Written by Dayo Olaide, dayo_olaide@yahoo.com; and Maxwell Kadiri; kadiri.maxwell3@gmail.com
It was their first pregnancy after eight years of marriage. Angela, 31 and her husband, Umaru, 33, were thankfully expectant as they counted down to the expected day of delivery (EDD). They had visited the hospital so many times together walking hand-in-hand and had become so used to the route, that they could both take the walk even with their eyes closed. They had made elaborate plans on how to get Angela to the clinic once they saw the signs that had been explained to them for the umpteenth time by the cheerful nurse at the local hospital.
Come the EDD, Angela and Umaru took the long walk with a bag containing their prized collections to welcome their baby hanging on Umaru’s shoulder. With excitements of becoming a father Umaru went into the delivery room with his lovely wife. Sadly, it was only Umaru that came out of the delivery room. He must now take that long walk back home without his wife and prized baby. The joy of motherhood had been aborted and Umaru is forced to join widowhood at his prime. He lost his wife and the new baby due to over-bleeding.
This story of Angela and Umaru, which reflects the lived reality of many Nigerians, certainly resonate with lots of households in the country, who have lost daughters, sisters, aunts, cousins and mothers arising from complications before, during or after childbirth. Many more die due to lack of emergency services, inadequate trained personnel, infrastructure decay, unaffordable health services, prolonged industrial action, poor investment in research and learning, poor regulation and absent accountability.
Despite halving maternal mortality ratio the last twenty years, from 1200 per 100,000 live births to about 576, according to the 2013, demographic health survey, Nigeria retains the record of having the highest maternal mortality figures per annum in Africa and second globally, behind India.
Albeit, death is indeed inevitable, however it is curiously inexplicable when more than 70% of death recorded, are entirely avoidable through simple adjustments to the health system. Unfortunately, this scenario depicts the lived reality of much of Nigeria’s health sector where available statistics remain depressing despite huge investments by government, development partners and other non-state actors the last fifteen years or more.
Nigeria however has a unique opportunity to tackle once and for all, the many structural and institutional deficiencies, plaguing the health sector through a robust legislative framework contained in the National Health Bill which awaits Presidential assent.
Unless President Goodluck Ebele Azikiwe Jonathan, keeps to his name and brings “goodluck” to Nigeria’s Health Sector, by assenting to the National Health Bill, in the next 5days or less, the wonderful proposals contained in the Bill would all have been killed a second time by this administration.
The last time the bill made it this close to becoming a law, in similar circumstances, in 2011, President Jonathan, withheld his assent for undisclosed reasons and a new bill had to be introduced in the 7th National Assembly, for a fresh and tortuous legislative process.
It is now eight years since a groundswell of advocates, sympathetic policy makers and international allies rallied round to support the development of this landmark bill, which if passed will remarkably reform and improve the governance, administration, delivery and access to health services in Nigeria, be it in the primary, secondary and tertiary healthcare system. As things are currently, President Jonathan’s signature is all that stands between Nigerians and a promising, long overdue responsive, efficient and effective healthcare system.
Like the moribund power sector, Nigerians are desperate for a health sector that works for every Nigerian regardless of societal status, levels of income, place of residence and other considerations, which currently excludes the large majority from accessing quality healthcare. In this regard the recognition of the depressing state of the health sector gave rise to the various reform initiatives of the last fifteen years, which are also worth commending. Examples include, the strategic thrust of health sector reform under former President Obasanjo which aimed at improving the stewardship role of Government in Health Sector Reform; strengthening the National Health System and its Management; reducing the Disease Burden; improving availability and access to quality health services and enhancing consumer awareness of their health rights and obligations, to name a few.
Under that administration, it is on record that, health sector spending in relation to annual government expenditure averaged about 6% of the annual budget with the National Economic Empowerment and Development Strategy (NEEDS), the Millennium Development Goals (MDGs), the Health Systems Performance and Public Sector Reform Initiative serving as the main drivers of the administration’s reform agenda for the health sector.
Although far from the 15% recommended globally, but like the previous administration President Jonathan’s government has maintained about the same level of public spending on health and in its mid-term score card, reported a wide range of interventions covering improvements in leadership and governance of the sector, infrastructure and service delivery, disease control and surveillance, human resource development, research and development, etc,
According to Douglas Oronto, Senior Special Adviser to President Jonathan on Research and Strategy, the administration has laid a solid foundation for transforming the nation’s health sector. It is therefore safe to say that signing the National Health Bill into law is actually in the best interest of Mr. President, especially, because, doing so will transition extant ad-hoc interventions in the health sector into a more structured, systematic framework, with clear cut deliverables and developmental outcomes, backed up by law. Consequently, the Bill institutionalizes extant policy reforms and insulates the sector from ‘politicisation’ of reforms, which has previously blocked many reforms.
