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Population: spanner in the works for Lagos Maternal and Newborn Health

“There has been a tremendous reduction in stock-outs of essential life-saving commodities in (Lagos State) health facilities…” That was the verdict of the Lagos State Accountability Mechanism for Maternal and Newborn Health (LASAM) on the state’s performance in the area of programmes for the survival and health of mothers and newborn children in the first half of this year. Giving the verdict on 3 October 2017 at the dissemination of the three maternal and newborn health (MNH) scorecards it uses to measure MNH performance, LASAM however asked the state government to do more:

“We therefore request the Lagos State Ministry of Health and its agencies to sustain this good progress and ensure 100 per cent stock of essential life-saving commodities in all public health facilities offering maternal and child health services in Lagos State,” it said.

 

Top officials of the Lagos State health ministry at the Dissemination of the January-June 2017 MNH Scorecards held in the Conference Room of Folarin Coker Staff Clinic, Alausa Secretariat, Ikeja, were happy with the MNH performance. The scorecard has more greens than reds this year. For ease of reference, the scorecard uses a traffic lights approach to show performance in the different indicators measured. Red, for a score less than 50 per cent means Insufficient Progress; Yellow, for 50-74 per cent, means or Some Progress); and Green, for 75-100 per cent is Good Progress.

The scorecard in 2016 was virtually a red card. It had had more reds than greens and yellows combined. That of the first half of 2017 is a marked improvement, and everybody was happy – at least with the two scorecards on commodity stockouts in primary and secondary health facilities.

The third scorecard—Maternal, Newborn And Child Health Scorecard—with indicators such as  percentage of pregnant women reporting for antenatal care in the first 20 weeks;  percentage of pregnant women reporting for antenatal care after 20 weeks;  percentage of births attended by skilled attendant;  percentage of new diarrhoea cases in under-five year olds who are given ORS/zinc supplementation, and suchlike—was another ball game.

In respect of this scorecard, LASAM called on the Lagos State Ministry of Health to “improve the quality of data entered into DHIS2 by facilitating monthly data validation meetings with medical records officers and LGA officers.” This was because access to data and the authenticity of data obtained has always been a problem.

For instance, the percentage of females aged 15 - 49 years using any method of modern contraception, according to the scorecard, had jumped to 31 per cent (from 3 percent last year). The figure itself, which is actually a red is not the problem, it is how rapidly the state got there. It looks like wuruwuru or magomago (something dodgy) someone noted.

Lobatan, as they say these days. That was where the data arguments and expression of other displeasures started. And the most important issue – something underlying everything about Lagos State population-related data these days – is that the denominator is like a moving target. There is such a huge disparity between the official ‘Federal’ Lagos State population – about 12 million today according to the National Population Commission – and the 22 million plus claimed by the state government, and the United Nations’ 24 million. Therefore, depending on who gives data on Lagos State, the difference from the others’ could be as wide 50 - 100 per cent because different people quote different figures in-between the two extremes.

As different experts from the state’s health sector laboured to explain, the leap from 3 to 31 per cent was actually the result of data capture improvement efforts. The first to point this out was Dr Saidat Okaga, Lagos State Reproductive Health Coordinator – standing in for the Director of Family Health and Nutrition, Dr Folasade Oludara, and the Permanent Secretary, Dr Modele Osunkiyesi.

With the nation now trying to get modern contraceptive prevalence rate (CPR) to 27 per cent (from less than 10 per cent currently) by 2018, the nation pins much hope for achieving the feat on Lagos State, which is expected to get CPR to more than 70 per cent. That is because of its cosmopolitan nature and its population that is yet not acknowledged federally.

The difficult question then is: the CPR that Lagos is supposed to attain - whose 70 per cent will it be—Abuja’s or Ikeja’s?

It’s about time that Nigeria resolved this Lagos population question.

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