Nigeria Ministry of Health Introduces State-to-State Learning Visits to Scale Up DSD Implementation

Mar 8, 2023

Since June 2022, ICAP has partnered with Nigeria’s National AIDS and STI Control Program (NASCP) to implement state-to state learning visits based on CQUIN’s country-to-country (C2C) visits. Like the country-to-country visits, Ministry of Health officials, implementing partners, and recipient of care representatives from the Network of People Living with HIV in Nigeria (NEPWHAN) visit different Nigerian states to learn and observe differentiated service delivery (DSD) best practices.

“These state-to-state learning visits are part of a wider initiative in Nigeria to promote the use of innovative strategies to address HIV prevention, testing, and treatment,” said Adewale Akinjeji, MD, MBA, ICAP’s country director in Nigeria. “As we have witnessed with Nigeria’s participation in the CQUIN C2C visits, they are a valuable way to improve knowledge sharing about effective DSD implementation.”

With funding from the Global Fund under the multi country DSD Strategic Initiative and technical oversight from the World Health Organization (WHO), ICAP supported the Nigeria Ministry of Health to adapt the CQUIN C2C toolkit to enable state teams to conduct needs assessments, request state-to-state visits, and develop post-visit action plans. The ICAP in Nigeria team also works with the Ministry of Health to conduct follow-up visits with the state teams.

“We have had visits from the team to see what we are doing. This has helped to keep us on track and focused on our targets, and we didn’t lose sight of what we were supposed to be doing,” said Gladys Ezembu, the coordinator for NEPWHAN Anambra State. Ezembu was part of an Anambra State team that visited Akwa Ibom State in August 2022, a trip that focused on scaling up high-quality community-based and facility-based DSD models for recipients of care.

So far, 12 out of 36 Nigerian States are actively participating in the visits. In 2022, ICAP supported 12 state-to-state visits to facilitate the exchange of best practices on DSD approaches, including community-based pharmacies, monitoring and evaluation, DSD for children and adolescents, and integrating other non-HIV services such as non-communicable diseases and family planning services into existing DSD models.

“Nigeria is planning to progressively increase the number of exchange visits as part of their DSD scale-up plan,” said Gabriel Okpotu Anefu, MBBS, MHM, MBA, MWACP, State AIDS Program coordinator at Benue’s Ministry of Health and Human Services. Dr. Anefu requested a visit to River State last July to learn about their community-based pharmacy model. He was impressed by the rapport built between the pharmacists and recipients of care in the community and the program’s success, which inspired Benue State to scale up its own community pharmacy model. “NASCP plans to conduct up to 40 more visits in the next five years and may use the visits to also share lessons on HIV outside of differentiated service delivery,” he added.

At the CQUIN sixth annual meeting last December, participants from Nigeria shared the implementation and successes of the state-to-state visits in a poster session.

“Country-to-country visits have been an important part of the CQUIN network strategy,” said Miriam Rabkin, MD, MPH, CQUIN principal investigator. “Over time, the ICAP CQUIN team developed a structured approach to planning, prioritizing, and implementing visits to maximize opportunities for impact. It is great to see these strategies and tools being adapted for other contexts and projects.”

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