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Nigeria detected its first HIV/AIDS case in 1986, and since then, the country has gradually registered HIV/AIDS statistics that qualify for an AIDS epidemic. In 1991, the prevalence was 1.8%. In 1996, it shot up to 4.5%. In 2001, it recorded a high of 5.8% and finally in 2003, the figure was 5%.
The decline that Nigeria registered in 2003 is an improvement in its health standards, but it is still far from leaving the epidemic zone. Unfortunately, sub-Saharan countries such as Nigeria are more susceptible to breeding the virus because of certain circumstances and conditions, which are prevalent in them but absent in other systems.
The way people live, work, feed, school, and even engage in recreational activities determines how their health shall fare. Moreover, HIV/AIDS awareness programs are on the increase and a country like Nigeria is yet to reap the fruits of the knowledge dispatched by such programs. It has become apparent that the government alone cannot possibly bear the burden of a nation’s health crisis.
It requires all the assistance it can get from the civil society, nongovernmental organizations, and other parastatals. However, Nigerians are presently experiencing health inequalities that the government, with the assistance of the civil society, can easily alleviate if they collaborate to put in place a self-sufficient system of health that will serve its population adequately.
This paper reviews the Nigerian system of health from both the governmental and nongovernmental perspectives giving special attention to the activities of two civil society organizations in Nigeria, GHAIN-Global Health Action in Nigeria, managed by Family Health International FHI and HALT AIDS.
There are numerous repercussions of having a HIV / Aids epidemic in a nation but due to a limitation of space and subject, this paper shall only handle issues on HIV / AIDS and infant / mortality rate in Nigeria.
Of specific interest will be the causes, effects, and prevention, as well as treatment strategies adopted by the various civil society organizations to reduce infection, maintain the sickly, and cater for orphans and vulnerable children, (OVC). It shall also address possible solutions to the various problems that these civil society organizations face.
It is important to note that these two health issues are somewhat related and so for the purposes of this paper shall be studied as an integrated problem. HIV/ AIDs is a major cause of infant / maternal mortality with other factors also being major contributors, but likewise, these other factors, such as early sexual encounters are also causes of HIV / AIDS prevalence.
The Commission’s final report on Health Inequity
According to the Commission on Social Determinant of Health, hereafter referred to as ‘the commission,’ stated in its final report to the World Health organization, “Civil society refers to the arena of uncoerced collective action around shared interests, purposes, and values.
In theory, its institutional forms are distinct from those of the state, family, and market though, in practice, the boundaries between state, civil society, family, and market are complex.
Civil society is often populated by organizations such as registered charities, development nongovernmental organizations, community groups, women’s organizations, faith-based organizations, professional organizations, trade unions, self-help groups, social movements, business associations, coalitions, and advocacy groups” (Commission on Social Determinants of Health 2008, p. 7).
Riding on this definition, Global Heath Action in Nigeria, (GHAIN), is definitely a civil society and its contribution to the management of the Nigerian HIV / AIDS epidemic is vital to that country. Moreover, the commission’s report highlighted a summary of the causes of health inequity and several possible solutions to this quagmire.
The problems include poor daily living conditions across the borders from youth to the elderly and among both men and women. The effects of such conditions are mirrored a generation’s productivity and in most cases, there is heath inequity as a direct consequence of lack of proper living standards.
The recommended solution to this problem relies heavily on the education of young mothers of both girls and boys on how to take care of infants as well as how to nurture and provide for these newly born. By improving the well-being of both girls and women, one also guarantees that the circumstances in which their children are born will be friendly and supportive of a better and healthier lifestyle.
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This can happen by putting emphasis on early childhood development, improvement of living and working conditions, vouching for social policies that cater for everybody and finally, certifying that people can enjoy benefits accruing at their old age. Of course, for one to achieve all this, the government, civil society and the private sector need to collaborate to come up with results.
The second problem addressed by the commission is that of inequitable distribution of power, money and resources. Simply, poverty and exploitation of the poor by the wealthy and politically powerful is counterproductive to any nation’s healthcare.
