By NBF News
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L-R: Dr. Lilian Anomnacin, Mrs Tolani Busari and an associate

Family Health International (FHI) is looking into malaria, a major health issue in Nigeria, through global funds, while not relenting in its campaign against main primary focus area which HIV/AIDs.

Indications show that the Non-governmental organization (NGO) owered by the United States Agency for International Development (USAID) with 11 zonal offices in Nigeria and supporting 230 hospitals across the nation is well positioned to launch an anti-malarial campaign.

Disclosing this, while fielding questions during visiting.

The Sun Publishing Limited corporate headquarters, in Lagos Dr Lilian Anomnachi, Director of Communications and Knowledge Management, stated that while the organization is ready to work in other diseases whether in collaborating with other bodies or solo, their primary focus will remain HIV/AIDS.

Family Health International is involved in the GHAIN project which is the Global HIV project in Nigeria, which started in 2004 for HIV care and treatment programme. The project has expanded into TB care, sexual and reproductive rights issues, malaria and health strengthening.

She spoke on these and related issues.
Other diseases, collaboration with other NGOs
If we say more prevalent, I expect we'll talk about malaria. Yes, there's been a lot of awareness about cancer lately. Maybe because of focus on a few maybe, well known people. But if it comes as an African problem, I think HIV/AIDS is an African problem primarily. In Nigeria, we're still at number three in the world. And in terms of absolute number, we might be number two. Malaria is very serious and we're actually collaborating with the government of Nigeria, through the Global Fund. To work on malaria, we're actually mandated to help with the Lagos state campaign on malaria which should be sometime this February and March.

We're still trying to fix a date for it. We're not into cancer, except if it comes as a complication of HIV like in cervical cancer. Its actually part of the programme that we do, to screen women for cervical cancer because of the incidence, which is increasing with HIV and all that. But, if its just cancer in general, we work with funders mandate. And of course, every fund they're providing is tied to a particular programme area and target.

Attention on cervical cancer and Human Papiloma Virus

Even for us, it's not a routine thing; we're actually doing a pilot, our tag line for FHI in signs of improving lives. The signs of improving live means that, everything you do have to be evidence-based. And evidence-based is that you need to be able to demonstrate and show scientifically and with the aid of statistics that this is this much in this area and related to this. Therefore, we can now push money towards that. So, that is what we're trying to do in one or two of our sites or zones. I know its something that we have started.

Even initially, it's not as if we really didn't have money for cervical cancer, but because we can show from incidents of some people you see. So, that's the level we are right now, gathering information. And next, we can demonstrate it. And when you go to people and say; I need money for this, this is an important area of health and you can show proof; then, money can be voted and you'll have money to do a campaign, big campaigns and a programme.

Donor fatigue
We are cognizance of the fact that even though we're not solely funded by the GHAINS project which is our largest project is funded by the US government. But, we also work with the Nigerian government to implement the Global Fund. We also do some public-private partnerships, helping the oil and gas companies to implement project, we are at the Niger Delta.

And even with the US government project, we're cognizance of the fact that the funding may not continue at the rate with which it is for a long time, which brings the health system strengthening which I said is one of our area of focus now. Build sustainability within the government system where we work. And also, there's a focus on supporting local and indigenous organizations to build their capacity and help them grow to the level where they're able to access funds on their own. And also continue to help the government to implement such programmes, even in the absence of the much larger international donor agencies. And of course, we all look forward to the day when the government will believe and be able to provide what is needed in the health sector to carry out all the programmes.

Partnership with state governments
We have a lot of partnerships and I'll take the example of the Cross River. In that state, we've done a lot because the state government is one of our biggest partners. And even more recently, they called us and said, we know you've supported us all these time, now, we want you to support us to even do more.

Most recently, some of the things we used to supply, the government actually took over and is doing that. And even on the national level, initially, the US government was providing the drugs and all the treatment but for almost for the past two or three years, the government of Nigeria have been buying and distributing all the drugs. With that, we're able to diverge the money into scaling of more sites.

To much focus on HIV/AIDS
Initially, because of the magnitude of the problem and the drastic nature in which people were dying in their millions, yes, there was initial focus in creating vertical programmes for HIV/AIDS care and treatment. but, of course, as the years went by, if you remember the progression, i said with the GHAIN project, I we started with focus on HIV/AIDS. Then, it became clear that the person that has HIV/AIDS, could have malaria, could have TB and any of those things could kill him. So, there was a process of integration, integrating Sexual and Reproductive Care, malaria, TB, integrating HIV/AIDS care and all that.

And right now, generally, we speak of the global health initiatives, where we deal more of the holistic nature and the essence of the health system strengthening. So that we strengthen the whole system, so that every point of service, including maternal immunization and child care, one is not concentrated on one to the detriment of the other.

Change of focus
No. The focus now is the global health initiative and health system strengthening.

Collaboration at primary healthcare system
In our organization, we also work at primary healthcare, especially at the Prevention From Mother Child Transmission (PMTCT) programme, the prevention programme where most of our testing centres are located in the primary health centres. And most recently, there was a midwifery scheme. This is being supported by the National Primary Healthcare Development Agency. With the IMC which is the Integrated Maternal and Child Health programme, the idea was to build it, so that we don't have these midwives concentrated in one place, and then, you're doing programme in another place where there are no skilled people to work because of lack of human resources.

Actually, that is not our area of focus. Because the HIV/AIDS is still the core, the centre of what most of our other services revolves around. And most of the people affected are people within the reproductive age group - young men and young women; mostly, young women even more than the men. Still, they're living longer on drugs and feeling healthy and they can do everything, go back to work, they want to have children, they want to have a normal life. So, the idea there is to assist them to make sure that they have children safely, get pregnant when they want to.

And even when they're pregnant, assist them to make sure that they don't transmit the virus to their unborn children. That is, assisting them to have HIV negative children, making sure they're alive to take care of those children. Making sure they're alive to take care of these, children help to reduce the impact to the infant mortality rate. So, that's more the areas we have our focus on.

Accurate database
The HIV prevalence rate we actually studied in undertaking by antenatal sustenance surveys every other year and the Federal Ministry of Health undertakes it. The rates are actually been static. Static in the sense that, at anytime there's one rate, but then, through the years, there are different rates and this fluctuates. And there are different rates within states, within areas. So, if you come to me, I might put Abuja rate or Cross River or whatever. But, the national prevalence rate is one rate. But, if somebody doesn't know that results of the centennial survey of 2009 is out, it might give you the rate, give you the rate of 2007 centennial survey. And by 2009 rates is out, 2011, they already started doing another centennial survey.

And those that are in the know might then be quoting 2011 latest survey for you; meanwhile, the other person is quoting 2009. So that's why it seems that different people are giving different rates.

Problem of stigmatization
It's a big challenge. That is why we feel that prevention is still a big push in recent years. I think, some how through the last couple of years, the euphoria of treatment in some countries may have also made people a bit relaxed. But, there's a push now that, if you don't do a lot more in the area of prevention, you might as well be pouring water in a basket. Because, its true you're keeping people from dying, are you keeping more people from getting infected? This is where it becomes a job for every single person. All hands must be on deck to ensure that people don't feel stigmatized, people can go out there, get their test done, know their status, remain negative and if they're positive, seek help early and inform their loved ones without fear of being stigmatized or rejected or be ostracized.