AIDS Prevention Initiative in Nigeria (APIN): Development and Status

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

2. Outline • Development • Introduction • Governance • Phases of Transition • Management Systems • Status • Lessons learned • Questions from the field

3. 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. 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. 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. APIN Ltd and Harvard PEPFAR Sites Nigerian states that currently include sites under APIN Ltd & Harvard PEPFAR 1

7. APIN/Harvard PEPFAR Sites: as of 2007 Federal Medical Centre Nguru University of Maiduguri Teaching Hospital State Specialist Hospital Maiduguri Nursing Home Maiduguri Ahmadu Bello University Teaching Hospital University of Ibadan College of Medicine 3 Satellites under UCH Adeoyo Maternity Hospital Jos University Teaching Hospital Our Lady of Apostles Hospital Jos 8 Satellite Hospitals, 44 PHCs Federal Medical Centre Makurdi Sacred Heart Catholic Hospital Lantoro University of Nigeria Teaching Hospital Widowcare Abakiliki Ebonyi 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 Sites Under APIN Ltd Sites Under Harvard PEPFAR APIN Program Office

8. Site Allocation: 2007-2008 Harvard PEPFAR APIN 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. APIN/PEPFAR Sites: August 2010 Federal Medical Centre Nguru University of Maiduguri Teaching Hospital State Specialist Hospital Maiduguri Nursing Home Maiduguri Ahmadu Bello University Teaching Hospital University of Ibadan College of Medicine 3 Satellites under UCH Adeoyo Maternity Hospital 43 Oyo DOTS Centres Jos University Teaching Hospital Our Lady of Apostles Hospital Jos 8 Satellite Hospitals, 44 PHCs Federal Medical Centre Makurdi Sacred Heart Catholic Hospital Lantoro University of Nigeria Teaching Hospital 68 Military Hospital. Creek Hospital Widowcare Abakiliki Ebonyi Nigerian Institute for Medical Research Lagos University Teaching Hospital Mushin General Hospital PHC-Iru Victoria Island Onikan Women’s Hospital APIN Program Office

11. 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. 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. 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. 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. THANK YOU