THE INVESTMENT CASE (IC) DOCUMENT
SUMMARY OF THE INVESTMENT CASE (IC) DOCUMENT
ORIGIN OF THE IC:
In a bid to strengthen the performance of the Health Sector, the Ministry of Health initiated a collaborative effort with UNICEF to organise a 2-day Investment Case Advocacy and Health Partners Forum in December 2010.
OBJECTIVES OF THE IC:
THE INVESTMENT CASE is essential as an advocacy tool for mobilization and allocation of resources through the promotion of result driven expenditures by linking health budgeting to outcomes. This is in order to improve the Healthcare system.
The investment case has a work plan which allows for the effective implementation of the IMNCH(Integrated Maternal,Newborn and Child) strategy to achieve the MDGs 4,5&6 by adequately estimating financial requirements needed to provide these key interventions which are high impact and cost effective.
All of these and other processes have led to the production of an Investment Case document, which represents an advocacy tool for leveraging of resources from both the government and private sector to address, especially issues of inequities/disparities and facilitate attainment of health goals.
METHODOLOGY:
Data processing and preliminary analysis took place in 2011. The modeling was based on the recommended data collected during different workshops and made use of the costing and impact estimates tool called Marginal Budgeting for Bottleneck (MBB) Tool developed by The World Bank, UNICEF and The African Development Bank .
JUSTIFICATION
The city of Lagos, the 5th largest city in the world and the largest city in Africa was predicted to attain the status of Mega-City by 2015. However, with a projected population of 20.5million and an estimate of 24.4 million by 2015, Lagos would rank as the 3rd largest city in the world (behind Tokyo and Mumbai) and constitute the aggregate population of more than 32 African countries.
Without adequately planned investments in basic infrastructure, rapid population growth has led to unhealthy and deteriorating environmental conditions and sprawling urban slums. Urban investment will therefore unquestionably result in improved quality of life for many especially to include the high proportion of the world’s most severely deprived people who still live in rural areas
Promising Windows of Opportunities/ BENEFITS TO THE STATE:
The Government needs to continue its efforts to increase allocation to health and consequently health expenditure. It is important that transparency is seen in all spending processes and therefore government expenditure profiles should be made readily accessible and available. The Lagos State Government is currently in the planning phase in conducting a Public Expenditure Review (PER) in the health sector. It is hoped that this transparency process will attract opportunities for investment in the health sector.
• Public-Private Partnerships:
Lagos State Government has developed a vibrant private sector participation (PSP), public-private partnerships (PPP), in service delivery and infrastructure development.This should be sustained in the Health Sector.
• Policies on Poverty and Economic Inclusion
The overall objective of the Lagos state government has been to transform Lagos into Africa’s model Mega city; to build a world class city state that is clean, secure, livable, that functions efficiently and enables the people to express their potentials.
• Physical Development Policies and Programmes
The momentum behind the need to plan for sufficient health infrastructures to meet growing population needs, upgrade slums (in particular, investment in water and sanitation) and deal with the poor, unsafe housing issues, needs to be sustained. The current initiative to upgrade 7 slums in Lagos (LMDG programme) should be scaled up to cover the over 100 slums scattered all over Lagos
RECOMMENDATIONS:
1. Bring health services closer to communities
• Rehabilitate and revitalize primary healthcare (PHC) centres
• Increase the human workforce available to the most under-served populations
o Recruit, train and supervise more community health extension workers
o Institute rotating posts for doctors and nurses, along with performance-based financing
o Use performance-based contracts with private health providers
o Remove financial barriers:
Establish a State Health Insurance Scheme to provide social health protection for all
Effective free care initiatives,
Pilot Conditional Cash transfers
Close gaps in continuum of care through a re-energised and pro-active outreach programme in most under-served areas
Keep the momentum and strengthen existing campaigns
Identify champions at the highest level in Lagos State to campaign for the reduction of the fertility rate and for birth spacing of children
2. Bring communities closer to health
• Strengthen partnerships with community-based enablers and promoters
• Revitalize the role of Ward Health Development Committees
• Ensure the wards appoint community volunteers to support their role and ensure representation on public health-care centre management committees, the active promotion of health, and feedback and consultations with their ward members
3. More money for health, More health for the money
• An average of additional 15USD per capita per year until 2020
• With a progressive investment from 10 to 20 USD per capita per year until 2020
• Reduce U5 Mortality of 50 % by 2020
• Reduce maternal mortality by 30 % by 2020
• Guarantee the right to essential services to all Lagosian
• For a level of investment that is fully in Lagosian fiscal space
To this end, the Ministry of Health in collaboration with UNICEF launched the Investment Case Document by His Excellency, the Governor of Lagos State, on the 16th March, 2012.
