By Segun Oyegbemile.
ASIWAJU Bola Tinubu is a Nigerian politician and national leader of the All Progressive Congress. He was Lagos State Governor between 1999 and 2007.
Today, he bestrides the political firmament of the entire nation and beyond; leading a nationwide tendency of progressive proteges who have set landmark records in public service.
“Power is transient”, they say, but except inevitable death, he has broken the jinx with his exceptional democratic qualities more than two decades after he joined politics. No wonder, he stands tall above his contemporaries.
Upon assumption of office, he focussed on the health of the people.
His projects and programmes touched all aspects of health- HIV/AIDS, malaria, tuberculosis/leprosy, avian influenza, blindness, diarrhoea and Respiratory infections.
Emergency services, routine immunization services. School health programmes and other nutrition-related programmes received the necessary attention.
POLICIES/PLANS/PROGRAMMES
Policies, programmes and projects were developed to address major public health issues such as maternal and child health, financial protection to the poor, health, security, quality of care, access and the general empowerment of the residents. These include:
-Limb Deformity Corrective Surgery and Rehabilitation Programmes
-Cleft Lip and Palate Surgery
-Breast Cancer screening and surgery. Etc.
A few of the admirable legacies of the titan are:
FREE HEALTH SCHEME
The first of the cardinal health policy thrusts of the administration was the free community-based primary healthcare services. The scheme was in existence before 1999 but limited in scope. The Tinubu administration approved its expansion to cover.
*Free treatment of malaria (extended to LGAs)
*Free treatment of children aged 12years and below
* Free treatment of adults aged 60 years and above. Etc.
HIV/AIDS CONTROL
Given the multisectoral approach necessary for the HIV/AIDS Prevention and Control and the importance attached to it during his administration, the Lagos State Action Committee on AIDS (LSACA) was established under the office of the Governor in 2000, with the Ministry of Health constituting a major player/collaborator.
At the inception of Governor Tinubu’s Administration, the generalized epidemic of HIV was at a prevalence of 6.7% in the state. There were a few HIV testing centres and no coordinated response at the state level. There was a lack of responsiveness to persons living with HIV/AIDS, PLWHAs and their human rights.
Most of these issues were addressed before the end of ASIWAJU’s administration; one landmark achievement amongst others is the HIV prevalence reduction from 6.7% in 1999 to 3.5%. In 2007.
ADOLESCENT AND YOUTH EMPOWERMENT
The Hello Lagos program was created by the Ministry of health in the yar 2002 under the administration to cater for the services of adolescents who make up about a third of the population. With 13% of the youths being sexually active and with the attendant risk of transmitting STIs including HIV/AIDS, Hello Lagos provide a helpline and saved many teens from trouble.
Furthermore, incidences of procurement of illegal abortion and the rise in teenage pregnancy caused the government to innovate by setting up school programmes to accommodate drop-outs and put them back on track.
ROLL BACK MALARIA PROGRAMME
Malaria remains a major public health issue and is responsible for 50-70% of out-patient visits, 15% of hospitals admissions and 20-30% of deaths in children and pregnant women. Under Tinubu’s government, the State governments commitment to efforts at controlling Malaria through the Roll Back Malaria programme resulted in the adoption of strategies such as public enlightenment, prompt diagnosis and treatment, vector and environmental control, etc.
The frequent and inadequate supply of anti-malarial drugs in pharmacies and Primary health centres and the fact that 50% of uncomplicated malaria cases were being attended to at secondary health facilities led to the establishment of the Eko Free Malaria Programme during his first term.
TUBERCULOSIS CONTROL
The tuberculosis control programme on the ground in 1999 was rudimentary and was not DOTS compliant
. There were inadequate and ineffective AFB diagnostic units and the programme was poorly funded and managed. This led to a significant increase in drug-resistant TB cases and the increasing coexistence of Tuberculosis and HIV/AIDS compounded the problems making tuberculosis control a major public health issue. On this note, Governor Tinubu adopted the DOTS strategy in 2003 and improved detection and cure rates. As of May 2007, when he successfully finishes his second tenure, the cure rate was 66%.
