The story of the APIN Public Health Initiatives, which is set to mark its 25th anniversary, is a story of resilience and determination. A story of never-say-die spirit steeped in the stigmatised world of the HIV/AIDS epidemic. APIN, as it is known today, did not start as full Nigerian registered organisation working assiduously to help in strengthening public health in Nigeria. It was a programme management office for a Bill and Melinda Gates Foundation grant awarded to Harvard T.H. Chan School of Public Health in 2000. For six years, it operated within that framework, building systems and expertise in HIV programme delivery.
In 2007, it made a decisive break: it incorporated as an independent Nigerian non-governmental organisation, secured its first independent five-year Centre for Disease Control- President’s Emergency Plan for AIDS Relief grant in 2008 and would go on to complete four additional US PEPFAR HIV grant cycles.
The PEPFAR was actually initiated by then US President, George Bush Jnr., to stem the tide of HIV/AIDS in the world, especially in developing countries in Africa. Africa was not just the centre point of that intervention, but Nigeria was the main focus in Africa due to its sheer population. Any country that crossed the five per cent threshold of the HIV/AIDS prevalence was always an alarm bell and a disaster waiting to happen. By the turn of the century, Nigeria was ominously hovering around that dreaded threshold. This had to be stemmed. And the process of stemming the ugly tide is the success story of APIN as one of the organisations picked to spearhead that strategic intervention.
And today, APIN is not only no longer a project of the Harvard School of Public Health, but it is a fully registered Nigerian organisation which gets its funding directly and with a Nigerian Board. All thanks to years of hard work, resilience and determination to achieve success.
The Chief Executive Officer of APIN Public Health Initiatives, Professor Prosper Okonkwo, speaking to the media a couple of years ago when the organisation was launching a book on how it had successfully reversed the HIV/AIDS prevalence in Nigeria, said the need to tell its success story was borne out of the fact that the figures being churned out by some mushroom organisations about the rising tide of the scourge were totally not in tandem from credible and scientifically verified reports they were getting from the field.
“We need to publish that book to show the whole world that rather than HIV/AIDS prevalence increasing in Nigeria, it was in fact decreasing, and people were getting more and more educated and informed about the virus,” Okonkwo said.
APIN’s initial focus was on tertiary health facilities in Nigeria’s six geopolitical zones, but that changed between 2008 and 2013. The programme rapidly expanded, extending ART access to even more facilities in urban and semi-urban settings and pushing rapidly into rural and peri-urban areas.
The programme’s scope broadened to integrate tuberculosis and maternal and child health care, including robust PMTCT and pediatric HIV initiatives, as well as community-based adherence support, such as home visits and peer-led treatment assistance. APIN also strengthened laboratories to support viral load monitoring in line with US PEPFAR guidance.
It has not been an easy sail, though. The organisation, at one time, had to battle the crisis of identity as people had come to stigmatise them with the HIV/AIDS scourge.
The Deputy Chief Executive Officer (Programmes) of the organisation, Dr Jay Osi Samuels, said people were beginning to see them within the narrow prism of the epidemic itself.
“People simply saw us as ‘the HIV organisation,’” Samuels said in a recent media chat.
That was why, in September 2016, APIN rebranded as APIN Public Health Initiatives and expanded its focus to more public health subspecialties. It connected health services to overall well-being, aligning family planning, nutrition, non-communicable disease management, and HIV care, recognising health’s multifaceted nature. Implementation became more person-centred with models like multi-month dispensing and community ART refills to improve access, reduce patient burden, and increase capacity.
The period also focused on strengthening health systems through data analytics, health information systems, and supply chain management to support sustainable services. Quality improvement methods were adopted at APIN-supported facilities, and governance expanded to include government agencies, donors, civil society, and representation from community, traditional and religious institutions for planning, oversight, and accountability.
