Considerations for improved urban health

outcomes in the Lagos megacity region

Mogo, Ebelechukwu R. I.
Intern, World Health Organization Centre for Health Development,
Kobe, Japan
February- April 2011

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 Table of contents

1. Introduction to Lagos megacity

2. Internal health inequities in the Lagos megacity region
3. Transportation in the Lagos megacity region
4. Governance in the Lagos megacity region
5. Food security in the Lagos megacity region
6. Water and sanitation in the Lagos megacity region
7. Safety in the Lagos megacity region
8. Environmental issues in the Lagos megacity region
9. Conclusion
10.References

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 1. Introduction to Lagos megacity

Figure 1: Map of Nigeria: Adapted from WHO Country Cooperation Strategy for Africa, 2008-2013

Location, history and administration

The Lagos mega city region is located in Lagos state; one of the thirty six states of which the
Federal Republic of Nigeria is comprised. Lagos state is an elongated state located in the South-
Western region of Nigeria along the coastal flood plain of the Bight of Benin (Johnson, 2010). It
shares borders with Ogun state of Nigeria to the north, the Republic of Benin to the west and the
Atlantic Ocean to the south and it spans the Guinea coast of the Atlantic Ocean for more than
180 kilometres (Johnson, 2010). Lagos state occupies a land area of about 3577 square
kilometres with approximately 22 percent of this land area being occupied by water (Lagos State
Government, 2011). It lies between latitude 6°2 North to 6°4 North and longitude 2°45 East to
4°20 East (Johnson, 2010). Lagos state is a wetland region, with a dominant vegetation of fresh
water and mangrove swamp forests. It is prolifically drained; lagoons, rivers, canals and creeks
make up the majority of its water bodies and together, they constitute about a fifth of its land
area (Lagos State Government, 2011).

Lagos state is the smallest of the 36 regional administrative states of the Federal Republic of
Nigeria, occupying about five per cent of the land area of Nigeria - 356,861 hectares, 75,755

3
hectares of which are wetlands (Lagos State Government, 2011). This notwithstanding, Lagos is
the most populous state of the Federal Republic of Nigeria, and houses between five to eight
percent of the total population of Nigeria, with the mega city area housing more than a third of
all the urban residents in Nigeria (Okunlola, 2011).

At the heart of Lagos state lies about 153540 hectares of land known as the Lagos mega city
region (Bamidele, 2008). The mega city region lies between longitudes 2° 42E and 3°22’E and
latitudes 6° 22N and 6° 42N of the equator (Rasaki, 1988). Although it occupies only 37% of the
land area of Lagos state, this metropolitan area of Lagos state is often considered a city-state as it
houses about 90% of the population and is the nerve centre of the economic activities of the state
(Rasaki, 1988). This paper will therefore often make reference to the Lagos megacity
region/metropolis simply as Lagos.

The Lagos megacity region, Nigeria’s most populous area and the largest conglomeration of the
black race is considered one of the fastest urbanizing regions in the world (Rasaki, 1988)
(Bamidele, 2008). It is projected to be the third largest megacity in the world next to Tokyo in
Japan and Bombay, India (Lagos State Government, 2001, Okunlola, 2011).

In accordance with the constitution of the Federal Republic of Nigeria, Lagos State Government
is made up of three arms of government namely; the Executive Arm which is the decision
making body, the Judiciary Arm which administers justice in the different state courts, and the
Legislative Arm of the state, known as the State House of Assembly. The Executive Arm of
Lagos State Government is made up of the Office of the Executive Governor, currently occupied
by Babatunde Raji Fashola (Senior Advocate of Nigeria), the Office of the Deputy Governor,
currently occupied by Princess Sarah Adebisi Sosan, the State Commissioners for each of the
ministries, and the Special Advisers on key social issues (Lagos State Government, 2011). The
Judiciary is made up of the office of the State Chief Judge, the Chief Registrar, and two Deputy
Registrars (Johnson, 2010). The State House of Assembly is led by the speaker and is comprised
of elected members selected from different parts of the state, the Deputy Speaker, the Majority
Leader, the Deputy Majority Leader, the Minority Leader, Chief Whip, Deputy Chief Whip, and
Minority Whip (Johnson, 2010).

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Although recorded socioeconomic activity in the region now known as Lagos occurred as early
as the 15th century when it was a trading port, the official creation of Lagos as a state occurred a
few years after Nigeria’s independence in 1960, on the 27th of May, 1967 (Johnson, 2010).
Before the creation of the State of Lagos in 1967, the region now known as Lagos had formerly
been administered by two different local governments (Johnson, 2010). Metropolitan Lagos,
known as the city of Lagos, was administered by the Lagos City Council, and the colony
province of the now defunct Western region of Lagos was administered differently, having two
divisional councils, twelve districts and four local councils. With Lagos state’s creation in 1967,
there was need for a harmonization of the two administrative local governments that had been
inherited by the new state (Johnson, 2010). In August 1971, the two administrative systems were
harmonized to create seven administrative units. This structure has been changed several times
over the years, and by 2002 Lagos state’s 20 local government areas were further divided into 57
administrative units known as Local Council Development Areas for ease of administration.
Overseeing these Local Governments are the five administrative divisions of Ikeja, Badagry,
Ikorodu, Lagos Island and Epe (Lagos State Government, 2011).

Lagos city was made up of only Lagos Island and Mainland in the early 1950s and the 1940s and
has now spread spatially and demographically to become a megacity that is comprised of the
following 16 of the 20 Local Government Areas which make up the state; Lagos Island, Eti-Osa,
Lagos Mainland, Surulere, Ikeja, Ajeromi-Ifelodun, Amuwo-Odofin, Alimosho, Apapa, Ojo,
Somolu, Kosofe, Mushin, Oshodi-Isolo, Kosofe, Agege and Ikorodu. The remaining four Local
Government Areas namely Badagry, Ikorodu, Ibeju-Lekki and Epe are not part of the Lagos
mega-city, although they are within Lagos state (UN HABITAT). Within the megacity region,
the average population density is 20000 persons per square kilometre (Bamidele, 2008). The
national average is 1,308 persons per square kilometre (Bamidele, 2008), and the state average is
4193 persons per square kilometre (Lagos state government, 2011).

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Figure 2; Local government areas of the Lagos mega city region. Adapted from UNHABITAT (2011).

There are differing estimates of the population of Lagos State. According to the 2009 revision of
the World Urbanization Prospects published by the United Nations Department of Economic and
Social Affairs, Population Division, the population size of Lagos as of 2010 is about 10.6 million.
The 2006 national population census figures produced by the National Population Commission
of Nigeria (2006) place the population size at 9.1 million inhabitants. The Lagos State
Government had disagreed with the national census figures, considering the figure of about 17.6
million inhabitants recorded in its Social Security and Population Exercise as the authentic
population size figure (Lagos State Government, 2011).

Notwithstanding differing estimates, it is agreed by all and sundry that given current
demographic trends, the Lagos megacity region where 90% of the state’s population is found is
projected to be one of the world’s largest megacities, next only to Tokyo in Japan, and Bombay
in India by 2015 (Lagos State Government, 2011, Okunlola, 2011). Population growth rate is
about 8%, translating to an influx of 600000 people per annum, indicating a growth rate about
ten times that of New York or Los Angeles (Lagos State Government, 2011, Okunlola, 2011).

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This is almost four times the average population growth rate of Nigeria – 2.3% (World Bank,
2009)

As early as pre-colonial days, Lagos city has been a hub of economic activity; from its days in
the fifteenth century as a Portuguese trading port for the sale of peppers, ivory and slaves (UN
Cyber School Bus, 2011), to its days as the seat of the British colonial administration when the
Northern and Southern Protectorates of Nigeria were amalgamated in 1914 (Okunlola, 2011).
During this period it became Nigeria’s first central business district and housed the financial
market, the seat of the colonial government, and major local and foreign corporations (Okunlola,
2011). Post-independence, Lagos state became the administrative and political capital of the
Federal Republic of Nigeria in 1967. After the completion of the railways, Lagos also became
the economic capital of Nigeria. All these factors coupled with the flourishing economy during
the oil boom invited migrants from different states and countries, especially Ghana, Niger and
Chad into the Lagos metropolis. This led to an estimated doubling of the state population twice
in the first two decades after independence, once between 1965 and 1975, and again in the
following ten years from 1975 (Okunlola, 2011).

