Obinna Oleh was present as his sister bled to death shortly after giving birth to a set of triplet boys in an Abuja general hospital. He blamed the hospital for the tragedy.
The touching story, reported first by PREMIUM TIMES in May, shocked Nigerians as the family sought help for the newborns and their two older siblings.
The management of Bwari General Hospital where the woman, Nkechi Okonya, died as a result of excessive bleeding initially absolved itself of blames after the family of the deceased accused it of not attending to her for several hours even though it was an emergency.
But Mr Oleh, a public servant, who was with his sister all through countered the rebuttal, accusing the hospital of "recklessness and money consciousness."
"It is a lie. They did not attend to my sister promptly because of money. They are lying. I came to the facility with N120,000 but I left with only N15,000 and this hospital is claiming they did not collect a dime from us.
"I lost my sister due to their negligence and mistreatment and I am blaming the staff and management of the hospital entirely because if you cannot treat a patient on emergency without money at hand at a government hospital, then why are we Nigerians?"
When asked months later, Mr. Oleh was ignorant of the existence of the National Health Act (NHA), a body of laws signed in 2014 to address health issues such as that of his sister. It provides a legal framework for the regulation, development, and management of Nigeria's health system.
Mr Oleh became even more confounded when the provision of section 1 Part 3 of the Act which details 'emergency treatment' was revealed to him.
"A health care provider, health worker or health establishment shall not refuse a person emergency medical treatment for any reason. A person who contravenes this section commits an offense and is liable on conviction to a fine of N100,000 or to imprisonment for a period not exceeding six months or both", the section reads in part.
"If I knew, I would have sued that hospital", he told PREMIUM TIMES on Wednesday.
Just like Mr Oleh, many Nigerians have very poor knowledge of the Act and its provisions. In fact, a majority of Nigerians who participated in a recent opinion poll conducted by PREMIUM TIMES knows nothing at all about the body of law.
A total of 641 participants took part in the online poll which lasted about two weeks. The poll was conducted in such a way that made it impossible for a respondent to vote more than once from the same computer or mobile device.
The participants were asked a single question: "How much do you know about Nigeria's National Health Act?"
While 63.6 per cent of the respondents (441) said they know nothing at all about the Act, 20.4 per cent (133 respondents), said they know little.
Only about 16 per cent of the participants (104 votes) said they have adequate knowledge of the law.
Also, a survey jointly conducted by PREMIUM TIMES and PTCIJ, an arm of this newspaper, assessed the knowledge and perception of the Act by a cross section of Nigerians on social media.
The study population comprised 42 respondents (Accountants, medical doctors, civil servants, public servants, students, entrepreneurs, nutritionists, researchers, traders and journalists).
Even though majority of the respondents (64.3 percent) have at least heard about the NHA 2014 against the remaining 35.7 per cent who have not, most of the respondents (66.7 percent) still have no knowledge of the contents of the Act.
A 2016 survey published on Nigerian Medical Journal also showed that although health professionals in Nigeria have good awareness and perception of the NHA 2014, their knowledge of the Act is poor.
"One of the major problems the health sector is facing is lack of awareness and poor knowledge of the provisions of the Act", Henry Ewononu, a health expert said. "But more worrisome is the fact that most of its provisions are yet to be implemented or enforced by appropriate authorities.
"The long awaited Basic Health Care Provision Fund, a fundamental mandate of the Act has been added in the 2018 budget. It amounts to about N57.15b. According to the Act, five per cent of this fund should go into emergency treatment which would have averted cases such as the death of the triplets' mom.
"But this fund which has been appropriated in the budget, is yet to get approval for release because the appropriate authorities are yet to develop and submit a plan on how it will be disbursed and utilized", Mr Ewononu explained.
Dissecting the Act: What You Should Know
The National Health Act is made up of seven parts divided into various sections. Each part contains fundamental provisions which if effectively implemented will have a tremendous impact on health-care access and universal health coverage, health-care cost, quality and standards, practice by health-care providers, as well as patient care and health outcomes.
Below are highlights of the seven parts of the NHA:
Part 1: Responsibility for health and eligibility for health services and establishment of National Health System
It details structural flow of authority and responsibility within the National Health System. It provides and defines a framework for standards and regulation of health services in both public and private providers of health services.
Those in the National Health System range from the highest body in the sector; the Federal Ministry of Health to the least such as traditional and alternative health providers. The Health Ministry coordinates the system. It sets up and oversee various councils and committees such as the National Health Council and the National Tertiary Health Institution Standards Committee.
