Implementing Nigeria’s 2014 National Health Act: Avoiding pitfalls and learning lessons from the education sector
On the 23rd of April 2015, I had the privilege of participating in the first business meeting of the Technical Working Group for the implementation of the National Health Act (NHAct), which was signed into law by President Goodluck Jonathan in October 2014. The Act sets out the ideal way the Nigerian health system should be organized and guarantees the free access to a basic package of healthcare to all Nigerians, as well as other critical provisions relating to the quality of services to be provided and the rights and responsibilities of patients and healthcare providers. With the euphoria that heralded the signing of the Health Act now waning, many health experts and public policy analysts agree that the devil is in the detail of the implementation processes.
The NHAct represents the most significant watershed moment in the Nigerian health system, and the critical question being asked by the average Nigerian on the street remains, will the implementation of the NHAct translate into tangible health outcomes in the coming years? There is a deep concern that the NHAct will go the same way as the Universal Basic Education (UBE) programme, which tried, but failed, to transform the quality of education delivered in public schools and improve the literacy rate in Nigeria since its commencement in 1999. Today, the quality of primary education in most public schools is abysmally poor and the drop-out rate from primary and secondary schools remain high.
Some experts argue that this failure was due to a lack of involvement of the key stakeholders at the subnational level in the implementation of the policy, with choices being made centrally by the UBE Commission in Abuja. Considering that the NHAct provides a legal framework for the provision of a basic package of healthcare services to be financed through similar funding mechanisms for the UBE programme, it is imperative that we critically review the latter’s pitfalls and learn from the implementation challenges.
For instance, in managing the Basic Healthcare Provision Fund (a part of the NHAct which provides additional revenue to primary health services) we need to ask how the states and local government areas will contribute their required 25% counterpart funds to match the 1% annual grant from the Federal Government. Available evidence shows that few states generate significant revenue from their domestic sources, and those that depend mainly on allocations from the federal government to fund their annual budgets do not spend resources effectively. Given this, there is the need for citizens, civil society and other non- state actors to be actively involved in developing and defining the guidelines for the management of the Fund, as suggested by findings of a recent research on ‘Accountability Mechanisms for the Basic Healthcare Provision Fund'.
With the dwindling oil prices and depleting revenue, another challenge faced by the new Government will be how it can generate additional resources to fund its commitments to the health sector, in particular in achieving Universal Health Coverage as set out in the NHAct. Providing Universal Health Coverage for the large majority of Nigerians that do not have any form of health insurance will not be an easy task. While commending the efforts of the Federal Ministry of Health in coordinating the implementation of the NHAct, one cannot overlook the urgency of the hard work ahead for the Government and the Technical Working Group in developing the guidelines for the implementation of the NHAct.
As the new All Progressives Congress-led Government of General Muhammadu Buhari takes over the leadership of the country at the end of May, they need to ensure that the NHAct implementation goes seamlessly and ensuring that the major thrust of their health policies is anchored on improving the quality and coverage of health services available to all Nigerians.
Felix Abrahams Obi works as the RESYST Research Uptake Officer for the Health Policy Research Group, College of Medicine, University of Nigeria.