3. Long Term Key Performance Indicators
3
INDICATOR DESCRIPTION INDICES SDG Target
(2030)
Neonatal mortality rate Probability of dying within first month of life 33/1,000 12/1,000
Infant mortality rate Probability of dying between birth and first birthday 45/1,000 12/1,000
Under 5 mortality rate Probability of dying between birth and fifth birthday 50/1,000 25/1,000
Maternal mortality rate Number of pregnancy-related deaths per 100,000 live births 555/100,000 <70/100,000
Full immunization coverage Percentage of children age 12-23 months who received all
vaccinations recommended in the national immunization
schedule by their first birthday (measles by second birthday)
63.00% 85%
Skilled birth attendants Percentage of women age 15-49 years with a live birth in
the last 2 years who were attended by skilled health
personnel during their most recent live birth
94.00% 99%
Life expectancy 54 years 71.4 years
4. The Five Task of Strategic Planning
• Developing a Vision and a Mission
• Setting Objectives
• Crafting a Strategy
• Implementing and Executing Strategy
• Evaluating Performance, Reviewing the Situation and Initiating
Corrective Action
5.
6. Definition of Clinical Governance
• A framework through which a medical organization is
accountable for continually improving the quality of service,
training and research and safeguarding high standards of care
by creating an environment in which excellence in clinical care
will flourish for an interconnectivity between all the allied
health care professionals.
• Scally and Donaldson 1998
10. LAGOS STATE THEMES PILLAR 2 MANDATE
10
Overall Group Objective
Understand current status of Lagos State Health Sector and Identify broad themes and key initiatives for next four years that are in
keeping with the Manifesto for Lagos and the State’s Strategic Health Development Plan
Value Propositions:
Complete existing projects and define
tangible new projects that can be completed
during this administration along with the
specific strategies. Apply expected outcomes
and measures, as well as confirm the ability
of the State to fund some of these initiatives
and aggressively target new funding and
income generation projects.
11. DISCOURAGE DOING PROJECTS FOR
DOING SAKE
IT WON’T BE BUSINESS AS USUAL
EMPHASIS ON QUALITY AND IMPACTFUL
PROJECTS
REVENUE GENERATION
11
12. 12
CURRENT STATE
• Key Performance Indicators
• Key achievements and major initiatives
• Budget performance of 2019
• Source of new funding
• Policy analysis
• Strategic challenges
• Key partners
27
13. Defining the Healthcare System in Lagos State within the SMART CITY
PUBLIC HEALTH
Programs
- Health Promotion
- Disease Prevention
Disaster/Emergency/Epidemic
Preparedness
- Emergency Medical Services
- Disease Surveillance
- Biosecurity/Biosafety
- ONE HEALTH
Research
- Clinical
- Operations
- Population-Based
- Surveys
HOSPITAL SERVICES
Three Tier System:
1. Primary Healthcare
- 340 Primary Health Centres (PHCs)
1. Secondary Healthcare
- 26 General Hospitals
1. Tertiary (Specialist) Care
- 1 Teaching Hospital
CENTRAL
Governance
- Regulatory
- Policy
Health Financing
- Government
- Private
- Development Partners
- Competitive Grants
Health Information Management
Human Resources for Health
Partnership for Health
- PPP
- Community Participation
13
The Lagos State Government has adopted a three-pronged approach to the management of the Healthcare
Sector. These are detailed below:
14. Key Achievements of Last Administration
The outgoing administration achieved the following:
• Optimizing Medical Emergency Service with 20 Mobile Care Units and 26 Transport Ambulances ?
• Remodelling and Upgrade of 19 General Hospitals and Maternal and Child Centres ?
• Construction and Renovation of 34 Primary Health Care Centres ?
• Commissioning of Institute of Maternal Health (Ayinke House), LASUTH ?
• Commissioning of Critical Care Unit, LASUTH
• Expanded Diagnostic, Laboratory & Surgical Services in 26 General Hospitals + LASUTH ?
• Completion of Permanent Hostel, School of Nursing.
• Private Sector Operationalization of 43 Primary Health Centres (Access to Finance Initiative)?
• Launch of Lagos State Health Scheme.
