---

Note: This document may not always reflect the actual appropriations determined by Congress. Final budget allocations for USAID's programs are not determined until after passage of an appropriations bill and preparation of the Operating Year Budget (OYB).

---

NIGERIA

	FY 1997	FY 1998	FY 1999
	Actuals	Estimate	Request
Child Survival and Disease..........	$2,500,000	$5,000,000	$6,000,000
Development Assistance..............	$1,600,000	$2,000,000	$1,000,000

Introduction

A politically stable and economically strong Nigeria is in the vital interest of the United States because of its major oil resources, huge potential market for American products, role as a peacekeeper in the region, and major political and economic influence throughout Africa. Current U. S. investments in Nigeria are estimated at $8-10 billion. Unfortunately, Nigeria remains a politically troubled country in crisis with difficulties in democratic transition, human rights abuses, narcotics transiting, and international business scams. It is in the interest of the United States to avoid instability in Nigeria which could spread widely throughout the region, and to work constructively to the extent possible to help the country resolve its current crises. Targeted U.S. humanitarian and developmental assistance during this difficult and politically uncertain period supports the objectives of a balanced and broad-based foreign policy towards Nigeria.

The Development Challenge

A stable and democratic political environment is essential in developing Nigeria's recognized economic potential but this goal has eluded Nigeria for over three decades. Nigeria has been under military dictatorship for 28 of its 37 years. The current military regime has attracted worldwide condemnation for its disregard of the electoral will of its citizenry, as well as its record of human and civil rights abuses. The regime maintains, amidst widespread skepticism and cynicism, that it will return the country to democratic rule in October 1998. Most observers now believe the process is being managed to ensure that the current rulers will be the inheritors of power under a civilian government. Such a transition will be fundamentally flawed as the current rulers have not demonstrated a genuine interest in free and fair elections in their ostensible search for a political arrangement accommodating Nigeria's diverse ethnic and religious population.

Nigeria's economy has been in a downward spiral for two decades, although a slight upturn in economic growth and stability of the national currency was recorded from 1995 through 1997. The gross domestic product has declined from a high of $1,000 per capita in the mid 1980's to an estimated $250 for 1996. In January 1993, the inflation rate spiraled upward from a baseline of 22%, to a peak of 73% in 1995. As a result of initial economic reforms and a tight monetary policy, inflation has been reduced to 12% for the twelve-month period ending in the third quarter of 1997. However, if implemented, the 1998 budget would produce reflation.

A 1996 national survey revealed that ordinary Nigerians continue to suffer. Approximately 49% of Nigerians are below the poverty line of eight dollars or less of monthly household income. Nigeria's declining economy and deteriorating infrastructure are confirmed by the United Nations Development Program which shows Nigeria losing ground. In effect, past gains in life expectancy, literacy, education, child mortality, human rights, communications, and health care are being reversed. These indicators reflect poor Government of Nigeria (GON) leadership.

Nigeria's population of approximately 106 million continues to grow at 3.1%, well above the regional average of 2.8% and outpacing the GON's ability to provide social services. Contraceptive prevalence which reached approximately 12% among women in 1995 at the peak of USAID's family planning assistance is now reported at 7%. The HIV/AIDS prevalence rate in the general population has risen from 3.8% in 1994 to 6.7% in 1996 with over 3.5 million Nigerians infected with HIV/AIDS. This

constitutes over 60% of the regional HIV/AIDS burden. Nigeria's health and social sector services collapsed in the midst of the political crisis following the 1993 election annulment. The plight of Nigeria's vulnerable women and children has worsened. Chronic and acute malnutrition are commonplace. Although the GON has recently embarked on immunization campaigns which have increased the immunization coverage for most antigens including polio to approximately 56%, infant and maternal mortality rates remain very high at 84 per 1000 and 1000 per 100,000 respectively.

USAID ceased all support to the Government of Nigeria in 1994 and downsized its non-governmental assistance program from $23.5 million to $7 million per year and staffing from four to one U.S. direct hire employee. The program is catalyzing the growth and leverage of non-governmental organizations (NGOs) working at the community and national levels in health care support and democratization. Although the program cannot provide adequate resources to address the myriad development and political problems in Nigeria, it is providing pivotal moral and material support to the NGO sector, and bears witness to the political aspirations of the majority of Nigerians who are disenfranchised by the current regime.

