The story immediately went viral online when it was communicated that the national health bill was signed into law by the President of Federal Republic of Nigeria Dr. GoodluckEbele Jonathan on December 9, 2014.
It was an astatic moment as the struggle covered a period of 10 years. Many stakeholders should be commended for their tenacity and doggedness over the years to ensure its repeated passage in the national assembly and finally the assent by Mr. President. Notable to thank are; Legislature, Civil Society Organizations and the Media.
Why is the health act important?
Currently Nigeria is facing an insufficient amount of funds annually allocated to health sector which is below 10% of the country’s annual budget over the last 8 years?
1. The 2013 National Demographic Health Survey (NDHS) had scored Nigeria poorly in many health indicators. Our Maternal Mortality Ration is put at 576 maternal deaths per 100,000 live births which wasn’t significantly different from the ratio reported in the 2008 NDHS of 545/100,000.
2. Nigeria is one of the 10 worst places in which to be a mother, and has the second highest number of newborn deaths worldwide.
3. One woman out of every 41 Nigerians faces a lifetime risk of death in childbirth. This is in contrast to Ethiopia, where one woman out of 67 faces such a risk.
4. Currently, only 15% of Nigerians married or in-union aged 15-49 use any modern method of contraception. These numbers are shockingly low, and in stark contrast to Ethiopia where the rate is 27%. In Bangladesh 52% of women married or in-union aged 15-49 are using modern methods of contraception.
5. The estimated number of maternal deaths for 2013 is 40,000.
It is imperative at this juncture to also provide a good highlights of what the act intends to address.
The act is in line with the United Nation’s Every Woman Every Child Strategy, Africa Health Strategy 2007-2015, Maputo Plan of Action on Sexual and Reproductive Health and Rights and 15% Abuja Declaration.
Below are some key provisions;
• Establishes a National Health System anchored on the principles of coordination, collaboration, shared responsibility, efficiency, effectiveness, accountability, professionalism, promoting appropriate standards and clear cut regulation of health services across the Federation. It also clearly delineates a range of rights and duties of all stakeholders in the health sector, amongst other key positive values, in the three tiers of Government (i.e. the Federal, State and Local Government) and the private sector.
• It gives recognition to the right to good healthcare for Nigerians, including their entitlement to a basic minimum package of Health Services within a healthcare system that meets global standards.
• It incorporates into the National Health System a stratified framework that goes all the way down to the Local Wards and Village Health Committees and also includes Private Healthcare Providers, Traditional and Alternative Healthcare Providers too.
• It institutes a framework for the provision, in deserving cases, of free healthcare services in public health institutions that takes on board the peculiar health needs of vulnerable groups, such as Women, Children, Old People and People living with Disabilities.
• It gives appropriate legal recognition to the extant National Council on Health as the highest policy making organ for the health sector, nationwide, with responsibility to ensure the promotion, protection, improvement and maintenance of good health and healthcare services for Nigerians.
• It establishes a technical advisory committee composed of key experts and stakeholders in both the public and private health institutions, with a mandate to provide technical advice and support to the National Health Council.
• It creates a range of other technical support structures for the National Health System such as the National Tertiary Health Institutions Standards Committee, the National Health Research Committee, the National Health Research Ethics Committee, the National Drugs Formulary and Essential Drugs List Review Committee and the Committee on the Provision of Emergency Medical Treatment for Nigerians.
At a national meeting of some advocacy Civil Society Organizations (CSOs) in Abuja on Friday 12th December 2014, I was passing a joke that we the ‘CSOs’ got the health act but the government got the money. The act has a mandate for the establishment of a Basic Healthcare Provision Fund primarily financed through a combination of an annual grant of 1% from the Federal Government’s Consolidated Revenue Fund, grants from international donor partners and counterpart funding of at least 25% from States and Local Government Councils hosting projects financed through the Fund. It is to be managed by a consortium made up of the National Primary Healthcare Development Agency (NPHCDA), the National Health Insurance Scheme (NHIS) and the Committee on Emergency Medical Treatment for Nigerians.
Proceeds are to be disbursed as follows;
• 50% for provision through the National Health Insurance Scheme (NHIS), of a basic minimum package of health services to Nigerians in eligible primary and/or secondary healthcare facilities;
• 20% is for the purchase of essential drugs, vaccines and consumables for eligible primary healthcare facilities;
• 15% is for providing and maintaining healthcare facilities, laboratories, equipment and transportation for eligible primary healthcare facilities;
• 10% goes towards developing requisite human resources for the provision of primary healthcare in the country;
• 5% is for providing Emergency Medical Treatment for Nigerians.
We are just one step in to the struggle, we have to continuously be calling for greater accountability and transparency in a manner that these funds are allocated, disbursed and expended and also linking the funds with positive health outcomes.