14
15. Major Initiatives.
15
INITIATIVE KEY OUTCOMES
BUDGET ACTUAL TO DATE PERFORMANCE CONTRACTOR
Biosafety and Biobanking
Lab - 3
Strategic Global Partnership on Global
Health Security Agenda CAD$4.5m +
N110,551,060
CAD$4.5m +
N110,551,060
80% GPP
Lagos State Disability Fund Social Investment for registered
Persons Living with Disability
500,000,000 N/A N/A LASODA
Completion of the
Renovation and Extension
of Ayinke House at LASUTH
Referral & Training Centre for
maternal cases at the tertiary level 1,822,705,687.39 1,686,786,107.16 95%
Bentley & Jacobs
Limited
and Eralinks
Construction of Helipad at
LASUTH
Increased prompt accessibility to
emergency services/care 227,904,956.22 191,448,140.06 100%
First Infrastructural
Contractor
16. Budget for Health
• The following graphs
represent the budgetary
allocation and performance
for the health sector. As
seen, in the last 4 years,
the sector has been
receiving an average of
8.7% as percentage of
Government Expenditure.
This is less than the 15%
that was agreed upon by all
African Nations at the Abuja
Declaration in 2001.
16
18. Budget Performance: LASUTH & 2 Select General Hospitals
Sources of Revenue: Services provided Hospital Unit exclusive of revenue/net-income share from the 9 PPPs.
Capital costs cover mainly renovation of Ayinke House, Helipad, Various Hospital Equipment 18
Lagos University Teaching Hospital (LASUTH) and the 26 general hospitals are currently managed as appendages of the Ministry of Health.
Their revenue goes into the consolidated revenue account minus a percentage retained for buying diesel, minor repairs and some
drugs and consumables. The general hospitals are currently being run without governing boards. Oversight is provided by the Health
Service Commission.
21. MOH Source of Funding
SOURCE AGENCY AMOUNT
Budgetary Allocation Ministry of Finance Average 8% of Budget pledged to rise gradually to 14%
Federal Government
National Basic Health Care Provision Fund
(BHCPF)
1% Federal CRF, grants from donors and partners and funds from any
other sources.
FMOH– Saving One Million Lives (SOML)
Performance Based
Up to $3,000,000
Private Sector PPP Contracts Not Stated
Development Partners and
competitive Grants
WHO, UNICEF, BMGF, DFID, JICA, GPP, NIH >N500 million
21
Apart from Government Expenditure for Health, the Health System is supported by some additional funding from the Federal
Government, Private Sector and other Development Partners as highlighted below. Many of these donor funds are volatile and
largely tied to disease-specific priorities. There is increasing donor fatigue and some of the existing donor funds are reaching
the end of their lifespan. However, there are new opportunities for financing the Health Sector including Counterpart Funding,
Performance-Based Funding and PPP.
22. Strategic Challenges
CHALLENGE SEVERITY
(H, M, L)
IMPACT
(H, M, L)
SOLUTION STATUS
Governance Anomalies H H Reconstitute Governance Boards
Performance and Audit of income generation units
Not Implemented
Quality of Healthcare M H HEFAMAA as an Agency
Medical Etiquette
Promote PPP and Community Schemes
Ongoing
Access and Equity to affordable
Health Care
H H Lagos State Health Scheme
Resource Primary Health System
Ongoing
Emergency Services and
Emergency Preparedness
H H Revamp State Ambulance Service
Establish Biosafety and Biosecurity Agency
Not Implemented
Healthcare Financing, Partnership
for Health
H H PPP, Health Scheme, 1% CRF, Donor Funding
improve Doctors efficiencies
Process Stalled
Human Resources for Health H H Re-activate Volunteer Health Scheme; Leverage
Technology; Build Capacity; Benefits Packages for
Healthcare personnel
Not Implemented
22
The Challenges highlighted below have been strategically selected to indicate the areas that require interventions that will
improve performance of the Health System
23. 23
PATH FORWARD
Health
► Strategic Thrust (including THEMES Tenets)
► Action plan
► Quick and Long term wins
► Milestone Statement & Executive Orders
24. Path Forward
24
The promises in the manifesto of the incoming administration were targeted at promoting good health by
focusing on prevention through an optimal primary healthcare system funded by mass community-based health
insurance programmes designed to make healthcare more accessible and affordable at the doorstep of every
resident. The manifesto promises are highlighted below:
• Expand the Lagos State Health Scheme with a target of 500,000 households (2.5 million enrolments) by
Q4 2019
• Increase health spending from 8.86% to 15% of budget in line with the Abuja Declaration
• Create a database to capture the health needs of Lagosians by deploying a Electronic Healthcare
