Wednesday, November 2, 2016

The non-implementation of Nigeria’s National Health Act

“Non-implementation of the National Health Act 2014 which provides for not less than one per cent Consolidated Revenue Fund as basic health care provision fund has further worsened the travail of the health sector particularly at the grass roots, where the greater burden of the health disease resides. It has also added to the financial burden of the citizens in their quest to seek quality health care which in most cases is non-existent”
Nigerian Medical Association President, Prof. Mike Ogirima
 
As part of activities lined up to mark the 2016 Annual Physicians’ Week, the leadership of Nigerian Medical Association staged a protest march last Wednesday, October 26, to press for the implementation of the National Health Act 2014. It has been two years since former President Goodluck Jonathan signed the bill into law in December 2014. Unfortunately, the Act has been observed in breach since then.

Worried by this ugly development, the NMA has threatened a lawsuit against the Federal Government as well as embark on a bi-weekly protest march to Aso Rock if nothing is done by President Muhammadu Buhari.  Those who followed the developments that led to the passage of the health bill will know that it was a long and tortuous journey. It was only signed into law after its second passage by the National Assembly.
It is noteworthy that the implementation of the Health Act is vital to achieving Universal Health Coverage in Nigeria.  According to the NMA president, over 70 per cent of health care expenditure in this country is borne out of pocket. The NMA is right to be very emotional and concerned about the non-implementation of this critical Act. Ours is a country with very huge health infrastructure challenges. There are no enough health facilities and manpower. Many of our medical equipment are obsolete and health centres operate below capacity. It is on record that the 772 primary health care centres in the country offer sub-optimal services due to poor funding.
Tunde Ajaja In a features story in the Saturday PUNCH of October 29, 2016, entitled, “One physician to 3,500 patients, yet Nigerian doctors beg for posting”, narrated how despite the World Health Organisation recommendation of one doctor to 600 patients, (1:600) available record showed that in Nigeria, it is one doctor to 3,500 patients (1:3,500). This shows that the country has a huge shortfall of its required number of doctors. By the WHO standard, Nigeria with an estimated   population of 180 million needs at least 300,000 medical doctors. With a ratio of 1:3,500, it means Nigeria currently has about 51,428 doctors. This implies that the nation currently has a deficit of about 248,572. Ajaja quoted the NMA president as saying that there were about 87,000 doctors on the association’s register, out of which about 45,000 were practising in Nigeria, while the remaining, which is almost half, were either outside the country or dead.  Given that significant human resource deficit at the moment, and with the fact that only about 4,355 fresh doctors are produced yearly, it may take the country well over 50 years to meet up with the standard. Heart-rending!
The National Health Act seeks to provide a framework for the regulation, development and management of a national health system and set standards for rendering health service in the country. Some of the accruing benefits of the Act include the provision of free basic health care services for children under the age of five, pregnant women, the elderly and persons with disabilities in the country.  Additionally, the law guarantees the universal acceptance of accident victims in both public and private health institutions. Interestingly and deservedly too, the new law bans senior public officers’ use of public funds for treatment abroad, especially for ailments that can be treated locally. If this Act is implemented, it will help to achieve some of the Sustainable Development Goals especially SDG3 which talks about Good Health and Well-being by 2030.
At present, Nigeria has the highest infant and maternal mortality in Africa. A Demographic Health Survey in 2013 found that Nigeria contributes about 13 per cent of global maternal mortality, with estimated 36,000 deaths annually. Thus, the coming of this Act is expected to reverse that ugly trend as more pregnant women would have access to free delivery services while their children are assured of standard paediatric services in the nation’s health facilities.
The Chairman, Board of Trustees, Health Reform Foundation of Nigeria, Benjamin Anyene, was quoted in 2014 as saying that the implementation of the Act would save the lives of three million women and children over a five-year period.  At present, over 5,000 Nigerians reportedly travel to India, the United Kingdom and the United States for treatment while on the average, over $800m is reportedly lost annually by Nigeria to medical tourism. In the view of the former supervising minister of health, Dr. Khalliru Alhassan, the National Health Act would cause government’s savings in health care delivery to rise from N17bn in 2015 to over N211bn in 2025 if fully implemented.
The ex-minister observed further that “individuals and families will have more disposable income through reduction in catastrophic health expenditure occasioned by very high cost of out-of-pocket spending when the mandatory Social Health Insurance Scheme that will be supported by the Act is implemented” Moreover, “The Act provides for a minimum package of essential health services for all citizens to guarantee a more productive life and will impact positively on infant, child and maternal mortality rates which currently are highly unacceptable at 69 and 66 per cents respectively.” He concluded that “The multiplier effects of this will holistically manifest in increased life expectancy of Nigerians, as well as increased productivity. It is the one singular instrument required to unlock economic goodness and health to Nigerians.”
If the National Health Act has all the aforementioned benefits and prospects and is the magic wand to turn around the deplorable situation in our health sector, why is this administration paying a lip service to its implementation? Do we prefer the extant situation where Nigerians embark on medical pilgrimages to all parts of the world just to be treated of their diseases? That itself has now been made near impossible due to the scarcity of foreign exchange and the economic recession. Thus, many Nigerians now die avoidably for lack of affordable medicare. I lost a younger sister to the cold hands of death on May 19 this year due to the warning strike embarked on by resident doctors to press home for improved working conditions.
If we intend to stem the deplorable health care situation which has necessitated the sick going to prayer homes instead of hospitals, it is high time the administration of President Muhammadu Buhari made the implementation of the National Health Act 2014 a top priority.