By Ndidi Chukwu
Ensuring full implementation of the National Health Act (NHAct) by 2016 in Nigeria is one goal which has had the attention of all government agencies, CSOs, and partners seeking for fast improvement of the nation’s health system. The Nigerian government is mandated by law to make available at least one percent of the nation’s consolidated revenue fund, to become a basic healthcare provision fund.
Number 11, Part 1, of the National Health Act 2014, clearly states how Basic Health Care provision for all Nigerians will be financed. It says the Federal Government Annual Grants of not less than one per cent of its consolidated revenue fund shall be used to provide basic minimum health care for all Nigerians.
The section 3 of the Part 1, says
- 50% of the fund 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 percent of the fund shall be used to provide essential drugs, vaccines, and consumables for eligible primary health care facilities.
- 15 percent of the fund shall be used for the provision and maintenance of facilities, laboratory, equipment and transportation for eligible primary health care facilities
- 10 percent of the fund shall be used for the development of Human Resources for Primary Health Care.
- 5 percent of the fund shall be used for emergency medical treatment to be administered by a committee appointed by the National Council on Health
Section 4 of the Part 1, gave the National primary Health Care Development Agency (NPHCDA) the mandate to disburse funds for items 3 (b, c, and d) through State and Federal Capital Territory Primary Health Care Boards for distribution to local government and area council health authorities.
For States or Local Governments to qualify for a block grant pursuant to the Basic health Care provision Fund, such State or Local Government shall contribute;
- In the case of a state, not less than 25 per cent of the total cost of projects; and
- In the case of local government, not less than 25 per cent of the total cost of projects as their commitment in the execution of such projects.
The NHAct in its sub-section 6 of the part specifically said, the NPHCDA shall not disburse money to any
- Local government health authority if it is not satisfied that the money earlier disbursed was applied in accordance with the provisions of the Act.
- State or local government that fails to contribute counterpart funding and;
- States and local governments that fail to implement the National health policy, norms, standards and guidelines prescribed by the National Council on Health.
Sub-section 7 of the part also mandates the NPHCDA to develop appropriate guidelines for the administration, disbursement and monitoring of the fund in line with the approval of Minister in council.
But a huge task lies ahead of Nigeria, how to generate the needed fund amidst the nation’s dwindling oil price and the country’s gradual graduation from donor supports. As part of its responsibility, the Healthcare Financing Equity and Investment Team, a sub-committee of the Technical Working Group working on the implementation of the NHAct 2014, is looking at every facets of funding for full implementation of the NHAct.
Dr. Lekan Olubajo, Head, Health Financing for Department of Primary Health Care System Development, NPHCDA, said “Nigeria’s revenue has declined not huge money available but the country is ready to make the most effective use of funds available to it. How to get State governors to implement the act is the challenge the committee considers a possible setback. For funds to be disbursed to states “the guideline” has to be followed Olubajo said? The NPHCDA intends to use its State Primary health Care Development Agencies to drive its target but some states are yet to own SPHCDA since its launch. The committee may need to increase advocacy to the State governors to priories its targets for health.
For disbursement of the 50% going to the National Health Insurance Scheme(NHIS) the scheme has urged every state to develop functional State Health Insurance Schemes (SHIS), have an equity pull for vulnerable groups-pregnant women, children and the aged, who would begin to access free medical services with health insurance backup.
According to report made to the Healthcare Financing Equity and Investment committee, the NHIS would disburse funds to states based on the burden of the vulnerable group in a particular state, best performing states will also benefit more support and funds as an incentive.
The NHIS has also assured of good monitoring mechanism through its SHIS, if the state governments agree to establish SHIS, but Dr. Tarry Asuka, consultant and member of the committee said the NHAct is a law that has to be interpreted. “It is the responsibility of the TWG to ensure the regulation and adequately interpret the NHAct for states to align to its provisions” said Asuka.
The 5% to be disbursed by the Federal Ministry of Health according to Dr. Francis Ukwuije, FMoH, and Department for Planning Research and Statistics, will be channelled to fund treatment road traffic accident victims. The NHAct mandates all hospitals to treat all emergency cases, “we are looking at a way of having facilities that are willing to handle these emergencies. The FMoH plans to leverage on the actions of both the NPHCDA and NHIS towards improving access to Primary Health Care Services, to create a good PHC emergency response department with specialised nurse and doctors in accident and emergency units.
Ukwuije also said the planning team of the FMoH would encourage the Health Minister, who is the chairman of the National Council on Health, to set up a committee from the Federal Ministry of Health which will ensure grassroots implementation of the health emergency system.
Responding to the presentations by the three MDAs, Chairman of the Committee, Professor Obinna Onwujekwe, said the task for the TWG, which the Healthcare Financing, Equity and Investment committee is made of is to ensure that all funds are disbursed according to provision of the law, bearing in mind that the NHAct is well articulated and if properly implemented, the poorest poor in Nigeria will have access to the best of medical care.
“Unless we implement the NHAct, the 10 years advocacy for accent to this law while it was still a bill will be in vain” Professor Onwujekwe said while emphasising that the whole goal is to ensure that all effort aligns with Nigeria’s target of achieving Universal Health Coverage by 2020.