The controversial clause in the "new" National Health Bill


The “new” National Health Bill is stuck in the presidency where it has been sent to be signed, as health sector professionals quarrel over a significantly flawed yet, trivial clause in the bill. This does more to illustrate the state of national thinking and dialogue, than anything else in recent national discourse. It is a pity that all the politics in Nigeria is tribal – and this is not just about the ethnic based “tribes” – but is also the tribes of professionals – doctors’ vs pharmacists’ vs nurses’ etc. The tribes of “home grown” vs “diaspora” medical professionals. The tribes of “federal” vs “state”, the tribes of “PDP” vs the “rest of the world”, “public sector” vs “private sector”…..all our politics is tribal! So the debate on the health bill is not about how it will best affect the health of the Nigerian people, no! There is actually no pretence about it – its just about the professional tribes, and how they are positioned to manage 80% of the budgetry resources on health spent on tertiary care at the Federal level in Nigeria. This is currently spent on our 17 teaching hospitals, 3 Orthopaedic Hospitals, 8 Psychiatric hospitals, one National Eye Hospital and 22 Federal Medical Centres around Nigeria. Until now each hospital has had its own management structures, with a super powerful Chief Medical Director.

The bill sets up an innovative structure called the “National Tertiary Hospitals Commission” to better manage this 80% allocated to tertiary care annually. Specifically the Commision is mandated in the new health bill to do the following (amongst others)

  • Establish minimum standards to be attained by the various tertiary health facilities in the nation and also to inspect and accredit such facilities;
  • Advise the Federal Government on the financial needs, both recurrent and capital, of tertiary health services and in particular investigate and study the financial needs for training, research, and services and to ensure that adequate provisions are made for these;
  • Set standards and criteria for allocation of funds from the Federal Government, monitor their utilization, source for grants as laid down by the Commission;
  • Collate, analyse and publish information in relation to tertiary health care services annually;
  • Monitor and evaluate all activities and receive annual reports from the tertiary hospitals, reward performance, apply sanctions and supervise annual peer reviews; 

This is all great stuff, and there is little to argue about, rightly so! Now the crux of the matter holding up the bill, has nothing to do with all this but simply on the Commission’s leadership.  The new bill states that the “Executive Chairmanship of the proposed National Tertiary Hospitals Commission must be a; 

“Medical Director of the status of a Professor with a minimum of ten years working experience in a Teaching Hospital” 

This clause that limits the Executive Chairmanship to medical doctors in perpetuity has all the other health professions up in arms. Doctors argue that it is their traditional (read tribal) role to lead a medical team. The other health professions argue that they (their tribe) must also have a go at leading the commission. 
It is our contention at NHW, that this clause in the health bill is flawed, as it does not protect the best interests of Nigerians, and has placed tribal interests as belonging to a profession (a tribe of doctors), reaching an academic height (a tribe of professors) and having worked in teaching hospital (a tribe of public sector workers) – none of which ultimately guarantees a good leader and manager which the National Tertiary Hospitals Commission needs to fulfill its promise to the Nigerian people. 
Mr President – lead. On behalf of the Nigerian people, send the bill back to the Senate and House, let them remove the clause and open up the leadership of the commission to all those able to lead and manage, and let us move on to more important issues. The fundamental questions that we are not answering are –

– how best to organise and manage our health service
– how to fund our health service adequately
– how to balance the often conflicting demands and expectations of patients, staff and taxpayers
– how to ensure finite resources are targeted where they are most needed.

The health of our people should not be subject to tribal politics.

P/s declaration of a potential conflict interest – Chikwe is a medical doctor who believes that doctors should lead in the clinical management of patients!

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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