Towards A Decade of the National Health Act

National Health Act

By next year 2024, a decade to the signing of the National Health Act 2014, would have been recorded. The NHA (2014) was enacted after a long battle of advocacy for Nigeria’s health system to provide a law that can guarantee the right to health of Nigerians. Like so many other significant laws in Nigeria with beautiful provisions, the National Health Act is not an exception. The National Health Act has so many beautiful provisions which unfortunately have not translated to efficiency and effectiveness in Nigeria’s health sector. A review of some of the provisions of the NHA (2014) reveals minimal progress contrary to high level expectation. There are implementation challenges and haphazard or non-implementation of the law. For instance, one of the progresses recorded is the implementation of the allocation of One percent Consolidated Revenue Fund for the Basic Health Care Provision Fund.

The Act provides for the Basic Health Care provision Fund. According to the law, The Basic Health Care Provision Fund shall be financed from: (a) Federal Government annual grant of not less than one per cent of its Consolidated Revenue Fund. (b) grants by international donor partners; and ( c) funds from any other source. (3) Money from the Fund shall be used to finance the following: (a) 50% of the Fund shall be used for the provision of basic minimum package of health services to citizens, in eligible ‘primary or secondary health care facilities through the National Health Insurance Scheme (NHIS); (b) 20 per cent of the Fund shall be used to provide essential drugs, vaccines and consumables for eligible primary health care facilities; ( c) 15 per cent of the Fund shall be used for the provision and maintenance of facilities, equipment and transport for eligible primary healthcare facilities; and (d) 10 per cent of the Fund shall be used for the development of human resources for primary health care; (e) 5 per cent of the fund shall be used for emergency medical treatment to be administered by a Committee appointed by the National Council on Health.

Thankfully Since 2019, the FG has been allocating one percent of the CRF for the BHCPF despite this progress, the allocation of the fund have several challenges.  First is that the equity funds that is expected to come from the sub-national governments to execute the mandates of the funds across the states have not been remitted by the state governments. The non-remittance has made it difficult to achieve progress in provision of facilities, health insurance coverage and consumables at the states and local government. Secondly there seems to be lack of accountability mechanism in tracking the use of the funds disbursed to the states. There is no evidence to show that the funds are utilized according to the framework listed above. There are still cases of Health Care Facilities demanding for down payments before attending to patients on emergencies, despite the provision of 5 percent emergency fund for victims of emergency. Part of the challenge in the NHA 2014, is the lack of enforcement of the certificate of Standards. According to the law,

Without being in possession of a Certificate of Standards, a person, entity, government or organization shall not: (a) establish, construct, modify or acquire a health establishment, health agency or health technology; (b) increase the number of beds in, or acquire prescribed health technology at a health establishment or health agency; ( c) provide prescribed health services; or (d) continue to operate a health establishment, health agency or health technology after the expiration of 24 months from the date the Act took effect. This provision is meant to eliminate quackery in the health practices. Nine years to the implementation of the Act, most health establishments still operate without certificates of standards. Some Private Health Clinics, Hospitals and Chemists operate without certificates thereby endangering the lives of health seekers. The law provides that Any person, entity, government or organization who performs any act stated under section 13(1) without a Certificate of Standards required by that section commits an offence and shall be liable on conviction to a fine of not less than N500, 000.00 or, in the case of an individual, to imprisonment for a period not exceeding two years or both.

An improvement of the NHA (2014) led to the enactment of the National Health Insurance Authority Act 2022. The establishment of the NHIIA 2022 does not give rise to the abandonment of key provisions in the erstwhile law. Provisions such as the full implementation of the BHCPF must be given required attention. There must be enforcement of certificates of standards on all health establishments. Other provisions that should not be ignored include the establishment of a National Strategy on Health Research. The law makes provision for the promotion of health research by private and public health authorities to focus on solving Nigeria’s health priorities. Since the outbreak of Covid-19, it is expected that the committee in charge of health and information, facilitate move for adoption of home grown solutions in preparation to combat national and global pandemics such as covid-19, Ebola and diphtheria etc.

 

Victor Emejuiwe

Program Manager (Good Governance)

Writes from Centre for Social Justice, Abuja

08068262366

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