Reducing Health Disparities in Lagos

(An Investment Case)

by

Dr. Jide Idris

Commissioner of Health

April 24, 2012

Introduction

Minister’s presentationRole of Health - an economic driver - a development tool - a security issueHuman Resource – People - changes to assure PATH / role of healthActivities of Government – huge investment in healthChallenges still facedDocument – advocacy tool to mobilize resources for

health

Background

Poor performance on some health indicators Impact level change in health requires at least 8-10 years

of investmentNeed 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

Challenges

Rapid and still increasing population growth. Infrastructure for Health still inadequate Inadequate health budgetGross 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).

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

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-based care : families and

community-based agents can undertake themselves.

Data entry, quality checks, group discussions and consensus building meetings on data gaps

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

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:1)Decrease under-five mortality rates by 50%.2)Reduce maternal mortality by 33%.3)Significantly decrease the impact of HIV/AIDS,

tuberculosis and malaria.4)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%.

5)Reduce the disparities in health between the rich and the poor.

Levels of Financing RequiredTable 8

Service delivery modes x Investment/Recurrent 2012 2013 2014 2015 2016 2017 2018 2019 20201. Family oriented community based services 44,178 78,943 113,721 137,939 155,857 173,789 197,966 211,952 225,971

Capital investment 9,375 9,337 9,311 15,573 15,536 15,510 25,603 25,504 25,438 Recurrent 34,803 69,606 104,409 122,366 140,322 158,278 172,363 186,448 200,533

2. Population oriented schedulable services 31,988 46,242 62,123 77,649 76,598 77,494 94,094 88,487 85,356 Capital investment 12,250 6,968 3,447 13,567 7,316 3,149 17,438 9,685 4,516 Recurrent 19,738 39,274 58,676 64,082 69,282 74,345 76,656 78,803 80,841

3. Individual oriented clinical services 81,848 78,272 83,350 87,050 85,744 85,979 97,210 93,128 90,479 Capital investment 58,149 31,312 13,422 12,262 6,610 2,841 12,605 7,473 4,052 Recurrent 23,699 46,960 69,928 74,788 79,134 83,138 84,605 85,654 86,427

District, provincial and national governance and management 15,371 28,646 42,088 48,186 52,979 57,920 67,923 73,775 80,073 Capital investment 1,349 684 241 1,016 514 179 2,871 1,451 504 Recurrent 14,022 27,962 41,847 47,170 52,465 57,741 65,052 72,324 79,569

Total 173,384 232,103 301,281 350,824 371,179 395,182 457,193 467,342 481,879 Capital investment 81,122 48,301 26,421 42,418 29,975 21,680 58,518 44,112 34,509 Recurrent 92,262 183,802 274,860 308,406 341,204 373,502 398,676 423,229 447,370

1. Family oriented community based services 2.0 3.6 5.0 6.0 6.6 7.2 8.1 8.5 9.0 2. Population oriented schedulable services 1.5 2.1 2.7 3.4 3.2 3.2 3.8 3.6 3.4 3. Individual oriented clinical services 3.8 3.5 3.7 3.8 3.6 3.6 4.0 3.7 3.6 District, provincial and national governance and management 0.7 1.3 1.9 2.1 2.2 2.4 2.8 3.0 3.2

Per capita 7.95 10.44 13.29 15.15 15.75 16.47 18.67 18.80 19.09

Investment in USD/ per capita

2012 - 2014 2015 - 2017 2018 - 2020

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 HealthResource 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.

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).

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,

Thank You All For Listening

Eko o ni Baje o