AVIAH INFLUENZA (Bird FLU CONTROL PROGRAMME
Aviah influenza was not an issue at the inception of the administrator. The bird flu was first reported in February 2006. Following the first and only human case of bird flu recorded in the year 2006, the government set up a rapid response team and a technical inter-ministerial committee to engage in active surveillance of bird flu.
Sensitization seminars of health workers in the state, Intensive awareness campaigns, procurement of personal equipment were a few of the measures put in place to combat and successfully terminate the disease.
BLINDNESS PREVENTION PROGRAMME
Convinced that one of the basic ways to fight poverty was to heal and empower the disabled, the Bola Tinubu administration initiated the Blindness Prevention Programme.
Using the accepted assumption of 1% blindness prevalence in Nigeria and given the population of Lagos State, the blindness prevention programme was initiated in the year 2000 to reduce the prevalence of preventable blindness through the strategy of distribution of free eyeglasses based on results of screening exercise and provision of free eye surgery if corrective.
This led to the first Jigi Bola, (Bola’s Eyeglasses)/presentation.
The administration consolidated this by upgrading the Eye Clinic Complex at LASUTH Ikeja to the Eye institute with the provision of state of the art equipment including laser and eye scanning machines. To date, the institute performs the dual functions of serving as a modern eye treatment centre and a training institution for specialization in ophthalmology.
NATIONAL PROGRAMME ON IMMUNIZATION
Vaccine-Preventable Diseases accounts for 20% of morbidity and mortality in children before their fifth birthday. Children by the age of 1 should have completed their immunization schedule according to the National Programme on the Immunisation schedule.
The NPI program at the inception of the Tinubu administration lacked infrastructure. Its cold chain equipment broke down regularly and routine immunization coverage was poor.
To worsen matters, the local government outreaches did not function because the government at that level failed to take ownership.
To address these challenges, Governor Tinubu personally demonstrated leadership by ensuring that Lagos State participated in the National immunization Days (NIDs) carried out nationally as part of a global effort to eradicate poliomyelitis, with an average of 2.5million children under 5 years immunized per round of NID and successful implementation of the Integrated Measles Campaign with over 72% coverage (over 3,900,000 children immunized)
SCHOOL HEALTH PROGRAMME
When the Tinubu administration discovered that children in the State constitute about 40% of the population and account for over 30% of recorded visits to hospitals, it developed a new School Health Programme.
The programme recognised that over 80% of children are in primary or elementary schools (ages 6-14) while over 71% of the total childen population complete at least four years of primary schooling.
Governor Tinubu believed that the health of school children deserved special attention, hence the focus of the programme of imparting proper health knowledge, practices and skills to pupils in their most impressionable year’s and tackling malnutrition…
The programme was re-launched in the year 2006 with Health Education activities constituting a major component. Institutionalization of the school Milk Program with nutritionally adequate quantity of milk distributed to primary school twice weekly and the availability of the school eye screening program as an integral component of pupils health was implemented. The result: they improved punctuality and school attendance.
Overall, the range of activities which the School Health Programme covered include Free School Milk distribution, Free eye screening and provision of glasses, General medical and dental examination/screening, provision of first aid boxes, Assessments of basics sanitation of school environment and classroom ventilation, Monitoring of school food handlers, De-worming exercises and Distribution of IEC materials.
AMBULANCE / EMERGENCY MEDICAL SERVICES
Increasing urbanization and industrialization of Lagos State has led to an appreciable increase in the number of road traffic, industry and marine accidents and medical emergencies/disasters i.e. collapsed buildings and pipeline explosions.
Hence the strengthening of the base hospital cares i.e. Lagos State Emergency Medical Service (LASEMUS) and establishment of the pre-hospital care service, the Ambulance Service (LASAMBUS) in March 2001.
Both services have led to significant improvement in morbidity and mortality rates occasioned by medical emergencies.
THE LIMB DEFORMITY CORRECTIVE SURGERY AND REHABILITATION PROGRAMME
This programme was established in the year 2005 under the Asiwaju Tinubu led-administration with the sole purpose of improving the quality of life of those afflicted, most of whom being children, through the instruments of surgical intervention, physiotherapy and provision of walking aids
FREE CLEFT LIP AND PALATE RECONSTRUCTIVE SURGERY PROGRAMME
This program, termed Operation Smile, which started in July 2006, was designed to give succour and bring smiles back to the face; of afflicted children and their intermediate families. Over 237 patients were screened, 102 surgical interventions were performed, and milk and other nutritional supplements were given to these children in the first of the programme.
