APC and PDP on Improving Maternal and Child Health in Nigeria

As we approach the new date for the presidential elections, we decided to use the additional time provided by the postponement to scrutinize the two leading party manifestoes on health in a bit more detail. While there are other parties also in the race, we have chosen for convenience to focus on the manifestoes of the two front-runner parties – the People’s Democratic Party (PDP) and the All Progressives Congress (APC).

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The APC in its manifesto has a section on healthcare.

Within the healthcare section of its manifesto, the APC says that it will:

Prioritize the reduction of the infant mortality rate by 2019 to 3%; reduce maternal mortality by more than 70%; reduce HIV/AIDs infection rate by 50% and other infectious diseases by 75%; improve life expectancy by additional 10 years on average through our national healthy living program.
Increase the number of physicians from 19 per 1000 population to 50 per 1000; increase national health expenditure per person per annum to about N50,000 (from less than N10,000 currently).
Increase the quality of all federal government owned hospitals to world class standard within five years.
Invest in cutting edge technology such as telemedicine in all major health centers in the country through active investment and partnership programs with the private sector.
Provide free ante-natal care for pregnant women, free health care for babies and children up to school going age and for the aged and free treatment for those afflicted with infectious diseases such as tuberculosis and HIV/AIDS.
Boost the local manufacture of pharmaceuticals and make non adulterated drugs readily available.

The PDP section on health says that:
The party shall present a comprehensive health-care policy for the country, the essential aim of which shall be:

Health-care for all citizens;
Free medical services in all institutions of learning; and
Free medical services to the aged and the handicapped.

As its strategy, it says that: PDP in government shall:

Ensure that all Nigerians, particularly the young and the aged, shall have access to free medical services;
Provide free immunization to all children;
Progressively establish primary health centre, equipped with pharmacies, within the reach of every Nigeria, particularly the rural dwellers.
Progressively provide General Hospitals in all Local Government headquarters; specialist hospitals in all State Capitals.
Encourage research into traditional medical, practices and integrate these practices into the orthodox medical system.
Equip and expand the teaching Hospitals in the country;
Embark on mass training of paramedical personnel to meet the needs of our ruralpopulace;
Encourage more students to train as medical doctors;
Provide special incentives for medical practitioners and other medical Personnel with particular emphasis in those located in remote areas;
Stimulate the local production of medical drugs and other supplies;
Encourage family planning by providing family planning services and materials free of charge;
Regulate private hospitals, medical clinics, and pharmacies to protect Nigerians against exploitations; and
Make and enforce stringent laws against the manufacturing and sale of fake and adulterated drugs; and promote a healthy physical environment by intensifying the present periodic environmental sanitation exercises.

Generally speaking, both main parties promise to raise the number of medical doctors, provide free healthcare for children and the elderly, improve the quality of government/teaching hospitals, fight fake and adulterated drugs and boost the local pharmaceutical industry. In addition, the APC wants to improve maternal and child health, invest in cutting-edge technology and reduce the prevalence of infectious diseases, while the PDP aims to achieve universal healthcare, offer free medical services in all institutes of learning and free healthcare for the handicapped, improve the quality of private hospitals, promote environmental sanitation exercises, offer free family planning, increase medical personnel especially in rural areas, integrate traditional medical practices and increase the number of general hospitals, specialist hospitals and primary health centres.

Full Article on Nigeria Health Watch

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What Changes will the new “National Health Act”, bring to Nigeria?

About a week ago, in anticipation of the now postponed Nigerian presidential elections on February 14th, a 3 hour “tweetathon” was organized by on Twitter by @nighealthwatch, focusing on health, which has sadly been neglected in the current election campaigns. Together with partner organizations, using the hashtag #Feb14Healthissues that would like to be seen addressed by the political parties currently campaigning were discussed. Regrettably, none of the parties participated, although they had been invited to do so, perhaps an indication of the importance of health in their plans for the Nigerian people. It was however useful to air and document some of these issues and a Storify summary of the tweets can be found here.

Many of the contributions during the “tweetathon” referred to the National Health Bill signed into law by President Jonathan late last year. Earlier, the tortuous ten year campaign by various stakeholders to ensure that for the first time since independence in 1960 was described, Nigeria had a constitutional framework for a National Health System with clearly defined roles and responsibilities for the different tiers of government and non-governmental organizations.

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In this post, there is an attempt to summarize the Act and highlight the key provisions.

