PHCs University of Maiduguri Teaching Hospital State Specialist Hospital Maiduguri Nursing Home Maiduguri University of Maiduguri Teaching Hospital State Specialist Hospital Maiduguri Nursing Home Maiduguri University of Nigeria Teaching Hospital Ahmadu Bello University Teaching Hospital Widowcare Abakiliki Ebonyi Federal Medical Centre Nguru University of Ibadan College of Medicine 3 Satellites under UCH Adeoyo Maternity Hospital University of Ibadan College of Medicine 3 Satellites under UCH Adeoyo Maternity Hospital

8. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria Site Allocation: 2007-2008 Harvard PEPFARAPIN Ltd + Oyo 43 Oyo State DOTS Centres Benue: Federal Medical Centre Makurdi Borno University of Maiduguri Teaching Hospital State Specialist Hospital Maiduguri Nursing Home Maiduguri Ebonyi: Widowcare Abakiliki Enugu: University of Nigeria Teaching Hospital Ituku-Ozalla Kaduna: Ahmadu Bello University Teaching Hospital Lagos 68 Nigerian Army Reference Hospital Nigerian Institute for Medical Research National Military Hospital, ‘Creek’ Lagos University Teaching Hospital University of Lagos, College of Medicine Mushin General Hospital PHC-Iru Victoria Island Onikan Women’s Hospital Ogun: Sacred Heart Catholic Hospital Lantoro Oyo University of Ibadan College of Medicine 3 Satellites under UCH Adeoyo Maternity Hospital Plateau Jos University Teaching Hospital 8 Satellite Hospitals, 44 PHCs Our Lady of Apostles Hospital Jos Yobe: Federal Medical Centre Nguru

9. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria APIN/PEPFAR Sites: August 2010 Nigerian Institute for Medical Research Lagos University Teaching Hospital Mushin General Hospital PHC-Iru Victoria Island Onikan Women’s Hospital Nigerian Institute for Medical Research Lagos University Teaching Hospital Mushin General Hospital PHC-Iru Victoria Island Onikan Women’s Hospital Sacred Heart Catholic Hospital Lantoro University of Ibadan College of Medicine 3 Satellites under UCH Adeoyo Maternity Hospital 43 Oyo DOTS Centres University of Ibadan College of Medicine 3 Satellites under UCH Adeoyo Maternity Hospital 43 Oyo DOTS Centres APIN Program Office Federal Medical Centre Makurdi Jos University Teaching Hospital Our Lady of Apostles Hospital Jos 8 Satellite Hospitals, 44 PHCs Jos University Teaching Hospital Our Lady of Apostles Hospital Jos 8 Satellite Hospitals, 44 PHCs University of Maiduguri Teaching Hospital State Specialist Hospital Maiduguri Nursing Home Maiduguri University of Maiduguri Teaching Hospital State Specialist Hospital Maiduguri Nursing Home Maiduguri University of Nigeria Teaching Hospital Ahmadu Bello University Teaching Hospital Widowcare Abakiliki Ebonyi Federal Medical Centre Nguru

10. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria IndicatorYear 1Year 2Year 3 Cumulative On Care Adult150021,35033,341 Pediatric2001,0502.270 Current On ART Adult5501310016,854 Pediatrics20010501,561 No of Sites1511 PMTCT Services Pregnant women tested for HIV and received their results 5,00014,20050,000 HIV positive pregnant women receiving prophylaxis to reduce mother to child transmission 8521,702 No of Sites2611 Annual Budget$1.705m$12.325m$14.864m*

11. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria Management Systems Improvement imperative to: Receive and manage US funding directly Provide direct oversight to many big sites Objectively verifiable systems improvement Responses to HRSA’s recommendations, especially HR related. Systems adjudged adequate by other assessments

12. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria Status Management Systems (HR, finance, procurement etc.). Plans are on to recruit for key positions. Programs SI Data Management M&E QI/QA Supply Chain Management APIN 5 Yr. Strategic Plan. Moving from HIV/AIDS focus to the broader public Health domain.

13. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria Lessons learned Effective Communication and early buy-in among key stakeholders is crucial. Building on already existing structures makes for smoother transition. Building the capacity of the site personnel reduces the potential challenges of future TA. Willingness to modify implementation models to suit the transition plan

14. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria Questions How does the transition to local NGOs fit into program ownership by National Governments? What effects (if any) would regionalization, finalization of the partnership framework,etc.have on the implementation models of independent NGOs? What are the expected outcomes of transition ? How do we know if we have been successful or not?

15. Monday, October 26, 2015 AIDS Prevention Initiative Nigeria THANK YOU THANK YOU