The last section of part 1 details the establishment of the Basic Health Care Provision Fund, which provides for not less than one per cent Consolidated Revenue Fund for health funding. It states how the fund is to be generated and disbursed.
Part 2: Health Establishments and Technologies
This provides the health minister powers to regulate, coordinate and classify health establishments and technologies such as tertiary institutions as well as private health providers.
It is worthy of note that subsection 2 states that a health establishment, health agency or technology without being in possession of a certificate of standard cannot operate 24 months after the date the Act took effect.
This has being the crux of agitations over the non-implementation of the Act. Going by this provision, all hospitals and health establishments in the country are operating illegally because it is over 24 months (two years) since the Act was enacted and no hospital is yet to receive the certificate of standard.
Part 3: Rights and Obligations of Users and Healthcare Personnel
It made provisions for emergency treatment of cases such as Mr Oleh's sister; rights of health care personnel; security for health care provider; duty of the health provider to ensure confidentiality, obligation to keep record and give full knowledge of a health condition or procedure to the patient or his/her family among others.
Part 4: National Health Research and Information System
This provides for research, data and information collation and collection within the health sector. The minister shall establish the National Health Research Committee and its Ethics Committee with the responsibility to conduct research and experiment. The ministry of health shall create, facilitate and coordinate a comprehensive National Health Management Information System for collection of data and information of every health condition, treatments and procedures within any health establishment. The minister is mandated here to publish annual reports on the state of health of Nigerians.
This part details how the National Council on Health should ensure the widest possible catchment for the National Health Insurance Scheme (NHIS).
Part 5: Human Resources for Health
The development of a policy and guidelines by the minister with the concurrence of the National Council for distribution, management and utilisation of human resources in the health sector are detailed here. It provides for adequate recruitment, capacity building and distribution of well trained staff at all levels to meet the health needs of Nigerians.
Part 6: Control of Use of Blood, Blood Products Tissue and Gametes in Humans
It features the obligations of the National Blood Transfusion Service. It is stipulates the rules, principles and sanctions guiding the collection and prescription of blood products, handling of vital tissues and organ transplant.
Part 7: Regulations and Miscellaneous Provisions
It cites powers of the minister to make any other necessary regulations, appoint committees, assign duties and delegate authorities as the case may be.
Background to the Act: What we know
The National Health Act has been in existence for four years but its implementation has become a controversial issue in the health sector. It was the lacuna in the 1999 Constitution which failed to adequately provide for a legal framework for health care that birthed the idea for the enactment of the Act.
The National Health Bill was first proposed in 2004 during the time of Eyitayo Lambo as minister of health. It however took a decade of consideration before it was eventually passed and signed into law by former President Goodluck Jonathan on October 31, 2014.
This marked the beginning of the next phase of challenges in the implementation and enforcement of the Act.
Stakeholders in the health sector, especially the Association of Nigerian doctors (NMA) have since protested the non-implementation of the National Health Act.
They threatened the federal government with a lawsuit as well as embarked on a bi-weekly protest march in 2016 to urge lawmakers to include the Basic Health Care Fund (BHCPF) in the budget, a major objective of the Act which provides for not less than one per cent of the Consolidated Revenue for health funding.
In 2017, the Senate passed a resolution mandating its Appropriation Committee to make provision for the BHCPF in the 2018 budget.
The lawmakers when passing the 2018 budget in May earmarked N57.15 billion for the BHCPF as mandated by the Act as stakeholders in the health sector sighed in relief.
Meanwhile, the minister of health, Isaac Adewole, earlier in January argued that all other provision of the act have been fully implemented except the BHCPF, a position the former NMA chairman, Mike Ogirima, faulted.
"What have they even implemented in the Act? The components of the Act are so numerous. The Government and the Minister of Health only went ahead to set up many implementation committees, but a lot of things are yet to be implemented and operationalised", Mr. Ogirima, also a professor, told PREMIUM TIMES in a phone interview.
"When you talk about the certificate of standard for every health institution in the country, nobody is going around to issue that certificate of standard. A clinic needs to have some basic requirement. Can the government tell us one clinic they have visited? Can the committees tell if they have formed any committee on certificate of standard? That committee they formed is supposed to go round and register all clinics, hospitals and even teaching hospitals and private hospitals."
The question that remains unanswered is why does the Act still seem ineffective even after the inclusion of the BHCPF in the 2018 budget?
Why is the BHCPF yet to be released up till now?
Why are many other provisions in the Act such as issuing of certificate of standard yet to be implemented?
In a series called "Dissecting the NHA" PREMIUM TIMES will explain more comprehensively the provisions of the Act and its non-implementation. Watch this space.