This record is a partial extract of the original cable. The full text of the original cable is not available.

300624Z May 06

UNCLAS SECTION 01 OF 02 ABUJA 001255 
 
SIPDIS 
 
PASS HHS FOR OGHA STEIGER 
USAID (GLOBAL HEALTH AND AFR) 
 
E.O. 12958: N/A 
TAGS: EAID KHIV ELAB SOCI NI
SUBJECT: NIGERIA'S RESPONSE TO GLOBAL FUND CUTS 
 
REF:  ABUJA 2410 
 
¶1. Summary.  The Global Fund To Fight AIDS, Tuberculosis, 
and Malaria canceled on April 28 the funding of two five- 
year Nigeria HIV grants totaling $81 million.  The Fund did 
so because of "inadequate performance" by the Fund's 
principal recipient in Nigeria, the National Action 
Committee on AIDS (NACA), and the failure of the Nigeria 
Country Coordinating Mechanism (CMM) to conform to Global 
Fund standards.  Nigeria's ARV program was supposed to have 
14,000 people on treatment by the end of the program's first 
year, but the actual number was zero.  Nigeria was supposed 
to have 24,000 people on treatment by the end of the 
program's seventh quarter, but the actual number was 6,865. 
The USG, the Global Fund, and UNAIDS have made specific 
recommendations since 2004 on improvements to comply with 
Global Fund requirements.  The Fund's Nigeria CCM dissolved 
itself on May 8, 2006, and on May 22 elections were held to 
select representatives of six civil-society constituencies 
to create a new CCM.  The USG Nigeria team continues meeting 
with the GON and NACA to detail how they can improve their 
performance.  End summary. 
 
¶2. After only two years, the Global Fund To Fight AIDS, 
Tuberculosis, and Malaria programs in Nigeria canceled on 
April 28 two five-year HIV grants to Nigeria totaling $81 
million.  The Fund cited "inadequate performance" by the 
Fund's principal recipient in Nigeria, the National Action 
Committee on AIDS (NACA), and the failure of the Nigeria 
Country Coordinating Mechanism (CCM) to conform to Global 
Fund standards.  According to the Fund's Secretariat, lapses 
in Nigeria's HIV/AIDS program included failures to meet 
multiple targets, and disbursing funds at a much lower rate 
than intended.  Nigeria's anti-retroviral (ARV) program was 
supposed to have 14,000 people on treatment by the end of 
the program's first year, but the actual number was zero. 
Nigeria was supposed to have 24,000 people on treatment by 
the end of the program's seventh quarter, but the actual 
number was 6,865. 
 
Significant Program Failures 
---------------------------- 
 
¶3. Further, NACA provided "questionable data" to the Fund, 
reporting the numbers of people receiving treatment who 
instead turned out to be the numbers of people who could 
have been treated if all the drugs sent to health facilities 
had been used.  Nigeria's HIV/AIDS program spent money on 
"inappropriate activities," including foreign travel. 
Additionally, Nigeria's CCM failed to acknowledge or report 
many of these problems or to reform the CCM as promised. 
The multi-sectoral CCM develops and submits grant proposals 
to the Global Fund.  Once a grant is approved, the CCM 
oversees the progress in the programs financed by the grant. 
 
¶4. Nigerians currently receiving ARV treatment under the 
canceled grants will continue to have their care paid by the 
Fund for up to two years while alternatives are pursued. 
The Fund approved Nigeria for a major ARV grant worth more 
than $180 million -- but which likely will be administered 
by a different principal recipient once the grant agreement 
is signed. 
 
Previous U.S., Global Fund efforts to aid the GON 
--------------------------------------------- ---- 
 
¶5. Nigeria consistently failed to restructure its CCM to 
create a more efficient and transparent body, and to provide 
adequate oversight over NACA, the primary recipient.  The 
USG is a member of the CCM and first became concerned in 
July 2004 about the lack of progress of Global Fund Round 
One HIV/AIDS grants.  At that time, the USG worked with 
UNAIDS to arrange for a consultant to assist the CCM to 
reform.  The consultant's report listed concrete 
recommendations that the USG endorsed. 
 
