Before Mr President Signs the National Health Care Bill

Dr Aminu Magashi
These days any forum or meeting one attends, hardly will they conclude without making reference to National Health Bill which was passed on Thursday, 19th May 2011 by the last National Assembly and awaiting the signing into law by Mr President.

If signed, it becomes an act that provides a framework for the regulation, development and management of a national health system and set standards for rendering health services in the federation, and other matters connected therewith.

Health Reform Foundation of Nigeria, a non-governmental organisation has moved the advocacy beyond meeting rooms by publishing paid advertorials on the pages of newspapers notably This Day and Daily Trust newspapers requesting for the assent of President Goodluck to the National Health Bill passed by National Assembly.

The advertorial on page 42 of Daily Trust Newspaper of Friday, July, 29th, 2011, to my opinion created more questions to be pondered strategically and answered by all health advocates and of course Mr President before the bill becomes an act. It mentioned amongst others that;

The National Health Bill provides for:

• Free medical care for children under 5 years old, pregnant mothers, elderly (above 65 years) and disabled people.

• A guaranteed basic minimum health packages for all Nigerians

• Universal acceptance of accident cases by all health facilities in Nigeria (public and private)

• Ensure quality of health care services through the issuance of certificates of standard (public and private).

What is the economic implication for a country that is planning based on a health care bill to provide 'Free medical care for children under 5 years old, pregnant mothers, elderly (above 65years) and disabled people.' These categories of people are more or less the largest percentage of what constitute health facilities attendance and admissions. Can we provide free services to them in an efficient, effective, equitable and sustainable manner? Let me digress a bit to mention how the bill is planned to be funded.

Contained in the health bill, are some good innovations, such as the establishment of a National Tertiary Hospitals Commission, which already has an acting executive secretary and will surely gulp a lot of over head expenditure. The establishment of a National Primary Health Care Development Fund that will be financed directly from the consolidated fund of the Federation, with 2% of its value, with 50% earmarked for the provision of primary care via the National Health Insurance Scheme and the other 50% for drugs, infrastructure and human resources for primary health care to be managed by the National Primary Health Care Development Agency through State Primary Health Care Boards

We are also aware that a lot of critical commitments have relied on the bill . One of such is Nigeria's commitment to the United Nations Secretary General's Strategy on women's and children's health which affirms that the initiatives is in full alignment to our existing country-led efforts and strategies targeted for implementation for the period 2010 - 2015. In that regard, Nigeria has committed itself to fully funding its health programme at $31.63 per capita through increasing budgetary allocation to as much as 15% from an average of 5% by the federal, states and local government areas by 2015.

Based on available budget records, the aggregate Nigeria's expenditure for 2011 is N4.226 trillion and Health sector has taken N235.8 billion that is about 5% of the national budget. It is still not clear how we intend to move from 5% to 15% allocation from 2010 - 2015 - that's 2% increment every year until 2015. What is expected is to cost the implementation of the bill by looking at all that is proposed vis-a-vis the potential source of funding as well as the practicability of mobilizing resources to finance the bill.

'Free medical care for children under 5 years' old, pregnant mothers, elderly (above 65 years) and disabled people' requires deeper analysis. At what level of care are services going to be free; teaching hospitals/federal medical centres, secondary health facilities and/or primary health care. If user fees are withdrawn from teaching hospitals/federal medical centres which form largely their internally generated revenue that is used to take care of some overhead expenses, what will be the alternate source of funding? Will the Federal Government increase their monthly allocation? Our experience in many states providing free maternal and child health services have shown that, it is not effective, efficient and sustainable and lacks reliable records that maternal and under five mortality rates are reducing.

More questions need to be answered:

1. What is the current health budget in the 36 states as well as 774 LGAs? At the level of 5% health sector allocation, have we done an analysis to find out if there are budgets wasted, misplacement of priority as well as how the available scarce resources could be used in a strategic way of minimum input and maximum output?

2. Funding our health programme at $31.63 per capita across the 3 tiers of government is another challenge. What is the current per capita? What are the mechanisms at the states and LGAs to help them reach the desired per capita?

3. The Health Sector financing will also get additional funding based on the bill passed from the proposed 2% of the Consolidated Federal Revenue Capital. How realistic could that be in practical sense?

In conclusion, before Mr President hurriedly signs the bill into law only to have an 'Act' on paper that can't be implemented, lets support the system to do more economic analysis, evaluation, advocacy and awareness creation on how strategically the bill will be funded and implemented in a realistic way.

All comments to Dr Aminu Magashi at

http://allafrica.com/stories/201108021458.html