HEALTH PROGRAMS OF THE STATE
FREE HEALTH SCHEME:
This focuses essentially on the first of the three cardinal health policy thrust of the present administration i.e. free community-based primary healthcare services.
In the absence of a well-structured health insurance system, through it the government hopes to improve services especially to the indigent and vulnerables and at the same time target certain health goods and services which once offered benefit the entire population i.e. give good externality effect.
The scheme was in existence before 1999 but limited to civil servants only. The current administration approved the expansion of the program to include free health service for all citizens. Scope of the program covers:
- Free registration and consultation for all
- Free treatment of children aged 12 years and below
- Free treatment of adults aged 60 years and above
- Free ante-natal care
- Free Eko Malaria Treatment
- Free TB and leprosy treatment
- Free Breast cancer screening and treatment.
- Free emergency service for the first 24 hours
- Public servants, their spouse and 4 dependants aged 18 years and below
- Miscellaneous exemptions usually based on indigence
- Refund of local medical expenses and offer of medical assistance based on need assessment
- Overseas medical treatment based on non-availability of needed service.
EKO MALARIA PROGRAM
Malaria is responsible for 70% of out-patient visits, 15% of hospital admissions and 20-30% of deaths in Under 5s. The frequent and inadequate supply of anti malarias in pharmacy and Primary health centers and 50% of uncomplicated malaria cases being attended to at secondary Health facilities led to the establishment of the Eko Free Malaria Program.
Eko Free Malaria Treatment Program intensified in the areas of increased awareness (community and school-based IEC) and funding with attendant increase in utilization rates of program service.
The program was facilitated by the distribution of Eko Free Malaria drugs, antenatal drugs and other consumables to all LGAs for use at their primary care centers in order to revert back to the PHC centers the provision of malaria treatment hitherto (prior to June 2004) given by the secondary care center. The program also helped in reducing the additional burden for the secondary health facilities.
The Lagos State RBM Committee was set up in 2001 in line with the new World Health Organisation (WHO) approved malaria program. The strategies include
- Intermittent Preventive Treatment (IPT) of Malaria in Pregnancy: pre-packaged anti malarial drugs (sulphapyrimethamine) given to pregnant women in the 2nd and 3rd trimester.
- Promotion of the ownership and usage of Insecticide Treated Nets.
- Institutionalize Environmental management
- Strengthening Roll Back Malaria Partnership.
- Training of health workers and community service providers on case management of malaria.
- Procurement and distribution of anti -malarias to all public health facilities
BLINDNESS PREVENTIVE PROGRAM
Blindness load (blind and visually handicapped) in the State is very high (~ 100,000 using the accepted assumption of 1% blindness prevalence in Nigeria). Of this figure, 50% go blind as a result of cataract while others suffer from glaucoma, corneal diseases, childhood blinding disease, retinal disease and refractive errors.
It is the belief of this administration that one of the many ways to tackle poverty is by giving back sight to the blind. It is with this understanding in mind that the administration embarked on this program.
The blindness prevention programme was initiated in the year 2000 with the aim of reducing prevalence of blindness from 1% to 0.5% over a five year period
The Lagos State Blindness Prevention Program Committee was inaugurated in January 2000 while the BPP Unit was created at the Ministry with its own budget sub-head in September of same year. Strategy involves free eye screening at the community level from one LGA to the other, distribution of free eye glasses based of results of screening exercise and provision of free eye surgery if corrective
The program has also been integrated into the PHC system with this including training of Community Health Workers in basic eye care practices and distribution of basic eye equipment to all LGAs.
In addition, a pilot survey covering the 5 divisions of the State was undertaken under the School Eye Project. Findings showed a high prevalence of refractive errors with myopia (short sightedness) ranking highest, thus justifying an urgent need to institute a School Eye Care Program in the state. The School Eye Project commenced in 2006.
The Eye Clinic Complex at LASUTH Ikeja has been upgraded to the Eye Institute with the state of the art equipment including laser and eye scanning machines for eye surgery obtainable in the center, while plans are underway to commenced corneal banking and grafting in the state.
FREE LIMB DEFORMITY CORRECTIVE SURGERY AND REHABILITATION PROGRAM
The presence of a great number of people especially children with limb deformities and the bleak prospects of a well grounded future led to the establishment of a Free Limb Deformity Corrective Surgery and Rehabilitation program in the year 2004
The aim of the programme is to reduce/eliminate limb deformity in patients through surgical intervention and to rehabilitate inoperable cases through aggressive physiotherapy and provision of walking aids to otherwise immobile patients.