Management System
• Access additional funding for our primary healthcare centres through the National Basic Health Care
Provision Fund (BHCPF)
• Expand Lagos State Ambulance and Emergency Service coverage by increasing ambulance points by 50%
• Ensure a minimum of 3 doctors, 3 nurses and 5 community health workers in all 345 primary health
centres (PHCs) by 2021
• Ensure all 37 non-functional primary healthcare centres in the state are refurbished and adequately
equipped
• Provide 10 new primary healthcare centres for riverine and other underserved areas
• Introduce public-private partnership programmes to enhance the management of PHCs
• Strengthen the primary healthcare referral system to ease the burden on secondary and tertiary
healthcare facilities
• Provide adequate funding to ensure healthcare workers at all levels receive required training
• Leverage information technology for health data management including wearable devices and mobile
health
• Establish Access to Mental Health by investing in skilled human resources, creating infrastructures and
the use of technology
25. Path Forward - Short Term Strategic Thrusts
Thrust 1: Focus on Preventive Health
► Project HEALTHY LAGOS
► 500,000 Households enrolled in LSHS
► Access to Finance Project for PHCs
► Build and Resource PHCs
Thrust 2: Partnerships for Health
► Volunteer Health Corps
► Community Participation
► Boards for Health Institutions
► Donor Coordination Forum
Thrust 3: Improve Emergency
Preparedness
► Revamp LASAMBUS >> LASEMS
► Biosecurity/Biosafety Lab
► Blood Transfusion Services
Thrust 4: Technology for Health
► Implement DHIS2
► Innovation Challenge for Health
► Introduce E-Health
25
26. Path Forward - Long Term Strategic Thrusts
Thrust 1: Human Resources for Health
► Project HEALTHY LAGOS
► Improve remuneration and benefits
package
► Capacity building programs
Thrust 2: Improve Health Service Delivery
► Electronic Medical Records
► Develop Full Competency in LASUTH in 2
Specialties
► Resource/Build PHCs in Hard 2
Reach/Riverine
Thrust 3: Health Financing
► Expand Lagos State Health Scheme
► Public Private Partnerships (Access to
Finance)
► Medical Equipment Leasing Programme
Thrust 4: Social Health Intervention Program
► Launch Catastrophic Health Expenditure
Fund
► Sustain Disability Fund and Mental health
support
26
These are the highlights of the Long Term Strategic Thrusts
27. Action Plan
27
ACTION IMPACT
Priority Area 1: LEADERSHIP AND GOVERNANCE
Convene State Health Council and Stakeholder Forum Foster improved coordination, cohesion and robust
relationship among the LGAs, Health Partners and other
relevant stakeholders within the State.
Constitute Boards for Statutory Agencies: Health Service Commission, Lagos State
Health Management Agency, Primary HealthCare Board, Hospital Management
Board etc
Improved policy direction, accountability, innovation,
transparency and responsiveness of state health system
Update Medium Term Sector Strategy MTSS for 2020-2022 Improved policy direction, planning and implementation
Review Policy on Autonomy and Sustainability of State owned Hospitals Improved IGR generation by General Hospitals and
accountability of Medical Directors
Activate e-HEFAMAA platform Improvement of Standards and access to quality health
services in all hospitals in the State
Disseminate, implement and monitor Strat Plan: SSHDP-II (2018-2022) Provision of qualitative health service delivery and improved
health status of Lagos State residents from a strengthened
health system
28. 28
Action Plan
ACTION IMPACT
Priority Area 2: HEALTH SERVICES DELIVERY
Announce upgrade of Lagos State Ambulance Service to Lagos State Emergency
Medical Services (LASEMS)
Prompt response to medical emergencies, accidents, collapsed buildings
etc
Immediate implementation of Emergency Medical Services program of MOH:
- Renovation of all emergency rooms
- Provision of more ambulances
- Purchase of medical equipment for emergency services and consumables
- Improved bed space management procedure
- Engagement of biomedical engineering firm to ensure regular maintenance of
equipment and develop a biomedical institution long term
Emergency preparedness in all health facilities is high
Launch Lagos State Biosafety Level 3 Laboratory and Biobank Project - Diagnosis of infectious diseases like Ebola Virus Disease (EVD);
- Banking of biological and environmental samples;
- Containment of EVD and other biosecurity threats
Establish Catastrophic Healthcare Fund Makes available funding for treatment of cancer, cardiac and renal
disease for indigent patients
