Abstract / Summary
Abstract Background Nigeria has one of the largest HIV burdens globally, yet 70–90% of its HIV financing comes from external donors. Repeated financing shocks, including the 2009–2010 Global Fund suspension, the 2015–2016 fiscal crisis, and the 2025 PEPFAR stop-work order have exposed the country's persistent challenges to build financing resilience. This paper asks: What political economy conditions have limited Nigeria's ability to convert repeated shocks into durable HIV financing reforms? Methods We conducted a qualitative document analysis of 15 Nigeria-specific sources, comprising peer-reviewed articles, institutional reports, and grey literature (2005–2026). An integrated political economy framework guided the directed content analysis: Sparkes et al.'s actor analysis provided the political economy lens, while Blanchet et al.'s resilience typology (absorptive, adaptive, transformative) provided the conceptualisation of resilience capacities Findings Donor funding enabled major service expansions but entrenched three structural vulnerabilities: financial dependence (persistent failure to meet Abuja 15% budget target), institutional fragmentation (parallel coordinating bodies with overlapping mandates), and human resource distortion (internal brain drain). Bureaucratic resistance to decentralisation and erratic domestic budget release constrained implementation. Political leadership was episodic, failing to sustain attention across administrations. Adaptive resilience was evident, including Lagos State's HIV social health insurance integration (90% PLHIV enrolment), but absorptive resilience remained severely limited, and transformative capacity has not been achieved at scale. Key populations face criminalisation and receive disproportionately little funding. Impact For policymakers, strengthening domestic budget execution matters more than designing new adaptive strategies. For donors, parallel financing structures undermine long‑term sustainability. For other Low and Middle‑Income Countries (LMICs), the framework offers a diagnostic tool to assess resilience capacities before donor transitions occur. Conclusion Resilience capacities are politically produced outcomes, not merely technical properties. Without structural reforms addressing bureaucratic incentives, electoral cycles, and parallel donor‑funded institutions, future shocks will continue to provoke reactive fixes rather than systemic change.