Home to more than 200 million people, Nigeria is the most populous country in Africa and seventh largest in the world. A former British colony, Nigeria has a rich indigenous history and is very diverse in terms of ethnic groups, religion, demographics, topography and economic status. Of the estimated 250 ethnic groups, the three largest, each with its own language, are the Hausa–Fulani in the north, Yoruba in the west, and Igbo in the east, together comprising over 60% of the total population. The official language is English, chosen to facilitate linguistic unity at the national level. Marked differences exist between the north and the south of the country, not only in physical landscape but also in the social organization, religion, economic activity, and practices of the people. The north is predominantly Muslim whereas the south is mainly Christian. About half of the Nigerian people live in rural areas and densely populated settlements occur along the coast, but Nigeria boasts several very large cities, including Lagos, its economic capital and largest city, Abuja, its political capital, and Kano, the most dominant city in the north of the country.
Having gained its independence in 1960, Nigeria is today one of the world’s largest democratic countries. It experienced a civil war from 1967 to 1970, followed by a succession of democratically-elected civilian governments and military dictatorships, until achieving relative political stability in 1999; the 2015 presidential election was the first time an incumbent president had lost re-election.
Classified as a lower-middle income country, Nigeria’s economy is the largest in Africa and 24th in the world, as measured by GDP. However, there are wide varieties in wealth in the country’s population and many Nigerians live below the poverty line. Nigeria has a diverse economy with roughly one-half of all Nigerians living off of agriculture, but with large service and manufacturing sectors, including a very large informal sector. Nigeria’s economy is heavily dependent on oil, fluctuations in energy prices, and foreign direct investment. Unfortunately, Nigeria entered a recession in 2016, partly because of falling global oil prices, but saw progress with recovery within the next couple of years.
The country’s health system is fashioned after the three tiers of Government: federal, state, and local government authorities (LGAs). However, many Nigerians obtain their health care through the relatively unregulated private sector where the quality of services and products vary tremendously. Although Nigeria has one of the largest healthcare workforces on the continent, it is unable to meet the health needs of the population.
According to the WHO, Nigeria’s health indices are among the worst in the world. The country’s maternal mortality ratio is almost double the global average and, with 3.4 million people living with HIV (PLHIV), it carries the second largest burden of HIV in sub-Saharan Africa and the third largest HIV burden in the world. HIV prevalence in Nigeria is highest among vulnerable populations, including commercial sex workers, men who have sex with men, and people who inject drugs. HIV testing rates in the country remain low, and below global targets.
As in many other developing countries, infant mortality in Nigeria has declined drastically over the past two decades, and life expectancy has increased. Population growth has been rapid with almost three-fourths of the population under the age of 30.
According to UNICEF, 6.5 million children have lost one or both parents due to various causes in Nigeria. More than 20 percent of the estimated 1 million children orphaned by AIDS do not attend school regularly and 18 percent have experienced sexual abuse. Despite these dire statistics, there has been minimal state activity to provide a social safety net for the country’s growing numbers of orphans and vulnerable children (OVCs). Furthermore, linkages between the health, social welfare, and education sectors are extremely weak and greatly undermine the government’s response to OVC needs at all levels.
AIHA began working in Nigeria in 2008, launching a social work and OVC support initiative in Enugu State through our HIV/AIDS Twinning Center Program thanks to support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). This successful partnership graduated from the Twinning Center’s technical assistance program in late 2014 and laid the groundwork for two subsequent replication projects in other parts of the country, funded by USAID.
In 2014, AIHA established a local NGO, Twinning for Health Support Initiative, Nigeria (THSI). AIHA has been collaborating on various projects with THSI since its inception, including the Society for Family Health (SFH)’s Partnership’s Orphan and Vulnerable Child (OVC) project funded by USAID in Kano state which began in 2019, as described below. In 2020, AIHA also began activities under its newly awarded CDC1950 project, as described below:
Targeted Programmatic Support Across Countries (CDC1950)
In September 2019, the U.S. Centers for Disease Control and Prevention (CDC) awarded AIHA a five-year grant, providing a vehicle by which AIHA can assist the CDC at the global and country level, in support of the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.
AIHA initiated activities under the CDC1950 grant in Kenya (October 2019), Tanzania and Zambia, (April 2020), Nigeria (May 2020), Guatemala (July 2020), Haiti (October 2020), the Dominican Republic (October 2020), and the Philippines (2020) the goal of which is to strengthen Key Population (KP) and Civil Society (CSO) led organizations’ capacity to deliver services to vulnerable populations to stem the spread of HIV/AIDS through various prevention, care and treatment initiatives. The project also provides KP-led organization with the skills and abilities to enable them to operate as primary recipients (and sub-grantors) of US/PEPFAR and other donor funding.
