It’s almost two months since the National Health Bill was passed into law. Winifred Obgebo, in this piece, x-rays the bill and what Nigerians stand to benefit with its implementation
Nigeria’s maternal and child health indices are among the worst in the world. Needless to say, such indices are very important in measuring a country’s development.
A public health practitioner, Dr Seun Asala, said despite investments in the health sector, the health system, especially at the grassroots remained weak as evidenced by lack of coordination, dearth of resources, including drug and supplies, inadequate and decaying infrastructure, inequity in resources distribution and access to care, and very deplorable quality of care.He gave other contributory factors as the shortage of qualified personnel and finance, inadequate transportation, inaccessibility to communities, lack of maintenance culture and political instability. Lack of clarity of roles and responsibilities among the different levels of government, he also noted, had compounded the situation.
Asala identified human resource for health as being a challenge, pointing out that “attrition, misdistribution, non-engagement, especially at PHC level, poor and inequitable
remunerations, poor attitude to work and inadequate supervision” remained major issues.
In spite of decades of implementing primary health care and a short time left before the attainment of the MDGs, the progress made so far is still far from being favourable, as health status indicators have remained unacceptable. He said that primary health care, which is the bedrock of Nigeria’s health policy and identified as central to the healthcare delivery system remained prostrate. “The rank of government saddled with the responsibility of primary healthcare services provision (LGA) is the level least committed and with the least capacity to effect any significant changes”.
The president, Nigerian Medical Association (NMA), Dr Kayode Obembe, in his view, attributed the poor health indices to lack of financial access to healthcare. According to the World Health Organisation (WHO), Universal Health Coverage (UHC) is a system in which everyone in a society can get the healthcare services they need without incurring financial hardship. It is defined as a system of ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services of sufficient quality to be effective while ensuring that people do not suffer financial hardship when paying for these services.
The fact is direct-out-of-pocket payment is still operational in Nigeria with about 68 percent of cases being from household expenditure. Obembe, said since Nigeria started the National Health Insurance Scheme in 2005, only about 7 percent of the Nigerian population had been covered. According to him, the reason for the stagnation is due to the reluctance of state governors and local government chairmen to embrace the scheme.
After more than a decade of dogged fight by stakeholders and experts in the sector, President Goodluck Jonathan finally signed the National Health Bill into law in December 2014, and this legislation is assumed to have become operational. Now, with the Healthcare Act, it is expected that health services for Nigerians will be transformed, as the new health law provides funding from the Federal Government with counterpart funding from state and local governments for guaranteed basic minimum health care package for all.Part 1, Section 1 of this act states inter alia: “(e).Protect, Promote and fulfil the rights of the people of Nigeria to have access to healthcare services”
Article 11 of the National Health Act specifically makes provision for ‘Basic Healthcare Provision Fund’, not less than 1 percent of Consolidated Revenue Fund to be disbursed as follows:
50 percent-Basic Minimum Health Package (NHIS)
20 percent-Essential Drugs and Vaccines
15 percent-Laboratory Equipment and Transport
10 percent- Human Resources
5 percent- Emergencies
Children below the age of five, pregnant women, the elderly and people with disabilities would receive free healthcare even as the law requires universal acceptance of accident and other emergency cases by all health facilities, public and private. It provides for improved standards and quality of healthcare in health facilities; it curbs the use of public funds by public office holders and civil servants seeking treatment abroad, a popular trend that sees thousands of medical tourists spending millions of dollars’ worth of taxpayers’ money overseas.
The new health law empowers the minister of health to promptly resolve, within a fortnight, any industrial action in the health sector, which is one of the persistent challenges confronting healthcare development in Nigeria. It also provides for severe punishment and imprisonment for human organs, just as it prohibits reproductive and therapeutic cloning of human kind and much more.
Saying a proper template has been provided for the take-off of the universal coverage, the NMA boss pointed out “we are highly expectant therefore that the actual value of not less than 1 percent of the consolidated revenue fund would soon be defined by the budget office of the federation, disbursed according to the provisions of the Act and various governance framework set up for the actualization of the spirit and letter of the law.” He contended that if 50 percent of the consolidated revenue fund was judiciously expended for primary health care through the NHIS, the appalling health indices of Nigeria would seriously improve by leaps and bounds.