The commission’s solution to the problem of health inequity lies in addressing other inherent inequities such as equity between men and women in the society, thus, it proposes that women empowerment should take place in patriarchal societies.
It also requires that the private sector exercise accountability and the civil sector as well as the government respect collective action. This means that they should earn their legitimacy from the people in the nation and so act in accordance with what these people feel is appropriate in various circumstances. As a result, they shall be more trustworthy and people shall take heed to their regulations and policies.
In a way, it is citizen ownership in the projects. Such a government, civil society or private organization cannot possibly seek to defraud, manipulate, or oppress its publics and so equity is a guarantee. The final problem is that of lack of proper knowledge.
Most countries are unaware of the existence the issue of health inequity and consequently cannot realistically solve it. It starts with a realization that this problem exists, followed by a decision to resolve it and consequently putting in place measures to analyze and evaluate the extent of the problem in order to solve it.
With the above causes and solutions of health inequity, the next step is to zero in on Nigeria. In Nigeria, as noted above, specific regard is on the matter of HIV / AIDS and maternal / infant mortality. More specifically, the activities of GHAIN and HALT AIDS, both civil societies as per the definition given by the commission, and working to some extent in collaboration with the government to alleviate the HIV / AIDS epidemic.
Nigeria has a population of 133 million and out of these; four million are infected with HIV / AIDS (GHAIN 2009, p. 1). Two million have died of this infection or HIV / AIDS related diseases and the number of people affected by the virus is indefinite but quite high. In 2003, there were seven million orphans and out of these; 1.8 million were HIV / AIDS orphans.
It is, therefore, apparent that the issue of HIV / AIDS in Nigeria requires special attention as it is claiming many lives and leaving others in ruin in its wake. The repercussion of this is that the economy is in a precarious position, as sickly people cannot work to improve their economy.
Global Health Action in Nigeria (GHAIN)
Research indicates that among the factors contributing to HIV / AIDS prevalence include multiplicity of sexual partners, mother-to-child transmission, although now that is being referred to as parent-to-child transmission, blood transfusion, low condom use, untreated sexually transmitted infections, and denial by a majority of Nigerians of the possibility of being infected with HIV.
Besides, widespread poverty, ignorance or illiteracy, lack of women empowerment, and an overcrowded healthcare system further compound the situation in Nigeria. The government alone cannot bear the burden of the epidemic as numerous issues occupy its attention and scarce resources.
Consequently, it lies on the civil society, faith-based, and nongovernmental organizations in Nigeria to salvage the situation. One such organization is GHAIN, the Global Health Action in Nigeria. Since its launching in 2004, this organization has achieved quite a lot in the short time it has been in action.
GHAIN receives its funding from the President’s Emergency Plan for AIDS through the United States Agency for International Development, (USAID). It comprises of seven partners including Family Heath International at its head.
The rest include the American Red Cross and Nigerian Red Cross Society, the Axios Foundation, the Center for Development and Population Activities, German Leprosy and Tuberculosis Relief Association, and Howard University (GHAIN 2009, p. 1).
With its headquarters at Abuja and regional offices in various states within the nation including Kano and Lagos among others, GHAIN has played a major role in cutting back on HIV infection and spreading. It does this through various avenues including awareness education, provisions of voluntary testing and counseling services, anti-retroviral therapy, and provision of palliative care among other means.
Under the umbrella of GHAIN, Family Health International together with its local partners in Nigeria has been instrumental in the provision of technical support to the National Action Committee on AIDS. They have also assisted the National AIDS & STD Control Program in capacity building as well as in establishing National Guidelines and even manuals for managing HIV / AIDS and STDs.
GHAIN has integrated HIV / AIDS programming into important national systems such as the armed forces, the education syllabus, and workplaces. Some of its specific strategies include measures to prevent mother-to-child transmissions, which it achieves by preventing infection among women of childbearing age, preventing prenatal infection, and setting up follow-up procedures for mothers, infants and their families.