Restructure Disability Fund - Seed Fund to provide funding for People Living with Disability,
supported by contributions from Private Sector as CSR, Philanthropists
and Social Groups. Fund to be managed by PFIs
Provide solar power and inverters for all PHCs and energy plan for GH All PHCs are powered up 24/7. Remove dependence on expensive diesel
Complete renovation of PHCs Improved accessibility to primary healthcare services
29. 29
ACTION IMPACT
Priority Area 2: HEALTH SERVICES DELIVERY
Survey, fixed assets verification and issuance of certificate of occupancy for all LASG
Health facilities (GHs, PHCs, Colleges) with surveys and valuations
Information for planning, prevent encroachment, required data for PPP
projects
Review Policy for Capping of Hospital IGR to improve quality of care through a Hospital
Development Fund into which a percentage of IGR is seed for dedicated expenditures
like capacity building, maintenance contracts, DRF, basic procurements
Increased IGR and accountability in GH for improved service
performance and sustainability
PROJECT ONE HEALTH: to shift focus of health service delivery in Primary Health
Facilities to health promotion and prevention with massive awareness campaign on:
- environmental sanitation and health;
- personal hygiene;
- healthy eating;
- exercise;
- regular check-ups;
Improved Health Awareness in communities,
Improved Health Outcomes,
Reduced burden on Secondary and Tertiary Care Centres
Revive Volunteer Health Workers Scheme Increased capacity of Health workforce and increased community
participation and Ownership of Health
Implement and scale up the World Bank-supported Pollution Management and
Environmental Health Programme
To achieve a pollutant-free environment
Launch 3 new MCCs (Plan for recruitment and Equipping)
Improved accessibility to primary healthcare services
Action Plan
30. 30
ACTION IMPACT
Priority Area 2: HEALTH SERVICES DELIVERY
Convert Majidun to Psychiatric Hospital Access to Mental Health Services and Improved capacity of Health
System
Prioritize Cancer Registry
Accurate and complete cancer data that can be used for cancer control
and epidemiological research, public health program planning, and
patient care improvement
Introduce Health Technology Hubs for Innovation and Local Technology Development
Creates opportunities for innovation in Health Service delivery,
Opportunities for SMEs in mHealth, Improved delivery of Health Service
Introduce Clinical Facility Management under LASIAMA
Improved efficiency of Health Facility Management
Reinvigorate Service Charter initiative and empower Quality Improvement Teams
Improved skills and knowledge of service charter champion in resolving
complaints and providing qualitative health care to the people of Lagos
state thereby increasing patient satisfaction
Action Plan
31. 31
ACTION IMPACT
Priority Area 3: HUMAN RESOURCES FOR HEALTH
Approve balance of 30% staff recruitment memo from HSC Reduced disruption in service provision
3 doctors, 3 nurses and 5 community health workers in all 345 Primary
Health Centre (PHCs) by 2021
Ensure availability of health personnel
Skill Gap Analysis across the 3-tiers of healthcare Demonstrate capacity and capability of workforce
Restore Merit-Based Evaluations for Promotions/Appointments Ensure availability of competent, skilled health personnel
Provide cars and/or accommodation (close to duty point) for doctors to improve
conditions of service
Improved conditions of service and increased staff retention
Remove health workers remuneration from civil service structure Improved conditions of service and increased staff retention
Increase capacity to train more doctors and specialists Increased availability of healthcare professionals
Leverage Technology to augment capacity of medical workforce Close the gap in clinical service through Tele-Consulting, Tele-
Radiology (PAC system) service at the G-6 Hospitals
Develop masterplan for College of Nursing and Midwifery Increased production capacity for accredited Healthcare
Professionals
Increase capacity to train more community health workers Increased production of Healthcare Professionals
Introduce Accelerated Nursing Programme for graduates interested in Nursing Increased production of Healthcare Professionals
Reactivate nurse anaesthetist training Increased production of Healthcare Professionals
Action Plan
32. 32
Action Plan
ACTION IMPACT
Priority Area 4: FINANCING FOR HEALTH
Prioritize, promote and strengthen the Lagos State Health Insurance Scheme
(LSHS) Big step towards achieving Universal Health Coverage with increased %
coverage of residents with no threat of financial impoverishment in the
