Accordia Voices

A Modern West African Capital on the Move

At the invitation of senior representatives from the local USAID and CDC offices, I recently traveled with colleagues Paul Volberding, Alex Coutinho and Accordia staff member Kelly Willis to Abuja, Nigeria.  Our trip followed months of discussions with the Nigerian PEPFAR team and representatives from the University of Abuja and the Federal Ministry of Health about the possibility of creating a West African Infectious Diseases Institute in Nigeria.  While the local needs differ substantially from those in Uganda when the project launched almost ten years ago, the West African IDI would be largely predicated on the successful model of the Infectious Diseases Institute (IDI) at Makerere University.

The demonstrated ability to improve regional healthcare capacity through outreach and replication will be a critical measure of IDI’s success, and therefore is of enormous interest to Accordia Global Health Foundation.  It will also enable Accordia to leverage our collective knowledge about the very early stages of IDI development, what it takes to get an organization and programs like that off the ground, and how it can be effectively integrated into existing healthcare systems to firmly establish local ownership.  Our trip was largely intended to determine whether Nigeria is the place to do that – to bring Accordia’s expertise and resources to the table with PEPFAR and local Nigerian partners, and tailor the IDI model to fit local needs in West Africa.

At least 1/5^th of the entire population of sub-Saharan Africa resides in Nigeria. Abuja is Nigeria’s young capital – strategically located near the geographical center of the country, and as a federal entity independent from the 36 Nigerian states, much like Washington DC and other international capital cities.  Abuja is currently home to about 2 million people, and has obviously been planned for enormous expansion.  It is reportedly one of the fastest growing cities in Africa, and is expected by some to reach 10 million inhabitants before 2015.  For now, Abuja has an open and well organized feel to it – and on the surface appears to have a well-functioning, modern infrastructure.  Traffic flowed orderly and traffic lights were all in working order, we experienced no power or water outages during our stay, and internet access was consistent and faster than I’ve experienced elsewhere in Africa.

Nigeria has a reputation for corruption, but the federal government seems to be doing all the right things to change that.  Transparency International ranked it 147th most corrupt last year – which makes it more corrupt than Uganda (111th) but less corrupt than Kenya, Sierra Leone, DR Congo, and many other African countries. One of the things we’ve done successfully in Uganda is to manage around graft – and, in fact, to influence it away through our exemplary conduct and transparent systems at IDI.

Very few countries receive as much foreign aid from the US and other sources, and it doesn’t seem to be slowing down at all - on the contrary.  More importantly, the need for healthcare capacity-building activities remains enormous - Nigeria is the most populous country in Africa, and by itself accounts for 10% of the global AIDS burden – and many people predict that the “4 million infected” number is likely to double by 2010. I had the opportunity to join a PEPFAR-sponsored mobile night team for HIV counseling and testing among high-risk populations, led by the Institute of Human Virology. We visited a poor area near Abuja and set up shop at the back of the dance floor at a busy night club and brothel.  The lack of understanding about HIV/AIDS as well as the stigma associated with being HIV positive came through loud and clear.  The lack of health care infrastructure to deal with the HIV threat as well as basic human health issues was equally apparent.

Nigeria is also home to more than 40 medical schools, many of them among the oldest and best established universities in Africa.  While in some ways this creates a complicated environment in which to establish an academic “center of excellence,” in other ways it provides an unprecedented opportunity for regional impact - if we are successful in creating a cooperative spirit among schools, around a shared national resource physically located in Abuja, we could potentially develop a system capable of supplying the entire continent with advanced medical talent and expertise in infectious disease.

During our brief stay in Nigeria we met a remarkable number of influential individuals from the US agencies, as well as from the Nigerian Ministry of Health, Ministry of Education, National AIDS Control Agency, and other important stakeholders.  Without exception, the individuals we met were bright, dedicated, forthright and genuine in their determination to make this effort successful.  We visited the current campus of the University of Abuja, as well as the land already allocated for its future site, about 15 minutes closer to the airport and the center of town.  And we talked extensively about possible scenarios and iterations which could best tap existing national resources to create another African-owned, African-led institution of international caliber.

There’s still a lot of work to be done to determine the way forward, but we all left with a sense of great optimism about what might be possible in Nigeria, with the right set of committed partners and dedicated financial resources.

Posted by Dr. Warner Greene, Accordia President