The short term benefits of energizing and strengthening the NGO sector are already quite apparent as authorities are concerned about the growing community power and leverage of NGOs in community affairs and the political transition. The long term benefits will be an educated and strengthened civil society in Nigeria with the capability of sustaining a sound democratic transition in a stable political environment. The health portion of the program is contributing to basic needs at a time when the public sector services are largely ineffective, and also confronts regional disease outbreaks such as polio and HIV/AIDS.

Other Donors

Because of doubts concerning the GON's sincerity about generating a genuine political transition as well as ineffective public sector agencies, most donors have cut back drastically or eliminated development assistance to the Government of Nigeria. However, many donors have redeployed some resources to humanitarian activities in the private sector. Multilateral donors including the African Development Bank and United Nations agencies (United Nations Childrens Fund, United Nations Population Fund, and United Nations Development Program) continue to work with the GON and provide the largest share of development assistance to the GON.

The United States remains the largest bilateral donor in health and democracy/governance, followed by the United Kingdom, Germany, Norway, Ireland, Sweden and Denmark. Other countries of the European Union (EU) have small assistance programs. USAID and the U.S. Embassy meet quarterly with most of the EU countries who have increased their support for good governance projects. Other American NGOs such as the Ford and Macarthur Foundations are active in Nigeria with the Ford Foundation financing projects well in excess of USAID's planned funding levels.

FY 1999 Program

Proposed assistance to Nigeria is very modest and reflects a policy disapproval of previous GON actions and a measured response to the uncertain outcome of current political events in a country of vital interest to the United States. In response to the constraints identified above, USAID resources are channelled through NGOs and focused on integrated health and democracy activities. From a political viewpoint, the current program reflects a holding posture in Nigeria, pending implementation of the promised transition to a civilian government and an improvement in the U.S.-Nigerian bilateral relationship.

---

NIGERIA
FY 1999 PROGRAM SUMMARY
(IN THOUSANDS OF DOLLARS)

USAID Strategic and Special Objective	Economic Growth & Agriculture	Population & Health	Environment	Democracy	Human Capacity Development	Humanitarian Assistance	TOTALS
S.O. 2. Improved Maternal and Child Health Practices - CSD	---	4,000	---		---		---		---		4,000
Sp.O 1. Improved HIV/AIDS Prevention, Control & Mitigation - CSD		---			2,000		---		---		---		---		2,000
Sp.O. 2. Strengthened Civil Society Contribution to Democratic Participation and Civil Rights - DA		---		---		---		1,000		---		---		1,000
Total - CSD - DA	--- ---		6,000 ---	--- ---		--- 1,000		--- ---	---	---		6,000 1,000

USAID Affairs Officer: Felix Awantang

---

ACTIVITY DATA SHEET

PROGRAM: NIGERIA
TITLE AND NUMBER: Improved Maternal and Child Health Practices, 620-S002
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: $4,000,000 CSD
INITIAL OBLIGATION: FY 1995; ESTIMATED COMPLETION DATE: FY 2000

Purpose: To promote a healthier and more productive society through the provision of integrated maternal and child health services through non-governmental organizations (NGOs.)

USAID Role and Achievements to Date: USAID has led donors in efforts to develop private sector alternatives in the delivery of health services in Nigeria after the collapse of the public health services delivery system in 1995. These efforts have been focused on the identification and strengthening of the service delivery capacity of private, religious and for-profit health services networks. Support provided to these networks and their facilities have been in training, management, equipment, supplies and human resources development. The technical capacity of the NGOs has been reinforced in the areas of immunization, malaria treatment and prevention and oral rehydration therapy for diarrhea. Over 2,152 community-level voluntary health workers, traditional birth attendants and community-based distributors have been trained and equipped to provide quality services.

USAID assistance has been acknowledged by the Government of Nigeria (GON) in the support of recent National Immunization Day (NIDs) campaigns to increase the immunization levels of Nigerian children which remain the lowest in the region. In the latest series of immunization drives conducted in November and December 1997, USAID assistance through NGOs was critical in providing publicity and mass mobilization through over fourteen radio and ten television stations and community-level campaigns nationwide. Preliminary results of these efforts in support of this campaign indicate that the immunization coverage including polio has risen nationwide from approximately 30% to 60%. Encouraged by these results, the GON is planning more campaigns and procuring the vaccines and other supplies required for this effort. To strengthen routine, mass and accelerated immunization activities, community immunization days have been scheduled by some NGOs as follow-up to the national campaigns. USAID plans to continue funding to NGOs in future campaigns in support of the Global Health Summit goal of 90% coverage for all immunizations by the year 2000.