As of today, APIN has left its operational footprint in 30 of Nigeria’s 36 states, advancing outcomes in HIV/AIDS, malaria, TB, reproductive health, non-communicable diseases, and other communicable diseases. It has built research partnerships within and beyond Nigeria’s shores with institutions including the Harvard T.H. Chan School of Public Health, Northwestern University, Rice University, Emory University, and universities in Nigeria (e.g., Lagos, Jos, Ibadan).
APIN provides technical and administrative oversight for more than 440 HIV-supported sites and supports nearly 320,000 patients in care and treatment. We steward three major US PEPFAR grants: comprehensive prevention and treatment across five states, the public health information and data repository system underpinning the national HIV program, and the Reliance project supporting Nigeria’s national reference laboratory. Additional projects focus on neonatal health technologies, cervical cancer control, and integrated disease surveillance.
The APIN journey has been that of resilience, determination, and above all, success. And the figures are there to support this. The organisation is currently moving towards achieving the goal of 95-95-95. What this means is this: the first is about the percentage of people who know their status. This has been achieved. The second 95 is the percentage of people who, through data, have been infected with HIV and are on treatment. Currently, Nigeria is close to that 95 per cent. The third 95 is the percentage of people who are on treatment, receiving drugs and virus-suppressed. On these scores, Nigeria is doing very well.
Talking about human development indices, the number of people employed by APIN, either directly or indirectly, attests to the fact that the agency has been an agent of positivism. Currently, APIN has a workforce of close to 4,000. These include over 400 direct hires and over 3,000 indirect hires. One can only imagine the multiplying effect of that on the population of Nigeria and the family economy. Yet, APIN is just one of the several organisations implementing the US government’s intervention efforts in Nigeria. There are about 25 organisations working on that in the US. Without doubt, though, APIN is one of the biggest. In terms of human capital development, training and employment, as well as HIV investment infrastructure in Nigeria, the effect has been massive. APIN is currently working in five states, and they are supporting 443 health facilities in the country. And out of those 443, about 200 of them are being helped and supported by APIN in terms of capacity and human resources. Yet again, one can imagine the effect on income streams, healthcare delivery systems at the tertiary, secondary and local government levels.
As for APIN as an organisation, and the work they are doing, APIN has evolved from being a project of Harvard School of Public Health to being an institution in Nigeria, which is a locally registered, indigenous organisation. As a matter of fact, when the US government changed its policy about funding, nothing changed. There is a need to provide a background for this. What happened was that the US government was funding US organisations like Harvard to come and work in Nigeria. These US organisations usually looked for local organisations to work with. They usually sound out bodies like LUTH or UCH to set up a project office, and an organisation like APIN would then manage these projects for them. This was unlike some other US organisations that would bring Americans in and run the project themselves. What Harvard did was to build on Nigerian human resources, train them and support them in order to deliver. In fact, what they did was that they didn’t want samples to be moved from Nigeria to Boston to be tested. They wanted the type of clinical facilities they have in the US in Nigeria so that Nigerians can be capacitated to be able to do the work here.
The Deputy Chief Executive Officer (Programmes) of APIN, Dr Osi Samuels, said that this arrangement always came with a cost: “These American organisations have what they call statutory charges for overhead. For every $1m they get, 40 per cent or even 60 per cent goes to overhead. So, if it is $100 they got from the US, they take about $60 or thereabout and use the remaining to do the work. At some point, the US government became dissatisfied with that because they wanted every dollar to be used on what it was meant for. So, they started encouraging the policy of asking the US institutions to transition to local partners so that the overheads would be eliminated, and more funds would be freed for the projects to be executed.”
By the time the new US police came into effect, APIN was the first Nigerian organisation to be transitioned to as Harvard transferred to them in terms of full project management in Nigeria. Between 2010 and 2012, the financial responsibilities of Harvard were transferred to APIN. So, from them, APIN became funded 100 per cent directly from the US government.
This is not only massive but instructive. And that is why APIN is now beyond HIV/AIDS, but the whole gamut of public health management and support in Nigeria. The next 25 years can only be better than the first 25.
Ajayi, a media practitioner, writes in from Lagos
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