Despite the relocation of the Federal Capital Territory to Abuja, Lagos metropolis still remains
the power house of the Nigerian economy. It accounts for the majority of the national industrial
infrastructure and more than half of the economic development of Nigeria and therefore still
serves as a prime destination for migrants (Okunlola, 2011). The growth rate of the Lagos
metropolis and its prospect as one of the top three megacities in the world raise obvious
questions of sustainability; its ability as a developing economy in Sub-Saharan Africa to cater to
the demands and implications of urbanization and to evolve accordingly.

2. Internal health inequities in the Lagos megacity region

Although not exclusive to megacities, it is often the case that different socioeconomic
backgrounds represented in the megacities lead to internal differences in health outcomes
through complex causal pathways. This section will address the various factors which lead to
internal health inequalities in the Lagos metropolis and potential ways to address these issues.

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The following sources were consulted for information about the health profile of the Lagos
metropolis; Medline, Pub med, World Health Organisation, the website of the Lagos State
Ministry of Health, the website of the Federal Ministry of Health of Nigeria, Science Direct,
Google Scholar, and the Lancet. About 31 articles were found. Although information on the
general health profile in the Federal Republic of Nigeria was available and will be discussed
below, there was no publicly accessible data about the health outcomes for the Lagos metropolis
specifically. This paper will therefore proceed to imply that the major contributors to mortality
and morbidity in Nigeria such as malaria, infant and under-five mortality, maternal mortality and
HIV/AIDS should also be generally applicable within the Lagos metropolis.

According to the WHO, on average, the life expectancy of a Nigerian child at birth is 48 years
old (UNAIDS/WHO Working Group on Global HIV/AIDS and STI, 2008). Malaria still poses a
significant threat to health and economic productivity in Nigeria. It is responsible for 25%
mortality in under-fives, 30% childhood mortality, and 11% maternal mortality and is a major
inhibitor of child development (WHO AFRO, 2011). HIV/AIDS is another significant
contributor to health problems in Nigeria. The prevalence rate in 2008 was 4.6% (World Health
Organization, 2009). Maternal mortality is 1100 for every 100000 live births (UNAIDS/WHO
Working Group on Global HIV/AIDS and STI, 2008). Infant mortality rate is 99 per 1000 live
births in Nigeria (UNAIDS/WHO Working Group on Global HIV/AIDS and STI, 2008). Under-
five mortality rate is 191 per 1000 live births (UNAIDS/WHO Working Group on Global
HIV/AIDS and STI, 2008). Nigeria and five other countries contribute half of all deaths of
under-fives globally (WHO AFRO, 2011). In Lagos, maternal and infant mortality estimates are
8 per 1000 and 84.6 per 1000 respectively (PATHS 2, 2011).

Although no in-depth information on health statistics for Lagos was available, the majority of the
articles which discussed health in the Lagos metropolis alluded to the strong influence and
responsibility of the social determinants of health in determining health outcomes. In Lagos
mega city, health outcomes are thus understood best in the light of the prevailing socioeconomic
factors which ensure poor and inequitable health outcomes through affecting access to the social
determinants of health. Some of these include income, nutrition, water and sanitation, waste
management, education, housing and place of residence and will be discussed in detail below.

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Poverty is a socioeconomic issue that is largely accountable for the poor health outcomes. The
depth and severity of extreme poverty has increased more than seven times in urban Nigeria
(Osinubi, 2003). Lagos is not an exception to this trend; two in three Lagosians live below the
poverty line (PATHS 2, 2011). There are significant inequities in wealth distribution in Lagos
state which are mediated by differences in educational opportunities and household employment
(Osinubi, 2003). Poverty contributes to high child mortality as parents are not able to afford the
necessary health technologies (WHO, 2009). A study carried out within the megacity region to
assess the effect of urbanization and the increase in poverty levels on the nutritional status of
children between 0-5 years old has shown that most of the malnourished and anaemic children
belonged to parents in low income categories (Abidoye, 1999).

Inadequate access to potable water in Lagos also contributes to high incidence of malaria and
diarrhoea (PATHS 2, 2011). Lack of access to potable water also predisposes the children of the
urban poor in Lagos to malnutrition as it increases the occurrence of diarrhoeal diseases and
parasitic infections of the intestine, which are predisposing factors for malnutrition (Abidoye,
1999). Only 32% of the malnourished children surveyed in Agege, Lagos had access to regular
supply of water (Abidoye, 1999). The majority of children who used well-water supply were
malnourished, as against only a few of their mates who had access to boreholes (Abidoye, 1999).
Children who had no access to toilet facilities were also found to have high incidences of
anaemia (Abidoye, 1999). Overcrowding in the poor housing units among the urban poor of
Lagos contributes to increased incidence of communicable diseases, accidents in the home, and
poor nutrition (Abidoye, 1999). Significant levels of anaemia and malnourishment were found
among children living in crowded and makeshift housing (Abidoye, 1999).

Place of residence which is largely influenced by affordability influences utilization of health

facilities thereby affecting maternal and infant mortality. Local government areas tend to have
inequalities in the spatial distribution of health facilities among themselves (Iyayi, 2009). The
majority (78%) of malnourished children in a study carried out in Lagos did not make use of
health facilities (Abidoye, 1999). This reduced to 54 % among those who used health facilities
occasionally and 5% among those who used health facilities regularly (Abidoye, 1999). Poverty
also has a large bearing on the place of residence which also affects health outcomes through
determining living conditions and access to infrastructure. For example, in urban centres, due to

9
the high pressure on facilities, there is erratic supply of power, limited access to potable drinking
water and poor removal of wastes (Abidoye, 1999). Malnourishment is very high among children
who live in the single face-to-face homes in Lagos city (67%) (Abidoye, 1999). 71% of poor
households studied in the Agege local government of Lagos state showed that they lived in
houses that did not provide access to necessary conveniences like running water, toilets, and
kitchens (Abidoye, 1999). In the instance that these were available, they were shared by a large
number of people, with implications on health and sanitation. In these areas too, polluted well-
water is often used as drinking water (Osinubi, 2003).

Inequalities in education also lead to different health outcomes among the poor as illiteracy is
related to poverty, malnutrition and poor health. As literacy, especially that of the mother affects
the likelihood of accessing healthcare and type of healthcare accessed, it affects child mortality
(Labiran, 2005, Oluwagbemiga, 2008). 66% of the malnourished children studied in urban Lagos
were found to belong to illiterate mothers (Abidoye, 1999). Also, of the severely anaemic
children surveyed, 58% belonged to illiterate mothers (Abidoye, 1999).

Health inequities are also exacerbated due to the lack of functional mechanisms to reduce the
impact of healthcare costs incurred especially by the poor. With household expenditure
accounting for about 70% of total health expenditure, poor households incur catastrophic health
spending which pushes them further into poverty (Partnership for Transforming Health Systems
2, 2010). Although the National Health Insurance Scheme has been formulated, it is currently
only available to the formal sector (Partnership for Transforming Health Systems 2, 2010). This
can actually serve to worsen inequity, as the unemployed and those in the informal sector are yet
unable to take advantage of this scheme. Public health facilities, though more affordable, are
often considered a last alternative as they are not well funded. With the added burden of non-
communicable diseases to the existing burden of communicable diseases, coupled with the
increase in poverty, government expenditure is insufficient to cater to the needs of the people.
Public health expenditure is 6.3 % of the government’s total public expenditure, a far cry from
the 15% minimum recommended by the World Health Organisation (Partnership for
Transforming Health Systems 2, 2010). As a percentage of Gross Domestic Product, total health
expenditure is only 2.9% (Partnership for Transforming Health Systems 2, 2010).

