From Aidoghie Paulinus, Abuja
The Joint United Nations Programme on HIV/AIDS (UNAIDS) outgoing country director, Nigeria, Dr. Erasmus Morah, has stated that Nigeria can end the Acquired Immune Deficiency Syndrome (AIDS) in 2030.
In this interview with Daily Sun, Morah said at current coverage of 90-83, Nigeria is already well positioned to bring treatment to 95 per cent of all those in need and to keep 95 per cent of them on treatment virally suppressed.
Morah, however, said there are many things that Nigeria must still do to ensure that the end of AIDS in sight is realized without fail.
What were the critical priorities you had when you came to Nigeria, and what did you find when you arrived?
At the time of my appointment to Nigeria in 2017, the former Executive Director of UNAIDS, Michel Sidibé, told me, “Erasmus, you will have a difficult job in Nigeria. Not only are the coverage figures not good, but people just don’t believe any HIV data coming out of the country. We must find a way to help the country change this narrative.” These words have been like ‘a lamp unto my feet, a light unto my path.’ Indeed, when I arrived, treatment coverage for people living with HIV was estimated at a little more than 30 percent, and there were no reliable data for programming and targeting the response. Also, the Government of Nigeria had essentially left financing of the national HIV response to the international donor community.
What have been the biggest challenges working in Nigeria?
The biggest challenge I faced was the pervasive view that, “this is Nigeria, where nothing works and where things are impossible.” So, everyone expects you to comply and carry on with business as usual, until your assignment is up and then you move on. But here lies a big surprise for everyone, including me. When your colleagues and partners see that you are not resigned to ‘business as usual,’ they quickly warm up to you and join in doing more. I have found that trying to do the right thing and staying with it long enough and without hesitation is contagious.
What are some of your proudest accomplishments over the last five years in Nigeria?
I was extremely fortunate to have come to Nigeria when the “stars were aligned” for the HIV response. What do I mean by this? Several transformational leaders had started to build a foundation for change – Prof. Isaac Adewole as Health Minister and his predecessor, Prof. Chukwu Onyebuchi, Dr. Sani Aliyu as NACA director-general and his predecessor, Prof. John Idoko, and my own predecessor, Dr. Bilali Camara. At that time too, both the United States Government and Global Fund took bold decisions to invest massively in the Nigerian response.
Collaborating with the current national leadership of the HIV response – Mr Boss Mustapha, Minister Osagie Ehanire, Director-General Aliyu Gambo and NEPWHAN Coordinator, Abdulkadir Ibrahim, we have been able to achieve a lot over the past five years. My proudest achievement is the role that UNAIDS played in promoting the rights of people living with HIV, not the least of which is being a catalyst with WHO in the re-establishment of the National Treatment and Prevention of Mother to Child Transmission Programme. The national response recorded the breakthrough commitment from President Buhari to fund treatment for 50,000 additional Nigerians every year, as well as the successful launch of the private sector-led national HIV Trust Fund. These came in conjunction with the wider government and development partners-led treatment scale-up from 850,000 to over 1,600,000 people on treatment at present.
When I arrived in 2017, the biggest issue was the reliability of Nigeria’s HIV data and the need to rebase the HIV epidemic and ensure that the country had quality data for planning. As a member of the Steering Committee of the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), together with the Honorable Minister of Health and Director-General of NACA, I helped steer national ownership of this game-changing national survey to an impactful revision of the National Strategic Framework for HIV, and greatly improved targeting of programmatic actions across the country.
Also, in 2017, Nigeria had unsuccessful Global Fund grant applications with significant governance challenges, resulting in the government being barred from directly receiving any Global Fund grants. Today, the Nigerian government is a principal recipient of grants and the largest Global Fund investment portfolio worldwide. I am very proud to be associated with this dramatic turnaround.
I am also particularly proud of supporting Nigeria to document and convincingly tell its 35 years history of the national HIV response, in a coffee table book called the New Dawn. With the African saying that “until the lion learns to write, every story will glorify the hunter,” this has been of great importance in changing the narrative, and building ownership and recognition needed for the last mile. In a world getting increasingly noisier, knowledge management and ownership of the narrative can be everything. I always say to my Nigerian government counterparts, ‘if you must own only one thing in the development process, own the data and how it is communicated.”
Beyond HIV, I also played an important role in supporting the work of the Presidential Multi-sectoral Task Force on the COVID-19 pandemic in Nigeria, by bringing the lessons learned from HIV to bear, and helping the UN Resident Coordinator and UNDP to establish the One UN Basket Fund for COVID-19, which mobilized over $73 million. I further played a direct role in mobilizing an additional $300 million for the COVID-19 response from the Global Fund.
How do you see the HIV response progressing in Nigeria, and can we really end AIDS in Nigeria by 2030?
Yes, absolutely, Nigeria can end AIDS (not HIV) as a public health threat by 2030! At current coverage of 90-83, Nigeria is already well-positioned to bring treatment to 95 percent of all those in need and to keep 95 percent of them on treatment virally suppressed. However, there are many things that Nigeria must still do to ensure that this End of AIDS in sight is realized without fail.
Decades of evidence show that inequalities are among the key reasons why 2020 HIV targets were missed. Here in Nigeria, we continue to deplore structural barriers that impede equitable access to HIV services, such as the frequent arrest of members of the key populations.
Only 45 percent of children living with HIV know their status, 45 percent of them receive antiretroviral therapy and, among those, 31 percent have a suppressed viral load. Many health facilities still demand user fees from patients – despite evidence showing that user charges undermine uptake of antiretroviral therapy, hinder the retention of people in care and reduce the quality of care.
Finally, Nigeria needs to further expand ownership of the HIV response, at both federal and state levels, through the deployment of domestic resources and strengthening of primary health structures. In this regard, Nigeria should be hailed for the recent signing of the new National Health Insurance Act, which suddenly makes Universal Health Coverage possible.
What parting message do you have for Nigeria?
Refuse to believe that nothing works in Nigeria or that everything is impossible. Those would be my final parting words. Focus on your area of watch, influence and accountability, no matter how small. Prefer to be a “Nelson Mandela” who believed that “it is always impossible until it is done.” Nigerians are good people – smart, confident, motivated, warm, and exceedingly creative. You just need to lead with unwavering commitment, serve as a good example and have the courage of your conviction and the staying power.
Tell us about your new assignment in China. Are there any lessons from Nigeria you would like to take to China?
Firstly, let me say how excited I am to have been entrusted with the China assignment by the UNAIDS Executive Director, Winnie Byanyima. The centrality of China in today’s economic and geo-political world order is unambiguous, especially for the continent of Africa.
I will be moving to China as the Director of a new UNAIDS China Office where I will hold the dual mandate of leading the Joint Programme’s support to China’s partnerships and engagement with the rest of the world on attaining the SDGs and the goal of ending AIDS as a public health threat by 2030, as well as China’s domestic HIV agenda.
Among the lessons I will take with me to China is a firm belief in national ownership and leadership of the development process, and my strong affection for the people we serve. I will endeavor to put the government and people of China at the center of all that I will do.
Let us face it, Nigeria is an intimidating country for many. It is probably the one country in Africa where intelligence and self-confidence are not a comparative advantage, including for foreign expats and donors. I suspect this to be the case with China, if not more. Hence, I will also go to China with an unintimidated spirit, and with a heart heavy with gratitude and deep affection for the Nigerian people for the way I have been received and treated over the past five years.