Office of the Inspector General

Message from the Executive Director: Global Fund Grants in Nigeria

06 April 2022

Nigeria’s political and geographical complexities, combined with security impediments, make it a challenging environment for investments in global health. The COVID-19 pandemic has exacerbated these issues. COVID-19 exposes the most vulnerable and marginalized communities to greater risks, as lockdowns and restrictions to curb the pandemic hinder access to lifesaving treatment, care and prevention services. 

Despite the impact of COVID-19 on HIV, TB and malaria programs, the Global Fund commends Nigeria for the progress the country is making in the fight against the three diseases. HIV performance has improved greatly, with 90% of people living with HIV knowing their status, 98% of those who know their HIV-positive status on treatment and 95% of those on treatment having suppressed viral loads. HIV infections have also decreased by 28% over the last 10 years. TB notification has also increased, and TB treatment coverage has increased from 24% to 40% in the last three years. Nigeria has also made notable progress in malaria control, reducing the prevalence of the disease by almost 50% between 2010 and 2018. 

When COVID-19 struck in Nigeria in 2020, many clinical facilities were swiftly turned into COVID-19 isolation centers. HIV services and programs were severely impacted, and the number of people testing for the virus dropped dramatically. The country acted quickly to bring HIV services closer to the people. Integrating health services meant that when community health workers were out looking for cases of COVID-19, they were also looking for cases of HIV and TB. That led to an unexpected success: While HIV testing dropped drastically worldwide in 2020 due to COVID-19, Nigeria was one of the few countries to achieve an increase in the number of people diagnosed with HIV in 2020 compared to 2019.

We see several opportunities to increase program performance in Nigeria. The HIV alignment agreement between the government of Nigeria, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund has improved coordination on HIV prevention, diagnosis and treatment. Successful engagement of 21 states and the private sector, has resulted in increased TB case notification, and provides a platform for more effective coordination and improved implementation across all three diseases and COVID-19. Successful implementation of mass distribution campaigns for insecticide-treated bed nets in nine states and the scale-up of the seasonal malaria chemoprevention program for children in 10 states are impressive achievements.

Despite this progress, the OIG audit on Global Fund grants in Nigeria found there are significant challenges in our programs that need to be addressed. While investments in the three diseases in the country are performing well, with progress in prevention and treatment, the audit highlighted significant gaps in supply chains. It identified inadequate controls in the supply chains, including weak information systems and insufficient oversight over the storage and distribution of commodities, which in some cases contributed to stock variances and distribution of expired commodities. The audit also found that Nigeria had challenges in absorbing COVID-19 funds invested through the Global Fund COVID-19 Response Mechanism and that the overall management of those funds needs significant improvement. The audit also noted that there is a need for more work on domestic resource mobilization, especially regarding TB and malaria.

The Global Fund is committed to working with the Nigerian government and other partners to address the key issues and risks identified under the audit. We will work together to strengthen and implement appropriate systems as well as the relevant oversight frameworks. We are committed to supporting Nigeria in its efforts to strengthen systems for health, including procurement and supply chains, data systems and data use to ensure people get the quality medicines they need when they need them. We will support the government’s and other partners’ efforts to improve the management of investments in response to COVID-19 by addressing the bottlenecks that delay the implementation of essential activities, including the GeneXpert and oxygen optimization projects. 

We are actively working with the Nigerian government and other relevant partners to improve the design and implementation of interventions for those most affected by HIV, TB and malaria, including pregnant women, children under 5, adolescent girls and young women and other vulnerable and key populations. We are putting particular effort into working with partners to address identified shortcomings in prevention of mother to child transmission and early infant diagnosis,  into the diagnosis and treatment of drug-resistant TB as well as ensuring the country develops a roadmap to conduct a TB prevalence survey since the last one was done 10 years ago in 2012. We are also putting a keen focus on the design and implementation of community-based services to ensure optimal utilization of grants for improved absorption and impact.

The Global Fund recognizes that the significant delays and non-fulfillment of some of the Nigerian government’s co-financing commitments are affecting optimal program implementation. We have already addressed some of these gaps through conditional reinvestment of savings under the malaria grant. We will work with the Country Coordinating Mechanism and the Nigerian government to develop achievable resource mobilization and sustainability plans and urge it to fulfill its remaining co-financing commitments. 

We thank the OIG for this audit report. The work of the OIG continues to complement the active risk management and controls put in place by the Secretariat and uphold our proactive approach of full transparency both on disclosing the issues in the implementation of our grants and in highlighting the successes we can build on in the future. We are committed to continuing our investments in Nigeria as we seek to accelerate progress toward ending AIDS, TB and malaria as public health threats, defeat COVID-19 and build better defenses against future pandemics in the country and beyond.