Prof. Chinedu Idoko is a former Executive Secretary/Chief Executive Officer (CEO) of Enugu State Agency for the Control of AIDS (ENSACA) as well as former Chairman, Enugu State Hospital Management Board. Idoko is also a Senior Lecturer in the Community Medicine Department of the College of Medicine, University of Nigeria as well as a consultant physician in the University of Nigeria Teaching Hospital (UNTH), Enugu. In this interview with CHUKWUMA MUANYA, he explains the relationship between the harsh economic conditions in the country and noticeable rise in sudden deaths, proffering solutions to the situation. He also recommends how the government can sustain the free national HIV treatment programme despite the pullout of the major sponsor – the U.S. Government – and ultimately meet the global target to end Acquired Immune Deficiency Syndrome (AIDS) by 2030.

What have been the challenges towards Universal Health Coverage (UHC) or rather health for all in Nigeria? 
The challenges towards UHC involve all the building blocks of the health system including financing, governance, health infrastructure, medical supplies, service delivery, and human resources for health. The shortcomings in these various building blocks mount the biggest challenges to UHC.

What are the solutions? 
The solutions lie seriously in a strong political will to downplay out-of-pocket expenditures by encouraging, enabling, activating and promoting other workable healthcare financing options within the UHC umbrella. It is heartwarming that most state governments have set up their health insurance structures and strengthened them with enabling Acts. We should move on to the next level of ensured implementation and necessary diversification in financing options.

In recent times, unconfirmed reports suggest that cases of sudden death in the country have increased due to the harsh economic realities. How true is this? Can you throw more light on this?
If we understand the meaning of sudden death, then we can make various allusions/inferences. Basically and in a layman’s understanding, sudden death is death not expected, but arising within an hour of onset of symptoms from a heart related condition or a cause not of cardiac/heart origin but death occurring within 24 hours in someone not previously known to be ill.

With this in mind, certainly relationships could be drawn between sudden death and the increased harsh economic realities in the country. The harsh economic realities come with it, stress which could promote high blood pressure and other conditions that put a weight on the cardiac system. Furthermore, people are not able to afford basic healthcare and follow-ups, which all exacerbate already worsened health indices.

How can Nigeria achieve UHC under these harsh economic conditions? 
Community-based healthcare financing options like the community-based social insurance schemes could come in handy. This enables capture of people not opportune to be in formal employment. This includes self-employed persons – artisans, farmers, and a host of other groups – usually left out of the formal health insurance schemes. The good thing is that these structures could run under and be regulated by the UHC.

How can Nigeria sustain the free national HIV treatment programme for more than one million persons with Human Immuno-deficiency Virus (HIV) following the pullout of the major sponsor – the United States Government? 
The Nigerian government just has to come in; in full force. There has been this transitioning thing going on for quite some time with various modalities being ironed towards each country’s government taking ownership of the HIV control effort programmes (as the international agencies are withdrawing support). This is indeed the time for actual implementation of those modalities.  Furthermore, there should be a way of capturing HIV treatment in the UHC.

Can Nigeria and indeed the rest of the world end AIDS by 2030?
The awareness programmes on HIV/Acquired Immune Deficiency Syndrome (AIDS) has to be put in full gear and sustainability ensured. Increased number of people should be encouraged to take action by knowing their HIV status, preventive and treatment options available must be emphasised, increased involvement of government in funding programme structure, and implementation activated with sustained collaboration by the various stakeholders and key players, networks, Civil Society Organisations (CSOs) etc. This is the way forward to ending AIDS by 2030.

Already, cuts to international assistance for HIV have affected HIV prevention, treatment and community-led services and jeopardised future progress towards eliminating new HIV infections among children across sub-Saharan Africa.

The joint United Nations Programme on HIV/AIDS (UNAIDS) calls for the safeguarding of the global HIV response with continued support from the international community. UNAIDS also urges African leaders to accelerate efforts to strengthen and sustain their national HIV responses through political commitment and domestic investments. It also calls for the strengthening of community-led services and for a rights-centred response to HIV.

What are the key messages stabilising Africa’s HIV response amid disruptions?
Supporting countries and communities as they navigate ongoing programme and systems disruptions. There is a need for the need for political leadership, sustained financing and resilient service delivery solutions to protect progress towards ending AIDS.

African political leadership is essential to safeguarding progress in the HIV response. The Africa Group is encouraged to champion the Global AIDS Strategy and targets, while reinforcing the Joint Programme’s role in ensuring coherent, inclusive and multi-sectoral national responses during the transition.

Scientific breakthroughs, including long-acting prevention and treatment, can end AIDS, but only if they reach all who need them. UNAIDS calls for universal, affordable and stigma-free access through equitable policies and shared global response.

Africa’s future depends on reducing reliance on external supply chains. The Joint Programme champions African production, regional cooperation and technology transfer to make innovation sustainable, accessible and resilient.

Communities continue to drive resilience and innovation despite funding cuts and discrimination. Their leadership, expertise, and lived experience are essential to progress.

Are there other things you want us to know?
A good health services system in Nigeria would give a lot of hope to the populace. We should as a country look at a structure of supporting citizens with various forms of organ failure, example kidney failure. The affordability of treatment options for these forms of health conditions is usually totally out of reach of the average citizen (about 90 to 95 per cent of the populace cannot afford treatment of these conditions barring crowd funding). Furthermore, the packages available even for high end health insurances do not capture this level of treatment/management. It is obviously a tough one, but an area government should look at to see what can be done to provide some form of support to people in these situations.