USAID has been strengthening NGO capacities to respond to periodic epidemics of cholera, cerebro-spinal meningitis (CSM) and yellow fever. During the CSM and cholera epidemics of 1996, USAID mobilized all collaborating NGOs in support of mass immunizations and over 50,000 people were immunized. GON approved plans have been concluded for an epidemic preparedness and response strategy, which includes mass immunization. In collaboration with the GON and other donor agencies, USAID has completed the training of NGOs in the north in the technical requirements of the strategy and will soon initiate training in the southwest and east.

Description: USAID supports the delivery of child and maternal health services as a component of an integrated health care package. Implementing U.S. Cooperating Agencies (CAs) and their Nigerian NGO partners work in three geographic focus areas including a total of 14 northern, southeastern and southwestern states. NGO activities at the health facility and clinic level are directed at reducing high maternal and infant mortality rates by promoting routine, accelerated and mass immunizations activities, the use of oral rehydration therapy for diarrhea treatment, malaria prevention and treatment, appropriate home-based management of acute respiratory infections (ARI), and childhood nutrition including exclusive breastfeeding.

At the community and organizational level, USAID funds NGOs in mobilizing community-based organizations to create partnerships with private health establishments or networks. These establishments may be urban for-profit clinics, as is the case with the Community Partnerships for

Health (CPHs) in Lagos and Kano, or extended health networks such as those of the Christian Health Association of Nigeria. Such partnerships have become pivotal in community mobilization, service delivery and creating a sense of community and hope in some of the major urban areas. Twelve urban CPHs have been created in Lagos and Kano and nine sub-projects are being implemented in collaboration with the religious groups.

The community mobilization which characterizes these projects has helped to identify some critical needs of women. Women are being taught how to improve their negotiating skills in the making of critical decisions in the home. Micro-credit schemes are also being sponsored with other donor funding to empower women economically. These two activities appear to have emboldened women to initiate a third activity, political participation in NGO affairs. Youth, men and the community at large, have been motivated to promote community sanitation for malarial prevention, oral rehydration therapy and exclusive breastfeeding.

Host Country and Other Donors: The United Nations Children's Fund (UNICEF) provides a broad range of infant, child and maternal health inputs including vaccines, vaccine storage equipment and other essential commodities, through the public sector. UNICEF and the British also finance essential drugs for health facilities. The World Health Organization funds limited technical assistance in support of health planning and the integrated management of childhood illnesses. Polio-plus and Rotary International made significant contributions in the area of social mobilization during the NIDs. The United Nations Development Program continues to provide some support in poverty alleviation programs including guinea worm disease eradication. The GON has for the first time in 1997 made available sufficient quantities of vaccines for all antigens and vaccination supplies. These concerted efforts by the GON and other donors have led to the revision of USAID's target for 1998 from 40% to 60% and 90% by the year 2000.

Beneficiaries: Infants, children under the age of 5 years and mothers. USAID-supported programs target 14 focus states with a total estimated population of 55 million.

Principal Contractors, Grantees or Agencies: USAID implements activities through a participating agency services agreement with the Centers for Disease Control and through U.S. CAs who work with Nigerian NGOs. Major CAs include the Basic Support for Institutionalizing Child Survival Project, Initiatives, the Johns Hopkins University and the International Center for Research on Women.

Major Results Indicators	           Baseline	 	     Target
Improved Immunization Coverage:  i.e.measles 						20%   (1995)	60% (1998)
										90% (2000)
Increased proportion of children given
 correct home management of  diarrhea  	 						30%  (1995)		40% (1997)
 										80% (2000)
Improved Home Management of Malaria and    				  		 30%  (1995) 	35% (1997)
Acute  Respiratory Infections										60% (1998)
										80% (2000)
Child Nutrition (Exclusive Breastfeeding)							3%  (1995)		15% (2000)

---

ACTIVITY DATA SHEET

PROGRAM: NIGERIA
TITLE AND NUMBER: HIV/AIDS Prevention Control and Mitigation, 620-SPO1
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: $ 2,000,000 CSD
INITIAL OBLIGATION: FY 1995; ESTIMATED COMPLETION DATE: FY 1999

Purpose: To promote a healthier and more productive society through the prevention of HIV/AIDS and sexually-transmitted diseases (STDs) through non-governmental organizations.

USAID Role and Achievements to Date: USAID-supported programs focus on 14 focus states with an estimated population of 50 million. The program supports NGO efforts at the community level. Information, education and communication services have been provided to over 900,000 men and women who are at increased risk of contracting these diseases. This educational effort has been supported by 172 media spots and 440,000 information, education and communication material packages reaching a broader audience. Four hundred and sixty-two peer educators have been trained in various social groups to serve as agents of behavior change.