In proof of its trail blazing nature the Bill, for the first time in Nigeria’s post-independence history, emphasizes, protection and promotion of the rights of all Nigerians to access basic minimum package of health care services, including the provision of emergency medical services. It sets out the rights and obligations of health workers, healthcare providers and health establishments. It fosters the establishment of a stratified and coordinated National Healthcare System at all levels of governance, including in far flung villages and wards. All these and more can be found in Sections 1(2), 3(3), 20 – 30 of the Bill. Post enactment, enforcing the rights contained in this Bill will bring an end to the era of Nigerians being denied access to basic medical services, including emergency care, irrespective of where they live, their social status, income and literacy levels respectively, while also clearly delineating the rights and duties of health workers and health establishments.
The Bill recognizes the role and contributions of private, traditional and alternative healthcare providers and sets the foundation for cooperation and collaboration among the three tiers of government (i.e. federal, state and local government) under the proposed National Health System. The importance and impact of collaboration was recently clearly demonstrated in Nigeria’s successful containment of the deadly Ebola Virus Disease.
By giving legal recognition to the National Health Council, comprising heads of federal and state ministries of health and vesting it with clearly defined roles, powers and duties, in Sections 3 – 5, and creating a handful of technical committees mandated to provide expert advice and support to the work of the Council, the bill sets an important framework for systematic cooperation and collaboration considered necessary and important for improving efficiency, synergies and ensuring knowledge sharing and peer learning; all of which are considered vital ingredients of a well-functioning national healthcare system.
In an attempt to address the perennial problem of inadequate resource provision for Healthcare in Nigeria, the Bill creates a Basic Health Care Provision Fund, through which it proposes to finance the provision of basic minimum health package for every Nigerian (under a revitalized National Health Insurance Scheme), ensure availability of essential drugs, vaccines and consumables for all eligible primary health care services, provide and maintain health facilities, including laboratories, equipment and transportation, for all eligible primary health care facilities and support development of human resources for primary health care facilities and provision of emergency medical treatment.
The importance of the Basic Healthcare Provision Fund cannot be over-emphasized, especially because, empirical evidence shows that, more than 70% of Nigerians seek health services at the level of primary healthcare. As a result, deploying the fund in the manner proposed by the Bil increases the prospects of many more Nigerians in rural, semi-rural, urban and peri-urban areas finding it a lot easier to access and enjoy functional healthcare services thus saving more lives. Overall the Bill will improve public confidence in health facilities and reduce patronage of quacks.
It also seeks to address, the recurring incidence of protracted industrial actions in the health sector, to the detriment of Nigerians, by making it incumbent on the authorities to resolve industrial actions within two weeks. The Bill further seeks to address the perennial problem of quacks, sub-standard, fake drugs and other malaise traced to poor regulation and weak accountability framework by strengthening the governance and regulation of the sector. The Bill makes it illegal for anyone to, amongst other things, own, establish, construct, modify or acquire a health establishment, health agency or health technology; increase the number of beds in, or acquire prescribed health technology at a health establishment or health agency or provide prescribed health services, without being in possession of a certificate of standard issued by the appropriate government agency where such facility is located. Non-health facilities providing health services must also obtain such certificates and comply with the requisite standards. Offenders are liable to fines and/or imprisonment or both.
In order to reduce the flagrant medical tourism which is a major burden on the public purse, Section 46 of the Bill provides that no public officer of the government of the Federation or any part thereof shall be sponsored for medical check-up, investigation or treatment abroad at public expense except in exceptional cases on the recommendation and referral by the medical board and which recommendation or referral shall be dully approved by the Health Minister or State Commissioner for Health as the case may be. In addition to significantly reducing such incidents, it ensures greater accountability in this respect.
The Bill makes provision for human resource development, technical research conducted within ethical boundaries and knowledge development, amongst others. This is in addition to strengthening basic primary health care and linking it with secondary and tertiary healthcare. It also promotes effective oversight and regulation of health programming in Nigeria aimed at enhancing prospects of providing quality health services in Nigeria which comply with existing global best practice.
For the numerous positive provisions we humbly urge President Jonathan to promptly assent to the Bill within the few days left of the 30 days constitutionally recognized for presidential assent. We urge all people of goodwill to urgently reach out to President Jonathan on this all important Bill needed to save Nigerians from avoidable deaths that claim their lives, including those of, our mothers, daughters, sisters, cousins and aunties.
