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Nigeria: National Health Bill Enacted

(Dec. 16, 2014) It was reported recently that Nigeria’s President, Goodluck Jonathan, signed into law the National Health Bill, 2014. Ten years in the making, the law aims to improve the country’s healthcare system, including access to primary care for vulnerable segments of the population, such as women, children and the elderly. (Lekan Adetayo & Bukola Adebayo, Jonathan Signs National Health Bill into Law PUNCH (Dec. 10, 2014); Felix Abrahams Obi, The National Health Bill: After Ten Years in the Making Is an End in Sight?, NIGERIA HEALTH WATCH [NHW] (Nov. 4, 2014).)

Emergency Care and Free Basic Medical Care

The legislation includes notable language making the provision of emergency health services mandatory and failure to do so a crime. It specifically states “… a health care provider, health worker or health establishment shall not refuse a person emergency medical treatment for any reason whatsoever.” (National Health Bill, 2014 (SB. 215), § 20, NHW.) Healthcare providers include for profit or nonprofit private or public institutions that provide inpatient or outpatient treatment services. (Id. § 64.) Refusal to provide emergency health service is an offense punishable on conviction by up to six months in prison and/or a fine of NGN100,000 (about US$555). (Id. § 20.)

Another notable provision authorizes the Minister of Health to put in place a framework for identifying a category of persons eligible for the provision of free basic health services. (Id. § 3.) In doing so, the Minister must consider:

(a) the range of exempt [i.e., free] health services currently available;
(b) the categories of persons already receiving exemption from payment for health services;
(c) the impact of any such condition on access to health services; and
(d) the needs of vulnerable groups such as women, children, older persons and persons with disabilities. (Id.)

This is reportedly going to cover children under the age of five, pregnant women, senior citizens above the age of 65 and persons with disabilities. (Chukwuma Muanya, Pharmacists Commend Jonathan, N’Ass for Signing Health Bill into Law, GUARDIAN (Dec. 11, 2014).)

Funding of Health Care

Also noteworthy is a provision setting up the scheme for financing the programs envisaged under the legislation. The legislation establishes the Basic Health Care Provision Fund (the Fund), which will be largely supported by a “Federal Government Annual Grant of not less than one percent of its Consolidated Revenue Fund [CRF].” (National Health Bill, 2014, § 11.) The CRF is a fund that receives “[a]ll revenues or other monies raised or received by the Federation (not being revenues or other monies payable …into any other public fund of the Federation established for a specific purpose)… . (Constitution of the Federal Republic of Nigeria 1999, § 80(1), International Centre for Nigerian Law website.) The Fund will be used to finance various health programs throughout the nation. (National Health Bill, § 11.)

The distribution of funds for health programs at state and local levels would come with restrictions. For instance, for a state government to qualify for a block grant for a project, it will have to contribute at least 25% of the funds needed for the project and demonstrate that it has used previously allocated funds properly and followed the nationally set “health policy, norms, standards and guidelines.” (Id.) In addition, the legislation imposes controls on the manner in which funds drawn from the Fund are allocated. For instance, 50% of the amount drawn from the Fund must be used “for the provision of [a] basic minimum package of health services to citizens, in eligible primary/or secondary health care facilities through the National Health Insurance Scheme” and 5% of it must be used for the provision of emergency medical treatment. (Id.)

Potential Impact

The adoption of the legislation is expected to improve the country’s primary health care system. According to Benjamin Anyene, Chairman of the Health Reform Foundation of Nigeria, the implementation of the legislation will save the lives of millions of women and children over the coming few years. (Alexander Chiejina, Jonathan Finally Signs National Health Bill into Law, BUSINESS DAY (Dec. 9, 2014).) Osahon Enabulele, President of the Nigerian Medical Association, stated that the adoption of the legislation will re-energize Nigeria’s primary health care system and greatly reduce unnecessary deaths resulting from lack of access to basic medical facilities. (Matthew Asabor, NMA Lauds Senate over the Passage of National Health Bill, NIGERIAN TRIBUNE (Feb. 28, 2014).)

Nigeria’s health care system is currently lacking in many respects. Nigeria established a national health insurance scheme in 1999; however, the scheme only covers five million people (3% of the Nigerian population). (National Health Insurance Scheme Act, No. 35 of 1999 (May 19, 1999), Policy and Legal Advocacy Centre website; ARIN DUTTA & CHARLES HONGORO, SCALING UP NATIONAL HEALTH INSURANCE IN NIGERIA iv (Health Policy Project, Mar. 2013).) According to the World Health Organization, the average life expectancy in the country in 2012 was only 54 years, much lower than the global average of 70 years. (Nigeria: Health Profile, WORLD HEALTH ORGANIZATION (last updated May 2014).) Similarly, the maternal mortality ratio was 560 per 100,000 live births (compared to the global average of 210) and the under-five child mortality rate was 124 per 1,000 live births (compared to the global average of 48). (Id.)