HIV/AIDS awareness rose from 47% in 1993 to over 70% in 1997 among target populations of USAID-funded AIDS Control and Prevention Project (AIDSCAP) sub-project activities, while consistent use of condoms among some targeted high-risk groups increased by 26% to 62%. One million condoms have been distributed to high-risk populations through these sub-projects. This is stimulating the demand for condoms from other sources, and contraceptive social marketing sales rose from 24 million condoms in 1993 to 45 million in 1994 and 55 million in 1995. Projections in 1997 estimate annual condom sales have now reached 60 million. As a result of USAID's achievement in the empowerment of NGOs for community program implementation, the Government Of Nigeria (GON) now recognizes these donor-funded community NGOs as the most significant organizations working in HIV/AIDS prevention.

Description: The HIV/AIDS epidemic threatens millions of Nigerians. Current sero-prevalence estimates indicate that 3.5 million Nigerians are infected with the HIV virus. Thus over 12% of the global HIV burden is attributable to Nigeria alone. USAID has been leading the effort to enhance awareness and stimulate programs addressing the HIV/AIDS crisis and has a three part strategy: (1) behavior change communication through peer health education outreach, (2) sexually-transmitted disease management, emphasizing a diagnosis and treatment approach based on symptoms, and (3) the promotion of condom use. Due to the widespread disempowerment of women in marriage and sexual situations and the vulnerability of adolescents and young adults, the program provides peer support and training in negotiation skills for women and youth.

In order to address the vulnerability of women and youth to HIV infection, improved participation of women in decision-making and adolescent reproductive health have been introduced as cross-cutting program implementation strategies in all USAID-funded projects in Nigeria. NGO institutional strengthening and sustainability is being vigorously pursued through NGO capacity development and enhanced organizational sustainability which is another implementation parameter that cuts across all projects.

New cases of full-blown AIDS are on the increase and anecdotal evidence indicates that an average of three to five new cases are seen each day in some tertiary health institutions in the country. The number of cases of full-blown AIDS reported by the GON to the World Health Organization increased rapidly from 1,148 in April 1994 to 10,803 in November 1997, more than an 840% increase. These figures constitute the tip of the iceberg but still indicate an exponential growth in the magnitude of the AIDS epidemic in Nigeria.

Some available data, especially from Uganda, have shown that positive behavior change leading to a significant reduction in HIV transmission can take place among youth. USAID will therefore expand its country program to give more attention to youth, in and out of school, who constitute over half of Nigeria's estimated population of 106 million. USAID will also support operational research initiatives that complement and help direct the implementation of its country program.

Host Country and Other Donors: The GON established the National AIDS/STD Control Program to implement and coordinate their anti-AIDS efforts at the federal level. Similar program units have been established at state and local government levels. The total annual commitment from these three tiers of government to HIV/AIDS prevention and control efforts is $5.7 million, but disbursement has fallen short of this amount. The British provide screening equipment to the GON. The British also currently support commodity (inclusive of condoms for disease prevention) social marketing through a three-year $5.9 million contract with Population Services International. The United Nations Joint Program on AIDS has supported the GON's anti-HIV/AIDS efforts with a $200,000 grant to the National AIDS/STD Control Program and plans further inputs.

Beneficiaries: Sexually active adults and adolescents, particularly high risk populations.

Principal Contractors, Grantees or Agencies: USAID implements activities through the AIDS Control and Prevention Project with Family Health International.

Major Results Indicators: 					 Baseline 		Target  (1999)
Improved availability of condoms through 			17 million (1990)	60 million                                social marketing programs
         
Increased proportion of men and women 
knowledgeable about AIDS					47% (1993)  		 70%

Increased proportion of AIDS patients 
managed at home without stigmatization
and discrimination						0%  (1997)		 50%     

---

ACTIVITY DATA SHEET

PROGRAM: NIGERIA
TITLE AND NUMBER: Strengthened Civil Society Contribution to Democratic Participation and Civil Rights, 620-SPO2
STATUS:Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: $1,000,000 DA
INITIAL OBLIGATION: FY 1996 ; ESTIMATED COMPLETION DATE: FY 2000

Purpose: To strengthen civil society's contribution to democratic participation and civil rights.