THE BREAST CANCER SCREENING AND AWARENESS PROGRAMME The breast cancer screening and awareness were officially launched in 2006 in response to the ever-increasing number of cancer patients who reported frequently in late stages of the disease to the hospital due to a lack of awareness/information of available treatment options.
REPRODUCTIVE HEALTH PROGRAMME
The reproductive health situation in the state at the inception of the administration was characterized by a high maternal mortality rate of 650/100,000 live births and a high fertility rate due to low access to family planning. The ministry improved access to reproductive/Sexual Health services and information, trained health professionals and community health workers on Life Saving/ Essential Life Saving Skills, provision of Reproductive Health I.B.C materials, integration of RH programmes activities into secondary school curriculum and procurement of family planning commodities including training of FP personnel on FP commodity management.
STATE ENVIRONMENTAL HEALTH MONITORING UNIT
The issue of corpses and dead animals on our roads and highways inherited from the immediate past administration before 1999 constituted an irritating, embarrassing and environmentally unpleasant sight not to mention its public health implications.
The Tinubu administration introduced SEHMU with the responsibility of facilitating the sanitary disposal of unidentified corpses in public places. A total of 3,886 corpses were picked up by this unit, with RTAs, destitute and disasters accounting for 90% of cases before the end of the tenure.
CARDIAC SURGERY MISSIONS
This intervention was established by the administration with the twin objectives of conserving scarce foreign exchange expended in the management of children with congenital heart defects and developing local capacity
MEDICAL MISSIONS
The concept of medical mission under Ashiwaju led-administration was specifically to provide fairly comprehensive medical services periodically at the grass root to complement the regular facility-based services. These were executed in collaboration with various committed partners and organizations. Notable activities in this respect include (I). three missions with AMP at Ibeju Lekki, Lagos Island and Badagry LGAs were over 10,000 patients were seen and 2,275 surgical interventions were carried out. (II). Several others were conducted in smaller communities all over the state in collaboration with other NGOs, religious groups, community associations and clubs.
OCCUPATIONAL HEALTH
Modestly, the ministry of health under the Tinubu led-administration ensured optimal safety of workers in the workplace primarily by regulating factory operations. In this regard, a total of 453 factory inspections were conducted to ensure that factory operations conform with occupational health standards.
SERVICE PROVISION/ AND INFRASTRUCTURAL DEVELOPMENT
At all levels of health care delivery, the State government under Ashiwaju’s dispensation embarked on rehabilitation, refurbishment, and/ or upgrading of various facilities as well as the provision of necessary equipment. Some of the achievements to date include:
Rehabilitation of two (2) Primary Health Clinics in collaboration with the African Development Bank. These are Igbonla PHC and the Community Health Training Institute, Agbowa PHC.
The number of PHC facilities have increased from 160 in 1999 to 2009
Similar achievements at the SECONDARY HEALTH CARE level include:
- Rehabilitation of 19 existing secondary health facilities including the replacement of roofing, provision of boreholes, water treatment plants e.t.c.
- Establishment and rehabilitation of 5 new General hospitals located in Ifako-ijaiye, Somolu, Mushin, Alimosho and Ibeju-Lekki LGAs in line with the policy of at least one secondary health facility per LGA.
- Completion of the Dental Clinic, ward and canteen at General hospital, Surulere
- Renovation and equipping of Blocks A and B, Lagos Island Maternity Hospital
- Completion of Medical Staff Quarters at General Hospital, Agbowa
- Completion of doctors Quarters at General Hospital, Isolo.
- Completion of the Theatre/Ward Complex at Orile Agege General Hospital.
- Procurement and distribution of medical equipment including mammography machines to secondary health units. This is inclusive of donated equipment and consumable from abroad
- Rehabilitation of mortuary units at LASUTH and Gbagada as PPI
- Furnishing of Renal Dialysis Ward at General Hospital. Gbagada
- Establishment of Community Health Departments at the secondary health facilities
In line with the provisions of the Health Sector Reform Law of the State Government, service delivery at this level of care under Tinubu’s dispensation witnessed tremendous changes. The decision to grant some measure of autonomy to all hospital units was taken in the hope that it would encourage healthy competition and creativity amongst the units. This resulted in the devolution of certain roles and responsibilities hitherto performed by the defunct HMB to the hospital units. The running of the individual units is being conducted under strict management and financial guidelines as drawn up by the Ministry of Health.
