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Primary health care for all - Lagos State Government launches a ground breaking investment case: Nigeria’s megacity shines a light on the doable and affordable

© UNICEF Nigeria/2012
Mr. David Gressly, Regional Director, UNICEF WCARO, Her Excellency Mrs. Adejoke O Adefulire, Deputy Governor Lagos State, Dr. Suomi Sakai, Country Representative UNICEF, Dr. Jide Idris, Comm. of Health, Mrs. Sara Beysolow-Nyanti, Chief of UNICEF Lagos

Lagos, Nigeria, March 2012 - Last month, Lagos state government launched a ground breaking investment case which demonstrates the good economic sense in securing quality, affordable primary health services for every child, woman and man in Lagos.

The investment case – Reducing Disparities in Health Care in Lagos State - seeks to extend coverage of essential health services to all citizens, including to previously unreached areas. The case demonstrates that with an average investment of USD15 per capita per year, by 2020, Lagos could have reduced child mortality by 50% and maternal mortality by 30%. It would also reverse the HIV epidemic; with a 22% decrease in the number of new cases, and a corresponding decrease in the total number of persons living with HIV by 23%.

The Governor of Lagos State, Mr. Babatunde Fashola, noted that an investment case for health was appropriate because it also ‘tackles the non-financial obstacles that have limited our capacity to deliver health services, especially to those living on the peripheries among us. Therein lies the spirit of social justice and national security.’

Population size, growth and movements could make universal primary health coverage seem an impossible target for a megacity like Lagos. According to UNDESA, the city is home to ten million people, but this is a hotly contested number. The Lagos State Bureau of Statistics records the 2012 population at 20.5 million people.

However, the Lagos investment case posits that with the right partnerships in place and investments that are properly targeted at the right levels in the city’s health system and infrastructure, an essential package of primary health services can be delivered to all of its growing population, including an estimated 100 plus informal settlements in the greater Lagos metropolis.

© UNICEF Nigeria/ 2012
Her Excellency Mrs. Adejoke Oorelope Adefulire, Lagos State Deputy Governor launching the investment case document.

The Lagos Investment case is a strategy for change’, said UNICEF Regional Director of West and Central Africa, Mr. David Gressly who has previously lived in Lagos for a stretch of six years. ‘With carefully planned primary health care that provides facilities and trained personnel at a decentralized local level, Lagos will lead the way for other African cities in how to reduce chronic inequalities’, he said, pointing out that the city was on the right track to becoming a ‘model African megacity.’

Through its Lagos field office, the Nigeria country office in Abuja, and the Regional Office for West and Central Africa in Dakar, UNICEF has supported the investment case from conception to publication and will continue to accompany its implementation and Lagosians in their quest to attain quality, affordable primary health care for all.

Dr. Suomi Sakai, Representative of UNICEF Nigeria and a long-serving public health professional, stated that ‘the partnerships within government at state level and at the local government level, with the private sector and the communities’ as another reason why the investment case could be an example to other states of Nigeria and other African countries.

Chief of UNICEF Lagos Field Office, Mrs. Sara Beysolow-Nyanti, emphasized that the next steps would be of ‘paramount importance for Lagos’. In fact, the investment case is fact gaining traction as Lagos State Government has decided on the following, crucial steps to leverage the health investment case: presentation at an upcoming Lagos State Economic Summit; engagement of the private sector on their role and next steps; and presentation to the Federal Budget Appropriations Committee.

The Lagos State Investment case is the first urban inequity study in Nigeria (and possibly in Africa); and it addresses the inequities not only in the access to care, but also disparities within the health system such as skewed investments. For example, the research highlighted the fact that significantly more investments are made at the tertiary level of care, while the primary health care level - where many more lives could be saved - is under-supported. Curiously, the investment case also states that there are sufficient numbers of health care personnel in Lagos state - uncommon in many similar contexts in Africa - but points to an uneven distribution of health workers among the various levels of care. It is a key undertaking to understand and seek responses to the challenges faced by the urban poor, in Lagos and elsewhere.



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