USAID Role and Achievement to Date: The Nigeria Democracy and Governance (DG) Program is in its second year. First-year activities implemented through the Center for Development and Population Activities (CEDPA) and the Johns Hopkins University Population Communication Services Project, were built on the linkages USAID had established with the non-governmental organization (NGO) community through its health programs. Operating at the community as well as the national level, the NGO and pro-democracy groups have emerged as leaders in the struggle for democracy in Nigeria, and look to the U.S. for material and moral support. A small-grants program, managed by the United States Information Agency (USIA) through an inter-agency transfer, and the Embassy-managed Democracy and Human Rights program complement the USAID-managed DG activities and reach a wide range of NGO organizations that address a broad spectrum of DG issues pertinent to restoring democratic rule in Nigeria.

The DG program focuses on promoting popular democratic participation at the community and national levels, as well as on women's political empowerment and respect for fundamental human rights. In the first year of the program 31 small grants were given to partner NGOs and Community-Based Organizations in 14 States in the northern, south-western and south-eastern regions of Nigeria. Through NGO partners, awareness of gender inequalities and fundamental human rights has increased. Women in the target states have been mobilized and sensitized for increased participation in politics and decision making. In addition, the capacity of women journalists to provide effective media coverage to women's empowerment and DG activities has been strengthened. Legal centers for women have been established and para-legal assistants have been trained to run these centers. Media campaigns on DG issues are promoted through print media, radio and television. This has significantly increased the awareness of the public in target states in democracy, human rights and civic responsibilities. The program is estimated to have reached over 30 million women, men and youth.

Description: The current program provides modest technical assistance to NGOs that contribute to strengthening democratic participation and greater respect for human rights in Nigeria. The recipients include private consultant groups, the independent press, pro-democracy opinion leaders and others. The United States Information Agency, the U.S. Embassy and USAID collaborate to identify committed, credible and accountable grantees and to facilitate linkages among the various components of the DG program.

At the end of the first year, a stakeholder's workshop was organized to review the first phase of activities, results achieved, and lessons learned, and to establish guidelines for the second phase. Based on the recommendations of this review, USAID has identified additional stakeholders in other communities to expand the reach of the program and more clearly defined and focused activities for increased impact on political processes in society. A framework has also been developed to accommodate recommendations from the review. The new framework has been divided into three sub-objectives: a) to strengthen the capacity of the NGOs and community-based organizations (CBOs), with special emphasis on institution-building, internal democratic practices, transparency and accountability. b) to politically empower major groups and organizations of civil society, and c) to strengthen networking among NGOs/CBOs and other components of civil society in Nigeria for better advocacy.

The intermediate results identified in the new strategic framework are: an increased number of organizations promoting women's decision- and policy-making skills and empowerment, an increased number of organizations promoting youth's involvement in democratic practices and civic responsibilities, targeted civic organizations engaged in democratic self-governance and civic education, and strengthened and accountable local, state and national democratic institutions. As the country approaches the scheduled hand-over of power from the military to elected civilian government, the DG program will intensify pressure on the Government to keep its promise of a genuine and transparent transition to civil rule.

To further support the transition to democratic rule, USAID will broaden the scope of the DG Program to include conflict resolution, capacity building, sustainability of existing NGOs and networking among NGOs and CBOs within focus states and other areas. In the event of a credible transition to civil rule, USAID will review and redesign its DG Program to accommodate new challenges.

Host Country and Other Donors: Western democracies belonging primarily to the European Union have been active in supporting the pro-democracy groups to restore civilian rule in Nigeria. These countries include Germany, Denmark, the United Kingdom, Sweden, Norway, and Ireland. Most other donors have focused on human rights and made small grants to opposition groups.

Beneficiaries: The People of Nigeria who have been disenfranchised and suffered human rights abuses. Women are specifically targeted in most of the programs.

Principal Contractors, Grantees or Agencies: Center for Development and Population Activities (CEDPA), Johns Hopkins University and USIA. Management Systems International has recently been awarded a contract to provide technical assistance in DG work in Nigeria.

Major Result  Indicators						Baseline		  Target
									 (1997)		  (1999)

 Increased number of NGOs/CBOs participating 		 	      762 		      882
   in USAID-funded  DG activities.	

 Increased number of women leaders/politicians who go 		      450		      980
   through USAID funded public life skills training.

Increased number of women exposed to DG 				445,000		660,000
  sensitization and political awareness activities

Increased number of USAID sponsored legal clinics			           4		         12

Increased number of networking and coalition DG groups working	       226		       665
  on political issues.

Increased number of media NGOs involved in  	                    	           6		         12
  Publicizing  DG  activities.

---

[USAID Home]

[CP 99 Home]