POSITION PAPER ON THE NATIONAL HEALTH BILL BY THE BLOOD BANK SOCIETY OF NIGERIA

Introduction
THE BLOOD BANK SOCIETY OF NIGERIA is an umbrella body for Directors and owners of Private BLOOD BANKS in Nigeria. It is a body registered with the Corporate Affairs commission. The Society wishes to commend the National Assembly for her resolve to strengthen the health sector through appropriate legislation for health service organization and management in Nigeria. It is our considered view that this is the opportunity to remove the conflict that will arise from certain clauses and sections of the bill. It also affords the opportunity to professionalize the management and administration of the health sector by ensuring that professionally-trained administrative and management personnel are charged with the administrative leadership of the health sector in line with international best practices. This will go a long way in ameliorating the continuous decline in our nation’s health sector. May we observe that the Bill does not seem to recognize that there are a lot of legislations in Nigeria that adequately cover various aspects of the healthcare delivery system. The National Health Bill is supposed to bring all these into harmony for greater and better effect. It is in this light that we make the following observations the National Assembly might find useful.

Section 1: Establishment of National Health System.
(1) There is hereby established for the Federation; the national health system, which shall define and provide a framework for standards and regulation of health services and which shall –
Opinion: After the words “health services” highlighted above, insert the words “without prejudice to the various relevant professional regulatory statutes”.
Comments: The need to add the words as suggested is borne out of the fact that many provisions in the Bill are capable of contravening some provisions in the existing professional statutes.

Section (1) (1) (d) reads as follows: “set out the rights and duties of health care providers, health workers, health establishments and users,” and
Opinion: Sub-section 1 (1) (d) quoted above should be deleted.
Comments: the sub-section is ambiguous and in conflict with the statutory functions of the National Council on Establishment, which is empowered by law to prescribe duties and responsibilities for all cadres of workers in the public service through laid down procedure.
Section 4(1) Establishment and composition of National Council on Health

Opinion:  Insert Association of Medical Laboratory Scientists of Nigeria (AMLSN) among the listed Professional Associations in 4(1) (e) immediately after the Pharmaceutical Society of Nigeria as member of the National Council on Health. This is important because Medical Laboratory Scientists are statutorily and professionally responsible  for rendering  medical laboratory services in health facilities and majority of them are responsible for sourcing and ensuring appropriateness  and safety of blood for users especially in emergency cases (including primary health centres) just as Pharmacists and  Nurses are  responsible for Pharmaceutical and Nursing services respectively in health facilities. Inclusion of other essential professional associations such as the Nigerian Society for Physiotherapists and Radiographers Society of Nigeria will be necessary to make the composition all inclusive and fair representative of health professional associations.

     Section 6(2) (a) reads as follows: “ the Permanent Secretary of the Federal Ministry of Health who shall be the Chairman’

Opinion: After Permanent Secretary, insert ‘who shall be a professional health service administrator with experience in health management’
Comments: Professional health service administrators should be allowed to perform their professional role in line with international best practice. When they were in-charge of health service administration in the 1960s and ‘70s, (i.e. before the advent of Decree 10 of 1985) the Nigerian health service was ranked 4th in the Commonwealth in contrast to the abysmally poor ranking of 51st out of 53 in Africa today. Over-politicization of the health sector is the major problem bedeviling the sector. Core health professionals should concentrate on giving their professional services to the patient, while the organizational administration and management should be left in the hands of professional administrators.
                  

Section 6 (2) (m) should be re-written as one representative each from AGPMPN (Association of General Private Medical Practitioners of Nigeria), Blood Bank Society of Nigeria , Community Pharmacists. Opinion: These are registered professional bodies for Private health Providers in Nigeria and should be represented in the Technical committee established in section 6(1) of the  Health bill.     