TERTIARY NEW H C M I E
The Lagos State Teaching Hospital began to live up to her expectation as a teaching hospital because great attention was given to this facility during Asiwaju Bola Tinubu- led-administration in the areas of personnel recruitment and phased infrastructural development which enabled it to carry out its statutory functions. Full accreditation was granted for undergraduate and residency training in virtually all specialities.
HEALTH FINANCING
The health sector is faced with many challenges not unconnected with the peculiar status of the State being a megacity and commercial capital of the nation. You will agree with me that the management of the health status of an ever-increasing population of the state due to migration of individuals from a different state and neighbouring countries, in the face of limited resources and increasing government responsibility had left the health sector competing with other sectors for scarce public funds. To mitigate against this as well as show its commitment to the health of our people, the administration of increased the budgetary allocation to the sector.
Furthermore, alternative sources of funding such as public partnerships were initiated and insurance schemes were explored to broaden financing options and ensure sustainable development of the health sector. In absolute terms, the budgetary allocation to the health sector increased steadily over, the years from N1.6 billion in 1999 to N 11.8 billion in 2006.
It is pertinent to note that over the period, almost 80% of these figures was on recurrent expenditure with personnel constituting a significant chunk (60% on the average). Furthermore, significant increases were made in the proportion of the capital, especially in the first 3 years. Participation of over 11 public hospitals as secondary and primary providers in the pilot phase of the National Health Insurance Scheme was achieved.
HEALTH FACILITY MONITORING AND ACCREDITATION AGENCY
to improve and maintain the quality of care provided to the people by the public and private health sectors (quality assurance), under the health sector reform, Private Hospital Registration Authority was transformed into the Lagos State Health Facility Monitoring and Accreditation Agency in March 2006.
It was mandated to set standards with regards to specifications of the minimum requirement to a physical structure, equipment, staff, space allocation, services etc, accredit and license facilities, monitor and evaluate performance, and enforce compliance.
PHARMACEUTICAL SERVICES
The task force on Counterfeit/Fake drugs; The task force on counterfeit/fake drugs was inaugurated in April 2001 shortly after he assumed office as a governor of Lagos State in response to the unacceptably high prevalence of fake, counterfeit and adulterated drugs in the State. Some of the activities carried out by the Taskforce include the following:
awareness campaigns on the hazardous effect of fake, spurious and counterfeit drugs through advocacy visits to dominant figures/stakeholders and gatekeepers, mounting of giant billboards in strategic areas of the State, radio/television jingles, distribution of posters, handbills and stickers, Raiding of suspected premises and prosecution of offenders, Destruction of seized counterfeit and fake drugs, Collaboration with a national regulatory agency (NAFDAC) and the federal ministry of health.
DRUG QUALITY CONTROL LABORATORY
At the inception of the administration, the Drug Quality Control laboratory was an uncompleted building. The laboratory was established to complement the quality measures instituted all through the drug chain in Lagos State by testing for genuineness or otherwise of drugs. The facility, fashioned along with a WHO-modeled Medium Size Drug Quality Control Laboratory in terms of infrastructure and equipment, and the first of its kind to be owned by a state government in Nigeria, was commissioned in 2003 and has since received the recognition of the country’s drug regulatory body, the National Agency for Food and Drug Administration and Control (NAFDAC)
HUMAN RESOURCES FOR HEALTH
Globally, in the health sector, this issue is given priority consideration. Before the inception of the led-administration oll when the Health management Board coordinated the activities of the health workforce, there was apathy.
To address these, the HMB was transformed into the Health Service Commission (HSC) and charged with the overall responsibility of health personnel management on issues of recruitment, deployment, promotion, discipline, pension and welfare matters amongst others.
With the above facts and figures, there is no doubt that Asiwaju Bola Tinubu has what it takes to manage the administration of the Federal Government of Nigeria.
Lagos State, as the most complex, industrialised state and the El Dorado of many Nigerians was managed successfully by this rare gift to mankind. Managing Nigeria is the next level.