AIHA is conducting this work in collaboration with CDC/Atlanta and respective CDC Country Offices and National KP Consortia.
Once KP-led organizations in-country have been identified, the first step in the process is to conduct an assessment of organizational capacity. AIHA has used the Organizational Capacity Assessment (OCA tool), a self-assessment that each KP-led or KP-competent organization interested in participating in this project needs to complete to determine gaps and training needs. The OCA forms are analyzed and then shared along with recommendations with the national KP networks. This helps determine the list of KP-led CSOs to be included in the project and the input for the development of an organization-specific training plan.
The most common gaps identified with Nigerian CSOs were in Project, Finance, Human Resources and Organizational management. Due to the COVID19 pandemic, AIHA has been conducting trainings on priority areas via a set of webinars followed by one-on-one mentorships. All CSOs are welcome to listen to webinars but one-on-one mentorship is being provided to 12-15 organizations per country selected for the project.
In July-September 2020, AIHA – in collaboration with AVAC and the CDC – arranged stakeholders’ consultations with the Nigerian CSOs to discuss the needs of KP-led organizations and identify priorities for training and mentorship. 12 KP-led CSOs were determined for one-on-one mentorship.
In Year 1 AIHA conducted three on-line trainings on Strategic Planning, Governance and Advocacy that were delivered by AVAC. All trainings were followed by mentorships.
Key results of Project Year 1:
- Organizational Capacity Assessment competed. 30 CSOs participated, 12 selected for mentorship.
- AVAC provided 3 above-mentioned trainings online:
- 125 participants from 17 CSOs attended three online trainings;
- 116 mentorship hours were delivered by local mentors upon training completion.
In Project Year 2 AIHA focused on the following:
Objective 1: Strengthen financial resiliency through planning for diversified sources of revenue
In accordance with gaps identified in Year 1, AIHA delivered trainings on Finance and Human Resources Management followed by a two week-long on-line training on Social Enterprise and diversified sources of revenue. All trainings were followed up with in-country based mentorship. Upon completion of the training on Social Enterprise, participants submitted draft business plans that included a social enterprise scheme (e.g. a profit-generating activity).
Objective 2: Build capacity to implement and sustain social enterprise schemes
Small grants were provided to CSOs to address their capacity development needs followed by implementation of their social enterprise capacity development plans;
Local consultants and AVAC supported selected organizations in each country to implement their social-enterprise scheme.
- 116 mentorship hours were delivered by local mentors upon training completion.
- 24 participants attended and completed the Finance Management training from 12 CSOs
- 20 participants attended and completed the Human Resource training from 12 CSOs
- 20 participants attended and completed the Social Enterprise training from 12 CSOs
Key Results of eligible CSOs’ Phase 2 Capacity Building Grants:
- 10 Nigerian KP-led CSOs awarded Organizational Capacity Grants
- 10 of 10 KP-led CSOs successfuly completed their Organizational Capacity Grants
- 3 CSOs developed their 1st Organizational Strategic Plans
- 2 CSOs developed their 1st M&E Framework
- 2 CSOs revised all their organizational policies or developed new policies
- 1 CSO developed their 1st Human Resource Policies and Manuals with SHEA policy
- 1 CSO enrolled and completed 8 staff training of PMP (project management course)
- 1 CSO developed their 1st Advocacy and Communication Strategic Plans
Key Results of Phase 3 Social Enterprise Initiative:
- 10 of 12 eligible CSOs were trained in social enterprise
- 7 CSOs submitted business plans for Social Enterprise Mini-grants
- 3 CSOs awarded mini-grants to support their Social Enterprise initiatives through September 2021.
Nigerian CSOs will share their experiences, lessons learned and recommendations for follow-up in an on-line Learning Exchange Forum scheduled for November 2021.
Orphans and Vulnerable Children (OVC) in Nigeria
According to UNICEF, there were an estimated 13.8 million children and adolescents (0-18 years) worldwide who have lost one or both parents to AIDS as of 2019, 80% of whom live in sub-Saharan Africa. In Nigeria, there are an estimated 2.5 million orphans and vulnerable children due to HIV/AIDS. The Society for Family Health (SFH), a Nigerian-based NGO, in partnership with AIHA, Save the Children Federation (SCF), and the AIHA established Nigerian organization Twinning for Health Support Initiative (THSI-N) recieved a five year award from USAID entitled the Integrated Child Health and Social Services Award (ICHSSA 3) Program.
