Nigeria

Differentiated Service Delivery Implementation in Nigeria

Nigeria is the seventh most populous country in the world and with a population of 206 million (NPopC, 2019), the most populous country in Africa.

Nigeria joined the CQUIN learning network in November 2020.

The HIV Treatment Program in Nigeria, which started in 2002 is coordinated by the National AIDS/STI Control Programme (NASCP), under the Federal Ministry of Health. The overall mandate of NASCP is to coordinate the health sector response to HIV/AIDS in the country.

Nigeria integrated decentralization of care into service delivery by adopting and implementing the Hub and Spoke Network Model (Cluster System) of ART decentralization in March 2010. This enabled the devolution of stable PLHIV from larger, centralized secondary and tertiary facilities (hubs), to smaller more peripheral primary facilities (spokes) to continue receiving ART.

In August 2014, the FMOH released a task-shifting and task-sharing policy for essential healthcare services in Nigeria. This subsequently made it easier to integrate task shifting, decentralization, and ensure the simplification of care using differentiated ART models.

The Program has offered facility-level differentiated service delivery (DSD) for stable recipients of care using individual appointment spacing, which has provided multi-month ART refills and fast-tracked visits since 2015/2016.

Nigeria first recommended DSD packages of care in her 2016 National guidelines for HIV and AIDS Prevention, Treatment, and Care. With the adoption of Test and Treat in 2016, eligibility for ART was no longer the focus, rather how to ensure that all recipients of care received appropriate care packages using innovative strategies.

DSD recommendations have further been updated in the 2020 treatment guidelines. Based on these recommendations, Nigeria, currently implements a diversity of ART models that provide differentiated client flows, schedules, and locations to ensure that all recipients of care are provided with appropriate care packages in both stable and unstable contexts.

Nigeria, in collaboration with her donors and implementing partners provide several facility-based DSD models for children, adolescents, and adults and community-based DSD models for adults, adolescents, and key populations. These models include the following:

Facility-Based Models

• Facility-Based Individual Models
  • Multi-month ART refills
  • Fast track
• Facility-Based Group Models
  • Adolescent clinics/clubs (inc. weekend clinics)
  • Healthcare worker-led groups
  • Recipients of Care led groups (inc. Support groups, Mentor mother led groups/Postnatal clubs)
  • Integrated Clinics for Family ART Refills
  • Viremic clinics for the virologically unsuppressed and those requiring more intensive packages of care

Community-Based models

Community-Based Individual Models

• Community Pharmacies

Community-Based Group Models

• One-Stop Shops
• Drop-In Centers
• Healthcare worker-led community ART groups
• Recipients of Care led groups (inc. Mentor mother led groups)

Training and mentoring of healthcare providers and networks comprising recipients of care is a priority to ensure quality improvement. Capacity building for coordination, at all levels, monitoring, and evaluation, is also a top priority, as the nation rapidly scales up to improve coverage.