National Health Act’s 1% is an entitlement – Lecky

In all of the National Health Act, passed last December by former president Goodluck Jonathan, the most talked about bit is the “one-percent” funding. It illustrates benefits that a health act confers on citizens. But implementing the act itself has stalled since it was signed into law. Mohammed Lecky, Director of Health Reform Foundation of […]

In all of the National Health Act, passed last December by former president Goodluck Jonathan, the most talked about bit is the “one-percent” funding. It illustrates benefits that a health act confers on citizens. But implementing the act itself has stalled since it was signed into law. Mohammed Lecky, Director of Health Reform Foundation of Nigeria-which was among a coalition that stridently backed the act through years of controversy-says a one-percent is an entitlement.

What’s this one percent we have been talking about?
The one percent is part of the federal government’s share of the federation account. Federal and state governments share money monthly. The federal government has consolidated revenue fund – that is the federal share of the entire money. One percent will then be released for the purpose of funding the Basic Health Care Fund as contained in National Health Act.
The Act is very explicit on how that money should go. There are main principal organs to disburse it-one is National Primary Health Care Development Agency (NPHCDA), the other is National Health Insurance Scheme and about 5% will go for emergency treatment, which I believe should be administered by the Federal Ministry of Health, but they have to set up regulations and guidelines on how that it done.
The money for the primary health care agency will be used to deal with supply, side-training, equipment, drugs-in supplying basic minimum package of care. That means every Nigerian will have an entitlement to the basic minimum package of care regardless of where we live. This entitlement will be delivered through primary or secondary healthcare centres that belong to government.
Is this different from insurance?
It is very different. You cannot benefit from NHIS if you have not been contributing to it. So far, as I have been talking, I have not mentioned any contribution. It is an entitlement; it is your right to have access to that package of health services.
Is it clear how the disbursements will be monitored for accountability, transparency?
It is clear. It is stated that NPHCDA will disburse to states and only after they have accounted for money given to them, and the states would have paid their own counterpart funding. There are guidelines, there are matching grants. If a state doesn’t want its citizens to benefit from it, then it should not pay its matching grants, and I don’t see any state that will not pay. And of course we as civil society will ensure those states are held accountable.
The law is quite an unusual kind of law, very explicit about what needs to be done. It is for you and I. It is not my law, it is not for the Federal Ministry of Health. You should be screaming, you should be able to go to a centre and demand for the services. They are supposed to list the services you are entitled to, the hours they are open, all of that must be pasted on the wall for you to see. It is a game changer.
How successful is the groundwork to begin implementing the Act?
A lot is going on. It is a process, not a destination. The law was just passed this December, the meetings are taking place, the regulations and policies are being written. The law needs to be elaborated and amplified before it can be implemented. The law says you are entitled to basic minimum package you must enjoy. Now it is for us to sit and ask, what are those common diseases Nigerians suffer from, what else can we put on that list? We need to agree on that list, we have to listen. We have to agree, but also make sure you don’t go to put heaven and earth there and when the money comes in you are not able to do anything. That requires negotiation. Once that’s done, it is a good start and it then needs to be funded.
As someone close to this Act since it started as a bill and went through controversies, how soon can these hurdles be scaled?
The law says all the regulations, policies and everything we are doing now have to be approved by the National Council on Health, which the minister presides over. The council is the final authority, once it agrees, then implementation can commence. What we need to agree now is the funding-that one percent, must be in the budget. Because if the council approves all we are doing now and finds out there will be no money, there will be chaos.
People should be asking, is that money in the 2015-2016 budget, because that budget process has started now, and before it comes out in January, let’s make sure the money is there.
The money is not dependent on the services. It is simply a percentage of federal government’s money. They should put it there and make it available.