State and ultimately improved health indicators and quality of life
HE sign up for LSHS along with family and all senior political appointees
Shows that HE intends to create a world class health insurance scheme
Complete the processing of Access to Finance Framework for Health SMEs
(A2F) and sign-off of Agreements for the 43 PHC's with Private sector
providers
Improvement in service delivery at 43 PHCs to be operated by private
providers and supported by LSHS
Complete processing of Medical Equipment Leasing (MELS) programme
Availability of major medical equipment through leasing as an end-to-end
(procurement, installation, training, maintenance and repairs) service for
LASUTH and all 26 General Hospitals
Timely release of premium contributions from Civil Servants to LASHMA for
the LSHS
Appropriate Action
Define and promptly pay the 1% statutory Consolidated Revenue Fund to
LASHMA to help expand coverage for the poor and vulnerable Appropriate Action
Access additional funding for our Primary Healthcare Facilities through the
National Basic
Health Care Provision Fund (BHCPF)
Availability of Financial Resources for Primary Care Services, augmenting
State Government Financing
Seed/Contingency Fund for LASHMA to assist with operations
To act as a buffer to meet with its payment obligations to providers
Fast track Payment of outstanding fees to partners for delivered services
including CarePay for LASHMA, Access to Finance and MELS
Immediate deployment of IT enrolment tool
Commencement of Needs Assessment as a pre-cursor for the MELS
implementation
33. 33
Action Plan
ACTION IMPACT
Priority Area 5: NATIONAL HEALTH INFORMATION SYSTEM
Immediately implement DHIS II Software at all health facilities, provide hardware
and train staff on data management
Improved collection, transmission, analysis and dissemination of
health data
Leverage information technology for health data management for remote health
status monitoring: HE to receive medical monitor at sign up for LSHS
Enhanced monitoring of patients for health data for routine
management and quick intervention
Leverage on Innovative Technology to aid Access, Payment, insurance, PHC Provision
and Data Collection/ Analytics
Improve performance
Priority Area 6: COMMUNITY PARTICIPATION AND OWNERSHIP
Establish management committees at PHCs and GHs to include community
stakeholders, charitable organisations/individuals and CSOs
Improve Community engagement and improved health practices
Establish LGA Health Authority Improved coordination and implementation of Health policies and
strategies
Inaugurate Ward Health Committees Improved coordination and implementation of Health policies and
strategies
34. 34
Action Plan
ACTION IMPACT
Priority Area 7: PARTNERSHIPS FOR HEALTH
Strengthen Donor Coordination Forum
Improved relationship and efficient resource mobilization
Develop joint integrated operational work plan with existing partners
Improved collaboration
Establish Technical Working Group on Health Policy to include all partners
Continuous review and update of Policy brief and Direction
Conduct Annual Private Sector (Healthcare Federation of Nigeria) Forums with Gov-
Lag Improved Confidence of Private Sector
Review existing MediPark agreement
Legacy Project to reverse medical tourism
Priority Area 8: RESEARCH FOR HEALTH
Establish Medical Research Council to provide leadership in research and knowledge
management Generate Data for Healthcare solutions, Policies and Regulations
Establish comprehensive repository for health research at all levels including public
and non-public Availability and Access to Data
Prioritize and strengthen Cancer Registry Availability and Access to Data
35. 35
STRATEGIC THRUST ACTIVITY
PRIORITY
LEVEL
TIMELINE NOTES
Leadership and
Governance
Executive Order:
Constitute Boards for Statutory Agencies:
Health Service Commission
Lagos State Health Management Agency
Primary HealthCare Board
High July 1, 2019
PHC Board: No board since 2015 (Statutory - Health Care
Reform Law)
Health Service Commission: Statutory - Health Care Reform
Law
LASHMA Board yet to be inaugurated
Flag-Off
Convene State Health Council and
Stakeholder Forum
High July 4, 2019
Platform for His Excellency to engage Key Stakeholders, i
including Private Sector on the administration's strategic
direction for Healthcare, include the role of Public-Private
Partnerships, Donor Collaborations and Intergovernmental
relations
Executive Order:
Create Agency for Biosecurity & Biosafety
High August 5, 2019
To give the recently commissioned Biosafety Laboratory-3, a
governance structure and the ability to conduct research and
seek grants/funds for further expansion of capacity.