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In conclusion, although comprehensive health statistics for the metropolis were not found, it is
clear that inequitable access to the social determinants of health is largely responsible for poor
and inequitable health outcomes. Some key factors that are correlated to poor health include
poverty, poor access to potable water, place of residence and poor education. There therefore
remains an urgent need for inter-ministerial and inter-sectoral collaboration to improve health
outcomes equitably. The government also needs to reduce the translation of the differential
socioeconomic capacities of individuals and family units into wide disparities in health outcomes
within the metropolis through inculcating an equity perspective in the implementation and
formulation of policies. There is a need for rapid implementation of the National Health
Insurance Scheme so that the poor do not bear the brunt of catastrophic health care costs entirely.

3. Transportation in the Lagos megacity region

Transportation policies in megacities play a role in influencing urban health outcomes as they
affect a key number of health issues, one of which is the incidence of traffic accidents (World
Health Organization Centre for Health Development, 2009). Air quality is also impacted by
transportation as it is determined by the quality of vehicles plying the roads, as well as by the
extent to which city dwellers choose public over private transport, which will depend on the
availability of functional, accessible and affordable mass-transit systems (World Health
Organization Centre for Health Development, 2009). The availability of non-motorized transport
alternatives will affect the physical activity level of society, the incidence of traffic accidents,
and air quality (World Health Organization Centre for Health Development, 2009). Such non-
motorized options include walking and cycling and are impacted by whether or not infrastructure
and policies are put in place to ensure pedestrian and cycle safety by addressing such issues as
availability of quality sidewalks, pedestrian facilities, and cycle safety, among others (World
Health Organization Centre for Health Development, 2009). Below, the transportation situation
in the Lagos megacity will be discussed, paying specific attention to the challenges faced, recent
progresses made, and the corresponding negative and positive health implications.

Statistical analyses have shown that approximately 71% of the traffic congestion in Lagos is
accounted for by deficits in road infrastructure and maintenance, accidents, lack of integrated

11
systems of transport, poor traffic planning and poor driving (Aworemi, Abdul-Azeez, Oyedokun,
& Adewoye, 2009). The impact of transportation adequacies are felt most by the urban poor who
have to spend about 20% of their household budgets on transport (Lagos Metropolitan Area
Transport Authority). Having to take double or perhaps triple the required travel time also
impacts development and the quality of life of the inhabitants of Lagos (Lagos Metropolitan
Area Transport Authority).

With a road length per head of 0.4 kilometres per 1000 population, the network density of roads
in Lagos is low, even by continental standards (Lagos Metropolitan Area Transport Authority).
Infrastructural expansion has not been commensurate with the sustained increase in population
over time (Lagos Metropolitan Area Transport Authority). The networks are also unequally
tasked, with few roads carrying most of the traffic. These factors make transportation more
tedious and disorganized than it should be, thus affecting living and working conditions within
the metropolis. The high traffic levels in the metropolis also impacts air quality negatively.

In addition, there is significant lack of synchrony between transport and urban planning. Only a
few junctions are signalised in Lagos (Lagos Metropolitan Area Transport Authority). Parking is
usually inadequate and inadequately controlled, with on street parking being the order of the day
(Lagos Metropolitan Area Transport Authority). Street lighting, pedestrian facilities and traffic
enforcement are all inadequately maintained and in short supply (Lagos Metropolitan Area
Transport Authority). As the safety of non-motorized transport options is not guaranteed,
inhabitants are discouraged from making use of healthier alternatives like walking and cycling.

Mobility around Lagos is mainly road based. There is high level of car ownership in Lagos, as
half of the cars in Nigeria are found within the Lagos metropolis (Mobereola, BRT Presentation
at World Bank Transport Review Board in Washington DC, USA, 2009). About 200000 vehicles
are registered in Lagos alone, with an average of 222 vehicles per kilometre, as against the
national average of 11 vehicles per kilometre (Lagos Metropolitan Area Transport Authority).
Coupled with the fact that road users are often inadequately trained, the multiplicity of road users
on the roads of Lagos contributes to increased congestion and accidents on the roads of Lagos
(Lagos Metropolitan Area Transport Authority).

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There still is a high level of reliance on private commercial means of transportation, such as
motorcycles, locally known as okadas, and minibuses, locally known as danfos and molues.
These are the primary means of public transportation, especially for the lower income categories.
About 100000 minibuses ply the roads of Lagos (Lagos Metropolitan Area Transport Authority).
They are characterized by indiscipline and constitute the key cause of traffic congestion (Lagos
Metropolitan Area Transport Authority).

The following graphs demonstrate a significant average increase over time in vehicular accidents
within Lagos with the majority of accidents traced to private cars and buses, and motorcycles.

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Figures 3; Total vehicular accidents per year, and Figure 4; Accident rate based on vehicular classification.
Adapted from Olusina and Olaleye, 2009

The Lagos State Government has taken some major steps forward to address these transportation
challenges. The Lagos Urban Transport Project (LUTP) was created to address these issues,
build capacity for the management of transport in Lagos, and identify priorities for investment
and action to improve transportation in Lagos (LAMATA, 2009). With international help, the
Lagos Metropolitan Area Transport Authority (LAMATA) was created in 2003 by the Lagos
State Government as the executive agency of LUTP, exclusively serving the metropolitan area
(Kouakou, Lagos puts right conditions in place to exceed the doubling target, 2010). LAMATA
was empowered with exclusive rights on certain defined routes and within certain geographical
areas in the metropolis (Kouakou, Lagos puts right conditions in place to exceed the doubling
target, 2010).

The most notable achievement of this authority has been the creation of a dedicated public bus
service. The Bus Rapid Transit (BRT-lite) public transport system was introduced in March 2008
to tackle the problems faced with public transportation in the Lagos mega city region. The buses
currently run on the 22 kilometre corridor between Mile 12/Moshalashi – CMS corridor, Lagos
on segregated lanes (Kouakou, The Trans-Africa Project. Promoting Public Transport in Africa,
2009) (Lagos Metropolitan Area Transport Authority). This service has been largely successful.
It has successfully improved mobility along the above mentioned corridor; ordered boarding has
also improved organization along the corridor (UITP- International Association of Public
Transport, 2010). The BRT service made fares 30% cheaper than other commercial bus services,
reduced travel time by 35%, and saw a reduction in waiting time at the bus stops of between 55
and 73 per cent depending on the hour of the day (UITP- International Association of Public
Transport, 2010). With the high levels of patronage (200000 passengers per day), the BRT
service has been able to achieve reduced congestion, requiring 35% fewer buses than usual

(UITP- International Association of Public Transport, 2010) (Kouakou, Lagos puts right
conditions in place to exceed the doubling target, 2010). This has also had impacts on
sustainability as it led to a 32% reduction in fuel consumption by vehicles plying that corridor,
translating to savings in the order of 25000 tonnes of carbon dioxide per year- 20 times less
carbon dioxide emissions per passenger when compared to the use of private cars (UITP-

14
International Association of Public Transport, 2010). This leads to healthier living conditions for
those living along this corridor as pollution is reduced, less exposure to the risk of vehicular
accidents, and less stressful transportation along the exclusive lanes of the BRT.

The State Government has also been working on the expansion of existing roads and creation of
new ones, with many new roads completed, currently nearing completion, or under construction
(Fashola B. R., 2010). The key expressways such as the Lagos Badagry expressway connecting
Lagos to West Africa and the Lekki Epe expressway on the Lekki Peninsular are being expanded
(Fashola B. R., 2010). Some roads, such as that along Oshodi, which were previously used as
illegal trading places have been freed up for ease of transport (Fashola B. R., 2010).

Although the road expansion promises long term gain, this example also draws attention to the
need for integrating the residents into decisions being made for their wellbeing. The road
expansion project involved the demolition of houses on the road sides in order to expand the
roads. However this also brought severe inconvenience to the residents living along the corridor
whose houses were demolished, with some even dying from the shock of the demolition of their
houses. Although the government provided compensation, this was only available to home
owners who had the proper documentation. Since most of these houses had been longstanding,
often passed from one generation to another, some of the current owners did not have the
complete documentation at hand and thus suffered uncompensated losses. There is a need for the
people to be at the fore front of development to avoid such suffering from advancements that are
supposed to be in their interest.

