Laudable Achievements in Health Sector Under Otunba Gbenga Daniel's Watch, by Ajibola Osunjimi

The Health sector in Ogun state before Otunba Gbenga Daniel assumed office before 2003 could be said to be in comatose, it was during OGD's dispensation that the sector was resuscitated. Not only was the health sector vision-driven, it also enjoyed the administration's attention within the period of 8years.
The conceptual basis of the administration's programmes was spelt out thus:, "increase access to qualitative health care facilities, especially in rural community and to continously provide top-rate medical services across the State".
This vision became inevitable in view of the unpalatable situation of the health sector of Ogun state before the assumption of office of the Administration in 2003. Before then, the health sector was characterized by:

- Scarce resources were being utilized inefficiently;

- Inefficient management of existing services;

- Over centralization of health management;

- Low accessibility and utilization of services;

- Slow response to disease outbreaks and emergency service;

- Haphazard monitoring and supervision of services; and

- Inadequacy of drugs and skilled manpower at the Government Hospitals.

The firsthand experience gained during the tour of the 236 wards and about 1, 000 towns in all the twenty (20) Local Government Areas (LGA's) of Ogun state, prepared the Administration for what it had to do in the health sector as the team became fully aware of the enormous challenges in the health sector.
Therefore, the vision of the health sector was to enhance the quality of life for the people through the provision if excellent,  effective and efficient health services as well as to provide quality, accessible and affordable health care services to people living in the State, especially in rural community. The State Government's policy on health services is "Pro Poor".

The spring board for the take  off of these policies was the rejuvenation of the moribund  Health Management and Information System (HMIS) to conduct the study and data gathering. The data produced enabled planning for the State's health services and formed the basis for the establishment of some agencies like Ogun State Accident Service (OGSAS),  the strengthening of Olabisi Onabanjo University Teaching Hospital, School Health Services and Ogun State Primary Health Care Development Board to facilitate the execution of the health policy of the Administration.

The rejuvenation of the HMIS led to the production of First Health bulletin in Nigeria and massive recruitment of health workers from 1,175 in the year 2003 to 3,085 in 2011. Furthermore, the State could  only boast of 7 Consultants in the year 2003 and this was increased to 30 Consultants by 2011.

The State Government distributed 60 Computers and 20 laptops with full accessories to LGAs Monitoring and Evaluation/DSN officers, health training institutions, School of Nursing and Midwifery and the Ministry of Health. This was to enhance timely and complete collection, collation and analysis of qualitative health data. This data is subsequently disseminated through the publication of annual health bulletin and also used for informed decision making. The Ministry also introduced monthly data collation meetings to update the information contained in the data bank as well as annual  Local Government Health awards to encourage local level health data collection.

In order to draw the attention of the Government and the civil society to health problems, the slogan "Health is Wealth" was devised. In Ogun State, the Administration drove its programmes beyond the ambits of mere sloganeering and took concrete measures  to tackle the challenges.

The areas of focus of the Administration included:
- Increase access to qualitative healthcare facilities especially in the rural communities; and

- Continuous provision of top-rate medical services across the State.

In Conceptualizing its health programmes, the Administration had outlined certain targets/sub-goals in accordance with the Millennium Development Goals (MGDs). These included:
-At least one secondary health facility per Local Government and one Primary Health Care Facility per Ward.

- One State Hospital per Health zone and Empowerment of the State Teaching Hospitals to handle referrals.

- Improve contact of rural populace with specialist medical professionals.

-Promote the health of school children and adolescents.

-Combat the scourge of HIV/AIDs, Malaria, Tuberculosis,  Onchocerchiasis and Guinea worm.

A cursory look at how the Administration has gone about the execution of its programmes will reveal the best practices in the Ogun state health sector.

PRIMARY HEALTH CARE
The engine room of Government's primary health  care activities was the Ogun State Primary Health Care Development Board created in 2009 after the Federal Government mandated all the States in the Federation to establish one. The board was created with the mandate of making preventive health care affordable, available and accessible to the people.

