The National Health Act and the road ahead
The year 2014 ended with the signing of the harmonised National Health Bill by President Goodluck Jonathan. The Bill, which is now an Act of Parliament, is designed to provide a framework for the regulation, development and management of a National Health System and set standards for rendering health service in the country. Among other things, it provides a comprehensive integration of the functions of the different sectors of health care in Nigeria and provides a description of “The National Health System”.
The Act, which was long in coming, and the processes heralding the emergence of the harmonised version, which is believed to have been signed by the president, reflect the nature of the peculiar challenges facing the Nigerian health care industry. The sheer magnitude of the inter-professional rivalry that exists in the Nigerian health care sector was unveiled in the events leading to the presidential assent.
It is particularly notable that, at the news of the signing, President of the Pharmaceutical Society of Nigeria, Pharm. Olumide Akintayo, in his congratulatory remarks, expressed some reservations, particularly of his hope that the landmark document was not doctored after the harmonised version had been passed at the National Assembly. Prior to the harmonisation, the PSN and other associations had fought hard to ensure that specific clauses that favoured only medical doctors in the operation of the health care system be removed. Though the harmonised copy passed by the National Assembly reflects the success of their efforts, we are yet to confirm if it was the same one endorsed by the President.
In a statement signed by its President, the PSN said: “the harmonised version of the National Health Bill signifies the first time the borders of restriction in health care were opened as major Health professional associations and trade unions are represented in key structures of the new Health Act”. The Act, among other things, makes it a legal statute that 1 per cent of the consolidated revenue of the Federal Republic of Nigeria be dedicated to the funding of Primary Health Care. Though this represents a progressive effort in the right direction, it still does not reflect the realities of the Nigerian challenge. Considering that diseases like malaria account for 60 per cent of outpatient hospital visits in Nigeria, Primary Health Care in Nigeria needs greater attention – one that is embedded in a health insurance system that is adequately funded and managed.
At present, going by the 2013 and 2014 budgets, less than 6 per cent budgetary allocations were made to the health care sector, as against the agreed on 15 per cent in the Abuja declaration by African Heads of States in 2001.It is expected that the funding in 2015 would be even far less, considering the dramatically reduced government earnings, as a result of the global fall in oil prices. Our concern is that, given the level of bickering among health care professionals, the shrinking oil revenues and the present low level of health care funding, there are very tough times ahead. Hence, in as much as we must congratulate ourselves that we now have the Health Care Act, it must be emphasised that the journey is just beginning.
The next vital step is to design a pragmatic implementation system that is focused on the national health insurance structure – one that seeks to protect the lives of Nigerians in the days ahead, guaranteeing access to basic care, making the most of the 1 per cent of consolidated revenue commitment enshrined in the Health Act, while we ask for more.To achieve this, the Federal Government must, once and for all, take up the serious challenge of resolving the inter-professional bickering in the Nigerian health care sector, as this management challenge alone contributes a major bulwark hindering efficiency in the sector.