In 2022, HRI partnered with Henry Okiwu, who used an HRI tool to assess the landscape for increasing domestic financing for harm reduction in Nigeria. This report outlines the process used and the findings that emerged, covering the operational landscape for community-led, community-based and civil society organisations and the financial landscape for harm reduction. It maps advocacy opportunities and partnerships and makes key recommendations for increasing the domestic harm reduction financing.

• The Nigeria Drug Law Enforcement Agency Act (NDLEA Act 1989) criminalises the use of cocaine, LSD, heroin and other drugs and stipulates prison sentences of 15-25 years for drug-related offences including drug use, possession, and trafficking.
• The Nigeria Constitution provides the legal framework for individuals to access health services as a fundamental human right, and empowers non-governmental organisations (NGOs) in Nigeria to provide these health services.
• In Nigeria, the mechanism for social contracting includes grants, procurement, and contracting guided by a legal framework that includes the Health Policy Act 2007, the Financial Act 2020, and the Public Procurement Act. However, there is no social contracting between the government and civil society organisations within the HIV response.
• Harm reduction programmes are situated within the HIV response. The National HIV and AIDS Strategic Plan (NSP 2017 – 2021) is structured into five thematic areas that address cross-cutting issues including harm reduction.
• Harm reduction is not included within the National Health Insurance Scheme (NHIS)
• The HIV response in Nigeria is largely dependent on international donors, with PEPFAR and the Global Fund accounting for 67% and 15% of HIV funding.
• Reported HIV related expenditure was USD 532.4 million in 2018; however only 2% was spent on key populations programming.
• The federal government of Nigeria approved the implementation of core harm reduction services (needle syringe programmes, methadone maintenance therapy, and naloxone) in 2019. This was followed with the implementation of a pilot needle and syringe programme in four states between 2020 and 2021 funded by the Global Fund, OSF and ViiV.
• There is no identified domestic harm reduction funding and no government commitment in this regard. The National Drug Control Master Plan (NDCMP 2021-2025), which includes harm reduction as a strategic pillar, has not yet been operationalised.

• Government should prioritise and commit funding for harm reduction programmes in Nigeria;
• Government should improve social accountability mechanisms that will support the delivery of harm reduction services;
• Government should integrate harm reduction services into health insurance and ensure the inclusion of people who use drugs into Universal Health Coverage efforts;
• Technical partners should strengthen the capacity of civil society to advocate for increased domestic funding of harm reduction services;
• Donors should increase funding for harm reduction programmes;
• Civil society should document evidence from current harm reduction impact (with support from donors) to advance advocacy for increased domestic funding of harm reduction programmes;
• Civil society should explore opportunities within National Strategic Plan development and Global Fund GC7 processes to prioritise harm reduction programmes for government funding and to strengthen partnerships for implementation of harm reduction programmes
• Civil society should push for integration of harm reduction into ongoing community-led monitoring of HIV programmes and produce periodic monitoring reports.