Reducing Health Disparities in Lagos (An Investment Case) by Dr. Jide Idris

1. Reducing Health Disparities in Lagos (An Investment Case) byDr. Jide Idris Commissioner of Health April 24, 2012

2. Introduction • Minister’s presentation • Role of Health - an economic driver - a development tool - a security issue • Human Resource – People - changes to assure PATH / role of health • Activities of Government – huge investment in health • Challenges still faced • Document – advocacy tool to mobilize resources for health

3. Background • Poor performance on some health indicators • Impact level change in health requires at least 8-10 years of investment • Need to meet the MDGs • Indicators where we are performing well, there is an unacceptably large gap between the richest wealth quintile and the poorest • Key bottlenecks in the health system at household, community and state levels preventing access to quality healthcare • Being a progressive government, we saw the need to develop an evidence-based budget and plan which goes beyond zero-budgeting to look at marginal costs required to remove bottlenecks to access to health in Lagos

4. Challenges • Rapid and still increasing population growth. • Infrastructure for Health still inadequate • Inadequate health budget • Gross disparities across the Local Government Areas and communities-even with critical shortage of Health Care Personnel • Burden of disease, ill health and malnutrition are concentrated in the most excluded and deprived sector of the population • Providing these groups with essential package of care (IMNCH) will not only help reduce observed disparities in the state health system but also facilitate progress towards the attainment of the health-related Millennium Development Goals (MDGs).

5. Justification for Investment Case • Better health reduces the financial cost of healthcare for the family and the State • Healthy citizens are more productive and contribute to the economic development of the State (PATH) • The security of the state and the country also hinges on poverty reduction, but there can be no poverty reduction without improvements in health • Sustainable development is impossible without a healthy population. E.g. People dying of AIDS or cancer will not be able to teach, build roads or improve our IT systems. • An Investment Case for Health with focus on equity is an essential evidence-based advocacy tool for leveraging and mobilizing resources for effective improvement of the health care system by government, partners, private sector and the community

6. Process (1) • Assessment of constraints along 3 service-delivery modes: - Individually-oriented clinical services; - Population-oriented, schedulable services or outreached in communities; - Family- and community-basedcare : families and community-based agents can undertake themselves. • Data entry, quality checks, group discussions and consensus building meetings on data gaps

7. Process (2) • Comprehensive bottleneck analysis workshop for stakeholders and partners • Marginal Budgeting for Bottlenecks tool was applied with Lagos State data • Community involvement and participation : sharing of outcome of entire process with selected community members from 3 LGAs – Eti Osa, Ikorodu and Badagry (one each from the 3 senatorial districts of the State) • Document launched by HEG on Mar 16, 2012

8. Results of the Cost and Impact Modeling • An additional investment equal to an average of 15 USD per capita per year required. The initial investment would rise progressively, from 8 USD in 2012 to 19 USD in 2020. • By 2020, the proposed investment would: • Decrease under-five mortality rates by 50%. • Reduce maternal mortality by 33%. • Significantly decrease the impact of HIV/AIDS, tuberculosis and malaria. • Reverse the HIV/AIDS epidemic by decreasing the number of new cases by 22%, and lowering the total number of persons living with HIV (prevalence) by 23%. • Reduce the disparities in health between the rich and the poor.

9. Levels of Financing Required

10. Next Steps (1) • Advocacy with Federal Government for increased allocation to Lagos state using the evidence generated in the investment case • Need for dissemination to the Budget Appropriations Committee and Senate Committee on Health • Resource mobilization strategy to allow partners and private sectors key into Partnerships with the Government in the Areas of: - Infrastructure - Primary Health Care - Proactive outreach programs to the underserved, hard-to-reach areas through the provision of means of transportation i.e Life boats, ambulance boats etc.

11. Next Steps (2) • Strengthening of existing campaigns for MNCH e.g. provision of Family Planning Commodities, Mama Kits, LLINs, HIV Test Kits, • Capacity building on IMCI, ENCC, LSS, EmONC, PHC Review Methodology, etc • Support the establishment of the State Health Insurance Scheme to bridge financial barriers especially to the poor - Govt has commenced CBHI in 2 LGAs (need for scale-up).

12. Next Steps (3) • Bringing Community to Health: by Revitalizing the role of WHCs through a provision of motorcycles to all LGAs. • Addressing the problem of Quality of care - Align Lagos health services to international standards through capacity building of entire workforce, protocols, job-aids, etc • Strengthen e-Health: computerization of records, m-Health etc. to serve as hot lines for emergencies especially to underserved areas,

13. Thank You All For Listening Eko o niBaje o