The National Health Act was, ostensibly, enacted to address the problems of public health especially among the less privileged. With this Act in place, it is still a disturbing trend that most Nigerians continue to suffer the burden of out-of-pocket expenses on healthcare services.
It is important to point out that the National Health Bill was first proposed in 2004 during the tenure of Eyitayo Lambo as Minister of Health. It, however, took a decade of consideration before it was eventually passed and signed into law by former President Goodluck Jonathan on October 31, 2014.
The National Health Act has been in existence for almost nine years but its implementation has become a controversial issue in the health sector. The Act aims to establish a framework for the regulation, development and management of a National Health System; to achieve the Universal Health Coverage and meet the Millennium Development Goals (MDGs).
The Act also provides for the elimination of quacks from the health sector and provides healthcare insurance to certain class of people who are actually denied access to medicare due to their economic status.
A major objective of the Act, in our opinion, is the Basic Health Care Fund (BHCPF) in the budget which provides for not less than one per cent of the Consolidated Revenue for health funding. After a three- year hiatus and threat of downing tools by the Nigeria Medical Association (NMA), the federal government acquiesced in 2018, and approved N55.1 billion for the BHCPF. The allocation was reduced to N51.2 billion in 2019 and further shrank to N26.4 billion in 2020. In 2021, the budget jumped to N35 billion and N44.5 billion in 2022. The BHCPF got N47.6 billion in the 2023 budget proposal submitted by President Buhari earlier before his tenure ended.
On its part, the Federal Ministry of Health (FMOH) said it has disbursed a total of N28.59 billion across the 36 states of Nigeria and the FCT, as its year 2022 Basic Healthcare Provision Fund (BHCPF) allocation. Of the distribution, Kano, Katsina, Jigawa, Borno, and Sokoto States received the highest funding, Kano topping the list with a total allocation of N1.64 billion. The other states received N1.23 billion, N1.17 billion, N1.04 billion, and N1.03 billion respectively.
The five states that received the least were the FCT, Bayelsa, Edo, Ekiti, and Kwara states with N393.7 million, N411 million, N546.5 million, N558.4 million, and N560.2 million respectively. The components of the Act are so numerous that the Ministry of Health had to set up implementation committees, but a lot of matters in the Act are yet to be implemented and operationalised.
It is worthy of note that since the Act was enacted, there are still some yawning gaps in the implementation of some of its provisions.
For instance, the Act provides that five per cent of the BHCPF fund should go into emergency treatment but this is overlooked in view of the recurring high mortality rate of emergency victims in hospitals. Of the 1.6 million deaths recorded annually in Nigeria, 10 per cent–15 per cent occur in emergency department and that would translate to approximately 1000000 lives saved every year, or 3000 lives every day.
There’s no gainsaying the fact that many vulnerable Nigerians are still unable to access basic health care services in hospitals even in emergency situations as citizens are denied their rights to basic health. Over the years, Nigeria has continued to lag behind India as the country with the second highest maternal and infant mortality rate in the world, including other appalling health indices.
Till date, the National Health Insurance Agency (NHIA) has only 12 million enrollees from both the formal and informal sectors. This means that a large number of the estimated 200 million population are paying out of pocket for health services
We are worried that the overly touted access to universal health coverage will continue to be a mirage except concrete steps are taken to address the situation. Subsection 2 of the Act states that a health establishment, health agency or technology without being in possession of a certificate of standard cannot operate. After the Act took effect and going by this provision, all hospitals and health establishments in the country are operating illegally as very few have received certificate of standard six years after.
While the government has kept faith, no matter how small, to the allocation of the Basic Healthcare Provision Fund (BHCPF), that cannot be said about the utilisation of the fund. This newspaper, therefore, solicits for concerted efforts to be taken by all stakeholders to ensure that the Universal Coverage for Health is achieved.