By Femi Ogunyemi

_Last week, we looked at Articles 23 – 39 and concluded that Article 39 was an “ugly” disappointment because it did not address the availability of and access to pain medication in Nigeria.

Part V covers human resources for health. While its suggestions are welcome, it does not go far enough to correct or reverse the “brain drain”, nor does it tackle the living and working conditions of healthcare personnel in the country which has been underlying to many conflicts and strikes.

Regarding brain drain, many know that Indian Government leaders went to the USA and UK to meet with their indigenes who have succeeded in those countries. They asked what it would take to bring them back home; the leaders listened, went back and created plans to attract these indigenes back home.

What they did was no rocket science. They provided subsidies, housing assistance, low interest loans, duty waivers for medical equipment, government guaranteed loans, land and buildings. The brain drain reversal was enough to jump start he Indian healthcare system to what Nigerians patronize today.

What do we have here? An office for Nigerians in diaspora that is fluent with statistics of Nigerians in prisons worldwide but not of its immensely successful healthcare personnel in these same countries. How so often we hear public repeated cliches encouraging medical personnel to return home….with no active support!

Article 46 is also welcome as it finally addresses this issue of medical overseas travel. But it still leaves room for abuse, especially at high levels of public office. There should be NO exceptions. While a case can be made for payment exemption at facilities within the country, public officers should travel overseas for treatment at their OWN expense.

This aggressive approach is important for the development of our health system in Nigeria.

Perhaps the MOST UGLY disappointment in the Bill is Article 48:1(b). The patient’s “consent clause” CANNOT be waived! People should be encouraged to make a decision about organ donation (or not) BEFORE an emergency situation occurs.

This subsection MUST be removed. I have already addressed the fact that the Bill does not define what it refers to as an “emergency” medical situation.

It is worth noting also that a provider may choose NOT to treat an “emergency” patient in a circumstance of “harassment” by the patient.

Article 48:2 is puzzling: Articles 48-49 outlines prison terms galore. This is a good thing though, as, I am certain, perpetrators would not likely be reputable providers anyway.

Article 54:3(b) covers a responsibility that may be better done by, or together with, the “Ethics Committee” instead.

Article 55a (iii) offers a chance for pre-authorization (or not) for organ donation. The Bill misses the significant point that donating “body” is not the same as donating “organ(s)”.

Am I misreading Article 57? A dead person shall rise and revoke his donation? Perhaps a rewording is necessary.

In Article 58(a) one must remember that there are sometimes legal grounds for post mortems….death within 24 hours of surgery or anaesthesia (in some countries), in the very young and in suspicious circumstances.

Article 60:1 empowers the Minister, after “consultation” with the National Council, to establish as many advisory and technical committees as he believes “necessary”.

In Article 62 we find that officials don’t have to do what this Bill says – they can delegate someone else to do it! Under what circumstances, we don’t know.

And finally in Article 64, the use of the term “brain death” is welcomed. However the Bill should elucidate the set criteria, tests and standards needed to establish “brain death”.

The Bill has failed to install independent audit and outcomes monitoring bodies and has no internal checks for safeguarding patient advocacy.

Also significantly absent is direct plans for “lifestyle” diseases like hypertension, diabetes, cancers, obesity and heart disease. These are growing fast in Nigeria?

There is also no direct emphasis on the deaths of pregnant mothers and children under 5. Finally have we given up the fight, funding and research on aids, malaria and sickle cell?

The National Health Bill 2014 is nothing a good start ; the first step of a long journey.