The New Nigerian Health Bill and What It Means To You

This past December, while we were all busy making preparations for our holiday festivities, President Goodluck Jonathan signed Nigeria’s landmark National Health Bill into law.

Originally conceived in 2004, the bill replaces the country’s previous health policy, which was enacted in 1988, and which some argued was inadequate. The earlier policy’s shortcomings, such as no official legislation to describe the national health system, an uneven distribution of roles throughout the levels of government, and a lack of accountability to stakeholders, led to a largely uncoordinated system plagued with redundancies and chronically inhibited performance – a health system that was itself sick.

After ten years of gestation and cultivation by different organizations (such as the Health Reform Foundation of Nigeria, a coalition composed of several health related groups), the new health bill was finally born on December 9, 2014, when the president signed it into law. Many are celebrating the bill’s birth, but it is important to remember that, just as with the arrival of any new child, this birth brings with it the need for more responsibility.

Here is a quick look at the bill and its ten-year journey.

A Bill Is Born

A baby’s journey toward birth involves passing through various phases of growth, and a bill’s journey toward becoming law in Nigeria also involves passing through necessary phases, including four stages in both houses of the National Assembly and three readings. The new National Health Bill went through all of this and more.

The first draft of the National Health Bill was drafted in 2004, after a review of the National Health Policy as part of the Health Sector Reform Agenda. This draft was then sent to the National Assembly, and in 2006, the bill went through its first hearing. In 2008, it continued its journey through several committee meetings and workshops, as well as going back and forth many times in the National Assembly.

Why did it take so long to pass a bill that would change the face of the Nigerian Health Sector? Blame politics. Thanks to the tedium of bureaucracy, as well as dissention among the different stakeholders (Catholic entities calling for certain sections to be expunged, health officials suspicious of the ascendancy of the medical doctors, and so forth), the National Health Bill went through all of the requisite stages not once, but twice. Granted, the extended process did help to uncover some of the bill’s weaknesses, but the longer it took for the bill to be passed into law, the more Nigerians suffered as a result of limited access to quality health care.

Despite the delayed arrival, the baby is now here, and it has the attention of all: ministries, agencies, medical practitioners, both private and public, and ordinary citizens alike. So now let us see what this baby looks like. Let us see if its body is complete, and let us peer into its future and try to predict what it holds for Nigeria.

The Upsides

The 29-page document itself is beautiful and holds the best of intention — its main theme is better and more accessible health care for Nigerian citizens. They are the ones for whom the bill is intended. The beginning of Part II of the bill states: “A health care provider, health worker or health establishment shall not refuse a person emergency medical treatment for any reason whatsoever.” “Any reason whatsoever” should cover all the common excuses for delayed care, from mandatory up-front payment to police reports for gunshot wounds.

The bill also insists on broader Nigerian Health Insurance Scheme coverage and demands accountability by clearly stating the “healthy” roles of the different tiers of government. It designates health care workers as essential personnel who cannot be absent from work for more than two weeks.And it attempts to embrace all of the different stakeholders in the sector, even the traditional health practitioners. We applaud this!

What does the signing of the bill mean to the average Nigerian? For one thing, it means that when a woman is about to give birth and needs an emergency caesarean section, the procedure will not be delayed until payment has been made, and many needless deaths will be prevented.

Nigerians will also now have access to quality, affordable health care services. No longer will people be forced to travel abroad with their life savings in order to receive a kidney transplant. (A session of kidney dialysis at the Federal Medical Centre, Owo, costs about N30, 000, and a patient may require as many as three sessions per week depending on the severity of their condition; private hospitals are even more expensive. How many average Nigerians can afford this?)

It will be wonderful to see a decrease in health care costs, as well as the corresponding decrease in the health-related burdens that weigh down so many Nigerians.

And the Downsides

But even as we admire the positive aspects of our new arrival, let us not overlook our baby’s not-so-beautiful features.

