By Femi Ogunyemi

Nigerians and its health care professionals in particular, received a Valentine season present from the National Assembly on Feb. 19th. 2014.  The senate passed the National Health bill, aka SB 215, after its 3rd reading.  It had received its first reading on October 2nd 2012 and the second on December 12th    2012. The Articles of the Bill are divided into 7 Parts:

PART 1 – responsibility of national for health and eligibility for health services and establishment of national health system – articles 1-11

PART 11- health establishments and technologies – articles 12-19

PART 111- rights and obligations of users and healthcare personnel – articles 20-30

PART VI – national health research and information system – articles 31-40

PART V – human resources for health – articles 41-46

PART VI – control of use of blood, blood products, tissue and gametes in humans – articles 47-58

PART V11- regulations and iscellaneous provisions – articles 59-65

The functions of the Federal Ministry of Health is set out in detail on Article 2:1, only for all these functions to be duplicated and upstaged by numerous committees in later Articles.

The constitution and mandates of these committees dilute the functions of the FMOH and create a bureaucratic process with unclear “buck stops here” responsibilities.

Let’s take a look at the Committees.

First is the National Council of Health: a panel of Federal officers and State officers with differing funding sources, funding capacities and health priorities.

The NCOH formed by the NASS in Article 4:1 must meet at least twice a year to attend to ALL health issues in Nigeria!

Where are the other stakeholders of the health industry? Where are the representatives of the professional bodies and the private sector?

Such committees formed to help implement the NHS Bill in the UK often recruit corporate leaders who see the appointments as a vocation and a challenge and lend their expertise to its success.   Who funds these meetings? The FMOH?   And the NCOH gets its very own sub committee: the Technical Committee. Reading Article 6:1, can someone please do a head count of the members of this (sub) committee?

In Article 9:1, the NASS creates a National Tertiary Health Institution Standards Committee. Again its members count may reach 50 or 100 as it supposedly includes the representatives of all CEOs of tertiary hospitals and registrars of ALL health professions, regulatory agencies or councils in Nigeria. They are to meet a minimum of 4 times yearly.

Then there is the 13 member National Health Research and the 15 member National Health Research Ethics Committees formed by the FMOH in Article 31:1 and 33:1 respectively.

What are the added costs to health spending by these committees? Are there duplication of responsibilities? Are there existing structures in place for their functions? How easily will these committees reach informed collective decisions?

It takes a few readings to understand the language of Article 11 which deals with the (new?) Basic Health Care Provision Fund. How were these % allocations derived and assigned? Were they based on any data or evidence? Then in Article 11:3(e) we read of yet another committee to be formed by the NCOH: the Emergency Medical Treatment Committee. (The word “Emergency” is used frequently in this document. It has far greater significance, clinically, than the authors of the Bill may imagine. I will address this later.)

In Article 13 a Certificate of Standards is great idea, but why should the defaulter be allowed a further 2 years to carry on such (substandard) practice?

Article 20 talks of “ emergency” medical treatment. What exactly are they calling “emergency”?

When we triage surgical patients competing for theatre time in the UK or USA we classify elective as planned, urgent meaning within 24hrs, and emergency meaning: within the hour! The only other situation more desperate than an emergency is when a life threatening resuscitation is ongoing!

Do the lawyers really conclude, in Article 20:2, that imprisoning a health care provider for six months is the right option here?