I have followed the current state of Nigeria with the current insecurity, petro-politics and crass insincerity on the part of Nigerian leadership with pains. The reason being that as a health development person, I am confronted daily by unacceptable indices in the health system, and by virtue of my work, I wish daily for the best in terms of outcomes for both the health system and the overall human development index for Nigeria (NB: Nigeria was ranked 142 out of 169 countries on the Global Human Development Index according to the 2010 Human Development Report. Not to mention the fact that over 385,000 women die every year, which is considered the second highest in the world. Statistics from the World Health Organisation (WHO) show that a woman’s chance of dying from pregnancy and childbirth in Nigeria is 1 in 13. To further buttress this issue, 292,000 newborns die every year, which is also the second highest in the world. Hence, the deafening silence of the Nigerian President over the Health Bill is a sincere cause for worry.[Ohanyido, 2011]
I believe there is something we can call a health system in Nigeria, which is poorly defined, largely unregulated and inefficient. As a matter of fact neither “Health” nor “the health system” is captured by the current Nigerian 1999 constitution. The result is dearth of a systemic bulwark of statutory systematization of standards is lacking along the three tiers of the health system, namely Tertiary, Secondary and Primary level. This was of course one of the main reasons for the National Health Bill (NHB) 2011, which after 7 years of its tortuous legislative and stakeholder journey, has suddenly become widely politicized by the political class using all sorts of health sector pressure groups to prevent Jonathan Goodluck’s administration from giving assent to it. This is despite the fact that it has been passed by both chambers of the 6th National Assembly.
The reason for opposition from some segments of the government may be clearer, if we understand the politics. A major factor is the fact that the Local Government as the third tier of governance has become totally emasculated by state governments, who illegally appropriate significant portions the fiscal allocation accruing to the local governments. Ordinarily if this allocation to the Local Areas is available, it would have enabled them to undertake a modicum of primary care development. Do not forget that the NHB 2011 is mostly focused at the bottom of the pyramid of care, so as to revamp, standardize and reinvigorate it, taking into consideration the idiosyncratic facets of the political economy of the Nigerian health system. It would also enable better funding and infrastructure, as well as imbue the system with a capacity to track the monies vis-à-vis programmes.
Please see the benefits of the NHB2011 http://www.ayakaonline.com/politics/the-national-health-bill-and-citizen-nigeria-what-benefits/You can download the Harmonised NHB 2011http://www.herfon.org/docs/Harmonised-NATIONAL-HEALTH-BILL-2011%20doc.pdf
Last year, between December 1st -4th National Health Sector Reform Coalition (NHSRC) organised a retreat over the Health Bill at the picturesque Obudu Resort, towards a consensus building for Health Professionals and other stakeholders on moving the sector forward, especially towards having a common voice on the National Health Bill (NHB) 2011 in view of the silent treatment from the Presidency.
As can be seen from The NHB, it provides legal framework for coordination, administration, financing and governance of Health Care. It particularly defines the "National Health System" and emphasizes on capacity development at Primary Health Care level, which carries the health burden of the bottom-of-the pyramid...about 70% of disease burden.
In order to push for the passage of the Bill the NHSRC was formed. The membership include; HERFON, DFID|PATHS2 Project, Save the Children UK (SCUK), FIDA, NMA, Advocacy Nigeria, PRRINN-MNCH, White Ribbon Alliance, Bill & Melinda Gates| NURHI Project, CISHAN, National Association of Women Journalists (NAWOJ), National Council of Women Societies (NCWS), Nigerian Market Women Association (NMWA), Federation of Muslim Women Societies in Nigeria (FOMWAN), and Synergy PMP among others.
Some of the medical groups like the Association of General and Private Medical Practitioners of Nigeria (AGPMPN) which is a significant bloc within the Nigerian Medical Association (NMA) had expressed reservation to certain aspects of the Bill, while the allied health professionals through the Assembly of Health Professional Associations and Unions (AHPAU) had also expressed the same. It was felt that such falling out within the health sector family with the Bill over clauses that could be amended, could becloud the importance of the Bill as a stepping-stone to a better health system. Hence, the opportunity for consensus and speak with one voice was championed by the (NHSRC).
I am glad to write that the two day proper intensive work and opportunity for dialogue at the retreat was satisfactory to all stakeholders present, and all left with strong desire to reform the health system and push the Health Bill to its final conclusion.
Please see what is now known as “the Obudu Communiqué” http://herfon.org/docs/obudu.pdf
Images from NHSRC Obudu retreat 1st -4th December 2011