Health: Now, more than ever before

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Abraham Lincoln, one of America’s most pragmatic leaders ever, was a huge proponent of conscientious law making and democracy that considered all men equal, and therefore amenable to the same laws and standards. Lincoln’s approach and strive for conscientious law making, are a cornerstone of modern day democracy.

14 years into Nigeria’s democracy, and our conscientious law making continues to come under heavy scrutiny. A nation with an estimated 170 million people, 608 maternal deaths per 100,000 live births, 157 under-five deaths per 1000 live births and unquestionably some of the worst health indices from around the world, still does not have health legislation.

A former Minister of Health, Prof. Adenike Grange said in 2008, “the absence of a National Health Act to back up the National Health Policy has been a fundamental weakness which needs to be tackled frontally. This weakness means that there is no health legislation describing the national health system and defining the roles and responsibilities of the three tiers of government and other stakeholders in the system. This has led to confusion, duplication of functions and sometimes lapses in the performance of essential public health functions.”

The National Health Bill, is Nigeria’s first all encompassing health legislative. According to the World Health Organization (WHO), an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people. The National Health Bill fits the bill, on all of these counts.

The National Health Bill started its journey in 2004 at the National Assembly (NASS), scaled through by 2011, following re-reads and re-negotiation of some redundant bureaucratic hurdles within NASS. Finally passed in May 2011, the bill was refused assent by the President, for reasons that were never made public. A 7-year journey had hit a brick wall. During these 7 years of debate of the bill, the Nigerian Medical Association (NMA) estimates 7 million children and 385,000 mothers died in that interim.
After almost 2 years of inactivity, the bill has been returned to and re-opened by NASS, including a public hearing on the bill last week. This may be the beginning of another 7-year trip.

The National Health Bill seeks to define, streamline and provide a framework for standard and regulation of health services in the country. It spells out the rights and duties of healthcare providers, health workers, health agencies and users. It serves as a guide in the development, promotion and formulation of national health strategies amongst others. The National Health Bill promises to provide all Nigerians with a basic minimum package of health services. It pledges to develop a national health policy that includes about 60 billion naira (about US$380 million) devoted to primary health care each year, provision of essential drugs, and comprehensive vaccination programs for pregnant women and children younger than 5 years of age.

When the bill was passed in May 2011, the Lancet, one of the world’s leading medical journals, described the passage of the bill, as momentum that had never been seen before, towards making a real commitment to improving health in this country. The journal went as far as to say that on the evidence of the passage of the bill, that perhaps President Jonathan is more devoted to rectifying the appalling state of health in Nigeria than has been apparent thus far, in his regime. The journal, as far back as May 2011, pushed President Jonathan, saying “if he really is committed to providing equitable and affordable universal health care for all of his people, he should sign the National Health Bill immediately, as there was no better way to say “thank you” to the people for electing him.”

The National Health Bill, together with the amendment of the National Health Insurance Scheme (NHIS) Act, being debated in NASS, can together bring about a healthcare revolution in Nigeria. Primary Health Care will be re-energized, relevant financial commitment from the government will be available, health coverage will be extended to many who today cannot afford care because they have to pay out of pocket, and greater transparency and accountability within the health sector will be assured.

Nigeria needs both of these pieces of legislature to be adopted, signed into law and implemented, to lead our health sector out of the present dire straits that we find ourselves in.

A lot of opposition has arisen to the National Health Bill, especially around certain issues of unchecked authority for the Minister of Health, and issues surrounding embryonic and stem cell research. I personally do not see these issues as being controversial or irrational, as the surrounding debate around them may suggest. I however think that some of those issues merit an independent act that can be openly debated and decided upon as we see fit, without allowing those issues to hamper smooth sailing of the rest of the bill.

The time has come to move forward with the National Health Bill, for keeps. Its promises will not change everything for us, but the bill does allows us to finally hold the government to account for our right to health, including equitable access to care. To aid this process, Nigerians must make major demands, from all of us, who are involved in this bill, in one way or another.

We must demand that everyone debating or contributing to the bill keeps the big picture in mind, and finds the right balance between principle and compromise. Principle without compromise is empty. Compromise without principle is blind. If finding a balance will entail deleting or amending the controversial aspects of the bill or relinquishing them to a different legislative act, then let us do that and show that we place the numerous benefits of the bill high above all other issues that are debatable. There is definitely no debate about the number of lives that will be improved by the safe passage, assent and implementation of the bill.

We must also demand that the bill concludes its journey and be signed into law by the last quarter of 2013. This will among many things, ensure that relevant budget implications of the bill for the coming fiscal year are factored in. Nigerians have waited too long for the conclusion of this bill, for its implementation and above all, for adequate political support towards an improvement of our health and the available healthcare. We must therefore demand that a repeat of the events of 2011, does not play out. NASS must show its commitment to the people, not only by fast and smooth passage of the bill, but by additionally showing the willingness to garner the required two-thirds majority to sign the bill into law, without support or approval of the Federal Executive Council (FEC).

NASS were elected from among us and should stand for us, against all odds, within all the provisions of the constitution. The National Health Bill is back, and we will be looking to them, to do the right thing.

Assent and implementation of that bill must happen on this trip, because our need for it is biggest now, more than ever before!


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