Headed by an Executive Secretary, with relevant expertise in
Biosecurity and Biosafety
Executive Order:
Create Agency for Medical Emergency
Services (LASEMS) to replace LASAMBUS unit
Medium August 5, 2019
Revamp LASAMBUS in order to improve effectiveness and
availability of emergency services as an agency to replace the
LASAMBUS directorate of the Ministry of Health, to be headed
by a General Manager/CEO and directorates.
Expand Fleet and Emergency Points to include waterways for
Water Transport Emergency
Additional Fleet from Onboarding of Private Ambulances using
IT
Milestones: Health
36. 36
Health Service
Delivery
Project Flag-Off:
Establish Catastrophic Healthcare
Expenditure Fund
Low
September 5,
2019
Provide Seed Fund for Persons with Specified Chronic Dxs i.e.
Cancers, Kidney Disease etc.
Fund to be supported by Donors from Private Sector,
Philanthropists etc
Project Flag-Off:
Project One Health
High August 19, 2019
Inter-ministerial Collaboration for Health and Environment.
Platform to achieve 500,000 Household Target for Health
Insurance
Focus on Preventive Health, Sanitation and Hygiene
Create Demand for Primary Health Centres in selected
community
Executive Order:
Launch Volunteer Corp for Health
High August 2, 2019
Reactivate Volunteer Health Scheme:
Create Jobs, Expand reach of Community Health Workers,
Promote Health
Improve Effectiveness of Primary Health Centres
Project Flag-Off:
Introduce Innovation Challenge for
Healthcare
Medium August 15, 2019
Creates opportunities for innovation in Health Service
delivery, Opportunities for SMEs in mHealth, Improved
delivery of Health Service
Financing for Health
Executive Order:
Approve 1% Consolidated Revenue Fund for
LSHS
High July 1, 2019
1% Consolidated Revenue Fund (CRF) - Statutory as part of
Lagos State Health Scheme Law providing cover for protection
of the poor and vulnerable
Milestones: Health
STRATEGIC THRUST ACTIVITY
PRIORITY
LEVEL
TIMELINE NOTES
40. Once Projects have been activated a 3-point
rating scale will be established for PM monitoring
40
R
G
Y
Score Status
>80%
60-80%
<60%
Definition
On-Track
Watch
Off-Track
Meaning
meets or exceeds performance standard
close to performance standard but does not meet
performance standard
not close to performance standard
41. Pillar 2 Pillar 3 Pillar 5
Pillar 4 Pillar 6
Access to affordable health
care
R
Indicator Status
1. number of Scheme enrollees
2. % of budget spent on health
3. infant mortality rate
4. skilled personnel-to-patient ratio
G
Y
Y
Pillar 1
Indicators Tab View >>
41
42. Pillar 2 Pillar 3 Pillar 5
Pillar 4 Pillar 6
Increase life expectancy
and longevity
R
Indicator Status
1. malaria incidence per 1,000 population
2. % of population connected to piped water
3. air quality index (AQI)
4. full immunization coverage rate
G
Y
Y
Pillar 1
Indicators Tab View >>
42
43. STRATEGIC BUDGETTING
• THEMES ALIGNMENT
• PRIORITIES LSHS, BIOSECURITY AND HR
• IGR
• EFFICIENCIES
• E-HEALTH
• CASCADE ALIGNMENT WITHIN YOUR UNIT
• DEFEND YOUR BUDGET ON FRIDAY AND WEDNESDAY
• MOH WILL ENTER BILATERAL NEGOTIATIONS WITH MEPB
• HOUSE DEFENCE
43
44. Three-Prong Approach
Prong
1
PHC and LG
LSHS
ONE HEALTH
Surveillance
Prong
2
GH
Delivery of
Multidisciplinary
health Strategies
Prong
3
FMOH, LSMOH, All
Tertiary Inst.
PPP, Development
Partners
Strategy, Training,
cutting edge
medicine,
governance and
audit. E-Health.
44