Last year a Nigerian team of HIV/AIDS experts performed what many thought to be a miracle: they submitted a well-designed, thoughtfully written, and locally developed proposal to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The objective was to take successful pilot projects--including a nascent national anti-retroviral therapy (ARV) program--and expand them to cover thousands of patients.
Dr. Suritiri Fola, one of a handful of AIDS experts in Nigeria's Federal Ministry of Health, was, at age 32, directing the national ARV program. Dr. Fola was expert at doing a lot with a little. His constraints were overwhelming: antiquated technology, deteriorating or non-existent physical infrastructure, and an anachronistic health bureaucracy. To compose Nigeria's ARV proposal, he typed on a creaky old computer on loan from a colleague.
Fola had minimal support from colleagues to overcome the obstacles and frustrations he faced daily. Yet the Global Fund approved his proposal without reservation, and it committed to backing his efforts with $18 million over the next two years. For the first time, he would have sufficient staff, medicines, and training to put thousands on ARV therapy.
Even so, Fola's ideal plan will reach only a small portion of those who need therapy.