Screening session are carried out twice or thrice a year where patients are sorted and referred for appropriate treatment. Follow up clinics are held for patients who are only discharged from the clinic after certified healthy.
FREE CLEFT LIP AND PALATE RECONSTRUCTIVE SURGERY PROGRAM
The cleft lip and palate program was established to give succor especially to children with the deformities. Free surgeries are carried out for identified patients with defects.
BREAST CANCER SCREENING AND AWARENESS PROGRAM
The Breast Cancer and Awareness program was established as a response to the ever increasing number of cancer patients who reported at late stages of the disease to the hospital due to a lack of awareness/ information of treatment options available.
The program first came into inception in 2002, but was officially launched in 2006 to increase awareness. The program is conducted in collaboration with the Ministry of Women Affairs and Poverty Alleviation.
- A rapid assessment survey was conducted in Somolu and Ikeja LGAs to assess basic knowledge of people as regards breast cancer to enable the Ministry design the program to meet demands.
- Screening in Local Government in Lagos State, with appropriate referrals to nearby General Hospitals that are relevant to the breast cancer screening and awareness programme.
- Information, Education and Communication Materials are produced and distributed regularly at screenings.
- Lectures on breast cancer delivered regularly at screenings.
- Awareness programmes on radio, television and campaigns done regularly.
- The mammogram machines were installed at LASUTH Ikeja and Orile Agege General Hospital.
- Free surgeries (Lumpectomies and mastectomies were established for the breast cancer patients screened in Lagos State).
PROSTATE CANCER SCREENING AND AWARENESS PROGRAM
The Prostate Cancer and Awareness program serves as a screening program for cancer of the prostate. Screening programs are carried out at the LGAs using digital rectal examinations and measurement of Prostate Specific Antigens (PSA). Information, Education and Communication Materials are produced and distributed regularly at screenings, while referrals are made for appropriate patients to designated facilities.
RURAL HEALTH/ HYPERTENSION AND DIABETIC SCREENING
In response to inadequate/lack of access to healthcare especially at the deprived and hard-to-reach (riverine) areas of the State, the Rural Health Program was established in April 2002 essentially to improve the delivery of primary healthcare service to these areas and also detect early asymptomatic/undiagnosed cases of hypertension and diabetes especially among those at high risk.
The underlined strategies were utilized:
- Early detection of asymptomatic/undiagnosed cases especially those at high risk.
- Promotion of healthy lifestyles.
- Integrate program at the community level into the PHC framework with an efficient in-built referral system.
- Intensify follow-up of cases in order to ensure treatment compliance.
- Training of personnel in the technique of screening and healthy life styles.
- Ambulance boat services to “hard to reach” /riverine areas
HIV CONTROL PROGRAMME
At the inception of this administration, the generalized epidemic of HIV was at a prevalence of 6.7%. The were no identified HIV testing sites in the state, poor funding and management since there was no coordinated response at state level. There was also a lack of responsiveness to PLWHAs needs and rights.
Given the multispectral approach to HIV/AIDS Prevention/Control and the importance attached to it, the Lagos State Action Committee on AIDS was established under the Office of the Governor in 2000, with the Ministry of Health constituting a major player/collaborator.
- Various community, school-based and target group (youths, drivers, etc.) IEC campaigns and advocacy rallies and visits were carried out in all the LGAs of the State, including workshop on HIV/AIDS prevention for policy makers.
- Establishment and training of Local Government Action Committee on AIDS (LACA) throughout the State.
- Formed partnerships to care for orphans and vulnerable children, and facilitate PLWHA support groups including the establishment of micro credit, micro grant and retraining schemes and provision of employment for PLWHAs.
- Integration of HIV/AIDS education into primary and secondary schools curricula.
- Establishment of a stakeholder’s network involving partners such as WHO, UNAIDS, DFID, USAID, NACA, Civil Society organizations etc.
- Setting up of Voluntary and Counseling Centers (VCT) in 11 of the State’s General Hospitals and 2 primary care facilities.
- Launching of Blood for Life Program to encourage voluntary donation of safe blood and training of health workers in universal training precautions.
- Expansion/equipping of blood banks and HIV screening laboratories including training in proper handling of blood and blood products
- Prevention of Mother to Child Transmission of HIV
- Anti retroviral Therapy.
- TB/HIV Integrated programme
- Comprehensive HIV care and support programmes
- Research, Monitoring and Evaluation.
