Last week, in anticipation of the now postponed Nigerian presidential elections on February 14th, we organized a 3 hour tweetathon, focusing on health, which has sadly been neglected in the current election campaigns. Together with partner organizations, using the hashtag #Feb14Health, we discussed some of the issues that we would like to see addressed by the political parties currently campaigning. Regrettably, none of the parties participated, although they had been invited to do so, perhaps an indication of the importance of health in their plans for the Nigerian people. It was however useful to air and document some of these issues and a Storify summary of the tweets can be found here.
Many of the contributions during the tweetathon referred to the National Health Bill signed into law by President Jonathan late last year. We had earlier described the tortuous ten year campaign by various stakeholders to ensure that for the first time since independence in 1960, Nigeria had a constitutional framework for a National Health System with clearly defined roles and responsibilities for the different tiers of government and non-governmental organizations.
In today’s post, we attempt to summarize the Act and highlight the key provisions.
The new National Health Act (a very readable 29 pages) is divided into 6 parts:
Part I sets out the responsibility and roles of different players in the Nigerian health sector. It establishes a national health system comprising of public and private providers of health services, traditional and alternative healthcare providers and the health ministries and departments at each tier of government and defines the entitlement of all Nigerians to a basic minimum package of health services. Furthermore, it establishes processes for exempting certain groups from paying for services in public hospitals.
The Federal Ministry of Health is given the role of oversight, coordination and planning but is also now required to prepare and present an annual report on the state of health of all Nigerians and the National Health System to the National Assembly and the President
Part I also establishes a Technical Committee to advise the National Council of Health (minister of health and state commissioners), which is tasked with implementing the health plans developed by the Federal Ministry of Health.
A National Tertiary Health Institutions Standards Committee is also established by the Act, to oversee and set standards for tertiary health institutions in the country and also publish annually “information in relation to tertiary healthcare services”. Tertiary hospitals will also be required to undergo annual peer reviews.
To fund the basic health care package entitlement, the Basic Health Care Provision Fund (a FG annual grant of not less than one per cent of consolidated revenue fund plus foreign grants and any other money from other sources) is mandated by the Act. 50 per cent of the Fund is to be used for basic minimum package of health in eligible primary and secondary centres via the National Health Insurance Scheme; while the rest is to be used for drugs, vaccines, equipment, maintenance, human resource development and emergency medical treatment
National Primary Healthcare Development Agency (NPHCDA) funds will be disbursed via State Primary Health Care Boards to LG health authorities with a requirement for co-funding, allowing NPHCDA to withhold funds where counterpart funding is not provided or previous grants are misused.
Part II of the Act sets out a process for regulating health establishments and technologies and ensuring quality and standards. Health establishments will now need to have a certificate of standards which defines how many beds and what technologies they can have. Operating a health establishment without a certificate of standards 24 months after the Act has been passed will be punishable by a fine of 500.000 naira or 2 years imprisonment.
Part II also provides mechanisms for public hospitals to retain a proportion of the revenue they generate (subject to minister and in states, commissioner discretion).
Part III of the Act focuses on the rights and obligations of users and healthcare personnel and makes it an offence to refuse emergency medical treatment punishable by a 100.000 naira fine or 6 months imprisonment.
This part also sets out the rights of healthcare personnel and indemnifies them from claims where they have not been negligent.
Healthcare workers are now required to give users relevant information (health status, diagnosis and treatment options and risks and benefits, right to refuse treatment) to their state of health and treatment unless there are exceptional circumstances.
Health establishments are also now required to clearly define their services, complaints processes and timetables and to keep records for each user with confidentiality standards.
Part IV establishes the National Health Research and Information System with a 13 member National Health Research Committee established to promote research and ensure that it aligns to priorities.
A National Health Research Ethics committee with 17 members, one of whom must be a woman, is also established and any institution carrying out research is required to have an ethics committee.
Part IV also requires the Federal Minister of Health to facilitate the creation of a comprehensive National Health Information Management System and to prescribe data for collection at every level of the health system. Public and private establishments are required to establish and maintain a health information system, which will be a requirement for the award of certificate of standards.
The Minister and commissioners of health are required to publish annual reports on the health of the citizenry and the health system.
Part V focuses on human resources for health and requires the National Council of Health to develop policy and guidelines for training and distribution of health workers. In relation to strikes, health services classified as essential services and the Minister is required to apply all reasonable measures to ensure return to normalcy after disruption within 14 days.
This part also bars all public officers from medical check up, investigation or treatment abroad at public expense, except in exceptional cases approved by a medical board and minister or commissioner.
Part VI establishes the National Blood Transfusion Service, outlines procedures for obtaining consent and bans the sale of blood and tissue. It also prohibits the manipulation of genetic material (“cloning”) and the import/export of embryos.
Part IV specifies that transplantation can only be done with the approval of a medical practitioner and also establishes a process for living wills for organ donation.
Part V establishes conditions for post mortems and outlines who can authorise them- spouse, child, parent, guardian, brother or sister-in that order.
Finally, the Act requires the minister to set up a National Consultative Health Forum and allows him or her to prescribe further transitional arrangements as may be necessary for the implementation of the Act.
There are many obvious questions that arise from the Act; and its implementation will throw up many challenges, but those will be the subject of future posts from us. For now – as we continue to prepare for the elections – let’s keep these issues on the agenda. What do you think of the new National Health Act? We would love to hear from you.