¶6. The Government of Nigeria (GON) implemented none of these 
reforms by February 2005, when the USG team again became 
concerned about the lack of progress toward benchmarks.  As 
chair of the Donor Coordination Group, the USG invited the 
CCM Secretariat to inform donors of the situation and to 
discuss the likelihood of achieving targets before the Phase 
Two renewal process began.  At that time, the CCM 
Secretariat was unwilling to discuss candidly with donors 
 
SIPDIS 
the status of the program. 
 
¶7. The USG held follow-up meetings with NACA, the principal 
recipient of Nigeria's Round One Global Fund grants, and 
with Nigeria's Ministry of Health (MOH), the principal sub- 
recipient.  They informed the USG that while these programs 
got off to a very slow start, they were making every effort 
to accelerate progress before the May 2005 deadline.  The 
USG offered its support to NACA and the MOH to achieve 
results.  The MOH requested assistance in drug procurement 
and logistics, which the USG continues to provide.  NACA 
requested and is receiving support in monitoring and 
evaluation, especially in developing an ARV patient- 
monitoring and patient-management system. 
 
¶8. The USG is a key member of the Country Implementation 
Support Team (CIST) created in October 2005 to coordinate 
multilateral and bilateral support to Global Fund programs 
in Nigeria.  The CIST assessed the situation and created a 
coordinated donor support body to help the CCM and NACA 
correct their shortcomings. 
 
¶9. The Global Fund cited numerous deficiencies to NACA in 
October 2005, warning that a second phase of funding could 
be suspended.  The USG then met with representatives of 
bilateral and multilateral agencies.  While the USG 
concluded in November 2005 that NACA had made some progress, 
it found the CCM had not made significant progress in 
adopting recommended reforms.  The CCM requested and 
received the Global Fund's support to develop a plan to 
reorganize the CCM by the end of May 2006.  This was a 
prerequisite to sign Round Five tuberculosis and HIV/AIDS 
grants worth more than $200 million.  The USG reviewed the 
Global Fund consultant's preliminary report and agreed with 
all of its recommendations.  The CCM, however, failed to 
adopt or implement the consultant's recommendations, 
resulting in the Global Fund's canceling the $81 million in 
grants. 
 
Next steps 
---------- 
 
¶10. The USG Nigeria team continues to meet with the GON and 
NACA to specify what they must achieve to comply with Global 
Fund accountability requirements.  The GON must demonstrate 
the will to change drastically its management of these 
Global Fund programs in Nigeria.  The first steps occurred 
on May 8 when the CCM dissolved itself and put in place an 
interim CCM (ICCM) with the mandate to hold elections to 
choose new CCM members.  With the support of the CIST, new 
election procedures were put in place, and the bilateral and 
multilateral partners held elections under an official 
observer, then reported back to the ICCM.  On May 22, 
representatives of six CCM constituencies were elected with 
the assistance of a facilitator and an observer; elections 
of representatives of about one third of other CCM 
constituencies remain pending.  The USG was represented as a 
facilitator and an observer and determined that these 
elections were carried out acceptably.  The ICCM planned to 
hold a Global Fund orientation and the first meeting of the 
new CCM on May 23-24.  These activities were delayed 
following UNAIDS' suggestion that they instead take place in 
early June with technical assistance from UNAIDS and the 
Global Fund. 
 
¶11. The CCM is required to meet by the end of June the 
deadline for the Global Fund's Malaria Phase II renewals, as 
well as for the selection and confirmation of the Round Five 
principal recipient.  The USG Nigeria team continues to 
monitor and participate in these processes to increase 
accountability and strengthen the operations of Global Fund 
recipients in Nigeria. 
CAMPBELL