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ukwuije's picture

Hello, am Dr Francis Ukwuije, Medical Doctor, Senior Health Economist and Head, Healthcare Financing & Equity at the Federal Ministry of Health, Abuja, Nigeria.

For my full profile, visit HERE

You are welcome to ask questions related to "The 2014 National Health Act" by posting it in the comment section below. I will do my best to answer your questions on Wednesday, 23rd March 2016 at 5pm.

ogungbo's picture

This is fantastic and a great opportunity to know more about the National Health Act. Looking forward to a lively session.

ukwuije's picture

Many thanks Doctor!

niyiosams's picture

Dear Dr Ukwuije, let me first thank you for taking time out from your busy schedule to be on Meet The Guru.

1. How will the Basic Health Care Provision Fund (at least 1% of the Consolidated Revenue Fund at the Federal level) affect management of emergencies in particular and hospital practice in general?

2. What is the implication of the "Certificate of Standards"?
a) Is it a condition to be fulfilled by only hospitals?
b) Will it be required from facilities in both the public and private sector?

3. What are the key rights of a medical doctor under the Act?

4. Is there provision for the operationalization of the Act in the 2016 budget?

5. The Minister of Health, Prof. Isaac Adewole, has said as part of the present administration’s commitment to achieving Universal Health Coverage (UHC), the Federal Government will build/rehabilitate 10,000 Primary Health Care centre's. How will the Act assist in Nigeria's quest to achieve UHC?

ukwuije's picture

1. Part 1, Section 11, Sub-section 1 of the National Health Act (NHAct) 2014, establishes the Basic Healthcare Provision Fund (BHCPF). Sub-Section 2 outlines the 3 main sources of the fund namely (a) Federal Government Annual Grant of not less than 1% of the Consolidated Revenue Fund (CRF); (b) grants by international donor partners; (c) funds from any other source. Sub-section 3 outlines how the fund will be used (a) 50% for provision of basic minimum package of health services for all citizens through NHIS; (b) 20% for essential drugs, vaccines, and consumables in eligible PHCs; (c) 15% for maintenance of facilities, equipment and transport for eligible PHCs; (d) 10% for development of human resources for eligible PHCs; while (e) 5% is for emergency medical treatment.

Based on the 5% provision for emergency care above, the Act has in Part 3 Section 20, Sub-section 1 stated that a healthcare provider, health worker or health establishment shall not refuse any person emergency treatment. Contravening of this part of the Act attracts a fine of N100,000.00 or imprisonment not exceeding 6 months period or both.

2. The NHAct has in Part 2, Section 13, Sub-section 1(a)-(d) prescribes Certificate of Standards as a pre-requisite for any person, entity, government, or organisation to establish and run health establishments, health agency, or health technology. Certificate of Standards shall therefore be issued for the operations of health establishments, health agency, or health technology based on the services they are classified to provide. Sub-section 1(d) specifically states that no person, entity, government, or organisation, shall continue to operate a health establishments, health agency, or health technology without this Certificate of Standards after 24 months from the date the Act took effect.

3. The whole of Part III of the Act deals with rights and obligations of health personnel and Users.

4. The current administration of President Muhammad Buhari has adopted the processes of operationalizing the NHAct 2014 that commenced from his predecessor. It is expected that the 2016 Budget will include provisions of the NHAct especially the establishment of BHCPF.

5. The UHC Agenda of the FMOH under the Honourable Minister of Health, Prof. Isaac Adwole is to make 10,000 PHCs functional. Part of the funding for this agenda and it's long-term sustainability is expected to come from the BHCPF.

Ucmervisoghroro2's picture

Why are Nigerian states reluctant to implement PHC Under one Roof, as provided for in the Act; and, can states benefit from the 1% Basic Health Fund without being "Under one Roof"

ukwuije's picture

PHC Under One Roof (PHCUOR) in operations means that a State has (i) State Primary Healthcare Development Agency (SPHCDA) which is the governance structure; (ii) the SPHCDA is backed by law and has appropriate staffing as recommended by NPHCDA; (iii) has one Plan of Action for PHC in the State; and (iv) one Monitoring Framework.

The FMOH, NPHCDA, NHIS and relevant stakeholders are developing operational guidelines for the implementation of the Act. One of the requirements for States to benefit from the BHCPF is establishment of SPHCDA and implementation of PHCUOR. At the moment, over 90% of the States in Nigeria have SPHCDA.

philip.njemanze's picture

1. Why is there no Donor Consent in Section 51 to grant authorization for transplantation?

2. Why is the Consent Clause in Section 48 (1b) waived?

3. Why is no post mortem allowed without the authorization of the medical director?

4. Why is "tissue" defined to include gametes? Does this mean you can collect gametes (egg and sperm) without consent?

5. Certificate of standards is for building and equipment. Hence 13(1a) means that all buildings used for health is to be recertified. Why? How does this improve health indicies. Certificate of standards for hospital buildings is based on the international building code of hospitals. This would not be met by 98 percent of hospitals. Does this mean we are phasing away our hospitals?

