Comparative Assessment of Donor and Domestic Funding Contributions to PMTCT Program Sustainability in Benue State (2015–2021)

Abstract

This study investigated the financial structure and sustainability of PMTCT programs in Benue State by comparing the extent and impact of donor and domestic funding sources from 2015 to 2021, and exploring stakeholder perspectives on long-term viability. Fieldwork was conducted from June to August 2023. Semi-structured interviews were performed with key informants from a diverse range of stakeholders, including facility managers, policymakers, program managers, service providers, donor representatives, and implementing partners. The framework for conceptual analysis was provided by the Primary Healthcare Performance Initiative (PHCPI). Of the $1,194,987 allocated to PMTCT in Benue State between 2015 and 2022, donors contributed $1,135,395.66, amounting to 95% of the total expenditure. Resources rose markedly, nearly doubling from 103,087.18 US Dollars to 200,276.96 US Dollars (Linear Regression (LR): R2 value = 0.6832, P=0.001). Moreover, donor support generated both beneficial and adverse outcomes for the Benue State PMTCT programme. On the positive side, it expanded access to PMTCT services, improved testing coverage and ART initiation for mothers and infants, and lowered MTCT alongside HIV-related mortality and morbidity among mothers and infants. On the negative side, donor aid fostered rising dependence on external resources, failed to adequately strengthen sustainability, and encouraged the growth of a parallel health system with distinct data collection, information management, and supply chain systems. It also intensified internal brain drain by drawing health personnel into HIV-focused roles, leaving heavier workloads for staff in other health programmes. Overall, this study demonstrated a steady increase in PMTCT funding that improved numerous health indicators. However, the heavy reliance on external resources was equally linked with profound and lasting harm to the health system. Since continued dependence on donor support is not sustainable, urgent measures are needed to mitigate risks and design donor exit frameworks and strategies. Proposed solutions should prepare for two scenarios – abrupt and gradual withdrawal of donor financing.