As a distinguished Senator in the 7th National Assembly, I was dedicated and devoted to the sponsorship of various bills to regulate, develop and manage the National Health System. Of particular interest were my concerns for improvement of the regulation, development, and access to health services through the following Bills that I sponsored or supported in its passage:-
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a.The National Health Act
b.The National Health Insurance Scheme,
c.The Prevention, Control and Management of Sickle Cell Diseases
d.The Prevention of Discrimination against HIV patients and advancement of human rights and dignity of persons living with HIV.
The National Health Act provides the legal framework for the regulation, development and management of the National Health System, setting standards for the rendering of health services in the Nigerian federation. Translating and implementing the provisions of the Act to achieve quality and accessible healthcare for all citizens of Nigeria will require the various segments of the health delivery system working in synergy.
There is growing evidence that improved quality of service leads to enhanced service uptake desire in the populace. Experiences from the Kwara State Health Insurance Scheme programme and Jigawa State Gunduma Health System, a WHO recommended district health system meant to improve quality of healthcare delivery, further supports this growing evidence. Effective health legislation has led to improved quality of health services from these schemes, resulting in significant increase in health service uptake by the citizens. However, sustainability of the quality of service is imperative for enduring success.
The National Health Act 2014 encompasses the legal provisions required to regulate and ensure efficient and quality of healthcare services in Nigeria. In synergy with an efficient Health Financing System, the ensured quality health service becomes affordable and accessible with the citizens of the nation becoming the ultimate beneficiaries.
The Act prescribes for the following among others:-
1.Policy and Governance Structure of the Healthcare Delivery Processes;
2.Establishment of Basic Health Care Provision Fund
3.Establishment of a system for ensuring quality of healthcare services in public and private health facilities through certification of standards for registration and a monitoring mechanism.
4.Human Resource for Health Development
5.Rights and Obligations of users and Healthcare Personnel
6.Research and Information Management Systems
7.Ethical Considerations and Regulation in Healthcare Service Practices
The Act through the establishment of a governance structure, has defined a role and relationship for and between the tiers of government. Realising that the healthcare load is bottom-heavy with over 70% of our people accessing care at the primary level, the NHA had provided for the establishment of a Basic Health Care Provision Fund of at least 1% of the consolidated Revenue Fund at the Federal level, with counterpart funds from both the States and Local Governments.
This Fund will be applied to the development of health care, infrastructure, provision of equipment, medication and the development of human resource at the Primary Health Care level. Ensuring quality and access at this level will boost health care outcomes naturally, especially among the poor and vulnerable. Fifty percent of the Fund is expected to be managed by the National Health Insurance Scheme (NHIS) for the provision of basic health insurance for the vulnerable in our society, thereby improving access and health outcomes.
The legislation in establishing a system for ensuring quality of healthcare services in public and private facilities through the certification of standards will reduce quackery, ensuring that appropriate healthcare personnel attend to the needs of users. Those who offend this aspect of the legislation can then be effectively prosecuted in accordance with the law. The need for appropriate human resource development, rights and obligations of users and healthcare personnel have been adequately provided for in the Act.
Ethical considerations in practice and research, with regulations in healthcare practices have been sufficiently provided for in the Act, ensuring that control mechanisms are enhanced.
Another key provision in the Act capable of improving standards and outcomes is the clause providing for an annual national and State stakeholders Consultative Forum for health to discuss health outcomes, challenges, prospects and policies. This is made mandatory, with the stakeholders expected to include user groups, civil society groups, donor groups and healthcare providers. Such forum will provide opportunities for interaction and user inputs, advocacy, enlightenment and policy impact assessment.
The Act provides, for the first time, an all-encompassing legal framework for delivery of affordable and quality healthcare in Nigeria. Like every other legal document in which there is no perfection, opportunities for improvement in the provisions of the Act through established legal review process is necessary. However, the Act in its current form has made adequate provision for improving the entire healthcare system value chain and it is imperative for all stakeholders to support its implementation.
What I feel we need now is a clear national strategy that defines the comprehensive vision of a healthcare system that creates value for both the patient and the healthcare provider and the processes required to achieve it. The central focus of a healthcare delivery process should be centered on continuously increasing value for the patient with value defined as “Health Outcomes Achieved per Naira Spent”.
This process, when efficiently managed, ultimately leads to improved patient outcome. The improved patient outcome potentiates the patient interest and belief in the healthcare delivery practice, leading to higher yield for the healthcare provider. In other words, improved quality in a full cycle care ultimately leads to an improved healthcare practice and benefit for both the patient and the healthcare provider.
In a value-based healthcare delivery system, achieving and maintaining good and quality health is inherently less costly than dealing with poor health. The new focus for the country’s healthcare delivery reorientation process should be towards quality and value-based Universal Health Care and the restructuring of the care delivery systems for better patient outcomes. Both are interrelated and essential and the National Health Act 2014 provisions support this effort.
A strategic healthcare service reorientation will be required to achieve the goal of Universal Health Care in Nigeria as encapsulated in the provisions of the National Health Act 2014. An important step in this reorientation process will be a robust Health Insurance Scheme that gives access to affordable and quality health services backed by an effective legislation.
Around the world, there are various laws in place to regulate, develop and manage the health system of each country. The ability of these laws to ensure improved quality of health service has been the differentiating component for the overall success of the health service delivery process.
Leveraging on my medical training, my legislative experience and direct role in the passing of the National Health Bill that became the National Health Act, I recommend that the National Postgraduate Medical College of Nigeria should try to engage the policy formulators and administrators in further enhancing health quality outcomes through the following:-
i.Technical Committees of the National Council of Health
ii.The National Tertiary Health Institutions Standards Committee
iii.Establishment of Certificate of Standards for Hospitals
iv.Classification of Health Establishment and Technologies
- Evaluating Services of Health Establishments
vi.Development and Provision of Human Resources in National Health System
vii.Health Research and Research Ethics Committees
viii.National Consultative Health Forum
The list is not exhaustive. The aspects of the Act that require development of an implementation framework and the eventual implementation process, will greatly benefit from the College’s coordinated participation and input. It will also elevate the College to the right policy influencing role that its peers play in other countries like the U.K.
The College should, therefore, utilise this opportune moment of a new government to re-assert itself in health policy development in Nigeria. The first step is for the College to encourage all its members to make themselves very conversant with the Act and all its provisions for strategic engagement.
The Delta state Government of which I am Governor has made the attainment of the Universal Health Care and provision of quality and accessible healthcare service in the state a cardinal programme as encapsulated in our S.M.A.R.T agenda. Within two weeks of my assumption of office, I sponsored a Bill to establish the Delta State Contributory Health Commission. The Bill is currently for 2nd Reading at the Delta State House of Assembly with effort to get it passed into law in the course of the year.
It is expected that increasing health insurance coverage in Delta will significantly increase the demand for health services, which will in turn require expansion of service delivery facilities and personnel and increase the need for standardisation and enforcement of quality.
The College is a critical partner for this and my government will foster closer relationship with it to achieve our health objectives. A healthy and prosperous Delta State is what we desire and I earnestly look forward to partnering with the College and other stakeholders to translate this vision to reality.
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