Speeches

2008 Public Health Lecture

Aug 6, 2008 - It is a pleasure for me to be here in your midst at the occasion of this lecture culminating the 2008 Public Week celebration. I have been informed that Public Health is not just the science, but also the art of improving the population's health through organized efforts of the society using the techniques of disease prevention, health protection and health promotion. A major attraction, especially to responsible and responsive political leaders, is its ability to improve the health and well-being of people in local communities and across the nation, especially the less privileged. This becomes more so in Lagos State considering our population, the diversity of the people and the various challenges faced.

The dramatic achievements of Public Health in the 20th Century have improved the quality of life, even as manifested in an increase in life expectancy, worldwide reduction in infant and child mortality, and elimination or reduction of many communicable diseases in many countries of the world. This may not be so in this part of the world. Today and into the 21st Century, Public Health leaders –many of the very best in the country who are gathered here today– must strengthen their roles and advocate for improved population-based health delivery in an international global community, but more importantly in our country.

A cursory look at the impact of Public Health in the nation building experience of the United States of America is instructive. Since 1900, the average life expectancy for Americans increased by about 30 years. Over 25 of the 30 years can be accredited to Public Health initiatives, while medical advances account for less than 4 years. Yet over 80 percent of health expenditure is being devoted to curative medicine (infrastructure and equipment such as CT Scan, MRI, etc.) and less than 20 percent on Public Health issues. The cost-effectiveness of Public Health initiatives and interventions is, therefore, not in doubt.

It is against this background that I fully identify with the 2008 Public Health Week celebration with the theme: ‘Your Health, My Health, Our Responsibility, organized by the State Ministry of Health, which ends with today's Public Health Lecture: Your Health, My Health, Our Responsibility.

The choice of today's lecture topic i.e. "Peculiar Diseases and Health Conditions in Nigerians: We Shall Overcome Them and We Must Overcome Them" is very apt. This is more so as all of us in Lagos State, working together, flint-faced, are over-comers even as we shall overcome these peculiar diseases and health conditions. The reputation of the guest lecturer - Prof. O. O. Hunponu-Wusu, as an international Professor Emeritus in Public Health is not in doubt. From his inspiring lecture, you will all agree with me that he has done justice to the topic to the extent that we have all been further enriched.

As you are all aware, Public Health initiatives are best implemented within the framework of the Primary Health Care (PHC) system. By way of government policy and in concert with Local Government Administration in the State, efforts are being intensified in revitalizing the Primary HealthCare system. The government has rolled out a policy of at least one PHC Center per ward to be implemented in phases. Upgrading of infrastructure, in collaboration with development partners, is currently going on. A prototype PHC building and equipment schedule has been developed for standardization and replication. Priority is being given to underserved areas and focus is on the rehabilitation of existing facilities and construction of new ones where necessary. Also, a minimum package of services to be offered has been developed with the provision of preventive services and health information as the focus.

Government will continue to invest in the human resources for health by recruiting appropriate personnel and training of all cadres at all the 3 levels of care. The referral system is being strengthened and each one of the LGAs/LCDAs now has an ambulance to complement the Lagos State Ambulance Service (LASAMBUS). Our concern for maternal and child health informed our establishment of the 5 Maternal and Child Care Centres in Ikorodu, Surulere, Amuwo Odofin, Isolo and Ifako-Ijaiye, as part of our global plan to address this issue of unacceptably high maternal mortality rate. These 100 bed centres will be ready, fully staffed and fully equipped by the end of this year. They will serve as referral centres and will surely assist in the reduction of maternal, infant and child morbidity and mortality in the State.

Just last month, our Community-Based Health Insurance Scheme - the Ikosi-Isheri Mutual Health Plan was launched at the Olowoira PHC - on a pilot basis, essentially to improve access to health care especially by our indigent populace. The Lagos State managed scheme is also being packaged to target especially the formal sector.

Still, this government will continue to improve on the implementation of our people-oriented programmes with public health flavour. These include Roll Back Malaria, Immunization program, HIV/AIDS and TB Control, Reproductive Health, the School Health Programmes, Integrated Management of Childhood Illnesses (IMCI), Avian Influenza (Bird Flu) Control, and our Free Health Programmes.

Our Special Programmes include Free Screening for Hypertension and Diabetes, Free Screening for Breast, Cervical and Prostate Cancers, the Blindness Prevention Programmes, Limb Deformity Corrective Surgery and Rehabilitation Programmes, the Cleft Lip and Palate Reconstructive Surgery Program, State Environmental Health Monitoring Unit (SEHMU), the Adolescent Reproductive Health and Youth Empowerment Program (Hello Lagos), our periodic medical and surgical missions which have been fortified with the procurement of mobile medical and dental clinics, and of course our ambulance service (LASAMBUS) whose fleet has also recently been increased

In furtherance of these initiatives, the State government will continue to devote enormous resources to the following:

TRAINING
Apart from various professional and management courses organized by the Ministry of Health, the government in the last couple of years trained 1,965 health workers at the three levels of health care in Integrated Management of Childhood Illnesses (IMCI), Safe Motherhood, Roll Back Malaria, HIV/AIDS, Good Laboratory Practices, Drug Management, etc. The training and retraining of doctors and nurses in Emergency Obstetric Care has commenced and will be expanded to all other tiers of care.

