Following the recent 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.
1.
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 of the 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in South Africa, 12 laws in their health sector were fully repealed, while the
13th law had nine sections repealed.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 study of the proposed National Health Bill
shows four functional categorizations namely:
i. 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
of funding 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 clearly 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 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.” Nothing could be farther from the
truth.
Whereas,
all the professional groups (Medical laboratory scientists, Pharmacists, Nurses,
Physiotherapists, Radiographers 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 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 HERFON and
NMA were televised life during the recent 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 of the health sector in Nigeria. Putting a halt to the gross
mismanagement of the sector by 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. 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 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 expert 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. 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 clamour by 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 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. Nobody should be deceived or try to pull
wool over our eyes in the 21st 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. Godswill C.
Okara
National President
Association of Medical Laboratory Scientists of
Nigeria
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