The potential for other modes of transportation remain inadequately exploited. Due to poor
service, utilization and maintenance, the rail corridors and waterways of Lagos remain largely
untapped, carrying less than one per cent of the total traffic (Lagos Metropolitan Area Transport
Authority). These factors contribute to transportation challenges within the mega city region
such as a high rate of traffic accidents, high rate of traffic related pollution, high costs of
transportation, traffic congestion and chaotic and inefficient transportation (UITP- International
Association of Public Transport, 2010), thus negatively impacting health outcomes, safety and
wellbeing.

15
LAMATA has also developed a Strategic Transport Master Plan to guide the development of the
transport sector in Lagos state. The key priorities under this master plan are to increase transport
options such as bus, rail and water, integrate these various transport systems, increase
affordability, accessibility and convenience, reduce emissions, optimise road use, integrate land
use planning with transport planning, and secure long term financing of the transport plans
(Lagos Metropolitan Area Transport Authority). In alliance with the need for alternative means
of transport to reduce the demand on 7 corridors identified as key and overburdened, LAMATA
proposed a Light Rail Mass Transit scheme to run between Iddo, Lagos and Ijoko, Ogun State
(Lagos Metropolitan Area Transport Authority). 14 stations are proposed for this scheme, with
an estimated ridership of 500000 passengers daily (Lagos Metropolitan Area Transport
Authority). Construction has commenced on one of the seven proposed lines named the blue line
which is hoped to be functional by 2012 and run along the Badagry expressway of Lagos, from
Mile 2 to Ojo/Okokomaiko, with possible extensions into Marina in the future (Lagos
Metropolitan Area Transport Authority).

Given that Lagos is made up of many water bodies, water transportation is another mode being
seriously considered by the state government for the Lagos metropolitan area. Feasibility studies
are being conducted to see to the improvement of the waterways of Metropolitan Lagos, to
establish appropriate regulatory mechanisms, and encourage private sector participation in
service provision (Lagos Metropolitan Area Transport Authority). Seven main routes have been
identified, with 3 routes and the terminal considered as priorities. LAMATA has also
commenced work in rehabilitating four jetties, with two almost completed, and work on the
remaining two about to commence (Lagos Metropolitan Area Transport Authority).

LAMATA’s vision for the megacity region is to have an integrated network of railways,
waterways and expanded bus rapid transit coverage to attend to at least 39% of the motorized
transport needs of Lagosians (Kouakou, Lagos puts right conditions in place to exceed the
doubling target, 2010). There are also plans for an expanded and extended BRT network,
migration to electronic ticketing, job creation through the training of operations personnel and
pilots, and the introduction of Park and ride and formal feeder routes (Mobereola, Lagos BRT
Lite Success Story, 2009).

16
The urgent need for the integration of the modes of transport and the diversification of the modes
of transport available in Lagos seem to have been given the necessary consideration in
LAMATA’s vision for 2020, and time will tell whether these plans are followed through with, as
well as the efficiency and impacts of these proposed new changes on the transport situation
within the metropolis. Some foreseen impacts of the proposed advancements on health and
wellbeing include the reduction of emissions and increase in air quality, the reduction of traffic
congestion and its negative impacts on wellbeing, savings of time and money on the part of the
masses, and reduction in vehicular accidents.

Some key transportation challenges are yet to be duly addressed by the master plan, one of which
is the need for the healthier transportation options to be imbibed by the populace. One way to
achieve this is through increased integration of urban planning considerations for health with
transport planning. Citizens are dispossessed of the choice of non-motorized options for
transportation when these alternatives do not seem available, safe or consistent. There is need for
increased consideration of pedestrians through the creation and maintenance of sidewalks, street
lights, functional traffic signs, considerations for cycle safety such as bicycle lanes and
consideration of the transport needs of the handicapped members of society. Encouragement of
green modes of transport such as the above mentioned (cycling, walking, among others) will also
help to improve physical activity, while reducing traffic and emissions. There is also a need for
increased enlightenment of road users and more thorough enforcement of traffic and licensing
regulations for all vehicles in order to reduce the rate of accidents through ensuring responsible
road use and behaviour.

In conclusion, this section has discussed the various transportation challenges within the
metropolis and implications for health. Poor road networks contribute to traffic congestion,
leading to increased air pollution with its attendant negative impacts on environmental and
respiratory health. Increased commuting time and increased stress while commuting reduce
productivity and well being, and also increase the exposure of commuters to the risk of transport
accidents.

Poor urban planning considerations for transportation as exemplified by inadequate public

parking options, poor availability and coverage of street lights, and inadequate and often poorly
maintained pedestrian facilities such as sidewalks make transportation in many regions within

17
the metropolis disorganized and chaotic, while making the choice of healthier transportation
options such as cycling and walking sometimes impracticable. This reduces the possibility of
increased physical activity. Poor integration of urban planning and health also endangers the
safety and life of pedestrians who still have to ply the roads, especially those who cannot afford
more convenient means of transportation.

There is a need for increasing diversification of transport options. Heavy reliance on cars in
Lagos coupled with low reliance on public transport contributes to high traffic congestion,
thereby exposing motorists and pedestrians to the environmental and personal health dangers of
air pollution. The recent introduction of the public bus services known as the BRT-lite has been
commended, as the accrued benefits have been beneficial to public health. Reduction in travel
time, waiting time, and traffic congestion on the routes where this service is available have all
contributed to healthier living conditions for the people who live along this corridor through
reduced risk of vehicular accidents, reduced pollution, and less stress experienced while
travelling along the corridor.

As the BRT-lite has been successful, expansion of its coverage will make safe and affordable
transport available to more people thereby helping to improve environmental health and reduce
the risk of traffic accidents. This section has also noted the need for an integrated system of
transportation to reduce the pressure on the roads. Diverse and integrated means of transportation
will have positive impacts on health as they will help to reduce emissions thereby improving air
quality; they will reduce traffic congestion and the risk of traffic accidents, and will lead to
saving of time, money and productivity, thereby improving quality of life. It is therefore hoped
that the government will go forward on its plans to broaden and integrate transport options in
order to make public transportation more convenient, reliable and affordable. There is also the
need for residents to have the option and incentives to choose healthy transport options like
walking and cycling. In order to do this, sidewalks, streetlights, traffic signs, need to be
functional and maintained, while also providing considerations for cycle safety like bike lanes.
This will help to increase physical activity and reduce air pollution, congestion and traffic
accidents.

18
 4. Governance in the Lagos mega city region

In order for relevant cross sectoral action to be taken on the social determinants of health, there is
need for a supportive governance structure to be present. However, common to most rapidly
urbanizing cities globally are challenges in efficient governance accounted for and compounded
by their population sizes, spatial spread, and political and organizational structure (World Health
Organization Centre for Health Development, 2009). Being complex, megacities face
organizational dilemmas such as an ambiguity in the roles of governance structures present, or
role conflict between the different levels and administrative units of government present in the
same city (World Health Organization Centre for Health Development, 2009). This is further
compounded by the strong presence of the public sector in megacities which might lead to
tension between them and the local governments if inadequately attended to (World Health
Organization Centre for Health Development, 2009). The Lagos metropolis is familiar with these
governance challenges.

Lagos State Government is made up of three arms of government namely; the Executive Arm
which is the decision making body, the Judiciary Arm which administers justice in the different
state courts, and the Legislative Arm of the state, known as the State House of Assembly. The
Executive Arm of Lagos State Government is made up of the democratically elected Office of
the Executive Governor currently occupied by Babatunde Raji Fashola (Senior Advocate of
Nigeria), the Office of the Deputy Governor, currently occupied by Princess Sarah Adebisi
Sosan, the appointed State Commissioners for each of the ministries, and the appointed Special
Advisers on key social issues (Lagos State Government, 2011). The Judiciary is made up of the
office of the State Chief Judge, the Chief Registrar, and two Deputy Registrars (Johnson, 2010).
The State House of Assembly is led by the speaker and is comprised of elected members selected
from different parts of the state, the Deputy Speaker, the Majority Leader, the Deputy Majority
Leader, the Minority Leader, Chief Whip, Deputy Chief Whip, and Minority Whip (Johnson,
2010).

