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Nigeria

As the country with the largest population in Africa, Nigeria needs strong health system information and management. Nigeria has the highest TB burden in Africa (311 per 100,000) and the fourth highest worldwide. An estimated 3.3 million Nigerians are living with HIV/AIDS. Health Systems 20/20 provides vital data that inform decision makers and trains local institutions to support sustainable health programs.

Capacity Building

Capacity building activities offer sustainable solutions to strengthen institutions and personnel in Nigeria. Project activities include supporting a comprehensive medical school curricula review, and training staff at the National Tuberculosis and Leprosy Training Centre (NTBLTC) to provide courses to TB and HIV managers. Since training with Health Systems 20/20, NTBLTC has given several national and international TB and HIV management courses to health professionals.

Measuring & Monitoring Health Systems Performance

One of the biggest challenges facing developing countries is the lack of reliable information for making decisions regarding health planning and resource allocation. Health Systems 20/20 implements tools such as the health systems assessment, which provides a rapid yet comprehensive assessment of the health system, and the public expenditure management review that identifies gaps in public health funds management. (See the Nigeria Health Systems Assessment)

Tuning into technology, the project is strengthening health information systems; using geographic information systems to map HIV/AIDS, TB, and malaria health service delivery; and developing decision-support software to manage health programs.

HIV/AIDS

With Nigeria’s large HIV/AIDS burden, the project is implementing various activities that include analyzing of the system wide effects of activities supported by PEPFAR and Global Fund, assessing the roles of non-health government agencies in the mainstreaming of HIV, and examining the role of non-state actors in prevention and mitigation. In addition, Health Systems 20/20 is working with the Nigerian Agency for AIDS Control to determine the cost and feasibility of decentralizing antiretroviral treatment services to improve access and lower unit costs of delivery. The project also contributed to a service provision assessment, which identified disparities in service between rural and urban areas as well as among the three tiers of the national health care delivery system.

Health Systems 20/20 also worked in Nigeria to complete a HIV/AIDS Program Sustainability Analysis Tool (HAPSAT) assessment. HAPSAT was developed by Health Systems 20/20 to help governments and donors develop of HIV/AIDS policies and implement plans. HAPSAT utilizes a computer-based model to forecast and analyze the sustainability of HIV/AIDS programs during periods of service delivery scale-up and/or when facing limited or unknown future resource levels.

Tuberculosis

Over the course of the project, Health Systems 20/20 has implemented several activities to improve the delivery of services to Nigerians. Programs include using personal digital assistants for TB supportive supervision, conducting TB leadership and management training, and supporting the development of the TB and Leprosy Strategy for Nigeria. In addition, Health Systems 20/20 developed a customizable costing model in MS-Excel to look at the direct cost implications of the Nigerian TB control program during 2008-2012. Several TB activities were presented at the Union Africa Region 2011 TB Conference.