The National Health Act 2014: What you need to know by Chief Ignatius
A Presentation On The National Health Act (NHA 2014) By Chief Ignatius T. Ahula
A TALK ON THE NIGERIAN NATIONAL HEALTH ACT (NHA 2014) DELIVERED BY CHIEF IGNATIUS T. AHULA FWACN TO NURSES AND MIDWIVES DURING THE MCPDP AT THE SCHOOL OF NURSING MAKURDI FROM 27TH -31ST MAY, 2019
Protocol/Introduction
I wish to thank our State Chairman of NANNM for inviting me to give a talk on the Nigeria Health Act and Members of the Central Planning Committee for agreeing that I should come. The National Health Act (NHA) as a piece of legislation was passed by the 7th Assembly and was signed into law by the former President Dr. Goodluck Ebele Jonathan on the 9th of December, 2014. The interpretation of the Act falls within the jurisdiction of the law and the courts but its application to our practice is what shall concern us.
Therefore, we shall be looking at the Act to see how it touches on our practice and our services. But before we do that let us look at the highlights of the act and its main provisions as enshrined in the Nigeria National Health Act No. 145, Vol. 101.
This is the first time since independence in 1960 that Nigeria has come up with a constitutional framework for a National Health System with clearly defined roles and responsibilities for the different tiers of government and non-governmental organizations. The aim of the Act is to establish a framework for Regulation, Development and Management of a National Health System, to set standards for rendering health services in the Federation and other matters concerned therewith. The Act was designed to achieve Universal Health Coverage and meet the Millennium Development Goals (MDGS) and other health related challenges.
The National Health Act 2014 is divided into six parts.
Part 1 talks of the roles and responsibility of different players in the Nigerian health sector. It establishes a National Health System comprising of public and private providers of health services traditional and alternative health care providers, health ministries and departments at each tier of government. Part 1 also defines the entitlement of all Nigerians to a basic minimum package of health services. This part also establishes the processes for exempting certain groups from paying for services in public hospitals. Apart from oversight, coordination and planning functions, the Federal Ministry of Health is now required to prepare and present an annual report on the State of Health of all Nigerians and the National Health System to the National Assembly and the President. Included in this part is a Technical Committee that is to advise the National Council of Health on plans developed by the Federal Ministry of Health. A National Tertiary Health Institutions Standards Committee is included in the part and its function is to oversee and set standards for tertiary institution in the country and publish annually “information in relation to tertiary health care services.”
Tertiary hospitals will also be required to undergo peer reviews. The Act talks about the establishment of Basic Health Care Provision Fund (BHCPF). This will come from annual grant by the Federal Government of not less than one percent of consolidated revenue fund plus foreign grant and any other money from other sources. 50% of the Basic Health Care Provision Fund will be used for basic minimum package of health in eligible primary and secondary centres through the National Health Insurance Scheme, while the rest is to be used for drugs, vaccines equipment, maintenance, human capital development and emergency medical treatment. The Act provides that National Primary Health Care Development Agency (NPHCDA) funds will be disbursed via State Primary Health Care Boards to LG health authorities with a requirement for co-funding allowing NPHCDA to withhold funds where counterpart funding is not provided or precious grants are misused.
Part II of the Act outlines the processes for regulating health establishments and technologies and ensuring quality and standards. Health establishments under the Act are required to have a certificate of standard which will define how many beds and what technologies they can have. A fine of N500, 000 or 2 years imprisonment is the penalty for anybody operating a health establishment without a certificate 24 months after the Act. Part II also provides mechanism for public hospitals to retain a proportion of the revenue they generate (subject to Minister and in States, Commissioner discretion).
Part III talks about the rights and obligation of users and healthcare personnel, and makes its an offence to refuse emergency medical treatment punishable by a fine of N100, 000 or 6 months imprisonment. The rights of healthcare personnel are highlighted in this part and the Act clearly indemnifies healthcare personnel from claims where they have not been negligent. Healthcare workers are now required to give users relevant information regarding their health status, diagnosis and treatment options, risks and benefits, right to refuse treatment to their state of health and treatment unless there are exceptional circumstances. Health establishment on their part are required to clearly define their services, complaints processes and timetables and to keep records for each user with confidentiality standards.
In Part IV a National Health Research Committee is established. It has 13 members National Health Research Committee to promote research and ensure that it conforms to identified priorities. There shall be a National Health Research Ethics Committee with 17 members one of whom shall be a woman. Every other health institutions carrying out research shall have an ethics committee. Part IV also requires the Federal Ministry of Health to facilitate the creation of a comprehensive National Health information Management system and to prescribe data for collection at every level of the health system which will be a requirement for the award of certificate of standards. The minister and commissioners of health are required to publish annual reports on the health of the citizenry and the health system.
