There is no doubt that the 2014 National Health Act (NHAct) is one of the most innovative reforms within the Nigerian health sector; it provides a legal framework for the organization of primary health services and, more importantly, it guarantees every citizen the right to a minimum package of care. Amidst the excitement that heralded the new policy, some health advocates have expressed concerns about the government’s commitment towards its operationalization. Their fears are not unfounded considering the spate of poor implementation of key reforms over the years.

Governance Framework for the Implementation of the NHAct

Plans for the implementation of the NHAct initially bought together stakeholders from government, civil society and research communities. By March 2015, a National Council on Health (NCH) was convened, along with governance structures for the implementation of the NHAct. These structures include a Steering Committee and Technical Working Group (TWG) with sub-committees on topics relating to governance, financing, healthcare quality, knowledge management and advocacy.

Despite initial progress, a year on, the TWG is yet to hold a follow-up meeting and key milestones that were set to ensure the NHAct becomes operational have been missed. There are several factors contributing to this including:

Delay in Gazette Process: For any law to take effect, it has to be gazzetted and printed by the Government Press in Lagos. This process was delayed until December 2015 - 14 months after the NHAct was signed into law.

Delay in Development of Guidelines and Manuals: According to the NHAct, a costed work plan, guidelines and manuals should have been developed by the end of 2015. However many guidelines, including those on quality standards for healthcare, health information and knowledge management, have yet to be drafted or finalized.

Low Awareness of NHAct among Nigerians: Most Nigerians including key stakeholders within the health sector are not aware of the NHAct and its provisions. A survey conducted by UNICEF in 2015 showed that about 80% of the population are unware of the NHAct. Information materials aimed at increasing awareness have yet to be printed for dissemination across the country.

Important achievements despite slow progress

Whilst most of the TWG subcommittees have not met regularly, the Healthcare Financing, Equity and Investments Subcommittee, coordinated by the Healthcare Financing Unit of the Federal Ministry of Health (FMOH) has been active in producing several draft guidelines for the NHAct and the Basic Health Care Provision Fund (BHCPF) within it.

This work was made possible through strong leadership from the FMOH and related agencies, who worked closely with the subcommittee to mobilize human and technical resources. It is likely that if other subcommittees had adequate support and funding, the implementation of the NHAct would have progressed as initially expected. Another key achievement in the implementation process is the development of the draft 2016 National Health Policy, which incorporates the key provisions of the NHAct into its policy directions.

How Committed is the Government towards NHAct Implementation?

During the visit of the Africa Regional Director of the World Health Organization (WHO). President Buhari made a public commitment to establish the BHCPF and reportedly directed the Federal Ministry of Finance to set up structures for the establishment of the BHCPF. Stakeholders within the health sector are alarmed that resources for the BHCPF, which were to be statutorily deducted from the Consolidated Revenue of the Federation, were not included in the 2016 Budget for the FMOH. Although about one billion Naira is needed for the operationalization of the NHAct, a review of the FMOH budget shows that little or no funds were earmarked for the implementation of the NHAct in 2016.

Not only does the delay in implementation of the NHAct cost the health and lives of citizens who cannot access quality primary care services, but also the Government risks being sued by a section of the Nigerian public to enforce their health rights as guaranteed by the NHAct. The government must show political will and commitment towards implementing the NHAct and achieving universal health coverage by providing the needed resources to fast-track the stalled implementation process in 2016.

This blog is a shortened version of an article originally published in Africa Health Nigeria.