Head or tail, should the health sector continue to suffer because of the battle for supremacy over the National Health Bill? WINIFRED OGBEBO examines the issues
With anguish, a housewife in Jigawa State recounted her experience , “When my sister went into labour, we went to get a car from town. There is only one car in this village, once it is gone; it is hard to get another car. While we were searching for a vehicle, her condition deteriorated seriously. We took her to Kawo. They turned her down. Before we got to town, she died.”
The acting executive secretary, National Health Insurance Scheme (NHIS), Dr Abdulraman Sambo, said that the bulk of Nigerians which constitute the informal sector live in the rural areas where the level of poverty is very high.
? Among others, the country has one of the highest numbers of HIV infected people in the world and the fourth highest TB burden. Maternal, newborn and child mortality rates are still high, though decreasing. Life expectancy at birth has been reported to be 44 years by the 2009 UNICEF State of the World’s Children report.
?Hence the above have led to a paradigm shift in health promotion approaches, especially to include the socially excluded. In order to ameliorate the impact of a less satisfactory health system, the National Health Bill was initiated, debated and passed by the National Assembly for improved health service delivery to Nigerian citizens.
The bill provides for women, children and vulnerable people and makes way for universal access to health.
?A child does not have a voice, says a consultant paediatrician at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Dr Rosamund Akuse. “If the bill is implemented, children and mothers will have free health care service.? “Take care of a woman and you take care of a child but if you don’t take care of a woman when she is badly nourished when she is pregnant, you get a weak, sick baby. So if you take care and empower the woman, the baby too would be taken care of by her.”
The United Nations Children Education Fund (UNICEF) Communications specialist, Geoff Njoku, observed that an impact can be made at that Primary Health Care (PHC) level for reduction in maternal mortality and infant mortality and that some provisions in the health bill would release more money into that level of care.
? According to him, in places where there are no Primary Health Care centres, they can be built and the inadequate ones renovated. “With more money in the system, they can go ahead and fix the ones that have broken down and the ones that are nonexistent will be put in place.”
?? Experts are of the opinion that most of the users of health services in the country are women and children and the burden of diseases also rest upon them.
According to them, “When you put money to the health system particularly health care delivery, it will directly benefit the women and children”
?? Highlighting four key areas of benefits, Dr? Nelvin Eze says, “First of all, it is the PHC fund which provides for the minimum? package of care for all Nigerians and also provides for supposed primary health care institutions in terms of drugs, human resources and infrastructure. When you put these together, it complements the existing services and the existing efforts by individuals, states and local government and it will help to boost service delivery and in that way, it directly benefits women and children.”
Secondly, according to him,? because of the large number and size of the population, and the amount of fund which might accrue from the PHC fund, it might not be enough to cover everybody so there will be a need to target, that is, making the utilization of the fund need-based.
? “Of course where you have the greatest burden is women and children. Those are the ones that are direct benefits either in terms of insurance package which is basically to provide minimum care for all Nigerians. So those are the two key areas.”
?Speaking further, he revealed that sections 2 and 3 of the NHB that has to do with the right of care seekers.
“Now a lot of reason why women don’t patronize health services isthe poor attitude of workers. So by the time you have improvement in service delivery coupled with good monitoring, setting up of certificate of standard and then you also have the bill of right which allows patients to seek redress,? you will see? improvement in those areas and then we can have more people patronizing the health facilities. So those are some of the ways the bill will benefit women and children.”
?? The bill grants financial access that is, there is also provision for exemption. Coupled with health insurance, the bill recognises that not all Nigerians can afford basic health care so? it takes care of a majority of people.
The president of Society of Gynaecology and Obstetrics of Nigeria (SOGON), Dr Fred Acham said for there to be a regular financial provision for health, that’s what the National Health Bill was meant to do; provide 2 per cent of the National Budget to primary health care.
?Though the bill, as widely touted, has the potential of doing so much for the health sector, it met with stiff opposition from all corners even within government and outside government circle, the health care industry, faith-based organisations and so on and so forth, a year now after it was passed by the Senate in May last year.
The? immediate past president of the Nigerian Medical Association (NMA), Dr Omede Idris,? said the bill neither contradicts existing laws as regards regulations and setting of standards for different health professionals, nor set to favour the medical doctors more than other professionals in the health sector, as claimed by the health workers.
?“The bill is about service delivery to Nigerians at all levels with emphasis on Local Government. It is about access to quality, effective and sustainable healthcare services by children, women, people with disability and also health financing.
“This is why beyond any primordial considerations, personal and self interest, the NMA accept the bill despite some limitations to the medical and dental profession,” Idris said.
The AHPAU through its spokesperson, Dr Godswill Okara, had criticised the bill, saying that the first part which seeks to regulate and set standards for the practice of various health professional was unnecessary since there were professional organisations set up by the government to do so.
He also criticised the section of the bill which proscribed that the proposed Tertiary Heath Commission should be headed by a medical doctor, suggesting that it should be made open to all the health professionals to aspire to.
?However, UNICEF , the Health Reform Foundation of Nigeria (HERFON), civil society organisations and several other keen observers of the industry have consistently maintained that there is no law that is perfect and that the bill could be amended later if the issues raised by the health workers are justified. According to them, to throw away the National Health Bill altogether would amount to throwing away the baby and the bath water, which they say is a great injustice which Nigerians cannot take.
Acham said, “We are doing all we can to regenerate interest in the National Health Bill. I think its undergoing some restructuring and we will use advocacy to get the details and arrange ourselves where we can begin to influence a change in that direction. We cannot continue to pay lip service to healthcare delivery.”
But the chairman of LEADERSHIP Chapel, of the Nigerian Union of Journalists, Abuja, Mr Romeo Eze wondered why President Goodluck Jonathan was still holding on to the bill without assent.
He said despite the protest generated by the fuel subsidy removal last January which resulted in loss of lives,? the President still went ahead to do his wish at the end of the day.
?Eze queried the rationale behind keeping the bill in the cooler now for the past one year when everyone agrees it’s what would? improve the country’s health outcomes. “Why is he afraid to grant the clamour of the majority of Nigerians to pass the National Health Bill? Is it because there is no money involved in it, instead you’re asking the federal government to release 2 percent of the national budget to health?”
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