Health Bill: Issues still pending

Several withdrawals and amendments later—not to mention strikes—the bill has inched its way into the House of Representatives for a reading last week.The Senate passed the bill on February 19 this year, after a third reading.The reading by the House of Representatives coincided with fresh calls and continued opposition from the Assembly of Healthcare Professional […]

Several withdrawals and amendments later—not to mention strikes—the bill has inched its way into the House of Representatives for a reading last week.
The Senate passed the bill on February 19 this year, after a third reading.
The reading by the House of Representatives coincided with fresh calls and continued opposition from the Assembly of Healthcare Professional Associations (AHPA).
In a memo to the House Speaker Aminu Tambuwal, AHPA said, “Policymakers most times bend to pressures from powerful interest groups, which facilitate mischief-making in execution of statutes in our country based on recent experiences.”
AHPA wants three clauses amended and another one deleted, claiming it will protect the interest of all stakeholders in healthcare and the public.
The first amendment AHPA wants is to Section 1(1)—establishment of a national health system.
The second targets the secretary of a committee that monitors standards for tertiary health institutions, which AHPA called “unconstitutional”, insisting equality principle should guarantee “equal rights and privileges for all citizens.”
The clause spells conditions for establishing and running a tertiary health institution, which a handful of states have begun to set up at will.
AHPA finds it contentious that the bill specifies that the secretary should be a director of hospital services working in the federal health ministry, and wants an amendment for the secretary to be “a person with vast knowledge and experience in health service delivery of at least 15 years.”
It also wants a particular clause giving the health minister power to issue directives to the committee—sometimes not related to its particular function—deleted.
The third is about possession of a certificate of standards before anyone can construct or modify any hospital, provide any health service or continue to provide health service 24 months after the NHB takes effect.
Another is section 33 (2), about the composition, function and tenure of a National Health Research Ethics Committee.
The contentions also target sections that deal with control of use of blood, blood products, tissues and gametes in humans, but AHPA does not specifically say what it considers contentious about the sections.
It however said it wanted the sections qualified to avoid “exploitation of our people,” according to its president Godswill Okara, chairman of Medical Laboratory Science Association of Nigeria.
“There are no real issues,” said Dr Ben Anyene, of Health Sector Reform Foundation of Nigeria. “The National Health Bill is not a beauty contest.”
Proponents of the bill as it is—as well as opponents wanting a handful of amendments—are locked in intense lobbying.
AHPA visited the house speaker last week, at the same time the Health Sector Reform Coalition, which backs the bill’s passage, commenced advocacy.
The coalition consists more than 20 civil society groups including UNICEF, Save the Children, women, journalists, doctors and allied health professionals.
The drive is to have the House of Representatives pass the NHB, exactly the version the Senate passed in February, so attention to turn to the Presidency for assent.
Any modifications would require harmonization of two different versions from the House and the Senate, before presidential assent even becomes a consideration. And the window is fast closing: lawmakers recess on June 18, resume on September 18, and then election campaigns starts to dominate political space.
How many of them eventually return to legislation after elections is uncertain.
What’s certain is, “If you don’t do it now [use the window] and this group of politicians leave, we have to start all over again,” said Vera Onyeaka, communication adviser for Partnership for Transforming Health Systems Phase-2, an HSRC member.
“That means the work for the past eight years is a waste.
“The House of Representatives must read it, so we can start working on the President,” said Dr David Olayemi of Save the Children, a member of the HSRC.
The essence of the bill makes health a right, and spells roles for government levels.
“Right now, if the government decides not to put anything on health in budget, no law can hold him,” said Dr Olayemi, citing a worse-case scenario. “It is not perfect. There are still many gaps, but this bill will be taking us from a situation where we have nothing to something.”
The bill is still a superstructure—a framework with slots to be fleshed out in details about how its provisions will be implemented, experts say.
Continued objections to the NHB comes from positions entrenched behind personal concerns, according to proponents—from opposition to roles of doctors and who should head specific institutions to what powers are accorded the minister.
Said Olayemi: “Anything before the National Assembly is our law, not for one section against the other.”