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Health Bill- Nigeria

Celebrations are afoot in Abuja. On May 19, the two Houses of the Nigerian National Assembly finally passed the National Health Bill into law, after 7 years of inaction and procrastination. The controversial bill, which promises to provide all Nigerians with a basic minimum package of health services, was originally proposed in 2004 and passed in May, 2009, before being withdrawn for bureaucratic reasons. It has effectively lain untouched since. The Nigerian Medical Association estimates that 7 million children and 385 000 mothers have died in the interim.

As the most populous country in Africa (one in four Africans live in Nigeria), providing universal health care is no easy task. But even allowing for the difficulties posed by providing health care to a large population, the country still underperforms. Life expectancy at birth averages just 54 years for both sexes. Maternal mortality is 608 per 100 000 livebirths, and the mortality rate for children younger than 5 years is more than double the global average at 157 per 1000 livebirths. Nigeria is the only country in the African continent to have never eradicated poliomyelitis, and only 3% of HIV-positive mothers receive antiretrovirals. Just 6% of the country’s gross domestic product (GDP) is spent on health and there are enormous inequalities in its allocation between the rich and poor areas of the country.

The bill provides a framework for the regulation and provision of national health services, defines the rights of health workers and users, and stipulates guidelines for the formulation of a national health policy. Its promises will not change everything for Nigerians, but the bill does allow them to finally hold the government to account for their right to health, including equitable access to care. Never before has there been such momentum towards making a real commitment to improving health in this country.

The bill pledges to develop a national health policy that includes 60 billion naira (about US$380 million) devoted to primary health care each year, commitments to the provision of essential drugs, and comprehensive vaccination programmes for pregnant women and children younger than 5 years of age. It rightly devotes a whole section to strategies to reduce the crippling effect of the brain drain on health care; there are as many Nigerian doctors working in the USA as there are in the public health-care sector of Nigeria. The bill thus commits to providing adequate resources for ongoing education and training of doctors, including a continuing professional development programme. The health bill stipulates the need for measures of accountability, which are central to the bill’s success. The country’s performance and the state of citizens’ health need to be assessed by an independent authority, and the government must be accountable for delivering on their promises.

On May 29, many Nigerians celebrated again as Dr Goodluck Jonathan was inaugurated as President for the next 4 years. The zoologist succeeded President Umaru Yar’Adua after his death last year, and in April, 2011, Jonathan was re-elected in what is widely considered the most transparent and legitimate election Nigeria has ever held. This is an exciting time for the country: it has a leader with a clear mandate, its economy is flourishing (it is predicted to have the highest average GDP growth of any country over the next 40 years), and efforts are being made to reduce its sporadic civic and religious tensions and endemic corruption.

However, until now, health has been lamentably absent from Jonathan’s declared priorities. Although progress has been made in poliomyelitis eradication and health-systems strengthening since he came to power in May, 2010, these are only two of hundreds of indicators in dire need of improvement. Many societal groups grew concerned over his neglect of a health agenda. On May 18, thousands of women protested about the delay in the passage of the health bill outside the National Assembly. Their efforts were rewarded with the passing of the bill the very next day. At the time of going to press, all that remains outstanding is presidential assent to make the National Health Bill a federal law.

This auspicious turn of events gives cause for hope. Perhaps President Jonathan is more devoted to rectifying the appalling state of health in Nigeria than has been apparent thus far. If he really is committed to providing equitable and affordable universal health care for all of his people, he should sign the National Health Bill immediately. There is no better way to say thank you for electing him.

Editorial from The Lancet
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3 thoughts on “Health Bill- Nigeria

  1. Objections to the National Health BILL
    1. NHB did not include the Private Doctors in Nigeria represented by Association of General and Private Medical Practitioners of Nigeria (AGPMPN) in the National Council on Health as a stakeholder. The Private doctors own as their capital investment 85% of the Health facilities in Nigeria.
    2. AGPMPN should be represented in the technical committee and the main decision-making body in the Council.
    3. Government cannot make discretionary use of private hospitals even in the case of emergency without due consent; the NHB by requiring in Part III, Section 20 (1) compulsory emergency care nationalized all private hospitals in Nigeria. Note the penalty was a huge fine or imprisonment.
    4. In Part IV Section 51 (1-3), legalized Human Ovarian Egg and Embryonic Tissue Trafficking (with permission of the Minister of Health).

  2. I Oppose to the signing of the health bill because it will bring about chaos in the health sector.

    A sizable portion of the bill was “copied and pasted” from Republic of South Africa’s National Health Bill (as amended by the Portfolio Committee on Health (National Assembly)). A conservative plagiarism match test conducted on the bill gave a plagiarism score of 57 per cent.

    Both bills encompass public and private providers of health services; promote a spirit of cooperation and shared responsibility among all providers of health services; provide for persons living in each country the best possible health services within the limits of available resources; and protect, promote and fulfill the rights of the people to have access to health care services.

    They both dwell, almost verbatim, on issues like rights and duties of users and health care personnel; health establishments; control of use of blood, blood products, tissue and gametes in humans; national health research and information and several others. However, unlike the South African bill which presented the nation’s National Health Council as one that advises the minister on policies concerning any matter that will protect, promote, improve and maintain the health of the population; Nigerian National Health Council, according to the bill, will be the all-in-all as stated section 1 subsection 1.

    Section 1 Subsection 1
    There is hereby established for the Federation the National Health System, which shall define and provide a framework for standards and regulation of health services, and which shall –

    (a) Encompass public and private providers of health services;
    (b) promote a spirit of cooperation and shared responsibility among all providers of health services in the Federation and any part thereof;
    (c) provide for persons living in Nigeria the best possible health services within the limits of available resources;
    (d) set out the rights and duties of health care providers, health workers, health establishments and users; and
    (e) protect, promote and fulfill the rights of the people of Nigeria to have access to health care services.

    This portion of the bill is the major reason why so much dust is being raised by Assembly of Healthcare Professional Associations and Unions. This subsection makes the proposed NHS the alpha and omega when it comes to every health decision in the nation.

    Currently, there are numerous regulating bodies – usually on professional basis. For instance, medical laboratory practice in Nigeria is regulated by the Medical Laboratory Science Council of Nigeria as established by the Medical Laboratory Science Council of Nigeria Act 2003. Section 4 (b) of the act empowers the council to: “regulate the practice of Medical Laboratory Science in Nigeria”. Other professions are also backed by similar laws. But with the National Health Bill, these regulatory bodies would be rendered insignificant – or at best, impotent. And the NHS would coordinate and regulate everything.

    Section 1 Subsection 2
    This subsection defines who will be included in the National Health System thus:

    The National Health System shall include –
    (a) the Federal Ministry of Health;
    (b) the State Ministries of Health in every State and the Federal Capital Territory ;
    (c) parastatals under the federal and state ministries of health;
    (d) all local government health authorities;
    (e) the ward health committees;
    (f) the village health committees;
    (g) the private health care providers; and
    (h) traditional and alternative health care providers.

    This subsection does not favor other medical professionals apart from the NMA whose members are the minister of health, state commissioners for health, heads of health parastatals and other members of the NHS. This is seen as a calculated move by the brains behind the bill to totally remove the inputs of other health professionals from the operations and day-to-day running of the nation’s health system which according to AMLSN’s Dr. Godswill Okara, is an orchestration of the ministry and NMA who are seeking to legitimize the culture of tyranny in the sector, “by choosing to ignore our views”. But the logical question to ask is that why did they wait until the bill is passed before screaming at high decibels? . . . (to be contd)

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