Spillover Effects of HIV Foreign Aid on the Delivery of Maternal and Child Health Services in Nigeria: 2008 – 2018

BackgroundThis study expands the current body of knowledge by investigating the impact of the Global Health Initiatives (GHI) on the Nigerian health system. Using robust multilevel analytic approaches, this study examined system-wide impacts of foreign aid on the Nigerian health system– a country that has witnessed substantial Development Assistance for Health disbursements in the last two decades, yet has one of the worst maternal and child health indices globally. Most of the health aid to Nigeria has been for HIV programs; and has sparked debates among stakeholders. Critics have asserted the possibility that HIV aid might not be working and could have had unintended negative consequences on the delivery of non-HIV services. Others maintained that such prioritized attention to HIV could have had a crowding-out or negative spillover effect on the delivery of other health programs in Nigeria. Thus, the focus of this study is to ascertain the nature of the spillover effect of HIV aid on the delivery of maternal and child health services in NigeriaResultsThis study identified that donor HIV financing to Nigeria increased up to 2012, and decreased steadily afterwards between 2008 – 2018. This was suggested to be linked to PEPFAR priority shift to health systems strengthening in the second round of their funding cycle. This study also identified a negative spillover effect of HIV-specific aid on the delivery of non-HIV services, and is suggested to be attributed to the prioritized attention given to HIV programs by global health systems.ConclusionsStudy findings provide systematic evidence to inform policy on the frameworks for developing a national roadmap for the effective alignment of GHIs’ coordinating mechanisms with national health priorities. Future studies should explore the effects of the Development Assistance for Health among low- and middle-income countries including Nigeria to provide evidence for policy, and substantiate how the growing interests in health systems strengthening is overcoming vertical programs and fostering systemic improvements. Government should identify turnaround strategies to strengthen Nigerian health systems for the Sustainable Development Goals, and formulate policies that improve the effectiveness of GHIs in Nigeria.