Since the inception of the agency in January 8, 2009, Otunba Gbenga Daniel did not spare efforts in ensuring that the board actualized its mandate.
While other States that had created their boards were yet to get suitable office accommodation, Otunba Gbenga Daniel provided office accommodation for the Ogun State Primary Health Care Board in the old Ogun State Broadcasting Corporation (OGBC) building at Ibara Housing Estate, Abeokuta, Ogun state.

Moreover, it is to the credit of the Otunba Daniel-led administration that the Bill setting up of Ogun State Primary Health Care Development Board was expeditiously signed into law in April, 2010. This is a significant record time for the passage of the bill and its signing into law, considering that other states were yet ti get their own bills signed into law.
This further showed the readiness of the OGD led administration displaying high level of efficiency, pragmatism and above all uncommon dexterity in handling a purposeful governance.

Prior to the creation of the Board in Ogun state, the Primary Health Care Programme was handled by the Ministry of Health and the activities include, among  others, coordination of immunization exercises, roll-back malaria programme, health education of the public, reproductive health programmes and the servicing of nutritional needs of the vulnerable.(i.e children). With the creation of Primary Health Care Development Board, the department of PHC in the Ministry of Health was renamed Department of Public Health to reflect  the new global best practice.

Several milestones had been covered by the administration of Governor Gbenga Daniel in its Primary Health Care Development Programmes.
These included the following:
-Local Health Authorities: Eleven (11) out of the 20 Local Governments in the state constituted their Local Health Authorities in line with the Federal Government guideline that each Local Government in the state should establish Local Health Authorities that would provide the primary health care services at the local level. The remaining others were making efforts to do so. The seriousness with which Otunba Daniel viewed this project was aptly demonstrated when he inaugurated the Local Health Authorities of Yewa North and Yewa South Local Governments on March 27, 2009.

Immunization:The Ministry of Health had been an active participant in several routine immunizations. When the board came into being, it continued with the tradition. The board had participated in the National Immunization Plus Days (NIPDs), Supplementary Immunization Plus Days (SIDPs) and the Local Immunization Plus Days (LIPDs).
It is on record that the Otunba Daniel administration scored 100 per cent and came first in the Federation having met all the guidelines set by the Federal Government in Health Care Activities in the whole of the South-West.

Roll-Back Malaria: It was during the tenure of Otunba Daniel that Ogun state was awarded first position in 2009 at the National Conference organized by the National Malarial Control Programme in Enugu. In the bid to reduce morbidity and mortality rates attributed to malaria, this Administration in December, 2009, distributed over 1.6 million pieces of Long Lasting Insecticide Treated Nets (LLITN) to households in Ogun state in conjunction with the Society for Family Health (SFH).

Reproductive Health: To enhance the practice of Reproductive Health, traditional and mission birth attendants in Ogun state were mobilized and trained by the board.
Furthermore, in order to reduce maternal and neonatal mortality, the board collaborated with the National Primary Health Care Development Agency to commence the Midwife Service Scheme, whereby the Federal Government paid midwives engaged in the pilot scheme in designated Local Governments across the country.

Cold Chain and Dry Store: An Ultra Modern Cold Chain and Dry Store which meets international standard was built by a development partner,  the EU-PRIME, in collaboration with the State Government. The cold chain store is still in use till this moment.

The work done by the Administration in the area of  Primary Health Care was laudable and has been described as a role model to other States in the Federation. It was not surprising that some states like Ekiti, Kwara and Nasarawa sent delegations to understudy Ogun State Primary Health Care Development Board.

