Are HIV/AIDS global health initiatives strengthening or weakening the Nigerian health system? A mixed methods analysis

Charles Chikodili Chima, The University of Texas School of Public Health


Health aid to Nigeria has been increasing rapidly since the late 1990s, and a significant portion of the funds were earmarked for HIV programs in most years. Three Global Health Initiatives (GHIs) – the US President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank Multi-AIDS Project – have been responsible for most of HIV financing in Nigeria. Critics have asserted that GHIs burden fragile health systems in resource-poor countries and that health system constraints in these countries pose a limitation to the achievement of the objectives of the GHIs. This study set out to answer two broad questions: the impact of HIV program scale-up on the delivery of non-HIV health services and whether HIV GHIs are providing support in ways that strengthen the Nigerian health system. A mixed methods approach was used. Analysis of secondary data by multivariate logistic regression models showed that aid earmarked for HIV programs exhibited a negative spillover effect on the uptake of childhood vaccinations in Nigeria between 1998 and 2007. Qualitative assessments showed a mixed impact of GHIs on the health system. They have contributed to the strengthening of physical infrastructure for healthcare, improvement in the quality of health workers, development of local capacity and infrastructure to conduct research, improvement in service quality, strengthening of the role of non-state actors in healthcare, and to the strengthening of health information systems. On the negative end, HIV donor funding has bred a culture of dependency on foreign aid, scaled up service delivery in an unsustainable manner, diverted attention to HIV programs at the expense of other health care needs, led to the development of a parallel procurement and supply chain management system, and increased administrative costs through the contracting of international NGOs and other technical partners. Also, harmonization between donor agencies working on HIV is suboptimal, but the greatest limitation to the optimal use of donor resources for health in Nigeria is poor leadership from government. The findings show the importance of paying attention to the unintended consequences of global health policy and financing interventions in developing countries.

Subject Area

African Studies|Public health|Health care management

Recommended Citation

Chima, Charles Chikodili, "Are HIV/AIDS global health initiatives strengthening or weakening the Nigerian health system? A mixed methods analysis" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3639412.