AIHA and partners aim to integrate evidence-informed strategies to enhance OVC services, strengthen social services for OVC, and improve the OVC systems’ services and support in Kano, Nigeria, and in other states in Nigeria. Specifically, the objective of the ICHSSA 3 Program is “to ensure that OVC are cared for and protected by their households, communities, local and state government” through civil society and partnerships. Nigeria was initially selected because at the time of the project award, there was a significant risk among adult populations not on HIV/AIDS treatment (40%) and low use of ART among HIV-positive pregnant women (30%) – indicating a significant at-risk population that could benefit from pre-OVC and OVC services as part of HIV prevention and treatment programs. Since 2019, AIHA and our partner organization THSI-N, and in conjunction with the prime contractor, the Society for Family Health Nigeria, have been working to deliver a full package of technical assistance activities to ensure that local and state governments have sufficient, high performing human resources to protect and care for OVC. Details about the project and its accomplishments can be viewed here.
PEPFAR Civil Society Organization Initiative
(2016 – 2019)
At the request of the Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC), the Health Resources Services Administration (HRSA) and its partners, AIHA and the National Alliance of State and Territorial AIDS Directors (NASTAD), created a project with the goal of improving engagement between country teams for the President’s Emergency Plan for AIDS Relief (PEPFAR) and civil society organizations (CSOs).
The CSO Engagement Initiative is a PEPFAR-wide project to support collaboration between in-country/regional PEPFAR teams and CSOs in the PEPFAR planning and implementation process. It enlists the efforts of staff from HRSA and its partners, AIHA and NASTAD. HRSA, AIHA, and NASTAD provide a wealth of expertise in successfully engaging civil society into HIV service planning, prioritization and service delivery, both domestically and globally.
At the outset of the project, HRSA, AIHA, and NASTAD held multiple calls with PEPFAR country teams to discuss their needs and expected outcomes. The project team then provided a menu of specialized technical assistance options, based on these communications, for PEPFAR country teams and CSOs to choose from, should they be interested in utilizing the project. These options included support for the following: CSO recruitment for participation in COP planning and implementation, meaningful CSO engagement in COP planning, meaningful CSO engagement in PEPFAR implementation, and evaluation of CSO engagement and dissemination of tools.
Ultimately, PEPFAR teams from four countries requested technical assistance (TA) from the CSO Engagement Initiative during the FY 2016-2019 period of performance: Ethiopia, Mozambique, Nigeria, and Uganda. The project encompassed a series of activities customized to each country’s needs and timed to coincide with COP-related activities as appropriate.
- The project team conducted an assessment of the state of civil society and its relationships with PEPFAR country teams prior to additional activities in each country. While every country is unique, common themes included PEPFAR teams finding CSOs lacking in sophistication when it comes to data and unable to provide the type of information that PEPFAR requires from them. In turn, CSOs often described PEPFAR teams as insufficiently engaged with them. Both PEPFAR and CSO respondents agreed on the need for capacity building for CSOs to help them become better partners with PEPFAR in the fight against HIV/AIDS.
- The project team conducted Data Presentation Workshops. The purpose of these workshops was to help PEPFAR better communicate their highly sophisticated data to an audience who may not be as comfortable with technical terms. In some countries, CSO leadership participated in these workshops as well. There was near unanimous agreement that these workshops were helpful to all.
- After the Data Presentation Workshops, the project team conducted CSO Orientation Development Workshops and supported PEPFAR country teams as they in turn conducted CSO Orientation Meetings prior to COP 19 activities in Ethiopia. The CSO Orientation Development Workshops provided PEPFAR teams and CSO Leadership with support to design and Orientation Meeting for CSOs to help orient them to COP processes. Once again, PEPFAR team members and CSO leadership reported that the Development Workshops helped them in designing the Orientation Meetings, and Meeting participants reported that they felt more prepared to meaningfully engage with PEPFAR.
- The project took an explicitly adaptive approach, using data gathered from each activity to improve. This adaptive approach allowed the project team to be as responsive as possible to individual country needs and to change their approach when necessary, contributing to project success.
Sustainable Mechanisms for Improving Livelihoods and Household Empowerment (SMILE) Program
(2014 – 2017)
THSI, a Nigerian NGO established by AIHA in 2014, is collaborating with Catholic Relief Services (CRS) on the USAID-funded Sustainable Mechanisms for Improving Livelihoods and Household Empowerment (SMILE) program, a five-year project designed to scale-up care and support services for OVC in five states in Central Nigeria — Benue, Kogi, Edo, Nasarawa, and Federal Capital Territory (FCT).
AIHA established an NGO known as the Twinning for Health Support Initiative, Nigeria (THSI) in 2014. With a similar mission to AIHA, THSI replicated the highly successful Auxiliary Social Worker Training Program (known in other countries as Para Social Worker) that AIHA piloted in Nigeria under an HIV/AIDS Twinning Center partnership with local social work training institutions in Enugu State from 2008 to 2014.