TUBERCULOSIS CONTROL PROGRAM
The tuberculosis program on ground in 1999 was rudimentary and was not DOTS complied. There were inadequate and ineffective AFB diagnostic units and the program was poorly funded and managed. This led to a significant increase in drug resistant TB cases and the increasing co-existence of Tb and HIV/AIDS compounded the problem
The strategies that are employed are:
- Advocacy on TB programme including awareness of TB as a curable and/or preventable disease.
- Institutional development through renovation/equipping of chest clinics at all the 20 LGAs HQs PHCs and 6 referral centers including provision of microscopes and reagents.
- Capacity building through training of TB unit staff and laboratory.
- Production, printing of recording formats
The focus is on the control of leprosy in the State. The case findings were an average of fifty cases registered quarterly before 1999. After 1999, the case findings have been reduced tremendously and the disease is nearing eradication.
- Introduction of new manual for the treatment has helped improve the quality of the programme.
- Cases sent to laboratory for confirmation
AVIAN INFLUENZA (Bird Flu) CONTROL PROGRAM
No reported case of Avian Influenza worldwide at inception of the administration. Bird flu was first reported in February, 2006. In response to the threat of the infection, the Ministry of Health initiated the following steps:
- Setting up of immediate rapid response team
- Establishment of active surveillance teams for bird flu
- Sensitization seminars of health workers in the state
- Intensive awareness campaign
- Procurement of personal protective equipment
- Upgrading of IDH isolation wards to handle any case of human infection
- Printing of behavioural change communication materials
- Procurement of drugs (Tamiflu)
- Analysis of samples from affected farms in Eti-osa and Ifako-ijaiye in LGAs
- Rapid assessment of level of preparedness and awareness conducted in Eti-osa and Ifako-ijaiye LGAs
- 15 hotlines designated for improved communications
- Technical inter-ministerial committee on Bird flu set up
- Active collaboration with state Ministries of Health and Information and AI crisis in Abuja.
- Training of LGA DSNO’s on surveillance
- Sharing of field investigation findings with all stakeholders
- Continuing medical Education for health providers on case management on AI
- Appointment of a desk officer under the World Bank assisted Avian Influenza Control Program (AICP)
NATIONAL PROGRAM ON IMMUNIZATION
Vaccine Preventable Diseases accounts for 20% of morbidity and mortality in children under 5s. Children by the age of 1 should have completed their immunization schedule according to the NPI schedule.
The NPI program at inception was characterized by deteriorating infrastructure including break down of the cold chain equipment, low routine immunization coverage, non functioning of the outreach’s at the LGAs and poor ownership of immunization activities at the LGA levels.
The Ministry of Health adopted the following key strategies:
- To achieve Universal Childhood Immunization coverage (80%) of all the antigens by 2007.
- To achieve global polio eradication through the Polio Eradication Initiative. (PEI)
- To improve utilization of immunization services through availability of quality/effective cold chain system and community participation.
- Development and dissemination of IEC materials.
- Institutional development including the provision of cold chain equipments and procurement of generators for the maintenance of the vaccines at the State cold store and the 20 LGA’s.
- Capacity building through refresher training of Local Government Immunization Officers (LIO’s) and other HW’s on cold chain vaccine maintenance, micro planning, new policy issues and vaccination procedures.
- Monthly cluster meetings with the LIO’s.
- Compilation of monthly Routine Immunization (RI) data to know the percentage coverage.
- Re-vitalization of the outreaches to strengthen RI through the Reach Every Ward (REW) Approach.
- Increase RI coverage through Child Health Week.
Currently there is active participation of the State in the National Immunization Days (NIDs) carried out nationally as part of global effort to eradicate poliomyelitis, with an average of 2.5 million children under 5years immunized per round of NID.
Tuesday of every week has been set aside for routine immunization against vaccine preventable diseases in all primary health care facilities in the State.
Is made up of three units: Safe Motherhood, Family Planning and Adolescent Sexuality and Reproductive Health (HELLO Lagos)
The reproductive health situation in the state at inception of this administration was characterized by High maternal mortality rate of 650/100,000 live births and high fertility rate due to low access to family planning.
Some of the contributory factors included poor access to trained personnel especially at the community level, low socio-economic status of women reducing their ability to take important decisions about themselves including exercising their reproductive rights, inadequate service delivery points and poor referral system.
The Ministry sought to improve access to reproductive/Sexual Health services and information, train health professionals and community health workers on Life Saving Skills/Essential Life Saving Skills, provision of Reproductive Health I.E.C. materials, integration of RH programme activities into secondary school curriculum and procurement of family planning commodities including training of FP personnel on FP commodity management.