Another strategy the GHAIN employs involves abstinence and ‘be faithful’ initiatives, which mostly target the youth and married couples. On this front, GHAIN wages the battle against HIV / AIDS using faith-based organizations to tap into the religious potential of discouraging immorality.
Emphasis is on education of youth, both by experienced and respected personnel as well as by peers trained in such education. The result is that the facilitators of these trainings are capable of establishing a healthy bond with their audience and so the lessons learnt are more productive in the lives of the youth.
Other targeted audiences include the uniformed services personnel and their families. This is an important group because HIV / AIDS prevalence among army wives, so to speak, is on the increase. Most of them engage in extramarital affairs in the absence of spouses commissioned to serve in distant lands.
Moreover, those spouses themselves are prone to engage in promiscuous behavior wherever stationed because of the separation from their spouses. Consequently, it becomes crucial to educate both uniformed forces personnel and their families on the prevention and treatment of HIV / AIDS. The other target group is transport workers, also very critical in the spread of HIV / AIDS.
Most of the drivers, pilots, and sailors among others are in constant travel and have little or no time for family. Consequently, most of them engage the services of commercial sex workers or have flighty affairs with the cabin crew, which are dangerous for their health.
Moreover, the issue of the perception of women also comes in handy because of the perception men have of women, as usable and disposable objects (Middleton-Lee 2010, p. 9). Nigeria is a heavily patriarchal society and most of its citizens are either very customarily inclined or religiously biased.
Consequently, they either view women as lesser beings (under customary laws) or as less important members of society, mostly to be seen and not heard (under Islamic law). Either way, the situation is precarious for those who have this mentality, and for the women who suffer at their hands.
Linked with this group are the commercial sex workers who have infiltrated the alleys of Nigeria. GHAIN conducted a survey whose shocking results indicated that clients pay more to have unprotected sex. This is a clear indication of the mind-set of such clients, which is also the mindset of most sexually active persons: the inconvenience of using condoms.
Consequently, GHAIN came up with a forum specifically tailored to address the needs of this audience and it constantly provides education on HIV / AIDS infection and spread as well as providing counseling and testing services to attempt to reform such deviance.
Other targeted individuals include men and women at the workplace, who are under constant pressures to engage in illicit affairs while their spouses are absent. GHAIN provides education, counseling, testing, and antiretroviral therapy for all these individuals. GHAIN has gone as far as including homosexuals in its prevention and treatment programs.
It has catered for the needs of both gays and lesbians. Finally, GHAIN also targets the People Living with HIV / AIDS, (PLHA). For this group, it provides access to antiretroviral therapy (ART) and counseling. To do all this, GHAIN works in collaboration with “nongovernmental organizations, community based organizations, national associations and unions, and the private sector” (GHAIN 2009, p. 2).
It is important to note here that, in accordance with the commission’s findings on health inequity, it is not sufficient simply to address the health issue at hand, but also to address the causative factors in order to prevent a re-manifestation of the same problem in the next generation.
With this in mind, GHAIN has sought to improve the lives of girls and women in the society by sponsoring women is their small enterprise, rallying for girl-child education, which has been a difficult feat to achieve due to the Islamic background of Nigeria.
This is because the system of education is intrinsically almost impossible for women to scale and achieve success rivaling that of their male counterparts. However, GHAIN has been at the forefront of launching campaigns against this rigid and gender-insensitive system leading to flexibility in most of the sectors.
Moreover, in terms of equitable distribution of resources, GHAIN has sponsored many community-based income-generating projects meant to secure the financial needs of most citizens. It has been instrumental in the construction of several market places, car washes, schools and other initiatives initiated by young entrepreneurs.
In additional to all these, GHAIN through its respective partners also provides education on financial security measures meant to insure the elderly after retirement. It also provides seminars on early childhood development for boys and girls at the local regions and attempts to equip all these new parents with the adequate parenting skills.
Its activities are so far reaching that they cover communities, secondary and primary health care providers in providing palliative care for basic health care support.
