CONSIDERATIONS FOR IMPROVED URBAN HEALTH OUTCOMES IN AFRICANMEGACITIES.

CASE STUDY- THE LAGOS MEGACITY REGION.

WHY LMCR/ AFRICAN MEGACITIES? Africa- fastest urbanizing region of the world Urbanization occurs in advance of an industrial basis

for growth Implications on health especially due to poverty LMCR- Located in Lagos state- smallest state in Nigeria Houses 1/3 of the urban residents of Nigeria Houses 90% of the population of Lagos state-

considered a city-state Largest conglomeration of the black race Projected to be 3rd largest megacity next to Tokyo and

Bombay by 2015 Case study for rapid urbanization especially in the

context of development

Analytical evaluation of progress on social determinants of health in the Lagos megacity region

- Health equity- Transportation- Governance- Food security- Water and sanitation- Safety- Health care- Environment

TRANSPORTATION IN THE CITY Transportation policies Infrastructure- mass transit options- non-motorized transport options- sidewalks, streetlights, traffic signals,

pedestrian and cycle safety,- integrated systems of transport Maintenance

LMCR 71% of traffic congestion – infrastructural

inadequacies Poor maintenance Poor roads Poor traffic planning Lack of integrated transport systems Low road network density High traffic levels- Few roads carry most of the traffic Poorly developed connection between transport and

urban planning` Heavy reliance on motor vehicles Mobility is mostly road based Poor parking, streetlights, and pedestrian facilities

HEALTH IMPLICATIONS

Poor quality of life- increased stress and time in commuting

Poor development- reduced productivity Increased incidence and risk of accidents Sub optimal physical activity level High incidence of accidents Poor air quality due to high traffic and poor quality

of cars- poor environmental and respiratory health Poverty- 20% of household budgets spent on

transport by the urban poor Use of healthy transportation options like cycling

and walking unsafe and impracticable

ACHIEVEMENTS Lagos Metropolitan Area

Transport authority (LAMATA) (2003)

Road expansion Bus rapid lite transport

system (BRT-lite) - improved mobility

along corridors - reduced congestion - reduced travel and

waiting time - reduced emissions - reduced stress

TO DO Increasing diversification of transport options Shift from mainly road based to water, railway, etc Need to integrate means of transport Expand coverage of the BRT-lite Choice of healthy transport options

functional and maintained streetlights, traffic signs, sidewalks, bike lanes, etc

Effects Reduced emissions- better air quality Reduced risk of accidents Reduced traffic congestion- improved well being Increased physical activity

GOVERNANCE IN LMCR Lagos state- 20 Local government areas- 57

administrative units- LCDAs 20 of 16 LGAs- LMCR Governance mediates translation of policies

to development at the grassroots Therefore LGAs impact provision of social

determinants of health

CHALLENGES 1. Role conflict between multiple governance

instrumentse.g. Downstream oil regulation Department of Petroleum Resources, National Oil Spill

Detection and Response Agency, Lagos State Environmental Agency, Federal Ministry of Environment, National Environmental Standards and Regulation Enforcement Agency, Nigerian Maritime Administration and Safety Agency, Nigerian Ports Authority

inefficiency and diffusion of responsibility

Need for strategic framework for intersectoral collaboration

CHALLENGES 2. Constitutional ambiguities Item 17 in concurrent legislative list- right to make laws on health safety and

welfare – national assembly Item 19 in concurrent legislative list of

constitution of FRN- right to make laws on health safety and

welfare - state assemblies conflict in delivering social determinants of

health between agencies with similar mandates

CHALLENGES 3. Need for improved monitoring and

accountability Govt policies↔ Local Govt ↔Grassroots development Poor accountability abandoned contractsoverestimation of project costs poor infrastructure- roads, health services, potable water

THANK YOU!

Questions?