The state is further divided into 20 local government areas (LGAs) containing 57 administrative
units known as Local Council Development Areas. Of these 20 LGAs, 16 are part of the Lagos
megacity. Each local government area is under the administration of an elected local government
chairman. Local governments were created for the following purposes; as conduits to
19
communicate the government’s policies and to encourage active participation by the citizenry,
for convenience in administering state and federal programmes, to ensure effective resource
mobilization for development within each administrative unit, and to preserve each region’s
traditional heritage, while using this shared heritage to foster increased development and
participation (Oviasuyi, Idada, & Isiraojie, 2010).

The local governments are therefore important in ensuring access to the social determinants of
health as they are responsible for translating the policies at the state and national levels into
tangible results at the grassroots. When the local government administration is marked by
incompetence in service delivery, administration and/or human capital, this translates to stalled
development, poor access to social determinants of health and poor health outcomes. In practice,
this is often the case as the function of the local governments as agents of development is largely
handicapped for several reasons discussed below.

Corruption is an issue which cannot be overemphasized in this context, and it contributes to

ineffective administration. The appointment of local government leadership is disjointed from
the Independent National Electoral Commission, as installment of leaders at the local
government level is carried out through elections which are overseen by the Lagos State
Independent Electoral Commission. Less supervision of this political process gives room for
corruptions, and the influence of political godfathers on the political leadership of the
constituencies, leading to the recruitment of people without the wherewithal to deliver the
dividends of democracy to the people. At the local government level, there are often instances of
abandonment of awarded contracts, overestimation of project costs and price inflation (Oviasuyi,
Idada, & Isiraojie, 2010). In some cases, the financial demands of political godfathers are often
put before the needs of the people (Oviasuyi, Idada, & Isiraojie, 2010). Therefore, despite
allocation of funds, some local governments are left without basic infrastructure, with
uncompleted road projects, poor access to portable water, and poor access to functional health
services. Sometimes projects which are abandoned half-way often pose more problems for the
citizens than had they been addressed at all. A good example is road projects which are often
excavated and left for a long time without being filled and tarred by the contractors. With the
coming of the rains, these roads that are excavated and then forgotten until further notice are
made more deplorable (Nkanga, 2009).

20
Another governance challenge that is evident in Lagos is the presence of a multiplicity of
governance instruments with inadequately defined and often conflicting mandates. This leads to
inadequate coordination and makes efficient organization for cross sectoral action on the social
determinants of health very difficult. Inadequate coordination accounts significantly for poor
primary health coverage in Lagos (Jagun, 2007). Weak collaboration and supervision between
the state and local governments in the state make intersectoral action for health very difficult, as
the different levels of care tend to operate in isolation (Jagun, 2007).

Due to the previous status of the mega city region as the nation’s political and administrative
capital, there is still a significant presence of federal institutions within the metropolis and these
contribute their share of governance challenges. For example, the following organisations all
handle similar issues with regard to downstream oil regulation issues and this leads to conflict
and ambiguities in their roles; The Department of Petroleum Resources, The National Oil Spill
Detection and Response Agency, The Lagos State Environment Agency, the Federal Ministry of
Environment, the National Environmental Standards and Regulations Enforcement Agency, the
Nigerian Maritime Administration and Safety Agency, and the Nigerian Ports Authority.

Most of the role conflicts between the federal ministries and their state counterparts are traceable
to ambiguities in the constitution of the Federal Republic of Nigeria. Constitutional ambiguities
can also be considered to account for governance problems. Under the constitution of Federal
Republic of Nigeria, the right to make laws on health, safety and welfare comes under the
concurrent legislative list (Federal Republic of Nigeria, 1999). Item 17 in this list gives the
national assembly the right to make these laws while item 19 indicates that state assemblies are
not precluded from the same right. This poses challenges in practice, especially when state and
federal ministries are present in the same region. Instead of aiding cooperation in order to
improve delivery of the social determinants of health, this rather leads to conflict between
various agencies with similar mandates within the metropolis.

In conclusion, governance is important to health as it determines the extent to which policies that
impact on the social determinants of health are felt at the grassroots. Governance is a key issue in
the Lagos megacity region as with other megacities due to the large presence of the public sector
and the multiplicity of bodies attending to similar issues. Although this can be an advantage as it
brings resources closer to the people, it can also be a disadvantage, leading to role conflict and

21
ambiguity and diffusion of responsibility. There is a need for greater inter-sectoral cooperation
within the metropolis. The local governments are very key in improving health and development
at the grassroots. This potential needs to be optimized through more efficient monitoring and
accountability mechanisms. Constitutional ambiguities also lead to role conflict and are yet to be
addressed.

5. Food security in the Lagos megacity region

Food security refers to consistent access to sufficient food for health and productivity (Omonona
& Agoi, 2007). This comprises four interrelated elements; availability of food, the utilization of
adequate quantities of optimal quality of food, purchasing power to ensure access to quality food,
and sustainability of access (Omonona & Agoi, 2007). Food security is an important determinant
of health as it is one of the contributing factors to low levels of nutrient intake which leads to
mortality and morbidity from malnutrition.

Food security tends to be a challenge for megacities due their high population density, urban
sprawl and the complex networks for food distribution (World Health Organization Centre for
Health Development, 2009). This often leads to disparities in access to sound nutrition in
different parts of the megacities. Governmental interventions can facilitate the production and
distribution of necessary foods such as staples, marketing of foods (which impacts on food
quality), as well as increase access to sound nutrition while regulating utilization of less healthy
food options.

The Lagos metropolis is estimated to require about 18 times its size to sustainably cater to the
food needs of its people (Akinmoladun & Adejumo, 2011). About three quarters of households
within in the metropolis have been found to be food insecure, and about a third of the households
being food insecure with hunger (Ajani, Adebukola, & Oyindamola, 2006). Food security is
positively correlated with the income level, educational status and professional status of the
household head, and negatively correlated with age of household head, size of the household and
dependency ratio (Omonona & Agoi, 2007). Food insecurity is also significantly higher in
female headed households and among the unemployed (Omonona & Agoi, 2007).

22
Urban farming in Lagos includes poultry farming, fishing around the coastal areas, roadside
horticulture, gardens and free range herding (Akinmoladun & Adejumo, 2011). However,
metropolitan Lagos relies on surrounding rural areas within the state, other states and imports for
most of its food resources. Despite having 22% of its surface area comprised of water,
metropolitan Lagos has a huge supply deficit of fish and relies heavily on imports from
neighbouring states and European countries. The Southwestern states of Nigeria such as Ogun,
Oyo, and Ondo supply most of the poultry products, garri, fruits and vegetables. The North
Eastern and North Western states supply most of the beef and mutton (Akinmoladun & Adejumo,
2011).

With increasing population growth in the megacity, demand for food is increased yet a reduction
in supply of food is also observed due to construction activities, degradation of the environment
and a general marginalization of urban agriculture (Adedeji & Ademiluyi, 2009).Especially
given the migrant status of most of the urban farmers in Lagos, land availability is a major factor
militating against urban agriculture (Adedeji & Ademiluyi, 2009). Farmers often do not have any
rights to the lands they cultivate, as they usually cultivate on empty sites proposed for use by
corporate organisations, governments and individuals (Ezedinma & Chukuezi, 1999). Most of
these unauthorized plots are found along the many wetlands in the megacity and are often
cultivated for perishable goods like spinach, lettuce, cabbage, carrot by the Hausa ethnic group
or other migrant farmers unable to secure employment (Akinmoladun & Adejumo, 2011).

