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A long wait for the National Health Bill

With the 2015 Millenium Development Goal (MDG) around the corner, stakeholders are earnestly calling for the president to assent the national health bill, which has been fraught with a lot of controversies

SIGNING the country’s National Health Bill (NHB) into law has become an exercise trailed with so many controversies, especially within the populace. Mixed feelings have continued to trail the non-assent of the bill by President Goodluck Jonathan over one year of its passage by the National Assembly (NASS).

To health professions and other professional groups, non-validation of the National Health Bill (NHB) has been considered one of the major causes of health woes plaguing the country. They also said it is the reason for the country’s high maternal and child mortality rate.

The World Health Organisation (WHO) rated Nigeria the second highest country in the world with high maternal mortality. According to WHO, motherhood appeared a death sentence for 59,000 Nigerian women yearly from preventable deaths: “50,000 women plus 9,000 still die during pregnancy and childbirth,” said the body.

“One in 18 pregnant women dies from avoidable causes during or after childbirth in Nigeria as compared to the United States where only one in 4,800 obtains. In Sweden, zero deaths were reported between 2006 and 2011,” said Senior Lecturer, Lagos State University College of Medicine (LASUCOM), Dr. Simbiat Elias.

Experts noted that these disparities are mind-boggling and one wonders why it seems like rocket science for the Nigerian health system to create an environment where mothers are not sentenced to death just because they are charged with the responsibility of ensuring that human species does not go into extinction.

According to WHO, paucity of maternal care is also a major cause of infant deaths and disabilities in Nigeria. “All over the world, over 133 million babies are born annually, 90 per cent in low and middle income countries and the death of their mothers reduce their chances of survival.”

The report also has it that three million babies are stillborn annually and almost one quarter of them die during birth. The causes of the deaths are similar to the causes of maternal death. Poorly treated maternal health and disease during pregnancy is contributive to intrapartum death as well as other babies born preterm and with low birth weight.

Furthermore, among the 133 million babies who are born alive each year, 2.8 million die in the first week of life and slightly less than one million in the preceding three weeks and for Nigeria to achieve an accelerated success in improving maternal and child health, quality health system and barriers to access health services have to be identified and tackled at all levels, even down to the grassroots, which is being advocated by the proposed NHB.

It should be noted that one of the Millennium Development Goals (MDGs) is to improve maternal and child health care. This was adopted by the international community at the United Nations Millennium Summit in 2000 with the aim of achieving 75 per cent drop in the level of maternal and child mortality in the year 2015.

As part of the approaches to solving these problems, NHB has been drafted and passed by the National Assembly (NASS) for presidential assent but yet to receive presidential nod, due to a number of squabbles, controversies and infighting among the different professional groups within the health sector, who are neck-deep involved in the implementation of the bill.

Though the bill has the potentiality of turning Nigeria’s medical sector into Africa’s medical hub and medical tourist centre in the continent, it experienced a harvest of criticisms due to the tone of certain sections, which could be considered religious, professional and political, and as a result, some of these grey areas are required to be addressed before signing the bill into law by the president.

For instance, Part VI of the proposed bill, which says, “No person shall import or export human zygotes or embryos without the prior written approval of the Minister on the recommendation of National Ethics Research Committee” is viewed by religious groups and medical moralists as a slave trade in disguise. They said this clause introduces aggressive exportation of human zygotes to the western world for alteration and does not safeguard women’s health in the country, especially that of younger generations.

Section 8(1) of the bill, which deals with establishment and membership of National Tertiary Hospital Commission (NTHC) has also generated heated argument among the health professionals, pharmacists, doctors, nurses, lab technicians among other professions, who called on the President not to assent the bill until issues on the membership of the Commission are logically addressed.

However, the benefits of the proposed bill, especially in the efforts to save the lives of Nigerian women and those at high risk and those with limited resources for alternative health care services are enormous. Many Nigerians and Civil Society Groups, among others, have called on the president to sign the bill into law for the sake of mother and child survival.

The bill was passed for presidential assent since May 19, 2011 by NASS but till date, the President has not commented on the bill neither has he signed it. This has renewed calls on NASS to re-visit the bill, adjust certain issues and possibly veto it into law in line with constitutional provision.

An Abuja-based legal luminary, Charles Ndukwe in the chambers of Charles Ndukwe and Co., said when a bill is passed by NASS and sent for presidential assent under 1999 Constitution of the Federal Republic of Nigeria, and the President refuses or delays to sign it into law for a period exceeding 30 days, the NASS is, therefore, empowered by the constitution of the land to veto it into law by two-third majority of the House.

