This document discusses considerations for improving urban health outcomes in African megacities, using Lagos, Nigeria as a case study. It analyzes progress on key social determinants of health in the Lagos megacity region (LMCR), including transportation infrastructure, governance challenges, and recommendations. Transportation in LMCR faces issues like inadequate infrastructure, poor maintenance, lack of integrated systems, and overreliance on motor vehicles. This leads to health problems from traffic, accidents, and pollution. The document recommends expanding diversified transportation and improving governance coordination between various agencies to better deliver social services.

1. CONSIDERATIONS FOR IMPROVED URBAN HEALTH
OUTCOMES IN AFRICAN
MEGACITIES.
CASE STUDY- THE LAGOS MEGACITY REGION.

2. WHY LMCR/ AFRICAN MEGACITIES?
 Africa- fastest urbanizing region of the world
 Urbanization occurs in advance of an industrial basis for
growth
 Implications on health especially due to poverty
 LMCR- Located in Lagos state- smallest state in Nigeria
 Houses 1/3 of the urban residents of Nigeria
 Houses 90% of the population of Lagos state-
considered a city-state
 Largest conglomeration of the black race
 Projected to be 3rd largest megacity next to Tokyo and
Bombay by 2015
 Case study for rapid urbanization especially in the
context of development

3.  Analytical evaluation of progress on social determinants
of health in the Lagos megacity region
- Health equity
- Transportation
- Governance
- Food security
- Water and sanitation
- Safety
- Health care
- Environment

4. TRANSPORTATION IN THE CITY
 Transportation policies
 Infrastructure
- mass transit options
- non-motorized transport options
- sidewalks, streetlights, traffic signals, pedestrian
and cycle safety,
- integrated systems of transport
 Maintenance

5. LMCR
 71% of traffic congestion – infrastructural inadequacies
 Poor maintenance
 Poor roads
 Poor traffic planning
 Lack of integrated transport systems
 Low road network density
 High traffic levels- Few roads carry most of the traffic
 Poorly developed connection between transport and
urban planning`
 Heavy reliance on motor vehicles
 Mobility is mostly road based
 Poor parking, streetlights, and pedestrian facilities

6. HEALTH IMPLICATIONS
 Poor quality of life- increased stress and time in
commuting
 Poor development- reduced productivity
 Increased incidence and risk of accidents
 Sub optimal physical activity level
 High incidence of accidents
 Poor air quality due to high traffic and poor quality of
cars- poor environmental and respiratory health
 Poverty- 20% of household budgets spent on transport
by the urban poor
 Use of healthy transportation options like cycling and
walking unsafe and impracticable

7. ACHIEVEMENTS
 Lagos Metropolitan Area
Transport authority
(LAMATA) (2003)
 Road expansion
 Bus rapid lite transport
system (BRT-lite)
- improved mobility along
corridors
- reduced congestion
- reduced travel and waiting
time
- reduced emissions
- reduced stress

8. TO DO
 Increasing diversification of transport options
 Shift from mainly road based to water, railway, etc
 Need to integrate means of transport
 Expand coverage of the BRT-lite
 Choice of healthy transport options
 functional and maintained streetlights, traffic signs, sidewalks,
bike lanes, etc
Effects
 Reduced emissions- better air quality
 Reduced risk of accidents
 Reduced traffic congestion- improved well being
 Increased physical activity

9. GOVERNANCE IN LMCR
 Lagos state- 20 Local government areas- 57
administrative units- LCDAs
 20 of 16 LGAs- LMCR
 Governance mediates translation of policies to
development at the grassroots
 Therefore LGAs impact provision of social
determinants of health

10. CHALLENGES
 1. Role conflict between multiple governance
instruments
e.g. Downstream oil regulation
Department of Petroleum Resources, National Oil Spill
Detection and Response Agency, Lagos State
Environmental Agency, Federal Ministry of Environment,
National Environmental Standards and Regulation
Enforcement Agency, Nigerian Maritime Administration
and Safety Agency, Nigerian Ports Authority
 inefficiency and diffusion of responsibility
 Need for strategic framework for intersectoral
collaboration

11. CHALLENGES
2. Constitutional ambiguities
 Item 17 in concurrent legislative list
- right to make laws on health safety and welfare –
national assembly
 Item 19 in concurrent legislative list of constitution
of FRN
- right to make laws on health safety and welfare -
state assemblies
 conflict in delivering social determinants of health
between agencies with similar mandates

12. CHALLENGES
 3. Need for improved monitoring and accountability
 Govt policies↔ Local Govt
↔Grassroots development
 Poor accountability
 abandoned contracts
overestimation of project
costs
 poor infrastructure- roads,
health services, potable water

13. THANK YOU!
 Questions?