Health sector stumbling on non-implementation of Act, weak governance

Government’s failure to implement the National Health Act, along with a weak governance structure in the health system are stunting the development of the sector as the nation bleeds from an over $1billion dollar annual spend on health tourism.
Health sector experts who spoke to BusinessDay worry that despite billions of naira in budgetary allocation and other forms of intervention attracted from key global bodies, Nigeria’s health sector posts one of the worst indices globally. For instance, Nigeria is categorised as one of the worst places to give birth, in addition to persistent endemic diseases, which often overwhelm the system and take it unawares.
Ben Anyane, Board Chairman of Health Reform Foundation of Nigeria, expressed concerns that government has not even commenced the process of certification of hospitals,which ought to be the initial step government has to take in ensuring standardisation and grading of its hospitals, as spelt out in the Act which was signed into Law in 2014.
“Government has not even commenced grading and certification of the hospitals. In fact, the health Act is explicit on this issue,that the government could be sued after two years of signing the health Act,if hospitals have not been certified. It would even surprise you to note that there is no certification or grading of hospitals going on anywhere in the country.”
Many health experts had decried the poor state of Nigeria’s health system, describing it as a worst place for health care service. Already,findings show many Nigerians are even resorting more to traditional medicine,while expressing lots of disbelief for the Nigerian health system.
The National Health Act provides the legal framework for the regulation, development and management of the National Health System, setting standards for the rendering of health services in the country.
On the contrary,the Federal Ministry of Health, which should provide leadership on the implementation of the Health Act,has not commenced any step on the implementation,the least of which is certification of hospitals, as spelt out in the Act.
Speaking on the weak governance structure in the nation’s health system, Michael Asuzu,a professor of Public Health and Community Medicine at the University of Ibadan, says the weak governance structure in the health sector has exposed it to all sorts of corruption,which have affected the health sector adversely,while exposing the health system to further ridicule,where patients die as a result of tooth haemorrhage.
Also, Obi Onwujekwe,a professor of Health Sciences at the University of Nigeria, Nsukka and a consultant to the Federal Ministry of Health, told BusinessDay in a telephone conversation, that,”the administrative style in most of our hospitals, at the federal and state level is weak,and gives room for inefficiency.
“There is poor health administration in both the federal and state governments. A lot of government workers spend more time in their private clinics than in the government hospitals which ought to be their area of primary duty,and sanctions are not applied due to poor administrative style.”he said.
Citing example with the poor administrative style of the nation’s teaching hospitals, Onwujekwe said,”The way the teaching hospital is being run needs lots of reforms. Many medical schools do not have adequate carrying capacity for training,and yet the government keeps licensing many medical schools in the country. Surely,this is not the way to go.
“For instance,if any medical school is taking 150 medical students,they must have the carrying capacity for such,and that has been a major concern on even the quality of the medical students being churned out of our universities. Many of the rules are not adhered ,and we can all see the result in the poor health system we have.”
Speaking further on the situation of the government hospitals,he said,”There is a study conducted in the South East by my foundation. We discovered that all the government hospitals were inefficient to the tune of 60 percent. The inefficiency was mainly on the workforce. There ought to be drastic reforms to ensure a restoration of our system.”
Suggesting the way forward,he said,” government should eat humble pie and embrace Public Private Partnership (PPP) to revamp the health sector.
The way to go is to encourage private sector investments in the health sector through PPP. The funding pattern of the health sector is such that there must be an effective collaboration on monitoring and evaluation mechanisms to track developments in the sector,”he added.
Meanwhile,Omobolanle Olowu,the director of PPP at the Federal Ministry of Health, at a separate briefing, told BusinessDay exclusively that the Federal Government is not closing down options in the private sector-led investments in the health sector,but had been reaching out through several initiatives such as diasporan investments and opportunities in the Sovereign Investment Authority”
Olowu said, “The government is exploring opportunities in such investments to support budgetary provisions in the health sector which oftentimes are not enough.”
Nigeria’s health sector has maintained a downward trend and has been a source of concern to many health experts.
To worsen it all,the situation of malnourishment of about 2.2 million children in the north -east, according to a report from the United Nations, shows the weak structure of Nigeria’s health system even in the least of things like the basic health care provisions which ought to be made available to all Nigerians.
Health experts had insisted that the Federal Government must be put on consistent pressure till the letter and spirit of the Health Act is implemented.
For instance,Osaho Enabulele, the former Nigerian Medical Association, (NMA) President told BusinessDay that,”Nigerians should own the Health Act and drum up support for the implementation of the Health Act. All advocacy groups must ensure they sustain the same pressure .
“Our Health indices are annoying. Go to our Hospitals and you will shed tears on what is going on there. The government must be put on its toes to act for millions of lives are at risk. The women group,the children,market women, everyone should own the scheme and pressurise the government on its implementation,”Osaho said.
Recall,Nigeria rates high in maternal and child mortality globally,with an estimated I million women and children dying annually, largely from preventable diseases.
Nigerian hospitals have a poor referral system,with many Nigerians rushing to secondary healthcare for ailments that could have been corrected if primary healthcare is standardised.
In view of the direct link between poverty and health outcomes, the Federal Government has signed several conventions and declarations in the past but too little has been done to meet the committments.The most significant of these is the Abuja Declaration of 2001,where African countries committed 15 percent of national budgets.
Since 2012,Nigeria’s budgetary allocation to health has been at best six percent.While the current budget indicated the provision of 4.6 percent allocation to the sector,health experts insist the Federal Government needs to step up efforts in implementing the National Health Act to avert the devastating decay in the sector.