HOSPITAL SERVICES
The services in the General and States Hospitals were nothing to write home about prior to 2003. Despite the Execution of African Development Bank's Assisted Programmes in the hospitals, signs if neglect and decaying infrastructure were visible.
With the emergence of the Administration in 2003, the conditions of our hospitals improved tremendously. The policy of each Local Government having a General Hospital was implemented under the administration. Three new General Hospitals were built in Omu-Ijebu, Itori and Atan making it 29 General Hospitals in the state.
There was also a realization about the importance of adequate staff in the health sector. Despite the raising wage bill, coupled with diminishing funds, the Administration did not have any cause to retrench staff in the health sector. instead,  because of its shrewd use of funds and blockage of wastage in the system, more people were employed. Consequently, the number of doctors in the hospitals increased by over 300 per cent (from 46 - 156),  the number of pharmacists by 400 per cent (from 11-47), the number of laboratory scientists by 400 per cent (from 14-52), while the number of nurses increased by 50 per cent (from 539-792).

With the provision of facilities such as modern medical equipment, adequate portable water(through the provision of boreholes) and provision of Generators, the General Hospitals were certified for the training of House Officers and Post-Graduate Doctors. In addition, one of hospitals, the Ijaiye State Hospital was certified for the training of Specialist Doctors by the West Africa Post-Graduate Medical College.
Other positive development brought by Otunba Gbenga Daniel's initiatives were:
- Construction of obstetrics and gynaecology buildings, furnishing and supply of equipment at State Hospital, Ota;

-Fencing and Landscaping of  General Hospitals at Itori and Olikoye Ransome-Kuti Memorial Hospital, Asero;

-Renovation of General Hospital, Ijebu-Ife, which was renamed Olumayowa Olukoya Hospital;

-Continuous provision of HIV screening tests for all citizens at subsidized rate;

-Collaboration with several non-Governmental organizations and USA based concerned Nigerians for various free eye surgeries, repair of cleft lips and palates and other medical operations;

- Provision of Ambulance Services and

-Provision of free ante-natal services.

TERTIARY HEALTH CARE
The Olabisi Onabanjo University Teaching Hospital (OOUTH) was the nerve centre of the administration's tertiary health care during the period. With the accelerated development of infrastructure and provision of equipment  and facilities, OOUTH was raised up to become one of the leading medical institutions in Nigeria. The administration was conscious of the need to reinvigorate the facilities at the tertiary health care sub-sector in order to complement the laudable services that were in place at the primary health centres and General/State hospitals.

The efforts to boost the tertiary health were as glaring as they were legion.They included:
- Construction and Equipping of an Accident, and Emergency Complex with modern facilities for the resuscitation and treatment of trauma patients.

- Construction of ultra-modern morbid anatomy and histopathology complex.

- Modernization / beautification of the Hospital Complex.

- Provision of hospital equipment, including two dialyses machines, incubator, patient monitors, electrophoresis machines, vehicles, and other life saving medical equipment.

- Construction and equipping of ultra-modern diagnostic centre with CT scanner, mammogram, fluoroscopy and static and mobile ray;

- Renovation of Gynaecological wards and flats of resident doctors, and construction of 14 studio apartments for doctors.

- Provision of first class Trauma and Diagnostic centre in which the administration partnered with the private sector to reduce dependence on Government and for sustainability of the project;

- Construction of private wards.

- Employment of fellows at OOUTH, which was increased from nine (9) in 2003 to thirty-two (32) in 2011(an increase of over 200 percent.

SCHOOL HEALTH SERVICES
The health-friendly Government was very much interested in the health of children and adolescents in the State and this led to the resuscitation of the School Health Services in September,  2007. The Scheme employed 250 Nurses and 350 Community Health Workers deployed to Primary and Secondary Schools in the 20 Local Government Areas(this method can be adopted by the present administration as Covid-19 is ravaging the world).
Regular activities of the School Health Workers include
 - Screening and treating of students for minor ailments;

- Supervision of school meals and screening of school food vendors.

