The beginning
In 1999, there were things that put in place by Asiwaju Bola Ahmed Tinubu when he was Governor. He set up different committees to address, one was on health. He established a committee headed by late Prof Olikoye Ransome-Kuti and that committee looked at the health sector and gave its recommendation; where it felt there were challenges. A major one was the primary healthcare; two, how to take care of the poor, and three, health promotion, disease prevention and the issue of immunisation, etc.

That committee gave some recommendations and when I came in and we looked at them and I said to myself the recommendations had made my job a bit easier. We saw the areas of challenge they highlighted. When we came we did not have to start grumping. We decided to start addressing all those issues. If you remember all those programmes that were started, such as blindness prevention, immunisation, HIV and AIDs etc., we were addressing them one by one.

But the challenge was that if we wanted to do health insurance and everybody was talking of free health, we realised that it is more like a financing scheme for any health system. If you have health system with no financing mechanism then you would not go far because no government can raise all the resources for the health sector.

As we got along a couple of years, we decided to have a review of the whole system. That was when we decided to embark on reform of the sector.
Health reform

We sensitised people on the need for reform. Reform basically is to look at areas of challenge that we need to address. We must understand that reform on its own is not the end product. As you are solving a problem, other problems will come up. To restructure the h system, we are going to address the system of infrastructure, human resources. We went about sensitising people and the essence was that restructuring the system has to be reorganising the system itself.

What we did was to let the ministry be seen to be doing what it was meant to do, which was policy making, planning and monitoring and research. We created avenues for people who would provide service delivery so that the hospitals and the facilities would do their bit but let us do the monitoring.

We faced the issue of primary healthcare knowing that primary healthcare is the bedrock of any health system. That is where 70 percent of the basic health problems can be resolved. Once you can resolve that, other things are easier to achieve. That is what health reform is all about.
In the process, we decentralised so many things. To make it easy for decision making so that people can go about doing their work without coming the centre to get direction.

Responsibility and accountability
That was when we decided to set up the Hospital Board for different hospitals to let them take decisions at that level. Gone are the days when you wanted to take a decision when you are in Badagry you will now have to come to Lagos.
If you recall, in those days, most hospitals were mere consulting rooms. If you didn’t have a proper facility to work then the people would not work. The doctors were restless because they had nowhere to work and no tools to work with. Hard decisions had to be made. Of course we made some decisions, some people were not happy but the decisions we made were for the benefit of the people.

We addressed the issue of infrastructure, refurbishing hospitals, building new ones, modernising some. We needed to divert money to do that. Some things had to suffer. You could not recruit as many people as you wanted. But again, Lagos state has a huge population, as you are making progress more people are coming in and adding to your burden.

Healthcare financing
The major issue we were addressing was healthcare financing. How do you cater for the poor? Whether you like it or not, a lot of people are poor. That was why we decided on free health schemes. But how do you provide free health services when you don’t have resources? If you are going to provide free health, you will spend a lot of money which is not there.

That was why we have to adjust, and say, children 12 years and below and adults from 60 years are treated free. Even to provide that was a huge challenge. Any government would have to look at how to raise funds to address the health sector which is the issue of the health insurance scheme.

So Nigeria or Lagos will not be different. We decided to do pilot project in this area and see how people would react so that we can see our mistakes and see how we can address them.
We are running four pilot schemes now. We have seen what could be done. Luckily , the House of Representatives has passed the bill and it has been assented to by the Governor.

The next thing is implementation. If the Law is properly implemented, the poor will be properly protected, service delivery will be better because, now, you are raising more resources. You can bring in the private sector to improve the number of people you have that can provide services.

Government now can plan with the money and face public health infrastructure which is what the role of government is including disease prevention and health promotion.

Health Infrastructure
Everybody is talking about Ebola but we are not there yet because the public health infrastructure is not there. We are on our way but we are not there. We still need to sit up. The media has to enlighten the people on hand washing etc. People need take responsibility about their health.

The health sector is complex but without it, you can’t have economic progress. People have to be healthy before they can be productive. We have made progress because different administartions increased budgetary allocation to the health sector. We still have a long way to go. Another major challenge in the health sector is human resource.

Trying times
Most trying times for me were the period of strikes. I understand the strikes happened because the health workers were not happy. The conditions of service are there but they are poorly paid. That is a fact. But, again, you have to weigh what they are paid and the resources of the country. If you need to make progress, all those things have to be addressed. Nobody will be happy if the health workers are on strike because it is the people that will suffer. That is why we must do everything within our capability to ensure that those strikes do not happen. The health workers must learn to resolve their issues without strike, without putting people at a disadvantage.

They must embrace dialogue. Again, there are roles government has to play. It is a two-way thing. In this world, if you fight a battle or war, at the end of the day, those who fight the war will come back to the table to dialogue. So why kill people? Why allow people to die? It takes courage, it takes determination and commitment for health workers to sit down,d iron things out and work together. But it can be done.
Message to successor

In the spirit of Lagos there is continuity. Governor Fashola built on what Asiwaju Tinubu did and I am very sure that Governor Ambode will build on what Fashola has done. Our benchmark is different and Lagos state is better for all.
Success

It is always good when given the privilege to do something, you make that place better than you met it. I did not do it alone. Jide Idris worked with some dedicated teams. Many times we fought and many times we laughed. Some people say Idris shouted. It is a matter of opinion. Some people say he will just look at you and when you finish talking, he will say bye bye. But the fact remains that everybody came with something positive and we worked together as a team. Nobody is an island. We worked together and Lagos state is better for it.