Sunday, June 05, 2011

On the Health Bill

Editorial from The Lancet:

Celebrations are afoot in Abuja. On May 19, the two Houses of the Nigerian National Assembly finally passed the National Health Bill into law, after 7 years of inaction and procrastination. The controversial bill, which promises to provide all Nigerians with a basic minimum package of health services, was originally proposed in 2004 and passed in May, 2009, before being withdrawn for bureaucratic reasons. It has effectively lain untouched since. The Nigerian Medical Association estimates that 7 million children and 385 000 mothers have died in the interim.

As the most populous country in Africa (one in four Africans live in Nigeria), providing universal health care is no easy task. But even allowing for the difficulties posed by providing health care to a large population, the country still underperforms. Life expectancy at birth averages just 54 years for both sexes. Maternal mortality is 608 per 100 000 livebirths, and the mortality rate for children younger than 5 years is more than double the global average at 157 per 1000 livebirths. Nigeria is the only country in the African continent to have never eradicated poliomyelitis, and only 3% of HIV-positive mothers receive antiretrovirals. Just 6% of the country's gross domestic product (GDP) is spent on health and there are enormous inequalities in its allocation between the rich and poor areas of the country.

The bill provides a framework for the regulation and provision of national health services, defines the rights of health workers and users, and stipulates guidelines for the formulation of a national health policy. Its promises will not change everything for Nigerians, but the bill does allow them to finally hold the government to account for their right to health, including equitable access to care. Never before has there been such momentum towards making a real commitment to improving health in this country.

The bill pledges to develop a national health policy that includes 60 billion naira (about US$380 million) devoted to primary health care each year, commitments to the provision of essential drugs, and comprehensive vaccination programmes for pregnant women and children younger than 5 years of age. It rightly devotes a whole section to strategies to reduce the crippling effect of the brain drain on health care; there are as many Nigerian doctors working in the USA as there are in the public health-care sector of Nigeria. The bill thus commits to providing adequate resources for ongoing education and training of doctors, including a continuing professional development programme. The health bill stipulates the need for measures of accountability, which are central to the bill's success. The country's performance and the state of citizens' health need to be assessed by an independent authority, and the government must be accountable for delivering on their promises.

On May 29, many Nigerians celebrated again as Dr Goodluck Jonathan was inaugurated as President for the next 4 years. The zoologist succeeded President Umaru Yar'Adua after his death last year, and in April, 2011, Jonathan was re-elected in what is widely considered the most transparent and legitimate election Nigeria has ever held. This is an exciting time for the country: it has a leader with a clear mandate, its economy is flourishing (it is predicted to have the highest average GDP growth of any country over the next 40 years), and efforts are being made to reduce its sporadic civic and religious tensions and endemic corruption.

However, until now, health has been lamentably absent from Jonathan's declared priorities. Although progress has been made in poliomyelitis eradication and health-systems strengthening since he came to power in May, 2010, these are only two of hundreds of indicators in dire need of improvement. Many societal groups grew concerned over his neglect of a health agenda. On May 18, thousands of women protested about the delay in the passage of the health bill outside the National Assembly. Their efforts were rewarded with the passing of the bill the very next day. At the time of going to press, all that remains outstanding is presidential assent to make the National Health Bill a federal law.

This auspicious turn of events gives cause for hope. Perhaps President Jonathan is more devoted to rectifying the appalling state of health in Nigeria than has been apparent thus far. If he really is committed to providing equitable and affordable universal health care for all of his people, he should sign the National Health Bill immediately. There is no better way to say thank you for electing him.


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