The new National Health Act (a very readable 29 pages) is divided into 6 parts:

Part I sets out the responsibility and roles of different players in the Nigerian health sector. It establishes a national health system comprising of public and private providers of health services, traditional and alternative healthcare providers and the health ministries and departments at each tier of government and defines the entitlement of all Nigerians to a basic minimum package of health services. Furthermore, it establishes processes for exempting certain groups from paying for services in public hospitals.

The Federal Ministry of Health is given the role of oversight, coordination and planning but is also now required to prepare and present an annual report on the state of health of all Nigerians and the National Health System to the National Assembly and the President

Part I also establishes a Technical Committee to advise the National Council of Health (minister of health and state commissioners), which is tasked with implementing the health plans developed by the Federal Ministry of Health.

A National Tertiary Health Institutions Standards Committee is also established by the Act, to oversee and set standards for tertiary health institutions in the country and also publish annually “information in relation to tertiary healthcare services”. Tertiary hospitals will also be required to undergo annual peer reviews.

To fund the basic health care package entitlement, the Basic Health Care Provision Fund (a FG annual grant of not less than one per cent of consolidated revenue fund plus foreign grants and any other money from other sources) is mandated by the Act. 50 per cent of the Fund is to be used for basic minimum package of health in eligible primary and secondary centres via the National Health Insurance Scheme; while the rest is to be used for drugs, vaccines, equipment, maintenance, human resource development and emergency medical treatment

National Primary Healthcare Development Agency (NPHCDA) funds will be disbursed via State Primary Health Care Boards to LG health authorities with a requirement for co-funding, allowing NPHCDA to withhold funds where counterpart funding is not provided or previous grants are misused.

Part II of the Act sets out a process for regulating health establishments and technologies and ensuring quality and standards. Health establishments will now need to have a certificate of standards which defines how many beds and what technologies they can have. Operating a health establishment without a certificate of standards 24 months after the Act has been passed will be punishable by a fine of 500.000 naira or 2 years imprisonment.

Part II also provides mechanisms for public hospitals to retain a proportion of the revenue they generate (subject to minister and in states, commissioner discretion).

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Part III of the Act focuses on the rights and obligations of users and healthcare personnel and makes it an offence to refuse emergency medical treatment punishable by a 100.000 naira fine or 6 months imprisonment.

This part also sets out the rights of healthcare personnel and indemnifies them from claims where they have not been negligent.

Healthcare workers are now required to give users relevant information (health status, diagnosis and treatment options and risks and benefits, right to refuse treatment) to their state of health and treatment unless there are exceptional circumstances.

Health establishments are also now required to clearly define their services, complaints processes and timetables and to keep records for each user with confidentiality standards.

Part IV establishes the National Health Research and Information System with a 13 member National Health Research Committee established to promote research and ensure that it aligns to priorities.

A National Health Research Ethics committee with 17 members, one of whom must be a woman, is also established and any institution carrying out research is required to have an ethics committee.

Part IV also requires the Federal Minister of Health to facilitate the creation of a comprehensive National Health Information Management System and to prescribe data for collection at every level of the health system. Public and private establishments are required to establish and maintain a health information system, which will be a requirement for the award of certificate of standards.

The Minister and commissioners of health are required to publish annual reports on the health of the citizenry and the health system.

Part V focuses on human resources for health and requires the National Council of Health to develop policy and guidelines for training and distribution of health workers. In relation to strikes, health services classified as essential services and the Minister is required to apply all reasonable measures to ensure return to normalcy after disruption within 14 days.

This part also bars all public officers from medical check up, investigation or treatment abroad at public expense, except in exceptional cases approved by a medical board and minister or commissioner.

Part VI establishes the National Blood Transfusion Service, outlines procedures for obtaining consent and bans the sale of blood and tissue. It also prohibits the manipulation of genetic material (“cloning”) and the import/export of embryos.

Part IV specifies that transplantation can only be done with the approval of a medical practitioner and also establishes a process for living wills for organ donation.

Part V establishes conditions for post mortems and outlines who can authorise them- spouse, child, parent, guardian, brother or sister-in that order.

Finally, the Act requires the minister to set up a National Consultative Health Forum and allows him or her to prescribe further transitional arrangements as may be necessary for the implementation of the Act.

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There are many obvious questions that arise from the Act; and its implementation will throw up many challenges, but those will be the subject of future posts from us. For now – as we continue to prepare for the elections – let’s keep these issues on the agenda. What do you think of the new National Health Act? We would love to hear from you.

Culled from Nigeria Health Watch