Among other things, they give insight on how to manage opportunistic infections, how to provide people living with HIV / AIDS with home-based care and support, and they also educate clinical personnel on how to handle those infected with HIV but who have not yet qualified for antiretroviral therapy.
The other organization that this paper looks into is HALT AIDS whose activities in Nigeria are also noteworthy. Most of the activities that HALT engages in are similar to those of GHAIN and so to avoid repetition, this paper shall only address those not touched on by GHAIN. HALT has been instrumental in the provision of palliative care for HIV and Tuberculosis.
It achieves this end by focusing on the relationship between HIV and tuberculosis and consequently integrating the services for HIV and TB. In provides education, counseling, testing and treatment services for both HIV and Tuberculosis and the campaign for this is so widespread that the rate of spread of both HIV and Tuberculosis is on the decrease (HALT AIDS 2010, p. 78).
HALT takes credit for increasing awareness on Tuberculosis in Nigeria. The organization was instrumental in getting people to know that a person can have tuberculosis without HIV infection, and vice versa. HALT has also championed in the provision for Orphans and Vulnerable Children, (OVCs).
With specific regard to their protection as well as the improvement of their well-being, HALT has lifted some of the burden of HIV / AIDS off the shoulders of these children, the community, and their extended families.
Initially in Nigeria, members of the extended family often took up orphans or sometimes if this was not the case, they had to fend for themselves, a situation that resulted in a lot of child labor. HALT AIDS’ intervention has reduced the latter’s occurrence.
The organization provides medical education to adults responsible for the orphans and vulnerable children and provides psychological support for these children. Moreover, it has built several orphanages to provide for such children better and it supports households that support such orphans.
HALT AIDS is also responsible for widespread counseling and testing of tuberculosis patients, most at-risk populations, maternal and child healthcare patients, and patients of all other healthcare providers. In addition to this, it has created numerous avenues within secondary healthcare facilities through which those infected with the virus can access antiretroviral therapy.
For this strategy to be effective, it continues to engage clinical staff in training on standard operating procedures for administering ARTs. It also campaigns for the improvement of drug storage facilities as well as pharmacies and laboratories.
It has conducted numerous research projects meant to improve the standard of healthcare in Nigeria and to identify the best way to adopt technology from western countries that are more developed. Finally, HALT AIDS has been instrumental in advocating for confidentiality in patient handling.
This has gone a long way in the reduction of stigmatization, which in the past was the cause of most premature deaths of those infected with HIV / AIDS, as well as the cause of people shying away from being tested.
Health inequity is a relatively new concept. It is a critical aspect that affects the way that any nation handles its population. In sub-Saharan Africa, it is even more crucial to address this issue, as there is still a lot of inequity in most political, social, and economic grounds, and by extension, in the health sector.
The government alone cannot resolve the problem of health inequity and it becomes important for other non-governmental organizations to intervene. Nigeria presents a good example of how civil societies, nongovernmental organizations, and the private sector can collaborate to bail out the government in resolving these issues.
This paper looked into the activities of GHAIN and HALT AIDS in Nigeria and concludes that, nongovernmental organizations such as these, tailored to address specific needs, are more effective in addressing those needs, which a government preoccupied by a myriad of responsibilities, cannot address effectively.
Moreover, they have the liberty to exercise their rights in the type of activities that they will undertake as well as the amount of funding that they will allocate for such activities. Besides, investors and sponsors find these organizations easier to deal with and therefore, funding is not a problem.
Commission on Social Determinants of Health. (2008). Closing the Gap in a Generation: Health equity through action on the social determinant of health. Geneva: Commission on Social Determinants of Health & World Health Organization.
GHAIN. (2009). Global HIV/ AIDS Initiative in Nigeria. Available at <https://www.fhi360.org/>
HALT AIDS. (2010, November 28). HALT AIDS. Web.
Middleton-Lee, S. (2010). Accelerating Action to End Pediatric HIV / AIDS by 2015 – A Status Report. Nairobi, Kenya: Global AIDS Alliance.