Federal Government’s paltry allocation of 4.32 percent in 2017 proposed budget to the health sector has once again dampened the hope of implementing the National Health Act, which is key in substantially solving worrying issues in that critical but neglected sector.
In the 2017 budget currently at the National Assembly, President Muhammadu Buhari is proposing N51 billion as capital spending for the health sector, with a the huge recurrent bill of N252 billion.
But stakeholders are not just worried about the poor status of Nigeria’s health systems, but that government has not shown enough commitment and urgency to improve Nigeria’s poor health indices.
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 Nigerian federation.
A key provision in the Act is the certification of hospitals, which ought to be the initial step in ensuring standardisation and grading of its hospitals as spelt out in the Act, signed into Law in 2014.
“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 Nigerian hospitals have not been certified. It would even surprise you to note that there is no certification or grading of hospital going on anywhere in the country,” Ben Anyane, board chairman of Health Reform Foundation of Nigeria, said.
Nigeria’s health sector posts one of the worst health indices globally, as it has the records of one of the worst places for pregnant mothers to give birth, in addition to persistence of endemic diseases, which often overwhelms the already dilapidated health infrastructure, prompting wealthy Nigerians to spend whooping $1 billion on medical tourism.
Nigeria hospitals have poor referral system, with many Nigerians rushing to secondary healthcare for ailment that could have been corrected if the primary healthcare is standardised.
In 2001, Nigeria signed on to the Abuja declaration where African heads of state and government made a 15 percent minimum allocation to the health sector. But since 2012, allocation has been 6 percent at best.
Health experts insist that the Federal Government must be put on consistent pressure till the implementation of the Health Act is implemented.
Osahon Enabulele, former president, Nigerian Medical Association (NMA), notes 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, and market women everyone should own the scheme and pressurise the government on its implementation,” Enabulele says.
Minister of health, Isaac Adewole, has, however, explained the current efforts of the government towards implementation of the National Health Act, saying for instance that the government has developed guidelines for the operationalisation of the basic care provision fund, which is a key component of the Act.
“We have approved the constitution of committees for the Act. We have set up an advisory group on the implementation of the Act, and also committee on standards. We have spoken to Mr. President to launch the steering committee, and he had agreed to do that early next year,” the minister says.
Michael Asuzu, a professor of Public Health and Community Medicine at the University of Ibadan, is of the view that the weak governance structure in the health sector has exposed it to all sorts of corruption, and exposed it to further ridicule.
Also, Obi Onwujekwe, a professor of Health Sciences at the University of Nigeria Nsukka and a consultant to the Federal Ministry of Health, says the administrative style of most of the nation’s hospitals both 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.
“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.
“There is a study conducted in 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,” Onwujekwe suggests.
He says government should eat the humble pie and embrace Public Private Partnership (PPP) to revamp the health sector.
However, Omobolanle Olowu, director of PPP at the Federal Ministry of Health, says the Federal Government is not closing down options in the private sector led investments in the health sector, but has been reaching out through several initiatives such as Diaspora investments and opportunities in Sovereign Investment Authority.
According to her, “The government is exploring investment opportunities to support budgetary provisions in the health sector, which oftentimes are not enough.”