Part V focuses on human capital development and capacity building of health personnel. The National council of Health is expected to develop policies and guidelines for training and distribution of health workers. Health services are classified as essential services and it is expected that there shall be no disruption of these services. Health workers shall not be out of work for more than two weeks. This part also bars all public officers from medical tourism at public expense. However, medical check-ups, investigation or treatment abroad can only be approved by a Minister or Commissioner for health in exceptional cases.
Part VI provides for the establishment of the National Blood Transfusion services and it outlines the procedures for obtaining consent. It also bans the sale of blood and tissue and it further prohibits the manipulation of genetic material and the import/export of embryos.
Organ transplantation is only to be done with the approval of a medical practitioner and a process for living wills for organ donation is set out in this part. Conditions for post-mortems-spouse, child, parent, guardian, brother or sister are clearly defined. The act has a provision that says the Minister can set up a National Consultative Forum which will allow him or her to prescribe further transitional arrangements as may be necessary for the implementation of the Act.
Summary and conclusion
Nigeria National Health bill was signed into law by former president Goodluck on 9th of December, 2014. The aim of the law is to establish a framework for the Regulation, development and management of a National Health system, to set standards for health services in the Federation and other matters concerned therewith.
The act is set to achieve the universal coverage and meet the Millennium Development Goals (MDGs) target. It provides for the elimination of quacks from professionalism and provides basic health funds needed by Nigerians.
The act was enacted for the purpose of providing health insurance to certain class of people who are at disadvantage i.e. the vulnerable group. It seeks to help healthcare workers especially Nurses and Midwives to reduce maternal and infant mortality rates. This is because more pregnant women will have access to free delivery services and their children are assured of standard pediatric services in our Nation’s health facilities.
The Act provides for increased funding of health care services at the grassroots so that people don’t have to travel far to access health services. States are also required to take part in improving health centres through a counterpart fund that would enable them benefit from the consolidated funds. It has a provision that when properly implemented will cut down significantly on medical tourism.
The Basic Health care provision Fund (BHCPF) shall be financed from the Federal government annual grant of not less than one percent of its consolidated revenue fund and grants by international donor partners. The funds shall be managed by the following organizations:
i. The National Health Care Development Agency which will manage 45% of the fund to be disbursed via each state and the FCT primary Health Care Development Board for the provision of essential drugs, vaccines and consumables.
ii. The National Health Insurance Scheme will manage 50% of the fund for the basic minimum package of health facilities.
iii. The Federal Ministry of Health will manage 5% of the fund for the provision of basic minimum package of health facilities. The Act is also for the purpose of providing health care insurance for certain class of people who are actually deprived. It provides that NHIS would provide health courage to cover pregnant women, children who are under five years, the elderly and the physically, challenged persons. Part of the funds will be used to train Nurses and midwives.
Currently 28 states and the FCT with their Local Government Areas have started by establishing state primary health care development agencies in readiness for the implementation of the Act but on May 22, 2019 the Minister of health, Professor Isaac Adewole said that the 8th Assembly had embarked N55.15bn in the 2018 budget as one percent of the consolidated Revenue Fund for the Basic Health Care provision Fund (BHCPF) but that 14 states including Benue state cannot access this money because they do not have health insurance scheme law in place, and have not deposited the required N100 million into the dedicated account at the Central Bank of Nigeria (CBN) which is their stipulated counterpart funding portion. While the Minister was trading blames with the various states government on the floor of the Senate, representatives of the various States government said the Federal government was over politicizing the health policy thereby making things difficult for them to access the fund. They argued that the choice of beneficiaries for the health care fund was allegedly skewed in favour of states who are in the good books of the Federal Government (Punch Newspapers, May, 22 2019).
But the truth remains that the National Health Bill was conceived in 2004 and it underwent a gestational period of ten years before it was assented to in December, 2014. Four years after its passage, we are still talking about non-implementation and trading blames. It simply shows there is no enough supportive political will on the part of our political class and leaders.
Distinguished colleagues, ladies and gentlemen, what we need in this country is a supportive political climate in which health is viewed and treated as part of human development and the right of each individual. On our part, Let us continue to ‘dispense comfort, compassion and care to our clients/patients without even a prescription’.
Thank you for listening.
References:
1. Ahula, I. T. (2015) Dimensions in Nursing Practice and Society Health: A collection of papers on Nursing Profession and Humanity. (1st Edition) Makurdi, Mikroticha and Associates (Nig) Ltd. Makurdi.
2. Nigeria Health Water on February 10, 2015
3. Odebode Niyi et al (2019) Five States lock horns with FG over health care fund. The Punch Newspapers May 22, 2019. Lagos.