Their insecure status on the lands they cultivate places the farmers under constant threat of
eviction, conversion of the land to other uses, and harassment from officials such as policemen
(Adedeji & Ademiluyi, 2009). This discourages long term investments and as such, farmers tend
to grow seasonal crops that yield quickly, avoiding investments they could make in improving
soil quality, preventing erosion, water harvesting, and fencing (Adedeji & Ademiluyi, 2009). As
farmers do not invest in concrete well walls, production costs are increased through hiring labour
to excavate hand dug wells for improved water yield during the production season. Lack of
perimeter fencing also leads to theft of produce and refuse dumping which is hazardous to output
(Ezedinma & Chukuezi, 1999).

Another related problem urban farmers face is lack of access to credit. Lack of rights to land
coupled with the low educational level and migrant status of most of the farmers discourages

23
banks’ confidence and investment (Ezedinma & Chukuezi, 1999). Farmers also tend to lack
access to appropriate technologies to reduce production costs and this affects output (Ezedinma
& Chukuezi, 1999). Other problems include lack of skilled labour and increasing cost of farm
inputs (Ezedinma & Chukuezi, 1999).

So far, the food security efforts of the government have been on increasing agricultural output in
order to improve food security. This has been through increased funding for the agricultural
sector channelled towards the areas of comparative advantage which include the production of
poultry, vegetables, rice, fishing and marine aquaculture and animal husbandry (Governor
Babatunde Fashola SAN). The state government has also invested in the training of new farmers
through Agric YES, the agriculture based youth empowerment scheme (Governor Babatunde
Fashola SAN). Through the Fadama 11 project which is assisted by the World Bank, investments
have been made in the acquisition of agricultural assets, infrastructure and increased capacity
building for urban agriculture. The commercial agriculture development project has worked at
the creation of agricultural estates some of which include the Piggery at Gberige, Ikorodu and a
fishery at Araga, Epe (Governor Babatunde Fashola SAN).

Other recommendations to improve output will be discussed below.

Land: Land remains a very central issue in discussing improving food security within the
metropolis. One way to address this issue will be to facilitate use of already acquired land and
waterways within the metropolis belonging to the federal, state and local governments. In
addition, there is a need to integrate urban land use planning with urban agriculture to increase
the permanence of urban farmers’ access to land thus encouraging the employment of sustainable
farming practices and discouraging the excessive use of agricultural input.

Credit: There is also need for a positive policy environment to enable urban farmers access
credit facilities and insurance, thus minimizing the uncertainties they and the industries they
supply face. Farmers should be encouraged to form cooperatives so that they will be able to
access agricultural credit. Agro-based microfinance should also be accessible to small scale
urban farmers.

Crop yield: To increase crop yield and sales, vulnerability, suitability and demand and supply
analyses can be used to identify appropriate food crops and sea food to be raised by urban

24
farmers. A conceptual framework for research in urban agriculture and extension networks
within the metropolis will help to improve the number and output of urban farmers. A marketing
scheme can also be put in place ensure optimal sales of harvested crops.

Food availability, though important is not the only issue of concern in improving food security.
There is need to also address issues of access to and choice of high quality food as well as
sustainability of access. This means that not only must food be available; the urban poor should
be able to afford the food necessary for healthy living. A possible way to achieve this end is
through availing the urban poor of food subsidies. Few staples which regularly constitute the
diets of the urban poor can be subsidized for all, or subsidies can be made available in particular
geographic regions where the urban poor reside. Another possible way is to give out vouchers
and food stamps to identified poor households.

In conclusion, food security is an important determinant of urban health as it affects nutrient

intake which is an underlying factor for malnutrition. Improving food security is an intersectoral
issue. Recommendations have been outlined above and will require collaboration between such
sectors as the Lagos State Ministry of Agriculture and Rural Development, Lagos State Ministry
of Justice, Lagos State Ministry of Environment and Lagos State Ministry of Physical Planning
and Urban Development.

6. Water and sanitation in the Lagos megacity region

Inadequate supply and poor quality of water impact negatively on health in megacities. Although
the negative health impacts of poor water quality on health seem the most obvious, poor access
has been found to constitute a more serious health hazard than poor water quality in urban
settings, especially for the urban poor (Acey, 2005). Poor access to water supply can lead to
water pollution due to poor sanitation and sewerage (Acey, 2005). Poor hygiene as a result of
poor access promotes transmission of disease and poor environmental health impacts such as
water borne disease (Acey, 2005). The economic impacts of costly water reduce available money
for attending to nutrition and health needs. Desperate alternatives created to meet the need for
water such hand dug wells in certain parts of Lagos expose the users to health hazards from
contaminants in the water (Acey, 2005).
25
The Lagos state water corporation (LSWC) has monopoly over the provision of potable water to
residents of the Lagos metropolis (Obayagbona, 2008). The state-provided water is heavily
subsidized, as users pay about 50 naira per cubic metre, compared to the 400 naira per cubic
meter which users of other sources of water have to pay (Obayagbona, 2008). However, with
coverage of only 30% by LSWC, close to 70% of the people of Lagos have no access to safe
water and are served by non-state actors such as water vendors, private wells, water tanker and
boreholes (Moe & Rheingans, 2006). Most of the water produced by LSWC (about 60%) is
eventually lost through illegal connections and leakage (Moe & Rheingans, 2006). Even in
neighbourhoods connected to the LSWC, water supply is quite irregular and the water is often
contaminated. Water supply in Lagos is usually from the surface and groundwater resources
(Water and Development Research Group). However, these sources are often exposed to
multiple sources of contamination before getting to the final consumer. For one, sewerage is poor
in the Lagos metropolis as there is no central collection system for wastewater (Moe &
Rheingans, 2006). Most of the wastes end up being disposed into the Lagos lagoon, open ditches
and gutters by rainwater (Water and Development Research Group). This sewage is also often
washed into wells by the rains. During this dry season, the wastes often clog drainage channels,
creating pools of contaminated water (Water and Development Research Group). Other sources
of water contamination include industrial wastes from breweries, food processing industries,
domestic sewage, sawmills, chemical industries and seepage of wastes from industries (Water
and Development Research Group).

The estimated demand for water by 2020 is about 440 million gallons per day, yet the capacity of
LSWC in 2007 was only 151.64million gallons per day (Obayagbona, 2008). The urban poor
bear the brunt of this the most as low income neighbourhoods are not connected to the pipes
which convey water from the LSWC, they have to pay more for water from non-state actors than
the state subsidized water supply. They therefore do not benefit from the low flat rate of the
LSWC. As such, the supply of water by the LSWC is not only poor in terms of safety,
consistency and coverage, but also from an equity perspective.

Various reasons are responsible for the inadequacy of water supply in the metropolis, one of
which is resources. The LSWC needs huge financial investments in order to double its
infrastructure to be able to provide safe drinking water for all residents of the metropolis

26
(Odunfa). Another problem cited is the low efficiency of bill collection which encourages
wastage of water. Political interference is also an issue as it discourages competitive recruitment
of employees of the LSWC. Role conflict between the different bodies involved in regulation of
water supply in Lagos has helped to weaken regulation and leads to very inefficient regulation of
water supply in Lagos (Obayagbona, 2008). There is no central body for regulating water supply,
and bodies like NAFDAC, LASEPA and LSWC are all involved in regulation, independent of
one another (Obayagbona, 2008).

To address the shortage of water supply, the state government has a target of providing 769
million gallons of water per day by 2020 (Fashola B. R., 2010). This is through the addition of
15 mini waterworks most of which have been completed to service the area, providing an
additional 30 million gallons of water to supplement the 105 million gallons estimated to be
produced by the Iju and Adiyan water works (Lagos Indicator Online). An independent power
facility generating 12.5 megawatts was also provided for the Iju and Adiyan water works which
supply 90% of water used in the metropolis to solve the problem of erratic power. Water supply
is also to be increased through 5 kilometre reticulation for each of the 15 new water works. The
2011 budget is focused on increasing the coverage of the existing water works from 40% to 60%.

