Two Nigerian States See Increased Budget Allocations for HIV and AIDS Programs

Donor funding accounts for more than 70% of the country's HIV/AIDS response, highlighting the need for increased domestic resource mobilization to sustain and expand care. To address this gap, Nigeria's State Agencies for the Control of AIDS (SACA) have developed domestic resource mobilization strategies for the HIV/AIDS response, with support from USAID/Nigeria, HFG, and the SIDHAS project. Four Nigerian states, Rivers, Cross River, Lagos, and Akwa Ibom, have implemented strategies to stimulate government financing for HIV/AIDS programs and outline potential new funding sources, including those from the private sector. These strategies aim to effectively govern the allocation and use of funds, despite wider economic challenges, including the impact of low oil prices. Cross River state has seen a significant increase in budgetary allocation for HIV/AIDS programs, with a 300% increase in 2016, and a sustained 24% increase in 2016 compared to the previous year. Lagos state also experienced a 38% increase in budgetary allocation for HIV/AIDS in 2016. The HFG project, in partnership with state institutions, is supporting the implementation of specific parts of each strategy. The project is conducting financial analyses, including a fiscal space analysis for the HIV and AIDS response, an HIV/AIDS and health sector budget tracking analysis, and a public financial management (PFM) process review. An initial rapid assessment found limited quantitative information and PFM issues, with budgets not well-defended and funding not being released. In Lagos state, the project provided data to support the quantification of gap costs and worked with the SACA to strengthen the budget defense process by highlighting the impact of HIV/AIDS programs on population health. The HFG project has effectively engaged with the finance, economic planning ministries, and governing bodies, such as state government houses of assembly committees on health, to build support for increased state funding for HIV and AIDS. This multi-dimensional approach to domestic resource mobilization has addressed several bottlenecks simultaneously, a first at the state level. The project has built on the achievements of the Health Systems 20/20 project and is a flagship project of USAID's Office of Health Systems, supporting its partners in low- and middle-income countries to strengthen the health finance and governance functions of their health systems, expanding access to life-saving health services.