30 May 2011

Nigeria: Making Health Bill Work for All


This latest fight is not new. Many keen watchers of the sector are aware of the simmering feud between medical health workers and medical doctors, which requires little or no effort to bring to the boil.

But this time, the recently passed National Health Bill by the National Assembly is the bone of contention.

Health workers have consistently argued that the factors at play for efficient and effective delivery of health services are many and not necessarily tied to health alone, there is, nonetheless, a need for a strong legal framework for operations of the health sector as available in other sectors.

It would be recalled that the National Health Bill was passed by the Senate last Friday after six years of legislative debate and intense pressure by some civil society groups in the country.

Addressing journalists shortly after the passage of the bill, Chairman, Senate Committee on Health, Senator Iyabo Obasanjo-Bello, said the bill sought to define, streamline and provide a framework for standard and regulation of health services in the country; and spell out rights and duties of healthcare providers and health workers.

However, the workers, under the Assembly of Healthcare Professional Associations and Union threatened to disrupt activities in the health sector and embark on industrial action if President Jonathan went ahead to sign into law, the Health Bill.

As early as 10am, last week, thousands of the protesting health workers converged at the entrance of the Eagle Square, carrying placards with inscriptions: "No to conflicting sections in the health bill"; "Health Bill-more crises in the health sector"; "Mr. President don't sign the health Bill", and singing solidarity songs.

They accused the doctors of manipulations, saying the doctors had manipulated the bill and doctored the provisions of the bill to favour them against other professionals in the health sector and the interests of Nigerians.

The associations, led by the First Vice President, Association of Medical Laboratory Scientists of Nigeria (AMLSN), Dr. Godswill Okara, said, "If President Jonathan went ahead to pass the Health Bill into law, the answer is obvious, it will take the crisis in the health sector to higher level. We are all Nigerians, trained to provide services in the health sector. It will be met with stiff opposition, legal and extra-legal, professional and extra-professional.

"We will disrupt health care services; we will take every means to ensure that there is no peace in the health sector. The action will include nationwide strike, we will down tool until our demands are met. This time around, we are going to meet this with stiff opposition because the consequences are better imagined.

"If the bill is allowed to be passed into law, one wonders what the health sector will be. The issue must be corrected, we can no longer continue like this."

The associations and unions involved are: AMLSN, the Pharmaceutical Society of Nigeria (PSN), National Associations of Nigerian Nurses and Midwives (NANNM), Association of Radiographers of Nigeria (ARN), Nigerian Society of Physiotherapy (NSP), Health Information Managers Association of Nigeria (HIMAN), and the Medical and Health workers Union of Nigeria (MHWUN).

Others are: Nigerian Union of Pharmacists, Medical Scientists and Professions Allied to Medicine (UNPMTPAM), Senior Staff Association of Universities, Teaching Hospitals, Research Institutes, and Associated Institutions (SSAUTHRIAI), and the Non-Academic Staff Union of Educational and Associated Institutions (NASU).

Citing examples of what he referred to as obnoxious provision, Dr. Okara condemned Section 1, sub section 1; Section 1 sub section 1(d); Section 8 sub section 1 and 2; and Section 9 sub section 1(c).

He explained that every profession in the health sector had statutory regulatory body charged with specific responsibility of determining the standards of knowledge and skill to be attained by its practitioners and regulating their practice.

He stated therefore that the Health Bill should not in any way overtly or covertly usurp or infringe on this specific legal and statutory function of various professional regulatory councils and boards in the health sector as Section 1(1) provided.

The associations condemned the power given to the medical doctors in the bill, which they say, was against global trends.

Okara said, "We say no to it, and we call on all men and women of goodwill in Nigeria who wish our health sector well to appeal to President Goodluck Jonathan not to sign the bill into law until it is corrected."

They frowned at the provision that also says that the executive chairman of the National Tertiary Hospitals Commission shall be a medical doctor, saying that modern healthcare delivery system is a multi-disciplinary and multi-professional endeavour.

"The bill also assigned the power to prescribe functions and duties of various health professionals to itself. We believe the National Council on Establishment is already saddled with the responsibility to do that, and giving the same duty to any other body is duplications.

The associations said that the declining condition of the health sector and hospitals in Nigeria, since 1984, when medical doctors hijacked the administrative position from professional hospital administrators did not support the continued exclusive appointment of medical doctors as chief executive officers of healthcare agencies.

They alleged that all their contributions during the public hearings and presentations at various fora which were earlier adopted were removed through the manipulation by the doctors in connivance with the Ministry of Health and the minister.

He said, "No doubt, the National Assembly has good intentions in passing the bill to strengthen the health sector. However, the reverse will be the case should this bill be signed into law in its current form. In fact, the National Health Bill in its present state will do more harm than good since the bill does not take into cognisance existing professional regulatory laws and statutes in the healthcare industry in Nigeria.

"The bill will not only conflict with the existing regulatory laws and statutes, but will increase the crises in the health sector in Nigeria. The victims of this crisis shall be the innocent patients, healthcare professionals and the larger society that patronise our healthcare facilities."

However, in his reaction, the President, Nigerian Medical Association (NMA), Dr Omede Idris, said that the National Health Bill was a bill about service and service delivery to Nigerians at all levels.

He stated,"NMA has repeatedly clamoured for service and service delivery in health. That is why beyond any primordial consideration, personal and self interest, we have decided to accept the bills despite some limitations even to the Medical and Dental profession. NMA's centre of interest is that clients-children, pregnant women, elderly, persons with disabilities, indigent and entire populace are squarely addressed by this bill. The bill is about service, not about post sharing or profession. These are addressed by the laws of regulating the various professions ."

While welcoming the passage of the health bill, Dr Idris said he was hopeful that President Jonathan would assent to it immediately and not be distracted by unnecessary wrangling.

"He should begin to turn around the fortunes of health in this country by signing this bill into law. We could achieve the MDGs particularly MDGs 4, 5 and 6 if the implementation guidelines, tools and advocacy are developed on time."

According to him, the bill went through due processes and did not emanate from the blues.

"It did not abrogate any of the laws of the Regulatory bodies including Medical and Dental Council of Nigeria which regulates the practice of medicine and dentistry in Nigeria.

Appearing alongside Senator Obasanjo- Bello on Tuesday Live, an NTA phone in, live interview programme, the Minister of Health, Prof Christian Onyebuchi Chukwu, said that the bill would deliver services to the people no matter it's imperfections.

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