4. Ojo Jide(2016) The Non-implementation of Nigeria National Health Act. The Punch Newspapers, Lagos.
5. The official Gazette of the National Health Act No: 145 Vol. 101 of 27th October 2014, Lagos.
A TALK ON THE NIGERIAN NATIONAL HEALTH ACT (NHA 2014) DELIVERED BY CHIEF IGNATIUS T. AHULA FWACN TO NURSES AND MIDWIVES DURING THE MCPDP AT THE SCHOOL OF NURSING MAKURDI FROM 27TH -31ST MAY, 2019
Protocol/Introduction
I wish to thank our State Chairman of NANNM for inviting me to give a talk on the Nigeria Health Act and Members of the Central Planning Committee for agreeing that I should come. The National Health Act (NHA) as a piece of legislation was passed by the 7th Assembly and was signed into law by the former President Dr. Goodluck Ebele Jonathan on the 9th of December, 2014. The interpretation of the Act falls within the jurisdiction of the law and the courts but its application to our practice is what shall concern us.
Therefore, we shall be looking at the Act to see how it touches on our practice and our services. But before we do that let us look at the highlights of the act and its main provisions as enshrined in the Nigeria National Health Act No. 145, Vol. 101.
This is the first time since independence in 1960 that Nigeria has come up with a constitutional framework for a National Health System with clearly defined roles and responsibilities for the different tiers of government and non-governmental organizations. The aim of the Act is to establish a framework for Regulation, Development and Management of a National Health System, to set standards for rendering health services in the Federation and other matters concerned therewith. The Act was designed to achieve Universal Health Coverage and meet the Millennium Development Goals (MDGS) and other health related challenges.
The National Health Act 2014 is divided into six parts.
Part 1 talks of the roles and responsibility of different players in the Nigerian health sector. It establishes a National Health System comprising of public and private providers of health services traditional and alternative health care providers, health ministries and departments at each tier of government. Part 1 also defines the entitlement of all Nigerians to a basic minimum package of health services. This part also establishes the processes for exempting certain groups from paying for services in public hospitals. Apart from oversight, coordination and planning functions, the Federal Ministry of Health is now required to prepare and present an annual report on the State of Health of all Nigerians and the National Health System to the National Assembly and the President. Included in this part is a Technical Committee that is to advise the National Council of Health on plans developed by the Federal Ministry of Health. A National Tertiary Health Institutions Standards Committee is included in the part and its function is to oversee and set standards for tertiary institution in the country and publish annually “information in relation to tertiary health care services.”
Tertiary hospitals will also be required to undergo peer reviews. The Act talks about the establishment of Basic Health Care Provision Fund (BHCPF). This will come from annual grant by the Federal Government of not less than one percent of consolidated revenue fund plus foreign grant and any other money from other sources. 50% of the Basic Health Care Provision Fund will be used for basic minimum package of health in eligible primary and secondary centres through the National Health Insurance Scheme, while the rest is to be used for drugs, vaccines equipment, maintenance, human capital development and emergency medical treatment. The Act provides that National Primary Health Care Development Agency (NPHCDA) funds will be disbursed via State Primary Health Care Boards to LG health authorities with a requirement for co-funding allowing NPHCDA to withhold funds where counterpart funding is not provided or precious grants are misused.
Part II of the Act outlines the processes for regulating health establishments and technologies and ensuring quality and standards. Health establishments under the Act are required to have a certificate of standard which will define how many beds and what technologies they can have. A fine of N500, 000 or 2 years imprisonment is the penalty for anybody operating a health establishment without a certificate 24 months after the Act. Part II also provides mechanism for public hospitals to retain a proportion of the revenue they generate (subject to Minister and in States, Commissioner discretion).
Part III talks about the rights and obligation of users and healthcare personnel, and makes its an offence to refuse emergency medical treatment punishable by a fine of N100, 000 or 6 months imprisonment. The rights of healthcare personnel are highlighted in this part and the Act clearly indemnifies healthcare personnel from claims where they have not been negligent. Healthcare workers are now required to give users relevant information regarding their health status, diagnosis and treatment options, risks and benefits, right to refuse treatment to their state of health and treatment unless there are exceptional circumstances. Health establishment on their part are required to clearly define their services, complaints processes and timetables and to keep records for each user with confidentiality standards.
In Part IV a National Health Research Committee is established. It has 13 members National Health Research Committee to promote research and ensure that it conforms to identified priorities. There shall be a National Health Research Ethics Committee with 17 members one of whom shall be a woman. Every other health institutions carrying out research shall have an ethics committee. Part IV also requires the Federal Ministry of Health to facilitate the creation of a comprehensive National Health information Management system and to prescribe data for collection at every level of the health system which will be a requirement for the award of certificate of standards. The minister and commissioners of health are required to publish annual reports on the health of the citizenry and the health system.