Note section 8 of the bill provides for the conduct of the proceedings of the Technical committee

thus:  (1) The Technical Committee shall strive to reach its decisions by consensus but where decision

cannot be reached by consensus; the decision of the majority of the members shall prevail and be

regarded as the decision of the Technical Committee.

Opinion: In the light of the above, membership and composition of the Technical committee should be

such that no professional group  in the health sector will have undue advantage by having preponderance

of its members in the technical committee because that will make the views of such professional body to

always sail through when such professional group has majority of members of the Committee.

Section 10: Functions of the National Tertiary Institutions Standard Committee
Section 10 (1) (c) reads as follows: “establish minimum standards to be attained by various tertiary health facilities in the Nation and also to inspect and accredit such facilities.”
Opinion: After the word facilities highlighted above, insert without prejudice to the provisions in various regulatory books of statutes.
Comments: Some of these provisions in section 9 (1) (c) are part of the functions of statutory regulatory agencies of each profession in the health service system be it public or private.
Section 13 (1) reads “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; Section 13 (2) reads: “The Certificate of Standards referred to in subsection (1) may be obtained by application in prescribed manner from the appropriate body of government where the facility is located. In the case of tertiary institutions the appropriate authority shall be the National Tertiary Hospital Commission”.
Opinion: In section 13 (2) after the word appropriate, insert ‘health regulatory bodies’.
Comment: Since the health professional regulatory Councils and Boards are statutorily charged to determine and set standards of skill and knowledge required to practice, as well as regulates the practice and services provided by her professionals, it is better and more cost effective and efficient to allow these organs of government set up by law to perform their statutory functions rather than duplicating bureaucracy with the attendant waste of scarce resources to usurp these functions.

Section17.

Referral from one public health establishment to the other: (1) Subject to this Bill, a user may attend any public health establishment for the purposes of receiving health services (2) If a public health establishment is not capable of providing the necessary treatment or care, the public health establishment in question shall transfer the user concerned to an appropriate public health establishment which is capable of providing the necessary treatment or care.(in such manner or such terms as may be prescribed by regulation) Opinion: section 17(2) should be re-written to read if a public Health Establishment is not capable of providing the necessary health services, the public health establishment in question shall transfer the user concerned to another health establishment(public or private) which is capable of providing the necessary services. Some private health establishment could have better facilities and manpower more than even public establishment. Limiting referrals to only public establishments may deny the user(s) access to such private health facilities.

Section 32: Research of experimentation with human subject.
Section (32) (1): “Notwithstanding anything to the contrary in any other law, every research of experimentation on a living person shall only be conducted:-
(a) In the manner prescribed by the relevant authority; and
(b) With the written consent of the person (subject) after he has been informed of the objects of the research or experimentation and any possible effect on his health.”
Section (32) (2): “Where research or experimentation is conducted on a minor for a therapeutic purpose the research or experimentation may only be conducted:-
(a) If it is in the best interest of the minor;
(b) In such manner and on such conditions as may be prescribed; and
(c) With the informed written consent of the parent or guardian of the minor.”

