1. The National Health Bill: Biting More than we can chew, a recipe for the total collapse of the Health Sector Following the public hearing organized by the Senate Committee on Health, it has become imperative to point out the following for the notice of well-meaning members of the National Assembly and the Nigerian Public.
The National Health Bill which was copied from the South African Health law 2003 is full of contradictions, conflicting legal clauses and sections capable of worsening the declining condition ofthe Nigerian health sector. The post-Apartheid South African government enacted the law in 2003 in order to dismantle and remove the discriminatory and segregational situation created .by over a century of apartheid political system in that country. For the law to be operational in South Africa, 12 laws in their health sector were fully repealed, while the 13'" law had nine sections repealed. Nigeria does not share or have similar political and historical past with South Africa. Whereas Nigeria operates a Federal system, South Africa is not operating a federal constitutional system.
2. A careful studyofthe proposed National Health Bill shows fourfunctional categorizations namely:
L Regulation of health services.
ii. Setting of standards for health services.
iii Prescription of duties and responsibilities for healthcare professionals/workers & users of healthcare services.
iv, Provision offunding mechanism for universal health coverage.
3. Since 1960, Nigeria attained her political independence and self-governance, it has enacted several laws to regulate, standardize and fund health services to varying degrees. Some of these laws dearly provide a legal framework for regulatory activities as mandated by the Councils, Boards and Agencies charged with the responsibility of implementation of these laws. There are over thirty five (35) of such laws in the health sector presently. It is therefore misleading for anybody to claim that there are no laws in Nigeria to regulate, standardize, prescribe duties/responsibilities and fund health services. This is clearly contrary to the remarks by the Distinguished Senator (Dr.) Ifeanyi Okowa, Chairman, Senate Committee on Health in his welcome address during the public hearing:
"As of today, the health industry in Nigeria is left largely unregulated, without norms and standards, lacking protection of health users and providers. The National Health Bill is expected to close the gap, providing the legal framework needed in the regulation, development and management. of National Health System, setting standards and norms in health practice and research." With due respect, nothing could be farther from the truth. Whereas, all the professional groups (Medical laboratory scientists, Pharmacists, Nurses, Physiotherapists, Radiographers, Environmental Health Officers, Health Information Managers etc) and all the five registered Labour Unions in the health sector are calling for the removal of the identified offending clauses and sections of the bill and the insertion of a clause to recognize the existing laws in the health sector to avoid professional regulatory conflict and confusion; the Nigerian Medical Association (NMA) and the Health Reform Foundation of Nigeria (HERFON) are pushing for a quick passage of the bill without the amendments being sort by others. This is an open invitation to crisis of the worst dimension in the health sector.
4. It was observed that the presentations by H ERFON and N MA were televised life during the Senate Public Hearing on the bill, while the presentations by other professional Associations and Unions were blacked out to prevent the observing public from hearing first-hand the argument and reasons for the principled objections to the bill. This is most unfortunate and misleading to put it mildly. The practice of bandying and manipulating statistics to paint a doomsday picture will never solve the problem ofthe health sector in Nigeria. Putting a halt to the gross mismanagement of the sector by some medical practitioners will save the health sector. Removing avoidable conflict and contradictory clauses from the bill will save the sector; otherwise the bill will be dead on arrival.
5. Universal health coverage all over the world is provided through health insurance mechanism, but the proponents of the bill claim that Nigeria exists as an island in the moon and should therefore allocate 2% of the Federation's Consolidated Fund for health care services in Local Government Areas. When the National Assembly should be making laws to strengthen fiscal federalism, we are being dragged back to the days of military unitary command structure in the health sector. The National Health bill may as well go the way of the Urban Development law passed by the National Assembly, which the Lagos State Government challenged at the Supreme Court for being in conflict with constitutional federalism; it was nullified and thrown to the trash bin by the Supreme Court The Comrade Governor, Adams Oshiomole had recently told a gathering in Asaba presided over by the Distinguished Senate President, Dr. David Mark GCON, that there was no need for the National Health bill. Money statutorily allocated to local Governments which should be used for provision of health and other infrastructure are being misapplied
and misused, the National Assembly can easily make laws to free these funds, some fellows prefer to propose laws that will further compound the situation.
6. The Nigerian Medical Association and some of her members are known to oppose and obstruct the enforcement of professional regulatory standards by other health professions; for example, the Pharmacists Council's statutory inspection to enforce regulatory standards in pharmacy practice in private clinics and hospitals in Lagos State was resisted and challenged in court by the Association of General Private Medical Practitioners. They claimed that the Council had no right to come to their premises since they are medical practitioners who are all-knowing and experts in all health professions in addition to medicine and surgery, but the High Court in Lagos passed judgment and upheld Pharmacists Council position that it had statutory mandate to enter any premises wheresoever pharmacy is practised in Nigeria. The NMA sometime ago also ordered her members not to allow the Nursing and Midwifery Council inspection team access to their private clinics and hospitals; a similar obstructive disposition was adopted against the Radiographers Board and the Medical Laboratory Science Council inspection teams. The same fellows obstructing the enforcement of practice standards by professional statutory councils will turn around to shout and complain about "dubious medical laboratories and reports" all in the bid to give dog a bad name to hang it. These professional regulatory laws confer statutory mandate and powers on the Councils and Boards to enforce professional practice standards, duties and
responsibilities as well as disciplinary sanctions on members for misconduct and malpractice. The laws exist to protect members of the public from harm by licensed professionals. The ciamour by some medical practitioners to have the National Health Bill passed into law is a concealed calculated attempt by them to legitimize their impunity and lord over their views on other professions in the health sector. If this is allowed under whatever guise, the Nigerian health sector will be going into perdition. We strongly believe that men and women of good conscience-in the National Assembly of the Federal Republic of Nigeria will not allow this to happen.
7. Professional regulatory Councils, Boards and Agencies should be allowed, properly funded, strengthened and supported to function fully and effectively to strengthen the health sector. The Nigerian Medical Association should proactively tell her members to subject themselves to the laws of Nigeria. Fighting for the passage of an omnibus umbrella law to make medical practitioners the regulator of all professions in the health sector will never stand. Nobodyshould be deceived or try to pull wool over our eyes in the 21" century Nigeria, There is no need whatsoever for the National Health bill, it is an unnecessary duplication of laws and bureaucracy, a constitutional aberration in a federal system to legislate for local and state governments on matters on the concurrent legislative list.
May God save Nigeria and the health sector.
Dr. Godwill C. Okara
National President, Association of Medical laboratory Scientists of Nigeria
Chairman, Assembly of Healthcare Professional Associations