6.Section 20 (1) mandates free treatment of emergencies with no way to pay for it. Except that if you declare an emergency you waive your right to consent in Section 48. Your organs could be poached without consent!

7. Section 45 (3) empowers the Minister to apply all reasonable measures to ensure a return ro normalcy after 14 days of a strike. Does this not mean that the Minister now has the right that would include firing all health workers who refuse to come back to work?

8. Section 43 (e) empowers the Minister to recruit from outside Nigeria, are we not about to see retrenchment of Nigerians to be replaced by socalled foreign experts?

ukwuije's picture

1. This is one of the issues that have been noted. There is room for amendment of the NHAct and we have asked all our partners and stakeholders to commence collection of relevant information that will support amendment as soon as possible.

2. Part VI, Section 48, Sub-section 1(b) of the NHAct states that the consent clause (for removal of tissue, blood, or blood products from the body of another living person) may be waived for medical investigations and treatment in emergency cases. I believe this is a good reason if we all agree that the purpose is to save lives in emergency cases without allowing the inability to secure consent under this circumstance when even relatives may not be available can be a challenge.

3. Part VI, Section 58, Sub-Section 1 states as follows: (1) Subject to subsection (2) of this section, a post mortem examination of the body of a deceased person may be conducted if: (a) the person, while alive, gave consent thereto; (b) the spouse, child, parent, guardian, brother or sister of the deceased not below the age of 18 years in the specific order mentioned, gave consent thereto; or ( c) such an examination is necessary for determining the cause of death.

Sub-Section 2 states that (3) A post mortem examination may not take place unless: (a) the medical practitioner in charge of clinical services in the hospital or authorised institution or of the mortuary in question, or any other medical practitioner authorised by such practitioner, has authorised the post mortem examination in writing and in the prescribed manner; or (b) In the case where there is no medical practitioner in charge of clinical services, a medical practitioner authorized by the person in charge of such hospital or authorized institution, has authorized the post mortem examination in writing and in the prescribed manner.

The reason for the above is quite debatable for many reasons. I think this is to ensure that such actions and procedures will be duly accounted for especially in this environment where Doctors can be contracted on locum basis or even be drafted to cover another who is supposed to be on duty but is unable to make it. Such Doctors who provide such cover are not necessarily known to the hospital management and in this case, this section of the act is appropriate should there be need for such a Doctor to perform or authorize post mortem procedures.

4. I'm not sure this connotes that. Again, there is room for amendment if there is an aspect of the Act here that gives room for perverse manipulations.

5. The reason for Certificate of Standards is to ensure optimum quality of healthcare in Nigeria on our road to UHC. Unfortunately what brings people to our hospitals are not usually what kills them. In fact many will leave the hospitals with complications, sometimes not even related to the main complaints. I'm certain that most families in Nigeria including our Medical colleagues have got their own sad stories to tell. The reason is poor mechanisms for quality assurance. I guess our Medical Colleagues should run hospitals (public or private) that befit our profession. I'm very sorry to say that some of the places Colleagues designate as hospitals and clinics do not actually befit such statuses. Rather than feel threatened by the provisions of the Act, I think our esteemed Colleagues should join hands with the FMOH to ensure proper classification of our health establishments and development of criteria for issuing Certificate of standards in line with the Act.

6. Part I section 11, Sub-section 3(e) provides 5% of the Basic Healthcare Provision Fund (BHCPF) for emergency treatment.

7. This Section is to ensure that health workers do not embark on incessant strikes. From independent analyses, it happens that Nigerian health workers hardly work for up to 6 cumulative months in one year while they still receive salaries for work they did not do to the disadvantage of our own people (patients) many of whom will have complications and or even die. There are however other legal labour instruments that will check unwarranted actions by the Honourable Minister of Health in this regard. in addition, the HMH is answerable to the NCH.

8. It will be useful not to interpret this section out of context. Part V Section 43 is about "Regulations relating to management of human resources in the health system. Sub-sections (a)-(i) deal with training, recruitment, retention, motivation, and retrenchment. Now 43(i) prescribe circumstances under which health care personnel may be recruited from other countries to provide health services in the Federation. While it is valid to query the rationale for this provision, it is important to note that at the moment, there are foreigners who work in the Nigerian health system at the moment. does it mean that Nigeria should not have standards for admitting such people into the health system? We do not pray for such situation as was wrought by Ebola in countries like Liberia where almost all their health personnel were wiped out.

salisbauchi's picture

Is there provision for the operationalization of the Act in the 2016 budget?

ukwuije's picture

Yes there is.