New WHO guideline on HIV may increase Nigerian government spending- Officials

The WHO recently released new guideline for HIV treatment.

Stakeholders in the health sector are already concerned about the cost implication of the new World Health Organisation, WHO, guidelines for HIV treatment, with a Senator calling it ‘a burden on our national budget’.

This is as a result of the United Nation’s, UN, latest prediction that there would be greater drift of assistance from Africa to middle-income countries.

The UN in her Millennium Development Goals Report 2013, launched on Monday by the Secretary-General, Ban Ki-moon in Geneva had stated that “The current shift in aid away from the poorest countries and Africa, and towards middle-income countries, will continue, with a greater share of aid being offered in the form of soft loans rather than grants”.

It disclosed that bilateral net official development assistance to sub-Saharan Africa amounted to $26.2 billion in 2012, an 8 per cent drop from 2011.

These, the stakeholders explained, are part of their reasons for fretting over the WHO’s guidelines as people living with HIV (PLWH) in Nigeria do not pay for drugs; while the country is not getting aids like she used to, hence, would have to create allocations in the healthcare budget for the new recommendation to thrive.

The WHO released its new HIV treatment guidelines on Sunday in her report tagged “Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection”.

The recommendation stipulates that all countries should initiate treatment in adults living with HIV when their CD4 cell count is about 500 cells/mm or less. This means when their immune system is still strong.

Previously, the global health body had in 2010 set 350cells/mm or less as the CD4 count at which treatment should commence.

CD4 is a medical terminology for the type of immune cell attacked by the HIV virus.

“Treating people with HIV earlier, with safe affordable, and easier-to-manage medicines can both keep them healthy and lower the amount of virus in the blood, which reduces the risk of passing it to someone else.

“If countries can integrate these changes within their national HIV policies, and back them up with the necessary resources, they will see significant health benefits at the public health and individual level,” the report states.

The recommendation also encourages providing antiretroviral therapy (ART) regardless of CD4 count to all children under five years of age living with the virus, all pregnant and breastfeeding women with HIV and to all persons who are HIV-positive but in a relationship in which their partners are not infected.


A senator has now expressed fear over the implications of the new guideline saying “this new guideline if adopted would place an extra burden on the nation’s healthcare budget.”

He said the allocations for health hasn’t been sufficient while donors are not forthcoming like before. This, he said will add more pressure to the budget.

However, the Executive Director, Plan Foundation, Ibadan, Oyo State, Obatunde Oladapo, disagrees with the lawmaker.

“I would say that response is myopic and is based on very little knowledge about the issue of treatment as a strategy for HIV prevention,” Mr. Oladapo told REMIUM TIMES.

“The person is simply considering the various categories and numbers of people to provide ARVs and ARTs for but leaving out the fact that this new regimen will subsequently ensure an HIV/AIDs free Nigeria”.

Also, John Idoko, the Director General, National Agency for the Control of AIDS, NACA, told PREMIUM TIMES in an interview that the guideline is a welcome development long overdue.

Addressing the possible extra pressure on the health budget, he said “it’s a question of balancing between extra budget and the number of lives we would lose. We would have to choose between the two. Are we interested in having more people free of HIV or are we interested in Nigeria full of HIV?

“If we don’t bring and invest the money in preventing and managing the condition, the burden (HIV) will increase and we would lose more people- both the young and old and we won’t be saving lives”.

Also speaking, the Minister of State for Health, Muhammad Ali-Pate, agreed that the new guideline will mount some pressure on the nation’s budget as well as those of developing partners.

“There is always that challenge of resource constraint but we have to look at it from the angle of the patient. But sincerely speaking, of course, it would put pressure on the budget of government and developing partners but I hope that we would put in all resources that can be gotten so that where efficiency is needed, they can actually be gained,” he said.

“There’s always the constraint of resources but we’re working out other ways to cushion the effect this would bring on the budget. For instance, NACA has just developed a new plan for HIV/AIDs and I hope states and local governments will also chip in their own resources and not leave everything to be done by the Federal Government because not much is actually allocated for HIV/AIDS.

“I know some states are more endowed than others so I hope those that are more endowed will put in more,” the minister added.

A consultant to the Senate Committee on Health, Wale Okediran, also said that the new regulation “would be an extra burden on our budget especially in view of the latest UN (United Nation) report”.

Mr. Okediran, however, said the guideline will help the nation as a whole to look inward.

“Personally, I think this is one of the things we need to get us on our feet. For too long, we have been depending on foreign donors for everything and I don’t think it is right. In short, somebody said may be this is why corruption is rampant because we have excess money to play with whereas, if donors don’t come close, we would be forced to use that money.

“At the same time, I think it would help us look inward for funding. Our country is too serious to be left alone with politicians and that is why we need to encourage our philanthropists to come into the health sector. I believe that all over Africa, we need to encourage our rich people and corporate organisations to put in some support in health and not only sport and beauty pageant. If they want to organise Miss Nigeria now, you would be surprised how much dollars would be donated, when the health sector which is very important is there. I think we need to allow the donors to move away” he added.

Uncertain about kick-start of guideline in Nigeria

Mr. Idoko also said he was uncertain about when the recommendation would be adopted and started in Nigeria.

“I don’t know when we would commence the implementation in Nigeria but we have to work with WHO and all other partners to see how we can go about it because it would help even the country to not only solve HIV but other health conditions such as Tuberculosis, malaria and even maternal-child care related issues,” he said.

The Health Minister also added that “the guideline is just out so we would have to make deliberations, but I know that the ministry would work closely with NACA on this and make preparations to ensure that we commence it as quickly as possible.

“To expedite this action, we would ensure that in the 2014 budget, more resources would be allocated to the prevention, treatment and management of HIV as well as the procure of ARVs.”

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