ACOMIN, Global Fund Launch Community-Led Monitoring in Kaduna

From Femi Oyelola, Kaduna

Civil Society in Malaria Control, Immunization, and Nutrition (ACOMIN), with support from the Global Fund, has increased efforts to improve the continuum of care for HIV/AIDS, Tuberculosis, and Malaria (ATM) in Kaduna State through a Community-Led Monitoring (CLM) project that prioritizes citizen accountability.

According to a brief signed by Ogidi Niccodemus, the State Program Officer of ACOMIN, the initiative aims to tackle ongoing barriers that prevent communities from accessing prevention, testing, treatment, referral, and follow-up services, despite notable progress made by the government and development partners.

The brief states that although Nigeria has made advances through deploying health workers, upgrading facilities, and supplying essential medicines, many communities still experience gaps in the ATM care continuum. Data from ACOMIN’s CLM indicate that weak referral systems, treatment disruptions, shortages of trained health personnel, inadequate facility resources, and economic pressures continue to hamper health outcomes.

Weak referral systems, the report highlights, obstruct timely access to appropriate care. For instance, some patients diagnosed with TB or HIV are not properly connected to treatment centers, which leads to delays in starting treatment. Primary Healthcare Centers (PHCs) unable to handle severe malaria cases are often not linked to secondary facilities for referrals, leaving patients without necessary care.

Treatment disruptions pose another major challenge. The brief notes that rising transportation costs compel some patients to skip clinic appointments, resulting in missed doses and poorer health outcomes. Stock-outs of drugs and interruptions in directly observed treatment for TB contribute to defaulting on treatment and the development of drug resistance. Similar issues affect HIV and malaria care, with many patients lost to follow-up.

The CLM also identified shortages of trained healthcare workers as a significant obstacle. Staff at PHCs often juggle multiple roles, including screening, testing, counseling, dispensing medications, and record-keeping, which can cause long waiting times and lower care quality. Rural facilities are especially impacted, lacking personnel trained to manage complex HIV cases or monitor treatment failures.

Inadequate facility resources further hinder service delivery. Many clinics face shortages of test kits and medicines for HIV, TB, and malaria. Limited access to functioning diagnostic tools, such as GeneXpert machines, means patients often travel long distances for testing. Frequent stock-outs of rapid diagnostic test kits and antimalarial drugs hinder prompt diagnosis and treatment, allowing infections to go undetected.

Economic pressures worsen these issues. The brief explains that indirect costs such as transportation, lost wages, and feeding expenses discourage patients from completing treatment even when HIV, TB, and malaria medications are free. For daily wage earners, attending clinic appointments often means losing income, leading them to prioritize food and family expenses over health care.

To bridge these gaps, ACOMIN’s CLM, supported by the Global Fund, empowers communities to identify barriers, produce evidence, engage policymakers, and advocate for timely solutions. The approach emphasizes availability, accessibility, acceptability, affordability, and quality of care to enhance accountability and boost service uptake in Kaduna.

Notably, the CLM has helped mobilize domestic resources and foster community ownership. Contributions include financial support, renovation of health facilities, borehole installation, provision of hospital beds, gloves, blood pressure monitors, malaria medicines, test kits, and human resources such as security personnel, volunteers, and cleaners. The initiative has also strengthened referral pathways and improved responsiveness from health facilities and authorities.

Despite these successes, the brief emphasizes that communities still face challenges related to the availability, accessibility, affordability, and quality of care. ACOMIN calls for collective efforts and accountability from government at all levels, development partners, the private sector, philanthropists, community stakeholders, media, and health workers.

“We call on all stakeholders to strengthen referral systems, ensure uninterrupted access to essential medications and diagnostics, invest in healthcare workforce development, expand community-based screening services, and reduce financial barriers to healthcare,” Ogidi Niccodemus stated. He added that these actions are vital to closing gaps in the HIV/AIDS, TB, and malaria care continuum and achieving better health outcomes for all Nigerians.

The brief concludes by asserting that fighting HIV, TB, and malaria as public health threats requires resilient, accessible, and functional health systems that put communities at the heart of service delivery. Through partnerships, accountability, domestic resource mobilization, and ongoing community engagement, Nigeria can develop a more responsive health system that leaves no one behind.