In the last two months, I’ve had a first-hand understanding of the wide gap between what Nigeria’s health administrators tell international agencies and the realities on ground. There is no better place where this is happening more frequently than HIV prevention and control.
Several weeks ago, I was on a road trip to Owerri in the eastern part of the country to interview some HIV-positive Nigerian gays. I realised that even though Nigeria’s HIV/AIDS guideline ensured the care of males having sex with other males (MSM), drug users, commercial sex workers and other individuals that are at most risk of getting infected with HIV, the reality on ground indicated that MSMs and other risk groups still suffer discrimination and are not accessing the ideal kinds of care that they ought to be getting – which explained why HIV prevalence is highest among the groups than others.
That was just the tip of the iceberg.
I recently wrote a piece for Devex on why almost no one in Nigeria in using HIV prevention drug. You can read the piece here.
In the course of my research, I interviewed past and present heads of the Nigerian Agency for the Control of AIDS (NACA). Even though there were slight differences, the conclusions of both interviews were similar – Nigeria is not yet providing pre-exposure prophylaxis, or PreP, to individuals at most risk of acquiring HIV infection, even though it is boldly written in the country’s HIV guideline that individuals that have HIV-positive sex partners should be placed on PreP.
After hearing the explanations and excuses of every stakeholder on why Nigeria is not really offering stuffs that are boldly written in its guidelines, I began to ask myself how deeply rooted is the discordance between Nigeria’s documentations and realities – in addition to its potentially strong impacts on health policies?
Without mincing words, recommending something in the national guideline but not effecting it in daily practice is a disservice to the original purpose of the guideline since it will only deceive practitioners that are seeing patients at clinics, it will also mislead international observers that rely on such documents to ascertain the standard practice; it will also confuse those that care to take a closer look at comparing what is happening in the fields to what is stated in the books.
I also believe that international donors should no longer entirely rely on documents provided to make serious decisions. Instead of doing that, they should embark on independent fact-finding exercise themselves before taking and implementing any actions.
My experience really showed a very wide gap between what those official government documents claim and the realities on ground across Nigeria.
While this is quite disheartening looking back, I actually consider it, now, as an eye-opener to a major reason why the country has not been able to achieve almost all of the globally set targets.
The documents upon which policies about Nigeria are made are far from the truth hence the more reason why we should go back to the basics – face, embrace and document reality.