The National Health Bill Brouhaha

Since the first republic, Nigerian legislature has been passing bills ranging from serious national issues like national security to selfish laughable and unarguably comic ones like the one that apportioned a sizable portion of the national cake to political office holders’ wives. In all, despite the fact that the National Assembly is a strong third arm of Nigeria’s democracy – and the nation at large, it’s been the least respected considering the numerous corruption allegations, boxing bouts, fat paychecks, and less insightful arguments on the floors of the two chambers. And to the average Nigerian, the National Assembly is nothing but expensive chambers filled with all sorts of people.

Since 1999 when the country returned to democracy, the National Assembly has processed a total of 206 bills into Acts. According to LEADERSHIP, a total of 556 bills (220 Senate and 336 House of Representatives) were passed by the National Assembly between 1999 and 2009. Between 1999 and 2011, 206 were forwarded for presidential assent of which 176 have been signed into laws, while 32 are still awaiting presidential assent.

Out of the 556 bills, only one has so far attracted appreciable attention and generated sufficient ripples that got everyone talking. It is the National Minimum Wage (Amendment) Bill, 2011, which was sent for presidential assent on March 13, 2011. The reason is simple, Nigerian civil servants want some share of the oil windfall, excess crude oil account, and other sources of national funds that the executive and legislature dip into monthly.

Apart from this, Nigerians worry less about legislative duties. Or who among the traders in Bodija, Amakohia, Lokoja, Okenne and dust-laden Mararaba markets would worry him or herself about Supplementary Appropriation Bill 1999, Second 1999 Supplementary Appropriation Act, 1999, Appropriation Act, 2000, Appropriation (Amendment) Act, 2000, Appropriation Bill, 2001, Corrupt Practices and Other Related Offences ATC, 2000 (Explanatory Memorandum) and National Assembly Service Comm. Act, 2000, National Order of Precedence of Public Officers and Other Persons Bill, 2000, Niger Delta Development Commission Act, 2000 or Police Service Commission Act, 2000? None I guess.

But on Wednesday, May 18, 2011, ‘angry’ Market Women Association members and several pressure groups protested at the National Assembly against the delay in passing a Bill that several erudite Nigerians – including National Assembly seat warmers and salary earners – are unaware of. They threatened to go into the Chambers naked if security personnel prevented them from going in.

According to Daily Independent’s report, some of the placards displayed read: “Market Women Association (FCT), Pass the National Health Bill; 241,000 new born die yearly!!! Stop the death!!”, “Nigeria needs the Health Bill; Life Expectancy: Nigeria – 42 years, Ghana – 60 years,” and “We have voted, give us health care, pass the Bill; fix the health system, pass the National Health Bill.”

The protesters were pacified by Obasanjo-Bello and Senator Gyan Dantong, both of who assured them that work on the Bill was in progress. Obasanjo-Bello told them that the Senate had worked on the Bill night and day so that health care in Nigeria can be well funded, that the Conference Committee had met over it and that by Thursday the legislative work would have been completed, leaving the rest for bureaucracy and the executive.

And on Thursday, the bill was passed. Senate President David Mark said it was an important Bill which took a while to go through the legislative mill. He explained that anything that deals with health needs to be scrutinized rigorously, so “We did not pass the Bill because people were protesting; we are only doing our work. The Bill was slated in the Order Paper when they were protesting.”

The dust seemed settled until less than twenty four hours later when real war of words broke out. Threats were issued, ultimatums were given and the various factions are now challenging themselves to public debates. The end is not in sight until President Goodluck Jonathan decides whether or not to sign the controversial bill into a federal law.

On May 24, 2011, Vanguard duo of Victoria Ojeme and Caleb Ayansina reported that the Assembly of Healthcare Professional Associations and Unions has called on President Goodluck Jonathan not to give assent to the National Health Bill recently passed by the Senate. According to the report, the association said “there will be no peace in the health sector if the bill becomes law.” The National Vice President of the Association of Medical Laboratory Scientists of Nigeria, Dr. Godswill Okara, who spoke alongside other executives, maintained that the bill single-handedly proposed by the Federal Ministry of Health infringed on their rights and vowed to take legal means to fight it.