E-HEALTH
Realizing the importance of information and communication technology and the need to improve and increase access to medical records by medical personnel across the State, the Ministry of Health, in collaboration with the Ministry of Science and Technology, has embarked on the e-health project. The pilot project is based in three health facilities i.e. LASUTH, Ikeja; General Hospital Lagos and General Hospital, Isolo. Installation of the hardware systems including servers with appropriate software, computers, scanners, radio, etc. is in various stages of completion. This would ensure that all points that have the system can access the software. Training and retraining of personnel would follow. Also, the second phase of the project involving additional 10 designated hospitals has been budgeted for in the 2008 appropriation bill. This will ensure that patients' medical history can be accessed easily and assist in better case management. But more importantly, the use of this technology must be in the field of health education at all levels, not only in making the knowledge of specialists available to everyone, but also educating our future health professionals.

IMPACT OF OTHER SECTORS ON HEALTH
Considering the wide scope of public health, a major strategy in the implementation of our Public Health initiatives is the Sector Wide Approach (SWAP). This is essentially because other sectors as you all are aware, impact on public health outcomes as evidenced below:

Largely, public health has its developmental roots in the identification and control of environmental health threats. Our operation green exercise, aimed at restoring the aesthetics of Lagos, has gone full stream. A collateral advantage is the long-term improvement in the ozone layer and attendant reduction in skin cancers that have of recent assumed public health significance. Our efforts in deflooding our drains and improving environmental sanitation also have the potentials of reducing the incidence of malaria as the breeding sites of mosquitoes are being simultaneously eliminated.

On disaster management, the Lagos State Emergency Management Agency (LASEMA) responds to disaster situations immediately and mobilizes all stakeholders so that the effects are minimized. The emergency preparedness of our LASAMBUS, LASEMS and indeed all our hospitals have ensured that loss of lives is minimized and disease outbreaks are contained effectively in these situations. Government is now in the process of reorganizing and integrating disaster management into the PHC system and also introducing it at community level. Training, being a major component of this programme will now involve personnel drawn from different agencies of government and the communities at the grass roots. These will be trained in Basic life support as fires responders, while our health workers also drawn from the three tiers will be trained in basic and advanced trauma care etc.

With respect to the Eko Meat Van, the transport of meat from the abattoir to the meat market in a hygienic condition, through the introduction of the Eko Meat Van, will ensure that wholesome meat reaches the consumers and thus prevent food-borne diseases.

The recently revised Lagos State Coroner's System Law has as one of its major objectives the respect for the sanctity of human life. An anticipated consequence of the law is improved healthcare services rendered by medical and allied health workers, with attendant improvement in the quality of life and increased life expectancy.

On transportation, improvement in traffic management will reduce stress and in turn reduce the incidence of high blood pressure with its dire consequences. The introduction of the BRT system will further reduce stress on commuters.

Our youths are being organized into the Street Soccer Programmes and are thus positively and productively engaged. This will ensure that they have 'a sound mind in a sound body' as apart from the physical exercise, they will be prevented from engaging in risky behaviours and practices that damage their health.

Government is equally committed to providing affordable housing and reducing poverty. Success of the programmes aimed at achieving these will ensure that families can afford the basic needs of life and shelter. These have direct impact on the health of the families.

Distinguished Guests, Ladies and Gentlemen, I wish to assure you that the Lagos State Government will continue to support Public Health activities in view of their cost-effectiveness and the opportunity they afford to rapidly achieve the health-MDGs 3, 4 and 5 i.e. reduction of infant/child mortality, improving maternal health, and combating HIV/AIDS, malaria and other endemic diseases. No doubt these constitute over 70 percent of the state's burden of disease.

Public health also involves engaging people. And considering the peculiarities of Lagos State and the numerous challenges of infrastructure, the huge population we need to cater for, the poverty level, I wish to charge you professionals here to come up with more innovative ways to addressing these challenges.

Finally, I commend the Ministry of Health and the organizing committee of the 2008 Public Health Week for their efforts in increasing the awareness of policy makers, relevant stakeholders in health (health managers, NGOs, corporate bodies, students) and indeed the general public on topical health issues of public health significance. With all our efforts, we believe that our promise to deliver quality, preventive and proactive healthcare services to Lagosians have started yielding fruits.

I thank you all for listening.

EKO O NI BAJE O!

BABATUNDE RAJI FASHOLA (SAN)
GOVERNOR OF LAGOS STATE