SMILE worked to improve the well-being of 500,000 vulnerable children in the target states, along with 125,000 caregivers. Other key goals included improving Nigeria’s capacity to address the needs of vulnerable children at the state level by strengthening the technical and organizational capacity of local government authorities (LGAs) in close collaboration with the local bureaus of the Ministry of Women Affairs and Social Welfare, and facilitating enhanced collaboration among CSOs and communities to better integrate and manage comprehensive care and support programs for vulnerable children, including household economic strengthening (HES) services.
During its first year working on SMILE, THSI and our expert resource partners from the University of Nigeria-Nsukka and the Federal School of Social Work adapted AIHA’s Auxiliary Social Worker (ASW) curriculum to the local context and are currently rolling out initial trainings across the five project states.
Systems Transformed for Empowered Action and Enabling Responses (STEER) for Vulnerable Children and Families Project
(2013 – 2017)
As part of a consortium led by Save the Children, AIHA helped five states in Northern Nigeria to strengthen local capacity to provide much-needed care and support services to some 500,000 vulnerable children and 125,000 caregivers in the target states of Bauchi, Kaduna, Kano, Plateau, and Sokoto through the USAID-funded Systems Transformed for Empowered Action and Enabling Responses for Vulnerable Children and Families (STEER) project.
STEER was 5-year project is designed to mitigate the impact of HIV and AIDS on Nigerian children and families by creating greater country ownership and leadership through strengthened governments, civil society, and families.
For the past decade, reliance on the ability of community volunteers to interface with families at the household level, identify their needs, and link them to appropriate services has been a key element of the support community-based organizations (CBOs) and civil society organizations (CSOs) provide for orphans and vulnerable children and families in this region.
In 2013 when Project STEER was launched, AIHA was the only pre-service implementer in Nigeria that is addressing the country’s critical social welfare workforce shortage through our successful Auxiliary Social Worker (known in other countries as Para Social Worker) Training Program in Enugu State.
Under STEER, AIHA worked closely with Save the Children and its partners to bolster the professionalism of the social welfare workforce in Northern Nigeria, focusing on building the capacity of staff at CBOs, CSOs, local government authorities (LGAs), and other organizations throughout the region.
We worked with state-level bureaus of the Ministry of Women Affairs and Social Welfare, LGAs, polytechnic institutes, institutes of social work, and community service organizations (CSOs) in the five project states to train Auxiliary Social Workers (ASWs). Together with these stakeholders and the Nigerian National Board for Technical Education (NBTE), AIHA adapted the current curriculum to the northern context; we’ve also upgraded it to a certificate-level course.
Tapping into the knowledge and experience of our Twinning Center partners from Enugu State, we have trained 27 master trainers from institutions of social work in the North, who are taking the lead on the rollout of the ASW Program across the five project states, delivering ASW training to 739 individuals working at the LGAs and CSOs, as well as to community volunteers associated with the project.
Nigeria Social Work and OVC Support Initiative
AIHA and our technical experts worked to strengthen the capacity of two Nigerian schools of social work to provide high quality pre-service and in-service training for individuals who provide care and services to orphans and vulnerable children in Enugu State and throughout the country.
Based on the successful Para Social Worker Training Program being implemented in Tanzania, the Nigeria Initiative was carefully adapted to the country’s unique needs and regional cultural context. The program was closely aligned with the Nigerian Government’s health system strengthening efforts and played a critical role in building sustainable capacity to train Social Workers and Para Social Workers (PSWs) at both Nigerian universities. It was implemented in collaboration with the Federal Ministry of Women’s Affairs and Social Development and the Enugu State Ministry of Gender Affairs and Social Development with funding from PEPFAR and CDC / Nigeria.
PSWs are community-level health extension workers who receive specialized courses that arm them with foundational skills in basic social work and child development concepts, as well as service delivery for OVC. In between a social worker and a volunteer, most PSWs are already working in their communities and can be quickly trained to effectively provide much-needed services to vulnerable children and their caregivers.
PSW training modules focus on:
- Improving knowledge of HIV/AIDS and available interventions;
- Making active referrals to HIV counseling and testing services;
- Linking clients to HIV-related treatment, care, and support services, as well as to other healthcare services, via active referrals;
- Providing case management to increase adherence to HIV treatment and improve health outcomes; and,
- Helping ensure access to comprehensive, holistic care, including nutrition, education, legal, psychosocial, economic, and other needed support.
To increase recognition and absorption of this new cadre of community-level social workers, AIHA worked with the Nigerian Association of Social Workers (NASOW) to have PSWs included in new national social work legislation, which is currently in its final hearing stages.
From 2008 to 2014, the two partner institutions in Enugu State trained 1,141 PSWs. These workers subsequently returned to their communities better able to provide care, support, and referrals for needed services to children in need.