Section (32) (3): “Where research or experimentation is conducted on a minor for a non-therapeutic purpose, the research or experimentation may only be conducted:-
(a) In such manner and on such conditions as may be prescribed by the research committee; and
(b) With the informed written consent of the parent or guardian of the minor.”
Opinion: The medical Laboratory Scientists   should be legally protected by this section by including them in the Research Committee. Medical Laboratory Science is the Practice involving the analysis of human or animal tissue , body fluids, excretions, production of biological materials, design and fabrication of equipment for medical Laboratory diagnosis, treatment and research.
The practice includes Medical Microbiology, Clinical Chemistry, Chemical pathology, Haematology, Blood transfusion science, Virology, Histopathology, Histochemisty, Immunology, Cytogenetics, Exfoliative Cytology, Parasitology, Forensic science, Molecular biology, Laboratory Management or any other related subject.
Section 33: Establishment, composition, functions and Tenure of National Health Research Ethics Committee
Section 33 (2): The membership of the ethics committee shall consist of not more than 15 persons which shall include:-
(a) a Chairman
(b) a medical doctor;
(c) a Legal Practitioner;
(d) a Pharmacist;
(e) a Nurse
(f) not less than two religious leaders representing the Christian and Muslim religions.
(g) a community health worker
(h) One researcher in the medical field;
(i) One researcher in the pharmaceutical field;
(j) Three other persons one of whom shall be a woman who in the opinion of the minister are of unquestionable integrity.
Opinion: Section 33(2): after (e) a Nurse, insert “a medical Laboratory Scientist” which shall become new (f);
Section 33(2): after (i) one researcher in a pharmaceutical field, insert “one researcher in medical laboratory science field”
Section 33(2): (j) after three other persons, insert “selected from the following specialties: Accountancy (for effective research budgeting and fund management), Biomedical engineering (for effective equipment servicing and maintenance), Bio/medical statistics (for effective research data collation, analysis and interpretation), Health Information management ( for proper research  information management) one  of who shall be a woman”
Comments: The three insertions are highly desirable in view of the daily scientific tests, works, and experiment in the area of medical diagnostics, treatment and research being carried out by Medical Laboratory Scientists in the field of Medical Laboratory Science and other specialists as listed above.

43 (c) Should be restructured to read ‘the Minister of Health in conjunction with existing health regulatory bodies, shall be empowered to create new categories of health care personnel to be educated or trained.

Opinion: This empowerment should take cognisance of professionalism in the health sector. It should not encourage quackery, sub-standard  or unprofessional practices. Such empowerment should take note of the standards , skills and knowledge required by various professional regulatory bodies.
Section 49: Removal of Tissue, Blood products from living persons:
Comments: While our society believe that the consent of patients should be sought while blood or blood products are to be taken from or given to a person/patient, the classification of the conditions as in section 49 of blood and blood products with other tissues that are organs or solid in case of transplantations will be counterproductive particularly in the area of blood product transfusion which are regarded in most cases as the last option for patients.
Section 53: Removal, Use or Transplantation of Tissue and administering of Blood and Blood product by medical practitioner or Dentist:
(1) Only a registered medical practitioner or dentist may remove any tissue from a living person, use tissue so removed for any of the purposes stated in this bill or transplant tissue so removed into another living person.
(2) Only a registered medical practitioner or dentist, or a person acting under the supervision or on the instructions of a medical practitioner or dentist, may administer blood or a blood product to or prescribe blood or a blood product for a living person.
Opinion: 53(1) Insert ‘in the case of blood, only a medical practitioner or any other professionally trained and licensed providers may remove blood from a living person’. There should be Sub-section 53 (3) to wit: “ a registered and licensed Medical Laboratory Scientist with specialty in Haematology and Blood Transfusion/Banking Science shall determine the safety and suitability of blood and blood products in a blood bank, for transfusion into a specific recipient.”
Comments: The reason for insertion of sub-section (3) is that only the Medical Laboratory Scientists are trained and licensed in blood analysis and can determine the suitability of blood and blood products for transfusion. The problem/confusions that will be created by arbitrary lumping of blood and blood products with other body tissues are clearly demonstrated in section 53. The Association’s position on sections 52 and 53 is further confirmed by the definition of organ and tissue in section 65, the interpretation section.
Conclusion:
We absolutely support the philosophy of National Health Bill but find the Bill as couched at present to be capable of destroying further the already precarious harmonious working relationship existing among the health delivery team. As it stands now, the bill deserves a re-touch along the lines of the observations stated above by the National Assembly.

Dr Bart Ifionu

Mr Amos Fatokun

For  Blood Bank Society of Nigeria.

Reps

(1) Alh Toyosi Y Raheem(Team leader)

(2) Daniel Nanbol

(3) David Dantong

(4) Akogwu Noah

(5) Sunday Igwe