This is the position of Nigerians as regards non-signing of the bill by Mr. President to ensure that the poor masses, especially the most vulnerable groups would enjoy their right to life as enshrined in the constitution.

The NHB, if signed into law, would develop a national health policy, including annual N60 billion devoted to Primary Health Care (PHC) and committed to provision of essential drugs, comprehensive vaccination for pregnant women and children younger than five years.

“The urgent need for signing of NHB into law to increase the life expectancy of Nigerians comes on the heels of the passage of the Freedom of Information (FOI) bill, which makes access to information easier for Nigerians on government policies and activities,” said United Nations Children Emergency Fund’s (UNICEF) communications specialist, Geoffrey Njoku.

He noted that the bill might not provide all that the sector needed to make Nigeria Africa’s medical hub, but a giant stride by Nigeria to improve her healthcare delivery and foster healthy competition with the rest of the world by making Nigeria a medical tourist centre, as it pertains to mother and child’s well-being and survival.

A Senior Lecturer in the Department of Mass Communications, University of Lagos, Dr. Abigail Ogwezzy-Ndisika said that NHB stipulates the need for measures of accountability and country’s performance as well as the conditions of citizens’ health to be assessed by independent authorities and government as well as the ability to turn around the health service delivery in Nigeria, especially for the socially excluded.

Ogwezzy-Ndisika noted that NHB is a bold step in the right direction to ensure that modicum of infrastructure needed for improved health financing better health services in Nigeria are put in place to douse the effects of poor medical delivery on the voiceless children and mothers, who do not have resources to access alternative services.

“Innocent children and mothers are those paying heavily with their lives for non-signing of the bill. Despite attempts made by governments to address high mortality in Nigeria, daily morbidity and mortality rates remained high, due to lack of basic life-saving facilities,” she noted.

Experts argued that lack of validation of Clause III of the proposed bill has escalated the problem of patients’ rejection during emergencies and subsequent death, arguing that the provision of Clause III (Section 1) of NHB, which prohibits a healthcare provider or health establishment from refusing a person’s emergency medical treatment, would have addressed the issue if put in place.

Experts believe that Clause III of NHB, which reads in part: “No healthcare provider, health worker or health establishment shall refuse a person emergency medical treatment for any reason. Any person who contravenes this section is guilty of an offence and is liable on conviction to a fine of N10, 000.00 or to imprisonment for a period not exceeding three months or to both fine and imprisonment,” would stampede delay, which accounts for two per cent causes of maternal deaths in the country and increase access to medical emergency treatment of patients.

Tackling the issue of poor financing of the sector, which has left the country’s health sector in a comatose condition for years, Deputy Director, National Primary Health Care Development Agency (NPHCDA), Dr. Olalekan Olubajo said health financing is needed to turn the sector around as provided by Section 10 of the bill.

“Several studies, including DHS 2008 indicate that financial access is a major constraint to utilisation of health services by a large number of people in Nigeria, especially the lower income groups and major drivers of the inequalities observed among the various groups in Nigeria,” he said.

He noted that the provision of two per cent of the consolidated revenue of the federation- one per cent for health insurance, covering a minimum package of care and the remaining one per cent for the development of PHC would substantially reduce the level of financial access, hence the need for increased funding of the sector by the governments at all level as proposed in section 10 of the bill.

For many women, as stated by Olubajo, financial and physical barriers hinder access to health services with about 38 per cent of the highest quintile and 72 per cent of the lowest quintile lacking financial access. “The situation is worsened by limited coverage of insurance and prepayment schemes.”

He pointed out that gross inequities in health outcomes and access to preventive health services, which exist across socio-economic groups and geographic locations, including skilled birth attendants, Antenatal Care (ANC) visits, immunization, treatment of common ailments and nutritional status among others are the major problems NHB is poised to address, adding that there is an urgent need for healthcare financing to enable the socially-excluded persons access quality health service delivery in the country.

Meanwhile, as a way of achieving the desired goals in the country’s health sector, Nigerians across the country have recommended sustained advocacy for the presidential assent of the health bill, awareness creation to the Nigerian populace on the benefits of the health bill, inclusion of health on the concurrent list during the proposed constitutional review by the National Assembly (NASS), routine resource tracking of all health sector funds, establishment of guidance on fund utilisation based on evidence.



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