Research identifies ‘spatial injustice’, brain drain as major challenges facing healthcare in Lagos

A new research has identified “spatial injustice” and brain drain, among numerous others, as key factors affecting the provision of quality and affordable public healthcare services in Lagos State, Nigeria’s commercial nerve centre.

These were part of the findings of the African Cities Research Consortium (ACRC) in a recent research titled: “Lagos City of Systems: Food Security, Health and Safety, Environmental Sustainability”.

ACRC, according to the consortium’s Lagos City Lead and Professor of Urban Development and Governance at the University of Lagos (UNILAG), Akoka, Taibat Lawanson, is a six-year investment by the Foreign, Commonwealth and Development Office (FCDO) of the United Kingdom, which is targetted at funding “new, operationally-relevant research to address intractable development challenges in African cities”.

Mrs Lawanson presented the research findings during an annual education summit by the Education Writers’ Association of Nigeria (EWAN), a body of journalists reporting educational matters in Nigeria and beyond.

On hand to support the researcher was the consortium’s Director of Uptake and Professor of Communication, Ismail Ibraheem.

The researcher said apart from the healthcare sector, the research also looked into other areas including transportation, water and sanitation, waste management, energy, food distribution, finance and ICT, law and order, and education.

Findings

Breaking down the findings, Mrs Lawanson said the term “spatial injustice” refers to the city’s uneven distribution of health facilities, noting that both the facilities and personnel are skewed towards Lagos Island.

She added that brain drain within the healthcare sector has led to an exodus of health workers from the state abroad, adding that the “demon of papers” are also critical challenges affecting the provision of good health system in the city.

“The demon of papers is another thing that is grinding on us. In the health sector, we were unable to get real-time disease surveillance systems because of paper-based health records,” she said.

She said her team raised some fundamental questions about reconciling the brain drain and what interventions are necessary to mitigate against the impact.

The researcher said: “We also considered how healthcare facilities could be more equitably distributed; the role of technology in health management; the effect of the commodification of healthcare on healthcare mandate, and the impacts of the infrastructural gains of COVID-19 on the healthcare infrastructure in Lagos “given extensive investments across the board and Lagos, being a beneficiary of so many health funds towards addressing the pandemic.”

She said the research also noted the prevention and non-formal medical systems, and that advocacy for health-promoting behaviour is not well entrenched in the city’s health systems planning.

On water, sanitation

Mrs Lawanson said the research revealed that Lagos State has a daily water demand of 3.83 billion litres per day as of 2021 but that only 40 per cent of this is provided by the Lagos Water Corporation (LWC) daily, and that less than 16 per cent of the population gets water from the corporation consistently.

She said informal service providers, “especially at community levels are either unrecognised or criminalised, even though informal water provisioning is more reliable- though largely unsafe.”

“Despite official rhetoric, sanitation is not prioritised and no LGA in Lagos State has been declared open-defecation free. There are no clear operational procedures, technologies, facilities, and safety mechanisms in place to oversee sanitation work or workers, and workers have limited access to occupational health and safety protection measures,” the research further noted.

The university lecturer urged the government to consider reconciling what she described as the position of “water as an economic good and the view of civil society of water as a social justice.”

“How can we recognise, upscale, and regulate the activities of local water and sanitation service providers? This is because unlocking the potential of those who work in the sector will catalyse improvement in that sector,” she added.

On waste management

Mrs Lawanson said the research revealed that 50 per cent of waste generated in Lagos is food waste, noting that though the city has the longest history of organised solid waste management in Nigeria, “it has been unsuccessful with waste separation from source.”

“The research identified huge informal sector participation in the waste sector, though with recurrent prohibitions by official waste regulators, and found plastics and recyclable products as an emerging resource, largely driven by informal actors.”

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To address the concerns around waste management, the researcher suggested “mainstreaming the process of informal waste worker formalisation, especially waste pickers, recyclers, dumpsite sorters, among others.”

Review

Reviewing the recommendations after the presentation, a Professor of Environmental Law and former Vice-Chancellor of Lagos State University (LASU), Olanrewaju Fagbohun, said apart from the fact that the report is comprehensive, it is captured in very simple language “and you have broken it down into the different sectors.”

He said as an outcome of empirical studies, the recommendations must be embraced by all, “particularly the state government.”

“If we are going to implement this document, government must be ready to invest in it, and no investment will be too much if we consider the focus as a sustainable city. We must therefore consider participatory cooperative research approach and knowledge cocreation so that the local communities can be carried along,” Mr Fagbohun said.

Government reacts

Reacting on behalf of the Lagos State Commissioner for Basic and Secondary Education, Jamiu Alli-Balogun, the Director of Education Resource Centre, Omolayo Akinlade, thanked the consortium for the efforts, and pledged the support of the state in the implementation of the recommendations.

“The administration of Governor Babajide Sanwo-Olu is is a listening one, and that is clearly evident in the passion and commitment towards achieving the T.H.E.M.E.S plus agenda, which have incorporated almost all the sectors touched in the research,” she said.

Mrs Akinlade said she would make the document available to the commissioner but pleaded with the organisers of the event- EWAN, to provide avenue for all the concerned ministries and agencies to have access to the recommendations.

ACRC target

The research consortium currently operates across 12 African cities of Lagos, Maiduguri in Nigeria; Accra (Ghana), Addis Ababa (Ethiopia), Kampala (Uganda), Dar es Salaam (Tanzania), Freetown (Sierra Leone), Mogadishu (Somalia), Nairobi (Kenya), Lilongwe (Malawi), and Bukavu in the Democratic Republic of Congo.

According to Mrs Lawanson, the consortium is tasked with rethinking approaches to urban policies and programming.

About EWAN Summit

Annually EWAN organises summit on key issues within and around the education sector with the sole purpose of bringing together relevant stakeholders to identify solutions and ensure proper implementation.

The last edition, where ACRC’s research findings were presented, was themed: “Research for National Development: Nigeria’s Internal Security in Focus”. The keynote speaker was the immediate past Vice-Chancellor of the University of Lagos (UNILAG), Akoka, who is currently the Chairman of Lagos State Research and Innovation Council (LASRIC), Oluwatoyin Ogundipe, a professor.

The forum drew critical stakeholders from government, industries, and academia including vice-chancellors and rectors, and representatives of civil society and the labour union.