Countries must now use their own resources to address health challenges
Over twenty-five years, Nigeria transformed a devastating HIV epidemic into one of the developing world's most celebrated public health achievements — through free treatment, decentralized care, and community-rooted prevention. Yet as health leaders gathered in Abuja to mark the anniversary of APIN Public Health Initiatives, the celebration carried a quiet urgency: international donor support is receding, and the millions of lives sustained by this system now depend on whether Nigeria will fund its own future. Progress, as history reminds us, is never self-sustaining — it must be chosen, again and again.
- Twenty-five years of HIV intervention have saved millions of Nigerian lives, but the funding architecture that made it possible is quietly collapsing as international donors withdraw.
- APIN alone manages treatment for nearly one in five Nigerians living with HIV across 30 states — a system so vast that its fragility is itself a public health emergency.
- Former Health Minister Adewole issued a direct warning: without a decisive shift to domestic financing, hard-won gains in HIV, TB, malaria, and maternal health could unravel within years.
- Nigeria's health leadership is calling for the country to claim ownership of its own survival — moving from dependency on foreign aid to sovereign investment in public health infrastructure.
Nigeria's fight against HIV stands as one of the modern world's most consequential public health stories. Over twenty-five years, free antiretroviral therapy, decentralized clinics, and community prevention programs transformed a crisis defined by stigma and despair into a measurable victory — reducing new infections, cutting AIDS-related deaths, and improving life for millions. Similar progress has touched maternal health, tuberculosis, and malaria, reshaping the country's broader health landscape.
But on Tuesday in Abuja, as officials gathered to mark 25 years of APIN Public Health Initiatives, former Health Minister Prof Isaac Adewole delivered a celebration shadowed by warning. The traditional pillars of Nigeria's health funding — international donors and overseas development assistance — are eroding. Antimicrobial resistance, climate change, and economic shocks compound the threat. "The issue of local funding has become critical," Adewole said plainly. "Countries must now use their own resources."
The weight of that statement is not abstract. APIN now manages care for nearly one in five Nigerians living with HIV, operating across 30 states with laboratory networks, trained health workers, and integrated primary care. CEO Prosper Okonkwo acknowledged the organization has been preparing for the funding shift — but its capacity to endure depends on national commitment. NACA Director-General Dr Temitope Ilori added her own caution, pointing to drug-resistant TB, rising non-communicable diseases, and the persistent HIV burden among key populations as unfinished battles.
Nigeria has already proven it can build something extraordinary in public health. The question now before its leaders is whether the country will choose to sustain it — not because donors require it, but because its own people do.
Nigeria has built something remarkable in its fight against HIV. Over the past quarter-century, the country transformed what was once a crisis marked by stigma and despair into one of the modern world's most consequential public health achievements. Free antiretroviral drugs, decentralized clinics, prevention programs that reach into communities—these interventions have saved millions of lives and fundamentally altered the trajectory of the epidemic. But on Tuesday, as health leaders gathered in Abuja to mark 25 years of APIN Public Health Initiatives, a sobering message emerged from the podium: all of this progress now sits on fragile ground.
Prof Isaac Adewole, Nigeria's former Health Minister and incoming Ambassador to Canada, did not mince words. The HIV response, he told the assembled officials and development partners, represents one of the greatest public health victories of our time. The expansion of treatment, the prevention of mother-to-child transmission, the behavioral interventions and community-based care—these have reduced new infections, cut AIDS-related deaths, and improved quality of life for people living with the virus. Similar gains have rippled across other health domains: maternal and child mortality have fallen through better immunization coverage and stronger healthcare services; tuberculosis control has advanced through new diagnostic technology and integrated care; malaria interventions, from insecticide-treated nets to artemisinin therapies to newly introduced vaccines, have saved countless lives.
Yet Adewole's celebration came wrapped in warning. Antimicrobial resistance, climate change, pandemics, economic shocks—these emerging threats loom over the horizon. More immediately, the traditional sources of health funding are drying up. International donors, the countries and organizations that have underwritten much of Nigeria's health infrastructure, are reducing their overseas development assistance. Without a deliberate shift toward domestic financing, Adewole cautioned, the hard-won gains could unravel. "The issue of local funding has become critical," he said. "Countries must now use their own resources in order to address health challenges."
The stakes are concrete. APIN, the organization being celebrated that day, now manages treatment for nearly one in five Nigerians living with HIV—a staggering responsibility spanning 30 states. The organization has strengthened laboratory networks, built data systems, trained health workers, and expanded access to care through primary healthcare centers. Its work aligns with the Federal Government's broader Health Sector Renewal Investment Initiative. Yet even as APIN's leadership spoke of commitment and enthusiasm, they acknowledged the shifting terrain. The global health funding landscape, as CEO Prosper Okonkwo put it, has changed in ways few predicted. APIN has been preparing for this moment, he said, but the organization's ability to deliver depends on whether Nigeria can sustain what it has built.
Dr Temitope Ilori, Director-General of the National Agency for the Control of AIDS, echoed the caution. The persistent burden of HIV among key populations, drug-resistant tuberculosis, the rise of non-communicable diseases, the need for sustainable domestic financing—these remain formidable challenges. The public health landscape of 25 years ago was daunting, marked by widespread fear and fragile infrastructure. Nigeria has moved beyond that moment. But the next chapter will be written not by international donors or external partners, but by Nigeria itself. The question now is whether the country will commit the resources necessary to keep what it has built standing.
Citações Notáveis
The HIV response remains one of the great public health success stories of our time. Free and subsidised antiretroviral therapy, decentralised HIV care and prevention services have helped improve outcomes for millions of people.— Prof Isaac Adewole, former Health Minister
The issue of local funding has become critical, and countries must now use their own resources in order to address health challenges.— Prof Isaac Adewole
A Conversa do Hearth Outra perspectiva sobre a história
When Adewole talks about Nigeria's HIV response as a "success story," what does that actually mean on the ground? What changed?
It means millions of people who would have died are alive. It means a mother can take a pill and not pass the virus to her child. It means someone diagnosed today can walk into a clinic and get free treatment that lets them live a normal lifespan. That's not abstract—that's the difference between a death sentence and a life.
But he's warning about sustainability. Why is that warning necessary if things are working?
Because the money that made it work is leaving. The international donors who funded the clinics, the drugs, the training—they're stepping back. Nigeria built something extraordinary, but it was built partly on someone else's dime. Now the bill is coming due, and the question is whether Nigeria will pay it.
APIN manages treatment for 20 percent of Nigeria's HIV patients. That's a huge responsibility. What happens if funding dries up?
You start making choices about who gets care and who doesn't. You close clinics in rural areas because they're expensive to run. You ration drugs. The gains don't disappear overnight, but they erode. People who were stable on treatment miss doses. New infections start climbing again.
Is this a Nigeria problem or a global problem?
Both. Every country that relied on donor funding is facing this. But Nigeria's situation is particular because the epidemic here was so massive—millions of people on treatment. The infrastructure is there, the expertise is there. What's missing is the political will to fund it domestically.
What would sustained domestic funding actually require?
It means the Federal Government prioritizing health spending in the national budget. It means allocating resources that compete with defense, infrastructure, education. It's a choice about what a country values. Nigeria has made that choice before—that's how it got here. The question is whether it will make it again.