-Educating teachers and students towards having a healthy environment

OTHER PUBLIC HEALTH SERVICES
The Ogun State Rural medical Scheme (OGRUMED) was the flagship of the public health service introduced by the administration. It provided free specialist medical and surgical expeditions to the teaming rural dwellers free of charge. It was re-packaged as OGRUMED PLUS in 2010 to reflect the new emphasis on preventive Medicare.
A key element of OGRUMED PLUS is OGRUMED HOUSE TO HOUSE which deploys CHEWS to
- Screen household members for communicable and non communicable diseases;

-Treat minor ailments;

-Educate household members health wise;

-Check immunization status of children in the houses; and

- Educate on usage of Insecticides Treated Nets (ITN)

The scheme also helps in improving hospital utilization as awareness was created during the program, health facilities used are repaired/renovated by both the State/Local Government and the Community.
Some of these achievements under OGRUMED are as follows:

- Over 4000 surgeries were performed with no death recorded.

- Over 17,550 (ANC) Free welfare care for Pregnant women

- Over 6,450 free deliveries

- Distribution of over 5,000 free eye glasses;

- Free ante natal and post natal delivery services for all pregnant women;

- Health talk to all Local Government officials;

- Decrease in Infant mortality rate form 26/1, 000 in 2003 to 13/1, 000 in 2011;

-Decrease in Maternal Mortality rate from 178/1, 000 in 2003 to 140/1, 000 in 2011;

-Complete eradication of Guinea Worm and polio in the state

OGUN STATE ACCIDENT SERVICE (OGSAS)
This is also an initiative of the Administration which has helped to reduce deaths due to road traffic accidents. It is a medical emergency outfit established by the Administration on assumption of office in 2003 to attend to prompt evacuation and treatment of road traffic accident victims on the highways in Ogun state. In this respect, four ambulance points were established at Ibafo, Sagamu interchange, Ijebu-Ode and Wasinmi.
The responsibilities OGSAS included:
- Provision of prompt rescue to victims of Road Traffic Accident (RTA) on our highways.

- Offering succour and relief to the patients in their hour of needs;

- Offering of health education and counselling to the populace on ways of reducing RTA;

- Liaising with other law enforcement/security agencies and stakeholders on safety issues;

- Provision of medical treatment free of charge for the first 24hours until relations of victims are located; and

- Creation of a reliable trauma management mechanism for Ogun state.

From inception in 2003 to 2011, there have been 2,618 RTA cases,  15,918 victims and 1,484 deaths. The fatality rate on our highways was reduced from 15.2% in 2008 to 7.7% in 2011

*CONCLUSION*
The applause of the citizens for the first-class health services could be heard beyond the borders of Ogun state. Driven by team work and vision, the State's health sector was rejuvenated. For the first time, the primary health care became functional as services were taken to the doorsteps of citizens, both in urban centres and rural areas. With a clean environment, the warmth and responsiveness of health workers and availability of drugs, the hospitals became centres of medicare in the true sense of the word. There could be no doubt that a greater number of Ogun state citizens had access ro quality and affordable health services in the state within the period under review.

The reforms introduced also led to the eradication of Guinea Worm and Polio in the communities. A reduction in infant mortality rate was achieved.
Prior to 2003, it was 26 per 1,000 but was reduced to 13 per 1,000. Maternal mortality rate was reduced from 178 per 1,000 to 140 per 1,000. Hospital utilization rates increased from 112,934 in 2004 to 343,241 in 2007. There was a noticeable reduction in HIV prevalence rate from 3.6 percent of the entire population of Ogun state in 2005 to 1.7 percent in 2008.
All this can be attributed to the reforms in the health sector in terms of free drugs, quality health care services, free ante-natal and delivery services for all expectant mothers. The increase in the number of General Hospitals and the upgrading of the old ones helped to restore confidence  in the delivery of health care service in Ogun state. It must be mentioned here that the arrival of the HMIS also contributed to the improvement in the health sector through regular data-gathering and monthly data sharing meetings. The data served as a platform to adequately plan for the health care of the citizens.