ADOLESCENT SEXUALITY AND REPRODUCTIVE HEALTH (HELLO LAGOS)
The “Hello Lagos” program was created to cater to the services of adolescents who make up about a third of the population. With 13% sexually active and with the attendant risk of transmitting STIs including HIV/AIDS and abortion and teenage pregnancy being quite common, there was a need to institutionalize a program for in-school adolescents in the state.
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)
Malaria, measles, diarrhea, malnutrition and Acute Respiratory Infections (ARI) accounts for 70% of under 5 mortality. Past effort focused on vertical programmes e.g. Control of Diarrhoea Diseases (CDD), ARI, NPI, Malaria and nutrition with weak organizational support to the Health Facilities.
IMCI is a holistic approach towards the management of childhood illnesses, to improve the quantity of care provided to children under five at the facility and community levels.
The strategies include training of health workers on IMCI guidelines, integration of IMCI programme into the curriculum of School of Nursing, College of Health Technology etc. and empowering mothers on home management of common childhood illnesses through IEC materials and training
SCHOOL HEALTH PROGRAM
Children in the State constitute 40% of the population and account for over 45% of recorded visits to hospitals. Over 80% of children in primary or elementary schools (ages 6-14) while over 71% of total children population complete at least four years of primary schooling. Health of school children deserves special attention. Many of the school children are survivors of high childhood mortality.
The Governor of the State inaugurated a technical committee late 1999 to work out modalities for the revitalization of this important program after which series of meetings culminated in the launching of the program on January 25, 2001.
Health Education activities constitute a major component of this program. Other areas of intervention include the provision of first aid boxes to schools, nutrition, training of volunteer school health workers, immunization, deworming exercises, promotion of active living and personal hygiene, counseling, periodic medical examination and screening and rehabilitation of disabled children.
Institutionalization of the School Milk Program with nutritionally adequate quantity of milk distributed to primary school children twice weekly and the school eye screening program have improved punctuality and school attendance.
The ratification of the food and nutrition policy by the Nigerian Government (NPFNN 2001) is a major landmark in the current efforts to deal with the scourge of malnutrition and nutrition related illnesses.
The ultimate goal is to initiate, develop and implement policies, concepts, strategies and programmes to meet the nutritional needs of the State’s citizenry, particularly the most vulnerable members’ of the society.
- There was inadequate knowledge of good and appropriate nutritional practices.
- 43% of children under 5 are stunted and underweight and 52% of under 5 deaths are due to malnutrition.
- Malnutrition is correlated with low learning ability and general poor academic performance in primary schools.
- High prevalence of micronutrients and vitamins deficiency arising from nutritional deficiency.
- To promote, protect and support infant & young child feeding initiatives.
- To reduce significantly the burden of malnutrition and its attendant problems among school age children.
- To promote appropriate maternal nutrition practices and nutrition education.
- To advocate increased commitment of policy makers and other relevant stakeholders on the relevance of nutrition as central to development and health.
- Sustained implementation of school milk programme from inception (2003) till date
Increasing urbanization and industrialization of Lagos State has led to an appreciable increase in the number of road traffic, industrial and marine accidents and medical emergencies, hence the strengthening of the inherited base hospital care i.e. Lagos State Emergency Medical Service (LASEMS) and establishment of the pre-hospital care service i.e. Lagos State Ambulance Service (LASAMBUS) in March 2001. Both services run on a 24/7 basis and have led to significant improvement in the response time and quality of care with attendant improvement in morbidity and mortality rates occasioned by medical emergencies.
- Awareness campaign on the preventive aspect of medical emergencies including home/road traffic/industrial accidents; and how to access services.
- Establishment of an efficient communication/radio network linking the public, LASAMBUS, LASEMS and the Ministry of Health;
- Training of personnel in pre-hospital and hospital-based management of trauma and medical emergencies, and effective radio communication.
STATE ENVIRONMENTAL HEALTH MONITORING UNIT (SEHMU)
The issue of corpses and dead animals on our roads and highways inherited from the immediate past administration constituted an irritating, embarrassing and environmentally unpleasant sight not to mention its public health implications.
Though, removal of corpses from the highways is the statutory responsibility of local government councils, neglect of this activity by the LGAs occasioned an executive mandate to be given by the State Governor to the Ministry of Health to take over the duty of ridding our highways and roads of corpses.
Consequently, the Lagos State Environmental Health Monitoring Unit (SEHMU) was launched on August 21, 2000 to rid the streets of Lagos State of corpses and other health-related hazards.
Number of Lagos state public health institutions: