By Abubakar Jimoh
Recently, President Goodluck Jonathan gave his assent to the long waiting “Bill for an Act to provide a framework for the regulation, development and management of a national health system and set standards for rendering health services in the federation, and other matters connected therewith, 2014”, which effectually became National Health Act.
Prior to the presidential assent, there was no health legislation describing the national health system and defining the roles and responsibilities of three tiers of government and other stakeholders in the health sector. This had led to confusion, duplication of functions and sometimes lapses in the performance of essential public health functions.
However, it is noteworthy that the road to getting presidential assent to the Bill was rough; as it failed to merit the President’s assent in 2010, following heated dissention over certain portions not agreed with by some health stakeholders in the country. This milestone consequently marked second time the bill would be passed to the president in four years.
Meanwhile, it is a bit of good news that Nigeria’s health sector is finally getting some plausible attention. For pregnant women, under-five children and the elderly in the country that often die as a result of lack of basic health care, the new National Health Bill signed into law on December 9, 2014 by President Goodluck Jonathan offers a huge relief.
The Act is critically important as it represents the best attempt thus far, at providing a legislative framework that seeks to comprehensively address the many challenges afflicting Nigeria’s health sector, thus contributing towards the realization of the right to health and by extension the right to life of Nigerians guaranteed under Section 17(3)(c), 17(3)(d) and 33 of the 1999 Nigerian Constitution as amended. It established for the Federation the National Health System, which shall define and provide a framework for standards and regulation of health services to: promote a spirit of cooperation and shared responsibility among all providers of health services in the Federation and any part thereof; provide for persons living in Nigeria the best possible health services within the limits of available resources; set out the rights and obligations of health care providers, health workers, health establishments and users; and protect, promote and fulfil the rights of the people of Nigeria to have access to health care services.
It would be interesting to know that the Act recognizes as part of the National Health System, Federal Ministry of Health; Ministry of Health in every state and the Federal Capital Territory Department responsible for Health; parastatals under the federal and state ministries of health; all local government health authorities; the ward health committees; the village health committees; the private health care providers; traditional health care providers; and alternative healthcare providers.
The Act establishes a Basic Health Care Provision Fund to be financed from Federal Government Annual Grant of not less than one per cent of its Consolidated Revenue Fund; grants by international donor partners; and funds from any other source.
Out of the fund, 50% shall be used for the provision of basic minimum package of health services to citizens, in eligible primary/or secondary health care facilities through the National Health Insurance Scheme (NHIS); 20% shall be used to provide essential drugs, vaccines and consumables for eligible primary health care facilities; 15% shall be used for the provision and maintenance of facilities, equipment and transport for eligible primary healthcare facilities; and 10% shall be used for the development of Human Resources for Primary Health Care; 5% of the fund shall be used for Emergency Medical Treatment to be administered by a Committee appointed by the National Council on Health.
As contains in the Act, in order to ensure effective distribution of the fund to Local Government and Area Council Health Authorities, the National Primary Health Care Development Agency shall through the State and Federal Capital Territory Primary Health Care Boards, disburse the funds to provide for: essential drugs, vaccines and consumables for eligible primary healthcare facilities; maintenance of facilities, equipment and transport for eligible primary healthcare facilities; and development of Human Resources for Primary Health Care.
However, the Act prohibits National Primary Health Care Development Agency from disburse money to any: Local Government Health Authority if it is not satisfied that the money earlier disbursed was applied judiciously as provided in the Act; State or Local Government that fails to contribute its counterpart funding; States and local governments that fail to implement the national health policy, norms, standards and guidelines prescribed by the National Council on Health. It further mandates the National Primary Health Care Development Agency to develop appropriate guidelines for the administration, disbursement and monitoring of the fund with the approval of the Minister.
Without being in possession of a Certificate of Standards, the Act prohibits a person, entity, government or organization from: establishing, constructing, modifying or acquiring a health establishment, health agency or health technology; increasing the number of beds in, or acquire prescribed health technology at a health establishment or health agency; providing prescribed health services; continuing to operate a health establishment, health agency or health technology after the expiration of 24 months from the date this Act took effect.
The Act mandates the Minister to prescribe mechanisms to ensure a co-ordinated relationship between private and public health establishments in the delivery of health services. In this case, Federal Ministry, any state ministry or any Local Government or any public health establishment may enter into an agreement with any private practitioner, private health establishment or non-governmental organization in order to achieve any objective of the Act.
More importantly, the Act prohibits a health care provider, health worker or health establishment from refusing a person on emergency medical treatment for any reason whatsoever, making any person who contravenes this guilty of an offence and liable on conviction to a fine of N100, 000.00 (one hundred thousand naira) or to imprisonment for a period not exceeding six months or to both. However, except for Psychiatric patients, a health care provider may refuse to treat a user who is physically or verbally abusive or who sexually harasses him or her, and in such a case the health care provider must report the incident to the appropriate authority.
Against the years of unethical behaviours of healthcare providers that discourage attendance at health facilities, the Act encourages any person to lay a complaint about the manner in which he or she was treated at health facilities. It mandates the Minister, Commissioner or any other appropriate authority to establish a procedure for the laying of complaints within the areas of the national health system for which the Federal or State Ministry is responsible.
In order to ensure comprehensive National Health Management Information System for use in effective planning and decision making, the Act saddles Federal Ministry of Health with the responsibility to facilitate and co-ordinate the establishment, implementation and maintenance of Health Information System by State Ministries, Local Government Health Authorities and the private health sector at national, state and local government levels.
The Act allows for use, approved compendium of drugs in health facilities throughout the Federation. This shall be under periodic review of the National Drugs Formulary, and Essential Drugs List Review Committee. It encourages indigenous and local manufacture and production of as many items in the formulary as practicable; and mandates the National Council on Health to ensure widest possible catchments for health insurance scheme throughout the country.
As part of the efforts to resolve inadequacy and lopsidedness allocation of healthcare personnel across the country, especially the grassroots, the Act charges National Council on Health to develop policy and guidelines for, and monitor the provision, distribution, development, management and utilisation of, human resources within the national health system. This includes facilitating and promoting adequate distribution of human resources; providing appropriately trained staff at all levels of the national health system to meet the population’s health care needs; and effective and efficient utilisation, functioning, management and support of human resources within the national health system.
Similarly, Minister of Health and the National Council on Health shall determine guidelines that will enable the State Ministries and Local Governments to implement programmes for the appropriate distribution of health care providers and health workers. This includes availability of adequate resources for education and training of healthcare personnel to meet the human resources requirements of the national health system; prescription of a re-certification programme through a system of continuing professional development; identification of shortages of key skills, expertise and competence within the national health system, and prescribe strategies to make up for any shortfall in respect of any skills, expertise and competences; and prescribe strategies for the recruitment and retention of health care personnel within the national health system and from anywhere outside Nigeria.
Addressing the years of persistent industrial disputes bedeviling the health sector, the Act demands serious attention towards resolving industrial disputes in the public sector of Health with zero tolerance for all manner of disputes that result in total disruption of health services delivery in public institutions of health throughout the country; and charges the Minister with 14 days of occurrence to exercise all reasonable measures to normalcy any dispute in the health sector.
Moreover, Nigeria has been reported as a leading country outbound medical tourism in Africa; and overseas medical care has become a fad for public officers and their families at the expense of public funds. The Act bans public officer of the government of the Federation or any part thereof from sponsoring medical check-up, investigation or treatment within and outside the country at public expense except in exceptional cases on the recommendation and referral by the medical board and proper approval by the Minister or the Commissioner of health of the state.
Civil Society Legislative Advocacy Centre (CISLAC) believes the Act contains many positive provisions, which if fully implemented would affect the lives of Nigerian citizens. Therefore, all relevant stakeholders are expected to take advantage of the new Act and bring positive development into the health sector; and ensure full-fledged allocation of the proposed at least 1% oil revenue allocation to the sector. The National Primary Health Care Development Agency owns the fundamental duty to ensure greater accountability and transparency towards judicious utilization of the fund.