In addition to this, there is a need to move from the singular perspective of improving supply to
integrating a holistic strategy which has equity considerations at its core. Subsidized supply of
safe water needs to be available for those who need it the most- the low income neighbourhoods.
There is also need for the state government to cooperate with the already active non-state actors
that have evolved to fill the unattended role of the state. In a field already dominated by non-
state actors, the state needs to act as the central facilitating body. It is able to play an enabling
role through collaboration, regulation, and dialogue (Obayagbona, 2008). The state can also
develop policy and legal frameworks which stipulate regulations to be abided to by non-state
actors that intend to be involved in water provision (Obayagbona, 2008). The end is the
improvement of water coverage, quality and price regulation, improved and reliable service and
accountability (Obayagbona, 2008). By taking up a more assertive role, the government will be
better positioned to encourage competition, discover potentials and constraints and optimize
resource use.

27
In conclusion, the supply of safe water remains a challenge for Lagos. Safe water is necessary to
reduce contamination, improve sanitation and reduce disease outbreak. The LSWC which has the
monopoly over water supply is still found wanting with regard to efficiency, equity, and
effectiveness. Some recommendations have been given above on the role the state can play to
improve water quality and supply in Lagos state. These include a more assertive role in engaging
the already present non-state actors and a greater equity approach which prioritizes the poor
during efforts to scale up water coverage in the state. There is also need to address the issue of
poor disposal of wastewater which eventually ends up in water used by the residents of Lagos.
The government needs to invest in efficient sewage disposal facilities or supervision of non-state
actors involved in sewage collection and disposal with efficient monitoring to ensure that sewage
is not being disposed of in ways that endanger public health.

7. Safety in the Lagos megacity region

Crime in megacities goes a long way in impairing aspirations for socioeconomic development,
human rights, democratic ideals and well being of residents. These in turn impact health
outcomes and well being. Due to Lagos’ position as the socioeconomic nerve centre of Nigeria,
crime is most endemic in this megacity (Alemika & Chukwuma, 2005).

Surveys by the CLEEN foundation (2005) revealed the most prevalent crimes reports in the
metropolis. In the surveys conducted,

25% of respondents had been victims of theft

12% of the respondents had been assaulted

9% of the female respondents had been victims of sexual violence

9% had been victims of robbery

9% had been burgled and 6% had witnessed attempted burglary

6% of households with vehicle owners had been victims of automobile robbery

5% of households with vehicle owners had been victims of vehicle theft

23% of the households with vehicles had been victims of theft of property from an automobile
belonging to the household

28
1% of the respondents had reported the murder of a member of their household (Alemika &
Chukwuma, 2005)

Two fifths of the respondents had been victims of corruption, especially from public officials
who demand for bribe. There was a spatial pattern to criminal victimization, with some crimes
being more prevalent in some local government areas than others (Alemika & Chukwuma, 2005).
Perception of the attitude of the police is quite poor, especially from individuals who have had
contact with the police, often complaining of their ineffectiveness and impoliteness.

The government has made recent investments in tackling safety issues, perhaps accounted by the
majority of respondents’ perception of a reduction in crime in their local government areas.
Some of these include investing in equipment and logistic support for the Nigerian Police Force
through the establishment of a security trust fund (Fashola B. , Political Commitment to Urban
Health, 2010). There has also been increased remuneration of the police with welfare packages
such as a life insurance scheme. The government also invested in the distribution of equipment,
vehicles and helicopters, among others to security agencies. A toll free emergency response
communication line has also been established. All of these have contributed to a reported
reduction in crime within by metropolis by about 79.95% (Fashola B. R., 2010).

There is need just to tackle crime but the underlying socioeconomic ills which make engaging in
crime an attractive option. There is a need to lift individuals out of the desperate situations which
predispose them to engaging in crime. Some of these include unemployment and poverty.
Through the creation of new jobs in the field of driving, transport, waste and environmental
management, the state government has taken some steps forward in addressing this issue (Lagos
Indicator Online). However, given the dense population and high rate of migration,
unemployment still remains an issue to be further addressed in the metropolis.

There is also need for the government to emphasize improved relations between the police
community and the general public in order to improve their efficiency in meeting citizens’ needs.
Given consideration of the spatial distribution of victimization, resources should be allotted to
reflect the difference in safety levels of different local government areas such as Lagos Island,
Ajeromi-Ifelodun, Apapa, Oshodi-Isolo, Ojo and Mushin which have higher incidence of
victimization (Alemika & Chukwuma, 2005)

8. Environmental issues in the Lagos megacity region

The environmental conditions in the megacity play a part in influencing health outcomes. For
example, air pollution such as noise from industries and traffic, smoke from factories, poor waste
management practices and cooking, odour from poor sanitation among others can lead to health
problems, disease outbreak and respiratory problems. Poor environmental hygiene can create
breeding grounds for flies, mosquitoes and rodents which spread disease and spoil food. These

29
are a few consequences of poor environmental sanitation showing the importance for the
environment in megacities to be given prime consideration in order to improve health outcomes
in megacities.

Slum proliferation

One of the environmental problems Lagos is facing with its rapid urbanization and population
growth is the attendant problem of slum proliferation due to inadequate housing. The provision
of housing and infrastructure has not met the demand of the population growth in Lagos. As a
result the Lagos metropolis accounts for 31% of the national housing deficit of 18 million
(Chartered Institute of Housing, 2010). This deficit has led to a proliferation of slums and
shantytowns in the Lagos metropolis. There are an estimated 200 slums within the Lagos
metropolis which could be as small as a conglomeration of shacks and as large as entire regions
such as Ajegunle and Mushin (Ngomba, 2011). Urban squatters, who are rural-urban migrants
who move to the metropolis in search of better life opportunities often have to build rudimentary
shelters illegally on vacant pieces of land (Ngomba, 2011). Although these places are occupied
rent-free they often expose their inhabitants to high levels of risk and discomfort. These slums
often have poor or no infrastructure. The roads are usually poorly constructed and narrow,
without consideration for drainage. As these areas are usually socially and physically devalued
they are often prone to environmental problems such as ocean surge and flooding. Noise,
atmospheric and water pollution are common place in these settings.

Some of these informal settlements are located in ecologically vulnerable areas (examples
include Ijeh, Amukoko and Makoko), some are located in regions where atmospheric pollution is
very high (examples include Olososun and Ojota), some of these regions are especially prone to
flooding (examples are Ajegunle and Orile). Also, due to substandard infrastructure, building
collapse is often high in some dwellings of the urban poor like Ketu, Ebute Metta, Ajegunle and
Orile (Oduwaye, 2009). These slums are often densely populated, with more than 75% of slum
dwellers living in single rooms with an average density of 4.6 people to one room (Ngomba,
2011). This density gets as high as 8 people per room in Mushin (Chartered Institute of Housing,
2010). These settlements lack basic amenities and infrastructure and often have high conflict and
crime rates, high rate of epidemics and disease and poor sanitation exemplified by areas such as
Ajegunle, Isale Eko, Mushin, Makoko, Oshodi, Ojo and Orile (Ngomba, 2011), (Oduwaye,
2009). Often viewed as social ills, these slums have often been demolished by various
government agencies, leading to mass eviction of the thousands of the urban poor occupying
them (Ngomba, 2011). Rather than solve the problem, evictions tend to exacerbate the problem
as they fuel the growth and expansion of new or already existing slums (Ngomba, 2011).

Water related hazards

As Lagos is located on one of the low-lying coasts in West Africa, with over 40% of its land area
made up of water and wetlands, and another 12% being subject to floods, water related hazards

30
are a serious issue in the metropolis. This challenge is worsened by poor wastewater disposal and
poor drainage (Akiyode, 2010). In addition, Lagos often experiences cases of flooding at the Bar
Beach coastline bordering the Atlantic Ocean. These ecological changes caused by water hazards
lead to the damage of infrastructure and create breeding places for vectors, thus explaining the
observed increase in the incidence of malaria over time (Akiyode, 2010).

Climate change

Due to the location of Lagos along the coastline and due to its booming population which makes
it more vulnerable to hazardous ecological changes, long term impacts of urbanization on the
climate of this megacity are noteworthy as they will have serious implications on the
environment and ecology. Due to the consumption of high amounts of ecological goods and
services, high population size, industrial presence, transportation and related pollutants, housing,
and waste generation among others, Lagos, like other megacities can be expected to make large
contributions of greenhouse gases (Akiyode, 2010). This is expected to have local environmental
impacts such as increased mean temperature, and sea level rise which will further affect
environmental health and wellbeing within the metropolis (Akiyode, 2010).

Waste Management

Waste management in the metropolis has increasingly been accorded attention especially due to
the improved efficiency of the Lagos State Wastes Management Authority (LAWMA). LAWMA
currently partners with private sector participants (PSPs) for the collection and removal of wastes
in the metropolis (Fashola B. R., 2010). Through increased funding, compactors have been made
available for handling wastes, and bins have been provided for refuse disposal along the street
corners (Fashola B. R., 2010). Sweepers have also been employed to clear the streets of refuse
daily (Fashola B. R., 2010). These efforts have also created jobs for over 25000 Lagosians in the
past few years (Fashola B. R., 2010). LAWMA is also involved in the handling and disposal of
medical wastes. LAWMA provides healthcare facilities with disposal material and then
evacuates these wastes regularly through disinfection, treatment and burying at dumpsites
(Onisarotu, 2010). LAWMA is also involved in generating awareness through interactive
sessions of medical waste management and capacity building for medical waste collectors and
the private sector participants (Onisarotu, 2010).

In addition to medical wastes, another type of hazardous wastes which need mention are
electronic wastes (e-wastes). These are wastes from discarded electronics which can pose serious
and chronic health problems such as affecting development, internal organs, DNA structure, the
skins, among other deleterious impacts thus necessitating their proper management. The volume
of e-waste in Lagos is increasing due to imports as well domestically generated wastes. The
Lagos State Environmental Protection Agency (LASEPA) regularly carries out lectures for
stakeholders on the necessity of e-waste inventorization. In addition, LASEPA has
commissioned a consultant for the evacuation of e-wastes from organizations, manufacturers,

31
industries, markets among others to a specified collection site in Ikorodu, Lagos. A discussion
with a LASEPA staff confirmed that thus far, nothing is being done with these wastes besides
collection at the dumpsite. However, LASEPA is currently involved in capacity building for
handling e-wastes and has plans to either recycle these wastes or to export them for recycling
depending on which is more cost efficient.

Recommendations to address the various environmental concerns

In addition to the current efforts of the government, there is need for increased awareness of the
general public on the necessity for proper management of wastes, especially hazardous wastes
and the health implications. Public awareness is still generally low; for example e-wastes are
often recycled in the informal sector using crude techniques such as acid leaching and burning
which often lead to loss of value, pollution and severe damage to the environment (Onisarotu,
2010). Especially in densely populated areas of the metropolis, there is a clear lack of ownership
exhibited in the attitude of Lagosians to the environment. Indiscriminate dumping of wastes,
even human wastes on the streets, sidewalks, and drainages are still a largely common practice
(Onisarotu, 2010). It is therefore necessary not just to avail the residents of street sweepers and
garbage bins but to clearly emphasize the duty of every Lagosian in attaining an aesthetically
pleasing and healthy environment, and reducing the impacts of climate change through instilling
an attitude of ownership. Waste reduction should also be emphasized.

Again, function overlap remains an issue in management of the environment. Various bodies
such as the Lagos State Environmental Protection Agency, LAWMA, and local governments are
charged with similar responsibilities with regard to waste management leading to conflict and
overlap of functions (Onisarotu, 2010). In order to encourage optimal enforcement of
environmental laws, waste collection and disposal, this issue needs to be dealt with. There is the
need to enlighten all stakeholders, such as Lagosians, urban planners, environmental
organizations among others on the why and how of sustainable management of the environment.

There is also need to adopt more recent up to date methods of waste management. Dumpsites are
still the trend in Lagos state, due to technical and financial constraints common in developing
countries (Onisarotu, 2010). However, the use of more standard means of disposal such as
recycling, landfills, bio-treatment, neutralization, incineration, among others will help to
minimize waste and its effect on the environment (Onisarotu, 2010). Currently, recycling is often
left to the informal sector, especially scavengers who pick valuable items from the dumpsites as
a means of livelihood (Onisarotu, 2010).

In order to reduce slum proliferation, the housing crisis has to be addressed to disengage the
negative relationship between poverty and slum proliferation which encourages environmental
degradation. The most recent initiatives to address the housing problem by the state include
establishing the Lagos Metropolitan Development and Governance Project, the Lagos Island
Revitalization Project, and the development of a Medium term Sector Strategy for the Housing

32
Sector for Lagos. It is hoped that by the end of the period 2011-2013 the medium term strategy
will improve access to quality housing for every citizen (Ngomba, 2011). The Lagos
Metropolitan Development and Governance Project is backed with a loan from the World Bank
with the intention of increasing access to urban services through infrastructural investments. One
of the goals of this project involves the rebuilding of the nine biggest slums in the Lagos
metropolis (IRIN and UN HABITAT, 2007). The state government also recently signed into law
a bill for the establishment of the Lagos State Mortgage Board in order to make housing more
affordable and accessible to Lagosians through the provision of mortgages to the working class
(Lagos Indicator Online). There are still issues which need to be addressed by this bill. Given
the low minimum wage of 18000 Naira per month, affordability is still very questionable. With
this minimum wage, it is hard to see one catering to his or her household while still being able to
afford decent housing. Given the high level of unemployment and informal employment within
the metropolis, there is also the concern about whether the provision of mortgages to the
employed might not serve to further exacerbate inequitable access to quality housing. The issue
of housing needs to be further addressed with a view to improving not just availability of housing,
but also equity.

In conclusion, it is clear that the urban poor are the most vulnerable victims of environmental
problems and their health impacts in the metropolis due to their proximity to the most degraded
parts of the environment. There are many aspects and challenges in environmental management
in Lagos. Some tackled in this paper are slum proliferation, climate change, waste management
and water related hazards. Recommendations stressed herein include the need for public
ownership of the issue of waste management, more refined methods of waste management, the
need to address the housing crisis and the need to address role conflicts between environmental
organizations in the metropolis.

33
 9. Conclusion
The Lagos metropolis has increasingly been a central focus on discourse about healthy
urbanization, especially in developing countries. Lagos is a fascinating subject of discussion due
to its booming economic activity, population size, social characteristics, natural endowments,
among other unique features. Of all these features its population growth rate can be said to stand
out the most, placing it prospectively among one of the biggest megacities in the world by 2015.

Megacities are very dynamic conglomerations and thus each of them brings unique
considerations to the discussion. However, they do share some similarities; one of which
concerns the types of challenges they face in the goal of healthy urbanization. Some of these
challenges discussed in this paper with regard to the Lagos metropolis are health equity,
transportation, governance, food security, water and sanitation, safety, healthcare and
environment. Each of these challenges goes a long way in affecting the quality of life and the
health of Lagosians.

This paper has therefore looked at how these challenges are being addressed in Lagos and
discussed areas for improvement while also highlighting areas that need increased consideration.
Altogether, the examples, improvements achieved and problems discussed make it clear that
healthy urbanization in the Lagos metropolis might be a big dream, but not one that is impossible
to achieve given strong commitment on the part of all stakeholders. Recent successes the state
government has achieved in a short time frame due to increased political will and support from
the people serve to buttress this point.

Apart from the need for political will, it is also clear that in order to address every above
mentioned challenge there is need for a strong equity perspective. This implies intersectoral
cooperation, rather than conflict. Urban health is a very complex issue and every sector has
unique strengths, viewpoints and human resources to bring to table. Not the least among the
viewpoints to be considered is that of Lagosians, especially the urban poor. In the absence of
their considerations, any development said to be at their interest runs the risk of being
presumptuous and perhaps disadvantageous in practice.

It is therefore hoped that this brief analysis conducted in this paper will be vital in engaging the
stakeholders especially the state government in making sure that urbanization is not at the
detriment of health but rather goes hand in hand with improved health equity and outcomes in
the Lagos metropolis.

34
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