Nigeria’s National Health Bill (NHB) – seen by many as urgent and necessary to rejuvenate the country’s ailing health sector – has been a long-time coming. It was first presented to the National Assembly in 2006 and, having made its way through various bureaucratic bottlenecks, was passed by the House of Representatives and the Senate in May 2011. However, following disagreements, disputes and political stalling, President Goodluck Jonathan declined to sign it into law and it was returned to the National Assembly once again last year.
As Nigeria’s healthcare sector continues to struggle, many decry these delays. “For each day the NHB is delayed”, Osahon Enabulele, president of the Nigerian Medical Association, told Think Africa Press, “there is a worsening of access to healthcare services (particularly primary healthcare) and quality of healthcare services – all of which negatively impact on Nigeria’s health status indicators as well as the overall health of Nigerians.”
Recent statistics from the World Health Organisation (WHO) regarding Nigerian health make for sobering reading. The average life expectancy at 54 is well below the global average and especially worrying for a middle-income country. Maternal mortality is 608 per 100 000 live births – twice as high as South Africa’s 300 per 100,000 and almost ten times Egypt’s 66 per 100,000. And only 3% of HIV-positive mothers receive antiretroviral treatment.
In a bid to turn all this around, Nigeria’s National Health Bill pledges a budget of N60 billion ($380 million) for primary healthcare each year, and promises to ensure the provision of free medical care for the most vulnerable. The bill is said to establish minimum guarantees of basic healthcare services for select groups – such as children below the age of five, pregnant women, adults above the age of 65 and people with disabilities – and help extend primary healthcare to 60% of Nigerians living in hard-to-reach rural communities.
“The Bill also removes barriers to access emergency healthcare as it instructs medics to treat any emergency first before asking for money or police report”, Tonte Ibraye, National Coordinator, White Ribbon Alliance for Safe Motherhood, told Think Africa Press. “And the health bill formally recognises the establishment of Village Health Committees which gives room for community participation and ownership of the health centres”. The bill further seeks to reform the recruitment, training, and professional development of health sector workers.
These changes would be facilitated by the creation of a National Primary Healthcare Development Fund (NPHDF), which would be funded by Nigeria’s consolidated revenue fund. 50% of NPHDF would be spent on the basic provision of health services; 25% on the procurement of drugs and equipment; 15% on the provision and maintenance of facilities, equipment and transportation; and 10% on upgrading workers' skills in the primary healthcare sector.
To the annoyance of many, however, bureaucratic bottlenecks and in-fighting between the various health sector stakeholders discouraged President Jonathan from signing the bill into law last year, and he instead returned it to the National Assembly for further discussion.
Whilst no specific reasons were given, there have been disputes over matters in the bill such as the perceived increased of power awarded to the health minister, the favourable position given to doctors over other health workers, and the funding of the bill.
Some have also claimed that vague language in section 51 of the bill – regarding the donation of embryos and other genetic material – offers insufficient protection against the trade of such material and ethically-contentious issues such as cloning and research, and leaves too many important decisions to the health minister. Nduka Ugwu of the Private Medical Practitioners of Nigeria told Think Africa Press: “Introducing section 51 through the back door is treacherous and lacking in respect for the life of Nigerians and human society. This enigmatic clause is an affront on the dignity of man. The merchandising and trafficking on human gametes, zygotes, embryos or human cloning should be banned outright and not left to the whims and caprices of the Minister of Health.”
Another area of weakness in the bill lies in the relations between different levels of government. While the bill may recognise community involvement, for example, the interaction between local, state and federal is not specified clearly enough. Ironing out this issue will be important as the practice of shifting blame between authorities blights the current system.
In its basic form, Nigeria’s proposed health bill encapsulates many reforms that will be crucial – such as access to services, accountability and restructuring. But it also continues to contain a number of uncertainties which have led to disagreements and delays to the process.
Many stakeholders insist that these details and specifics must be ironed out before any further progress, but Osahon Enabulele, president of the Nigerian Medical Association, perhaps best captured the overriding popular attitude when he commented:
“Although the National Health Bill may not solve all the problems and challenges of Nigeria’s health system, in many ways the NHB signifies an important and bold step to positively turn around the fortunes of Nigeria’s health system.” It may not be perfect, but until it is passed and Nigeria can go about reforming the ailing sector, it will be ordinary Nigerians lacking in the most basic requirements necessary for good health that will be suffering as they wait.
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