MELISSA BLOCK, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.
ROBERT SIEGEL, host:
And I'm Robert Siegel.
It has been two years since President Bush announced his plan to help people with AIDS in African and Caribbean countries. Other international donors have increased their support as well, and now hundreds of thousands of people in Africa and the developing world are being treated for HIV. Hospitals are being refurbished and health workers are being trained. NPR's Brenda Wilson spent an afternoon with a Nigerian health official whose job is to make sure that the money is well-spent.
BRENDA WILSON reporting:
At a glimpse, the life of a public official fighting AIDS is one of constant meetings, discussions and debates, the ordinary headaches of bureaucracy.
Dr. ABDULSALAM NASIDI (Virologist): I look at this, you know, from the perspective of really how they are, and I try to be objective as possible.
WILSON: Dr. Abdulsalam Nasidi is a virologist who identified the first case of HIV in Nigeria in the early 1980s. Today he's the director of special projects in Nigeria's Ministry of Health. His job is to speed up the flow of funds and juggle the agendas of a score of international aid organizations now bearing down on the country.
Dr. NASIDI: The key is all that is happening is excellent to Nigeria, to Africa and to all the, you know, poor countries that are getting access to all the support.
WILSON: For every multimillion-dollar grant, there's a maze of paperwork and a line of people who have to sign off on expenditures. Right now he's arranging to meet later with a staff member to make sure donors release funds.
Dr. NASIDI: Now let's meet at 3:15 before you go.
WILSON: But Nasidi's most important meeting today is with a representative from an AIDS treatment program underwritten by the United States emergency AIDS relief plan PEPFAR. It's the one that really counts these days, but it comes with strings. Seventy percent of the funds must be spent on US goods and contracts with US vendors.
Dr. NASIDI: Of course, we'll have preferred that the PEPFAR money is given to Nigerian institutions, but we don't dictate to the donors.
WILSON: Nigeria gets nearly half a billion dollars in assistance, most of it from PEPFAR. The other big donor, the Global Fund to Fight AIDS, Tuberculosis and Malaria, brings together contributions from many countries.
Dr. NASIDI: The difference is that they leave the country to decide what to do with the money, how to really get it done.
WILSON: Though the money from the Global Fund is intended to help the country become more self-sufficient, everything has to be done in consultation with community representatives, so programs don't get off the ground as fast as with PEPFAR. Of the 600,000 people in Nigeria who need anti-retroviral drugs to fight AIDS, about 20,000 people are now getting them. Dr. Nasidi is expecting PEPFAR to double that number by the end of the year. But a lot has to happen in Nigeria before hundreds of thousands of people can get the medicine. Doctors, laboratories, nurses and hospitals must be ready to deliver care, a challenge for Dr. Abdulsalam Nasidi.
Dr. NASIDI: Yeah, we have to go now.
WILSON: Nasidi has to get to that appointment with the US AIDS expert, but he is stopped by a tall, downcast young man who has been waiting most of the day in the outer office.
Unidentified Man: I want--I need to have...
WILSON: He's infected with HIV, and he's heard that treatment for AIDS is coming. Nasidi does not turn him away. He is a doctor, after all.
Dr. NASIDI: OK. So you come back--no, wait for me. Wait for me. I'll be back by 4:00, 4, 4:15, and then I will see what I can do to arrange it so that you get ...(unintelligible) one of the treatment centers, OK?
WILSON: And we are finally out the door.
(Soundbite of door closing)
Dr. NASIDI: I see people like this every day. They say, `Doctor, you know, what do we do? How do we get the drugs? Where do we go to? Where do we do this?' It's very pathetic, but it's real. It's real.
(Soundbite of construction)
WILSON: A short ride away at a Sokoto hospital, a treatment center is about a month away from opening.
(Soundbite of construction)
Dr. NASIDI: Hello, John.
WILSON: Dr. John Vertefeuille is here on a visit he makes every two months from the Institute of Human Virology, the University of Maryland Medical Center.
Dr. JOHN VERTEFEUILLE (Institute of Human Virology, University of Maryland Medical Center): Unlike some other countries that have major HIV problems, Nigeria has a very educated population, particularly in the medical profession, and so they do have the base resources and the clinical expertise to do this kind of thing.
WILSON: Vertefeuille takes great pains to say there'll be no slew of new hires for new programs. The people already on staff will be trained to administer anti-retroviral therapy in the country's existing hospitals and clinics.
Dr. VERTEFEUILLE: So the focus is on scale-up and capacity-building in a way that will ensure longevity of the program, even beyond its end.
WILSON: A lot will depend on how much Nigeria commits to health care out of its own budget. It promised to increase funding for health care to 15 percent. Dr. Abdulsalam Nasidi says they're getting there. Health-care spending is up by 6 percent this year.
Dr. NASIDI: We are not saying, `Oh, America, come and do everything for us.' No. We are independent country; we're a big nation; we have natural resources. All we want is empowerment, assistance to do it ourselves.
WILSON: If that actually happens under the United States Emergency Plan for AIDS Relief or the Global Fund to Fight Aids, TB and Malaria, then they will have done something few other development programs ever have: put themselves out of business. Brenda Wilson, NPR News.
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