This is totally against the view of Nigerian Tribune’s report of Friday, April 8, 2011 in which the Nigerian Medical Association (NMA) called on President Jonathan to exercise his executive power and ensure that the National Health Bill is passed and assented to before the end of this legislative and executive term. Addressing a press conference in Abuja, President of NMA, Dr Omede Idris, said: “For the health bill to go through this current legislative assembly without passing it into law smacks of the government’s insensitivity to the plight of all Nigerians — adults, men, women, youths, children and newborns alike, health wise. Over this period of six years, six million Nigerian children and 317,400 Nigerian mothers have died.”

“These children and mothers do not have voices; neither do they have deep pockets to have alternative choices of place of care. The government must know and realize that health is one of her key social and humanitarian responsibilities to it citizens.”

On the surface, one can conclude that democracy just got interesting but closer second, third, infinite views of past and current events in Nigerian health politics would reveal the poor prognosis that the system has on its perdition-bound journey along Destruction Avenue. Almost every Nigerian professional medical association has scores to settle with at least one professional body. The crisis range from simple administrative paper works to life deciding decisions thus putting the lives of unsuspecting members of the public – like members of Abuja Market Women Association – at great risk.

Anyone that is familiar with the crisis in Nigerian health sector would see the current series of attacks on the newly passed National Health Bill as yet another unnecessary uproar by perturbed professionals. I had the same view when I first heard the news. The position was sustained when I got a copy of the bill and read it for the first time. Even after a second peruse, I saw nothing wrong with the bill. However, my attention was drawn to some quite salient aspects of the bill that speak volumes.


A sizable portion of the bill was “copied and pasted” from Republic of South Africa’s National Health Bill (as amended by the Portfolio Committee on Health (National Assembly)). A conservative plagiarism match test conducted on the bill gave a plagiarism score of 57 per cent.

Both bills encompass public and private providers of health services; promote a spirit of cooperation and shared responsibility among all providers of health services; provide for persons living in each country the best possible health services within the limits of

available resources; and protect, promote and fulfill the rights of the people to have access to health care services.

They both dwell, almost verbatim, on issues like rights and duties of users and health care personnel; health establishments; control of use of blood, blood products, tissue and gametes in humans; national health research and information and several others. However, unlike the South African bill which presented the nation’s National Health Council as one that advises the minister on policies concerning any matter that will protect, promote, improve and maintain the health of the population; Nigerian National Health Council, according to the bill, will be the all-in-all as stated section 1 subsection 1.

Section 1 Subsection 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 –
(a) Encompass public and private providers of health services;
(b) promote a spirit of cooperation and shared responsibility among all providers of health services in the Federation and any part thereof;
(c) provide for persons living in Nigeria the best possible health services within the limits of available resources;
(d) set out the rights and duties of health care providers, health workers, health establishments and users; and
(e) protect, promote and fulfill the rights of the people of Nigeria to have access to health care services.

This portion of the bill is the major reason why so much dust is being raised by Assembly of Healthcare Professional Associations and Unions. This subsection makes the proposed NHS the alpha and omega when it comes to every health decision in the nation.

Currently, there are numerous regulating bodies – usually on professional basis. For instance, medical laboratory practice in Nigeria is regulated by the Medical Laboratory Science Council of Nigeria as established by the Medical Laboratory Science Council of Nigeria Act 2003. Section 4 (b) of the act empowers the council to: “regulate the practice of Medical Laboratory Science in Nigeria”. Other professions are also backed by similar laws. But with the National Health Bill, these regulatory bodies would be rendered insignificant – or at best, impotent. And the NHS would coordinate and regulate everything.

Section 1 Subsection 2
This subsection defines who will be included in the National Health System thus:

The National Health System shall include –
(a) the Federal Ministry of Health;
(b) the State Ministries of Health in every State and the Federal Capital Territory ;
(c) parastatals under the federal and state ministries of health;
(d) all local government health authorities;
(e) the ward health committees;
(f) the village health committees;
(g) the private health care providers; and
(h) traditional and alternative health care providers.

This subsection does not favor other medical professionals apart from the NMA whose members are the minister of health, state commissioners for health, heads of health parastatals and other members of the NHS. This is seen as a calculated move by the brains behind the bill to totally remove the inputs of other health professionals from the operations and day-to-day running of the nation’s health system which according to AMLSN’s Dr. Godswill Okara, is an orchestration of the ministry and NMA who are seeking to legitimize the culture of tyranny in the sector, “by choosing to ignore our views”. But the logical question to ask is that why did they wait until the bill is passed before screaming at high decibels? . . .

(to be contd)

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