Part V focuses on human capital development and capacity building of health personnel. The National council of Health is expected to develop policies and guidelines for training and distribution of health workers. Health services are classified as essential services and it is expected that there shall be no disruption of these services. Health workers shall not be out of work for more than two weeks. This part also bars all public officers from medical tourism at public expense. However, medical check-ups, investigation or treatment abroad can only be approved by a Minister or Commissioner for health in exceptional cases.
Part VI provides for the establishment of the National Blood Transfusion services and it outlines the procedures for obtaining consent. It also bans the sale of blood and tissue and it further prohibits the manipulation of genetic material and the import/export of embryos.
Organ transplantation is only to be done with the approval of a medical practitioner and a process for living wills for organ donation is set out in this part. Conditions for post-mortems-spouse, child, parent, guardian, brother or sister are clearly defined. The act has a provision that says the Minister can set up a National Consultative Forum which will allow him or her to prescribe further transitional arrangements as may be necessary for the implementation of the Act.
Summary and conclusion
Nigeria National Health bill was signed into law by former president Goodluck on 9th of December, 2014. The aim of the law is to establish a framework for the Regulation, development and management of a National Health system, to set standards for health services in the Federation and other matters concerned therewith.
The act is set to achieve the universal coverage and meet the Millennium Development Goals (MDGs) target. It provides for the elimination of quacks from professionalism and provides basic health funds needed by Nigerians.
The act was enacted for the purpose of providing health insurance to certain class of people who are at disadvantage i.e. the vulnerable group. It seeks to help healthcare workers especially Nurses and Midwives to reduce maternal and infant mortality rates. This is because more pregnant women will have access to free delivery services and their children are assured of standard pediatric services in our Nation’s health facilities.
The Act provides for increased funding of health care services at the grassroots so that people don’t have to travel far to access health services. States are also required to take part in improving health centres through a counterpart fund that would enable them benefit from the consolidated funds. It has a provision that when properly implemented will cut down significantly on medical tourism.
The Basic Health care provision Fund (BHCPF) shall be financed from the Federal government annual grant of not less than one percent of its consolidated revenue fund and grants by international donor partners. The funds shall be managed by the following organizations:
i. The National Health Care Development Agency which will manage 45% of the fund to be disbursed via each state and the FCT primary Health Care Development Board for the provision of essential drugs, vaccines and consumables.
ii. The National Health Insurance Scheme will manage 50% of the fund for the basic minimum package of health facilities.
iii. The Federal Ministry of Health will manage 5% of the fund for the provision of basic minimum package of health facilities. The Act is also for the purpose of providing health care insurance for certain class of people who are actually deprived. It provides that NHIS would provide health courage to cover pregnant women, children who are under five years, the elderly and the physically, challenged persons. Part of the funds will be used to train Nurses and midwives.
Currently 28 states and the FCT with their Local Government Areas have started by establishing state primary health care development agencies in readiness for the implementation of the Act but on May 22, 2019 the Minister of health, Professor Isaac Adewole said that the 8th Assembly had embarked N55.15bn in the 2018 budget as one percent of the consolidated Revenue Fund for the Basic Health Care provision Fund (BHCPF) but that 14 states including Benue state cannot access this money because they do not have health insurance scheme law in place, and have not deposited the required N100 million into the dedicated account at the Central Bank of Nigeria (CBN) which is their stipulated counterpart funding portion. While the Minister was trading blames with the various states government on the floor of the Senate, representatives of the various States government said the Federal government was over politicizing the health policy thereby making things difficult for them to access the fund. They argued that the choice of beneficiaries for the health care fund was allegedly skewed in favour of states who are in the good books of the Federal Government (Punch Newspapers, May, 22 2019).
But the truth remains that the National Health Bill was conceived in 2004 and it underwent a gestational period of ten years before it was assented to in December, 2014. Four years after its passage, we are still talking about non-implementation and trading blames. It simply shows there is no enough supportive political will on the part of our political class and leaders.
Distinguished colleagues, ladies and gentlemen, what we need in this country is a supportive political climate in which health is viewed and treated as part of human development and the right of each individual. On our part, Let us continue to ‘dispense comfort, compassion and care to our clients/patients without even a prescription’.
Thank you for listening.
References:
1. Ahula, I. T. (2015) Dimensions in Nursing Practice and Society Health: A collection of papers on Nursing Profession and Humanity. (1st Edition) Makurdi, Mikroticha and Associates (Nig) Ltd. Makurdi.
2. Nigeria Health Water on February 10, 2015
3. Odebode Niyi et al (2019) Five States lock horns with FG over health care fund. The Punch Newspapers May 22, 2019. Lagos.
4. Ojo Jide(2016) The Non-implementation of Nigeria National Health Act. The Punch Newspapers, Lagos.
5. The official Gazette of the National Health Act No: 145 Vol. 101 of 27th October 2014, Lagos.
Comments
Post a Comment