Why still so many hands in the name of committees when two hands would be enough? There is the National Council on Health, the Technical Committee of the National Council on Health, the National Ethics Committee (which is actually the National Health Research Ethics Committee), the National Tertiary Health Institution Standards Committee and the Committee on Emergency Health Treatment. Do these committees really mean more action, or just more bureaucracy?

Another chink in the bill’s armor is that the penalties for noncompliance with standards are mere slaps on the wrist. How do you charge a hospital N500, 000 when so many lives have been lost as a result of its substandard practices? And in cases in which it is a government facility that has fallen below the accepted standards, who will pay the fines? Who will take responsibility? Who will be punished?

The provision of Section 53 involves the wrongful removal of tissue, blood or blood product from the body of another living person. Breaking this provision incurs a fine of N100, 000, or imprisonment for a term not exceeding one year, or both. For this law to be effective, the punishment must be harsh enough to serve as a deterrent to others, and its execution must be ensured. How exactly will this occur?

When an Act Is Silent

The act contains some glaring omissions, such as a clear outline of the prerequisites for the position of minister of health. Most ministers of health have been medical doctors (a fact which has been the root of a silent battle between several Nigerian associations of health professionals, such as the Nigerian Medical Association (NMA), the Medical Consultant Association of Nigeria (MDCAN) and others). It is interesting, and perhaps wise, that the health bill is mute on this subject. Nonetheless, it is an omission that did not go unnoticed as Nigerians weighed in on social media following the bill passage.

Temie Giwa (Twitter handle @Temite), who herself is not a medical doctor, is excited about her prospects of becoming a minister of health in the future tweeting: “I have always wanted to be an honourable minister of health. But I thought that it wasn’t possible, and now it is.”

So there is an unspoken question that the bill could, but does not, answer: Should the head of a hospital, or the head of the health ministry, always be a medical doctor?

The bill also does not provide a solution for cases of long-term health care strikes, cases which we have seen repeatedly in Nigeria, cases that a minister presiding over meetings with warring factions simply cannot solve. Should we expect this bill to bring an end to medical personnel’s demands for higher pay?

But let us not throw away the baby with the bath water. Surely there must be ways for all parties involved to work with and adapt the act as it stands so that it might efficiently and effectively deliver better health care.

The Work Ahead

Opeyemi Salami-Agbejule, an Ibadan-based English literature graduate, wonders exactly what the National Health Bill is: “Is it NHIS—the National Health Insurance Scheme?”

One wonders about the fate of the masses in understanding this new law made for them. How will they learn about the provisions of the act? How will it empower them and improve their health? The dissemination of information alone will require both logistics and legwork, and ward and village health committees will have their hands full.

It is not yet time to rejoice fully; the bill is still only a framework. Everyone who laboured and pushed for this child to be born will have to continue working hard to ensure that all of the agencies, organizations and, of course, committees that this act empowers do not lie passive, but rather that they spring into action. For the bill to have an impact, we all must act. This baby needs to be nurtured if it is to live.

The government and its agencies and ministries must not allow the act’s good intentions to be lost in the bureaucratic machine. And for our part, it is not enough to wait for the government to act. We as a society must continue to lobby for a more active health sector and to develop strategies for implementation of the act, complete with actionable key points.

Citizens need to be empowered with the means of reporting poor medical service, and there should be ways by which they can assess the bill’s effectiveness – even in the most rural locations – and give feedback which could be implemented.

Finally, the media must move beyond the headlines and get down to the hard work of looking into the real-world effectiveness of the act, while at the same time calling out its detractors. Take, for example, the ongoing Joint Health Sector Unions (JOHESU) strike; according to the new law, health workers are now essential service providers, and strike actions can last only 14 days. This being the case, the minister should act in accordance with the bill and bring this strike to a close.

We welcome the new National Health Bill into our midst and are all eager to see it in action – after all, it must be called an “act” for a reason.

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